Agunwa C C, Obi I E, Ndu A C, Omotowo I B, Idoko C A, Umeobieri A K, Aniwada E C
Department of Community Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku Ozalla Campus, Enugu, Enugu State, Nigeria.
BMC Health Serv Res. 2017 Nov 13;17(1):715. doi: 10.1186/s12913-017-2653-x.
Women and children constitute a large proportion of any population. They are the most vulnerable to morbidity and mortality especially in developing countries. In many situations the problem of poor maternal and child health stems from the poor use of available services even when they are not of optimum quality. This study seeks to describe the patterns of utilization of Maternal and Child health (MCH) services in a rural area of Enugu State, and identify factors that are associated with and responsible for determining them.
The study used a cross sectional analytic design. Pretested semi structured questionnaires were administered by interviewers to 602 women from a rural community in Enugu state, South east Nigeria. Two focus group discussions (FGDs) involving 8-10 men/ women each were conducted to identify factors affecting service utilization. Chi square analysis was done to identify factors associated with Maternal and Child Health services utilization. Logistic regression was used to identify determinants of utilization patterns. N vivo software was used to analyze findings of the FGDs.
The study revealed that increasing age, educational level, monthly income, number of children and occupation of both women and their husbands were associated with increased MCH service utilization. Average monthly income (OR: 1.317, p = 0.048, CI: 0.073-0.986) and number of children (OR: 1.196, p < 0.01,CI: 1.563-7.000) were determinants of increased use of child care services while educational level (OR: 0.495, p < 0.001, CI: 1.244-2.164) and age (OR: 0.115, p < 0.001, CI: 0.838-0.948) determined better use of delivery and family planning services respectively.
Improved use of MCH services is related to socio economic challenges women face such as illiteracy and low income. Furthermore, the way health facilities and their staff are perceived by rural women affect how they use some of these services and should be considered in programs which seek to reduce maternal and child mortality. Behavioral change programs with high local content need to be implemented within rural areas especially among younger, illiterate women .
妇女和儿童在任何人口中都占很大比例。他们最易患病和死亡，尤其是在发展中国家。在许多情况下，孕产妇和儿童健康状况不佳的问题源于对现有服务的利用不足，即使这些服务质量并非最优。本研究旨在描述埃努古州一个农村地区孕产妇和儿童健康（MCH）服务的利用模式，并确定与之相关以及决定这些模式的因素。
本研究采用横断面分析设计。经过预测试的半结构化问卷由访谈者对尼日利亚东南部埃努古州一个农村社区的602名妇女进行发放。进行了两场焦点小组讨论（FGD），每场讨论分别有8 - 10名男性/女性参与，以确定影响服务利用的因素。采用卡方分析来确定与孕产妇和儿童健康服务利用相关的因素。使用逻辑回归来确定利用模式的决定因素。使用N vivo软件分析焦点小组讨论的结果。
研究表明，年龄增长、教育水平、月收入、子女数量以及妇女及其丈夫的职业与孕产妇和儿童健康服务利用率的提高相关。平均月收入（OR：1.317，p = 0.048，CI：0.073 - 0.986）和子女数量（OR：1.196，p < 0.01，CI：1.563 - 7.000）是儿童保健服务利用率提高的决定因素，而教育水平（OR：0.495，p < 0.001，CI：1.244 - 2.164）和年龄（OR：0.115，p < 0.001，CI：0.838 - 0.948）分别决定了分娩和计划生育服务的更好利用。
孕产妇和儿童健康服务利用率的提高与妇女面临的社会经济挑战有关，如文盲和低收入。此外，农村妇女对卫生设施及其工作人员的看法会影响她们对这些服务的使用方式，在旨在降低孕产妇和儿童死亡率的项目中应予以考虑。需要在农村地区，特别是在年轻的文盲妇女中实施具有高度地方特色的行为改变项目。
