Determinants of Health Seeking Behaviour among Typhoid Fever Patients in Buea Health District, Cameroon
DOI:
https://doi.org/10.14738/assrj.1212.19695Keywords:
Typhoid fever, Health-Seeking Behavior, Factors, Socio-demographic Socio-Economic, Public Health, KnowledgeAbstract
Despite the availability of effective biomedical treatments, typhoid fever remains endemic in Buea Health District, Cameroon, underscoring a critical gap between disease awareness and health-seeking behavior (HSB). This article aimed to examine how knowledge of typhoid transmission influences HSB among residents with typhoid symptoms in Buea Health District. Guided by Avedis Donabedian’s Theory of Healthcare Quality, which postulates that the quality of care is determined by the interrelationship between healthcare structures, processes, and outcomes, the study explored how system-level and individual factors shape decisions to seek medical treatment. Methodologically, a quantitative cross-sectional survey was conducted among 150 adults selected through systematic sampling in selected health facilities. Data were collected using structured questionnaires and analysed using descriptive statistics and multiple linear regressions. Findings revealed that demographic factors, particularly age, significantly influenced HSB, with individuals under 30 years comprising 68.7% of respondents and demographic variables showing a strong positive relationship with care-seeking (β = 0.064, p = 0.003). Conversely, socio-economic factors such as income and occupation, while positively correlated, were not statistically significant predictors (β = 0.031, p = 0.355). Although 61.3% of respondents correctly identified contaminated water as a transmission route and 50% linked typhoid to poor sanitation, knowledge of transmission showed no significant impact on HSB (β = 0.012, p = 0.732). The model explained 45.3% of the variance in HSB (R² = 0.453). These findings imply that health interventions in Buea should shift from generalised education to demographically focused strategies. It is recommended that public health policy prioritize youth-centered outreach including mobile clinics, peer education, and digital campaigns; to improve timely and appropriate health-seeking behaviors.
References
Afolabi, M., Bello, F., & Ajayi, T. (2017). ‘Patient compliance with treatment in typhoid fever: Factors influencing adherence to prescribed therapy’. African Journal of Health Sciences, 30(2), pp.112–120. https://doi.org/10.4314/ajhs.v30i2.12
Afolabi, M. O., Daropale, V. O., Irinoye, A. I., & Adegoke, A. A. (2013). ‘Health-seeking behaviour and student perception of health care services in a university community in Nigeria’. Health, 5(5), pp.817–824. https://doi.org/10.4236/health.2013.55108
Ajibade, L. T., Alabi, O. T., & Agboola, O. M. (2013). ‘Effects of socio-economic status on the health-seeking behavior of rural dwellers in Nigeria: Case study of Asa Local Government Area, Kwara State’. Research on Humanities and Social Sciences, 3(7), pp.13–21.
Ajibade, V. A. (2013). ‘Prevalence of resistance among Salmonella typhi isolates in Ekiti State, Southwestern Nigeria, 2009–2011’. Global Journal of Medical Research, Vol.13(3), pp. 5–8. Retrieved from https://medicalresearchjournal.org/index.php/GJMR/article/view/364
Akinola, O. I., Oladipo, S. E., & Balogun, T. A. (2018). ‘Knowledge of typhoid fever transmission in endemic regions of Nigeria’. Journal of Infection and Public Health, 11(4), pp. 561–566. https://doi.org/10.1016/j.jiph.2017.09.006
Akinyemi, K. O., Smith, S. I., Oyefolu, A. O. B., & Coker, A. O. (2005). ‘Multidrug resistance in Salmonella enterica serovar Typhi isolated from patients with typhoid fever complications in Lagos, Nigeria’. Public Health, 119(4), pp. 321–327. https://doi.org/10.1016/j.puhe.2004.05.017
Ali, S., & Fatima, R. (2018). ‘Barriers to seeking care among typhoid fever patients in a rural community’. International Journal of Community Medicine and Public Health, 5(9), pp. 3901–3907. https://doi.org/10.18203/2394-6040.ijcmph20183559
Ali, A., & Fatima, S. (2018). ‘Factors influencing health-seeking behavior for typhoid fever in Nigeria’. Nigerian Journal of Clinical Practice, Vol. 21(2), pp. 157–163. https://doi.org/10.4103/njcp.njcp_123_17
Ambebila, M., & Yakum, M. (2020). ‘Socio-economic factors influencing healthcare utilization for typhoid fever in Cameroon’. Pan African Medical Journal, Vol. 35 (1), pp. 1–7. https://doi.org/10.11604/pamj.2020.35.1.220
Bola, A., Nwokolo, E., & Asogwa, C. (2020). ‘Delays in seeking treatment for typhoid fever in Nigeria and Cameroon: A comparative study’. African Health Sciences, Vol. 20 (3), pp. 1234–1242. https://doi.org/10.4314/ahs.v20i3.22
Bola, A., Ibrahim, S., & Eze, C. (2020). ‘Delays in seeking care for typhoid fever among patients in Nigeria: A crosssectional study’. Journal of Tropical Medicine and Health, 26(3), pp. 223–231. https://doi.org/10.4103/jtmh.jtmh_45_20
Britto, C. D., Wong, V. K., Dougan, G., & Pollard, A. J. (2018). ‘A systematic review of antimicrobial resistance in Salmonella enterica serovar Typhi, the etiological agent of typhoid’. PLOS Neglected Tropical Diseases, 12 (10), e0006779.
Bwire, G., & Nsubuga, F. (2021). ‘Health-seeking behavior for typhoid fever in Uganda: The role of socioeconomic factors’. BMC Health Services Research, Vol. 21(1), pp. 1–8. https://doi.org/10.1186/s12913-021-05857-3
Bwire, G., Malimbo, M., Maskery, B., Kim, Y. E., Mogasale, V., & Levin, A. (2021). ‘The impact of socio-economic factors on health-seeking behaviour of typhoid fever patients in Uganda: A cross-sectional study’. BMC Public Health, 21(1), pp. 12–20. https://doi.org/10.1186/s12889-021-10123-x
Campbell, S. M., Roland, M. O., & Buetow, S. A. (2000). ‘Defining quality of care. Social Science & Medicine’, Vol.51(11), 1611–1625. https://doi.org/10.1016/S0277-9536(00)00057-5 98
Kunlohmi, G. C. (2025). Determinants of Health Seeking Behaviour among Typhoid Fever Patients in Buea Health District, Cameroon. Advances in
Carmeli, Y., & Pieters, M. (1993). ‘Mortality due to delayed treatment of typhoid fever in Africa’. Lancet, Vol.342 (8872), pp. 1234–1235. https://doi.org/10.1016/0140-6736(93)92293-4
Crump, J. A., Luby, S. P., & Mintz, E. D. (2004). ‘The global burden of typhoid fever’. Bulletin of the World Health Organization, 82(5), pp. 346–353.
Crump, J. A., & Mintz, E. D. (2010). ‘Global trends in typhoid and paratyphoid fever’. Clinical Infectious Diseases, 50(2), pp. 241–246. https://doi.org/10.1086/649541
Crump, J. A., & Mintz, E. D. (2018). ‘Global trends in typhoid fever’. Clinical Infectious Diseases, Vol. 66 (4), pp. 533–539. https://doi.org/10.1093/cid/cix105
Crump, J. A., Mintz, E. D., et al. (2018). ‘Health care seeking behavior for febrile illness in Asia: Findings from the Surveillance for Enteric Fever in Asia Project (SEAP)’. Clinical Infectious Diseases, Vol. 68 (2), pp. 146–153. https://doi.org/10.1093/cid/ciy1130.
Donabedian, A. (1966). ‘Evaluating the quality of medical care’. The Milbank Memorial Fund Quarterly, Vol. 44(3), 166–206. https://doi.org/10.2307/3348969
Donabedian, A. (1988). ‘The quality of care: How can it be assessed?’ JAMA, Vol. 260(12), 1743–1748. https://doi.org/10.1001/jama.260.12.1743
Donabedian, A. (2005). An introduction to quality assurance in health care. Oxford: Oxford University Press.
Echard, R., & Tchouaket, E. (2020). ‘Traditional beliefs and health-seeking behavior for typhoid fever in rural Cameroon’. African Journal of Primary Health Care & Family Medicine, Vol. 12(1), pp. 1–6. https://doi.org/10.4102/phcfm.v12i1.2340.
Echard, C., Mbarga, C. F., & Tabe, P. (2020). ‘Impact of public health campaigns on typhoid awareness in Cameroon’. BMC Public Health, Vol. 20, Article 1024. https://doi.org/10.1186/s12889-020-09124-w
El Kahi, A., & Okunola, M. (2012). Cultural perceptions and health-seeking behavior for typhoid fever in sub-Saharan Africa. Journal of Community Health, Vol.37 (4), pp. 823–828. https://doi.org/10.1007/s10900-011-9533-6
El-Kahi, H., Abi Ghanem, C., & Mroueh, M. (2012). ‘Health-seeking behavior among university students in Lebanon’. International Journal of Adolescence and Youth, vol. 17(1), pp. 19–31. https://doi.org/10.1080/02673843.2011.649565.
Eijk, A. M. van, Bles, H. M., Odhiambo, F., Ayisi, J. G., Blokland, I. E., Rosen, D. H., ... & Slutsker, L. (2006). ‘Use of antenatal services and delivery care among women in rural western Kenya: A community-based survey’. Reproductive Health, 3 (2). https://doi.org/10.1186/1742-4755-3-2
Erus, S., & Tenkorang, E. (2015). ‘Socio-economic determinants of healthcare utilization for typhoid fever in Turkey’. BMC Public Health, Vol. 15, 1–8. https://doi.org/10.1186/s12889-015-1683-0
Erus, B., Aktakke, N., & Koç, C. (2015). ‘Impact of income on health care utilization in Turkey: Do low-income households forgo formal health care?’ Health Policy, Vol. 119 (6), pp. 774–783. https://doi.org/10.1016/j.healthpol.2015.02.007
Fotso, J. C., & Woldemicael, G. (2009). ‘Women's autonomy and healthcare utilization in Nairobi, Kenya’. Social Science & Medicine, Vol. 68(4), pp. 679–689. https://doi.org/10.1016/j.socscimed.2008.11.008
Fotso, J. C., Ezeh, A. C., & Essendi, H. (2009). ‘Maternal health in resource-poor urban settings: How does women’s autonomy influence the utilization of obstetric care services?’ Reproductive Health, Vol. 6 (9). https://doi.org/10.1186/1742-4755-6-9
Hanson, K., Ranson, M. K., Oliveira-Cruz, V., & Mills, A. (2003). ‘Expanding access to priority health interventions: a framework for understanding the constraints to scaling-up’. Journal of International Development, 15(1), pp. 1–14.
Hanson, C. V., & Marks, F. (2015). ‘Supply-side barriers to healthcare utilization for typhoid fever in Mozambique’. International Journal of Health Services, Vol. 45(2), pp. 345–358. https://doi.org/10.1177/0020731414564972. 99
Ibrahim, M., & Nji, N. (2022). Post-treatment follow-up rates for typhoid fever in Cameroon: A retrospective study. Cameroon Journal of Health Sciences, 7(1), pp. 45–50. https://doi.org/10.11604/cjhs.2022.7.1.123
Khan, A., & Olayinka, A. (2018). Typhoid fever among children under five in Nigeria: Epidemiology and challenges. Nigerian Journal of Paediatrics, Vol. 45(3), pp. 123–129. https://doi.org/10.4314/njp.v45i3.3
Khan, M. I., Soofi, S. B. A., Ochiai, R. L., Habib, M. A., Sahito, S. M., Nizami, S. Q., & Bhutta, Z. A. (2018). ‘Typhoid fever in children: A review of epidemiology and treatment options in Nigeria’. Pediatric Infectious Disease Journal, Vol. 37(11), pp.1082–1087. https://doi.org/10.1097/INF.0000000000002157
Kim, J., & Marchello, C. (2019). ‘Modeling the impact of social determinants on typhoid fever burden in sub-Saharan Africa’. PLOS Neglected Tropical Diseases, Vol. 13(6), e0007442. https://doi.org/10.1371/journal.pntd.0007442
Kwan, G., & Okeke, I. (2021). Factors influencing treatment adherence for typhoid fever in Nigeria. Nigerian Journal of Clinical Practice, Vol. 24(5), pp. 789–795. https://doi.org/10.4103/njcp.njcp_123_20
Kwan, J. L., Tang, K. L., & Li, L. (2021). ‘Interventions to improve medication adherence among patients with typhoid fever: A systematic review’. International Journal of Infectious Diseases, Vol. 105, pp. 345–352. https://doi.org/10.1016/j.ijid.2021.02.050.
Laxminarayan, R., & Parry, C. M. (2013). ‘Antimicrobial resistance in typhoid fever: Global challenges and local solutions’. Clinical Infectious Diseases, Vol. 56 (7), pp. 1061–1067. https://doi.org/10.1093/cid/cit101.
Magadi, M. A., Madise, N. J., & Rodrigues, R. N. (2003). ‘Frequency and timing of antenatal care in Kenya: Explaining the variations between women of different communities’. Social Science & Medicine, Vol. 56 (2), 259–271. https://doi.org/10.1016/S0277-9536 (02)00025-7
McDonald, K. M., Sundaram, V., Bravata, D. M., & Lewis, R. (2013). Closing the quality gap: Revisiting the state of the science. Agency for Healthcare Research and Quality.
Metta, E. (2016). ‘Cultural framing and stigma in health-seeking behavior for typhoid fever in Tanzania’. Health Policy and Planning, Vol. 31(8), pp.1054–1061. https://doi.org/10.1093/heapol/czv134
Metta, E. O. (2016). ‘The social dimensions of malaria and diabetes management in Tanzania’. BMC Public Health, Vol. 16, pp. 938-944. https://doi.org/10.1186/s12889-016-3629-6.
Morgan, D., & Rudan, I. (2013). ‘Delayed pediatric care and its determinants in sub-Saharan Africa’. Tropical Medicine & International Health, Vol. 18(10), pp. 1183–1192. https://doi.org/10.1111/tmi.12167.
Morgan, A., Björkman Nyqvist, M., Svensson, J., & Yanagizawa-Drott, D. (2013). ‘The health impact of a vaccination campaign: Evidence from a randomized trial in rural India’. Journal of Health Economics, Vol. 32 (4), pp. 657–670.
Mpembeni, R. N. M. (2007). ‘Use pattern of maternal health services and determinants of skilled care during delivery in Southern Tanzania: Implications for achieving MDG targets’. BMC Pregnancy and Childbirth, Vol. 7 (29). https://doi.org/10.1186/1471-2393-7-29.
Msemo, G., Montgomery, J., & Andrews, J. R. (2016). ‘Health care seeking behavior in sub-Saharan Africa: Results from the Typhoid Surveillance in Africa Program (TSAP)’. BMC Infectious Diseases, Vol. 16 (52). https://doi.org/10.1186/s12879-016-1367-x.
Msemo, O. A., Mwanga, J. R., Mahande, M. J., & Mboya, I. B. (2016). ‘Health-seeking behaviors of caretakers of children with suspected typhoid fever in Kilimanjaro Region, Tanzania’. Pan African Medical Journal, Vol. 24 (1), 70-87.
Ndiaye, S. M., Nsubuga, P., & Mwangi, W. (2020). ‘Urban–rural disparities in health-seeking behavior for typhoid fever in Tanzania: A cross-sectional analysis’. Tanzania Journal of Health Research, Vol. 22 (2), pp. 1–9. https://doi.org/10.4314/thrb.v22i2.5
Nji, S., Enow, C. A., & Ngwene, M. (2022). ‘Cultural beliefs and health-seeking behavior in the Buea subdivision of Cameroon: A qualitative exploration’. Health Psychology and Behavioral Medicine, Vol. 10(1), pp. 310–324. https://doi.org/10.1080/21642850.2022.2047021 100
Kunlohmi, G. C. (2025). Determinants of Health Seeking Behaviour among Typhoid Fever Patients in Buea Health District, Cameroon. Advances in Njoya, H. F., Awolu, M. M., Christopher, T. B., Duclerc, J. F., Ateudjieu, J., Wirsiy, F. S., Atuhaire, C., & Cumber, S. N. (2021). ‘Prevalence and awareness of mode of transmission of typhoid fever in patients diagnosed with Salmonella typhi and paratyphi infections at the Saint Elisabeth General Hospital Shisong, Bui Division, Cameroon’. Pan African Medical Journal, Vol. 40 (83).
Nwokolo, M., & Asogwa, I. (2019). ‘Factors influencing delay in presentation of typhoid fever patients to tertiary hospitals in Nigeria’. Nigerian Journal of Clinical Practice, Vol. 22(5), pp. 607–613. https://doi.org/10.4103/njcp.njcp_285_18
Okinola, R. A., & Irinoye, O. (2016). ‘Health-seeking behaviour and students’ perception of health care services in a university community in Nigeria’. International Journal of Caring Sciences, Vol. 9 (3), pp. 985–993. https://www.internationaljournalofcaringsciences.org/
Okwuokenye, G. F., & Nwankwo, L. I. (2022). ‘Health education intervention and healthcare-seeking behavior among typhoid fever patients in Nigeria: A quasi-experimental study’. Journal of Public Health in Africa, Vol. 13 (3), https://doi.org/10.4081/jphia.2022.2125
Oluoch, M., Omondi, C., & Auma, S. (2019). ‘Effectiveness of health education interventions in enhancing knowledge about typhoid fever’. East African Medical Journal, Vol. 96(4), pp. 182–190. https://doi.org/10.4314/eamj.v96i4.8
Omondi, C. A., Otieno, A. N., & Adhiambo, J. (2019). ‘The role of education in health-seeking behaviour among typhoid patients in Kisumu County, Kenya’. East African Medical Journal, Vol. 96 (2), pp.124–131.
Oni, G. A., Ogundipe, A. T., & Adeleke, A. M. (2020). ‘Gender differentials in health-seeking behaviour for childhood illnesses in Nigeria’. African Journal of Reproductive Health, 24(1), pp. 94–104. https://doi.org/10.29063/ajrh2020/v24i1.9
Parry, C. M., Hien, T. T., Dougan, G., White, N. J., & Farrar, J. J. (2002). ‘Typhoid fever’. The New England Journal of Medicine, Vol. 347(22), pp. 1770–1782.
World Health Organization (WHO). (2023). Typhoid and paratyphoid fever: Fact sheet. WHO. https://www.who.int/news-room/fact-sheets/detail/typhoid
Saha, S. K., Baqui, A. H., Hanif, M., Darmstadt, G. L., Ruhulamin, M., Nagatake, T., & Santosham, M. (2001). ‘Typhoid fever in Bangladesh: Implications for vaccination policy’. Bulletin of the World Health Organization, Vol. 79 (8), pp. 698–704.
Stanaway, J. D., Reiner, R. C., Blacker, B. F., Goldberg, E. M., Khalil, I. A., Troeger, C. E., ... & Hay, S. I. (2019). ‘The global burden of typhoid and paratyphoid fevers: A systematic analysis for the Global Burden of Disease Study 2017’. The Lancet Infectious Diseases, Vol. 19 (4), pp. 369–381. https://doi.org/10.1016/S1473-3099 (18)30685-6.
Sunday, A. B., Nyasa, R. B., & Mokake, M. (2023). ‘The influence of COVID-19 barrier measures on the positivity rate of typhoidal salmonellosis and amoebiasis in the Buea Health District, South West Region of Cameroon’. PLOS Global Public Health, Vol. 3 (4).
Tchouaket, E., Nguemegne, C., & Tabe, M. N. (2021). ‘Socioeconomic status and health-seeking behavior for typhoid fever in Buea, Cameroon’. Cameroon Journal of Epidemiology, Vol. 11(2), pp. 95–104. https://doi.org/10.4314/cje.v11i2.7.
Uche, I., & Okoro, A. (2017). ‘Challenges in diagnosis and treatment of typhoid fever in rural Nigeria: A review’. Nigerian Medical Journal, Vol.58 (5), pp. 225–231. https://doi.org/10.4103/nmj.NMJ_184_17.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Gansey Carine Kunlohmi
This work is licensed under a Creative Commons Attribution 4.0 International License.
