Abstract
BackgroundWomen and children constitute a large proportion of any population. They are the most vulnerable to morbidity and mortality especially in developing countries. In many situations the problem of poor maternal and child health stems from the poor use of available services even when they are not of optimum quality. This study seeks to describe the patterns of utilization of Maternal and Child health (MCH) services in a rural area of Enugu State, and identify factors that are associated with and responsible for determining them.MethodsThe study used a cross sectional analytic design. Pretested semi structured questionnaires were administered by interviewers to 602 women from a rural community in Enugu state, South east Nigeria. Two focus group discussions (FGDs) involving 8–10 men/ women each were conducted to identify factors affecting service utilization. Chi square analysis was done to identify factors associated with Maternal and Child Health services utilization. Logistic regression was used to identify determinants of utilization patterns. N vivo software was used to analyze findings of the FGDs.ResultsThe study revealed that increasing age, educational level, monthly income, number of children and occupation of both women and their husbands were associated with increased MCH service utilization. Average monthly income (OR: 1.317, p = 0.048, CI: 0.073–0.986) and number of children (OR: 1.196, p < 0.01,CI: 1.563–7.000) were determinants of increased use of child care services while educational level (OR: 0.495, p < 0.001, CI: 1.244–2.164) and age (OR: 0.115, p < 0.001, CI: 0.838–0.948) determined better use of delivery and family planning services respectively.ConclusionsImproved use of MCH services is related to socio economic challenges women face such as illiteracy and low income. Furthermore, the way health facilities and their staff are perceived by rural women affect how they use some of these services and should be considered in programs which seek to reduce maternal and child mortality.Behavioral change programs with high local content need to be implemented within rural areas especially among younger, illiterate women .
Highlights
Women and children constitute a large proportion of any population
In Nigeria, only 38.1% of women receive skilled attendance at delivery and immunization coverage ranges between 43% and 16% in urban and rural areas [7] while 25% of children are fully immunized at age 23 months [7] in a country where the service has been almost completely free since its inception
Unless the factors responsible for observed service utilization patterns in rural areas of developing countries are identified it will be difficult to properly intervene to correct the discrepancy in health service supply and demand which occurs in Nigeria and other developing countries
Summary
Women and children constitute a large proportion of any population They are the most vulnerable to morbidity and mortality especially in developing countries. This study seeks to describe the patterns of utilization of Maternal and Child health (MCH) services in a rural area of Enugu State, and identify factors that are associated with and responsible for determining them. More than 200 million women become pregnant, 15% of which are at risk of complications that have the potential to cause disease and death [1] These risks exist in different societies and situations [2]. Low utilization rates of Maternal and Child health (MCH) services in developing countries [3, 4], have led some authors to the conclusion that programs that rely only on ANC as a delivery system are likely to have poor coverage and compliance [5]. Unless the factors responsible for observed service utilization patterns in rural areas of developing countries are identified it will be difficult to properly intervene to correct the discrepancy in health service supply and demand which occurs in Nigeria and other developing countries
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