DETERMINANTS OF EYE CARE SERVICES UTILIZATION AMONG ADULTS IN URBAN SLUM IN KOGI STATE, NIGERIA

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DETERMINANTS OF EYE CARE SERVICES UTILIZATION AMONG ADULTS IN URBAN SLUM IN KOGI STATE, NIGERIA

CHAPTER ONE:

INTRODUCTION

1.1 Background of the Study

Eye health is a critical component of overall well-being, yet it remains one of the most neglected areas of healthcare, particularly in low-resource settings. Globally, millions of people suffer from preventable and treatable visual impairments due to a lack of access to adequate eye care services. In Nigeria, where the burden of visual impairment and blindness is significant, the utilization of eye care services remains suboptimal, especially among vulnerable populations residing in urban slums.

Urban slums in Nigeria are characterized by overcrowding, poor sanitation, inadequate healthcare infrastructure, and high levels of poverty. These factors contribute to the residents’ limited access to essential healthcare services, including eye care. Kogi State, located in the North-Central region of Nigeria, is no exception. The state’s urban slums are home to a large proportion of the population, who often face numerous barriers to accessing eye care services. Despite the availability of eye care facilities in urban areas, many residents of these slums do not utilize these services, leading to untreated visual impairments and preventable blindness.

The utilization of eye care services is influenced by various determinants, including socioeconomic status, awareness of eye health, cultural beliefs, accessibility of services, and perceived quality of care. Understanding these determinants is crucial for developing effective strategies to improve eye care utilization and reduce the burden of visual impairment in urban slums. Previous studies have highlighted the importance of addressing both demand-side and supply-side factors to enhance the uptake of eye care services. However, there is a paucity of research specifically focused on the determinants of eye care service utilization among adults living in urban slums in Kogi State.

This study aims to fill this gap by examining the factors that influence the utilization of eye care services among adults in urban slums in Kogi State, Nigeria. The findings of this research will provide valuable insights for policymakers, healthcare providers, and public health practitioners to design targeted interventions that improve access to and utilization of eye care services in underserved urban communities.

Visual impairment and blindness are major public health concerns globally, particularly in low- and middle-income countries where access to eye care services is limited. In Nigeria, the burden of visual impairment is substantial, with millions affected by conditions that are preventable or treatable with timely and adequate eye care. Despite efforts to improve healthcare infrastructure and access to services, significant disparities remain, particularly among vulnerable populations such as those living in urban slums.

Urban slums are characterized by overcrowding, poor sanitation, inadequate housing, and limited access to essential services, including healthcare. Residents of these areas often face multiple barriers to accessing eye care services, such as low income, lack of awareness, cultural beliefs, and geographical inaccessibility. Kogi State, located in North-Central Nigeria, has a significant population residing in urban slums, where these challenges are prevalent. The limited utilization of eye care services among adults in these areas contributes to the high prevalence of untreated visual impairments and preventable blindness, exacerbating poverty and reducing the quality of life.

The utilization of eye care services is a complex issue influenced by a variety of factors, including socioeconomic status, awareness and knowledge of eye health, cultural practices, accessibility of healthcare facilities, and perceived quality of care. Understanding these determinants is crucial for developing targeted interventions that can improve eye care service uptake and address the unmet needs of populations living in urban slums.

While previous studies have explored the barriers to healthcare utilization in Nigeria, there is a lack of specific research focusing on the determinants of eye care service utilization among adults in urban slums, particularly in Kogi State. This study seeks to fill this gap by investigating the factors that influence the utilization of eye care services among adults in urban slums in Kogi State. The insights gained from this research will provide valuable information for policymakers, healthcare providers, and public health practitioners to design and implement effective strategies that enhance access to eye care services, reduce the burden of visual impairment, and improve the overall well-being of residents in these underserved communities.

The utilization of health care services is fundamental to healthy living, socio-economic and infrastructural development. Health care utilization is influenced by certain characteristics including the availability of healthcare facilities. Availability has a wide dimension which entails distance, accessibility, awareness, transport, language, cultural barrier, and preference. Others are the cost of health care service, and quality of service provided by health care personnel. The utilization of health care still differs greatly between urban and rural communities due to the availability of basic equipment and the presence of trained medical personnel in the urban area with a relatively low supply of same at the rural community where more than 60% of the population resides. The disproportionate utilization between rural and urban communities in Nigeria has resulted in varied morbidity and mortality rates. For instance, the 2018 NDHS results show that the infant mortality rate was 67 deaths per 1,000 live births for the 5 years preceding the survey. The child mortality rate was 69 deaths per 1,000 live births, while the under-5 mortality rate was 132 deaths per 1,000 live births (6). The under-5 mortality rate is higher in rural areas than in urban areas (157 and 92 deaths per 1,000 live births, respectively) (6).

While 84% of women in urban areas had supervised delivery by a doctor, nurse, or midwife compared with only 56% of women in rural areas

Overall progress in health indicators has been slowed down, Nigeria ranks among the countries with the highest maternal mortality ratio. The maternal mortality ratio for the 7 years before the 2018 NDHS is estimated at 512 maternal deaths per 100,000 live births (6). The figures are worse in the rural communities where utilization of modern health facilities is limited and most inhabitants patronize local traditional birth attendants. The utilization of health facilities among rural and urban communities is greatly affected by the distribution of health facilities and the availability of health care personnel at the facilities. Others are the condition of service, lack of working equipment, lack of infrastructure, and poor communication service and access road have been blamed for these seemingly persistent gaps.

It is important to note that private health care providers operate in urban settings where income levels are generally high and clients are perceived to have the ability to pay for service rendered. Conversely, there is poor access to qualified and competent health professionals for people living in rural and deprived areas that bear a great portion of the disease burden. High cost of health services have equally been blamed for the seemingly disproportional utilization of health services for instance, as much as 43% of respondents in a study reported high cost of transportation, cost of medication and service at the health center, and man-hour lost, were obstacles to utilizing health care services both at the rural and urban facilities. A study by Fatusi et al on poverty reduction strategy identified that about 40% of their respondents were living in poverty and close to 27% live in extreme poverty. Most of these population lives in the rural community with limited access to health care service.

Health care utilization among rural dwellers is characterized by longer travel times and greater distances to health centers constituting barriers to repeat visits. The inadequacies in access to health facilities have reduced the life expectancy of rural inhabitants, urban slum dwellers, and increased infant mortality (15). Although the urban communities have access to health care services in terms of the road network and availability of personnel, the cost of accessing these services is a form of constraint to urban dwellers, especially the less privileged. The need to address the differences in utilization of health care services among rural and urban communities is important to providing equitable health care services and reducing morbidity and mortality. This study “Comparison of predictors of health service utilization among rural and urban areas Enugu south LGA, Enugu State, Northcentral, Nigeria” sought to identify the differential factors that determine healthcare utilization and the predictors of the determinants. This study bridged the information gap on healthcare utilization and its predictors among selected communities Enugu south Local Government Area (LGA) of Enugu State.

1.2 Statement of the Problem

Visual impairment and blindness are significant public health challenges in Nigeria, with a substantial portion of the population affected by conditions that are either preventable or treatable. Despite the availability of eye care services in urban areas, the utilization of these services remains low, particularly among adults residing in urban slums. This underutilization of eye care services contributes to the high prevalence of untreated visual impairments and blindness, which in turn exacerbates poverty, reduces productivity, and diminishes the quality of life of affected individuals.

Urban slums in Kogi State are home to a large number of adults who are at risk of visual impairment due to factors such as poverty, poor living conditions, and limited access to healthcare services. However, the specific determinants that influence the utilization of eye care services among this population have not been adequately explored. Without a clear understanding of these determinants, efforts to improve eye care utilization and reduce the burden of visual impairment in urban slums may be ineffective.

This study seeks to address this gap by identifying and analyzing the factors that determine the utilization of eye care services among adults in urban slums in Kogi State. By understanding these determinants, the study aims to inform the development of targeted interventions that can enhance the uptake of eye care services, ultimately reducing the prevalence of visual impairment and improving the overall health and well-being of residents in these underserved communities.

1.3 Objectives of the Study

The main objective of this study is to investigate the determinants of eye care services utilization among adults in urban slums in Kogi State, Nigeria. The specific objectives are as follows:

To assess the level of awareness and knowledge of eye care services among adults in urban slums in Kogi State.

To identify the socioeconomic factors that influence the utilization of eye care services in urban slums.

To examine the cultural and belief systems that affect the perception and use of eye care services among adults in urban slums.

To evaluate the accessibility and availability of eye care services in urban slums and how these factors impact service utilization.

To analyze the perceived quality of eye care services and its influence on utilization among adults in urban slums.

1.4 Research Questions

The study aims to answer the following research questions:

What is the level of awareness and knowledge of eye care services among adults in urban slums in Kogi State?

How do socioeconomic factors, such as income and education, influence the utilization of eye care services in urban slums?

What cultural and belief systems affect the perception and use of eye care services among adults in urban slums?

How does the accessibility and availability of eye care services in urban slums impact their utilization?

What is the perceived quality of eye care services, and how does it influence the decision to utilize these services among adults in urban slums?

1.5 Significance of the Study

This study is significant for several reasons. First, it addresses a critical gap in the literature by focusing on the determinants of eye care services utilization among adults in urban slums in Kogi State, a population that is often overlooked in public health research. Second, the findings of this study will provide evidence-based insights that can guide the development of targeted interventions aimed at improving eye care utilization in urban slums, thereby reducing the burden of visual impairment and blindness.

Additionally, the study will contribute to the broader body of knowledge on healthcare utilization in low-resource settings, with implications for other regions facing similar challenges. Policymakers, healthcare providers, and public health practitioners can use the insights gained from this research to design and implement strategies that address the specific barriers to eye care utilization in urban slums, ultimately improving health outcomes for vulnerable populations.

1.6 Scope of the Study

The scope of this study is limited to the investigation of factors influencing the utilization of eye care services among adults residing in urban slums in Kogi State, Nigeria. The study will focus on both demand-side factors (e.g., awareness, socioeconomic status, cultural beliefs) and supply-side factors (e.g., accessibility, availability, and quality of services) that impact the decision to utilize eye care services. The study will involve a cross-sectional survey of adults aged 18 years and above living in selected urban slums in Kogi State.

1.7 Definition of Terms

Eye Care Services: Healthcare services aimed at the prevention, diagnosis, and treatment of eye conditions, including vision screening, refractive services, cataract surgery, and management of other eye diseases.

Utilization: The act of using or benefiting from available healthcare services, in this context, eye care services.

Urban Slums: Densely populated urban areas characterized by substandard housing, inadequate access to basic services, and poor living conditions.

Determinants: Factors that influence the likelihood of utilizing healthcare services, including socioeconomic status, cultural beliefs, accessibility, and perceived quality of care.

Visual Impairment: A significant reduction in vision that cannot be corrected with standard glasses or contact lenses, and that impacts an individual’s daily activities.

Hepatotoxicity: Liver damage caused by chemical substances, in this context, the study will focus on paracetamol-induced liver damage.

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