Barriers to accessing health care in Nigeria: implications for child survival
Sunday A Adedini1, Clifford Odimegwu2, Olusina Bamiwuye3
1Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa; Demography and Social Statistics Department, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria; sadedini@cartafrica.org.
Insights
Barriers to healthcare in Nigeria significantly increase the risk of under-five child mortality. Addressing these barriers, including cultural, resource, and physical obstacles, is crucial for improving child survival rates.
Area of Science:
- Public Health
- Demography
- Child Survival Studies
Background:
- Nigeria faces high under-five mortality rates, with approximately one in six children dying before age five.
- While improved healthcare access is known to enhance child survival, significant barriers hinder access in Nigeria.
- A systematic examination of how these healthcare access barriers impact under-five mortality in Nigeria was lacking.
Purpose of the Study:
- To investigate the association between barriers to healthcare access and under-five mortality in Nigeria.
- To quantify the risk of under-five mortality associated with different types of healthcare access barriers.
Main Methods:
- Utilized data from the 2008 Nigeria Demographic and Health Survey, encompassing 18,028 women and 28,647 live births.
- Employed Cox proportional hazard models to estimate the risk of death in children under five.
- Results were presented as hazard ratios (HR) with 95% confidence intervals (CI).
Main Results:
- Children whose mothers faced cultural or resource-related barriers exhibited a significantly higher risk of under-five mortality (HR: 1.44, CI: 1.32-1.57).
- Physical barriers to healthcare access also increased under-five mortality risk (HR: 1.13, CI: 1.04-1.24).
- Healthcare access barriers remained a significant predictor of child survival, even after controlling for confounding factors.
Conclusions:
- Eliminating barriers to healthcare access is essential for reducing under-five mortality in Nigeria.
- Improving access to adequate healthcare services is a critical strategy for achieving substantial reductions in childhood mortality.
Background:
Existing studies indicate that about one in every six children dies before age five in Nigeria. While evidence suggests that improved access to adequate health care holds great potential for improved child survival, previous studies indicate that there are substantial barriers to accessing health care in Nigeria. There has not been a systematic attempt to examine the effects of barriers to health care on under-five mortality in Nigeria. This study is designed to address this knowledge gap.
Data And Method:
Data came from a nationally representative sample of 18,028 women (aged 15-49) who had a total of 28,647 live births within the 5 years preceding the 2008 Nigeria Demographic and Health Survey. The risk of death in children below age five was estimated using Cox proportional hazard models and results are presented as hazards ratios (HR) with 95% confidence intervals (CI).
Results:
Results indicate higher under-five mortality risks for children whose mothers had cultural barriers and children whose mothers had resource-related barriers to health care (HR: 1.44, CI: 1.32-1.57, p<0.001), and those whose mothers had physical barriers (HR: 1.13, CI: 1.04-1.24, p<0.001), relative to children whose mothers reported no barriers. Barriers to health care remained an important predictor of child survival even after adjusting for the effects of possible confounders.
Conclusion:
Findings of this study stressed the need for improved access to adequate health care in Nigeria through the elimination of barriers to access. This would enable the country to achieve a significant reduction in childhood mortality.
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