Utilization of Primary Health Care Services… Agofure, O. et al.

339

ORIGINAL ARTICLE
Utilization of Primary Health Care Services in Jaba Local
Government Area of Kaduna State Nigeria
Agofure Otovwe 1*, Sarki Elizabeth1

ABSTRACT

OPEN ACCESS BACKGROUND: Primary health care was designed to provide

accessible health care for all. However, most primary health care
Citation: Agofure Otovwe, Sarki
facilities are in various states of disrepair, catering for less than
Elizabeth. Analysis Utilization of Primary 20% of potential patients in the population. This study was
Health Care Services in Jaba Local designed to investigate the utilisation of primary health care
Government Area of Kaduna State
Nigeria. J Health Sci 2017;27(4):339. doi: services in Jaba Local Government Area of Kaduna State Nigeria.
http://dx.doi.org/10.4314/ejhs.v27i4.5 METHODS: The study employed a cross-sectional study design
Received: January 9, 2017 conducted among 383 respondents utilising simple random
Accepted: January 10, 2017
Published: July 1, 2017 sampling techniques. A pretested semi-structured questionnaire
Copyright: © 2017 Mesfin Agofure O., was administered to obtain information from respondents, while
et al. This is an open access article
distributed under the terms of the
descriptive statistics was used to analyse the data.
Creative Commons Attribution License, RESULTS: The results show that almost all of the respondents,
which permits unrestricted use, 333(97.90%), were aware of the existence of primary health care
distribution, and reproduction in any
medium, provided the original author and services in their community. Furthermore, the majority of the
source are credited. respondents, 304(89.40%), utilized primary health care services
Funding: Nil while 293(86.20%) and 212(62.40%) were satisfied with the amount
Competing Interests: The authors
declare that this manuscript was approved of charges for services and the supply of drugs respectively.
by all authors in its form and that no According to the respondent, weak services in primary health care
competing interest exists.
Affiliation and Correspondence:
includes; personal hygiene and nutritional education, management
1
Department of Public and of chronic diseases and cancer screening. Factors that influence
community Health, College of Health the utilization of primary health care services according to the
Sciences, Novena University Ogume,
Delta State Nigeria respondents were availability of trained personnel (AOR=1.828
*
Email: [email protected] 95% CI=0.410-1.672), attitude of staffs (AOR=1.114 95%
CI=0.527-2.355), waiting times (AOR=1.110 95% CI=0.584-2.224)
and availability of diagnostic services (AOR=0.951 95% CI=0.472-
1.918).
CONCLUSION: The study highlighted the weaknesses in some of
the services offered at the various primary health centres and the
factors which can hinder the residents from patronizing primary
health care services.

KEYWORDS: Primary Health Care Services, Utilisation,

Satisfaction, Jaba

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340 Ethiop J Health Sci. Vol. 27, No. 4 July 2017

INTRODUCTION example, health outcomes and utilization of health

care in Nigeria have been found to be low but vary
The International Conference on Primary Health across regions with the Northeast and Northwest
Care (PHC) defined primary health care as an regions and rural areas faring considerably worse
essential health care based on practical, off than the rest of the country, a pattern largely
scientifically sound and socially acceptable attributed to the high levels of poverty in the north
methods and technology made universally (5). Similarly, in a study in South Africa on the
accessible to individuals and their families in the 285 participants, 209(73%) people were reported
community through their full participation and at a to have utilized just one of the different services
cost that community and country can afford to available while 76(27%) people utilized 2 to 3 of
maintain at every stage of their development in the the services (6). Also, a study in Southwest
spirit of self-reliance and self-determination (1). Nigeria showed that only 42.50% of the
The goal of PHC was to provide accessible health participants in the study utilized primary health
for all by the year 2000 and beyond. care services (7)
Consequently, to achieve this goal, the National Furthermore, several barriers have been
Health Policy (2) brought a comprehensive health shown to influence rate of utilization of PHC
care system based on primary health care. The facilities. Although facilities in all states in
main objective is to promote, protect, prevent, Nigeria offer exemptions and waivers to a limited
restore and rehabilitate all citizens within the degree in services such as routine immunization,
context of available resources. As a result family planning and antenatal care; the cost of
individuals and communities are assured of receiving health care remains a main barrier to
productivity, social well-being and enjoyment of access health services in the country (8).
living. Similarly, differences in type of facilities across
The health services, based on PHC, include urban and rural areas have been shown to
among other things, education concerning influence utilization of health services. As
prevailing health problems and the methods of expected, higher level facilities including facilities
preventing and controlling them, promotion of in urban areas are more likely to offer a larger
food supply and proper nutrition, maternal and variety of services seven days a week, 24 hours a
child care (including family planning, day, thus are more likely to have more
immunization against the major infectious patronization of health care services than their
diseases, prevention and control of locally rural counterpart (5). Other barriers highlighted to
endemic and epidemic diseases) and provision of affect utilization of primary health care services
essential drugs and supplies. However, primary includes socioeconomic, psychological,
health care, which is supposed to be the bedrock demographic or geographical barriers (9).
of the country's health care policy, is currently Therefore, this study was designed to
catering for less than 20% of the potential patients investigate the utilisation of primary health care
(3). While most PHC facilities are in various states services in Jaba Local Government Area of
of disrepair, with equipment and infrastructure Kaduna State Nigeria. The Health Belief Model
being either absent or obsolete, the referral system (HBM) was used to explain the utilization of
is almost non-existent (4). primary health care services among residents of
This state of most PHC facilities does not only Jaba Local Government Area of Kaduna State.
pose danger to the nation but also affects the rate
of utilization of primary health care facilities. For

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 Utilization of Primary Health Care Services… Agofure, O. et al. 341

Diagrammatic representation of the health belief model on the utilization of PHC services by the residents
of Jaba Local Government Area of Kaduna State

Modifying
Variables Perceived Benefits
Awareness Reduction of
Knowledge morbidity & mortality
Socio-cultural
Perceived severity due to diseases
variables Perceived Barriers
Knowledge of the Taking action against Likelihood of Utilizing
risk involved in socio-cultural barriers PHC facilities and
not utilizing PHC to utilize PHC services services
services Self Efficacy
Perceived Knowledge of the
Susceptibility benefits & utilizing
Susceptibility to PHC services
Cues to Action
Figure 1: Adapted
Morbidity & Awareness through
Mortality due to TV, Radio, Health
diseases Edu., Posters
Figure 1: Adapted from U.S. Department of Health and Human Services, 2005
calculation are: Z at 95% confidence interval
METHODS obtained from statistical table of normal
distribution, Prevalence of 42.50% which is the
The study is a cross-sectional design, utilizing
prevalence of utilization of PHCs services in a
quantitative method of data collection to assess the
study conducted in Southwest Nigeria (7) and
utilization of primary health care among residents
degree of accuracy desired at 0.05. The sample
of Jaba Local Government Area of Kaduna State.
size of 340 was obtained after calculation.
Jaba is a Local Government Area in Kaduna State,
Inclusion criteria: Respondents for the study
Nigeria. Its headquarters is in the town of Kwoi
were those residing in and around the nine
(Har Kwain) in Hyam, the language of almost all
communities where PHC is located in Jaba Local
the entire inhabitants of the local area. The people
Government Area. This was done in order to
know themselves as the Ham and speak Hyam but
assess their utilization and satisfaction of PHC
are called 'Jaba' by the Hausa. The study
services.
population consists of residents of communities
Exclusion criteria: All residents of communities
where primary health care centres are located in
outside the nine communities where PHC is
Jaba Local Government Area of Kaduna State.
located were excluded from the study.
The communities include Nkunchem, Daddu, Fai,
Sampling procedure: The nine communities
Sab-Zuro, Sabon Gari Chori, Nok, Nduya, Fada,
where primary health care was located in Jaba
Samban Gida.
Local Government Area were selected for the
Sample size determination: The formula for
study. Thereafter, stratified sampling was used to
sample size calculation for single proportion was
proportionally allocate number of respondents to
used for the study. The parameters used for the
be sampled from each of the selected
communities, which gave the following figures
Nkunchem (50) Daddu (50) Fai (30) Sab-Zuro
(20) Sabon Gari Chori, (50) Nok (30) Nduya (30)

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342 Ethiop J Health Sci. Vol. 27, No. 4 July 2017

Fada (50) Samban Gida (30). Thereafter, the Ethical consideration: Ethical approval for the
respondents were sampled through simple random study was obtained from the ethical committee of
sampling technique from the selected the Department of Public and Community Health,
communities. Novena University.
Instrument for data collection: The instrument Limitation of the study: The main limitation of
for data collection was a semi-structured the study was the possibility of recall bias. The
questionnaire which was developed in part by the study solely depended on responses of the
researcher, while some part was adapted from the participants without doing a confirmatory check if
World Bank working paper of improving Primary the participants actually attended PHCs prior to
Health Care Delivery in Nigeria, Evidence from the study.
Four States (5). The questionnaire was divided
into six sections A-E. It was distributed to RESULTS
sampled respondents on the day of data collection
Socio-demographic characteristics of the
in the selected communities, and the filled
respondents: According to Table 1, almost two
questionnaire was retrieved immediately. Trained
third, 108(31.20%), of the respondents were
nurses who were recruited from PHCs in the
between the ages of 35-44 years while majority,
selected communities assisted the researcher in the
238(70.0%), were married and 278(81.80%) had
distribution of the questionnaires.
attained tertiary education. In addition, more than
The validity of the questionnaire was
half, 196(57.60%), were civil/public servants and
improved by pre-testing it. Furthermore, the
234(68.80%) lived in areas of less than 5km from
reliability of the instrument was determined using
the nearest primary health care.
the Cronbach’s Alpha technique. The data were
Awareness and types of services rendered
analyzed with Statistical Product for Service
among the respondents: As shown in Table 2,
Solution (SPSS) version 15.0 (IBM Corp.,
almost all, 333(97.90%), of the respondents were
Chicago, USA). Descriptive statistics such as
aware of the existence of primary health care
mean, standard deviation and inferential statistics
services in the community, with health workers,
such as Chi-square and logistic regression were
168(50.50%), as the source of information for
used to test for associations between variables of
most of them. Furthermore, 227(22.30%) of the
interest set at P< 0.05.
respondents were aware of vaccination as a type of
Measurement: The level of utilization of primary
service offered in primary health care in the area,
health care services was measured using a 14-
while 192(18.80%) listed sphygmomanometer as a
point scale. The scales were 0-6 as poor utilization
type of equipment present in primary health
primary health care services and >6 as good
centres in the area, and 223(21.90%) affirmedanti-
utilization of primary health care services.
malaria as a type of basic pharmaceutical present
in primary health centre in the area.

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 Utilization of Primary Health Care Services… Agofure, O. et al. 343

Table 1: Socio-Demographic Characteristics of the Respondents

Variable Frequency Percentage Utilisation of PHC

Name of ward
Sabon Gari Chori 50 14.70
Sab-Zuro 20 5.90
Nkumchem 50 14.70
Fada 50 14.70
Daddu 50 14.70
Fai 30 8.80
Nok 30 8.80
Sambam 30 8.80
Nduya 30 8.80
Age of respondents (in years)
15-24 62 18.20
25-34 106 31.20
35-44 108 31.20
45-54 58 17.10
55-64 5 1.50
65-74 1 0.30
Marital Status
Single 90 26.50
Married 238 70.0
Divorced/Separated 4 1.20
Widow/Widower 8 2.40
Highest level of education
Primary 2 0.60
Secondary 56 16.50
Tertiary 278 81.80
No formal education 4 1.20
Occupation
Unemployed 48 14.10
Business/Petty trading 29 8.50 *0.000
Civil/public servant 196 57.60
Artisan 4 1.20
Student 63 18.50
Monthly Income
Less than N5000 102 30.0
N5000-N10,000 31 9.10 *0.004
N11,000-N20,000 19 5.60
N21000-N30,000 40 11.80
N31000 & above 148 43.50
Distance of house to PHC
Less than 5km 234 68.80
5-10km 83 24.40 *0.015
Greater than 10km 23 6.80
*P-value
Table 2: Awareness and type of services rendered in PHC

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344 Ethiop J Health Sci. Vol. 27, No. 4 July 2017

Variable Frequency Percentage

Awareness of the existence of primary health care services in the
community
Yes 333 97.90
No 7 2.10
Source of information on existence of primary health care
Television 28 8.40
Radio 38 11.40
Newspaper 10 3.0
Friends/Relative 51 15.30
Health workers 168 50.50
Church 33 9.90
Community leaders 5 1.50
Type of services offered in PHCs in the area
Vaccination 227 22.30
General disease checkup 210 20.60
Blood pressure check 206 20.20
Blood group & Genotype 66 6.50
HIV counseling & testing 77 7.50
Malaria prophylactic treatment 65 6.40
Weight monitoring 63 6.20
Breast feeding practice & family planning 51 5.0
Personal hygiene & nutrition education 31 3.0
Cancer screening 8 0.80
Management of chronic diseases 16 1.60
Type of equipments present in PHCs in the area
Generator 158 15.50
Refrigerator 150 14.70
Sphygmomanometer 192 18.80
Child weighing scale 118 11.60
Thermometer 120 11.80
Bandages 103 10.10
Stethoscope 74 7.30
Disposable syringes & needles 65 6.40
Urine test strip 40 3.90
Type of basic pharmaceuticals & vaccines present in PHCs
Anti-malaria 223 21.90
Paracetamol 212 20.80
BCG & DPT vaccines 213 20.90
Measles 157 15.40
Pregnancy test kit 132 12.90
Contraceptives 83 8.10

Level of Utilisation of Primary Health Care that their main reason for utilizing primary health
Services: According to Table 3, the majority, care services was to monitor the health status of
330(97.10%), of the respondents utilized primary their children, and 175(51.50%) said that the last
health care services with 359(35.20%) affirming time they visited a primary health centre was less

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 Utilization of Primary Health Care Services… Agofure, O. et al. 345

than a month. The reasons for the visits to primary respectively. Figure 2 shows that most of the
health care according to the respondents were respondents, 304(89.40%), utilized primary health
immunization, 115(34.30%), malaria treatment, care services in the study area, while 36(10.60%)
108(32.20%), and family planning 9(2.70%) utilized primary health care services poorly.

Table 3: Level of utilization of primary health care services

Variable Frequency Percentage
Respondents that utilize primary health care service
Yes 330 97.10
No 10 2.90
Reasons for utilizing PHCs
To monitor my health 230 22.50
To monitor the health status of my child/children 359 35.20
Antenatal care 250 24.50
Family planning 181 17.70
When last respondents visited PHCs
Less than a month 175 51.50
1-6 months 99 29.10
More than 6 months 59 17.40
Never 7 2.10
Reasons for the visits to PHCs
Immunization 115 34.30
Malaria treatment 108 32.20
Family planning 9 2.70
Antenatal 18 5.40
Blood pressure checkup 35 10.40
Treatment of other fever 50 14.90
If you were to decide on a place of treatment, where would you prefer
Home 97 9.50
Primary health centre 267 26.20
General Hospital 274 26.90
Traditional healers 167 16.40
Private 130 12.70
Prayer house 85 8.30
Reasons for preference of the above place of treatment
Spouses decision 67 19.70
It is cheap 94 27.60
To confirm with tradition 1 0.30
They attend to me fast 178 52.40

Level of Satisfaction of Primary Health Care care as satisfactory. These include;

services among respondents: As shown in Table vaccination/immunization services 312(91.80%),
4, the majority of the respondents, 293(86.20%), child care services 31(91.50%), antenatal care
were satisfied with the amount charged for services 310(91.20%) and management of chronic
services. Similarly, majority also graded the diseases 107(31.50%).
following services rendered at the primary health

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346 Ethiop J Health Sci. Vol. 27, No. 4 July 2017

Table 4: Level of satisfaction of PHC services

Variable Frequency Percentage

Satisfaction with the amount charged for services
Yes 293 86.20
No 47 13.80
How would you grade the supply of drugs
Poor 128 37.60
Satisfactory 212 62.40
How would you grade the vaccination/immunization services
Poor 28 8.20
Satisfactory 312 91.80
How would you grade the treatment modalities
Poor 75 22.10
Satisfactory 265 77.90
How would you grade the family planning services
Poor 55 16.20
Satisfactory 285 83.80
How would you grade the management of chronic diseases
Poor 233 68.50
Satisfactory 107 31.50
How would you grade the dissemination of information on disease
& care 25.0
Poor 85 75.0
Satisfactory 255
How would you grade the services of child care
Poor 29 8.50
Satisfactory 311 91.50
How would you grade the Antenatal care services
Poor 30 8.80
Satisfactory 310 91.20
How would you grade the Postnatal care services
Poor 60 17.60
Satisfactory 280 82.40
How would you grade the delivery services
Poor 49 14.40
Satisfactory 291 85.60
How would you grade malaria and prophylactic treatment services
Poor 51 15.0
Satisfactory 289 85.0
How would you grade the services of STI/HIV/AIDS
Poor 90 26.50
Satisfactory 250 73.50
How would you grade health education services
Poor 65 19.10
Satisfactory 275 80.90
How would you grade nutritional services
Poor 129 37.90
Satisfactory 211 62.10
How would you grade referral services
Poor 133 39.10
Satisfactory 207 60.90

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 Utilization of Primary Health Care Services… Agofure, O. et al. 347

Figure 2: Level of utilization of PHC services

Factors influencing the utilization of PHCs in utilization of primary health care (AOR=1.828
the study area: According to Table 5, after 95% CI=0.410-1.672) followed by attitude of staff
adjusting the crude odd ratios multiple logistic (AOR=1.114 95% CI=0.527-2.355), waiting times
regression of the factors influencing utilization of at the health centre (AOR=1.110 95% CI=0.584-
primary health care shows availability of trained 2.224) and distance from the facility (AOR=1.053
staff is one of the major factors influencing the 95% CI=0.526-2.110).

Table 5: Factors that influence the utilization of PHCs in the study area
Factors COR AOR 95% CI
Upper Lower
Availability of drug supply 0.846 0.535 0.267 1.072
Availability of other essential supplies 0.838 0.515 0.257 1.031
Treatment modalities 1.253 0.778 0.358 1.691
Availability of staff 0.422 0.355 0.176 0.719
Attitude of staff 2.021 1.114 0.527 2.355
Availability of equipment 0.705 0.548 0.272 1.104
Availability of diagnostic services 2.086 0.951 0.472 1.918
Information on diseases & care 0.435 0.475 0.233 0.967
Information on facility management 0.926 0.950 0.770 1.171
Waiting times 1.269 1.110 0.584 2.224
Availability of trained personnel 1.252 1.828 0.410 1.672
Distance from facility 1.062 1.053 0.526 2.110
Cost of drugs & treatment 0.315 0.331 0.164 0.668
Poor referral system 0.917 0.743 0.369 1.496
COR: Crude Odds Ratio, AOR: Adjusted Odds Ratio, CI: Confidence Interval

DISCUSSION

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348 Ethiop J Health Sci. Vol. 27, No. 4 July 2017

According to the findings, socio-demographic are still poor. This finding is similar with the study
characteristics of the respondents showed that in Southeastern Nigeria (10).
more were between the ages of 35-44 years, and Furthermore, the finding shows that the type
the majority were also married. This finding is of equipment present in primary health care in the
different from a study conducted in South Africa area includes sphygmomanometer, generator and
where the majority of the respondents were above refrigerator, thermometer, among others. This
45 years of age (6). However, the finding is finding is similar with the World Bank Survey
similar with a study conducted in Southeastern across Primary Health Care facilities in four states
Nigeria (10). In addition, the majority were in Nigeria (5). In addition, according to the
educated and civil servants. This finding is also finding, the basic pharmaceuticals and vaccines
different from the study in Southeastern Nigeria present in the selected primary health care
where the majority were small scale traders, facilities in the study area includes anti-malaria,
artisans and business men and women (10). paracetamol, BCG and DPT vaccines, measles
According to the findings from this study, the among others. This is also similar to the World
majority of the respondents were aware of the Bank study (5).
existence of primary health care services in the The findings show that many of the
community, with their source of information being respondents utilized primary health care services,
health workers, friends/relatives and radio majorly because they want to monitor their health
programmes. This finding might be attributed to and that of their children. This finding is,
the educational level of the respondents who, due however, lower than previous studies (4,11) but
to their exposure, will always want to seek similar with the study carried out in South Africa
information about their health from health workers where over 70% of the respondents utilized health
and the mass media. This finding is similar with a care services (6). However, it is not surprising that
study conducted in Southwestern Nigeria where most of the respondents patronized primary health
respondents demonstrated awareness of primary care services because of immunisation and malaria
health care facilities in their respective treatment. These two conditions have been shown
communities (11). to cause both maternal and infant morbidity and
The ward minimum health care package, as mortality in Nigeria (5).
defined in 2007, includes maternal and child care. Furthermore, affordability of services offered
Consequently, according to the study, the type of at health institutions in Nigeria has been shown to
services rendered in the study area include, among influence the choice of services utilized (12).
others, vaccination, general disease check-up and Therefore, it is not surprising that most of the
blood pressure check-up. This finding is similar respondents with higher income actually
with the World Bank survey of primary health patronized the health services. In addition, the
care in four states of Nigeria where child care was more educated civil servants and students utilized
available in most facilities in all the four states of the services more than the other category of
Bauchi, Cross-River, Kaduna and Lagos states (5). respondents. This finding is in line with the
This finding is also similar with the study in findings of Awusi et al. (13), who concluded that
Southeastern Nigeria where immunization and women with more education and income-yielding
treatment of ailments were the two most provided occupations tended to utilise antenatal care
services rendered (10). Although treatment of services.
chronic diseases has been included as part of the The study showed overall satisfaction with
ward minimum health care package, treatment of the services offered at the primary health care
chronic diseases is still poor despite the increasing centres studied. This finding is different from the
trend of chronic diseases in Nigeria. Similarly, World Bank study of primary health care centres
general health education, HIV counseling and in four states in Nigeria. In that study, Bauchi and
testing, nutritional services and malaria treatment Kaduna residents were the least satisfied states
with availability of equipment, supply of drugs

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 Utilization of Primary Health Care Services… Agofure, O. et al. 349

and waiting times, among others (5). This finding are optimum. Special focus should be given to
is similar with the study in South Africa where the services related to the treatment and management
majority of the respondents were satisfied with the of chronic diseases. In addition, more equipment
services offered at the facilities (6). for the running of such services should be
Factors influencing the utilization of primary provided and upgraded regularly.
health care services after adjusting the crude odd
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DOI: http://dx.doi.org/10.4314/ejhs.v27i4.5