Journal of Community Medicine and Primary Health Care. 29 (2) 74-83 JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE Perception of Community Health Extension Services among Women in a Rural Community in Ilorin East, Kwara State, Nigeria 1Adefalu LL, 1Awoete OM, Aderinoye-Abdulwahab SA, 2Issa BA 1Department of Agricultural Extension and Rural Development, Faculty of Agriculture, University of Ilorin, Ilorin, Nigeria; 2Department of Behavioural Sciences, University of Ilorin ABSTRACT Background: Rural women in developing countries, including Nigeria are faced with a Keywords: number of health problems with very limited access to health care facilities. This study Perception, assessed the perception of women in rural areas on community health extension services in Community Ilorin, Kwara State. Health Methods: One hundred and twenty rural dwelling women were sampled from six rural communities selected by simple random sampling method. A structured questionnaire was Extension used for data collection. Data was analyzed using SPSS version 18. Level of significance was Services, set at p-value of ≤ 0.05. Women Results: The mean age of the respondents was 45 years and 69.3% of them were married. Over a third (36.7%) of the respondents, had no formal education and 40.0% were farmers with an average monthly income of ₦14,146.00. High awareness level on community health extension services was observed but 65.5% lived at a distance beyond 3 km from the health centers and they usually trek to the facilities. Maternal, child care services and first aid treatment were available; however, mental health was poorly ranked in terms of effectiveness of community health extension services provided in the area. Age (p<0.001) was inversely significant while educational level (r = 0.334, p < 0.01) was positively related to the frequency of availability of community health extension services. Conclusion: The respondents were aware of community health extension services, however, most of them live far from the health facilities. We recommend that Community Health Extension Workers should embark on home visits in order to improve access to health services in the rural communities. Correspondence to: Adefalu L.L Department of Agricultural Extension and Rural Development, Faculty of Agriculture, University of Ilorin, Ilorin, Nigeria. [email protected] INTRODUCTION processing and marketing.2 Rural women farmers play a vital role in food production Rural development in Africa cannot be and food security and the responsibility achieved without the active participation of placed on the shoulders of women in the rural women.1 Women play important roles in areas to meet the daily food and need of most agriculture as they carry out different families cannot be overemphasized.3 Many activities relating to food production, 74 JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 29, NO 2, SEPTEMBER 2017 rural women farmers have poor health status. perform a broad range of activities related to This could be due to heavy farm work, health including preventive counselling, childbearing and rearing and poor nutrition.4 health education, behaviour change communication and health promotion, as well Health, according to the World Health as screening, treatment and referral for a Organization, is a state of complete physical, range of diseases (malaria, tuberculosis, HIV, mental and social well-being and not merely among others). In addition, they help mobilize the absence of disease or infirmity and it is a communities for vaccination and other major determinant of the socioeconomic community health activities.12 development of people and this is based on the fact that all human endeavours require Despite the budget allocated yearly to sound minds in sound bodies for full Nigeria’s health sector, the residents of rural realization of aspirations.5, 6 Despite the huge communities are deprived of adequate health differences that may occur between facilities. The rural people, particularly the developing and developed countries of the rural women, are faced with various world, access to health services is the major difficulties as regards access to proper issue in rural health around the world. Access healthcare services. There is a need to bridge to health services is particularly low in rural the gap between rural people and health areas, where a large percentage of the services as their health has an effect on population still lives. The few health facilities agricultural productivity because the bulk of that are available usually favour urban or agricultural activities take place in the rural wealthy areas. Together with an uneven areas with the rural people, particularly the distribution of health manpower often results women, being the major labour force. The in poor availability and poor quality of health health needs of women and girls in rural areas services in rural areas.7, 8 According to WHO, are often neglected, compared to the needs of Primary Health Care means essential health those in urban areas, and their access to care based on practical, scientifically sound services is often too low. They encounter and socially acceptable methods made numerous constraints in accessing affordable, universally accessible to individuals and adequate health services in rural areas.13 families in the community through their full The difficulty in recruiting doctors prompted participation and at a cost which the country the use of community health extension can afford to maintain at every stage of their workers in rural areas. Despite the training development in the spirit of self-reliance and and experience many people are in doubt of self-determination.9 The community health their competence to diagnose accurately, talk extension workers (CHEW) in Nigeria were to less of treating endemic disease like malaria.14 bring health care as close as possible to where There is a need to determine the perception of people live and work, and would constitute rural women on the use of community health the first element of continuing health care extension workers to meet their health needs. process.10 CHEWs are health workers In the light of the problems enumerated specially trained to provide primary health above, this study sought to describe the care in Nigeria. They are members of a socioeconomic characteristics of the rural community who are chosen by the women in the study area, identify the community members or organizations to respondents’ level of awareness on the provide basic health and medical care to their available community health extension community.11 Community health workers services in the study area, examine 75 JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 29, NO 2, SEPTEMBER 2017 respondents’ level of access to community population is > 10,000; N = estimate of the health extension services in the study area, population size. Thus, nf = 384/1+(384/150) and evaluate the effectiveness of community =107.9 ≈108 but considering attrition, 120 was health extension services as perceived by the used. respondents in the study area. The study population were rural women in METHODOLOGY Ilorin East LGA of Kwara State. Ilorin East LGA was purposively selected because it has The cross-sectional study was carried out in basic health centres. Six rural communities in Ilorin East Local Government Area (LGA) of the LGA were selected using simple random Kwara State between January and June, 2016. sampling method by balloting. The selected Ilorin East is located between latitude 8° 5’N communities were: Sentu, Ile-Apa, Budo- and longitude 4° 5’E. The LGA shares a Aare, Alalubosa, Oke-Ose and Oke-Oyi. boundary with Ilorin South, Ilorin West, Moro House listing was done and ten (10) and Ifelodun LGA, has land area of about households were selected using simple 486km2 and a population of 207,462.15 The random sampling method by balloting from proportion of females was put at 49.5% of the each community. Subsequently, two (2) adult total population.15 The population of people women respondents were purposively aged 15 and above was 122,282. The projected selected from all listed houses giving a total of population of women between this age group twenty (20) respondents from each of the is 60,530 by the year 2016. Majority of the selected communities and a total sample size people in Ilorin-East LGA are farmers who of 120 respondents from the study area. engage in the production of crops like melon, Respondents should have been in the maize, locust beans, pepper, cassava and yam. community for at least six months in order to Anecdotal report from the LGA Headquarter be used to the dynamics of rural living and the at Oke-Oyi indicated that the population of respondents must have also consented to adult women in these selected villages participate in the study. Rural dwellers who involved in agriculture was about 150. did not meet these criteria were excluded The sample size for the study was estimated from the study. The study protocol was using Fisher's formula16 for population > approved by the Faculty of Agriculture 10000, n = z2pq/d2 Where n = the desired Ethical Committee and the University of Ilorin sample size; z = the standard normal deviate Central Ethical Committee. Permissions of the set at 1.96 [95% confidence level]; p= the Ilorin East Local Government Authority was estimated lifetime prevalence of substance use also sought and obtained through the in this population = 50% (i.e. half of the Supervisory Councillors for Health and population when p is unknown, as Agriculture. Community entrance was recommended by Fisher); q=1-p. Therefore, further facilitated by the Heads of the q= 1-0.50= 0.50; d= absolute precision or respective communities, the Magajis, Baales or sampling error tolerated =5%. The calculated Alangwa as appropriate. sample, n = 384. Since the women were less Pretesting of the questionnaire was done in than 10000, a further analysis was done as Ogbondoroko Community of Asa LGA, follows: Kwara State particularly to test the ease and nf = n/1+ (n/N), where nf is the desired timing of completing the questionnaire.