
==== Front
J Educ Health Promot
J Educ Health Promot
JEHP
J Edu Health Promot
Journal of Education and Health Promotion
2277-9531
2319-6440
Wolters Kluwer - Medknow India

JEHP-13-176
10.4103/jehp.jehp_1878_23
Original Article
Health problems and health-seeking behavior of Muslim women in southern India
Nasreen I
Guthigar Mohammed 1
Veigas Irene 1
Department of Social Work, Yenepoya (Deemed to be University) Deralakatte, Mangaluru, Karnataka, India
1 Depatment of Social Work, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
Address for correspondence: Dr. Mohammed Guthigar, Department of Social Work, Yenepoya (Deemed to be University), Mangalore - 575 018, Karnataka, India. E-mail: guthigar@gmail.com
2024
05 7 2024
13 17617 11 2023
05 3 2024
Copyright: © 2024 Journal of Education and Health Promotion
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
BACKGROUND:

The health of women and girls is of particular concern because, in many societies, they are disadvantaged by discrimination rooted in sociocultural factors that prevent them from benefiting from quality health services and attaining the best possible level of health. Muslim women face a number of unique health challenges, including discrimination, poverty, and lack of access to healthcare. These challenges can lead to a number of health problems, including mental health issues, chronic diseases, and infectious diseases.

MATERIALS AND METHODS:

A descriptive research was conducted among the Muslim women in Dakshina Kannada among n = 675 participants drawn using two-stage stratified random sampling through interview method using semistructured questionnaire.

RESULTS:

The majority of the participants reported musculoskeletal and noncommunicable diseases. A majority of them resorted to modern medicine and there was a statistically significant association found with respect to spending on health problems (χ2 = 29.933, P < 0.001).

CONCLUSION:

The study reveals that women had a high incidence of musculoskeletal problems, and noncommunicable diseases such as cardiovascular disease, carcinoma, kidney, diabetes, and liver problems. They preferred allopathic medicine and sought treatment from local public health centers and private clinics since the majority of them were homemakers.

Behavior
health-seeking
India
Muslim
women
==== Body
pmcIntroduction

Health refers to complete physical, social, and mental well-being and not mere absence of disease or infirmity.[1] From decades onwards, women’s health has been a global concern.[2] Women prioritize their commitment to others so they often neglect their health.[3] Though men and women have the same health problems, women have specific health issues that need special attention. Unique issues of women are pregnancy, musculoskeletal problem, menopause, and gynecology problems including uterine fibroids.[4,5,6,7] The World Health Organization has stated the important health issues of women such as maternal health, reproductive health, cancer, violence, HIV, and venereal diseases psychological ill health.[8] Depression and anxiety are more common among women than men, similarly rate of heart attacks is higher among females.[9]

Developing countries face different kinds of health problems such as maternal mortality, infant mortality, malnutrition, and chronic diseases.[10] The UN has also highlighted health in its Millennium Development Goals (MDGs). Out of the seven Millennium Development Goals, the third and fifth pledged to promote gender equality and women empowerment and to improve maternal mortality rate (MMR).[11] Maternal mortality in India according to 2011–13 statistics with the estimation of 167 per 1,00,000 live births. According to 2013 Sample Registration Statistics (SRS), UP/Uttarakhand has the highest number of maternal deaths (292 per 100,000) and Kerala has the least (61 per 100,000).[12,13,14] According to the 2011 census, the gender ratio (number of females per 1,000 males) in India was 943 females. The highest and lowest gender ratios are 1084 and 618 in Kerala and Diu Daman, respectively.[15]

There are gender-based inequality issues, such as education, income, employment, and healthcare limitations, in society. Some of the health challenges distress both men and women equally, but women face difficulties in getting healthcare facilities when required.[16] Poor financial state and other resources affect women’s health. Though it is proved that the life expectancy of the female population is more than male, all over the world women suffer more from health-related problems and disabilities compared to men. According to the WHO (World Health Organization), “Gender disparities in health care are often striking. Families may invest less in nutrition, health care, schooling, and vocational training for girls than boys. Sex discrimination and low social status of girls and women frequently result in poor physical and mental health.”[2]

Muslims are lagging in terms of social, economic, political, and many human development indicators in India. Muslims are the largest minority population in India and they constitute 14.23% of the nation’s population. Although they are the largest, Muslim women face economic, social, and health problems and suffer from deprivation such as stigma, and traditional beliefs in the community. Muslim women and girls are lagging behind the males and the women from other communities. Lack or low level of education, and illiteracy result in their dependency on their husbands to make decisions and it affects their health. India has improved the public health and the status of Muslim women in the past 30 years, but still, they face different kinds of health problems and issues, because of the poor education level, lack of awareness, a weak economy, and political vulnerability.[17,18,19,20,21] The study conducted in Qatar found that there was a significant association between income level and health awareness among Arabic women living in Qatar.[22] A study conducted in Kenya on health-seeking behavior shows that there are factors that define the healthcare behavior of the individual. Inadequate health information, costs, gender issues, and distance to cover were the causes of the reduction in the demand for health care.[23] A study conducted in Raichur, India, on Muslim women stated that the majority of women had the symptoms of reproductive tract infections such as abnormal vaginal discharge, itching, backache, and low abdominal pain which they do not consider serious enough to seek medical attention because of low socioeconomic status of women.[24] A study showed that orthopedic injury patients should generally receive similar treatment whether they are male or female. On the other hand, women tend to suffer from musculoskeletal injuries more often or in a particular way than men.[25]

The low socioeconomic condition of Muslim women had adverse effects on their health.[26] Financial backwardness, accessibility, and availability of services were hindering seeking health care by women.[27] Elimination of violence, sexual exploitation, forced marriage, recognizing unpaid services, household shared responsibilities, decision-making, equal opportunity, effective participation, empowerment, and provision of financial services will improve women’s health.[28]

Materials and Methods

Study design and setting

A descriptive study was conducted among 675 Muslim women in the five taluks of Dakshina Kannada, Karnataka, India., through direct interviews using semi structured questionnaire.

Study participants and sampling

The study unit was Muslim households in Dakshina Kannada. Among these households, women (n = 675) were recruited as participants for the study from five taluks of Dakshina Kannada, namely, Mangaluru, Bantwal, Puttur, Belthangadi, and Sullia. The households were selected using the two-stage stratified random sampling strategy. The study population was divided into different strata consisting of panchayaths and wards. The number of households selected for study was from the panchayaths/wards.

The formula for sample size estimation is-

In the first stage, panchayaths/wards were selected using simple random sampling without replacement (SRSWOR). The criteria used for the first stage sample size are10% of the total panchayath/wards.

Allocation of the sample size for each strata is given by nh = (n/N) Nh

In the stage second of sampling, calculate sampling length k = Nh/nh

The detailed sample size estimation is given Figure 1.*

Figure 1 Detailed sample size estimation representation of sampling technique. P = Panchayath W = Ward R = Rural U = Urban

Data collection tool and technique

A semistructured questionnaire was formulated to assess the health problems and health-seeking behavior of the participants. The first part of the questionnaire contains sociodemographic details, such as age, palace of resident, marital status, education level, occupation, and income. The second part of the questionnaire includes their health problems, total expenditure, and health-seeking behavior.

The questionnaire was testedand validated, and appropriate changes were made. The interviewmethod was used to collect data. After filling out the questionnaire, the data were analyzed with the use of SPSS (ver. 27). To find the correlations between the variables, the Chi-square test and Wald test with the test statistics—Chi-square with one degree of freedom—were used with a significant cutoff P value of < 0.05.

Ethical consideration

The ethical approval for this study was received from the ethics review committee, Yenepoya (Deemed to be University), protocol no.(YEC-1/2018/235). Legal permission paper to carry out the study was secured with the copy of the proposal. Written informed consent was obtained from each of the participants who agreed to participate in the research after explaining the aim and the importance of the study. All research-related activities, including data collection, were created with respect for and protection of human rights, such as authentication of informed consent, voluntary participation, and confidentiality.

P = Panchayath W = Ward R = rural U = Urban.

Results

The prevalence of any health-related problem is 54.67% (95% CI is [50.82% 58.45%]). The following table gives the various health problems experienced by 369 participants.

The results of the study show that 29.8% (110) and 29.3 (108) of the participants were between the age group of 41–50yrs and 31–40yrs, respectively. The majorityof the participants, 81.6% (301) were married, 68.6% (253) reside in a rural area, 81.3% (300) speak Beary language, 45.8% (169) educated up to primary level, and 26.3% (97) were nonliterates. Among the participants majority, 64.0% (236) of them live in nuclear families, 38.5% (142) were homemakers, and 20.9% (77) were beedi rollers. The income of the families range from ₹ 3001–5000 (60.2%) per month. [Table 1].

Table 1 Distribution of study participants based on their sociodemographic variables (n=369)

Variables	Categories	Frequencies (%)	
Age (Yrs)	21–30 yrs	61 (16.5)	
31–40 yrs	108 (29.3)	
41–50 yrs	110 (29.8)	
51–60 yrs	67 (18.2)	
>60 yrs	23 (6.2)	
Location	Rural	253 (68.6)	
Urban	116 (31.4)	
Mother tongue	Malayalam	13 (3.5)	
Urdu/Hindi	56 (15.2)	
Beary	300 (81.3)	
Education level	Iliterate	97 (26.3)	
Primary	169 (45.8)	
High School	39 (10.6)	
PUC	35 (9.5)	
Degree	29 (7.9)	
Family type	Nuclear	236 (64.0)	
Joint	133 (36.0)	
Marital status	Single	33 (8.9)	
Married	301 (81.6)	
Widow	35 (9.5)	
Occupation	Unemployed	46 (12.5)	
Daily wage worker	2 (0.5)	
Homemaker	142 (38.5)	
Beedi roller	77 (20.9)	
Govt. servant	3 (0.8)	
Agriculture	1 (0.3)	
Self-employed	3 (0.8)	
NA*	95 (25.7)	
Per capita income (INR)	<3000	4 (1.1)	
3001–5000	222 (60.2)	
5001–7000	30 (8.1)	
7001–9000	20 (5.4)	
9001–1100	25 (6.8)	
>11,001	68 (18.4)	
*Indicates—students and incapacitated to work

The majority 88 (23.8%) participants were having problems with bones and joints followed by other problems 77 (20.9%) and noncommunicable diseases 68 (18.4%). The majority of 292 (79.1%) participants tried allopathic medicine, while 77 (20.9%) of the participants tried other sources of medicines like—Ayurveda, Homeopathy, Unani, traditional, or faith healing. [Table 2].

Table 2 Distribution of study participants based on their health problems and health-seeking behavior (n=369)

Factors	Categories	Frequency (%)	
Health	Respiratory system related	50 (13.6)	
problems	Communicable diseases	7 (1.9)	
Noncommunicable diseases*	68 (18.4)	
Bones and joints	88 (23.8)	
OBG	32 (8.7)	
Other problems#	77 (20.9)	
Nonspecific complaints	2 (0.5)	
Multiple problems$	45 (12.2)	
Type of treatment taken	Allopathy only	292 (79.1)	
Any other**	77 (20.9)	
OBG=Obstetrics and Gynaecology, Details: *Indicates—Cardiovascular disease, diabetes, cancer, thyroid, mental illness, hypertension and diabetes, kidney and liver problem, #Indicates—gastro-intestinal, eye problem, skin, dental, $Indicates—hypertension and diabetes, bones and joints + hypertension **indicates—Ayurveda, Homeopathy, Unani, traditional healer, and faith healer

The health-seeking behavior {Allopathy, any other} is considered as a response variable. The univariable analysis is carried out by considering one independent variable at a time, and any independent variable significant at the 20% level is taken to multivariable analysis.

The univariable analysis is carried out to identify the potential covariates having an impact on health-seeking behavior. From Table 2, the geographical location, educational level, family type, and monthly income are identified as potential covariates. The mother tongue is not found to have any impact on health-seeking behavior. From multivariable analysis, the odds of going for Allopathy treatment for illiterate people are less than those for educated people (all the odds ratios are less than 1). Illiterate people are more likely to prefer any other treatment over Allopathy. The odds of preferring Allopathy treatment for joint family members are less than those for nuclear family members (Odds ratio = 0.784). The odds of going for Allopathy treatment for families with a monthly income more than ₹.5000/- is around five times higher (odds ratio = 4.611) than those for families with a monthly income less than Rs. 5000/-. [Table 3].

Table 3 Distribution of study participants based on the impact of sociodemographic variables on health-seeking behavior in the past 6 months (n=369)

Independent variables	Univariable analysis	Multivariable analysis	
Odds ratio	P	95% CI	Odds ratio	P	95% CI	
Location			Lower limit	Upper limit		Lower limit	Upper limit	
Urban	Reference	Reference	
Rural	0.552	0.049	0.306	0.997	0.761	0.400	0.402	1.439	
Mother Tongue	
Beary	Reference		
Malayalam	0.563	0.352	0.168	1.889		
Urdu/Hindi	0.827	0.585	0.418	1.635		
Educational level	
Degree	Reference	Reference	
PUC	0.654	0.249	0.318	1.346	0.799	0.559	0.376	1.698	
High school	0.471	0.124	0.180	1.228	0.788	0.646	0.286	2.176	
Primary	0.133	0.000	0.054	0.327	0.195	0.001	0.075	0.509	
Illiterate	0.371	0.055	0.134	1.022	0.617	0.381	0.209	1.817	
Family type	
Nuclear	Reference	Reference	
Joint	0.705	0.206	0.410	1.212	0.784	0.415	0.436	1.408	
Monthly income (INR)	
<5000	Reference	Reference	
>5000	5.355	0.000	3.096	9.263	4.611	0.000	2.585	8.224	

There is an association between health problems and health-seeking behavior (χ2 = 15.7172, P = 0.032). [Table 4].

Table 4 Distribution of study participants based on an association between health problems and health.seeking behavior (n=369)

	Health seeking behavior	Total (%)	
Allopathy only (%)	Any other** (%)	
Health problems of participants in the past 6 months	
    Respiratory system related	41 (82.0%)	9 (18.0%)	50 (100.0%)	
    Communicable diseases	3 (42.9%)	4 (57.1%)	7 (100.0%)	
    Noncommunicable diseases*	59 (86.8%)	9 (13.2%)	68 (100.0%)	
    Bones and joints	72 (81.8%)	16 (18.2%)	88 (100.0%)	
    OBG	26 (81.3%)	6 (18.8%)	32 (100.0%)	
    Other problems#	60 (77.9%)	17 (22.1%)	77 (100.0%)	
    Nonspecific complaints	2 (100.0%)	0 (0.0%)	2 (100.0%)	
    Multiple problems$	29 (64.4%)	16 (35.6%	45 (100.0%)	
Total	292 (79.1%)	77 (20.9%)	369 (100.0%)	
OBG=Obstetrics and Gynecology, Details: *Indicates—cardiovascular disease, diabetes, cancer, thyroid, mental illness, hypertension and diabetes, kidney and liver problem, #indicates—gastrointestinal, eye condition, skin, dental, $indicates—hypertension and diabetes, bones and joints + hypertension, **indicates—Ayurveda, Homeopathy, Unani, traditional healer, and faith healer

There is an association between health seeking ehavior and the reasons (χ2 = 21.225, P = 0.001). The most frequent to prefer Allopathy is a fast recovery (30.5%), where as the most frequent reason to go for any other treatment is faith (49.4%). [Table 5].

Table 5 Distribution of study participants based on an association between health-seeking behavior and reason for the behavior (n=369)

	Reasons for this behavior	Total	
Faith	Free	Nearer to home	Fast recovery	Other#	
Health seeking behavior	
    Allopathy only	83 (28.4%)	21 (7.2%)	49 (16.8%)	89 (30.5%)	50 (17.1%)	292 (100.0%)	
    Any other*	38 (49.4%)	0 (0.0%)	3 (3.9%)	21 (27.3%)	15 (19.5%)	77 (100.0%)	
Total	121 (32.8%)	21 (5.7%)	52 (14.1%)	110 (29.8%)	65 (17.6%)	369 (100.0%)	
#Indicates—Ayurveda, Homeopathy, Unani, traditional healer, and faith healer, #Indicates—referred by family members, tried

There is an association between health-seeking behavior and the total medical cost (χ2 = 29.933, P < 0.001). Around 36.4% of the participants who preferred Allopathy only have spent more than Rs. 10,000/-, whereas only 9.4% of the participants who preferred any other treatment have spent more than. ₹10,000/-. [Table 6].

Table 6 Distribution of study participants based on an association between medical cost and health-seeking behavior (n=369)

	Total expenses for treatment (INR)	Total	
1000–5000	50,001–10,000	10,001–15,000	15,001–20,000	>20,000	
Health seeking behavior	
    Allopathy only	120 (41.1%)	66 (22.6%)	30 (10.3%)	30 (10.3%)	46 (15.8%)	292 (100.0%)	
    Any other*	50 (64.9%)	19 (24.7%)	3 (3.9%)	2 (2.6%)	3 (3.9%)	77 (100.0%)	
Total	170 (46.1%)	85 (23.0%)	33 (8.9%)	32 (8.7%)	49 (13.3%)	369 (100.0%)	
*Indicates—Ayurveda, Homeopathy, Unani, traditional healer, and faith healer

Discussion

The study indicated that there was a statistical association among the geographical location (urban and rural), educational level, and monthly income of the participants that influenced the health-seeking behavior (refer to [Table number 2]. A significant association was found concerning total expenses for treatment and health problems. In terms of education and occupation, the majority of Muslim women were nonliterate and homemakers. The results of the study fall in line with the similar study.[2] In this study, most of the women had musculoskeletal problems which conforms with other studies.[29,30] The amount spent by Muslim women for treatment ranges between ₹1000 and 5000/- as most of the women are economically poor in terms of affordability of healthcare providers so they found difficulty in spending on treatment, which is confirmed with the other study.[31] In this study, Muslim women preferred Allopathy medicine, which is confirmed with the other study findings[32] over alternative medicine since it relieves and heals the pain instantly and there was a statistical association found between health-seeking behavior and the reason for choosing particular sources of treatment.

Limitations and recommendations

To the best of our knowledge, this is the first descriptive study to explore the health problems and health-seeking behavior of Muslim women in Karnataka. The study mainly focused on determining the health problems and health-seeking behavior of Muslim women in rural and urban settings. In a majority of cases, women relied on their memory to narrate self-reported health problems and the treatment they had received. This may have implications for the validity of the study. Furthermore, we attempted to collect information about out-of-pocket expenses incurred for treatment during various morbidities in the family. However, in most Muslim families, men make decisions in financial matters and hence the information shared by women on out-of-pocket expenses may be inaccurate. In some families, while interviewing women, male members were also present, this could have affected the disclosure of information on reproductive health issues.

Based on the findings, we recommend conducting a comprehensive health study using a health screening approach to estimate the prevalence of communicable and noncommunicable diseases among Muslim women. We also suggest involving NGOs and CBOs working with the Muslim community to ensure better health outcomes. Moreover, we propose implementing health education interventions at the cluster level by identifying and training educated and motivated women volunteers in the community to raise awareness of health care matters among women. This is expected to reduce disease burden and ensure well-being with proper health-seeking behavior.

Conclusion

The research study highlights the health problems and health-seeking behavior of Muslim women. Study reveals that women had a high incidence of musculoskeletal problems, and noncommunicable diseases such as cardiovascular disease, carcinoma, kidney, diabetes, and liver problems. They preferred allopathic medicine and sought treatment from local public health centers and private clinics since the majority of them were homemakers. Affordability, accessibility, and faith were found to be the factors influencing the health-seeking behavior of Muslim women.

Contribution list

All the authors contributed adequately to the completion of this study. All authors have read and approved the manuscript.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Acknowledgement

We would like to thank Yenepoya (Deemed to be University) and the Minority Welfare Department, Prof. Ismail B, Prof. KK Achari, Mrs. Yashaswini K, Dept. of Statistics of yenepoya (Deemedto be University), panchayath representatives, functionaries, and our study participants.
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