Health Seeking Behaviour of Rajbanshi ethnic group in Katahari and Baijanathpur villages of Morang, Nepal (Part-1)
By:  Nawaraj Subba, MPH, MA   

Summary
Objective: The objective of the study was to assess the health seeking behaviors in Rajbanshi community. Specific objective of the study was to assess the practices of using traditional and modern medicine on the basis of economic and education status. Design: Descriptive, Quantitative as well as Focus Group Discussion (FGD) and Observation for Qualitative information. Setting: This study was conducted in two different Villages, Katahari and Baijanathpur of Morang district, selected purposively based on thick settlement. Subjects: 175 households of two VDCs were selected from the VDCs rosters using random number table for convenience and to cover the expected households. Main outcome measures: Demographic information, and medication practices on the basis of economic and education status. Results: Katahari and Baijanathpur VDCs had literacy rate 65% in the taken sample. Principal occupation was agriculture. Majority of people falls in the category of having zero (no land) to less then 2 bigahs. Average family size is 5.76 persons. There were 61% male and 39% female reported sick. Common types of diseases/ symptoms were reported as headache, bodyache, weakness (50.8) and then ARI (44), fever (30.8), Eye/ ENT (18.8), diarrhoea (13.7) respectively. Distribution of reported illness was highest among the age group of 66 year and above. People were getting service through private clinics (72.0%), hospital (33.3%) Sub-health post (15.4%). Economically Poor and medium people were adopting self-medication significantly higher than rich (P=0.0160). Similarly the use of self-medication by uneducated was significantly higher than those educated (P= 0.0000063). On the other hand rich was adopting alternative medication significantly higher than other (P= 0.0000). It was also found that there was no difference in the use of modern medication between educated and uneducated people(P=0.3753).Conclusions: There is a relationship between economic, education status and health seeking behaviour in Rajbanshi community.

Introduction
Rajbanshi is one of the 61 ethnic groups⁷ in Nepal. Ethnic or Indigenous people are having low health status in the world.⁸ Health Seeking Behaviour is a usual habit of a people or a community that is resulted by the interaction and balance between health needs, health resources, socio-economic and cultural as well as national/ international contextual factors ¹. It is behaviour of using health services within existing health system or treatment seeking behaviour of the latest illness as reported by them. This was categorized as (a) Modern medication such as Hospital, HP/SHP and private clinic (b) Alternative medication such as Ayurvedic and Homeopathic system of medication; and (c) Self-medication such as Dhami/Jhakri (Shaman healers), drug retailers, grocery keepers, drug peddlers, household medicine and other than modern and alternative medication. Kafle and Gartoulla ² (1993) and Gartaula ³ (1998) have categorized self medication as Shamanism, Priest, Dhami-Jhakri, herbal, drug retailers, grocery, kit-bag, drug peddler, neighbour, following old medicine prescriptions etc and except the present prescription by a qualified medical practitioners. WSMI ⁴ (2001) has indicated as "Self-medication is the use of specifically designed, labelled and authorized medicines available legally without prescription for the treatment or prevention of common illnesses, which can be recognized by the people. Traditional medicine is not included in the national health system. If traditional medicines are legally available without a doctor's prescription, then they are included in what we call self-medication. Alternative medicine is medicine which is outside the regular allopathic medicine ⁵. Sometimes it is accepted by national health plans for coverage and sometimes it is not ⁶. This would cover for example, acupuncture, Ayurved, naturopathy, and homeopathic medicine etc.

Methodology and materials.
1.The households were visited on the basis of random number table. They were asked relevant questions with the history of illness/ disease within three months from interview date. Of those who were ill / sick person of the above criteria were consulted for detailed information otherwise only demography was taken for the rest. 2. Roster analysis of VDC, DDC. 3. Secondary Sources. 4. Instruments. 5. Consent-Verbal 6. Interview. 7. Focus Group Discussion. The participants for FGD were requested to have one and half an hour’s sessions for the reason of their self-medication during household visits. Personal contacts with self-medicated population within three months of study period were made to have 8 persons in one FGD and attempted total ten FGD with 80 persons.

Instrumentation. (Development of tools).
Structured and in-depth questionnaire was prepared to interview the target people having disease or not; So, the interview would explore their health-seeking behavior. 1. Individual Interview. 2. Observation of medicines if any. 3. Focus Group Discussion guidelines.

In table No. I. In accordance to the peoples' existing perception, people were economically classified as: Poor - people having no land to having land up to 2 bigahas, Medium - people having 2.1 to 4 bigahas and Rich - 4.1 to above for the study purpose. Similarly, People were educationally classified as: Uneducated - illiterate to literate only and SLC passed and above were considered as Educated for the study purpose that is shown in table No. II.

Table III indicates that uneducated (74%) were getting more sickness than educated (26%)

Table IV presents as males were found to be reported sick by 61.1% and female 38.9%. This might be due to the gender bias in opportunity to report illness and problems.

Table V. Illness condition encountered in Rajbanshi community.

They reported that the nature of illness changes as the weather changes. Diseases such as ARI, TB, Kalazar, Asthma were mentioned clearly in the prescription by health care providers when the old prescription at their home were analyzed. The researcher observed some cases himself. Headache/ bodyache/ weakness was reported by 50.8%, ARI by 44.0%, Fever by 30.8%, Eye/ENT/Oral by 18.8%, Diarrhoea by 13.7%, Gastritis by 13.7%, skin diseases by 7.4% respectively.

Majority of the people were found using EPI-camp (79.4%) for immunizing their children. Half of the people have taken service from FCHV (50.2). But TBA, PHC-ORC and MCHW were of relatively low access.

Medication Practices: Figure I. presents the pattern of health care practices. 96% people were adopting modern medication as an alternative after self care. Alternative medication was adopted by 22.8% either in Homeopathic or in Ayurvedic one. This indicates that poly-practices in poly-pharmacy and or in polyclinics/HP/SHP/PHC/Hospital were the indicators of Rajbanshi health seeking behaviour.

(a) Modern medication i.e. allopathic medication through health care providers followed usually after self and alternative-medication. In the community out of 168 people private clinics were used by 72.0%, hospital by 33.3% and SHP/HP by 15.4%. In other words, people often went to the private clinics rather than hospital and health post/ sub-health post.

As presented in the table IX people were found using DJ by 51%(66), retailer by 31%(40) and herbal by 17%(22) and following old prescription by 1%. (1). Self-medication was adopted commonly by poor and medium economic classes in community. Dhami/Jhakris were doing Phukphak, Worship and Sacrifice. People used to go to Dhami/Jhakri /Shaman and were found still having strong belief upon their healing power. They regard DJ as a part of life that need in every ritual and without them their lives become incomplete. They were also familiar with the retailer's shop and used to buy drugs and preparing herbal medicine at home conventionally.

Table X. Illustrates that out of the total 175 respondents 22.8% (40) were adopting alternative medication and among them 70.0% (28) had adopted Ayurvedic and by 30.0% (12) patients had adopted Homeopathic medication.

Table XI presents that 97.2% poor, 90.9% medium and 95.6% rich people were adopting modern medication. Poor 63.6%, medium 63.6% and rich 39.1% people were adopting Self-medication respectively. Similarly Poor 17.7%, medium 31.8% and rich 87.0% people were adopting Alternative medication respectively. There was no difference in the use of modern medication among different economic level people that is statistically insignificant (P= 0.3871). It was found that there was highly significant practice of self-medication being adopted by poor (P=0.0160). Likewise, rich were found largely adopting the alternative medication than others which was statistically highly significant (P= 0.0000).

It was found that there was no difference in the use of modern medication between educated and uneducated (P=0.3753). But use of self-medication by uneducated was significantly higher than those educated (P= 0.0000063). And there was also no difference in the use of alternative medication between educated and uneducated (P= 0.2635).

Conclusion: There was no difference in the use of modern medication among different economic levels (P= 0.3871). Likewise there was no difference in the use of alternative medication between educated and uneducated (P= 0.2635). But Poor and medium people were adopting self-medications significantly higher than rich (P=0.0160). Similarly the use of self-medication by uneducated was significantly higher than those who were educated (P= 0.0000063). On the other hand rich were adopting alternative medication significantly higher than others (P= 0.0000). People were found using the EPI-Camp (79.4%) and FCHV (50.2%) but 89.2% population was still unknown to MCHW, TBA and PHC-ORC and its services.

References:
1. M.Corlien, et.al (1991), Designing and conducting Health System Research Projects,Heath system research training series, WHO/ IDRC.
2. Kafle, K.K.,Gartoulla,R.P., (1993), Self-medication and its impact on essential drugs Scheme in Nepal, W.H.O. DAP - 10.
3. Gartoulla, R.P. (1998), An introduction to medical sociology and medical anthropology, RECID, Kathmandu, Nepal.
4. Reinstein, J. (2001), World Self Medication Industry (WSMI), UK, www.wsmi.org
5. Agarwal S.K., (n.d.), A guide to Alternative medicine, Indian board of Alternative medicine (IBAM), Calcutta, India.
6. Gartoulla,R.P., (1998), Therapy pattern of conventional medicine with other alternative Medicine, RECID, Kathmandu, Nepal.
7. Prospectus (2000) of HMG, MLD, National Committee for Development of Nationalities,.
8. Mabuhang, B.K., (2000),"Policy Approaches to Indigenous People Health Issues"
Population and Development in Nepal Journal, TU CDoPS, Vol.7, Kathmandu.

      ©2002. Nawaraj Subba,    nrsubba@hotpop.com