title: Utilization of health services in a resource-limited rural area in Kenya: Prevalence and associated household-level factors.
abstract: METHODS
  Knowledge of utilization of health services and associated factors is important in planning and delivery of interventions to improve health services coverage. We determined the prevalence and factors associated with health services utilization in a rural area of Kenya. Our findings inform the local health management in development of appropriately targeted interventions. We used a cluster sample survey design and interviewed household key informants on history of illness for household members and health services utilization in the preceding month. We estimated prevalence and performed random effects logistic regression to determine the influence of individual and household level factors on decisions to utilize health services.
  
  
  CONCLUSIONS
  1230/6,440 (19.1%, 95% CI: 18.3%-20.2%) household members reported an illness. Of these, 76.7% (95% CI: 74.2%-79.0%) sought healthcare in a health facility. The majority (94%) of the respondents visited dispensary-level facilities and only 60.1% attended facilities within the study sub-counties. Of those that did not seek health services, 43% self-medicated by buying non-prescription drugs, 20% thought health services were too costly, and 10% indicated that the sickness was not serious enough to necessitate visiting a health facility. In the multivariate analyses, relationship to head of household was associated with utilization of health services. Relatives other than the nuclear family of the head of household were five times less likely to seek medical help (Odds Ratio 0.21 (95% CI: 0.05-0.87)). Dispensary level health facilities are the most commonly used by members of this community, and relations at the level of the household influence utilization of health services during an illness. These data enrich the perspective of the local health management to better plan the allocation of healthcare resources according to need and demand. The findings will also contribute in the development of community-level health coverage interventions that target the disadvantaged household groups.
authors.affiliation: Centre for Population Health Sciences, Faculty of Health Sciences-East Africa, Aga Khan University, Nairobi, Kenya.
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Ngugi
authors.affiliation: Centre for Population Health Sciences, Faculty of Health Sciences-East Africa, Aga Khan University, Nairobi, Kenya.|Department of Community Health, Faculty of Health Sciences-East Africa, Aga Khan University, Mombasa, Kenya.
authors.forename: Felix
authors.initials: F
authors.lastname: Agoi
authors.affiliation: Department of Medicine, Stanford University, Stanford, California, United States of America.|Department of Family Medicine, Faculty of Health Sciences-East Africa, Aga Khan University, Nairobi, Kenya.
authors.forename: Megan R
authors.initials: MR
authors.lastname: Mahoney
authors.affiliation: Centre for Population Health Sciences, Faculty of Health Sciences-East Africa, Aga Khan University, Nairobi, Kenya.|Department of Community Health, Faculty of Health Sciences-East Africa, Aga Khan University, Mombasa, Kenya.
authors.forename: Amyn
authors.initials: A
authors.lastname: Lakhani
authors.affiliation: Sub-County Health Management, Kaloleni Sub-County, Mariakani, Kilifi County, Kenya.
authors.forename: David
authors.initials: D
authors.lastname: Mang'ong'o
authors.affiliation: School of Nursing and Mid-wifery, Aga Khan University-East Africa, Nairobi, Kenya.
authors.forename: Esther
authors.initials: E
authors.lastname: Nderitu
authors.affiliation: Medical College, Faculty of Health Sciences-East Africa, Aga Khan University, Nairobi, Kenya.
authors.forename: Robert
authors.initials: R
authors.lastname: Armstrong
authors.affiliation: Centre for Population Health Sciences, Faculty of Health Sciences-East Africa, Aga Khan University, Nairobi, Kenya.|Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Sarah
authors.initials: S
authors.lastname: Macfarlane
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015995:Prevalence; D011336:Probability; D012044:Regression Analysis; D019035:Rural Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D012424:Rural Population; D018401:Sample Size; D012959:Socioeconomic Factors; D055815:Young Adult