Nigerian Journal of Paediatrics

Utilization of health facilities and preferred places of treatment for common health conditions in Lagos Nigeria

Niger J Paediatr 2019; 46 (1):15 –

ORIGINAL

Oluwole EO

CC – BY Utilization of health facilities and

Akinyinka MR

Odusanya OO

preferred places of treatment for

common health conditions in

Lagos, Nigeria

DOI:http://dx.doi.org/10.4314/njp.v46i1.4

Accepted: 16th February 2019

Abstract : Background:

When

Results: Two thousand participants

people are ill, the options for

were recruited. The mean age was

Oluwole EO

(

)

health-seeking

behavior

are

37.6±10.21years.

Government

Department of Community Health

shaped by several factors. Under-

hospitals were the most frequent

and Primary Care College of

standing these options is likely to

usual source of health care (41%).

Medicine, University of Lagos

contribute to early treatment and

Perceived effectiveness of treat-

PMB 12003, Surulere, Lagos

better outcomes. The objective of

ment, speed of service and low

Email: oluester2005@yahoo.com

this study was to investigate the

cost were main reasons for these

utilization and preferred places for

choices. Other sources of care such

Akinyinka MR, Odusanya OO

treating common health problems

as drug store, nursing homes and

Department of Community Health

in Lagos, Nigeria.

trado-medical facilities were pre-

and Primary Health care, Lagos

Methods: A cross-sectional sur-

ferred more frequently by more

State University College of

vey was conducted using both an

than a third of respondents for

Medicine

interviewer administered ques-

most conditions except for preg-

PMB 21266, Ikeja

tionnaire and focus group discus-

nancy care. Primary Health Care

sions to obtain data. Participants

centers were the least preferred

were recruited through multi-

sources of care.

stage sampling methods from four

Conclusion: Primary Health Care

local government areas in Lagos

centres were the least utilized

State. Conditions of interest in-

sources of care. Increased advo-

cluded fever in children, cough,

cacy is a recommended strategy to

diarrhoea and vomiting and preg-

improve early presentation to

nancy care. The Statistical Pack-

health facilities.

age for Social Sciences (SPSS)

version 22 software was used for

Keywords: Common health prob-

analysis while the qualitative data

lems, health-seeking behavior,

was analyzed with ATLAS.ti soft-

patient preferences.

ware version 7. The level of sig-

nificance was set at p < 0.05

Introduction

In rural Nepal a study reported that people sought for

When people fall ill, they utilize several treatment op-

formal healthcare only when sickness was moderate or

tions. The options are shaped in part by anticipated treat-

severe whereas mild illnesses were treated at home. In

ments or health outcomes, cognition, experience, reflec-

addition, traditional healers were the first to be visited

before other health workers. A study from Tanzania

tion and exist as the relatively enduring consequences of

values. The preferences may contribute to effective or

reported that up to 54% of participants used primary

ineffective treatment with impact on treatment out-

health care centres (PHC) as the most common first op-

comes. The preferences and utilization of health services

tion for child care followed by pharmacies. In addition,

is associated with the availability and accessibility of

women in urban areas and those with higher level of

health facilities and the effectiveness and efficiency of

education in that country utilized higher level hospitals

the services provided. Patients’ choices are related to

more commonly although the quality of care was sub-

optimal.

personal characteristics, accessibility to health facilities,

health system conditions and the quality of services.

Differences can exist in health needs as well as in the

A study that compared the perceived quality of private

effectiveness and the quality of care given by different

and public health services in Lagos, Nigeria reported

health units and their locations, for example, urban .

positive perceptions of the service quality provided by

both healthcare systems. However, when high-level hos-

tal of Nigeria until 1991. Ikeja is the capital city of the

pitals were excluded, the scores for the private hospitals

State. Lagos remains the economic capital of Nigeria.

were higher. The under-utilization of health services in

The State has 20 Local Government Areas (LGA). Six-

the public sector has been almost a universal phenome-

teen of the LGAs are classified as urban and four are

non in developing countries. A study from Osun State,

rural. Lagos is home to virtually all tribes of Nigeria,

Nigeria showed that mothers usually bought drugs from

Yoruba is the predominant Nigerian language. Health

chemist shops prior to utilizing health facilities and only

facilities are provided through a mix of private and pub-

a third presented to health facilities within 24 hours of

lic facilities. The health system has three tiers; primary,

the onset of illness. The level of maternal education was

secondary and tertiary.

significantly associated with initial treatment of febrile

illness.

Study design

A study of preferred places for treatment of common

The study design was a descriptive cross-sectional using

health problems in Abeokuta, Nigeria revealed that gov-

both quantitative and qualitative methods to investigate

ernment owned general hospitals were the most pre-

the preferred places of care for common health prob-

ferred places followed by private hospitals and PHC

lems. An interviewer-administered questionnaire was

centres were the least preferred. Significant factors that

used to obtain information for the quantitative aspect of

influenced the use of government hospitals more fre-

the study. Focus group discussions (FGDs) were held

quently than private hospitals were costs, attitudes of

for the qualitative aspect in the four LGAs.

providers, effectiveness of treatment whereas short wait-

ing time was significant in the choice of private hospi-

Sample size determination

tals, but proximity was not significant. In Ile-Ife, Nige-

ria, 60% (117/183) of pregnant women utilized ap-

The required sample size for quantitative data collection

proved health facilities for delivery. Significant factors

was determined using the appropriate formula for preva-

associated with the non-use of such facilities were ma-

lence studies. The statistical assumptions for determin-

ternal age > 30 years, religious beliefs, distance, low

ing the minimum sample size were: a type 1 error rate of

level of maternal education and unfriendly health work-

5%, a prevalence of 0.58 of positive perception of health

ers.

workers by community members, a precision of ±2.5

percentage points and a 20% non-response rate. Thus,

In Nigeria, late presentation to hospitals is often associ-

the calculated minimum sample size was 1919, which

ated with poor prognosis and has many causes including

was rounded up to 2000.The participants for the FGD

misdiagnosis, wrong treatment and seeking help from

were purposively selected. One FGD session was held in

inappropriate places. As many as 86% (12,140/14487)

each LGA and the number of participants was averagely

of eligible patients in Nigeria presented late for HIV

ten (10).

care. In another study, 55% (454/824) of patients with

eye problems presented late (after three months of dis-

Sampling techniques

ease onset) to a teaching hospital. The late presentation

was associated with age greater than 80 years, female

A multi stage sampling method was used to select the

gender, residence greater than 20 kilometres from the

subjects for quantitative data collection in this study. In

hospital and individual level deprivation. Common rea-

the first stage, out of the 20 Local Government areas

sons for late presentation to care amongst adults and

(LGA), four LGAs (three urban and one rural) were se-

children aged six years with cleft palate in Nigeria were

lected using stratified random sampling by balloting.

lack of money, lack of health care services nearby and

These were Ikeja, Mushin, Ojo (urban) and Badagry

lack of awareness/ availability.

Late presentation was

(rural) LGAs. In the second stage, at each of the selected

associated with higher fatality rate of up to 55%

LGA, two wards were selected by simple random sam-

amongst patients presenting with ileal perforation from

pling (ballot). In the third stage, using the sampling

typhoid fever. If treatment outcomes are to improve,

frame of all streets in the selected wards, a minimum of

patients must present early to appropriate facilities.

10 streets were selected by using a table of random num-

Thus, an investigation of the choices patients make

bers.

about where they receive treatment is important. This

study was carried out among adult residents in Lagos

The fourth stage involved selecting a consenting respon-

State to determine the preferred choice of health facili-

dent from each household from the selected streets. On

ties for selected health conditions as well as the factors

each street, the Local Government house numbering

that influences their choices.

system was followed, and each consecutive house start-

ing from the first number was approached. This was

done on all selected streets until the sample size was

attained.

Twenty-five respondents were selected from

Materials and methods

each street. An equal number (500) of respondents were

Background information to study area

selected per LGA. For qualitative data collection, one

focus group discussion was held per LGA. FGDs were

Lagos State was created on May 27, 1967. It is in the

held for female participants in Mushin, Ojo and Badagry

Southwest geopolitical zone of Nigeria. It was the capi-

and for male participants in Ikeja. Ten participants were

selected via purposive sampling to participate in each

tion between various respondents’ characteristics and

FGD session.

utilization of services as well as preferred places of care

for fever in children was sought for using the Chi-

Survey Instruments

Square test.

Questionnaire

Qualitative data

An interviewer- administered, pre-tested questionnaire

was used to collect data. The instrument had been devel-

Qualitative data was analyzed using ATLAS.ti software

oped from a review of the literature on the subject and in

version 7. The data analysis was conducted using con-

tandem with the objectives of the study. The instrument

stant comparison analyses and cross-case analysis con-

had two sections. The first dealt with socio-demographic

ducted as required.

characteristics of the respondents such as age, gender,

educational level and occupation. The second focused

Ethical considerations

on utilization of health facilities, accessibility, preferred

places for treatment of common health conditions and

The participants were informed of the objectives of the

reasons for use. The health problems of interest were

study and its potential benefits for the health system and

fever in children, cough and catarrh in children, diarrhea

the state. There was no risk of harm to them as there was

in children, fever in adults and pregnancy care.

no invasive procedure. Written informed consent was

Face validation of the instrument was done by all the

obtained from each participant prior to enrollment in the

investigators. It was pretested among residents of an-

study. Ethical clearance was obtained from the Lagos

other LGA which was not amongst the four utilized for

State University Teaching Hospital (LASUTH) ethics

the study. The alpha Cronbach reliability coefficient was

committee with Reference Number: LREC/06/10/755

0.792. The instrument was modified and administered

(08/11/16-08/08/17).

after pre-testing.

FGD guide

Results

A ten-itemed FGD Guide was developed in line with the

study objectives and used in the conduct of the FGD.

Two thousand respondents were recruited. The mean

The guide sought for information on the utilization of

age was 37.6±10.21 years. More than three quarter

health facilities, competence of health workers and prob-

(88%) of the respondents were less than 50 years of age.

lems encountered by the respondents during visits to

Majority (76%) of the respondents were married. Most

health facilities.

(66%) of the respondents had secondary school educa-

tion and most were self-employed (Table 1). Table 2

Data Collection

shows the accessibility and utilization of health facili-

ties. Hospitals both government owned and privately

The quantitative data was collected by four trained re-

owned were the nearest facilities to respondents; resi-

search assistants (who had a minimum of secondary

dences although government hospitals were the nearest.

school education) between February and March 2017.

Most of the facilities were accessible within 30 minutes

Participants for the FGD were invited and reminded via

of walking and a third were located within walking dis-

text messages and calls. The selected participants were

tance of ten minutes or less. Hospitals were by far the

within the same age range for each FGD. Each session

usual sources of health services with only 7% of resi-

was anchored by the researchers and trained research

dents utilizing PHC centres. Figure1 shows the prox-

assistants taking on the roles of a moderator, recorder

imity of facilities to residences of respondents with gov-

and note taker. All sessions had audio recordings done

ernment hospitals being more available and nearest. Fig-

after obtaining written informed consent from the par-

ure 2 shows the utilization of health facilities by prox-

ticipants.

imity. When government- owned or private hospitals

were the nearest, they were the most frequently utilized.

Data management

However, when PHCs were the nearest, they were not

Quantitative data

the most utilized.

All completed questionnaires were reviewed on the field

Fig 1: Proximity of various sources of health care services to

and in the office for completeness, consistency of infor-

respondents

mation. Data was entered using Statistical Package for

450

the Social Sciences version 22. Data was coded and

400

cleaned before data entry. Health facilities were catego-

350

Govt hospital

rized into four namely government hospitals, private

300

Private hospital

250

hospitals, PHC centres and others (drug stores, nursing

PHC

200

Drug stores

homes, traditional medicine). Furthermore, government

150

Nursing homes

facilities were government-owned hospitals and PHCs

100

Traditional

while private hospitals, pharmacies and nursing homes

Others

were grouped as private sources of health care. Associa-

<10 mins

10-29 mins

30-59 mins

>1 hr

Table 1: Socio-demographic characteristics of respondents

good equipment were the significant reasons for those

Variable

who preferred government owned facilities. The socio-

Age group (years)

demographic characteristics of respondents associated

< 20

0.6

with preferred health facilities are shown on Table 4.

20-29

456

22.8

More respondents (55%) younger than 40 years utilized

30-39

774

38.7

private hospitals than those older (48%, p<0.05). A

40-49

495

24.8

higher proportion of male respondents (91%) than

50-59

179

9.0

> 60

3.1

women (88%) utilized private facilities than government

Unstated

1.0

ones (p=0.016). The same observation was true for in-

2000

100

creasing level of education and income. Marital status

Gender

did not show any significant association in the utiliza-

Female

1105

55.2

tion of facilities.

Male

895

44.8

Marital status

Findings from the FGD revealed that some participants

Single

422

21.1

had changed their preferred health facilities for different

Married

1523

76.1

reasons such as attitude of health workers, quality of

Others

2.8

Educational status

services, cost of services and distance of health facili-

No formal Schooling

2.7

ties. Although participants preferred privately owned

Primary

167

8.4

health facilities more than government owned facilities,

Secondary

1324

66.2

it was observed that most of the participants had some

Tertiary and above

454

22.7

earlier unpleasant encounters when utilizing government

Occupation

owned facilities and their encounters had reinforced

Housewife

2.4

their preferences.

Student

3.5

Unskilled worker

629

31.5

Skilled worker

906

45.3

Professional

239

12.0

Some FGD participants mentioned that public hospitals

Unemployed/others

106

5.3

delay their clients.

Income (N)

1,000-10,500

148

7.4

A female participant in Ojo explained, “it depends on

10,501-18,000

125

6.2

sickness, because when I know that it is something a bit

18,001-50,000

751

37.6

serious, I go to general, if it is malaria and others, be-

50,001-100,000

170

8.5

cause they waste time in general, I use private.”

> 100,000

2.7

Not stated

757

37.9

Another female FGD participant in Ojo reported that she

used private and public health facilities for different

Table 2: Accessibility and use of health facilities by respon-

services. She receives immunization for her children at a

dents

public health facility and other treatments in a private

Variable

facility.

Closest health facility

Government hospital

775

38.8

“Participant 11: I stay at Iba, that’s where I stay, and I

Private Hospital

503

25.2

use Elshadai at Iyana school.

Primary Health Care Centres

359

17.9

Moderator: that’s private?

Others

363

18.1

Participant 11: private hospital.

Walking distance to closest facility

Moderator: why?

(minutes)

Participant 11: my own, when I give birth, I take my

< 10

669

33.4

children or babies to health centre.

10-29

952

47.6

Moderator: for immunization?

30-59

325

16.3

Participant 11: yes, I use that for immunization, but

> 60

2.7

Usual source of health care

when it comes to treatment, I go to Elshadai (private

Government hospital

814

40.8

facility). ( 40-year-old_female_single_Ojo LGA)

Private Hospital

760

38.0

Primary Health Care Centres

137

6.9

Many FGD participants preferred private hospitals to

Others

286

14.3

public hospitals because of the attitude of the staff as

shown in the quote:

The reasons for preferred places of health care are

shown on Table 3 and effectiveness of services was the

“I use private hospital, that’s where I do deliver my

most frequently mentioned reason (71%) amongst all

babies, and that’s where I receive treatment, because I

respondents. Respondents who preferred private health

don’t like general hospital at all, because the way they

facilities more significantly made the choice because of

are, when you get there, when I first got pregnant of my

effectiveness of treatment and faster speed of service (p

first born, that I went there for registration, they said

<0.001). However, affordability of costs, proximity to

they will collect blood first, that my husband’s blood

residence, perceived good services and availability of

will have to be taken for me first, that I will need blood

compulsorily, that I should go to primary health center,

Table 4: Socio-demographic factors associated with utilization

when I got there, those ones said, I will go back to gen-

of health facilities

eral hospital, I angrily went back home, I sat at home

Variable

Govern-

Private

Total

X2/ p

for long, before I later started going to private hospi-

ment facili-

facilities

value

tal… when you get to private hospital, they won’t ask

ties

n (%)

anything from you, they will strive to save your life first,

n (%)

before they will ask for money, their money might be

Age (years)

much, but I like the way they attend to me. I am not say-

< 40

560 (45.0)

683 (55.0)

1243

8.09,

0.004

ing that they don’t attend to patients very well in general

>40

380 (51.8)

354 (48.2)

734

hospitals, but I don’t use them [general hospitals], be-

Gender

cause human life is nothing to them [meaning the gen-

Male

77 (8.6)

815 (91.4)

892

5.79,

eral hospital staff do not value human life], and there is

0.016

a mortuary beside them. So that’s why I don’t use

Female

133 (12.1)

970 (87.9)

1104

there.” – (37years old_female_married_Badagry_LGA)

Marital status

Single

45 (9.8)

414 (90.2)

459

0.23,

The preferred places of treatment by respondents

0.63

showed that PHCs were the least preferred facilities for

Married

165 (10.7)

1371 (89.3)

1536

Educational level

all the conditions of interest. Up to 30% of respondents

None/primary

13 (6.9)

208 (94.1)

221

11.12,

preferred other sources (nursing homes, pharmacies) for

0.004

these conditions. However, 80% of respondents pre-

Secondary

160 (12.1)

1162 (87.9)

1322

ferred hospitals (both government and private) for preg-

Tertiary

37 (8.2)

414 (91.8)

451

nancy care (Table 5). Respondents ’socio -demographic

Income

factors associated with the preferred place of care for

>18,000

179 (65.6)

94 (34.4)

273

42.6,

fevers in children are shown on Table 6. A higher pro-

portion of women (53%), preferred PHCs whereas those

0.001

with higher educational status, those not married, and

18,000-50,000

341 (45.5)

409 (54.5)

750

< 50,000

84 (38.4)

135 (61.6)

219

income preferred other sources of care. Age was not a

significant factor in the preference of health facilities.

Table 6: Respondents’ Socio -demographic factors associated

Fig 2: Respondents’ utilization of the closet health facility to

with use of health facilities for treatment of fever in children

their residence

Variable

Primary

Other health

Total

X2/ p value

health care

facilities

centre

n (%)

Age (years)

< 40

138 (11.1)

1102 (88.9)

1240

1.31, 0.25

Govt hospital used

>40

71 (9.4)

684 (90.6)

755

Private hospital used

Gender

PHC used

Male

368 (41.2)

525 (58.8)

893

26.2, <0.001

Others used

Female

583 (52.8)

521 (47.2)

1104

Marital status

Single

194 (41.9)

269 (58.1)

463

7.61, 0.005

Married

757 (49.3)

777 (50.7)

1534

Govt hospital

Private hospital

PHC

Others

Educational level

Closest health facility to respondents

None/primary

138 (62.4)

83 (37.6)

221

31.1, < 0.001

Secondary

633 (47.9)

688 (52.1)

688

Table 3: Reasons for respondents’ utilization of health facili-

Tertiary

180 (39.6)

274 (60.4)

454

ties

Income

Reasons

Government

Private

Total

X2/ p value

>18,000

12 (4.4)

261 (95.6)

273

13.72,< 0.001

facilities

facilities N

18,000-

83 (11.1)

667 (88.9)

750

N (%)

(%)

50,000

Effective treatment

< 50,000

30 (13.7)

189 (86.3)

219

Yes

635 (44.6)

425 (55.4)

1425

18.3,< 0.001

314 (55.3)

254 (44.7)

568

Fast service

Yes

269 (25.7)

779 (74.3)

1049

392.2,< 0.001

653 (68.9)

295 (31,4)

968

Affordable service

Yes

590 (67.7)

282 (32.3)

873

249.3,< 0.001

359 (32.9)

764 (68.0)

1123

Proximity to house

Yes

437 (52.1)

401 (47.8)

839

11.69,< 0.001

513 (46.3)

645 (55.7)

1158

Perceived good services

Yes

315 (66.7)

472 (33.7)

787

28.9,< 0.001

633 (52.4)

574 (47.6)

1207

Good equipment

Yes

387 (52.4)

351 (47.6)

738

10.4, 0.01

564 (44.9)

693 (55.1)

1257

Table 5: Preferred places of treatment for selected health problems

Health condition

Preferred place of care

Primary Health Care

Private Hospital

Government

Other sources

Total

Centre n (%)

n (%)

Hospital

n (%)

Fever in children

210 (10.5)

582 (29.2)

604 (30.3)

599 (30.0)

1995 (100)

Cough and catarrh in chil-

165 (8.3)

413 (20.7)

446 (22.4)

971 (48.7)

1995 (100.0)

dren

Diarrhoea in children

258 (12.9)

465 (23.3)

495 (24.8)

777 (38.9)

1995 (100.0)

Fever in adults

184 (9.2)

476 (23.8)

511 (25.6)

829 (41.4)

2000 (100.0)

Pregnancy care

189 (9.4)

762 (38.1)

797 (39.8)

252 (12.6)

2000 (100.0)

a busy city like Lagos more than in Abeokuta. Related

to this was the finding that persons with higher educa-

tion and income used private facilities more than gov-

Discussion

ernment reflecting the choices of an enlightened and

more informed citizenry who want value for money. It is

This study set out to investigate the utilization of health

therefore important for government faculties to improve

services and preferred places of care for common health

the quality of services they offer if they are to increase

problems. Up to 80% of respondents reported that health

patronage. The FGD findings also showed that staff atti-

facilities were within 30 minutes walking distance from

tudes were poorer in government facilities thus hinder-

their homes thus ensuring adequate geographical cover-

ing utilization of services which is consistent with a

study from Ile-Ife.

age. The most proximal facilities were either govern-

ment (39%) or private hospitals (25%). The proximity of

health facilities observed in this study is like that re-

For the five selected common health conditions, there

ported in a study from Abeokuta, Ogun State, Nigeria.

was a very low preference for PHCs, most respondents

This proximity is expected to make it easier for clients

preferred hospitals and up to third preferred other

to utilize such facilities as long distance to facilities has

sources of care. For self-limiting conditions such as

been shown to be a major barrier to the use of healthser-

cough and catarrh in children, pharmacies and other

vices. However, unlike what was expected, the prox-

sources of care were preferred by almost half of the re-

imity did not match the utilization. The respondents

spondents which reflects in part the understanding of the

showed a preference for hospitals even when PHCS

respondents that the conditions were not severe. This

were the nearest to their homes. The low level of utiliza-

preference is not without its limitation as such users

tion of PHCs in this study contrasts with a 54% use re-

need to be reminded to move to higher levels of care if

ported from Tanzania but in agreement with a study

the symptoms do not improve within a few days. A re-

from eastern Nigeria where the utilization of health cen-

port from Osun state had shown that most mothers visit

tres for childhood fever was low (2% amongst mothers

these other sources to purchase medicines for their chil-

in rural areas and 7% amongst mothers in urban areas).

dren before coming to formal health facilities like the

finding of this study.

The low utilization may be related to perceived inade-

quacies of manpower, drugs and diagnostic facilities in

the PHCs rather than disease severity. The implication

Fever in a child may be viral or due to malaria in Nige-

of such non-use of PHCs is that simple health problems

ria and should be first seen at a PHC. This was not the

that are meant to be treated at the lower levels are then

case in this study due mainly to reasons of loss of confi-

brought to the higher levels of care with resultant

dence in the PHCs amongst clients and agrees with re-

ports by other researchers.

5,13

overcrowding, long queues, long waiting times and long

However, a study from

appointments at the latter which undermine confidence

Osun state Nigeria reported that 69% (86 of 137 moth-

in the health system and may attract patients to non-

ers) visited government health centre more frequently

formal facilities.

for treatment of childhood fever followed by local patent

medicine stores (11%). The use of orthodox medicines

The choice in the utilization of government and private

combined with herbal medicines was adopted by 91% of

facilities in this study was found to be influenced by

the mothers. The reasons for not seeking medical treat-

several factors. Effectiveness of service and speed of

ment at existing formal health facilities were high costs,

services were the more important factors amongst per-

lack of access to facilities, and preference for herbal

remedies.

sons using private facilities which imply a preference for

quality amongst these respondents. For those who chose

government facilities, affordability of costs, proximity to

These are areas that need to be addressed if government

residence and availability of equipment were the more

health centres will be used more frequently and the ex-

important factors. These reasons are in tandem with a

tension of health insurance programme to rural areas

study that investigated heath care preferences of com-

may be helpful. Strengthening services at PHCs will be

munity members in Abeokuta except that proximity

of benefit to the entire health system as bypass will be

which was reported in our study was not significant in

lower and turnaround time at the higher levels of care

that study. The difference may be that there are higher

will be shorter. The more use of other sources of care for

opportunity costs associated with proximity and time in

childhood fevers by the single, those with higher levels

of education and income may reflect higher economic

ers. Careful explanation of the objectives and the ano-

power and preference for higher quality. These should

nymity required helped to minimize this. In addition,

be considered in improving the services available at

recall bias is a known limitation of questionnaire-based

PHCs.

surveys.

Acknowledgements

Conclusion

The authors wish to thank the respondents who partici-

The utilization of PHC is low and were the least pre-

pated in the study and the cooperation received from the

ferred places of care amongst respondents. The main

Medical Officers of Health of the Local Government

reasons were because of perceived inadequate staffing

Area where the study took place (Mushin, Ikeja, Ojo and

and facilities. We recommend that the Lagos State gov-

Badagry). We are grateful to the data collectors and the

ernment should revitalize PHCs especially in the provi-

field supervisors.

sion of adequate manpower and simple diagnostic facili-

ties which will stimulate confidence in the citizenry and

improve utilization. It is important that staff receive

Authors contributions

training on inter personal relationships to improve staff

OEO participated in data collection, data analysis and

attitudes. Continuous advocacy is also needed to achieve

manuscript writing

the same and discourage utilization of non-formal

AMR participated in data collection, data analysis and

sources of health care.

manuscript writing

OOO was responsible for concept, design, participated

Limitations of the study

in data analysis and manuscript writing

All the authors approved the final manuscript

The study limitations included social desirability bias as

Conflict of interest: None

respondents are known to speak positively to interview-

Funding: None

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