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Try out PMC Labs and tell us what you think. Learn More. We carried out separate focus group discussions FGDs with 3 groups 6 women with children under 5 years old, 6 men, and 4 elderly women, respectively in a village in Assiut Governorate, an underprivileged region in Upper Egypt. Our showed that maternal health issues were often discussed by husbands and wives, while mothers-in-law had little apparent influence.
We also found that women could access support resources more easily than expected through their extended families. The study indicated that women received considerable support from co-resident family members, their natal family, and their neighbors, which helped women in seeking health services. In Egypt, basic health service coverage has been extended throughout the country. Upper Egypt, located in the south, or upstream along the Nile River, is known to be a conservative and underprivileged region, as shown by economic, social, and health indicators.
For example, under-five mortality rate in rural Upper Egypt To explore this finding further, we conducted focus group discussions FGDs to qualitatively assess the influence of family support, especially that of husbands and mothers-in-law, on maternal health, including care during pregnancy and delivery, and health-seeking behavior related to common illnesses of women and children.
This qualitative study was conducted in a rural village adjacent to the city of Assiut, the capital of the Assiut Governorate in Upper Egypt, which is located approximately km south of Cairo. The population of the village is about 20, We conducted the FGDs in November Three focus groups, consisting of women and those whom we believed to have influence on the women, were organized: 1 women who had given birth within the last 5 years, 2 men with children, and 3 elderly women with grandchildren.
A total of 16 people 6 women with children under 5 years old, 6 men, and 4 elderly women were purposively recruited by the health workers stationed at the health unit in the village. We conducted 3 FGDs at the health unit, one for each group. Six Egyptian health professionals and nursing college students took interview notes; each of them recorded the opinions and experiences of a single FGD participant.
We employed a printed topic guide to facilitate the discussions. The common illnesses mentioned during the discussions included diarrhea, fever, cough, and any other illnesses common in the area. Transcriptions of the interview notes, which were written in Arabic, were translated into English by the Egyptian investigators.
The English text was then qualitatively analyzed in depth using the framework approach, 131415 which consists of the following 5 steps: 1 familiarization, 2 identifying a thematic framework, 3 indexing, 4 charting, and 5 mapping and interpretation. Following these steps, A. Written informed consent was obtained from all participants before the discussions. The characteristics of the participants are shown in Table 1.
All participants were born in the village except for one man, who came from a neighboring village. Most participants had an extended family with an average of 7 people; the exception was a solitary elderly woman.
All the participants were Muslim. The female participants had 1 to 6 children between 1 and 17 years old.
All of the women were engaged in household work and were not employed in any work with a cash income, while their husbands were employed in paid jobs, such as governmental work and manual labor. The male participants had 2 to 6 children between 1 and 35 years old, and were employed in paid jobs, such as merchants, governmental employees, and manual workers.
The elderly female participants had 1 to 7 grandchildren between 1 and 15 years old. Each participant was recruited from a different family, although we had no information on their distant family relations. Data from the FGDs were summarized and abstracted by group, as shown in Table 2.
The following sections give the details of the findings. All the women utilized ANC during pregnancy with varying frequency at their own discretion. All women participants delivered their children at hospitals. When the women or their children felt ill, they often tried medicine from pharmacist or some other type of self-medication. If they saw no change for the better, they would visit a medical facility, such as a health unit, clinic, or hospital.
In case of cough, I try to drink hot drinks together with any natural anti-tussive. Woman in her 20s. Typical communication patterns related to maternal health care and care for common illnesses of women and children are illustrated in Figure 1. Mothers-in-law played little part in the health care decision-making process. For example, decisions regarding ANC visits and delivery were mostly a matter of consultation between the husband and wife and the mothers-in-law had little weight in this area. Man in his 50s. Regarding illnesses commonly experienced by these women, the final decisions were made between the husbands and wives, while the mothers-in-law mainly offered suggestions to their sons with regard to medical payments and to some degree advised their daughters-in-law on medical care.
With regard to common childhood illnesses, consultation between husbands and wives, as well as between mothers-in-law and sons, were reported. However, the mothers-in-law had relatively minor roles, and the husbands appeared to facilitate communication between their mothers and wives. Other family members did not seem to be involved in these discussions, although one participant mentioned that her father-in-law had some influence.
Her husband [my son] is responsible for the decisions, after asking my advice. Elderly woman in her 60s. At the same time, there was no common seat of decision-making authority that we could observe, making it difficult to extract any definable patterns. Family support differed between the situations of maternal health care and common illnesses in women or children.
During pregnancy and delivery as well as postpartum, the women of childbearing age were mainly supported by their blood relatives. One man explained the breakdown between family members in terms of support offered during the postpartum period:. There is a big birth ceremony seven days after delivery here. Man in his 60s. Because my wife has a very important role in our family, when she is ill, I suggest that she should go to a hospital.
Man in his 30s. The present study showed that family members were willing to support women during pregnancy or illness, thus enabling women to visit health facilities. These findings are consistent with the findings of a concurrent questionnaire survey, which showed that personal or cultural barriers, such as time allocation and family permission, did not ificantly prevent women from using health services. Thus, the present study added several important findings. First, mothers-in-law were not as influential as we had expected.
Decisions on issues related to pregnancy or delivery were often made through communication between wives and husbands, while mothers-in-law exerted only indirect influence through their sons. Most women had female relatives who assisted in the domestic duties during pregnancy and the postpartum period.
However, both our study and this study revealed that women with access to extended families get more support than women in nuclear families. The of our study agree with these studies in India. The situation was different from that in Pakistan, where men hold most of the authority in families and sometimes discouraged women from seeking health care.
Due to the constraints of traditional culture in the region where this study took place, our research activities had several limitations. Although we had planned to compare users and non-users of health units, we were only allowed to recruit participants through medical staff at the local health unit.
Therefore, we obtained information regarding health-seeking behaviors only from frequent users of the local health unit, who were likely to have positive perceptions. In addition, local authorities did not allow us to use audio recording equipment during the FGDs. Finally, while the village we chose was categorized as a "rural area," it may not be an entirely typical rural area due to recent rapid socioeconomic changes in rural Egypt, as shown by the fact that most male participants were salaried workers, not farmers. The authors wish to thank faculty members of Assiut University Faculty of Nursing for assistance in data collection, and Dr.
Leo Kawaguchi for valuable advice and support during the process of the research. National Center for Biotechnology InformationU. Nagoya J Med Sci. Author information Article notes Copyright and information Disclaimer. Received Jul 23; Accepted Oct 4. Copyright notice. This article has been cited by other articles in PMC. Data analysis Transcriptions of the interview notes, which were written in Arabic, were translated into English by the Egyptian investigators. Table 1. Participant Characteristics.
Open in a separate window. Table 2. Content of Focus Group Discussions. Health-seeking behavior All the women utilized ANC during pregnancy with varying frequency at their own discretion. Communication patterns surrounding health-seeking behavior Typical communication patterns related to maternal health care and care for common illnesses of women and children are illustrated in Figure 1.
Figure 1. One man explained the breakdown between family members in terms of support offered during the postpartum period: There is a big birth ceremony seven days after delivery here. Improvement in the status of women and increased use of maternal health service in rural Egypt. Nagoya J Med Sci; — Health Care Women Int; — East Mediterr Health J; — Impact of service provider incentive payment scheme on quality of reproductive and child-health services in Egypt.
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Predictors of Contraceptive Adherence among Women Seeking Family Planning Services at Reproductive Health Uganda, Mityana Branch