Utilization of health services by settled and nomadic groups in Wanjir district, Kenya
Dakane, Mohamed Maalim
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Inequalities in health are more obvious than ever before throughout the world in the different levels of socio-economic development. While substantial improvement in health status the world over has been gained as evidenced by the declining mortality and improved child survival, there remain substantial inequalities in health between countries, regions, socio-economic groups and individuals. These differences are not attributable to genetic or biologically factors but that governments do not see inequality as an important health problem that they can address. Large portions of the world population are inaccessible to treatment and medical care. Studies suggest that nomads have been left out of national health planning. Thus a study was designed to understand utilization patterns of health services by a disadvantaged people such as Nomads of North Eastern Province of Kenya. A comparative cross sectional descriptive study involving 600 mothers with children using questionnaires was done in Wajir. The study was conducted in ten clusters (four for settled people and six nomadic hamlets) involving women between 15-49 years and their children between 12-23 months. Data was collected on antenatal, maternal and family planning use, while for children information on immunization and sickness was gathered. Cluster sampling was employed. In the settled clusters seventy-five mothers with children were studied in each of the four clusters, while fifty women were interviewed in each of the six nomadic clusters giving a total of six hundred mothers for both groups. SPSS (9:0) software package was used for processing. Fisher's exact test, Z-score test, chi-square and Odd's ratio were employed to test relationships between the variables and the coverage rates. Results of the study indicate that: Shelter: 80% of settled and 98% of nomadic mothers live in Somali hut. Illiteracy is high in both groups (16.3% and 1.3% respectively). Clinic attendance: 89.7% (settled) and 7.3% (nomads). Delivery in a health facility: 65% (settled) delivered in health facility, while 95% of nomadic women delivered at home. Attendance by a skilled worker: a skilled worker attended 65% of settled women, while 95% of nomadic women were delivered by Traditional Birth Attendant (TBA). Family Planning (FP) knowledge is low (37.3% settled and 1% nomads). F/P use is very low. 9.3% of settled women and 0.3% nomads. Card possession is 87.3% (settled women) compared to 23.7% of nomads. Immunization knowledge was high among the settled (96.3%) and low (9.7%) among the nomads. Immunization rates are low among nomads. Sickness: 84% (settled) and 94%(Nomadic) children had been ill. Source of immunization: 90% (nomads) got immunizations from mobile clinics while 91% (settled) got it at static facilities. Only 28% of health workers said their facility conducted outreach services. Shelter, radio ownership, education, awareness of clinic location and distance influenced the use of health services. Settled people had higher utilization rates compared to nomads (Z Test; P<.001). Nomads' inaccessibility to health evidenced by low utilization rates should worry health planners. Innovative approaches such as targeting watering points, training pastoral associations in service delivery should be explored.