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BMC health services research
Sep 10, 2020;20 (1): 849.

Geographical and socioeconomic inequalities in the utilization of maternal healthcare services in Nigeria: 2003-2017.

Chijioke Okoli, Mohammad Hajizadeh, Mohammad Mafizur Rahman, Rasheda Khanam
Author Information
  1. Chijioke Okoli: School of Commerce, and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia. chijioke.okoli@usq.edu.au. ORCID
  2. Mohammad Hajizadeh: School of Health Administration, Dalhousie University, Halifax, Canada.
  3. Mohammad Mafizur Rahman: School of Commerce, and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia.
  4. Rasheda Khanam: School of Commerce, and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia.
PMID: 32912213 DOI: 10.1186/s12913-020-05700-w

Abstract

BACKGROUND: Maternal mortality has remained a challenge in many low-income countries, especially in Africa and in Nigeria in particular. This study examines the geographical and socioeconomic inequalities in maternal healthcare utilization in Nigeria over the period between 2003 and 2017.
METHODS: The study used four rounds of Nigeria Demographic Health Surveys (DHS, 2003, 2008, 2013, and 2018) for women aged 15-49 years old. The rate ratios and differences (RR and RD) were used to measure differences between urban and rural areas in terms of the utilization of the three maternal healthcare services including antenatal care (ANC), facility-based delivery (FBD), and skilled-birth attendance (SBA). The Theil index (T), between-group variance (BGV) were used to measure relative and absolute inequalities in the utilization of maternal healthcare across the six geopolitical zones in Nigeria. The relative and absolute concentration index (RC and AC) were used to measure education-and wealth-related inequalities in the utilization of maternal healthcare services.
RESULTS: The RD shows that the gap in the utilization of FBD between urban and rural areas significantly increased by 0.3% per year over the study period. The Theil index suggests a decline in relative inequalities in ANC and FBD across the six geopolitical zones by 7, and 1.8% per year, respectively. The BGV results do not suggest any changes in absolute inequalities in ANC, FBD, and SBA utilization across the geopolitical zones over time. The results of the RC and the AC suggest a persistently higher concentration of maternal healthcare use among well-educated and wealthier mothers in Nigeria over the study period.
CONCLUSION: We found that the utilization of maternal healthcare is lower among poorer and less-educated women, as well as those living in rural areas and North West and North East geopolitical zones. Thus, the focus should be on implementing strategies that increase the uptake of maternal healthcare services among these groups.

Keywords

Geographical inequalities socioeconomic inequalities Maternal healthcare Nigeria

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MeSH Term

Adolescent
Adult
Educational Status
Female
Health Surveys
Healthcare Disparities
Humans
Maternal Health Services
Middle Aged
Nigeria
Patient Acceptance of Health Care
Poverty
Pregnancy
Prenatal Care
Socioeconomic Factors
Young Adult
Journal Article
Article has an altmetric score of 39

Word Cloud

Created with Highcharts 10.0.0healthcareinequalitiesmaternalutilizationNigeriastudyusedservicesFBDgeopoliticalzonessocioeconomicperiodmeasureruralareasANCindexrelativeabsoluteacrossamongMaternal2003womendifferencesRDurbanSBATheilBGVsixconcentrationRCACperyearresultssuggestNorthGeographicalBACKGROUND:mortalityremainedchallengemanylow-incomecountriesespeciallyAfricaparticularexaminesgeographical2017METHODS:fourroundsDemographicHealthSurveysDHS200820132018aged15-49 yearsoldrateratiosRRtermsthreeincludingantenatalcarefacility-baseddeliveryskilled-birthattendanceTbetween-groupvarianceeducation-andwealth-relatedRESULTS:showsgapsignificantlyincreased03%suggestsdecline718%respectivelychangestimepersistentlyhigherusewell-educatedwealthiermothersCONCLUSION:foundlowerpoorerless-educatedwelllivingWestEastThusfocusimplementingstrategiesincreaseuptakegroupsNigeria:2003-2017

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