Utilization of health services in a resource-limited rural area in Kenya: prevalence and associated household-level factors
Background: Knowledge of utilization of health services and asso- ciated factors is important in planning and delivery of interventions to improve health services coverage. This knowledge is however limited in many developing countries. We determined the preva- lence and factors associated with health services utilization in a rural area of Kenya. Our findings inform the local health management in development of appropriately targeted interventions.
Methods: Design: Cluster sample survey. Population: Residents of Kaloleni sub-County in Kenya.
Participants/respondents: Household key informants. Outcomes: (i) History of illness for household members and (ii) health services utilization in the preceding month, (iii) factors associated with health services utilization. Analyses: Estimation of prevalence (outcomes i and ii) and random effects logistic regression (outcome iii).
Findings: 1230/6,440 (19.1%, 95% CI: 18.3%-20.2%) household members reported an illness in the month preceding the survey. Of these, 76.7% (95% CI: 74.2%-79.0%) sought healthcare in a health facility. The majority (94%) of the respondents visited dispensary-level facilities and only 60.1% attended facilities within the study sub-counties. Of those that did not seek health services, 43% self-medicated by buying non-prescription drugs, 20% thought health services were too costly, and 10% indicated that the sickness was not serious enough to necessitate visiting a health facility. In the multivariate analyses, relationship to head of household was associ- ated with utilization of health services. Relatives other than the nuclear family of the head of household were five times less likely to seek medical help (Odds Ratio 0.21 (95% CI: 0.05-0.87).
Conclusion: Dispensary level health facilities are the most commonly used by members of this community, and relations at the level of the household influence utilization of health services during an illness. These data enrich the perspective of the local health management to better plan the allocation of healthcare resources to health facilities according to need and demand. The findings will also contribute in the development of community-level health coverage interventions that target the disadvantaged household groups.