|Year : 2020 | Volume
| Issue : 3 | Page : 147-153
Health-seeking behaviour of commercial bus drivers in Uyo, Nigeria
Ofonime Effiong Johnson
Department of Community Health, University of Uyo Teaching Hospital, University of Uyo, Uyo, Nigeria
|Date of Submission||29-May-2020|
|Date of Acceptance||04-Oct-2020|
|Date of Web Publication||25-Mar-2021|
Ofonime Effiong Johnson
Department of Community Health, University of Uyo Teaching Hospital, University of Uyo, Uyo
Source of Support: None, Conflict of Interest: None
Background: Commercial driving is a highly demanding job which often exposes the drivers to different health problems necessitating treatment. Various treatment options are available to these drivers. The objectives of this study were to assess the health problems and health-seeking practices of commercial bus drivers in Uyo, Nigeria.
Methodology: This was a descriptive cross-sectional study carried out in March, 2020. Data collection was done using an interviewer-administered semi-structured questionnaire. Analysis of data was carried out with IBM SPSS Statistics, version 20.0. The level of significance was set at P < 0.05.
Results: A total of 121 male respondents participated in the study. The mean age of respondents was 40.45 ± 10.49 years. More than half 71 (58.7%) respondents had completed secondary education. The most common health problems reported by respondents were low back pain (55.4%), insomnia (55.4%) and body aches (52.1%). The usual sources of treatment were chemist (60.3%), herbal remedies (51.3%), health facility (25.6%) and self-medication (17.4%). Among 32 (26.4%) respondents that ever had fractures, 23 (71.9%) received treatment from bone setters. Care seeking in health facility as reported by the drivers was mainly influenced by treatment cost (43; 35.5%) and waiting time (23; 19.0%).
Conclusion: Commercial drivers in this study obtained treatment more frequently from places outside the health facilities. Health education on advantages of expert medical consultations and treatment in health facilities should be carried out through their transport unions. Furthermore, mechanisms to reduce waiting time and treatment cost in health facilities should be explored for this group of workers.
Keywords: Commercial drivers, health education, health-seeking behaviour, Nigeria, Uyo
|How to cite this article:|
Johnson OE. Health-seeking behaviour of commercial bus drivers in Uyo, Nigeria. Port Harcourt Med J 2020;14:147-53
| Introduction|| |
The road transportation system in Nigeria accounts for over 90% of mobility of individuals, with commercial road transport accounting for about 432 million tons of freight movement by road per annum. This reliance on public transportation makes operators of commercial vehicles an important component of the socioeconomic development. As a result of the high demands of their job, commercial bus drivers are vulnerable to various health hazards. Studies among occupational drivers in different regions have reported high prevalence of musculoskeletal pain, particularly low back pain.,,,,, The factors that contributed to such pain included prolonged sitting, poor postures, long driving time and few hours of sleep, exposure to whole-body vibration, heavy lifting, manual materials handling, poor diet or other psychosocial factors.,, Another study also found the prevalence of hypertension among bus drivers to be as high as 36%. Visual dysfunction has also been reported in studies., Occupational diseases reported in a survey of 400 male professional drivers in Nigeria included myalgia (88%), hypertension (22.5%), renal tubular acidosis (13%), short sightedness (10.3%), upper respiratory infections (5%) and sexually transmitted diseases (STD; 3.8%). Studies in Sagamu and Lagos, Nigeria, have reported that about three quarters (78.3%, 74.3%) of commercial drivers have multiple sexual partners., This practice increases exposure to STD among this occupational group.
With the various health conditions identified among professional drivers, health-seeking behaviour is an important issue to consider. Health-seeking behaviour refers to actions by a person in the setting of perceived illness for the purpose of finding an appropriate solution. This involves attitudes or actions adopted during actual or potential illnesses and the behaviour of healthy individuals towards prevention of illness, early diagnosis and treatment of already contracted illnesses and forestalling complications associated with already established disease. It can also be referred to as illness behaviour or sick-term behaviour. Health-seeking behaviour is situated within the broader concept of health behaviour, which encompasses activities undertaken to maintain good health, to prevent ill health, as well as dealing with any departure from a good state of health. This attitude or action is significantly influenced by a variety of socioeconomic variables such as social status, sex, age, the type of illness, perceived quality of the health services and access to health-care services. Furthermore, the cost of treatment, attitude of health providers and culturally acceptable health-care services are also important factors influencing access to health services.
Common health-seeking behaviour reported among occupational drivers in a previous study included use of self-medication and herbal remedies, with only few seeking hospital treatment. This pattern also seems to be common among other artisans in the informal sector. In a study in Nigeria to assess the health-seeking behaviour among sewing machine operators, the most sought-after health-seeking behaviour was self-medication (31.4%), followed by herbal preparations (17.8%). Only 3.7% of respondents sought hospital treatment exclusively, while 2.5% sought hospital treatment in addition to other treatments. Commercial drivers are often ignorant of the dangers of the consumption of herbal medication. In a survey in Lagos metropolis, Nigeria, among herbal medicine users, it was found that the users appeared to be ignorant of the potential toxicities of the herbs used. In a research of liver and kidney functions among medicinal plant users in South-East Nigeria, the most common toxicity from chronic use was liver problems. Herbal medicines can also be contaminated by bacterial organisms during preparation, thus putting the users at risk.
Although there have been few studies conducted on the health hazards and health-seeking practices among commercial drivers in certain parts of Nigeria, there is a dearth of information about studies on this subject among commercial bus drivers in the study area. This study, therefore, assessed the health problems and health-seeking practices among commercial bus drivers in Uyo to document findings and suggest possible ways of improving the health care of this group of workers.
| Methodology|| |
This study was conducted in Uyo, the capital of Akwa Ibom State in southern Nigeria with a projected population of a projected population of 436,606 in 2020. Uyo is a cosmopolitan city with people from various cultures and ethnicities. The most common spoken language is Ibibio. Many of the inhabitants are engaged in various occupations in the informal sector, while the educated ones commonly work as civil servants. There are four major motor parks in Uyo metropolis which house the majority of the commercial motor drivers in the city. These drivers facilitate intercity and interstate movements of the dwellers of Uyo metropolis. The types of vehicles used include salons, station wagon car and 10–14-seater buses.
This was a descriptive, cross-sectional study carried out in March 2020 among commercial drivers in Uyo, Nigeria.
The formula for estimating single proportion for cross-sectional studies was used in calculating the sample size (n = z2pq/d2), with a P value of 0.031 being the prevalence of commercial drivers who sought hospital treatment in a previous Nigerian study, z of 1.96 and sampling error set at 5%. A sample size of 46.16 was obtained, and after adding 10% to accommodate for non-response, it increased it to 53. The sample size was subsequently increased to 121 participants.
This study included only consenting commercial drivers in public parks who were above 18 years of age, had worked for up to 1 year and were members of either the National Union of Road Transport Workers or the Road Transport Employee's Association of Nigeria.
The four major parks in Uyo metropolis are Central Itam, Mbiabong Etoi, Nung Oku and Ekom Iman parks. The Central Itam Park was selected using simple random sampling technique by balloting. According to the list provided by the chairman of the commercial drivers associations of that park, there were 210 registered commercial drivers operating in the Central Itam Park as at the time of the study. The list served as the sampling frame and the desired number of drivers was selected using simple random sampling method with the aid of a table of random numbers. The list of the selected drivers was given to the chairman who informed them during their association meeting 1 week before commencement of data collection. Those who were either absent or not consenting were replaced during data collection by previously unselected drivers.
Data collection was carried out by three previously trained research assistants immediately the drivers resumed duty each day for a period of 7 days. The tool used was an interviewer-administered semi-structured questionnaire, which examined the sociodemographic characteristic, common health problems experienced and the health-seeking behaviour of the commercial drivers. Ten copies of the questionnaire were previously pre-tested on commercial drivers at a park in Abak, a nearby town to Uyo. All ambiguous questions were revised to ensure comprehension by the respondents.
Analysis of data was carried out using IBM SPSS Statistics for windows, version 20.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics (frequency and proportion to summarise variables) and inferential statistics (Chi-square to test the significance of association between two categorical variables) were explored. The level of significance was set at P < 0.05.
Ethical approval for the study was obtained from Akwa Ibom State Health Research Committee. Furthermore, permission was obtained from the chairman of the commercial drivers' association in the selected park. Adequate explanation was given to the respondents concerning the purpose, content and significance of the study. Only those who voluntarily gave informed consent participated in the study. Confidentiality was ensured as there were no identifiers on the questionnaires.
| Results|| |
A total of 121 respondents participated in the study. The mean age of respondents was 40.45 ± 10.49 years and a median of 39 years with 47 (38.8%) being 30–39 years. All were male and majority 86 (71.1%) were married. More than half (71; 58.7%) of the respondents completed only secondary education, while 22.3% had tertiary education. Fifty-nine (48.8%) respondents had worked for 1–5 years [Table 1]. The weekly income of about half (51.2%) of the respondents was 11,000–20,000 naira. Majority (71.9%) of the respondents worked for 5–6 days weekly and 66 (54.5%) worked for more than 8 h daily, while 33 (27.3%) reported having no break periods. About half (63; 52.1%) of the respondents did not own the vehicles they were driving and 47.1% had to pay the owners 11,000–20,000 monthly [Table 2].
The most common health problems reported by the respondents were low back pain (55.4%), insomnia (55.4%) and body aches (52.1%). Eighty-one (66.9%) of the respondents opined that all sicknesses should be treated in the hospital. However, the usual sources of treatment were chemist (60.3%), herbal remedies (51.3%), health facility (25.6%) and self-medication (17.4%) [Table 3]. Concerning the treatment of fracture, only 47 (38.8%) respondents opined that treatment should be received in a health facility. However, among the 32 (26.4%) respondents that ever had fracture, 23 (71.9%) received treatment from bone setters. Out of these, 16 (69.6%) respondents reported satisfactory outcome [Table 4].
Reasons given by respondents for lack of patronage of health facilities included high treatment cost (43; 35.5%) and long waiting time (23; 19%) [Table 5]. The relationship between health facility use and sociodemographic variables such as age, educational level and income were not statistically significant (P > 0.05) [Table 6].
|Table 5: Reasons for lack of patronage of health facility by respondents|
Click here to view
|Table 6: Association between selected characteristics of respondents and use of health facility|
Click here to view
| Discussion|| |
Commercial drivers constitute an important group of workers in the informal sector. They play a key role in ensuring the movement of commuters from one place to the other. They are mostly young and are thus able to cope with the demanding nature of the job. In the present study, all respondents were male with a mean age of40.5 ± 10.5 years, which was very similar to a mean age of 40.4 ± 10.4 years among drivers in a study in Ibadan and also findings of other studies.,, Commercial drivers generally operate very busy schedules in an attempt to make as much money as possible. Many drivers work daily, sometimes without having enough rest. The majority of the respondents in the present study worked for 5–6 days in a week and a quarter did not observe any break periods. This very busy schedule often exposes them to different health situations.
Work-related musculoskeletal disorders are prevalent among commercial drivers. Different studies among commercial drivers have reported the prevalence of low back pain of 30.7%–73.5%.,, In the present study, low back pain was also one of the health problems identified by more than half of the respondents. This may be contributed by the prolonged confined postures adopted by the drivers, especially as many often work for long periods of time daily. In a study among professional drivers in Kano, Nigeria, the prevalence of low back pain was associated with driving for >15 h/day, while in the present study, up to half of the respondents worked for more than 8 h daily. A similar finding in the current study was also reported in a study among taxi drivers in Malaysia where low back pain was found to be associated with working for more than 8 h daily. Moreover, the car seats may also not be well adapted to the drivers' body structures, thus possibly contributing to the occurrence of low back pain. Other health problems reported by the drivers in the present study included insomnia, body aches and STI. These findings are corroborated by other studies.,,
The health-seeking behaviour of commercial drivers is an important issue considering the health problems they often encounter. The drivers seek treatment for the different ailments they experience from various sources. In the present study, the usual sources of treatment were chemist (60.3%), herbal remedies (51.3%), health facility (25.6%) and self-medication (17.4%). Common health-seeking behaviour reported among occupational drivers in Ibadan Nigeria included use of self-prescribed drugs (35.8%) and herbal remedies (32.1%). Only 3.1% of respondents sought hospital treatment. Even though the proportion who utilised the health facilities in the present study was higher than the previously cited study, it was still considered to be low, especially when compared to other options of treatment which they utilised more frequently such as herbal remedies, which could have numerous toxic effects and the patronage of chemists, where drugs are prescribed by unqualified personnel. All drivers who sought treatment outside the health facilities, therefore, denied themselves the opportunity of receiving proper diagnosis and appropriate treatment from the experts and engaged in drug abuse/misuse with all the attendant negative effects. Care seeking in the health facilities in the present study was not influenced by any of the sociodemographic variables. This was surprising as one would have expected higher patronage from those who earned more and were more educated. The reasons they gave included high treatment cost and prolonged waiting time.
The cost of treatment is, however, a major factor influencing the health-seeking behaviour of the population, particularly the low-income earners in the informal sector. A study in Ibadan, Nigeria, found that cost/payment for service was 2.9 times more likely to predict the use of public health facility among respondents. A similar study also found that the relatively higher cost of orthodox drugs was reported to encourage use of alternative medicine among the populace. In North Central Nigeria, a higher proportion of low-income people were reported to patronise drug sellers. This is probably because they are usually willing to combine and dispense drugs worth whatever amount of money the buyers offer. In the present study, treatment cost was a key reason given for not seeking care in health facility by about one-third of the respondents. This is an important issue that the drivers often consider as there are several competing needs to handle from their daily earnings. Many of the drivers in the present study were married and, therefore, would likely have several family financial responsibilities to cope with in addition to their personal needs. Moreover, almost half of them had to remit some money to the owners of the vehicles they were driving. It was, therefore, not surprising if they therefore settled for cheaper treatment options to save as much money as possible.
Waiting time is another factor which has been identified as affecting the utilisation of health services among commercial drivers in several studies.,,, Since these artisans only earn money when they work, time is of essence to them. In the present study, waiting time was considered by one-fifth of the respondents to affect their patronage of health facilities. That might explain why chemists were most commonly patronised by them as they were more likely to get faster attention there than in health facilities.
The consumption of herbal remedies is a health-seeking practice that is common among commercial drivers. Such concoctions are usually affordable and often sold by hawkers in the motor parks. In the present study, up to half of the drivers admitted to using these herbs. These herbal concoctions usually contain different components some of which can be harmful to the users, such as alcohol and even cannabis. Moreover, since the dosing is not controlled, toxicity could also result from excessive use. In a study in Osogbo, although 40.5% perceived that the herbal drinks were harmful, many of the drivers were not willing to stop using them. They reported taking the herbal drinks for the treatment of common cold and other illnesses such as chronic back pain. Unwillingness to stop such herbal remedies could also be as a result of addiction to the constituents.
The perception of an illness has also been suggested to influence a person's health-seeking behaviour. Many sufferers of different illnesses in the Nigerian populace have preconceived ideas about locations that specific illnesses should be treated. The treatment of fractures, for instance, is generally considered to be best handled by bone setters. In the present study, 7 out of every 10 drivers who ever had fractures received treatment from bone setters. This behaviour was despite the fact that up to 80% of them had a minimum of secondary education. There is a need for behavioural change communication among commercial drivers to ensure improved utilisation of health facilities.
A major limitation of this study was the fact that findings were solely based on the responses of the respondents. To encourage truthful responses, the drivers were interviewed individually to ensure privacy. Furthermore, since the drivers were eager to commence the day's activities and were unwilling to interact for long, they may have left out some details which may have been of interest.
| Conclusion|| |
Commercial drivers in this study obtained treatment for their health conditions more frequently from chemists and hawkers of herbal remedies than from health facilities. They also preferred patronage of bone setters for the treatment of fractures rather than health facilities. Health education on advantages of proper medical consultation and treatment in health facilities as well as the cost–benefit analysis of qualified health services should be carried out through the transport unions as this would benefit the commercial drivers. Furthermore, mechanisms to reduce waiting time in health facilities and reduction of out of pocket treatment cost through health insurance should be explored for this group of workers.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Aworemi JR, Abdul-Azeez IF, Adewoye JO, Oyedokun AJ. An evaluation of the impact ofcondition of service of commercial vehicle drivers on road safety in South Western Nigeria. EurJ Sci Res 2009;35:426-35.
Chidi-Egboka NC, Bolarinwa OA, Awoyemi AO. Visual function test among commercial drivers in a North Central State in Nigeria. Health Sci J 2015;9:1-7.
Al-Dubai SA, Qureshi AM, Ismail NH, Rampal KG. Prevalence and determinants of low back pain among taxi drivers in Malaysia: A cross sectional study. J Adv Med Res 2012;2:129-43.
Rufa'i AA, Sa'idu IA, Ahmad RY, Elmi OS, Aliyu SU, Jajere AM, et al
. Prevalence and risk factors for low back pain among professional drivers in Kano, Nigeria. Arch Environ Occup Health 2015;70:251-5.
Akinpelu AO, Oyewole OO, Odole AC, Olukoya RO. Prevalence of musculoskeletal pain and health seeking behavior among occupational drivers in Ibadan, Nigeria. Afr J Biomed Res 2011;14:89-94.
Akinbo SR, Odebiyi DO, Osasan AA. Characteristics of back pain among commercial drivers and motorcyclists in Lagos, Nigeria. West Afr J Med 2008;27:87-91.
Samuel OA, Babajide LE. The prevalence of work-related musculoskeletal disorder among occupational taxicabs drivers in Nigeria. Int J Res Rev App Sci 2012;11:561-7.
Abledu JK, Offei EB, Abledu GK. Occupational and personal determinants of musculoskeletal disorders among urban taxi drivers in Ghana. Int Sch Res Notices 2014;2014:517259.
Robb MJ, Mansfield NJ. Self-reported musculoskeletal problems amongst professional truck drivers. Ergonomics 2007;50:814-27.
Okunribido OO, Magnusson M, Pope MH. The role of whole body vibration, posture and manual materials handling as risk factors for low back pain in occupational drivers. Ergonomics 2008;51:308-29.
Malomo BI, Yusuf MO. Demographic variable influencing the well-being of ikejadanfo drivers. Afr J PsycholStudy Soc Issues 2018;21:136-44.
Bhaskara SR, Ganga GB, Devi BM. A study on hypertension and It's Adewole AO, Ajumobi O, Gidado S. Health Care Seeking Behavior for Visual determinants among male bus drivers in state road transport corporation, Visakhapatnam, Andhra Pradesh. J Evid Based Med Healthc 2015;2:7324-9.
Adewole AO, Ajumobi O, Gidado S. Health care seeking behaviour for visual dysfunction among motor vehicle drivers in Osun State, Southwest Nigeria. Pan Afr Med J 2019;32:17.
Amoran OE, Salako AA, Jeminusi O. Screening for common occupational health diseases among long distance professional drivers in Sagamu, Ogun State, Nigeria. Int J Prev Med 2014;5:516-21.
Ekanem EE, Afolabi BM, Nuga AO, Adebajo SB. Sexual behaviour, HIV-related knowledge and condom use by intra-city commercial bus drivers and motor park attendants in Lagos, Nigeria. Afr J Reprod Health 2005;9:78-87.
Kay MP, Mitchell GK, Del Mar CB. Doctors do not look after their own physical health. Med J Aust 2004;181:368-70.
MacKian S. A Review of Health Seeking Behavior: Problems and Prospects. Health Systems Development Programme. Manchester: University of Manchester; 2003.
Zewude BG. Health seeking behavior and its determinants among medical wastecleaners in west arsi zone, oromia regional state, ethiopia. J Prev Infect Cntrol 2019;5:1-7.
Rahman MM, Arif MT, Safii R, Tambi Z, Akoi C, Jantan Z, et al
. Care seeking behavior of Bangladeshi migrant workers in Sarawak, Malaysia. Bangladesh Med Res Counc Bull 2019;45:47-53.
Akinpelu AO, Oyewole OO, Odole AC, Ogunbamowo FD. Work-related musculoskeletal pain and health-seeking behavior among Nigerian sewing machine operators. Trop J Med Res 2016;19:152-8. [Full text]
Oreagba IA, Oshikoya KA, Amachree M. Herbal medicine use among residents in Lagos, Nigeria. BMC Compliment Altern Med 2011;11:117-24.
World Health Organization. WHO Traditional Medicine Strategy 2002-2005. Geneva: World Health Organization; 2002.
Ofili EJ, Onyemelukwe N, Agwaga P, Orji I. The bioload and aflatoxin content of herbal medicines from selected states in Nigeria. Afr J Tradit Complement Altern Med 2014;11:143-7.
Uchendu OC, Ilesanmi OS, Olumide AE. Factors influencing the choice of health care providing facility among workers in a local government secretariat in South Western Nigeria. Ann Ib Postgrad Med 2013;11:87-95.
Oshodi OY, Aina OF. “Paraga”(masked alcohol) use and the associated socio-cultural factors among the Yoruba of south west Nigeria: A case study of secondary school students in Lagos. Quart J ment Health 2007;1:1.
Akande TM, Owoyemi JO. Health care-seeking in ayigba, North –central Nigeria. Res J Med Sci 2009;3:47-51.
Oche M, Adamu H. Determinants of patient waiting time in the general outpatient department of a tertiary health institution in north Western Nigeria. Ann Med Health Sci Res 2013;3:588-92.
] [Full text]
Ogaji DS, Mezie-Okoye MM. Waiting time and Patient satisfaction: Survey of patients seeking care at the general outpatient clinic of the University of Port Harcourt Teaching Hospital. Port Harcourt Med J 2017;11:148-55. [Full text]
Michael M, Schaffer SD, Egan PL, Little BB, Pritchard PS. Improving wait times and patient satisfaction in primary care. J Healthc Qual 2013;35:50-9.
Kehinde OS, Olusegun FF. Taking alcohol by deception II: Paraga (alcoholic herbal mixture) use among commercial motor drivers in a South-Western Nigerian city. BMC Res Notes 2012;5:301.
Hill S, Dziedzic K, Thomas E, Baker SR, Croft P. The illness perceptions associated with health and behavioural outcomes in people with musculoskeletal hand problems: Findings from the North Staffordshire Osteoarthritis Project (NorStOP). Rheumatology (Oxford) 2007;46:944-51.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]