Determinants of primary healthcare services utilisation in an under-resourced rural community in Enugu State, Nigeria: a cross-sectional study.

Introduction: primary health care (PHC) is essential towards achieving universal health coverage. Improving PHC services require understanding context-specific factors influencing utilisation. We assessed the factors influencing utilisation of PHC services in a rural community in Enugu, Nigeria. Methods: we conducted a cross-sectional community-based survey between May and June, 2017. Information on socio-demographic characteristics, utilisation of PHC services, community- and PHC facility-related factors associated with utilisation of PHC services was obtained from 335 adult residents aged ≥ 18 years using a pre-tested semi-structured interviewer-administered questionnaire. Data were analysed using descriptive and inferential statistics at 5% level of significance. Results: of the 335 respondents, 155 (46.2%) reported utilisation of PHC services the last time they were sick. Of 178 respondents who did not utilise PHC services, 51 (28.7%) reported poor quality health services, 41 (23.0%) unavailability of medical doctors, 31 (17.4%) long patient waiting time and 25 (14.0%) unavailability of drugs as reasons for non-utilisation. Being a female (AOR = 2.3 (95% CI 1.3 - 4.0)), affordability of health services (AOR = 2.4 (95% CI 1.3 - 4.6)), inadequacy of healthcare staff (AOR = 0.3 (95% CI 0.1 - 0.5)), shorter hospital waiting time (AOR = 2.2 (95% CI 1.2 - 4.3)) and satisfaction with PHC services during previous visit (AOR = 2.6 (95% CI 1.1 - 6.3)) influenced utilisation of PHC services. Conclusion: PHC services utilisation was low. Improving utilisation would require addressing cost of health services, adequacy of healthcare staff, patient waiting time and ensuring patient satisfaction with PHC services.

Water, sanitation and hygiene risk factors associated with diarrhoea morbidity in a rural community of Enugu, South East Nigeria.

INTRODUCTION: diarrhoea remains a public health problem globally with majority of diarrhoea morbidity and mortality occurring in low resource settings. This study assessed the prevalence of diarrhoea and factors associated with diarrhoea in a rural community in Enugu, South East Nigeria. METHODS: a community-based cross-sectional survey was conducted between May and June, 2017. Information on socio-demographic characteristics, water, sanitation, hand washing practices and diarrhoea history was obtained from 534 community residents using a structured interviewer administered questionnaire. Data were analyzed using descriptive statistics, Chi-square and logistic regression tests at 5% level of significance. RESULTS: prevalence of diarrhoea in the two weeks preceding the study was 7.47% and 10.77% among all ages and children younger than five years respectively. Of 469 residents aged five years and above, 206 (43.92%) accessed source of drinking water within 30 minutes round trip walking distance from their households, 275 (58.64%) practiced open defecation while 456 (97.23%) and 455 (97.01%) reported washing hands with soap or ash and water before eating and after using the toilet respectively. Two or more households sharing a toilet facility [AOR = 4.78 (95% CI 2.03-11.24)] was a risk factor for diarrhoea while washing hands with soap or ash and water before eating [AOR = 0.23 (95% CI 0.06-0.90)] and after using the toilet [0.16 (95% CI 0.04-0.55)] protected against diarrhoea. CONCLUSION: increasing access to improved sanitary sewage disposal methods and promoting hand washing with soap and water at critical moments would improve diarrhoeal disease control.