Neighborhood socioeconomic disadvantage, individual wealth status and patterns of delivery care utilization in Nigeria: a multilevel discrete choice analysis
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Date
2011
Journal Title
Journal ISSN
Volume Title
Publisher
International journal of women's health
Abstract
High maternal mortality continues to be a major public health problem in
most part of the developing world, including Nigeria. Understanding the utilization pattern of
maternal healthcare services has been accepted as an important factor for reducing maternal
deaths. This study investigates the effect of neighborhood and individual socioeconomic position
on the utilization
of different forms of place of delivery among women of reproductive age in
Nigeria.
Methods: A population-based multilevel discrete choice analysis was performed using the
most recent population-based 2008 Nigerian Demographic and Health Surveys data of women
aged between 15 and 49 years. The analysis was restricted to 15,162 ever-married women from
888 communities across the 36 states of the federation including the Federal Capital Territory
of Abuja.
Results: The choice of place to deliver varies across the socioeconomic strata. The results of
the multilevel discrete choice models indicate that with every other factor controlled for, the
household wealth status, women’s occupation, women’s and partner’s high level of education
attainment, and possession of health insurance were associated with use of private and
government health facilities for child birth relative to home delivery. The results also show that
higher birth order and young maternal age were associated with use of home delivery. Living in
a highly socioeconomic disadvantaged neighborhood is associated with home birth compared
with the patronage of government health facilities. More specifically, the result revealed that
choice of facility-based delivery is clustered around the neighborhoods.
Conclusion: Home delivery, which cuts across all socioeconomic strata, is a common practice
among women in Nigeria. Initiatives that would encourage the appropriate use of healthcare
facilities at little or no cost to the most disadvantaged should be accorded the utmost priority.
Description
Keywords
Delivery care, Maternal health services utilization, Multilevel discrete choice, Nigeria, Socioeconomic disadvantaged, Neigborhood, Health policy
Citation
Aremu, O., Lawoko, S., & Dalal, K. (2011). Neighborhood socioeconomic disadvantage, individual wealth status and patterns of delivery care utilization in Nigeria: a multilevel discrete choice analysis. International journal of women's health , 3 , 167. http://dx.doi.org/10.2147/IJWH.S21783