Access to Primary Health Care Services and Child Mortality in Orumba North

ABSTRACT 

Lack of access to Primary Health Care services has consistently posed serious health risks in Nigeria, especially in rural areas, where health facilities are largely inadequate or absent in extreme cases. This study examined the socio-cultural factors affecting access to PHC services and child mortality in Orumba North LGA of Anambra State. A cross-sectional survey research was conducted to generate data to answer the research questions as well as test the hypothesis. Both quantitative and qualitative research approaches were combined in the study. A sample of six hundred (600) women aged 15-49 years, who had at least one child or had been child-caregivers was given a set of questionnaire administered by trained research assistants. Qualitative data were generated by Focus Group Discussion (FGD) with community members as well as in-depth interviews (IDI) with health workers. The analysis of study data showed that the situation of PHCs in the LGA was generally poor. Results from multiple regression analysis showed that cost of services and personnel problems which included attitude of health workers, waiting time and appointment time were the major challenges the people encountered in accessing PHC services in the LGA. These were statistically significant at P≤0.001 level. Mothers were often reluctant to visit PHCs because of the shabby manner in which they were treated by the health workers. Another major problem the people encountered in accessing PHC services was distance and cost of transportation to the facilities. The study recommended more Government presence in the rural areas in form of provision of adequate health facilities, medical consumables and adequate sensitization to improved rural participation. Training and retraining of health workers was also recommended.

TABLE OF CONTENTS

TITLE PAGE .......................................................................................................................................... I

CERTIFICATION ................................................................................................................................. II

DEDICATION ....................................................................................................................................... III

ACKNOWLEDGMENTS ..................................................................................................................... IV

ABSTRACT ............................................................................................................................................ V

TABLE OF CONTENTS ....................................................................................................................... VI

LIST OF ACRONYMS ....................................................................................................................... VIII

LIST OF TABLES .................................................................................................................................. X

LIST OF FIGURES ............................................................................................................................. XIV

LIST OF MAPS .................................................................................................................................... XV

LIST OF PICTURES .......................................................................................................................... XVI

CHAPTER ONE: INTRODUCTION .................................................................................................... 1

1.1 BACKGROUND TO THE STUDY ............................................................................................................... 1

1.2 STATEMENT OF THE PROBLEM .............................................................................................................. 3

1.3 RESEARCH QUESTIONS .......................................................................................................................... 6

1.4 OBJECTIVES OF THE STUDY ................................................................................................................... 7

1.5 SIGNIFICANCE OF THE STUDY ................................................................................................................ 7

1.6 DEFINITION OF CONCEPTS ..................................................................................................................... 8

CHAPTER TWO: LITERATURE REVIEW ...................................................................................... 12

2.1 REVIEW OF EMPIRICAL LITERATURE ................................................................................................... 12

2.1.1 Global Trends in Child Mortality ............................................................................................... 12

2.1.2 Child Mortality in Nigeria .......................................................................................................... 13

2.1.3 Factors associated with child mortality in Nigeria ..................................................................... 14

2.1.4 Access to Primary Health Care Services in Nigeria ................................................................... 16

2.1.5 Factors Affecting Access to Health Care Services in Nigeria .................................................... 17

2.1.6 Efforts to Improve Access to Health Care Services in Nigeria ................................................... 21

2.2 REVIEW OF RELEVANT THEORIES ....................................................................................................... 22

2.2.1 Individual or Intrapersonal Health Behavior Models/Theories.................................................. 22

2.2.2 Interpersonal Health Behavior Model/Theories ......................................................................... 25

2.2.3 Community level model/theory ................................................................................................... 27

2.3 THEORETICAL FRAMEWORK ............................................................................................................... 28

2.4 STUDY HYPOTHESIS ............................................................................................................................ 29

CHAPTER THREE: RESEARCH METHODOLOGY ...................................................................... 30

3.1 RESEARCH DESIGN .............................................................................................................................. 30

ACCESS TO PRIMARY HEALTH CARE SERVICES AND CHILD MORTALITY vii

University of Nigeria, Nsukka

3.2 AREA OF STUDY .................................................................................................................................. 30

3.3 STUDY POPULATION ........................................................................................................................... 31

3.4 SAMPLE SIZE ....................................................................................................................................... 32

3.5 SAMPLING PROCEDURE ....................................................................................................................... 33

3.6 INSTRUMENT FOR DATA COLLECTION .................................................................................................. 34

3.7 METHODS OF DATA COLLECTION ....................................................................................................... 35

3.8 METHODS OF DATA ANALYSIS ............................................................................................................. 36

3.9 LIMITATIONS OF THE STUDY................................................................................................................ 37

CHAPTER FOUR: ANALYSIS AND PRESENTATION OF DATA ................................................. 39

4.1 SOCIO-DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS .............................................................. 39

4.2 ISSUES ON CHILD HEALTH: COMMON HEALTH PROBLEMS AMONG CHILDREN ................................... 44

4.3 SITUATION OF PRIMARY HEALTH CARE SERVICES .............................................................................. 54

4.4 ISSUES ON IMMUNIZATION AND USE OF INSECTICIDE TREATED NETS ................................................. 68

4.5 MULTIPLE REGRESSION ANALYSIS ..................................................................................................... 77

4.6 TEST OF HYPOTHESES ......................................................................................................................... 79

4.7 SUMMARY OF FINDINGS ...................................................................................................................... 86

CHAPTER FIVE: DISCUSSIONS, CONCLUSION AND RECOMMENDATIONS ........................ 88

5.1 DISCUSSIONS ....................................................................................................................................... 88

5.1.1 Options Taken in Child Health Care .......................................................................................... 88

5.1.2 Problems in Accessing PHC Services ......................................................................................... 89

5.1.3 Common Health Problems among Children in the LGA............................................................. 90

5.1.4 Awareness of Health Interventions like Immunization and ITNs ................................................ 91

5.3 RECOMMENDATIONS ........................................................................................................................... 92

REFERENCES ..................................................................................................................................... 94

APPENDIX 1: STUDY QUESTIONNAIRE ...................................................................................... 101

APPENDIX II: IN-DEPT INTERVIEW GUIDE WITH HEALTH WORKERS ............................. 115

APPENDIX III: FOCUS GROUP DISCUSSION GUIDE ................................................................ 116