Improving Health in Slums Collaborative (Including: Dasvarma, Gouranga Lal, Fayehun, Olufunke, Ajisola, Motunrayo, Uthman, Olalekan, Oyebode, Oyinlola, Oladejo, Abiola, Owoaje, Eme, Taiwo, Olalekan, Odubanjo, Oladoyin, Harris, Bronwyn, Lilford , Richard and Omigbodun, Akinyinka). (2022) A contextual exploration of healthcare service use in urban slums in Nigeria. PLoS One, 17 (2). e0264725. doi:10.1371/journal.pone.0264725

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Abstract

Introduction
Many urban residents in low- and middle-income countries live in unfavorable conditions with few healthcare facilities, calling to question the long-held view of urban advantage in health, healthcare access and utilization. We explore the patterns of healthcare utilization in these deprived neighborhoods by studying three such settlements in Nigeria.

Methods
The study was conducted in three slums in Southwestern Nigeria, categorized as migrant, indigenous or cosmopolitan, based on their characteristics. Using observational data of those who needed healthcare and used in-patient or out-patient services in the 12 months preceding the survey, frequencies, percentages and odds-ratios were used to show the study participants’ environmental and population characteristics, relative to their patterns of healthcare use.

Results
A total of 1,634 residents from the three slums participated, distributed as 763 (migrant), 459 (indigenous) and 412 (cosmopolitan). Residents from the migrant (OR = 0.70, 95%CI: 0.51 to 0.97) and indigenous (OR = 0.65, 95%CI: 0.45 to 0.93) slums were less likely to have used formal healthcare facilities than those from the cosmopolitan slum. Slum residents were more likely to use formal healthcare facilities for maternal and perinatal conditions, and generalized pains, than for communicable (OR = 0.50, 95%CI: 0.34 to 0.72) and non-communicable diseases (OR = 0.61, 95%CI: 0.41 to 0.91). The unemployed had higher odds (OR = 1.45, 95%CI: 1.08 to 1.93) of using formal healthcare facilities than those currently employed.

Conclusion
The cosmopolitan slum, situated in a major financial center and national economic hub, had a higher proportion of formal healthcare facility usage than the migrant and indigenous slums where about half of families were classified as poor. The urban advantage premise and Anderson behavioral model remain a practical explanatory framework, although they may not explain healthcare use in all possible slum types in Africa. A context-within-context approach is important for addressing healthcare utilization challenges in slums in sub-Saharan Africa.

Item Type:	Journal Article
Subjects:	H Social Sciences > HV Social pathology. Social and public welfare R Medicine > RA Public aspects of medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Medical care -- Nigeria, Health services accessibility -- Nigeria, Urban poor -- Health and hygiene -- Nigeria
Journal or Publication Title:	PLoS One
Publisher:	Public Library of Science
ISSN:	1932-6203
Official Date:	25 February 2022
Dates:	Date Event 25 February 2022 Published 15 February 2022 Accepted 7 July 2021 Submitted
Volume:	17
Number:	2
Number of Pages:	14
Article Number:	e0264725
DOI:	10.1371/journal.pone.0264725
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID 16/136/87 [NIHR] National Institute for Health Research http://dx.doi.org/10.13039/501100000272

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