Women’s knowledge of perceived severity of illness predicting healthcare seeking behaviour for antenatal, postnatal care, and institutional delivery services. Findings from a National Survey in Afghanistan

Abstract

Background The importance of healthcare seeking for women’s health is well documented. However, less is known how women’s knowledge of perceived severity of illness affects healthcare seeking behaviour. This study examined the associations of women’s knowledge of perceived severity of illness with healthcare seeking behaviour for maternal health services. Methods Data were used from the Afghanistan Health Survey 2018. Women’s knowledge in terms of knowing danger signs or symptoms related to maternal health was assessed. The signs or symptoms a woman was expected to name were bleeding, swelling of the body, headache, fever, or any other danger sign or symptom (e.g., high blood pressure). A categorical variable on knowledge was created. The outcome variables were defined as ≥ 4 ANC vs. 0–3 ANC; ≥ 4 PNC vs. 0–3 PNC visits; institutional vs. non-institutional deliveries. A multivariate regression model was applied. Results Data were used from 9,190 ever-married women, aged 13–49 years, who gave birth in the past two years. It was found that only 22% and 2% of women sought healthcare for ≥ 4 ANC, ≥ 4 PNC visits, respectively. Fifty six percent of women had institutional deliveries. Multivariate analysis showed that the odds ratios (ORs) for ANC visits were 1.76(95%CI;1.53–2.04), 2.25(95%CI;1.97–2.58), and 2.81 (95%CI:2.35–3.35) in women who knew 1, 2, and 3–5 signs or symptoms, respectively, compared to women who knew none. The ORs for PNC visits were 1.81(95%CI:1.12–2.93), 2.22(95%CI:1.42–3.48), and 3.37(95%CI:2.02–5.62) in women who knew 1, 2, and 3–5 signs or symptoms, respectively, compared to women who knew none. The ORs for institutional deliveries were 1.38(95%CI:1.22–1.56), 1.80(95%CI:1.59–2.04), and 1.97(95%CI:1.64–2.37) in women who knew 1, 2, and 3–5 signs or symptoms, respectively, compared to women who knew none. It was found that in women who did not use at least 4 ANC, 4 PNC visits, or institutional deliveries, 27%, 33%, and 23% of them, respectively, said that it was unnecessary to seek healthcare. Main perceived barriers mentioned, were distance to clinics, financial constraints, and lack of female staff. Conclusion Health interventions are needed to promote women’s knowledge of perceived severity of illness, and to address perceived barriers in accessing maternal health services.