Utilization of Health Care Services in Rural and Urban Areas: a Determinant Factor in Planning and Managing Health care Delivery Systems

Background: Disparities in use of healthcare services between rural and urban areas have been empirically attributed to several factors. This study explores the existence of this disparity and its implication for planning and managing healthcare delivery systems. Objectives: The objectives determine the relative importance of the various predisposing; enabling; need and health services factors on utilization of health services; similarity between rural and urban areas; and major explanatory variables for utilization Method: A four-stage model of service utilization was constructed with 31 variables under appropriate model components. Data is collected using cross-sectional sample survey of 1086 potential health services consumers in selected health facilities and resident milieu via questionnaire. Data is analyzed using factor analysis and cross tabulation. Results: The 4-stage model is validated for the aggregate data and data for the rural areas with 3-stage model for urban areas. The order of importance of the factors is need; enabling; predisposing and health services. 11 variables are found to be powerful predictors of utilization. Conclusion: Planning of different categories of health care facilities in different locations should be based on utilization rates while proper management of established facilities should aim to improve health seeking behavior of people

Barriers to Utilisation of Maternal Health Services in a Semi-urban Community in Northern Nigeria: The Clients' Perspective

Low level of utilisation of maternal health services is a major factor responsible for high maternal mortality in northwestern region of Nigeria. This study was aimed at determining the barriers to utilisation of maternal health services from the perspective of mothers in northwestern Nigeria. Materials and Methods: A cross-sectional study of 150 mothers; selected through multistage technique; was conducted. Data were collected using a structured interviewer-administered questionnaire; and analysed using SPSS statistics 17.0. Results: Only 2.7 utilised preconception service; 98.7 antenatal care service (ANC); 24.0 delivery; 35.3 postnatal care and 14.0 utilised family planning service. Major reasons for non-utilisation of delivery service were not having a delivery complication in the past (57 (CI = 47.4-66.1)) and negative provider attitude (23.7(CI = 16.4-32.7)). For non-utilisation of postnatal care; the major reasons were also not having a postnatal complication in the past (60.8 (CI = 50.4-70.4)) and negative provider attitude (27.8 (CI = 19.4-38.0)). As for non-utilisation of family planning service; the major reason was desire to have more children (32.6 (CI = 24.7-41.4)). Reasons for non-use of preconception care and ANC were not computed because respondents to these questions were not enough; only 6 (4.0) were aware of preconception care in the first place and only 2 (1.3) were aware of preconception care in the first place and only 2 (1.3) were not using ANC. Conclusion: Despite living near a health facility; most of the mothers were not using maternal health services. It is recommended that while there is the need to raise awareness on the utilisation of maternal health services; bring it closer to the mothers and make it more affordable; there is a more pressing need to improve its quality; especially through the alleviation of negative attitude of health care providers

Assessment of Iron Content of Breast Milk in Preterm and Term Mothers in Enugu Urban

Background: It is commonly assumed that preterm babies are malnourished and this has led to all forms of micronutrient supplementation including iron. Objective:The aim of the study is to compare the iron content in breast milk of mothers who had preterm and term babies.Methods:Ninety six (96) lactating mothers who delivered their babies at term and 68 lactating mothers who had preterm deliveries were recruited for the study. The mothers were attending the postnatal clinic of one secondary and two tertiary healthcare facilities in Enugu. Breast milk iron concentration was determined by Atomic Absorption Spectrophotometer.Results:The differences in the mean values for the iron concentrations in preterm and term breast milk were statistically significant (39.06±10.78 versus 32.79±14.17 µmol/L, P =0.02). In both groups, the breast milk iron concentration gradually decreased as lactation progressed. (P <0.0001).Conclusion:The iron content of breast milk from mothers who had preterm babies is higher when compared to mothers who had term babies. It may thus be needless to introduce exogenous iron during lactation