Predictors of maternal health service utilization: a community based, rural-urban comparison in Nigeria

Abstract

Objectives: Provision of skilled health care during pregnancy, childbirth and the early postpartum period is an effective strategy to reduce maternal mortality. This study was done to determine and compare the utilization of antenatal and delivery services in an urban and rural area of Lagos State.
Methods: A community based cross sectional study was done in Surulere and Ibeju Lekki LGAs among mothers of under-fives. Multistage sampling was used to select 600 respondents in both LGAs. Information was collected with a structured questionnaire. Data was analyzed with Epi info 3.5.1 and inferential statistics done were chi square, fisher’s exact and t tests at p<0.05. Multiple logistic regressions were also done to determine predictors of utilization.
Results: Eighty four percent of women in both areas had formal ANC; 79.7% (rural) and 75.0% (urban) had institutional delivery for their last confinement. Among both groups of women, increasing maternal age increased ANC use while higher maternal education was associated with delivery in a health facility. Predictors of ANC use were being married (rural), Christianity and lower parity (urban). For both groups of women, religion, maternal and spouse’s education had a positive effect on having skilled delivery. Among the rural women, ANC utilization positively influenced institutional delivery. Predictors of use of skilled delivery were being older, being married or co-habiting and lower parity (rural); being younger and higher educational level (urban).
Conclusion: There is high utilization of ANC services in both groups of women with a lower use of institutional delivery services in the urban area. There is need for intervention to further improve use of skilled delivery.

Keywords: Health-seeking behavior, ANC, Delivery, Rural, Urban, Nigeria