Healthcare-Seeking Behaviour for schistosomiasis-related signs and symptoms in Ghana’s capital

doi:10.21203/rs.3.rs-5038480/v1

Background: Schistosomiasis, a parasitic disease spread through contaminated water, remains a significant public health challenge in areas with poor sanitation, including the Ga South Municipal District in Ghana. Despite preventive efforts by the World Health Organization, understanding the healthcare-seeking behavior for schistosomiasis symptoms is crucial to improving treatment outcomes.

Methods: A cross-sectional study was conducted in the Galilea and Mahem communities of the Ga South District, near a lake known for schistosomiasis transmission. A structured questionnaire was administered to 242 randomly selected household heads to assess their healthcare-seeking behavior when faced with schistosomiasis symptoms. Data were analyzed using SPSS version 21 to identify trends and patterns in behavior.

Results: Awareness of schistosomiasis was high among respondents, with 92.6% indicating familiarity with the disease. About 77.7% reported that they would seek treatment at hospitals or clinics if infected. The choice of healthcare facilities was largely influenced by the perceived efficacy of treatment. A significant association was found between the respondents' area of residence and their healthcare-seeking behavior (p=0.007), suggesting that location plays a crucial role in how individuals approach treatment.

Conclusions: The high awareness of schistosomiasis in the Galilea and Mahem communities is likely due to ongoing educational efforts. While most residents preferred formal healthcare settings, there is still a need to address the risks associated with self-medication through further education. Enhancing accessibility to healthcare facilities and continued public health education could improve timely treatment and reduce the disease burden.

Schistosomiasis

Prevalence

Healthcare-seeking behavior

Self-medication

Transmission routes

Schistosomiasis, also known as Bilharziasis, is a parasitic disease of global significance, ranking second only to malaria in terms of public health and socio-economic impact (Neghina et al., 2009). The disease is caused by blood flukes belonging to the genus Schistosoma and can be broadly classified into two types: urogenital and intestinal. Urogenital schistosomiasis is primarily caused by Schistosoma haematobium, while intestinal schistosomiasis is caused by species such as Schistosoma mansoni, Schistosoma japonicum, Schistosoma intercalatum, Schistosoma mekongi, and Schistosoma guineensis (Mewabo et al., 2017; Yirenya-Tawiah et al., 2011). Schistosomiasis is endemic in 78 countries, with an estimated 290 million people infected globally and 600-780 million at risk of infection (World Health Organization, 2016). The disease is particularly prevalent in sub-Saharan Africa, which accounts for about 90% of global cases (Sady et al., 2015).

The transmission of schistosomiasis is intricately linked to environmental factors, particularly in tropical and subtropical regions where access to potable water and adequate sanitation is limited (Nkegbe, 2010). The disease cycle begins when humans come into contact with freshwater bodies containing cercariae, the larval form of the parasite. These cercariae penetrate the skin, enter the bloodstream, and mature into adult worms within the human host. The adult worms then produce eggs, some of which are excreted through urine or feces, while others become lodged in host tissues, leading to chronic inflammation and the clinical manifestations of schistosomiasis (Colley et al., 2014; Fairfax et al., 2012).

In Ghana, the construction of dams has been a significant factor in the spread of schistosomiasis. The Akosombo Dam, built on the Volta River in the 1960s, transformed the local environment, creating favorable conditions for the breeding of Bulinus snails, the intermediate host for Schistosoma haematobium (Scott, Senker, & England, 1982). Before the dam's construction, the prevalence of urogenital schistosomiasis in the area was relatively low, ranging from 5-10%. However, the prevalence skyrocketed to over 90% in communities along the Volta Lake, raising serious public health concerns (Scott, Senker, & England, 1982). Similarly, the Weija Dam, constructed on the Densu River in 1979, led to the formation of the Weija Lake, which has also become a hotspot for schistosomiasis transmission. In communities around the lake, the prevalence of urogenital schistosomiasis has been reported to be between 54.8% and 60% (Aryeetey et al., 2000).

The Ga South District of Ghana, particularly the communities of Galilea and Mahem, exemplifies the persistent challenge of schistosomiasis despite public health interventions. In these communities, the combined prevalence of schistosomiasis stands at 52%, which is more than double the national prevalence of 23.3% (Aboagye & Edoh, 2009; Kulinkina et al., 2018). This high prevalence persists despite the periodic administration of praziquantel, an antischistosomal drug recommended by the World Health Organization (World Health Organization, 2016). While praziquantel is effective in reducing morbidity and impacting transmission, it rarely eliminates the infection entirely, underscoring the need for comprehensive control strategies that go beyond chemotherapy (Muhumuza et al., 2009).

Healthcare-seeking behavior is a crucial component in the fight against schistosomiasis. Defined as the actions individuals take when they perceive themselves to have a health problem, healthcare-seeking behavior is influenced by a complex interplay of cognitive, socio-cultural, and economic factors (Olenja, 2003; Kakkar et al., 2013). In the context of schistosomiasis, healthcare-seeking behavior can significantly affect disease outcomes. For instance, individuals may choose to seek care at modern healthcare facilities, self-medicate with over-the-counter drugs, or resort to traditional remedies, each of which can influence the progression and transmission of the disease (Chippaux, 2000). In many tropical regions, traditional beliefs and practices often guide healthcare-seeking behavior, sometimes leading to delayed or inappropriate treatment (Acka et al., 2010). This is particularly relevant in the Ga South District, where traditional methods of treatment are prevalent, and the severity of schistosomiasis symptoms may be underestimated by the local population (Noël, 2014).

Despite the high burden of schistosomiasis and the ongoing efforts to control the disease, there is a notable gap in the literature regarding healthcare-seeking behaviors in schistosomiasis-endemic regions. Most research has focused on the epidemiology, transmission, and treatment of schistosomiasis, with limited attention to the socio-behavioral factors that influence how individuals respond to the disease (Noël, 2014; Acka et al., 2010). This study seeks to address this gap by exploring the healthcare-seeking behaviors of individuals in the Galilea and Mahem communities within the Ga South District. This study is justified by its potential to inform tailored public health interventions that address the socio-behavioral factors influencing healthcare-seeking behaviors in schistosomiasis-endemic communities, thereby contributing to the achievement of Sustainable Development Goals (SDGs) 3 (Good Health and Well-being) and 6 (Clean Water and Sanitation). By understanding the factors that drive healthcare-seeking behavior in these communities, public health interventions can be better tailored to address the specific needs and challenges of the population, ultimately reducing the prevalence of schistosomiasis and improving health outcomes.

2.1 Study area and setting

The study was conducted in the Ga South District of the Greater Accra Region, Ghana, with a population of approximately 507,192 (GSS, 2019). This district, established in 2012, includes the communities of Galilea and Mahem, both located near Weija Lake. These communities, with schistosomiasis prevalence rates of 58% and 49% respectively (Tay et al., 2011), rely heavily on the lake for daily activities. The inhabitants are predominantly fisherfolk, petty traders, and migrants.

2.2 Sample size and participant selection

The study targeted household heads in the Galilea and Mahem communities in the Ga South District, selected for their key roles in family health and decision-making. A sample size of 242 household heads was determined, adjusting from an initial estimate of 384 based on Cochran’s formula, considering a finite population of 650 households. The adjustment used the finite population correction formula. Purposive sampling selected Mahem and Galilea due to their proximity to the Schistosome-infected Weija Lake and high schistosomiasis prevalence. Simple random sampling was then used to select house numbers, with computer-generated random numbers ensuring an unbiased selection of 242 household heads for data collection.

2.3 Data Collection

The study employed a structured questionnaire administered through face-to-face interviews to gather comprehensive data from participants. The questionnaire was divided into four sections: socio-demographic characteristics, which captured details such as age, gender, education, and occupation; knowledge of schistosomiasis, assessing awareness of its causes, symptoms, and prevention; healthcare-seeking actions, exploring responses to schistosomiasis symptoms, including medical treatment, self-medication, or traditional remedies; and factors influencing these actions, examining economic, cultural, and accessibility issues that affect healthcare decisions. This approach provided a thorough understanding of the participants' behavior and the factors influencing their healthcare choices. Pre-testing was conducted with 20 household heads in Omega Community to ensure the reliability and validity of the tool.

2.4 Data analysis

Data was edited, coded, and analyzed using Microsoft Excel and SPSS version 21. Descriptive statistics, including frequencies and percentages, were used to analyze research questions. Cross-tabulations and chi-square tests assessed associations between socio-demographic factors and healthcare-seeking behaviors, while binary logistic regression analyzed relationships between socio-demographic characteristics and healthcare-seeking actions.

3.1 Study participants and their socio-demographic characteristics

Table 1 summarizes the socio-demographic characteristics of the study's household heads. The majority of respondents (28.1%) were aged 26-35 years, while the fewest (9.5%) were aged 56 years and above. Males comprised 68.6% of the sample, and 31.4% were females. Most respondents were married (83.9%), followed by divorced (7.4%), widowed (5%), and single individuals (3.7%). Educational attainment varied, with 41.8% having completed Middle School/JHS, and 2.9% having tertiary education. Ethnically, 32.6% were Ewes. Occupationally, 43% were traders and 41.3% were fisherfolks. Religiously, 87.2% were Christians. Residential distribution was even between Galilea and Mahem, with 50% residing in each. Additionally, 36% had lived in their community for 10 years or more, 32.2% for 1-5 years, and 31.8% for 6-9 years.

Table 1. Socio-demographic characteristics of household heads

Characteristic	Frequency	Percentage (%)
Age
18-25	48	19.9
26-35	68	28.1
36-45	62	25.6
46-55	41	16.9
56 and above	23	9.5
Total	242	100
Sex
Male	166	68.6
Female	76	31.4
Total	242	100
Marital status
Married	203	83.9
Divorced	18	7.4
Widowed	12	5.0
Single	9	3.7
Total	242	100
Educational qualification
Basic school	63	26.0
Middle school/JHS	101	41.8
SHS	41	16.9
Tertiary	7	2.9
No formal education	30	12.4
Total	242	100
Ethnicity
Akan	71	29.4
Ga-Adangbe	59	24.4
Ewe	79	32.6
Hausa	25	10.3
Others	8	3.3
Total	242	100
Main occupation
Teaching	16	6.6
Fishing	100	41.3
Trading	104	43.0
Labourer	15	6.2
Others	7	2.9
Total	242	100
Religious background
Christian	211	87.2
Islamic	29	12.0
African Traditional	2	0.8
Total	242	100
Area of residence
Galilea	121	50
Mahem	121	50
Total	242	100
Length of stay in the area
1-5 years	78	32.2
6-9 years	77	31.8
10 years and above	87	36.0
Total	242	100

3.2 Sources of water and usage of water from the lake

Details on the sources of water available to residents in both communities within the Ga South District (Fig. 2). The respondents’ indicated they had access to multiple sources of water such as borehole, lake, pipe borne water, and hand dug well. Therefore, the study revealed that 98.35% of the respondents indicated that pipe-borne water was a major source of water been used by residents of Galilea and Mahem communities in the Ga South District. Furthermore, the results showed that apart from pipe-borne been the major source of water, residents also obtain water from the lake (88.84%), borehole (34.71%), and hand-dug well (25.62%) as shown in fig 5 below.

On the other hand, the study sought the views of respondents regarding what they use water from the lake for (Table 2). It was found that 27.7% (67) of the respondents used the water for bathing, 57.8% (140) for washing, 2.1% (5) for construction purposes, 0.8% (2) for gardening, and 0.4% (1) for cooking. However, 11.2% (27) of the respondents indicated that water from the lake does not serve any purpose to them. In line with how often respondents fetch water from the lake within a day (Table 3), 21.5% (52) of them fetch water once, 36.4% fetch water twice, 25.2% (61) fetch water thrice, and 5.7% (14) fetch water four times. Additionally, 11.2% (27) of the respondents indicated that they do not fetch from the lake because water from it does not serve any purpose to them.

Table 2. Usage of water from the lake

Variable	Frequency	Percentage (%)
Water purpose Bathing	67	27.7
Washing	140	57.8
Construction	5	2.1
Gardening	2	0.8
Cooking	1	0.4
None	27	11.2
Total	242	100

Table 3. How often respondents fetch water from the lake within a day

Variable	Frequency	Percentage (%)
Water fetch (Lake)
Once	52	21.5
Twice	88	36.4
Thrice	61	25.2
Four times	14	5.7
None	27	11.2
Total	242	100

3.3 Knowledge of Schistosomiasis-related signs and symptoms

Table 4 presents knowledge of the respondents about the signs and symptoms related to schistosomiasis. From the study, 92.6% (224) of the respondents specified that they have ever heard of schistosomiasis while the remaining 7.4% (18) suggested otherwise. Based on how schistosomiasis is contracted, 10.7% (26) of the respondents indicated that it is contracted by drinking infected water, 78.9% (191) of them suggested it is contracted by swimming or walking in infected water, and the remaining 10.4% (25) of the respondents indicated they do not know how it is contracted. Concerning the susceptibility of schistosomiasis, 52.9% (128) of the respondents specified that boys were more susceptible, 43.8% (106) of them said men were more susceptible, 2.5% (6) indicated that girls were more susceptible and 0.8% (2) of the respondents stated women were more susceptible.

Majority of the respondents, 79.3% (192) asserted that men experiencing the passage of blood in urine from their penis is a sign of schistosomiasis. Furthermore, 20.3% (49) of the respondents also indicated that the passage of blood in urine is a sign of sexually transmitted infection. In comparison, 0.4% (1) of the respondents specified the passage of blood during urination as a sign of malaria. In addition, Fig. 3 provides details on the signs and symptoms related to schistosomiasis, as indicated by the respondents. With reference to the signs and symptoms of schistosomiasis, respondents noted that abdominal pain, blood in faeces, fever, blood in urine, painful urination, diarrhoea and swollen belly with their corresponding percentages of 44.63%, 37.19%, 20.66%, 80.58%, 41.74%, 20.66%, and 21.9% were likely to be seen as a result of schistosomiasis. Besides, 9.504% of the respondents did not know any sign or symptom related to schistosomiasis.

Table 4. Knowledge of schistosomiasis-related signs and symptoms by respondents

Variable	Frequency	Percentage (%)
Ever heard of schistosomiasis
Yes	224	92.6
No	18	7.4
Total	242	100
Schistosomiasis contraction
Drink infected water	26	10.7
Walk or swim in infected water	191	78.9
Don’t know	25	10.4
Total	242	100
Susceptibility of schistosomiasis
Boys	128	52.9
Girls	6	2.5
Men	106	43.8
Women	2	0.8
Total	242	100
Blood in the urine is a sign of:
Malaria	1	0.4
Sexually transmitted infection	49	20.3
Schistosomiasis	192	79.3
Total	242	100

3.4 Healthcare-seeking behaviour for schistosomiasis-related signs and symptoms

Table 5 presents information on the healthcare-seeking behaviour for schistosomiasis-related signs and symptoms. A greater proportion of the respondents (77.7%) indicated that infected persons within the family would visit the hospital for treatment, 16.9% specified that infected persons within the family would undertake self-medication with allopathic drugs, and 5.4% indicated that infected persons would visit the herbalist for traditional treatment.

When respondents were asked about the stage of schistosomiasis infected persons within their families would seek for healthcare, 82.2% (199) of the respondents (household heads) specified that infected persons would seek for healthcare as soon as the symptoms were recognized, 16.6% (40) of the respondents (household heads) specified that infected persons would seek for healthcare when symptoms persist for one week, 0.8% (2) of the respondents (household heads) indicated that infected persons would seek for healthcare when symptoms persist for two weeks, and 0.4% (1) of the respondent (household heads) noted that infected persons would seek for healthcare when symptoms persist for three or more weeks.

With regards to who decides where infected persons should seek for healthcare, 58.3% (141) of the respondents specified that the father chooses where infected persons should seek for healthcare, 23.1% (56) of the respondents indicated that the head of the house decides where infected persons should seek for healthcare, and 18.6% (45) of the respondents specified that the mother chooses where infected persons should seek for healthcare.

Concerning the groups of people who were most likely to seek for healthcare, 55.4% (134) of the respondents indicated that boys were most likely to seek for healthcare, 2.9% (7) of the respondents specified that girls were most likely to seek for healthcare, 40.9% (99) of the respondents indicated that men were most likely to seek for healthcare, and 0.8% (2) of the respondents noted that women were most likely to seek for healthcare.

Table 5. Healthcare-seeking behaviours of respondents for schistosomiasis

Variable	Frequency	Percentage (%)
Healthcare-seeking behaviour
Go to the herbalist (traditional treatment)	13	5.4
Go to the hospital or clinic	188	77.7
Self-medication (allopathic drugs)	41	16.9
Total	242	100
Healthcare-seeking stage
As soon as the symptoms are recognized	199	82.2
When symptoms persist for one week	40	16.6
When symptoms persist for two weeks	2	0.8
When symptoms persist for three or more weeks	1	0.4
Total	242	100
Healthcare-seeking decision taker
Father	141	58.3
Head of the house	56	23.1
Mother	45	18.6
Total	242	100
Groups likely to seek healthcare
Boys	134	55.4
Girls	7	2.9
Men	99	40.9
Women	2	0.8
Total	242	100

The association between the socio-demographic factors of the respondents and their healthcare-seeking behaviour is shown in Table 6 below. From the Chi-square test, it was revealed that the age of the respondents did not show a significant association with their healthcare-seeking behaviour (p=0.969). Moreover, the sex of the respondents did not show a significant association with their healthcare-seeking behaviour (p=0.127). Likewise, the educational qualification of the respondents was not statistically significant with their healthcare-seeking behaviour (p=0.328). Similarly, the occupation of the respondents was not statistically significant with their healthcare-seeking behaviour (p=0.368). The ethnicity of the respondents did not also show a significant relationship with their healthcare-seeking behaviour (p=0.101). The marital status of the respondents according to the Chi-square test, was not statistically significant (p=0.932). There was no association between the religious status of the respondents and their healthcare-seeking behaviour (p=0.318). Among the demographic factors of the respondents, only the area of residence showed a significant association with their healthcare-seeking behaviour (p=0.007).

Table 6. Association between socio-demographic factors and healthcare-seeking behaviours

	Go to the herbalist	Go to the hospital	Self-medication	Total	Chi-square value	P-value
Age (years)					2.331	0.969
18-25	1	38	9	48
26-35	5	51	12	68
36-45	3	50	9	62
46-55	3	31	7	41
56 and above	1	18	4	23
Total	13	188	41	242
Sex					4.126	0.127
Male	11	123	32	166
Female	2	65	9	76
Total	13	188	41	242
Educational qualification					9.173	0.328
Basic school	2	47	14	63
Middle school/JHS	5	84	12	101
SHS	2	32	7	41
Tertiary	0	6	1	7
No formal education	4	19	7	30
Total	13	188	41	242
Main Occupation					8.699	0.368
Teaching	0	15	1	16
Fishing	8	70	22	100
Trading	4	86	14	104
Labourer	1	12	2	15
Others	0	5	2	7
Total	13	188	41	242
Ethnicity					13.325	0.101
Akan	3	63	5	71
Ga-Adangbe	4	42	13	59
Ewe	4	60	15	79
Hausa	1	16	8	25
Others	1	7	0	8
Total	13	188	41	242
Marital status					1.859	0.932
Married	12	158	33	203
Divorced	1	13	4	18
Widowed	0	10	2	12
Single	0	7	2	9
Total	13	188	41	242
Religious status					4.717	0.318
Christian	11	168	32	211
Islamic	2	19	8	29
African Traditional	0	1	1	2
Total	13	188	41	242
Area of residence					9.930	0.007
Galilea	11	85	25	121
Mahem	2	103	16	121
Total	13	188	41	242

3.5 Healthcare-seeking actions for schistosomiasis-related signs and symptoms

When respondents were asked about their first line of healthcare-seeking action for schistosomiasis-related signs and symptoms (Table 7), 76.9% (186) of the respondents indicated that going to the hospital or clinic was their first line of action, 17.8% (43) stated that they resort to self-medication with allopathic drugs, and 5.4% (13) indicated that going to the herbalist for traditional treatment was their first line of action. For respondents second line of action for schistosomiasis-related signs and symptoms, 66.9% (162) of respondents indicated that self-medication with allopathic drugs was their second line of action in an event where the first line of action failed, 16.9% (41) of the respondents noted that going to the herbalist for traditional treatment was their second line of action in an event where the first line of action failed, and 16.2% (39) of the respondents specified that going to the hospital or clinic was their second line of action in an event where the first line of action failed.

Table 7. Healthcare-seeking actions of respondents for schistosomiasis

Variables	Frequency	Percentage (%)
The first line of action
Go to the herbalist (traditional medicine)	13	5.4
Go to the hospital	186	76.8
Self-medication (allopathic drugs)	43	17.8
Total	242	100
The second line of action
Go to the herbalist (traditional medicine)	41	16.9
Go to the hospital	39	16.2
Self-medication (allopathic drugs)	162	66.9
Total	242	100

Table 8 and 9 below present the cross tabulation of sex and area of residence of the respondents against the first and second line of healthcare-seeking actions. Concerning the respondents first line of healthcare-seeking actions for schistosomiasis, 11 males as against 2 females indicated that they would go to the herbalist for traditional treatment as their first line of seeking healthcare for schistosomiasis, 121 males as against 65 females specified that they would go to the hospital or clinic as their first line of seeking healthcare for schistosomiasis, and 34 males as against 9 females stated that they would self-medicate with allopathic drugs as their first line of seeking healthcare action against schistosomiasis. Regarding the respondents' second line of healthcare-seeking action for schistosomiasis in case the first line of action failed, 30 males as against 11 females specified that they would go to the herbalist for traditional treatment as their second line of action, 28 males as against 11 females indicated that they would go to the hospital or clinic as their second line of action, and 108 males as against 54 females stated that they would self-medicate with allopathic drugs as their second line of action should the first line of seeking healthcare failed.

Regarding the respondents first line of healthcare-seeking action, 11 respondents from Galilea as against 2 respondents from Mahem revealed that they would go to the herbalist for traditional treatment as their first line of seeking healthcare, 82 respondents from Galilea as against 104 respondents from Mahem indicated that they would go to the hospital, and 28 respondents from Galilea as against 15 respondents from Mahem stated that they would self-medicate with allopathic drugs. For the second line of healthcare-seeking actions by respondents, 26 of them from Galilea as against 15 of them from Mahem specified that they would go to the herbalist for traditional treatment as their second line of seeking healthcare for schistosomiasis, 26 of the respondents from Galilea as against 13 of the respondents from Mahem stated that they would go to the hospital, and 69 of the respondents from Galilea as against 93 of the respondents from Mahem revealed that they would self-medicate with allopathic drugs as their second line of action should in case the first line of seeking healthcare for schistosomiasis-related signs and symptoms fails.

In line with the Pearson Chi-square test, it was revealed that there was no significant relationship between the sex of the respondents and the first line of healthcare-seeking actions for schistosomiasis (p=0.090). However, concerning the area of residence of the respondents and the first line of healthcare-seeking actions for schistosomiasis, there was a significant relationship (p=0.002). Also, with the Pearson Chi-square test, it was revealed that there was no significant relationship between the sex of the respondents and the second line of healthcare-seeking actions for schistosomiasis (p=0.649). On the other hand, there was a significant relationship between the area of residence of the respondents and the second line of healthcare-seeking actions for schistosomiasis (p=0.004).

Table 8. Cross tabulation of sex and area of residence against the first line of healthcare-seeking action

Characteristics	Go to the herbalist	Go to the hospital	Self-medication	Total	Chi-square value	P-value
Sex					4.822	0.090
Male	11	121	34	166
Female	2	65	9	76
Total	13	186	43	242
Area of residence					12.763	0.002
Galilea	11	82	28	121
Mahem	2	104	15	121
Total	13	186	43	242

Table 9. Cross tabulation of sex and area of residence against the second line of healthcare-seeking action

Characteristics	Go to the herbalist	Go to the hospital	Self-medication	Total	Chi-square value	P-value
Sex					0.863	0.649
Male	30	28	108	166
Female	11	11	54	76
Total	41	39	162	242
Area of residence					10.840	0.004
Galilea	26	26	69	121
Mahem	15	13	93	121
Total	41	39	162	242

3.6 Factors influencing healthcare-seeking actions

In line with the factors influencing the respondents' healthcare-seeking actions (Table 10), 83.9% of them chose the hospital or clinic due to accessibility, 33.5% of them picked the hospital due to affordability, 83.9% of the respondents opted for the hospital due to availability, 92.1% of them chose it due to efficacy, and 42.1% of the respondents chose the hospital due to the time spent to receive healthcare. Furthermore, 72.3% of the respondents preferred self-medication with allopathic drugs based on accessibility, 72.7% of them preferred self-medication with allopathic drugs because of affordability, 74% of the respondents indicated self-medication with allopathic drugs as a result of availability, 28.9% of them selected self-medication with allopathic drugs because of efficacy, and 75.6% stated self-medication with allopathic drugs due to time spent to receive healthcare. Besides, when respondents were asked about their reasons for visiting or choosing the herbalist for traditional treatment as their healthcare-seeking choice, 26.4% indicated accessibility as their reason, 26% specified affordability as their reason, 25.2% stated availability as their reason, 14.9% identified efficacy as their reason, and 25.6% indicated time spent to receive treatment as their reason.

Tables 11 and 12 above presents the association between the socio-demographic characteristics of the respondents and hospital visit and as well as self-medication respectively. The association between the socio-demographic characteristics of the respondents and hospital visit and as well as self-medication was performed using binary logistic regression to estimate the P-values and odds ratios at a 95% confidence interval.

From Table 11, there was a significant association between residence in Mahem and visit to the hospital (OR=2.957; 95% CI 1.410, 6.199, P-value=0.004). Also, there was a significant association between Ga-Adangbe’s and visit to the hospital (OR=0.293; 95% CI 0.0905, 0.905, P-value=0.033).

From table 12, there was a significant association between Ga-Adangbe’s and self-medication (OR=4.330; 95% CI 1.200, 15.630, P-value=0.025) and also Ewe’s and self-medication (OR=3.626; 95% CI 1.095, 12.006, P-value=0.035).

Table 10. Factors influencing the choice of healthcare

Variable	Hospital	Self-medication	Herbalist
Factors Accessibility	203(83.9%)	175(72.3%)	64(26.4%)
Affordability	81(33.5%)	176(72.7%)	63(26.0%)
Availability	216(89.3%)	179(74.0%)	61(25.2%)
Efficacy	223(92.1%)	70(28.9%)	36(14.9%)
Time	102(42.1%)	183(75.6%)	62(25.6%)

Note: Multiple responses

Table 11. Binary logistic regression of socio-demographic characteristics with hospital visit

Variables	Odds ratio	P-value	95% CI
Age group (years)
18-25	1
26-35	0.903	0.851	0.309, 2.633
36-45	1.723	0.362	0.535, 5.550
46-55	0.771	0.686	0.219, 2.714
56 and above	1.517	0.582	0.344, 6.687
Sex
Male	1
Female	1.772	0.308	0.590, 5.320
Area of residence
Galilea	1
Mahem	2.957	0.004	1.410, 6.199
Length of stay in area
1-5 years	1
6-9 years	1.138	0.790	0.439, 2.952
10 years and above	0.778	0.601	0.303, 1.997
Religious status
Christian	1
Islamic	0.464	0.447	0.064, 3.357
African Traditional	0.427	0.596	0.018, 9.920
Marital status
Married	1
Divorced	0.544	0.362	0.147, 2.016
Widowed	1.433	0.700	0.230, 8.908
Single	0.401	0.337	0.062, 2.590
Education
Basic School	1
Middle school/JHS	1.187	0.698	0.500, 2.817
SHS	0.357	0.091	0.108, 1.177
Tertiary	0.220	0.357	0.009, 5.536
No formal education	0.439	0.142	0.147, 1.316
Occupation
Teaching	1
Fishing	0.076	0.078	0.004, 1.330
Trading	0.103	0.114	0.006, 1.720
Labourer	0.203	0.310	0.009, 4.413
Others	0.094	0.128	0.004, 1.981
Ethnicity
Akan	1
Ga-Adangbe	0.293	0.033	0.0905, 0.905
Ewe	0.358	0.054	0.126, 1.018
Hausa	0.358	0.376	0.037, 3.480
Others	0.915	0.952	0.051, 16.410

1 refers to the reference category

Table 12. Binary logistic regression of socio-demographic characteristics with self-medication

Variables	Odds ratio	P-value	95% CI
Age group (years)
18-25	1
26-35	0.810	0.720	0.255, 2.566
36-45	0.593	0.412	0.171, 2.064
46-55	0.832	0.795	0.208, 3.334
56 and above	0.651	0.590	0.137, 3.101
Sex
Male	1
Female	0.664	0.501	0.202, 2.187
Area of residence
Galilea	1
Mahem	0.471	0.062	0.214, 1.037
Length of stay in area
1-5 years	1
6-9 years	0.852	0.761	0.303, 2.393
10 years and above	0.888	0.821	0.317, 2.487
Religious status
Christian	1
Islamic	2.227	0.481	0.240, 20.643
African traditional	5.866	0.281	0.234, 146.748
Marital status
Married	1
Divorced	2.329	0.237	0.573, 9.462
Widowed	1.734	0.573	0.256, 11.755
Single	3.768	0.173	0.560, 25.350
Education
Basic school	1
Middle school/JHS	0.628	0.344	0.240, 1.647
SHS	2.430	0.172	0.679, 8.695
Tertiary	4.177	0.391	0.159, 109.557
No formal education	1.215	0.749	0.367, 4.019
Occupation
Teaching	1
Fishing	8.117	0.153	0.460, 143.149
Trading	6.232	0.197	0.387, 100.447
Labourer	3.009	0.495	0.127, 71.425
Others	9.237	0.153	0.438, 194.808
Ethnicity
Akan	1
Ga-Adangbe	4.330	0.025	1.200, 15.630
Ewe	3.626	0.035	1.095, 12.006
Hausa	3.977	0.280	0.325, 48.634
Others	0.000	0.999	0.000

1 refers to the reference category

The study's findings on healthcare-seeking behavior for schistosomiasis in the Ga South District revealed several contrasts and confirmations when compared to existing literature. Educational level did not show a statistically significant effect on healthcare-seeking behavior, diverging from Sacolo et al., (2018), who found that uneducated individuals were more susceptible to schistosomiasis due to a lack of knowledge about preventive measures. This study's results suggest that the frequent educational campaigns by the district health directorate had successfully improved disease awareness across educational levels, mitigating the impact of education on healthcare-seeking behavior.

Similarly, marital status did not significantly influence healthcare-seeking behavior in this study, which contradicts Ng'weng'weta and Tarimo (2017), who reported that married women in Tanzania had better knowledge of schistosomiasis compared to unmarried women. This difference may highlight regional variations in how marital status affects health knowledge and behavior. Area of residence was significantly associated with healthcare-seeking behavior, consistent with Danso-Appiah et al. (2010), who found that residents of Tomefa were more likely to visit health facilities compared to those from Manheim. This finding underscores the importance of geographic factors in healthcare access and behavior.

The study also revealed that respondents had a good understanding of schistosomiasis, including its transmission routes and symptoms, aligning with Ndamba et al. (1998) in Zimbabwe and Uchoa et al. (2000) in Brazil, who found high levels of disease awareness in their study populations. Knowledge that walking or swimming in infected water and drinking contaminated water could transmit schistosomiasis corroborates Koffi et al. (2018), who identified similar transmission routes in Northern Côte d’Ivoire and Southern Mauritania.

Regarding symptoms, respondents identified blood in urine, painful urination, diarrhea, blood in feces, swollen abdomen, fever, and abdominal pain as indicative of schistosomiasis. This aligns with Codjoe and Larbi (2016) but contrasts with Ukwandu and Nmorsi (2004), who interpreted blood in urine as a sign of growth rather than schistosomiasis. This discrepancy highlights differing local interpretations of disease symptoms.

The study found that boys and men were more likely to seek healthcare, which is consistent with Anto et al. (2013) and Kosinski et al. (2012), who reported higher infection rates among males due to their greater exposure to water bodies. However, this study's higher rate of men seeking healthcare compared to women contrasts with Galdas et al. (2005), who noted poorer healthcare-seeking behavior among men. This suggests variability in healthcare-seeking patterns that may be influenced by local factors or differing study contexts.

For healthcare-seeking actions, most respondents preferred visiting hospitals or clinics over self-medication, a finding in contrast to Mwanga et al. (2004), who observed a higher preference for herbalists in Tanzania. The emphasis on hospital visits reflects perceived treatment efficacy, whereas self-medication was favored for its affordability, a preference also noted by Musuva et al. (2014), who found cost to be a significant factor in treatment choices.

Finally, while no significant relationship was found between sex and healthcare-seeking actions, area of residence significantly influenced these actions. This aligns with Danso-Appiah et al. (2010), underscoring the impact of geographic location on healthcare access and behavior. This study highlights the role of education, marital status, area of residence, and socioeconomic factors in shaping healthcare-seeking behavior for schistosomiasis, providing valuable insights that align with some findings in the literature while also revealing regional variations.

The study showed that the respondents had a sound knowledge and awareness of schistosomiasis-related signs and symptoms. Based on the socio-demographic characteristics of the household heads, it was noted that the area of residence was significantly associated with the healthcare-seeking behaviour or actions of respondents for schistosomiasis-related signs and symptoms. Majority of the respondents’ indicated that they would visit the hospital as their first line of seeking healthcare for schistosomiasis-related signs and symptoms. Self-medication with allopathic drugs was the second most preferred treatment option behind hospital visit by the respondents. The factors influencing the choice of healthcare for schistosomiasis included accessibility, affordability, availability, efficacy, and time. The healthcare-seeking behaviour of inhabitants is, therefore, an important determinant in reducing the prevalence of schistosomiasis in these two communities.

Acknowledgements

We extend our gratitude to the household heads of Galilea and Mahem near Weija Lake in the Ga South District, Greater Accra Region, for their participation in the study. We also acknowledge the research assistants who contributed to the interviews and transcription. Lastly, we appreciate the anonymous reviewers for their valuable suggestions in improving the manuscript.

Funding

No funds were received

Data Availability

The datasets generated and/or analyzed in this study are not publicly accessible but can be made available by the corresponding author upon reasonable request.

Ethics approval and consent to participate

Ethical approval was obtained from the Ghana Health Service Ethics Review Committee (GHS-ERC) prior to the commencement of the study. Additionally, permission to conduct the research was granted by the Ga South Health Directorate. Informed consent was individually obtained from respondents after the study's objectives were verbally explained to them.

Consent for publication

Not applicable.

Conflict of Interests

We declare that we do not have any conflicting interests

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No competing interests reported.

Healthcare-Seeking Behaviour for schistosomiasis-related signs and symptoms in Ghana’s capital

Status:

Version 1

Abstract

Figures

1. Introduction

2. Materials and Methods

2.1 Study area and setting

2.2 Sample size and participant selection

2.3 Data Collection

2.4 Data analysis

3. Results

3.4 Healthcare-seeking behaviour for schistosomiasis-related signs and symptoms

3.5 Healthcare-seeking actions for schistosomiasis-related signs and symptoms

3.6 Factors influencing healthcare-seeking actions

4. Discussion

5. Conclusion

Declarations

References

Additional Declarations

Status:

Version 1