A cross sectional study to find out the health seeking behaviour of brick kiln workers

INTRODUCTION

India’s brick kiln industry contributes about 3 bn pounds to the country’s economy every year with an estimated demand of 120 bn bricks per year.¹ There are about 50,000 brick kilns all over India employing on an average 100 workers per unit.² Brick kiln workers are mainly the rural migrant labour which is amongst the most neglected sections of the society. Uninsured and low paid labourers mainly tend to utilize private clinics and most often pay out of pocket.³ The simplest definition of health seeking behavior is “sequence of remedial actions that individuals undertake to rectify perceived ill-health”.⁴ As there was no available literature to highlight the health seeking behaviour of the brick kiln workers, we decided to document the same through our study so that understanding this lacunae can help in planning health services suitable for them.

METHODS

The study was carried out for a period of 10 months from December 2016 to October 2017 in the rural field practice area of the medical college near Ganeshpuri. A cross sectional study design was adopted and the study area was mapped with the help of health workers. The workers present at the time of study, who were involved in the brick making process for at least 6 months were chosen. Those who did not give their consent to participate were excluded from the study.

The study subjects were approached at the site of their settlements during their non-working hours. The 420 workers falling into the eligibility criteria, were selected from the 65 brick kiln factories in the study area. Simple random technique was used to select the brick kiln factories. After having taken informed consent the study subjects were interviewed using a semi-structured questionnaire.

The responses given by the participants were entered in Microsoft Excel 2010 and analysed using SPSS version 20.

RESULTS

Mean age of the workers was found to be 35.34 years. Majority of the participants (51.7%) belonged to age group of 26-40 years. 55.7% were females and 44.3% were males. Only 16.9% were literate (could read and write) while 83.1% were illiterate. Majority of the workers belonged to class 3 as per BG Prasad classification.

Table 1 shows the sociodemographic profile of the workers. 59.5% were aware about the nearest available health facility. 49.5% would visit a government set up to seek care at the time of illness. In the event of past illness, 90.7% sought some kind of medical help while 9.3% did nothing. 63.4% immediately sought medical help upon falling ill. Table 2 shows the health seeking behaviour of the workers. Health seeking behaviour was further classified as good health seeking behaviour and bad health seeking behaviour.

Good health seeking behavior was constructed based on the response to –

Knowledge: About the nearest health seeking facility at both native place as well as place of migration.

Attitude: Seek care at the medical facility or seek care from quacks or do not seek medical care at all.

Practice: Sought care during their last episode of illness.

Only if the response to all of these factors was positive it was classified as good health seeking behavior. 48.9% of the participants showed a good health seeking behavior while 51.1% of the participants showed poor health seeking behavior as shown in Table 3. Age, sex and the type of work done at the brick kilns was found to be associated with good health seeking behavior. Association of the health seeking behavior with the socio demographic factors is presented in Table 4.

DISCUSSION

90.7% reported that they seek health care in an event of illness if they or any of the family members fall ill. It is appreciable that they didn’t follow the common trend of coming back to seek treatment even for minor ailments which results in loss of job and earnings. 46.2% visited private set up at the time of illness as the quality of health care and the accessibility for the respondents was better. A study done in South India indicates >70% of chest symptomatics make one or more efforts to seek care and that private practitioners are consulted more often than the government health care providers.⁵

Inspite of the government providing nearly free services, poor household spend a significant part of their income on transport and informal charges though drug expenditure occupies almost 70% of the total out of pocket expenditure.⁶ High level of private out of pocket expenditure can pose problems for these daily wage brick workers who are unable to pay, facing them into debt and leading them into a poverty trap.

1.9% of the respondents visited a quack in the event of an illness. This is in contrast to a study done in Pakistan which confirms up to 88% of the respondents visiting quacks.⁷ Another study reports 97% of the respondents visiting quacks with affordability and accessibility being the major reasons for the response of this overwhelming majority.⁸

63.4% sought help immediately when they were symptomatic, while remaining 31.5% showed a tendency to ‘accept’ the condition, bear the problem and not seek health care but to manage their problem until it becomes unbearable and distressing to their daily lives. They were the ones who sought medical help when they were unable to do work or when they got a holiday, or when they would receive their payment. Some would decide based on the perceived severity of their illness. If the individuals perceived their illness to be either mild or not for medical treatment, they would not seek healthcare treatment for the same. In a study done in South India, the major reason provided for not seeking health care was that the individuals did not consider their symptoms to be severe enough to seek care followed by inability to seek health care due to the pressure of work.⁹

A person's approach to health-seeking behaviour can be described as a “pattern of resort.” According to the Encyclopedia of Medical Anthropology, people usually opt for the simplest form of treatment, which usually is the cheapest, most effective treatment they deem to be. Only when the simplest form of treatment is proved unsuccessful do people seek higher level, more costly and unconventional treatments.¹⁰ This explains the behavior of 5% of the people who first tried home based treatment or did not take any medicines.

The World Health Organization defines the social determinants of health as the “conditions in which people are born, grow, live, work and age.” In 2011, the World Health Organization argues “the distribution of money, power and resources at global, national and local levels” creates these conditions.¹¹ Socio-economic status (SES), gender, race, and educations are factors of health-seeking behaviour that are influenced by the social determinants of health. In our study, it was seen that those in the older age groups showed better health seeking behaviour. The interpretation of our results may be due to the cumulative effects of long duration of the diseased conditions. It is possible that presence of chronic illness has an influence on seeking medical help, where by the participants who have chronic disease seek medical help more than others which could be the case with the older age groups.

In our study we found that women showed better health seeking behavior as compared to males. This was similar to a study in which it was found that men delayed seeking care when compared with women.⁹ It could be due to the fact that the men might shrug of symptoms as normal everyday muscle aches or normal regular occurrence. Women on the other hand might feel compelled to seek medical care in order to be able to work and assist their families in the various activities related to brick making.

It was noted that some of the individuals equated seeking treatment to announcing to public and especially their employers that they have an illness. This instilled a sense of insecurity in the workers which compelled them to delay their health seeking behavior till the time it was physiologically plausible.

The study is first of its kind in this population. It successfully helps to identify the patterns of health care seeking and provides a valuable insight into the migrant’s health. The study however lacked a qualitative aspect which could have provided an effective foundation for probing the relevant findings in a greater depth. Nevertheless, this study can be treated as a novel innovative beginning towards further research which will further strengthen the health needs of brick kiln workers.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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