Problems to health care utilization among women of reproductive age in The Gambia: A cross sectional study

Abstract

Background: In many countries, political commitment to provide universal access to sexual and reproductive health care services and universal health coverage is becoming an agenda in policy development to improve equity in health care. The problems to health care utilization by women are significant barriers in meeting the health needs of women, these problems can be financial, cultural, or geographical inaccessibility of services. In The Gambia, there is no sufficient evidence studying the problems to health care utilization by residence. Therefore, this study aims to examine the problems to health care utilization by residence among women of reproductive age in The Gambia.

Method: Data from The Gambia 2013 Demographic and Health Survey (DHS) was used in this study which includes 10,233 women 15 – 49 years of age. A systematic selection method with equal probability was employed for the data collection interviews. Visiting any health facility in the last 12 months is the outcome while problems to health care utilization was assess from four factors: permission to go, money needed for treatment, distance to health facility and not wanting to go alone were independent variables. Descriptive and logistic regression analyseis was carried out to assess the frequency distribution and the association of the problems to health care utilization by residence. The point estimates were reported in odds ratio (OR), 95% confidence interval (CI) and p value <0.05 significance level.  

Results: Most women in rural (77%) and urban (81%) residence areas utilized health care in the last 12 months. In rural residence, women who had big problem concerning long distance to health facility and not wanting to go alone had adjusted odds ratio (AOR, 0.82 CI: 0.70 – 0.95) and (AOR, 0.90 CI: 0.70 – 1.15) lower odds of health care utilization compared to women who did not have a big problem concerning long distance to health facility. In urban residence, women who had big problem getting money needed for treatment and not wanting to go alone had an adjusted odds ratio (AOR 0.86, 95% CI: 0.79 - 0.94) and (AOR, 0.83 CI: 0.75 – 0.93) lower odds of health care utilization compared to women who did not have a big problem getting money needed for treatment and not wanting to go alone for health care. 

Conclusion: The problems to health care utilization appear to be associated with financial and geographical inaccessibility, and cultural norms. Problems of long distance to health facility may be attributed to geographical inaccessibility due to inadequate transport and poor road infrastructure in rural residence. Getting money needed for treatment may be attributed to high women unemployment in urban residence, which predispose them to be financially constrained to utilize health care. Not wanting to go alone may be attributed to weak culture of social support for women in urban residence during health care-seeking. Policy makers should address the causes of geographical inequities in health care utilization to achieve universal health coverage.