Patterns of Antenatal Care Seeking Behavior in South East Nigeria: Exploring Relationship with Age, Education, and Socioeconomic Status

Background: Maternal and infant morbidity and mortality are major public health problems in Nigeria. Although it is well-known that appropriate antenatal care (ANC) is important in reducing maternal morbidity and mortality, there is limited information on inequities on ANC seeking pattern among the pregnant women in Nigeria. Aim: The study was designed to explore inequities due to age, education, and socioeconomic status (SES) of women of childbearing age in seeking ANC services in Nigeria. Subjects and Methods: A household survey was conducted in 10 randomly selected villages in Nnewi, Anambra State, South-East Nigeria. An interviewer-administered questionnaire was used to collect relevant data from 420 women of childbearing age from the villages. The effects of age, education, SES, and ANC seeking behavior were analyzed. Results: It was found that 61.4% (254/420) of the respondents attended ANC clinic at least 6times. Although most of the respondents sought ANC in formal health, a greater percentage utilized private hospitals/clinics more than public health facilities. Age (P < 0.01), educational level (P < 0.001), and SES (P < 0.01) had statistically significant effects on respondents’ antenatal clinic attendance and choice of facilities. The highest SES group was more likely to utilize teaching hospitals and private clinics than other SES groups. Conclusions: There were inequities due to SES, educational level, and age of respondents in the pattern of ANC seeking behavior. These inequities could negate the achievement of millennium development goals (MDGs). Interventions that would address the inequities should be developed and implemented if the health-related MDGs are to be achieved.KEY WORDS: Antenatal care, health seeking behavior, inequities, Nigeria, women of childbearing ag

Investigating determinants of out-of-pocket spending and strategies for coping with payments for healthcare in southeast Nigeria

<p>Abstract</p> <p>Background</p> <p>Out-of-pocket spending (OOPS) is the major payment strategy for healthcare in Nigeria. Hence, the paper assessed the determinants socio-economic status (SES) of OOPS and strategies for coping with payments for healthcare in urban, semi-urban and rural areas of southeast Nigeria. This paper provides information that would be required to improve financial accessibility and equity in financing within the public health care system.</p> <p>Methods</p> <p>The study areas were three rural and three urban areas from Ebonyi and Enugu states in South-east Nigeria. Cross-sectional survey using interviewer-administered questionnaires to randomly selected householders was the study tool. A socio-economic status (SES) index that was developed using principal components analysis was used to examine levels of inequity in OOPS and regression analysis was used to examine the determinants of use of OOPS.</p> <p>Results</p> <p>All the SES groups equally sought healthcare when they needed to. However, the poorest households were most likely to use low level and informal providers such as traditional healers, whilst the least poor households were more likely to use the services of higher level and formal providers such as health centres and hospitals. The better-off SES more than worse-off SES groups used OOPS to pay for healthcare. The use of own money was the commonest payment-coping mechanism in the three communities. The sales of movable household assets or land were not commonly used as payment-coping mechanisms. Decreasing SES was associated with increased sale of household assets to cope with payment for healthcare in one of the communities. Fee exemptions and subsidies were almost non-existent as coping mechanisms in this study</p> <p>Conclusions</p> <p>There is the need to reduce OOPS and channel and improve equity in healthcare financing by designing and implementing payment strategies that will assure financial risk protection of the poor such pre-payment mechanisms with government paying for the poor.</p