Determinants of primary healthcare services utilisation in an under-resourced rural community in Enugu State, Nigeria: a cross-sectional study

Abstract

Introduction: primary health care (PHC) is essential towards achieving universal health coverage. Improving PHC services require understanding context-specific factors influencing utilisation. We assessed the factors influencing utilisation of PHC services in a rural community in Enugu, Nigeria. Methods: we conducted a cross-sectional community-based survey between May and June, 2017. Information on socio-demographic characteristics, utilisation of PHC services, community- and PHC facility-related factors associated with utilisation of PHC services was obtained from 335 adult residents aged ≥ 18 years using a pre-tested semi-structured interviewer-administered questionnaire. Data were analysed using descriptive and inferential statistics at 5% level of significance. Results: of the 335 respondents, 155 (46.2%) reported utilisation of PHC services the last time they were sick. Of 178 respondents who did not utilise PHC services, 51 (28.7%) reported poor quality health services, 41 (23.0%) unavailability of medical doctors, 31 (17.4%) long patient waiting time and 25 (14.0%) unavailability of drugs as reasons for non-utilisation. Being a female (AOR = 2.3 (95% CI 1.3 - 4.0)), affordability of health services (AOR = 2.4 (95% CI 1.3 - 4.6)), inadequacy of healthcare staff (AOR = 0.3 (95% CI 0.1 - 0.5)), shorter hospital waiting time (AOR = 2.2 (95% CI 1.2 - 4.3)) and satisfaction with PHC services during previous visit (AOR = 2.6 (95% CI 1.1 - 6.3)) influenced utilisation of PHC services. Conclusion: PHC services utilisation was low. Improving utilisation would require addressing cost of health services, adequacy of healthcare staff, patient waiting time and ensuring patient satisfaction with PHC services.