Eze Paul, Aniebo Chioma Lynda, Ilechukwu Stanley, Lawani Lucky Osaheni
Department of Health Policy and Administration, Penn State University, University Park, PA, USA.
Department of Community Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.
Health Serv Insights. 2025 Mar 31;18:11786329251330032. doi: 10.1177/11786329251330032. eCollection 2025.
Many individuals in low- and middle-income countries with healthcare needs do not access the necessary, often lifesaving healthcare services. Existing universal health coverage (UHC) indicators do not account for a portion of the population with unmet healthcare needs.
To estimate the prevalence, wealth-related inequality, and determinants of unmet healthcare needs in Nigeria using data from the nationally-representative Nigeria Living Standards Survey, 2018-2019.
We analyzed data from a cross-sectional sample of 116 320 Nigerians from 22 110 households selected using multi-stage probability sampling. The outcome variable was self-reported unmet healthcare needs. We conducted concentration index (CIX) analyzes to assess wealth-related inequalities and performed multilevel logistic regression analysis to identify the determinants of unmet healthcare needs at the individual, household, and community levels.
The prevalence of unmet healthcare needs was 5.2% (95% CI: 5.0-5.5), representing about 11 million Nigerians (95% CI: 10.5-11.5 million). The most common reasons were high costs (unaffordability) and the perception that the illness or injury was not serious. Wagstaff-normalized CIX for unmet healthcare needs was pro-poor: -0.09730 for the general population and -0.10878 for those with chronic illnesses. Significant determinants of unmet healthcare needs include age (AOR: 0.99, 95% CI: 0.99-1.00), chronic illness (AOR: 8.73, 95% CI: 7.99-9.55), single-person households (AOR: 1.55, 95% CI: 1.20-2.02), poorest quintile households (AOR: 1.45, 95% CI: 1.19-1.78), and mildly (AOR: 1.17, 95% CI: 1.01-1.36) or moderately food-insecure households (AOR: 1.30, 95% CI: 1.11-1.51).
A significant proportion of Nigerians, particularly the very poor, chronically ill, those living alone, or food insecure, have unmet healthcare needs. This highlights the necessity for targeted interventions to ensure vulnerable populations can access essential healthcare services. To progress toward UHC, the Nigerian health system must address critical issues related to healthcare accessibility.
许多中低收入国家有医疗需求的人无法获得必要的、往往能救命的医疗服务。现有的全民健康覆盖（UHC）指标没有考虑到一部分有未满足医疗需求的人群。
利用2018 - 2019年具有全国代表性的尼日利亚生活水平调查数据，估计尼日利亚未满足医疗需求的患病率、与财富相关的不平等情况及其决定因素。
我们分析了来自22110户家庭的116320名尼日利亚人的横断面样本数据，这些家庭是通过多阶段概率抽样选取的。结果变量是自我报告的未满足医疗需求。我们进行了集中指数（CIX）分析以评估与财富相关的不平等情况，并进行了多层次逻辑回归分析，以确定个体、家庭和社区层面未满足医疗需求的决定因素。
未满足医疗需求的患病率为5.2%（95%置信区间：5.0 - 5.5），约为1100万尼日利亚人（95%置信区间：1050 - 1150万）。最常见的原因是费用高昂（负担不起）以及认为疾病或损伤不严重。未满足医疗需求的瓦格斯塔夫标准化集中指数有利于穷人：普通人群为 - 0.09730，慢性病患者为 - 0.10878。未满足医疗需求的重要决定因素包括年龄（优势比：0.99，95%置信区间：0.99 - 1.00）、慢性病（优势比：8.73，95%置信区间：7.99 - 9.55）、单人家庭（优势比：1.55，95%置信区间：1.20 - 2.02）、最贫困五分之一家庭（优势比：1.45，95%置信区间：1.19 - 1.78）以及轻度（优势比：1.17，95%置信区间：1.01 - 1.36）或中度粮食不安全家庭（优势比：1.30，95%置信区间：1.11 - 1.51）。
很大一部分尼日利亚人，特别是非常贫困、患有慢性病、独居或粮食不安全的人，有未满足的医疗需求。这凸显了有针对性干预措施的必要性，以确保弱势群体能够获得基本医疗服务。为了朝着全民健康覆盖取得进展，尼日利亚卫生系统必须解决与医疗可及性相关的关键问题。
