|ORIGINAL RESEARCH REPORT
|Year : 2015 | Volume
| Issue : 1 | Page : 9-13
Healthseeking preferences of residents of Mushin LGA, Lagos: A survey of preferences for provision of maternal and child health services
AA Roberts, MR Balogun, AO Sekoni, VA Inem, OO Odukoya
Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
|Date of Web Publication||14-Jul-2015|
Dr. A A Roberts
Department of Community Health and Primary Care, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos
Source of Support: None, Conflict of Interest: None
Introduction: Attendance at antenatal clinics, skilled care at delivery and timely access to postnatal care, immunization, and treatment in case of illness are essential to reducing adverse health outcomes in the community. This survey was conducted to identify the demographic and community members' preferences for health service facility for maternal and child care within the Mushin local government area (LGA). Materials and Methods: This descriptive cross-sectional survey was done among household residents in Mushin, Lagos to determine the healthcare provider preferences of residents for maternal and child services, severe and nonsevere illnesses in adults and children, as well as cases of behavioral illnesses. Results: The survey showed that a third (33%) of respondents expressed a preference for doctors in public health facilities for antenatal care and delivery. For severe childhood illnesses, the preference was for doctors in either private (45.1%) or public (44.1%) health facilities rather than nonphysicians. Regarding severe adult illnesses or behavioral illnesses, respondents preferred doctors in government facilities (48.1% and 59.9%, respectively). The educational level of household heads was positively associated with preference for maternal and child services in accredited health facilities and this association was statistically significant at P < 0.05. Conclusion and Recommendations: In view of the proximity of a tertiary health facility in Mushin LGA, the authors recommend further research into the decision-making dynamics within households in terms of preferences for healthcare provision.
Keywords: Healthcare provision, healthcare seeking patterns, Lagos, Nigeria
|How to cite this article:|
Roberts A A, Balogun M R, Sekoni A O, Inem V A, Odukoya O O. Healthseeking preferences of residents of Mushin LGA, Lagos: A survey of preferences for provision of maternal and child health services. J Clin Sci 2015;12:9-13
|How to cite this URL:|
Roberts A A, Balogun M R, Sekoni A O, Inem V A, Odukoya O O. Healthseeking preferences of residents of Mushin LGA, Lagos: A survey of preferences for provision of maternal and child health services. J Clin Sci [serial online] 2015 [cited 2019 Oct 15];12:9-13. Available from: http://www.jcsjournal.org/text.asp?2015/12/1/9/160759
| Background|| |
Despite the knowledge that attending antenatal clinics, having skilled care at delivery and adequate postnatal care impacts positively maternal, newborn, and child health, several studies have reported that there are still gaps in universal coverage. ,,
The Nigeria Demography and Health Survey (2008) documents that access to healthcare is determined by the availability of health services, and willingness to seek healthcare at the providing facility.  The common determinants of preferred place of healthcare among clients and caregivers of very sick children have been shown to be influenced by their educational level, age, and socioeconomic status. ,,
There are eight comprehensive primary clinics and a tertiary health facility, Lagos University Teaching Hospital (LUTH), in the area, and knowing the preferences of residents in the Mushin local government area (LGA) with regards to health service delivery can direct the social marketing of appropriate healthcare-seeking practices to reduce morbidity and mortality. This survey was conducted to identify the community members' preferences in terms of health facilities for maternal and child care within the Mushin LGA.
| Materials and Methods|| |
This was a descriptive cross-sectional survey carried out in the Mushin LGA of Lagos State, Nigeria. Lagos State has the smallest land mass in the country and an estimated population of 17.5 million based on the 2006 census. , The state is made up of five administrative divisions, namely Lagos, Ikeja, Ikorodu, Epe, and Badagry; they are further subdivided into 20 LGAs. Mushin was purposively selected, being the LGA in closest proximity to the LUTH.
The Mushin LGA is located 10 km north of the Lagos central business district, and is a densely populated mixed commercial and residential area with inadequate sanitation, low-quality housing, and an estimated population of 1,312,517 according to the Lagos State 2006 census.  There are eight comprehensive primary health centers as well as one tertiary facility, LUTH.
A sample size of 384 was calculated using the formula for descriptive studies: n = Z2P (1-P)/d2 where n is sample size, Z = z statistics at a specific confidence level of 95%. A prevalence or proportion (P) of people with an expressed preference for healthcare provision was taken at 50% and the desired level of precision (d) was set at 0.05. The calculated sample size was rounded upward to 400 to cater for incomplete data.
The multistage sampling method was used to select one of 19 wards and then three streets in that ward in Mushin by simple random sampling. The buildings have a primary healthcare (PHC) house number. The selection of 400 households was done by simple random sampling using the PHC house numbers as the sampling frame. Several distinct households reside within each building with shared sanitation facilities. In each building, the household selected had to be bona fide residents within the building. Commercial tenants in any selected building were not included. The household head was interviewed using a pretested interviewer-administered survey tool. In the absence of the household head, another adult householder was selected.
The survey tool sought information on the sociodemographic characteristics of the respondents. Household heads were identified as the father, mother, a grandparent, or other adult. The identity of the respondents' relationship to the household head was obtained as husband/wife, sibling/offspring, or other decision-maker. Other sociodemographic characteristics surveyed were educational level recorded as none/primary/secondary/postsecondary, type of employment as formal/self-employment/unemployment, ethnicity, and religion. Healthcare provider options were traditional healers/traditional birth attendants (TH/TBA), doctors in private or government hospitals, nonphysician healthcare workers (HCW) in private or government hospitals, and patent medicine vendors (PMV) (which included chemists and dispensaries). Health-related events enquired about were antenatal care, delivery of the last baby, postnatal care, circumcision of the last male child, immunization, routine checkups and treatment of minor and severe illnesses in children and adults, and the treatment of mental illness. 
Approval for this research was obtained from the Research and Ethics Committee of LUTH. Permission was also obtained from the Medical Officer of Health (MOH) of Mushin LGA. Informed consent was obtained from the household heads prior to the administration of the survey tool.
The data were analyzed using Stata/IC12 Stata Corp LP. Descriptive statistics were used to present the data. Categorical variables were presented as frequencies and percentages. Comparison between groups was analyzed using Pearson's χ2 tests and Fisher's exact test.
| Results|| |
The study enrolled 400 households resident within 3-5 km of the LUTH [Figure 1]. The age of the respondents showed bimodal peaks of 21-30 years and over 40 years. Slightly over half the respondents (54.5%) had secondary education and 8.5% were in formal employment [Table 1].
|Figure 1: Geographical location of respondents in relation to the Lagos University Teaching Hospital (LUTH)|
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|Table 1: Sociodemographic characteristics of survey respondents (n=400) |
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With regards to the preferred provider for maternal and child health services, 330 (82.5%) respondents provided information. Over three-quarters reported a preference for doctors in either private (51.5%) or government (33.0%) hospitals for antenatal care [Table 2]. Delivery of the last baby followed a similar pattern of preference for private doctors (48.5%) and doctors in government hospitals (33.0%). Less than 12% of respondents reported a preference for traditional birth attendants (8.8%) or nonphysician HCWs in private (3.3%) or government hospitals (1.5%). Almost all respondents reported that they (or their spouse) went for postnatal care, with 47.9% opting for doctors in private clinics and 38.8% for doctors in government hospitals. Similar patterns are reported for circumcision for the last male child; however, more respondents (51.5%) reported preferences for receiving immunization from doctors in government hospitals. Less than 10% of respondents expressed a preference for TH/TBA. Routine check-ups and mild childhood illnesses were likely to be taken to private health facilities in 48.7% and 38.8% of cases respectively. In cases of severe adult and behavioral illnesses, 48.1% and 59.9%, respectively, would rather go to government health facilities [Table 3]. Educational level was positively associated with preference for doctors in private hospitals for antenatal care (P = 0.004), delivery (P = 0.000), postnatal care (P = 0.004), circumcision of the last male child (P = 0.015), and immunization (P = 0.03).
|Table 2: Preferred health facilities for maternal and child health service (n=330) |
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|Table 3: Preferred health facility depending on type and severity of illness |
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| Discussion|| |
Despite the proximity of the respondents to the LUTH, the residents of Mushin expressed a preference for doctors in private hospitals over those in government hospitals and over nonphysician HCWs anywhere. Respondents used PMVs when they perceived the illness to not be severe, whether in a child or an adult. The proximity of PMVs to the community has been postulated as a reason for the high degree of patronage they enjoy, especially as they can be visited outside regular working hours and without appointments. , However, in cases of severe illness in children and adults, the preference was for physicians in private and public hospitals. Regarding maternal and child services, respondents reported a higher preference for using private hospitals. This is a pattern that has been reported before. Studies in Saudi Arabia and Iran have reported that the preference for a private or a government hospital is strongly linked to the sociodemographic characteristics of educational and income levels. ,, In Lagos, the use of private health facilities was significantly associated with ethnicity, religion, social class, and obstetric history.  Contrary to earlier research findings, there were fewer respondents reporting the use of TBA.  The use of doctors in government hospitals was higher for immunization services, doubtless due to the National Policy on Immunization that makes the service free for babies.  Despite the geographic proximity of all respondents to the LUTH [Figure 1], the residents expressed their preferences for private healthcare providers for cases of childhood illnesses, however, when the families perceived the issue to be severe adult illness or mental disease, the preference was for government health facilities. This reflects the preference for government health facility provisions seen elsewhere when families are dealing with mental illness. 
This descriptive study highlights the need for more qualitative studies to understand the decision-making dynamics of community residents that determine the pattern of use of healthcare providers. Strengthening the links in the community will encourage residents to access appropriate healthcare in a timely, informed manner, which will reduce adverse health outcomes.
| Acknowledgments|| |
The authors thank all members of the Department of Community Health and Primary Care for their contributions to the collection of the data during the community immersion program of the fourth-year medical and dental students. They also acknowledge the financial support from the Department in the entering of data.
Source of funding
No financial support exists.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]