title: Determinants of health care seeking behaviour during pregnancy in Ogun State, Nigeria.
abstract: BACKGROUND
  In Nigeria, women too often suffer the consequences of serious obstetric complications that may lead to death. Delay in seeking care (phase I delay) is a recognized contributor to adverse pregnancy outcomes. This qualitative study aimed to describe the health care seeking practices in pregnancy, as well as the socio-cultural factors that influence these actions.
  
  
  METHODS
  The study was conducted in Ogun State, in south-western Nigeria. Data were collected through focus group discussions with pregnant women, recently pregnant mothers, male decision-makers, opinion leaders, traditional birth attendants, health workers, and health administrators. A thematic analysis approach was used with QSR NVivo version 10.
  
  
  RESULTS
  Findings show that women utilized multiple care givers during pregnancy, with a preference for traditional providers. There was a strong sense of trust in traditional medicine, particularly that provided by traditional birth attendants who are long-term residents in the community. The patriarchal c influenced health-seeking behaviour in pregnancy. Economic factors contributed to the delay in access to appropriate services. There was a consistent concern regarding the cost barrier in accessing health services. The challenges of accessing services were well recognised and these were greater when referral was to a higher level of care which in most cases attracted unaffordable costs.
  
  
  CONCLUSIONS
  While the high cost of care is a deterrent to health seeking behaviour, the cost of death of a woman or a child to the family and community is immeasurable. The use of innovative mechanisms for health care financing may be beneficial for women in these communities to reduce the barrier of high cost services. To reduce maternal deaths all stakeholders must be engaged in the process including policy makers, opinion leaders, health care consumers and providers. Underlying socio-cultural factors, such as structure of patriarchy, must also be addressed to sustainably improve maternal health.
  
  
  BACKGROUND
  NCT01911494.
authors.affiliation: Department of Sociology, University of Lagos, Lagos, Nigeria. davidakeju@gmail.com.
authors.forename: David O
authors.initials: DO
authors.lastname: Akeju
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Olufemi T
authors.initials: OT
authors.lastname: Oladapo
authors.affiliation: Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Marianne
authors.initials: M
authors.lastname: Vidler
authors.affiliation: Centre for Research in Reproductive Health, Sagamu, Ogun State, Nigeria.
authors.forename: Adepoju A
authors.initials: AA
authors.lastname: Akinmade
authors.affiliation: Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Diane
authors.initials: D
authors.lastname: Sawchuck
authors.affiliation: Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan.
authors.forename: Rahat
authors.initials: R
authors.lastname: Qureshi
authors.affiliation: Directorate Division of Medical and Health Care Services, Ijebu Ode Local Government Secretariat, Ijebu Ode, Ogun State, Nigeria.
authors.forename: Muftaut
authors.initials: M
authors.lastname: Solarin
authors.affiliation: Centre for Research in Reproductive Health, Sagamu, Ogun State, Nigeria.|Department of Obstetrics and Gynaecology, Olabisi Onabanjo University, Sagamu, Ogun State, Nigeria.
authors.forename: Olalekan O
authors.initials: OO
authors.lastname: Adetoro
authors.affiliation: Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: von Dadelszen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011247:Pregnancy; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Health care; Pregnancy complications