Economic Determinants of Healthcare Demand Among Pregnant Women in Cross River State, Nigeria: A Negative Binomial Regression Analysis

Margaret Onwanyi Onoyom; Chukwuedo Susan Oburota; Etim Essien Bassey; Samuel Okoi Eno

doi:10.59413/eafj/v5.i3.7

Authors

Margaret Onwanyi Onoyom University of Calabar Author
Chukwuedo Susan Oburota University of Calabar Author
Etim Essien Bassey University of Calabar Author
Samuel Okoi Eno University of Calabar Author

DOI:

https://doi.org/10.59413/eafj/v5.i3.7

Keywords:

Healthcare Demand, Economic Determinants, Cross River State, Negative Binomial regression, Nigeria

Abstract

The study investigated the economic determinants of healthcare demand among pregnant women in Cross River State, Nigeria, employing a cross-sectional survey of 388 respondents across six purposively selected LGAs (Ogoja, Obudu, Yakurr, Ikom, Calabar Municipality, Akamkpa) using Cochran's formula (n=388, 95% CI, 5% margin). Anchored in Grossman's Health Demand Model, data collected via validated structured questionnaires (Cronbach's α = 0.734) were analyzed using Negative Binomial regression to model ANC visits (mean=3.88, overdispersed: variance= 4.296), confirmed appropriate by Kolmogorov-Smirnov (Z=2.559, p<0.001) and VIF<1.5 diagnostics. The study found that facility type is the dominant driver (public facilities: IRR=2.75, p<0.001; private: IRR=3.15, p<0.001 vs. traditional/church), with maternal age positively associated (IRR=1.21 per year, p<0.001). Contrary to economic theory, costs, income, and insurance showed non-significant effects (p>0.05), suggesting price-inelastic necessity demand, while distance (p=0.063) and education gradients were marginal. Policy recommendations include prioritizing supply-side interventions: CRSMoH to construct 10 rural PHCs, Cross River State Primary Healthcare Development Agency (CRSPHCDA) to deploy 20 mobile ANC units targeting adolescents (22% of sample), and Cross River State Health Insurance Scheme (CRSHIS) to mandate enrollment with subsidies for self-employed women (36%). These target facility access dominance to shift ANC utilization from modal 3-4 visits (36%) toward WHO 8-visit standard, addressing 10% zero-visit rate and 75% financial difficulties among Nigeria's maternal health priority population.

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References

Adhikari, R. P., Shrestha, M. L., Satinsky, E. N., & Upadhaya, N. (2021). Trends in and determinants of visiting private health facilities for maternal and child health care in Nepal: comparison of three Nepal demographic health surveys, 2006, 2011, and 2016. BMC pregnancy and childbirth, 21(1), 1.

Afape, A. O., Azubuike, P. C., Ibikunle, O. O., & Barrow, A. (2024). Prevalence and determinants of skilled birth attendance among young women aged 15–24 years in Northern Nigeria: evidence from multiple indicator cluster survey 2011 to 2021. BMC Public Health, 24(1), 2471.

Akanda, M. A. S. (2010). Demand for antenatal care in Bangladesh: An application of two-part model. South Asian Journal of Population and Health, 3(1).

Akin, J. S., Guilkey, D. K., & Hazel, E. (1995). Quality of services and demand for health care in Nigeria: a multinomial probit estimation. Social science & medicine, 40(11), 1527-1537.

Alex, D. (2025). What is snowball sampling? methods and examples. R Discovery. Retrieved May 21, 2025, from https://researcher.life/blog/article/what-is-snowball-sampling-methods-and-examples/

Azad, A. D., Charles, A. G., Ding, Q., Trickey, A. W., & Wren, S. M. (2020). The gender gap and healthcare: associations between gender roles and factors affecting healthcare access in Central Malawi, June–August 2017. Archives of Public Health, 78(1), 119.

Bolarinwa, O. A., Fortune, E., Aboagye, R. G., Seidu, A. A., Olagunju, O. S., Nwagbara, U. I., Ameyaw, E. K., & Ahinkorah, B. O. (2021). Health facility delivery among women of reproductive age in Nigeria: Does age at first birth matter? PloS one, 16, 11. e0259250. https://doi.org/10.1371/journal.pone.0259250

Bowling, A. (2014). Research methods in health: investigating health and health services. McGraw-hill education (UK).

Bujang, M. A. (2021). A Step-by-Step Process on Sample Size Determination for Medical Research. The Malaysian Journal of Medical Sciences: MJMS, 28(2), 15. https://doi.org/10.21315/mjms2021.28.2.2

Cameron, A. C., & Trivedi, P. K. (2013). Regression analysis of count data (No. 53). Cambridge university press.

Cochran, W. G. (1977). Sampling techniques (3rd ed.). John Wiley & Sons.

Creswell, J. W. (2014). Research design: qualitative, quantitative, and mixed methods approaches 3rd. Sage Publications

Cross River State Ministry of Health, CRSMoH, (2024).

Cross River State Statistical Yearbook, 2022.

Edgar, T. W., & Manz, D. O. (2016). Exploratory Study. Research Methods for Cyber Security, 95-130. https://doi.org/10.1016/B978-0-12-805349-2.00004-2.

Fatma, N., & Ramamohan, V. (2023). Healthcare seeking behavior among patients visiting public primary and secondary healthcare facilities in an urban Indian district: a cross-sectional quantitative analysis. PLOS Global Public Health, 3(9), e0001101.

Gana, G. N., & Mustapha, M. (2022). Determinants of Healthcare Choice in Kontagora Town. Lapai Journal of Economics, 6(1), 51-60.

Grossman, M. (2000). The human capital model. In Handbook of health economics (Vol. 1, pp. 347-408). Elsevier

Heffernan, E. (2025). Sampling methods: types descriptions & examples. Retrieved May 21, 2025, from https://quillbot.com/blog/research/sampling-methods/

Imo, C. K., De Wet-Billings, N., & Isiugo-Abanihe, U. C. (2022). The impact of maternal health insurance coverage and adequate healthcare services utilisation on the risk of under-five mortality in Nigeria: a cross-sectional study. Archives of Public Health, 80(1), 206

Khan Majlish, M. R., Tawhid, S. A., & Kibria, G. (2024). Urban Rural Disparities of Determinants of Antenatal Care in Senegal among Women of Reproductive Age: Evidence from 2023 Senegal Demographic Health Survey. medRxiv, 2024-10.

Khatri, R. B., Durham, J., & Assefa, Y. (2021). Utilisation of quality antenatal, delivery and postnatal care services in Nepal: An analysis of Service Provision Assessment. Globalization and Health, 17(1), 102.

Kolawole, B. O., Ucho Ejiroghene, C., Euba, M. I., Mercy, A. O., Adabra, M. S., & Onyeyili, I. N. (2024). Perceived factors affecting the utilization of maternity services in primary healthcare centre at a rural community in Northcentral, Nigeria. World Journal of Advanced Research and Reviews, 24(02), 903-914. https://doi.org/10.30574/wjarr.2024.24.2.3431

McGuire, A., Henderson, J., & Mooney, G. (1988). The economics of health care.

Mina, M. N., Nuruzzaman, M., Habib, M. N., Rahman, M., Chowdhury, F. M., Ahsan, S. N., Ahmed, F. F., Azizi, S., Mubin, N., Kibria, A. H. M. G., & Shuchi, F. A. (2023). The effectiveness of adequate antenatal care in reducing adverse perinatal outcomes: evidence from a low- or middle-income country. Cureus, 15(12), e51254. https://doi.org/10.7759/cureus.51254.

Muya, M., Ilembo, B., & Anasel, M. (2024). Predictive accuracy of the logit model to determine factors affecting delivery and postnatal care services utilization in Tanzania. International Journal of Health Governance, 29(4), 412-421.

Mwami, M. N., & Oleche, M. O. (2017). Determinants of utilization of health care services in Kenya. International Journal of Academic Research in Business and Social Sciences, 7(10), 132-156.

Nghargbu, R., & Olaniyan, O. (2019). Determinants of antenatal care utilization in Nigeria. African Development Bank.

Nigeria Demographic and Health Survey, NDHS. (2018).

Nikolopoulou, K. (2022). What Is Convenience Sampling? | Definition & Examples. Scribbr. Retrieved May 21, 2025, from https://www.scribbr.com/methodology/convenience-sampling/

Ningrum, E. W., Lusmilasari, L., Huriyati, E., Marthias, T., & Hasanbasri, M. (2024). Improving maternal health literacy among low-income pregnant women: A systematic review. Narra J, 4(2), e886. https://doi.org/10.52225/narra.v4i2.886.

Olajide, A. O., Ademuyiwa, I. Y., & Adetule, O. O. (2025). Determinants of Antenatal Care Attendance among Pregnant Women in Selected Primary Healthcare Centres in Ibadan, Nigeria: A Cross-Sectional Study. Journal Of Nursing Scientists and Health Services Today, 1(1).

Olubodun, T., Rahman, S.A., Odukoya, O.O., Okafor, I. F. & Balogun, M. R. (2023) Determinants of health facility delivery among young mothers aged 15 – 24 years in Nigeria: a multilevel analysis of the 2018 Nigeria demographic and health survey. BMC Pregnancy Childbirth 23(185). https://doi.org/10.1186/s12884-023-05492-x

Palamuleni, M. E. (2022). Prevalence, Trends, and Determinants of at Least Four Antenatal Visits in Malawi: Analyses of the Malawi Demographic and Health Surveys 1992–2016. Journal of Population and Social Studies [JPSS], 30, 309-331

Perkins, M., Brazier, E., Themmen, E., Bassane, B., Diallo, D., Mutunga, A., Mwakajonga, T., & Ngobola, O. (2009). Out-of-pocket costs for facility-based maternity care in three African countries. Health policy and planning, 24(4), 289–300. https://doi.org/10.1093/heapol/czp013

Peters, D. H., Garg, A., Bloom, G., Walker, D. G., Brieger, W. R., & Rahman, M. H. (2008). Poverty and access to health care in developing countries. Annals of the New York Academy of Sciences, 1136, 161–171. https://doi.org/10.1196/annals.1425.011

Runguo, W., Niying, L. & Angelo, E. (2020). The effects of private health insurance on universal health coverage objectives in China: a systematic literature review. IJERPH, MDPI, 17, 6, 1-21.

Socías, M. E., Koehoorn, M., & Shoveller, J. (2016). Gender inequalities in access to health care among adults living in British Columbia, Canada. Women's Health Issues, 26(1), 74-79.

Tadiri, C. P., Gisinger, T., Kautzky-Willer, A., Kublickiene, K., Herrero, M. T., Norris, C. M., Raparelli, V., & Pilote, L. on behalf of the GOING-FWD Consortium. (2021). Determinants of perceived health and unmet healthcare needs in universal healthcare systems with high gender equality. BMC Public Health, 21(1), 1488. https://doi.org/10.1186/s12889-021-11531-z

Tayal, C., Sharma, R., & Lata, K. (2024). Evidence from maternal healthcare services in South Asia: Demography vs. healthcare. International Journal of Healthcare Management, 1-13.

Uchendu, O. C., Bakare, A. A., Olojede, O. E., Sogbesan, A. A., Falade, A. G., Bakare, O. R., King, C. & Graham, H. (2024). Location of Antenatal Care and Delivery among Mothers in Lagelu Local Government Area, Ibadan: A Cross-Sectional Study with Preliminary Exploration of Predictive Factors. Afr. J. Med. Med. Sci, 53(3), 185-196.

Um, S., Phan, C., Dany, L., Veha, K., Pay, S., & Chau, D. (2024). The effect of health insurance coverage on antenatal care utilization in Cambodia: A secondary analysis of Cambodia Demographic and Health Survey 2021–2022. PLOS Global Public Health, 4(11), e0002954.

Wagstaff, A. (1986). The Demand for health: A Simplified Grossman model. Bulletin of Economic Research, 38(1).

Waroh, J. N., Akpenpuun, J. R., Starris-Onyema, P. N., & Iornyagh, B. T. (2024). factors affecting the utilization of maternal and child healthcare services in Kwande local government area of Benue state. POLAC Economic Review, 4(1) 2756-4428.

Wellay, T., Gebreslassie, M., Mesele, M., Gebretinsae, H., Ayele, B., Tewelde, A., & Zewedie, Y. (2018). Demand for health care service and associated factors among patients in the community of Tsegedie District, Northern Ethiopia. BMC health services research, 18(1), 1-9.

World Bank. (2016). Reproductive, maternal, newborn, and child health: Key messages from Disease Control Priorities, 3rd edition. Washington, DC: World Bank. https://doi.org/10.1596/978-1-4648-0348-2_ch7

World Bank. (2024). World Development Indicators.

World Health Organization (2023). Improving maternal and newborn health and survival and reducing stillbirth: progress report 2023. Geneva:. Licence: CC BY-NC-SA 3.0 IGO.

World Health Organization, WHO. (2015). Strategies toward ending preventable maternal mortality (EPMM). Geneva: WHO.

World Health Organization. (2023). Analytical fact sheet. World Health Organization. Retrieved January 14, 2025, from https://files.aho.afro.who.int/afahobckpcontainer/production/files/iAHO_Maternal_Mortality_Regional_Factsheet.pdf

World Health Organization. (2023). Trends in maternal mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. World Health Organization.

ZA, Z., AM, R., PY, L., & Juni, M. H. (2018). Healthcare demand and its determinants. International Journal of Public Health & Clinical Sciences (IJPHCS), 5(6).