Several factors influence health care utilization. Albeit a lot of the factors are comparable across geographies, their interrelation and impacts on peoples’ actions is often peculiar to a population in the context of the setting they live in. The focus of this study was to assess factors affecting healthcare services utilization in Eziama Obiato, Mbaitoli L.G.A. in Imo state, Nigeria.

Objective: The objective of this study was to assess the factors affecting health service utilization of healthcare services in Eziama Obiato, Mbaitoli L.G.A. in Imo state, Nigeria. Specifically, it sought to determine different forms of primary health care facilities that households used when ill and assess the proportion of households that used formal primary health care facilities when ill.

Methods: A mixed method approach was applied to collect data. A descriptive cross-sectional study with simple random sampling technique was used for the quantitative study. The study population was adults living in the Eziama Obiato, Mbaitoli L.G.A. A sample size of 169 was used. A structured questionnaire was used to collect quantitative data. Data was processed using Microsoft excel and exported to STATA version 15 for analysis. Semi-structured interview guide was used for the qualitative study.

The study found that women do not have the autonomy to seek healthcare when ill because they have to ask for permission from their household heads and some respondents still believed that not all sicknesses are cured by orthodox medicine.

The findings of this study demonstrates adequate utilization of health services in Eziama Obiato, Mbaitoli L.G.A. Level of utilization of 77.8% was higher than as observed in literature (50%). Some similarities and variations in associated factors were established. There is the need to invest in improving the NHIS.

1.1 Background to the study
The wellbeing of a society is intimately dependent on the health and survival of its people, more especially women and children. So it is universally acknowledged that when there is survival for women and children, then societies will progress (WHO, 2016). Universal access to primary health care is an intermediary goal by itself; as an essential human right (health), most regimes globally agree to supply health systems that enable equitable access to care for all citizens. Nigeria is no exception as the country of focus in this study. Nigeria’s National Health Policy states that “every citizen has the basic right to adequate health care” N (2017).

Utilization of a healthcare facility or system could be dependent on socio–demographic factors, social structures, education, cultural and religious beliefs and practices, gender, women empowerment, politico-economic systems, environmental conditions, and the disease morphology and pattern and healthcare system itself. Through this way, it is possible know how individuals interact with, use the health care system and how they use their autonomy and choice to decide in the best interest of their households to consult different types of healers (M. Saeed Siddiqui, M. Khalid Siddiqui, 2011).

In spite of this, health systems in Nigeria, as well as in many other parts of the world, are ineffectual in ensuring access to health care, which results in inequalities in health and health care utilization between different groups in society (Karim, Buse, Vaughan, Karim, & Buse, 2000; Syed Masud Ahmed, Alayne M. Adams & Bhuiya, 2000). This study attempted to determine factors which affect and or influence health service access and utilization among the rural poor in Nigeria, using a community in the Upper West Region as an example.

Previous research indicates that investing in supply-increasing interventions such as expanded service delivery does not necessarily increase use of services (Hjortsberg, 2003; Syed Masud Ahmed, Alayne M. Adams & Bhuiya, 2000; Thaddeus & Maine, 1994). Rather, it is advocated that policies aimed at increasing access and utilization should take on both a supply- and demand side approach. Empirical research shows that when ill, a variety of factors influence whether the individual seeks health care or not. These factors include socio-economic status, cultural and religious beliefs, geographical accessibility, disease pattern, waiting times, accessing, and receiving right treatment; as well as health system shortages that compromise the availability, accessibility or standard of care, Sexually Transmitted Infections such as Human Immunodeficiency Virus and Acquired Immuno-Deficiency Syndrome and other opportunistic infections (UNDP, 2012).

In Nigeria however, the Nigeria Health Service, which has the mandate to increase access to quality healthcare has worked tremendously to change this calamitous trend. Studying the past results and data available at the health sector, the success chalked can be attributed to improvement in general accessibility and utilization of healthcare services as well as concrete social interventions like the Health Insurance Scheme introduced in 2004.

This notwithstanding, a greater percentage of deaths resulting from inadequate utilization of healthcare services emanates from the poor communities. Although much has been done in research in the past, the Upper West Region still lag behind as women and children continue to die daily from preventable causes owing to medical healthcare accessibility problems. Reports indicate that the crude death rate for Imo state is 5.0 deaths per 1000. Accidents, violence, homicide and suicide account for 7.4% of all deaths while other causes constitute 92.6% of deaths in the Municipality (GSS, 2014).

Itu, a community in Imo state, happens to be one of these communities with high rates of illnesses and deaths registered annually. This study therefore, sought to determine the factors affecting utilization of healthcare services in Imo state, with Eziama Obiato, Mbaitoli as a case study.

1.2 Problem Statement
Universal health coverage is built around financial protection and access to comprehensive care for all individuals. The focus in many countries, including Nigeria has been on financial protection while accessing health services. Nonetheless, eliminating financial impediments does not necessarily remove other access barriers to the use of health services (L├ępine, Lagarde, & Le Nestour, 2018). Indeed, the coverage of a populations’ access to health care needs is dependent on varied community and health service factors. Hence, expending in equitable and accessible utilization of primary health care facilities is a key block of any health development strategy.

In Eziama Obiato, Mbaitoli, a community Imo state Nigeria, there’s no health facility to provide adequate and high quality healthcare services and the residents resort to other forms of health services when ill. These include over-the counter medications, self-medications, unscientifically tested traditional or herbal medicines to cater for their health needs. In addition, to access health services, community members travel for about 8km to the Wa Municipal Hospital or a nearby community-Bamahu, to access formal primary health care facilities. In emergency situations like labour or accidents, resultant effects such as fetal distress, maternal and or neonatal mortalities, disabilities and general mortalities are likely to be recorded (Garenne, 2015).

A majority of residents in this community are poor peasant farmers. Studies show that the poor people have less odds to utilize health care as against the rich (D. Boateng & Awunyor-Vitor, 2013; Jehu-Appiah et al., 2011; Oxfam, 2013). Generally, poor communities are caught up in a vicious cycle of poverty and health related web as their disease burden increases resulting from increased distance from the nearest health facilities available with little or no utilization (Billi, Pai, & Spahlinger, 2007). Even though there is evidence about utilization rates and factors affecting it in the general population, not much is known about that of peri-urban communities in Nigeria like Eziama Obiato, Mbaitoli. Additionally, existing literature have shown that utilization among the poor is low (Good & Kimani, 1980; Wang, Yip, Zhang, Wang, & Hsiao, 2005)

This study thus determined factors affecting utilization levels among peri-urban dwellers in Nigeria using Eziama Obiato, Mbaitoli as a case study.

1.3 Objectives of the study
General objective
The main aim of the study was to assess the factors affecting utilization of primary health care facilities in Eziama Obiato, Mbaitoli LGA, Imo state Nigeria.

Specific objectives
The specific objectives of the study were to:
1. To assess the different forms of primary health care facilities that households use when ill

2. To assess the proportion of households that use formal primary health care facilities when ill

3. To determine how socio-demographic/economic factors influence utilization

4. To explore how socio-cultural practices/factors influence healthcare utilization.

5. To assess how geographical/health facility factors influence healthcare utilization.

1.4 Research Questions
The main research question of the study is:

What are the factors affecting utilization of healthcare services in the Eziama Obiato, Mbaitoli L.G.A.?

Specifically, the study sought to address the following questions:

1. What are the different forms of primary health care facilities that households use when ill?

2. What proportion of households use formal primary health care facilities when ill?

3. Do household’s socio-demographic/economic status have influence on healthcare utilization?

4. How does socio-cultural practices/factors influence utilization of healthcare service in E. ziama Obiato, Mbaitoli?

5. What are some of the geographic/facility factors that influence utilization of healthcare services in Eziama Obiato, Mbaitoli?

1.5 Significance of the study
Nigeria's maternal and under-five mortality ratios remain unacceptably high irrespective of different magnitudes of efforts and initiatives by government and her development counterparts to reduce them. A huge population of women still die every year owing to pregnancy complications and problems such as: severe haemorrhage, eclampsia, pregnancy induced hypertension, infections, and incomplete or septic abortions (Bustreo et al., 2013). There must therefore, be collaborative efforts aimed at improving and maintaining the recent maternal and child survival specific and sensitive interventions which brought some improvement in the goal 4 and 5 of the Millennium Development Goals. Some of these interventions include: separating parents from their wards or children for effective NHIS coverage; increase use of Insecticide Treated Nets (ITNs); implementation of free maternal health services; and Emergency Obstetric and Neonatal Care (EmONC) (UNDP, 2012).

For all these interventions to achieve the desired results, access to quality and timely health care by new mothers and their children is crucial. However, access and consumption of primary health care facilities in the rural areas is still a major worry (UNDP, 2012).

The study therefore sought to bring to the fore possible causes or factors that have an influence on the utilization of primary health care facilities in Imo state with much concentration on rural inhabitants.

The outcome of this study will inform decision makers in the country as to whether or not to scale up the implementation of innovative schemes to other parts of the country in order to improve upon health condition of the rural people, more especially maternal and child primary health care facilities delivery. It will also add to the empirical studies on the subject and help bridge the gap in literature.

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