Literacy and healthcare-seeking among women with low educational attainment: analysis of cross-sectional data from the 2011 Nepal demographic and health survey

Abstract

IntroductionResearch suggests that literacy plays a key role in mediating the relationship between formal education and care-seeking among women in developing countries. However, little research has examined literacy’s role independently from formal education. This differentiation is important, as literacy programs and formal schooling entail distinct intervention designs and resources, and may target different groups. To assess the relationship between literacy and healthcare-seeking among Nepali women of low educational attainment, we analyzed data from the 2011 Nepal Demographic and Health Survey (DHS).MethodsFrom the 2011 Nepal DHS, our sample consisted of 7,020 women who had attained at most a primary school level of education, and a subsample of 4,875 women with no formal schooling whatsoever. We assessed associations between literacy and four healthcare-seeking outcomes: whether women identified “getting permission” as a barrier to accessing care; whether women identified “not wanting to go alone” as a barrier; whether among women who were married/partnered, the woman had some say in making decisions about her own health; and whether among women who experienced symptoms related to sexually-transmitted infections (STIs) in the past year, treatment was sought. We performed simple and multiple logistic regressions, which adjusted for several socio-demographic covariates.ResultsLiteracy was associated with some aspects of healthcare-seeking, even after adjusting for socio-demographic covariates. Among women with no more than primary schooling, literate women’s odds of identifying “getting permission” as a barrier to healthcare were 23% less than illiterate women’s odds (p = 0.04). For married/partnered women, odds of having some say in making decisions related to their health were 37% higher (p = 0.002) in literate than illiterate women. Comparing literate to illiterate women in the subsample with no formal schooling, odds of reporting “getting permission” as a barrier were 35% lower (p = 0.01), odds of having a decision-making say were 57% higher (p < 0.001), and odds of having sought care for experiences of STI-related symptoms were 86% higher (p = 0.04).ConclusionsFurther research should be undertaken to determine whether targeted literacy programs for those past normal schooling age lead to improved healthcare-seeking among Nepali women with little or no formal education.

Male Partner Involvement in Birth Preparedness and Utilization of Antenatal Care Services: A study in the West Mamprusi Municipality of Northern Ghana

“…This finding could also be attributed to low skilled delivery in the communities because most of the peoples who are Muslims according to them do not allow their wives to deliver in the hospital or go for antenatal care in any health facility. This finding is in agreement with studies conducted in Ghana which indicated that 66.3% of mothers who were Muslim faithful and a majority showed a preference for TBA (96%) [46]. This preference was also indicated by respondents in the focus group discussions.…”

Sociodemographic correlates of antenatal care visits in Nepal: Results from Nepal Demographic and Health Survey 2016

“…A similar positive association of women's level of education and four or more ANC visits was observed in the studies that analyzed the Ethiopian Demographic and Health Survey (EDHS) [28], and Bangladesh Demographic and Health Survey (BDHS) [25]. This may be due to better health-seeking behavior of women who had higher educational attainment [29][30][31].…”

Knowledge and Awareness of Human Papillomavirus (HPV), Cervical Cancer and HPV Vaccine among Women in Two Distinct Nepali Communities

“…Awareness of cervical cancer was positively associated with having knowledge of STIs, any formal education, current contraception use, and previously having had an abortion in our study population. Given that knowledge of STIs and formal education are both associated with health literacy (Dimmitt et al, 2013;Lam et al, 2013;Wang et al, 2014) and that both contraception use and abortion are indicative of accessing medical care, it is possible that women who are accessing health care for reproductive issues unrelated to cervical cancer are learning about cervical cancer through their doctors. Previous studies conducted in developing countries suggest that women who sought treatment of gynecological problems had higher levels of cervical cancer awareness, possibly indicating that knowledge of cervical cancer was transferred from doctor to patient during clinical visits (Dhamija et al, 1993).…”

“…Recent studies on the use and efficacy of the HPV vaccine in developing countries have suggested that vaccine distribution could be an effective way to mitigate cervical cancer in low-and middle-income countries (Fesenfeld et al, 2013;Termrungruanglert et al, 2012). Demonstration projects in Peru, India, Uganda, and Vietnam have shown high levels of vaccination coverage using schoolbased programs targeting teen girls (LaMontagne et al, 2011). While effective rollout of the HPV vaccine has been shown to be possible in low-income countries, disseminating knowledge of HPV and cervical cancer remains challenging.…”