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Inequities in healthcare seeking in the treatment of communicable endemic diseases in Southeast Nigeria

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  • Onwujekwe, Obinna

Abstract

This paper investigates the socio-economic inequities in healthcare seeking in the treatment of common communicable endemic diseases, with an emphasis on the use of primary health care (PHC) centres, where most endemic disease control activities take place. A questionnaire was used to collect information on occurrence of diseases and healthcare seeking from randomly selected households in four local government areas in Southeast Nigeria. Principal components analysis was used to create a socio-economic status (SES) index, which was divided into quartiles. The ratio of the values for the poorest quartile to that of the least poor quartile (bottom/top quartile) together with concentration indices for the variables under consideration was used as the measures of inequity. Logistic analysis was used to examine the determinants of use of PHC centres. The poorest quartile was more likely to use low-level providers (patent medicine dealers, shops, herbalists) and least likely to use the PHC centres. The concentration indices were -0.10, -0.06, -0.37, 0.11 and 0.04 for the use of herbalists, patent medicine dealers, community-health workers, PHC centres and hospitals, respectively. Also, the poorest quartile was more likely to lose person-days when ill. Logistic analysis showed that SES, availability of good services, proximity of the centres to the homes and polite health workers increased the use of the PHC centres. As such, improvement of quality of PHC services and improved geographic access could increase the overall use of PHC centres. Furthermore, in the long-term, a decrease in the amount of user fees, enhanced physical access and improved quality of services could decrease inequity in use of PHC centres and hospitals in the treatment of endemic diseases. The bottom/top quartile ratios and concentration indices produced similar results and hence both methods hence complement each other.

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  • Onwujekwe, Obinna, 2005. "Inequities in healthcare seeking in the treatment of communicable endemic diseases in Southeast Nigeria," Social Science & Medicine, Elsevier, vol. 61(2), pages 455-463, July.
    • Handle: RePEc:eee:socmed:v:61:y:2005:i:2:p:455-463
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    2. Sato, Azusa, 2012. "Do Inequalities in Health Care Utilization in Developing Countries Change When We Take into Account Traditional Medicines?," World Development, Elsevier, vol. 40(11), pages 2275-2289.
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    4. Anthony K Ngugi & Felix Agoi & Megan R Mahoney & Amyn Lakhani & David Mang’ong’o & Esther Nderitu & Robert Armstrong & Sarah Macfarlane, 2017. "Utilization of health services in a resource-limited rural area in Kenya: Prevalence and associated household-level factors," PLOS ONE, Public Library of Science, vol. 12(2), pages 1-12, February.
    5. Sahoo, Anil Kumar & Madheswaran, S, 2014. "Healthcare utilisation behaviour in India: Socio-economic disparities & the effect of health insurance," Working Papers 317, Institute for Social and Economic Change, Bangalore.
    6. Onwujekwe, Obinna & Dike, Nkem & Uzochukwu, Benjamin & Ezeoke, Ogochukwu, 2010. "Informal payments for healthcare: Differences in expenditures from consumers and providers perspectives for treatment of malaria in Nigeria," Health Policy, Elsevier, vol. 96(1), pages 72-79, June.
    7. Ralf Krumkamp & Nimako Sarpong & Benno Kreuels & Lutz Ehlkes & Wibke Loag & Norbert Georg Schwarz & Hajo Zeeb & Yaw Adu-Sarkodie & Jürgen May, 2013. "Health Care Utilization and Symptom Severity in Ghanaian Children – a Cross-Sectional Study," PLOS ONE, Public Library of Science, vol. 8(11), pages 1-1, November.
    8. Xiaxia Sun & Hongdao Meng & Zhiqiu Ye & Kyaien O Conner & Zhanqi Duan & Danping Liu, 2019. "Factors associated with the choice of primary care facilities for initial treatment among rural and urban residents in Southwestern China," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-14, February.
    9. Obinna Onwujekwe & Chima Onoka & Benjamin Uzochukwu & Eric Obikeze & Nkoli Ezumah, 2009. "Issues in equitable health financing in South Eastern Nigeria: Socio-economic and geographic differences in households' illness expenditures and policy makers' views on the financial protection of the," Journal of International Development, John Wiley & Sons, Ltd., vol. 21(2), pages 185-199.
    10. Dike, Nkem & Onwujekwe, Obinna & Ojukwu, Juliana & Ikeme, Arthur & Uzochukwu, Benjamin & Shu, Elvis, 2006. "Influence of education and knowledge on perceptions and practices to control malaria in Southeast Nigeria," Social Science & Medicine, Elsevier, vol. 63(1), pages 103-106, July.
    11. Ferdi Botha & Edwin Wouters & Frikkie Booysen, 2018. "Happiness, Socioeconomic Status, and Family Functioning in South African Households: a Structural Equation Modelling Approach," Applied Research in Quality of Life, Springer;International Society for Quality-of-Life Studies, vol. 13(4), pages 947-989, December.
    12. Onwujekwe, Obinna & Onoka, Chima & Uzochukwu, Benjamin & Okoli, Chijioke & Obikeze, Eric & Eze, Soludo, 2009. "Is community-based health insurance an equitable strategy for paying for healthcare? Experiences from southeast Nigeria," Health Policy, Elsevier, vol. 92(1), pages 96-102, September.
    13. Chiyoe Murata & Tetsuji Yamada & Chia-Ching Chen & Toshiyuki Ojima & Hiroshi Hirai & Katsunori Kondo, 2010. "Barriers to Health Care among the Elderly in Japan," IJERPH, MDPI, vol. 7(4), pages 1-12, March.
    14. Michael N Onah & Veloshnee Govender, 2014. "Out-of-Pocket Payments, Health Care Access and Utilisation in South-Eastern Nigeria: A Gender Perspective," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-11, April.

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