COMPARATIVE STUDY OF UTILIZATION OF MATERNAL AND CHILD HEALTH SERVICES IN URBAN AND RURAL COMMUNITIES IN ANAMBRA STATE
Introduction/Objective: Maternal and child health is an aspect of primary health care that seeks to promote both the health of the mother particularly through the child bearing period and also the health of the child. This study determined and compared the level and pattern of utilization of MCH services in urban and rural communities in Anambra State and identified factors influencing them.
Design and Method: A comparative cross-sectional descriptive study was carried out in two Local Government Areas in Anambra State; Nnewi North (urban) and Dunukofia (rural). The study was conducted between January-March 2009. A total of three hundred and thirty eight (338) mothers with children aged 0-59 months in each of the two LGAs selected by multistage cluster sampling technique were studied. Data was collected from them using a semi-structured, pre-tested, interviewer administered questionnaire. This was complemented with a 2 year retrospective review of public health facility records in the study communities on antenatal care, delivery services and postnatal care services utilization and routine immunization of children. SPSS version 13 software package was used for data analysis. The data collected was analyzed using statistical means, chi-Square test and percentages and the p-value was set at 0.05.
Results: Majority of the women were aged between 25–34 years of age, married and educated in both communities. However, women in the rural area had higher fertility rate (t=4.53, p<0.05) and more children alive (t=4.79,p<0.05) but the urban women were more educated and were of higher socioeconomic status. Knowledge of MCH service utilization was high among the respondents although higher in the urban area. Also, ANC, maternity and post natal services utilization rate was high in both communities but level and pattern of utilization differed in both localities. Majority in the urban areas utilized the services of the private hospitals while the majority of the rural women patronized the maternity homes and had less access to skilled birth attendants. Average ANC attendance and booking in the first trimester of the pregnancy were statistically significant in both areas (χ2 = 7.52, p < 0.05 and χ2 = 8.96, p < 0.05 respectively). Only 16% of women in the rural areas were involved in decision making of their health issues as against 12.1% of women in the urban areas. Physical and economic access, in addition to quality of service and family decision making process were the factors influencing MCH service utilization particularly in the rural women. Also, health facility assessment also revealed low MCH service utilization in the rural than in urban area.
Conclusion: The study demonstrated obvious difference in maternal and child health care service utilization in both localities. Women in the rural communities were less likely to have access to quality MCH services, because they are less
educated. Therefore, measures to improve maternal and child health service utilization should not only address the issue of access to care, but also improvement in quality of care and women empowerment.