Abstract
BackgroundAlthough Primary Health Care (PHC) was designed to provide universal access to skilled pregnancy care for the prevention of maternal deaths, very little is known of the factors that predict the use of PHC for skilled maternity care in rural parts of Nigeria - where its use is likely to have a greater positive impact on maternal health care. The objective of this study was to identify the factors that lead pregnant women to use or not use existing primary health care facilities for antenatal and delivery care.MethodsThe study was a cross-sectional community-based study conducted in Esan South East and Etsako East LGAs of Edo State, Nigeria. A total of 1408 randomly selected women of reproductive age were interviewed in their households using a pre-tested structured questionnaire. The data were analyzed with descriptive and multivariate statistical methods.ResultsThe results showed antenatal care attendance rate by currently pregnant women of 62.1%, and a skilled delivery of 46.6% by recently delivered women at PHCs, while 25% of women delivered at home or with traditional birth attendants. Reasons for use and non-use of PHCs for antenatal and delivery care given by women were related to perceptions about long distances to PHCs, high costs of services and poor quality of PHC service delivery. Chi-square test of association revealed that level of education and marital status were significantly related to use of PHCs for antenatal care. The results of logistic regression for delivery care showed that women with primary (OR 3.10, CI 1.16–8.28) and secondary (OR 2.37, CI 1.19–4.71) levels education were more likely to receive delivery care in PHCs than the highly educated. Being a Muslim (OR 1.56, CI 1.00–2.42), having a partner who is employed in Estako East (OR 2.78, CI 1.04–7.44) and having more than five children in Esan South East (OR 2.00, CI 1.19–3.35) significantly increased the odds of delivery in PHCs. The likelihood of using a PHC facility was less for women who had more autonomy (OR 0.75, CI 0.57–0.99) as compared to women with higher autonomy.ConclusionWe conclude that efforts devoted to addressing the limiting factors (distance, costs and quality of care) using creative and innovative approaches will increase the utilization of skilled pregnancy care in PHCs and reduce maternal mortality in rural Nigeria.
Highlights
Primary Health Care (PHC) was designed to provide universal access to skilled pregnancy care for the prevention of maternal deaths, very little is known of the factors that predict the use of Primary Health Centres (PHCs) for skilled maternity care in rural parts of Nigeria - where its use is likely to have a greater positive impact on maternal health care
Several studies have shown that pregnant women in rural areas of the country are at greater risk of dying during pregnancy or childbirth as compared to those that live in urban areas [1, 2]
We based the study on the premise that PHCs offer the best opportunity for rural women in Nigeria to enter the health care system to receive the most optimal evidence-based and cost-effective access to skilled delivery care [37, 38]
Summary
Primary Health Care (PHC) was designed to provide universal access to skilled pregnancy care for the prevention of maternal deaths, very little is known of the factors that predict the use of PHC for skilled maternity care in rural parts of Nigeria - where its use is likely to have a greater positive impact on maternal health care. Several studies have shown that pregnant women in rural areas of the country are at greater risk of dying during pregnancy or childbirth as compared to those that live in urban areas [1, 2]. This is largely due to limited access to maternal health care by rural women as health facilities are often located far from where they live, with the result that they rely more on use of traditional sources of care or to no care at all [3, 4]. The Federal Ministry of Health of Nigeria recommends Primary Health Care as the entry point to the health care system in order to generate universal health coverage for all citizens [6]
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