Decomposition and Spatiotemporal Analysis of Barriers to Healthcare Access among Women of Childbearing age in Nigeria, using Nigeria Demographic and Health Survey from 2003 to 2018

Abstract

Barriers to Healthcare Access (BHA) amidst cultural demands and abject poverty aggravate the prevailing health challenge among Nigerian women. We aimed to assess the BHA among women of reproductive age (15-49 years) in Nigeria. Four consecutive rounds of the Nigeria Demographic and Health Survey conducted every 5 years (2003, 2008, 2013, and 2018) were used for this cross-sectional study design. BHA classified into small and big barrier was generated based on 4 questions: getting permission to go for treatment, getting the money needed for treatment, distance to the health facility, and not wanting to visit a health facility alone. Data were analyzed using Logistic Regression Model, Wagstaff decomposition, and spatial mapping in ArcGIS (α=0.05). Experiencing big BHA was 41.0% (2003), 67.2% (2008), 52.7% (2013), and 53.7% (2018) among the women and was higher in the rural areas across the survey years. The odds of a big BHA reduced consistently with increasing level of education. Factors that contributed mostly to wealth inequality in big BHA from 2003 to 2018 included education (36.7%), partner’s education (41.1%) and residence (35.5%). Hot-spot for big BHA was mostly prevalent in the North West, North East, and South East geopolitical zones. Efforts should be geared towards alleviating BHA in Nigeria.