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. 2025 Jan 6;25(1):46.
doi: 10.1186/s12889-024-19798-8.

Determinants of health seeking behaviour in South Sudan: a cross-sectional household survey

Ilja Obels  1 , Harry Laurence Selby Coleman  2 , Masja Straetemans  2 , Margo van Gurp  2 , George William Lutwama  2 , Eelco Jacobs  3
Affiliations

Determinants of health seeking behaviour in South Sudan: a cross-sectional household survey

Ilja Obels et al. BMC Public Health. .

Abstract

Background: Access to healthcare is a major challenge in South Sudan, but evidence on the factors influencing health seeking behaviour (HSB) and the magnitude of their effect is limited. This study aims to identify which determinants are associated with seeking care for perceived health needs and with seeking care at private or public healthcare facilities in South Sudan.

Methods: A cross-sectional household survey was conducted in three purposefully-selected states (Central Equatoria, Western Equatoria and Warrap). A multi-stage, cluster sampling design was used. Univariable and multivariable logistic regression models were computed to explore the relationships between seeking care for perceived health needs and choice of facility, and individual and household characteristics based on an adapted Levesque framework.

Results: We identified that individuals who obtained medication (OR 2.45, 95% CI 1.15-5.23), obtained and paid for medication (OR 4.26, 95% CI 2.08-8.74), lived in Western-Equatoria (OR 9.05, 95% CI 2.35-34.54), and were aware of community health workers (CHWs) (OR 1.70, 95% CI 1.08-2.67), were significantly more likely to seek care for a perceived health need. Individuals who obtained and paid for medication (OR 3.03, 95% CI 1.59-5.81) and who lived further from a public health centre (OR 1.19, 95% CI 1.09-1.31) were more likely to seek care at a private facility, while individuals who had used the provider before (OR 0.52, 95% CI 0.34-0.78), lived in Western Equatoria (OR 0.24, 95% CI 0.13-0.46), lived in a rural household (OR 0.40, 95% CI 0.23-0.70) and had a longer travel time to the visited health facility, were less likely to seek care at a private facility.

Conclusions: Survey respondents' state of residence and awareness of CHWs were associated with health seeking, while their state of residence, age, whether they paid for medication or not, travel time and distance to facilities were associated with choice of facility. Our results suggest differences in patterns of HSB between states, but studies with larger sample sizes are needed to analyse this. Furthermore, qualitative studies into access to healthcare in South Sudan could help characterise the nature of determinants and their relationship.

Keywords: Determinants; Fragile states; Health seeking behaviour; Health systems; Health systems strengthening; Healthcare access; Healthcare utilisation; Household survey; South Sudan.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The research protocol received ethical approval by both the Royal Tropical Institute’s Research Ethics Committee (S-114, May 13, 2020) as well as South Sudan’s Ministry of Health (MoH/ERB5/2020). All research procedures were in accordance with the Declaration of Helsinki. Informed consent was obtained from all research participants and respondents, which included informing them of their rights to withdraw from the study at any time without any consequences. Confidentiality and privacy were assured as a safeguard against any harm to the participants and respondent. Consent for publication: Not applicable. Competing interests: At the time of the study KIT Royal Tropical Institute was the operational research partner for the Health Pooled Fund (third phase) programme, which is responsible for delivery of the majority of health services in the study sites. The affiliated authors feel that this does not constitute a substantive conflict. The authors declare that they have no conflicting or competing interests.

Figures

Fig. 1
Fig. 1
Sampled households (blue dots) in Western Equatoria, Central Equatoria and Warrap in South Sudan
Fig. 2
Fig. 2
Stages of sampling. 1. Eligible payams are safely accessible and supported by HPF3. 2. Per population size sampling of settlements can lead to exclusion of payams if no clusters are sampled in those payams
Fig. 3
Fig. 3
Flowchart of respondents included in the analysis
See this image and copyright information in PMC

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