Effect of community-based social–behavioural intervention on determinants of maternal care-seeking for under-five children in Cross River State, Nigeria
DOI:
https://doi.org/10.63950/gshh.2026.2.1.35Keywords:
Maternal care-seeking, Under-five children, Community-based intervention, Predisposing, enabling, and reinforcing factorsAbstract
Introduction: Under-five morbidity and mortality remain high in sub-Saharan Africa, partly due to poor maternal care-seeking. Despite improved healthcare access, behavioural and social barriers still delay timely care for childhood illnesses. This study assessed the effect of a community-based behavioural intervention on determinants of maternal care-seeking in Cross River State, Nigeria.
Methods: A quasi-experimental design guided by the PRECEDE–PROCEED model was used. Sixty mothers were selected through a multi-stage sampling process and assigned to either an intervention or control group. The four-week intervention consisted of knowledge and skills training, as well as behaviour change communication, delivered via community information booths. Data were collected at baseline and week ten using a validated interviewer-administered questionnaire assessing predisposing, enabling, and reinforcing factors. Between-group differences were analysed using independent t-tests and Multivariate Analysis of Covariance (MANCOVA) (p < 0.05), and Cohen’s d estimated effect sizes.
Results: Although the sample size was small (N=60), statistically significant improvements were observed. The MANCOVA indicated a strong multivariate effect (Pillai’s Trace = .876, p < .001), indicating that 87.6% of the variance in outcomes was attributable to group assignment. Univariate analyses showed significant improvements in knowledge (F = 68.21, p < 0.001, η² = 0.58), attitude (F = 15.33, p < 0.001, η² = 0.24), perception (F = 168.27, p < 0.001, η² = 0.77), and reinforcing factors (F = 168.22, p < 0.001, η² = 0.77). Enabling factors did not differ significantly between groups.
Conclusion: The intervention improved determinants of maternal healthcare-seeking for children under five.
Downloads
References
1. World Health Organization. Child mortality and causes of death. Geneva: World Health Organization; 2024. Available from: https://www.who.int/data/gho/data/themes/topics/topic-details/GHO/child-mortality-and-causes-of-death
2. Perin J, Mulick A, Yeung D, Villavicencio F, Lopez G, Strong KL, et al. Global, regional, and national causes of under-5 mortality in 2000–19: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet Child Adolesc Health. 2022;6(2):106–15. https://doi.org/10.1016/S2352-4642(21)00311-4
3. Child Health Task Force. Improving child survival through health systems strengthening. Washington (DC): USAID; 2023. Available from: https://www.childhealthtaskforce.org/sites/default/files/2023-03/Child%20Survival%20Action_Feb2023_clean.pdf
4. Oberoi S, Chaudhary N, Patnaik S. Understanding health seeking behavior. J Family Med Prim Care. 2016;5(2):463–4. https://doi.org/10.4103/2249-4863.192376
5. Acheampong PR, Mohammed A, Twumasi-Ankrah S, Sylverken AA, Owusu M, Acquah-Gyan E, et al. “This disease is not meant for the hospital, it is Asram”: implications of a traditionally defined illness on healthcare seeking for children under 5 in rural Ashanti, Ghana. PLoS Glob Public Health. 2022;2(9):e0000978. https://doi.org/10.1371/journal.pgph.0000978
6. Mekonnen EG, Workneh BS, Tamir TT, Zegeye AF. Prompt treatment of fever and its associated factors among under-five children in sub-Saharan Africa: a multilevel analysis. PLoS One. 2024;19(5):e0303680. https://doi.org/10.1371/journal.pone.0303680
7. Alkhawaldeh A, AlBashtawy M, Rayan A, Abdalrahim A, Musa A, Eshah N, et al. Application of Andersen’s behavioral model as a theoretical framework: a systematic review from 2012–2021. Iran J Public Health. 2023;52(7). https://doi.org/10.18502/ijph.v52i7.13236
8. Green LW, Gielen AC, Ottoson JM, Peterson DV, Kreuter MW. Health program planning, implementation, and evaluation: creating behavioral, environmental, and policy change. Baltimore (MD): Johns Hopkins University Press; 2022.
9. Rakhshani T, Limouchi Z, Daneshmandi H, Kamyab A, Jeihooni AK. Effect of PRECEDE–PROCEED–based education on preventive behaviors for musculoskeletal disorders among nurses. Front Public Health. 2024;12:1371684. https://doi.org/10.3389/fpubh.2024.1371684
10. Tesema GA, Seifu BL. Factors associated with mothers’ healthcare-seeking for acute respiratory infection symptoms in under-five children in sub-Saharan Africa: a multilevel Poisson regression. BMC Health Serv Res. 2023;23(1):10065. https://doi.org/10.1186/s12913-023-10065-x
11. Fadl N, Abdelmoneim S, Gebreal A, Youssef N, Ghazy R. Routine childhood immunization in sub-Saharan Africa: addressing parental vaccine hesitancy. Public Health. 2024;226:66–73. https://doi.org/10.1016/j.puhe.2023.10.049
12. Aboagye RG, Seidu A-A, Ahinkorah BO, Cadri A, Frimpong JB, Hagan JE, et al. Mass media exposure and maternal health service use in sub-Saharan Africa. PLoS One. 2022;17(9):e0275202. https://doi.org/10.1371/journal.pone.0275202
13. Adeoti I, Cavallaro F. Determinants of care-seeking for fever, acute respiratory infection, and diarrhoea among Nigerian children under five. Arch Dis Child. 2021;106(Suppl 1):A169. https://doi.org/10.1136/archdischild-2021-rcpch.169
14. Sacks E, Finlayson K, Brizuela V, Crossland N, Ziegler D, Sauvé C, et al. Factors influencing uptake of routine postnatal care: women’s perspectives from a qualitative evidence synthesis. PLoS One. 2022;17(8):e0270264. https://doi.org/10.1371/journal.pone.0270264
15. Iwasam E, Ukwayi JK, Okpa J. Barriers to routine immunization uptake in Odukpani, Cross River State, Nigeria: a qualitative study. Health Res Policy Syst. 2021;19(1):57. https://doi.org/10.1186/s12961-021-00709-5
16. Cockcroft A, Andersson N. Community engagement to increase childhood immunisation in Cross River State, Nigeria: a randomized trial. BMC Public Health. 2021;21:222. https://doi.org/10.1186/s12889-021-10213-3
17. Ganle JK, Obeng B, Segbefia AY, Mwinyuri V, Yeboah JY, Baatiema L. Intra-familial decision-making and maternal healthcare access in Ghana: a qualitative study. BMC Pregnancy Childbirth. 2015;15:59. https://doi.org/10.1186/s12884-015-0590-y
18. National Bureau of Statistics; UNICEF. Multiple Indicator Cluster Survey 2021. Abuja (NG): NBS & UNICEF; 2022.
19. Cross River State Primary Healthcare Development Agency; UNICEF. Maternal and Child Health Week Report 2024. Calabar (NG): CRSPHCDA & UNICEF; 2024.
20. City Population. Cross River State (Nigeria): population statistics, charts, map and location [Internet]. 2022 Mar 21. Available from: https://www.citypopulation.de/en/nigeria/admin/NGA009__cross_river/
21. Cross River State Bureau of Statistics. Statistical Year Book. Calabar (NG): Cross River State Bureau of Statistics; 2022.
22. Katz DL, Elmore JG, Wild D, Lucan SC. Jekel’s epidemiology, biostatistics, preventive medicine, and public health. 4th ed. Philadelphia (PA): Elsevier; 2013.
23. Opara UC, Iheanacho PN, Petrucka P. Cultural and religious structures influencing maternal health service use in Nigeria: an ethnographic study. Reprod Health. 2024;21:188. https://doi.org/10.1186/s12978-024-01933-8
24. Nwakamma IJ, Erinmwinhe A, Ajogwu A, Udoh A, Ada-Ogoh A. Mitigating maternal and child health injustices through faith community initiatives. Int J Matern Child Health AIDS. 2019;8(2):146–55. https://doi.org/10.21106/ijma.326
25. Bright T, Felix L, Kuper H, Polack S. Strategies to increase access to health services for children in low- and middle-income countries: a systematic review. BMC Health Serv Res. 2017;17(1):252. https://doi.org/10.1186/s12913-017-2180-9
26. Abiyu C, Belachew T. Effect of complementary feeding BCC delivered by community actors in rural Ethiopia: a cluster RCT. BMC Pediatr. 2020;20(1):72. https://doi.org/10.1186/s12887-020-02396-z
27. Flax VL, Ipadeola A, Schnefke CH, Ralph-Opara U, Adeola O, Edwards S, et al. Breastfeeding, interpersonal communication, phone support, and media messaging increase exclusive breastfeeding in Lagos private facilities. J Nutr. 2022;152(5):1316–26. https://doi.org/10.1093/jn/nxab450
28. Edward A, Krishnan A, Ettyang G, Jung Y, Perry HB, Ghee AE, et al. People-centered community-oriented interventions and skilled birth attendance: quasi-experimental evidence from Cambodia, Kenya, and Zambia. BMC Pregnancy Childbirth. 2020;20(1):13. https://doi.org/10.1186/s12884-020-03223-0
29. Le Roux KW, Almirol E, Rezvan PH, Le Roux IM, Mbewu N, Dippenaar E, et al. Impact of community health workers on maternal and child health outcomes in rural South Africa: a two-group comparison study. BMC Public Health. 2020;20(1):1400. https://doi.org/10.1186/s12889-020-09468-w
Downloads
Published
Data Availability Statement
The data supporting the findings of this study are available from the corresponding author upon reasonable request.
Issue
Section
License
Copyright (c) 2026 Ibor GO, Atulomah NO, Lawal SA, Oyakhilome V (Author)

This work is licensed under a Creative Commons Attribution 4.0 International License.