title: Perception and utilization of public health services in Southeast Nigeria: Implication for health care in communities with different degrees of urbanization.
abstract: BACKGROUND
  The relationship between people's perception and utilization of public health services was investigated.
  
  
  METHODS
  A survey of 840 households across selected urban, peri urban and rural communities, in the Southeast of Nigeria, was conducted using the mixed methods approach.
  
  
  RESULTS
  Of the nine (9) demographic variables, only the locality and status of the health system (strong or weak in terms of child immunization) was found to influence both the poor rating and utilization of public health services. Individuals from states with strong health system rated relatively higher and used public health services more (p < 0.001), than their counterparts from states with weak health care system. Similarly, those in the urban or peri-urban localities used public health services more (p = 0.013). The two perceptual variables significantly influence the rating and use of public health services. Those with a good perception of the quality of health service provided, rated and patronized them more (p < 0.001). Also, health centres that provide a high number of services enjoyed greater rating and patronage (p < 0.001 and p = 0.0524 respectively). The results of the structured questionnaire survey were confirmed by qualitative enquiry,based on in-depth interviews and focus group discussions.
  
  
  CONCLUSIONS
  It will be necessary to create a more responsive atmosphere in the health facilities, with culturally-sensitive and friendly health workers, and provision of affordable drug to improve the perceptions of the primary health care system, for it to succeed in providing health services for all.
authors.affiliation: Department of Sociology/Anthropology, University of Nigeria, Nsukka, Nigeria. nkechi.onyeneho@unn.edu.ng.|Takemi Program in International Health, Department of Global Health and Population, Harvard T.H, Chan School of Public Health, Harvard University, Boston, MA, USA. nkechi.onyeneho@unn.edu.ng.
authors.forename: Nkechi G
authors.initials: NG
authors.lastname: Onyeneho
authors.affiliation: , P.O.Box 3397, Main Post Office, Okpara Avenue, Enugu, Nigeria. amazigo4@yahoo.com.
authors.forename: Uche V
authors.initials: UV
authors.lastname: Amazigo
authors.affiliation: , P.O.Box 7117, Wuse, Abuja, Federal Capital Territory, Nigeria. ngonjep@yahoo.com.
authors.forename: Ngozi A
authors.initials: NA
authors.lastname: Njepuome
authors.affiliation: Department of Parasitology, Nnamdi Azikiwe University, Awka, Nigeria. obinwaorgu@gmail.com.
authors.forename: Obioma C
authors.initials: OC
authors.lastname: Nwaorgu
authors.affiliation: Department of Sociology/Anthropology, University of Nigeria, Nsukka, Nigeria. jokeibunor@yahoo.com.|Immunization, Vaccines and Emergencies, WHO Regional Office for Africa, Brazzaville, Congo. jokeibunor@yahoo.com.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Okeibunor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D010465:Perception; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data*; D011634:Public Health / Q000592:standards* / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014507:Urbanization