INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue X October 2025  
Utilization and Satisfaction Levels of Primary Health Care Services  
Among Adults in Umuna Community, Orlu Local Government Area,  
Imo State  
Okeke, Miracle Chidiebere1*, Aka-Okeke, Nnaedozie Ikemsinachi2, Evi, Akarogbe3, Oluka, Chinwuba  
Benedict4, Ekenze, Chigozie John5, Gilson, Chukwuemeka Chukwuma6, Anthony Precious Chima7  
1Department of Internal Medicine, Enugu State University Teaching Hospital.  
2Department of Surgery, Enugu State University Teaching Hospital.  
3Gulf medical university, Ajman, UAE.  
4Enugu State University of Science and Technology Teaching Hospital, Parklane.  
5Department of Optometry, Imo State University, Owerri.  
6Department of Community Medicine, Nnamdi Azikiwe University.  
7Nnamdi Azikiwe university, Awka  
DOI: https://dx.doi.org/10.51244/IJRSI.2025.1210000346  
Received: 02 November 2025; Accepted: 10 November 2025; Published: 22 November 2025  
ABSTRACT  
Primary Health Care (PHC) remains the foundation of Nigeria’s health system, yet utilization and satisfaction  
with PHC services remain suboptimal, particularly in rural areas. Understanding community-level patterns of  
knowledge, use, and satisfaction is essential for improving PHC delivery. This study assessed these factors and  
their determinants among adult residents of Umuna community, Orlu Local Government Area (LGA), Imo State,  
Nigeria. A community-based descriptive cross-sectional study was conducted among 400 adults selected through  
convenience sampling. Data were collected using a pre-tested, semi-structured questionnaire assessing  
sociodemographic characteristics, knowledge of PHC services, utilization patterns, and satisfaction. Knowledge,  
utilization, and satisfaction were scored using standardized scales. Data were analyzed with SPSS version 28  
using descriptive statistics and chi-square tests to explore associations between PHC utilization and  
sociodemographic variables. Most respondents were young adults (53.8%), female (68.3%), and traders or  
business owners. Knowledge of PHC services was moderate (39%), with high awareness of immunization  
(78%), antenatal care (67.3%), treatment of common illnesses (61.8%), and health education (59.5%). Overall,  
61.3% had used PHC services within the past six months, though many preferred hospitals due to perceived  
shortages of drugs, inadequate staffing, and poor equipment. Satisfaction with PHC services was generally low  
to moderate (34%), and was significantly associated with occupation and marital status. Utilization was  
significantly associated with monthly income, knowledge level, and satisfaction (p < 0.05). Although awareness  
and utilization of PHC services in Umuna were relatively high compared to many Nigerian settings, satisfaction  
remained low due to persistent system challenges, misconceptions about PHC functions, and inadequate service  
delivery. Strengthening PHC infrastructure, improving drug supply and staffing, and enhancing community  
health education are essential to improving trust and optimizing PHC use.  
Keywords: Primary Health Care, Utilization, Satisfaction, Knowledge, Community Health  
INTRODUCTION  
Primary Health Care (PHC) is globally recognized as the foundation of effective health systems, defined by the  
Alma-Ata Declaration as essential and universally accessible care delivered through scientifically sound, socially  
Page 4020  
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue X October 2025  
[1]  
acceptable, and affordable methods that encourage full community participation.  
As a patient-centered  
approach, PHC aims to promote health, prevent disease, treat common conditions, and ensure continuity of care.  
Its success depends heavily on public awareness, accessibility, and satisfaction with the quality of services  
provided. Client satisfaction—achieved when expectations of care are met—is widely regarded as an important  
indicator of service quality and a determinant of health-seeking behavior. [2]  
Health-care utilization reflects the degree to which individuals access health services for disease prevention,  
treatment, and general well-being. [3] In Nigeria, PHC became the central strategy for achieving “Health for All”  
following adoption of the 1978 Alma-Ata Declaration and the launch of the National Primary Health Care Policy  
in 1988. [4] The system is designed to function through a three-tier governmental structure and provides essential  
services such as maternal and child health, immunization, disease control, environmental health, health  
[5–7]  
education, and the provision of essential drugs.  
Despite these intentions, PHC performance across Nigeria  
has remained suboptimal. Less than 20% of potential users rely on PHC facilities, a situation worsened by  
infrastructural decay, inadequate staffing, obsolete equipment, and an almost non-functional referral system. [8,9]  
Utilization is further constrained by financial barriers, long travel distances, poor service availability in rural  
settings, and marked disparities between urban and rural facilities. [10–12] Although rural communities constitute  
more than half of Nigeria’s population, fewer than one-third have access to modern healthcare services. [13]  
Studies across Nigeria reveal wide variations in PHC utilization: from as low as 12% in Kwara State to over  
40% in parts of the southwest, and substantially higher rates in countries such as South Africa and Pakistan. [14]  
Persistent challenges in Nigeria—including uneven distribution of health workers, poor remuneration,  
dilapidated infrastructure, and cultural preferences for traditional healers—contribute to low uptake, particularly  
[15,16]  
in underserved rural areas.  
These disparities underscore the importance of assessing community-level  
knowledge, utilization patterns, and satisfaction with PHC services. Understanding how communities perceive  
and use PHC services is essential for strengthening primary care delivery, improving service quality, and  
informing health policy. Evaluating utilization and satisfaction provides insight into accessibility issues, quality  
gaps, and the effectiveness of PHC systems. It also helps identify barriers that must be addressed to achieve  
[17]  
equitable health outcomes and improve public trust in PHC as the first point of contact in the health system.  
This study contributes to this need by examining knowledge, service utilization, satisfaction, and associated  
determinants within a rural Nigerian community, providing evidence that can inform PHC improvement  
strategies across similar settings.  
LITERATURE REVIEW  
Primary Health Care (PHC) remains central to improving population health, yet evidence from low- and middle-  
income settings shows persistent gaps in awareness, utilization, and satisfaction. Knowledge of PHC services  
varies widely across countries, with some communities demonstrating strong awareness of services such as  
immunization and antenatal care, while others remain poorly informed due to weak community engagement and  
[18–21]  
inadequate publicity.  
Utilization is shaped by socioeconomic status, cultural beliefs, accessibility, and  
[22–25]  
health-system factors including drug availability, staff competence, and facility infrastructure.  
Studies  
across Africa and Asia consistently highlight low utilization in rural areas, driven by long distances, high costs,  
poor staffing, and non-functional referral systems. [26–31] Patient satisfaction—an essential indicator of quality—  
depends on staff attitude, waiting time, facility cleanliness, and availability of essential services, with higher  
satisfaction typically associated with older age, lower income, and previous positive experiences. [32–38] Despite  
global reforms emphasizing patient-centered care, satisfaction levels in many developing countries remain  
suboptimal due to infrastructural deficits and inconsistent service quality. [39–41] Socio-cultural norms, education,  
and affordability strongly influence health-seeking behaviour, with rural populations often relying on traditional  
[42–47]  
healers or home remedies when PHC services are perceived as inadequate, inaccessible, or unresponsive.  
Evidence consistently shows that improving PHC utilization and satisfaction requires strengthening  
infrastructure, ensuring equitable staffing, reducing financial barriers, and enhancing community-based health  
[48–50]  
education.  
These findings underscore the need to examine PHC usage patterns and determinants within  
rural Nigerian communities, where disparities in access, quality, and outcomes continue to persist.  
Page 4021  
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue X October 2025  
METHODS  
This study was conducted in Umuna community of Orlu, a semi-urban area in Imo State with a population of  
approximately 420,600, characterized by poor electricity supply, reliance on borehole water, and a  
predominantly farming and trading population where common illnesses include malaria, pneumonia, diarrhea,  
[51]  
HIV and tuberculosis.  
A community-based descriptive cross-sectional survey was employed among adult  
residents aged 18 years and above who were permanent members of the community and provided informed  
consent. Individuals who were severely ill, mentally incapacitated, unconscious, unavailable during data  
collection, or who withdrew consent were excluded. The minimum sample size was calculated using Cochran’s  
[52]  
formula, based on a prevalence of 30% from a previous study, and was rounded to 400 participants.  
Convenience sampling was adopted, selecting adults readily available at the PHC facility or nearby and willing  
to participate.  
Data were collected using a pre-tested, semi-structured questionnaire adapted from an earlier study, consisting  
of four sections: sociodemographic characteristics, knowledge of PHC services, utilization patterns, and  
satisfaction with services. Pretesting ensured validity and reliability. Knowledge, utilization, and satisfaction  
were measured using structured scoring systems: knowledge scores categorized as poor, moderate, or good;  
utilization classified into poor, moderate, or good; and satisfaction graded from poor to good based on Likert-  
scale responses. Completed questionnaires were cleaned, coded, and entered into Microsoft Excel before transfer  
to SPSS version 28 for analysis. Descriptive statistics (frequencies and percentages) and inferential tests,  
including chi-square, were employed, and results presented in tables and charts. Ethical approval was obtained  
and permission was secured from the PHC authorities. Written informed consent was obtained from all  
participants, with provisions for those unable to read or write. Confidentiality, voluntariness, and the right to  
withdraw were ensured throughout the study.  
RESULTS  
A total of 400 adult residents of Umuna, Orlu were interviewed on the utilization and satisfaction of primary  
health care facility services.  
Table 1: Socio-demographic Characteristics of Umuna Adult Residents  
Variables  
Age  
Frequency (n)  
Percentage (%)  
18-29  
215  
96  
53.8  
24.0  
15.8  
6.5  
30-39  
40-49  
63  
50 and above  
Total  
26  
400  
100.0  
Gender  
Male  
127  
273  
400  
31.8  
68.3  
100.0  
Female  
Total  
Marital status  
Page 4022  
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue X October 2025  
Married  
151  
228  
21  
37.8  
57.0  
5.3  
Single  
Divorced/Separated  
Total  
400  
100.0  
Religion  
Catholic  
Anglican  
Pentecostal  
Traditional  
Muslim  
169  
73  
42.3  
18.3  
30.5  
3.8  
122  
15  
10  
2.5  
None  
11  
2.8  
400  
100.0  
Total  
Educational level  
None  
9
2.3  
Primary  
26  
97  
268  
400  
6.5  
Secondary  
Tertiary  
24.3  
67.0  
100.0  
Total  
Occupation  
Civil servant  
Farmer  
59  
33  
175  
10  
88  
32  
3
14.8  
8.3  
Trader/Business  
Housewife  
Student  
43.8  
2.5  
22.0  
8.0  
Others  
None  
.8  
400  
100.0  
Total  
Income  
Page 4023  
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue X October 2025  
No income  
115  
50  
28.7  
12.5  
13.3  
15.3  
30.3  
100.0  
Less than N10,000  
N10,000-N24,000  
N25,000-N39,000  
N40,000 and above  
Total  
53  
61  
121  
400  
Family type  
Monogamous  
Polygamous  
Total  
345  
55  
86.3  
13.8  
100.0  
400  
Number of children  
None  
70  
17.5  
36.5  
26.5  
16.5  
3.0  
1-2 children  
3-4 children  
5-6 children  
More than 6 children  
Total  
146  
106  
66  
12  
400  
100.0  
Type of waste disposal  
Open dumping  
Covered bin  
Open bin  
78  
19.5  
38.0  
7.5  
152  
30  
Plastic bag  
140  
400  
35.0  
100.0  
Total  
Table 1 shows the socio-demographic characteristics of the respondents. It revealed that more than half (53.8%)  
of the respondents were within 18-29 years, a little above two-third (68.3%) were female, 57.0% were single,  
42.3% were Catholics, 67.0% had tertiary education, 43.8% were traders or business owner, 86.3% were of  
monogamous family type, 30.3% earned N40,000 and above, 36.5% had 1-2 number of children while 38.0%  
used covered bin.  
Page 4024  
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue X October 2025  
Table 2: Knowledge of PHC Services and facility among Umuna Adult Residents  
Variables  
Frequency (n)  
Percentage (%)  
Do you know if there is a  
primary health care facility in  
your area?  
No  
28  
7.0  
I don’t know  
101  
271  
400  
25.3  
67.8  
100.0  
Yes  
Total  
Antenatal care/delivery  
No  
131  
269  
400  
32.8  
67.3  
100.0  
Yes  
Total  
Immunization  
No  
88  
22.0  
78.0  
100.0  
Yes  
312  
400  
Total  
Family planning  
No  
185  
215  
400  
46.3  
53.8  
100.0  
Yes  
Total  
Treatment diseases and injuries  
No  
153  
247  
400  
38.3  
61.8  
100.0  
Yes  
Total  
Health education  
No  
162  
238  
400  
40.5  
59.5  
100.0  
Yes  
Total  
Page 4025  
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue X October 2025  
Referral services  
No  
234  
166  
400  
58.5  
41.5  
100.0  
Yes  
Total  
Ultra Sound Scan  
No  
325  
75  
81.3  
18.8  
100.0  
Yes  
Total  
400  
Does the primary health care  
facility provide free services  
No  
117  
180  
103  
400  
29.3  
45.0  
25.8  
100.0  
I don’t know  
Yes  
Total  
Does the primary health care  
facility provide services for 24  
ours  
No  
84  
21.0  
42.3  
36.8  
100.0  
I don’t know  
Yes  
169  
147  
400  
Total  
Table 2 shows the Knowledge of PHC Services and facility among Umuna Adult Residents. It revealed that a  
little above two-third (67.8%) knew that there was primary health care facility in their area. The knowledge of  
the availability of the following PHC services antenatal care/delivery, immunization, family planning, treatment  
of injuries and health education were 67.3%, 78.0%, 53.8%, 61.8% and 59.5% respectively.  
Figure 1: Level of PHC Services and Facility Knowledge among Umuna Adult Residents  
Page 4026  
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue X October 2025  
Figure 1 shows that there is moderate knowledge (39%) of Level of PHC Services and Facility Knowledge  
among Umuna Adult Residents  
Table 3: Utilization of PHC Facility Services among Umuna Adult Residents  
Variables  
Frequency (n)  
Percentage (%)  
Have you ever attended the  
primary health care facility  
for treatment  
No  
155  
245  
400  
38.8  
61.3  
100.0  
Yes  
Total  
If you have attended, how  
recently  
I have not attended  
less than 3 months ago  
3-6 months ago  
155  
83  
38.8  
20.8  
15.5  
25.0  
100.0  
62  
More than 6 months ago  
Total  
100  
400  
I have not attended the  
health facility  
I have attended  
I have not attended before  
Total  
245  
155  
400  
61.3  
38.8  
100.0  
The health staff know what  
they are doing  
Not a reason  
109  
151  
140  
400  
27.3  
37.8  
35.0  
100.0  
Yes a reason  
I have not attended  
Total  
Facility is near my house  
Not a reason  
106  
154  
26.5  
38.5  
Yes a reason  
Page 4027  
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue X October 2025  
I have not attended  
140  
400  
35.0  
100.0  
Total  
The staff give me immediate  
attention  
Not a reason  
Yes a reason  
I have not attended  
Total  
103  
157  
140  
400  
25.8  
39.3  
35.0  
100.0  
Drugs are available  
Not a reason  
Yes a reason  
I have not attended  
Total  
89  
22.3  
42.8  
35.0  
100.0  
171  
140  
400  
Drugs are cheaper  
Not a reason  
Yes a reason  
I have not attended  
Total  
97  
24.3  
40.8  
35.0  
100.0  
163  
140  
400  
Drugs are genuine  
Not a reason  
Yes a reason  
I have not attended  
Total  
118  
142  
140  
400  
29.5  
35.5  
35.0  
100.0  
The staff are caring  
Not a reason  
Yes a reason  
I have not attended  
Total  
104  
156  
140  
400  
26.0  
39.0  
35.0  
100.0  
Page 4028  
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue X October 2025  
The health services are  
always available  
Not a reason  
Yes a reason  
I have not attended  
Total  
149  
111  
140  
400  
37.3  
27.8  
35.0  
100.0  
If you were to decide on a  
place to receive treatment,  
where would you prefer  
Home  
38  
79  
235  
5
9.5  
Primary health facility  
Hospital  
19.8  
58.8  
1.3  
Traditional healers  
Prayer house  
8
2.0  
Pharmacy/medicine store  
Total  
35  
400  
8.8  
100.0  
Table 3 shows the Utilization of PHC Facility Services among Umuna Adult Residents. It revealed that a little  
below two-third (61.3%) of the respondents attended the primary health care facility for treatment, 38.8% have  
not attended PHC. The following reason made the respondents to attend primary health facility: the staff know  
what they are doing (37.8%), facility near their house (38.5%), the staff gives immediate attention (39.3%),  
availability of drugs (42.8%), drugs are cheap (40.8%), drugs are genuine (35.5%) and the staff are caring  
(39.0%). However, more than half (58.8%) of the respondents prefer to receive treatment from the hospital.  
Figure 2: Level of PHC Services and Facility Utilization among Umuna Adult Residents  
Figure 2 shows that there was poor utilization (50%) of Level of PHC Services and Facility Utilization among  
Umuna Adult Residents.  
Page 4029  
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue X October 2025  
Table 4: Satisfaction of PHC Facility Services among Umuna Adult Residents  
Variables  
Frequency (n)  
Percentage (%)  
I think the health center has  
everything  
needed  
to  
provide complete medical  
care  
Strongly disagree  
Disagree  
12  
48  
70  
82  
33  
245  
4.9  
19.6  
28.6  
33.5  
13.5  
100.0  
Uncertain  
Agree  
Strongly agree  
Total  
The medical care I have been  
receiving is just about  
perfect from the health  
center  
Strongly disagree  
Disagree  
2
0.8  
22  
70  
111  
40  
245  
9.0  
Uncertain  
Agree  
28.6  
45.3  
16.3  
100.0  
Strongly agree  
Total  
Sometimes health staff make  
me wonder if their diagnosis  
is correct  
Strongly agree  
Agree  
10  
72  
56  
77  
30  
245  
4.1  
29.4  
22.9  
31.4  
12.2  
100.0  
Uncertain  
Disagree  
Strongly disagree  
Total  
Page 4030  
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue X October 2025  
I feel confident that I can get  
the medical care from the  
center without paying much  
Strongly disagree  
Disagree  
3
1.2  
42  
49  
102  
49  
245  
17.1  
20.0  
41.6  
20.0  
100.0  
Uncertain  
Agree  
Strongly agree  
Total  
When I go to the health  
center, they are careful to  
check everything when  
treating and examining me  
Strongly disagree  
Disagree  
3
1.2  
31  
58  
113  
40  
245  
12.7  
23.7  
46.1  
16.3  
100.0  
Uncertain  
Agree  
Strongly agree  
Total  
I have easy access to the  
health center and I can  
afford treatment there  
Strongly disagree  
Disagree  
2
0.8  
19  
40  
124  
60  
245  
7.8  
Uncertain  
Agree  
16.3  
50.6  
24.5  
100.0  
Strongly agree  
Total  
Whenever I want, I see the  
health staff that I want to  
treat me  
Strongly disagree  
Disagree  
8
3.3  
29  
11.8  
Page 4031  
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue X October 2025  
Uncertain  
Agree  
69  
28.2  
39.6  
17.1  
100.0  
97  
Strongly agree  
Total  
42  
245  
In the health center people  
have to wait too long for  
emergency treatment  
Strongly agree  
Agree  
16  
73  
68  
58  
30  
245  
6.5  
29.8  
27.8  
23.7  
12.2  
100.0  
Uncertain  
Disagree  
Strongly disagree  
Total  
The health staff act too  
business-like  
and  
impersonal towards me  
Strongly agree  
Agree  
23  
83  
72  
43  
24  
245  
9.4  
33.9  
29.4  
17.6  
9.8  
Uncertain  
Disagree  
Strongly disagree  
Total  
100.0  
The health staff treat me in a  
very friendly and courteous  
manner  
Strongly disagree  
Disagree  
4
1.6  
24  
66  
90  
61  
245  
9.8  
Uncertain  
Agree  
26.9  
36.7  
24.9  
100.0  
Strongly agree  
Total  
Page 4032  
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue X October 2025  
The health staff sometimes  
hurry too much when they  
are treating me.  
Strongly agree  
Agree  
16  
84  
70  
50  
25  
245  
6.5  
34.3  
28.6  
20.4  
10.2  
100.0  
Uncertain  
Disagree  
Strongly disagree  
Total  
Health  
staff sometimes  
ignore what I complain  
about  
Strongly agree  
Agree  
30  
91  
53  
47  
24  
245  
12.2  
37.1  
21.6  
19.2  
9.8  
Uncertain  
Disagree  
Strongly disagree  
Total  
100.0  
I have some doubts about the  
ability of the health staff who  
treat me  
Strongly agree  
Agree  
23  
80  
56  
63  
23  
245  
9.4  
32.7  
22.9  
25.7  
9.4  
Uncertain  
Disagree  
Strongly disagree  
Total  
100.0  
The health staff treating me  
usually spend plenty of time  
with me  
Strongly disagree  
Disagree  
7
2.9  
50  
20.4  
Page 4033  
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue X October 2025  
Uncertain  
Agree  
92  
37.6  
26.5  
12.7  
100.0  
65  
Strongly agree  
Total  
31  
245  
I find it hard to get a referral  
to the general or teaching  
hospital from the health  
center  
Strongly agree  
Agree  
26  
77  
70  
49  
23  
245  
10.6  
31.4  
28.6  
20.0  
9.4  
Uncertain  
Disagree  
Strongly disagree  
Total  
100.0  
Table 4 shows the Satisfaction of PHC Facility Services among Umuna Adult Residents. It revealed that one-  
third (33.5%) of the respondents thinks that the health center has everything needed to provide complete medical  
care, 45.3% agree that the medical care they have been receiving is just about perfect from the health center,  
31.4% disagree that sometimes health staff make them wonder if their diagnosis is correct, 41.6% feel confident  
that they can get the medical care from the center without paying much, 46.1% agree that when they go to the  
health center, they are careful to check everything when treating and examining them, 50.6% agree that they  
have easy access to the health center and they can afford treatment there, 39.6% agree that whenever they want,  
they usually see the health staff that they want to treat them, 29.8% agree that in the health center people have  
to wait too long for emergency treatment, 33.9% agree that the health staff act too business-like and impersonal  
towards them, 36.7% agree that the health staff treat me in a very friendly and courteous manner, 37.1% agree  
that health staff sometimes ignore what they complain about while 31.4% agree that they find it hard to get a  
referral to the general or teaching hospital from the health center.  
Figure 3: Level of PHC Services and Facility Satisfaction among Umuna Adult Residents  
Figure 3 shows that there was 34% moderate satisfaction Level of PHC Services and Facility Utilization among  
Umuna Adult Residents.  
Page 4034  
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue X October 2025  
Table 5: Factors associated with level of utilization of PHC Facility Services among Umuna Adult  
Residents  
Variable  
level  
utilization  
of  
of  
Total %  
N=400  
PHC  
Facility  
Services  
Associated Factors  
Poor  
utilization  
Moderate  
utilization  
Good  
utilization  
Total (%)  
χ2/p-value  
Age  
18-29  
117(54.4)  
43(44.8)  
24(38.1)  
14(53.8)  
198(49.5)  
33(15.3)  
20(20.8)  
16(25.4)  
7(26.9)  
65(30.2)  
33(34.4)  
23(36.5)  
5(19.2)  
215(100.0)  
96(100.0)  
63(100.0)  
26(100.0)  
400(100.0)  
9.235/0.161  
30-39  
40-49  
50 and above  
Total  
76(19.0)  
126(31.5)  
Gender  
Male  
74(58.3)  
124(45.4)  
198(49.5)  
20(15.7)  
56(20.5)  
76(19.0)  
33(26.0)  
93(34.1)  
126(31.5)  
127(100.0)  
273(100.0)  
400(100.0)  
5.723/0.057  
Female  
Total  
Marital status  
Married  
62(41.1)  
124(54.4)  
12(57.1)  
198(49.5)  
32(21.2)  
38(16.7)  
6(28.6)  
57(37.7)  
66(28.9)  
3(14.3)  
151(100.0)  
228(100.0)  
21(100.0)  
400(100.0)  
9.887/0.042*  
Single  
Divorced/Separated  
Total  
76(19.0)  
126(31.5)  
Religion category  
Catholic  
Anglican  
Pentecostal  
Others  
79(46.7)  
36(49.3)  
60(49.2)  
23(63.9)  
198(49.5)  
35(20.7)  
15(20.5)  
24(19.7)  
2(5.6)  
55(32.5)  
22(30.1)  
38(31.1)  
11(30.6)  
126(31.5)  
169(100.0)  
73(100.0)  
122(100.0)  
36(100.0)  
400(100.0)  
5.690/0.459  
76(19.0)  
Total  
Education Category  
Page 4035  
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue X October 2025  
None/Primary  
Secondary  
19(54.3)  
48(49.5)  
131(48.9)  
198(49.5)  
4(11.4)  
12(34.3)  
28(28.9)  
86(32.1)  
126(31.5)  
35(100.0)  
97(100.0)  
268(100.0)  
400(100.0)  
1.927/0.749  
21(21.6)  
51(19.0)  
76(19.0)  
Tertiary  
Total  
Occupation category  
Civil servant  
Trader/Businessman  
Student  
17(28.8)  
44(50.0)  
98(56.0)  
39(50.0)  
198(49.5)  
16(27.1)  
16(18.2)  
30(17.1)  
14(17.9)  
76(19.0)  
26(44.1)  
28(31.8)  
47(26.9)  
25(32.1)  
126(31.5)  
59(100.0)  
88(100.0)  
175(100.0)  
78(100.0)  
400(100.0)  
13.210/0.040*  
Others  
Total  
Income  
No income  
76(62.8)  
29(58.0)  
22(41.5)  
27(44.3)  
44(38.3)  
198(49.5)  
16(13.2)  
3(6.0)  
29(24.0)  
18(36.0)  
17(32.1)  
20(32.8)  
42(36.5)  
126(31.5)  
121(100.0)  
50(100.0)  
53(100.0)  
61(100.0)  
115(100.0)  
400(100.0)  
23.423/0.003*  
Less than N10,000  
N10,000-N24,000  
N25,000-N39,000  
N40,000 and above  
Total  
14(26.4)  
14(23.0)  
29(25.2)  
76(19.0)  
Family type  
Monogamous  
Polygamous  
Total  
163(47.2)  
35(63.6)  
198(49.5)  
67(19.4)  
9(16.4)  
115(33.3)  
11(20.0)  
126(31.5)  
345(100.0)  
55(100.0)  
400(100.0)  
5.485/0.064  
76(19.0)  
Number of Children  
None  
84(57.5)  
27(38.6)  
48(45.3)  
31(47.0)  
8(66.7)  
22(15.1)  
17(24.3)  
23(21.7)  
12(18.2)  
2(16.7)  
40(27.4)  
26(37.1)  
35(33.0)  
23(34.8)  
2(16.7)  
146(100.0)  
70(100.0)  
106(100.0)  
66(100.0)  
12(100.0)  
400(100.0)  
10.093/0.259  
1-2 children  
3-4 children  
5-6 children  
More than 6 children  
Total  
198(49.5)  
76(19.0)  
126(31.5)  
Page 4036  
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue X October 2025  
Type of waste disposal  
Open dumping  
Covered bin  
39(50.0)  
77(50.7)  
16(53.3)  
66(47.1)  
198(49.5)  
11(14.1)  
28(18.4)  
7(23.3)  
28(35.9)  
47(30.9)  
7(23.3)  
78(100.0)  
152(100.0)  
30(100.0)  
140(100.0)  
400(100.0)  
3.164/0.788  
Open bin  
Plastic bag  
30(21.4)  
76(19.0)  
44(31.4)  
126(31.5)  
Total  
Level of Knowledge  
Poor Knowledge  
Moderate Knowledge  
Good Knowledge  
Total  
105(82.7)  
62(39.7)  
31(26.5)  
198(49.5)  
14(11.0)  
41(26.3)  
21(17.9)  
76(19.0)  
8(6.3)  
127(100.0)  
156(100.0)  
117(100.0)  
400(100.0)  
99.825/0.00*  
53(34.0)  
65(55.6)  
126(31.5)  
Level of Satisfaction  
Poor Satisfaction  
Moderate Satisfaction  
Good Satisfaction  
Total  
172(72.9)  
18(21.7)  
8(9.9)  
29(12.3)  
23(27.7)  
24(29.6)  
76(19.0)  
35(14.8)  
42(50.6)  
49(60.5)  
126(31.5)  
236(100.0)  
83(100.0)  
81(100.0)  
400(100.0)  
130.504/0.00*  
198(49.5)  
The following socio-economic characteristics, level of knowledge and satisfaction were significantly associated  
with level of utilization of PHC Facility Services: Marital status (p<0.042), occupation category (p<0.040),  
monthly income (p<0.003), level of knowledge (p<0.00) and level of satisfaction (p<0.003).  
DISCUSSION  
This study assessed knowledge, utilization, and satisfaction with primary health care (PHC) services among  
adults in Umuna community and revealed patterns consistent with, yet distinct from, findings across Nigeria and  
other low-resource settings. The majority of respondents were young adults aged 18–29 years, which differs  
from reports in South Africa where older adults constitute the primary PHC users but aligns with studies in  
Western and Southeastern Nigeria where younger adults and traders predominated. [53,54] The high proportion of  
female respondents can be attributed to greater daytime availability, similar to findings from Kwara State where  
women were more likely to be encountered at home and hence sampled more frequently.[55] Utilization of PHC  
services in this study (61.3%) was substantially higher than levels reported in earlier Nigerian studies, including  
those in Kwara and Osun States where utilization ranged from 12% to 44%, but comparable to findings in South  
[55–58]  
Africa and Pakistan, which reported considerably higher community engagement with PHC services.  
Moderate knowledge of PHC services reflects partial community awareness, particularly regarding maternal  
care, immunization, and treatment of common illnesses—services known to be widely recognized across many  
[59]  
low-income countries.  
Immunization utilization was notably high, consistent with the essential preventive  
role PHC facilities play in most health systems and the impact of Nigeria’s nationwide immunization campaigns.  
However, utilization rates remained lower than those reported in Pakistan, likely due to differences in coverage,  
outreach activities, and service integration. [58]  
Page 4037  
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue X October 2025  
Despite PHC being designed as the first point of contact in the Nigerian health system, many respondents  
preferred hospitals for initial care. Their preference stemmed from perceptions of inadequate staffing, lack of  
doctors, poor drug availability, and insufficient equipment at PHC centers. Similar patterns have been observed  
in Pakistan, the United Kingdom, and parts of Europe, where perceived higher-quality care and better diagnostic  
capacity attract patients to hospitals even for minor conditions. [60–63] The limited use of referral services in this  
study further reflects weak integration within Nigeria’s health system and contributes to overburdening higher-  
level facilities. Satisfaction with PHC services was moderate (34%), considerably lower than satisfaction levels  
reported in London, India, Kosovo, Iraq, and Saudi Arabia, where patient satisfaction levels range between 50%  
[64–66]  
and 73%.  
Local insecurity, inadequate staffing, and drug stock-outs may have contributed to reduced  
satisfaction among residents in this region. Satisfaction was significantly associated with occupation and marital  
status, mirroring evidence from Middle Eastern and African studies that socioeconomic and demographic factors  
strongly influence patient experience and service perception. [64,67] Respondents frequently believed PHC centers  
were only suitable for women and children—a misconception documented in several Nigerian communities and  
one that undermines PHC’s broader mandate as a comprehensive first-contact service.  
While many respondents acknowledged that PHC centers were accessible and affordable, deficiencies in  
infrastructure and human resources continued to limit trust and full engagement. Shortages of essential drugs  
and the exodus of health professionals—driven by poor remuneration, limited career incentives, and security  
[68]  
challenges—have been reported nationwide and remain barriers to service delivery.  
Consequently, PHC  
facilities struggle to meet community expectations, contributing to low satisfaction and suboptimal utilization  
for non-maternal and non-child health services. Overall, the findings underscore persistent gaps between the  
design and actual functioning of PHC services in Nigeria. Addressing these discrepancies requires improving  
staff availability, strengthening drug supply chains, enhancing facility infrastructure, and intensifying  
community health education to correct misconceptions and encourage appropriate use of PHC services.  
Limitations  
The study relied on self-reported data, which may have introduced recall and social desirability biases. Despite  
interviewer training, interviewer influence cannot be fully excluded. The use of convenience sampling limits  
generalizability, as the sample may not fully represent all demographic groups in Umuna. Additionally, the  
cross-sectional design precludes establishing causal relationships between sociodemographic factors and PHC  
utilization or satisfaction.  
REFERENCES  
1. World Health Organization. Declaration of Alma-Ata. WHO; 1978.  
2. Donabedian A. The quality of care: How can it be assessed? JAMA. 1988;260(12):1743–8.  
3. Andersen RM. Revisiting the behavioral model and access to medical care. J Health Soc Behav.  
1995;36(1):1–10.  
4. Federal Ministry of Health Nigeria. National Primary Health Care Policy. Abuja; 1988.  
5. National Health Policy. Federal Ministry of Health Nigeria; 2016.  
6. World Health Organization. Primary Health Care Systems Review. Geneva; 2017.  
7. Oladipo JA. Utilizing primary health care in Nigeria: Challenges and recommendations. Afr Health Sci.  
2014;14(2):452–61.  
8. Abimbola S, et al. The state of primary health care in Nigeria. BMJ Glob Health. 2015;1:e000008.  
9. Adebayo AM, et al. Status of PHC facilities in Nigeria. Niger J Clin Pract. 2012;15(3):302–10.  
10. Adeyemo DO. Public health and PHC utilization in Nigeria. J Public Health Afr. 2010;1:e3.  
11. Onah HE, et al. Healthcare access barriers in Nigeria. Afr J Reprod Health. 2006;10(3):47–53.  
12. Uzochukwu B, et al. Rural–urban disparities in PHC utilization. Health Policy Plan. 2004;19(1):31–7.  
13. National Population Commission (NPC). Nigeria Demographic and Health Survey; 2018.  
14. Oguntunde O, et al. Utilization of primary health care facilities in Nigeria. Afr J Prim Health Care Fam  
Med. 2018;10(1):1–6.  
15. Akinyemi JO. Health manpower distribution challenges in Nigeria. Afr Dev Rev. 2016;28(1):1–14.  
16. WHO. Rural health realities in developing countries. Geneva: World Health Organization; 2015.  
17. Merkouris A, et al. Patient satisfaction: A key measure of quality. Int J Nurs Stud. 2004;41(4):349–58.  
Page 4038  
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue X October 2025  
18. Rajpurohit N. Utilization of primary health centre services in rural northern India. Indian J Public Health.  
2013;57(3):157–62.  
19. Rushender R. Effective utilization of PHC and sub-centre services in rural Tamil Nadu. J Family Med  
Prim Care. 2016;5(2):420–6.  
20. Yayasanni W. Awareness and utilization of community clinics among rural women in Bangladesh. BMC  
Health Serv Res. 2017;17:1–9.  
21. Andersen RM. Health service utilization determinants. J Health Soc Behav. 1995;36(1):1–10.  
22. Uzochukwu B et al. Barriers to primary health care use in Nigeria. Health Policy Plan. 2004;19(1):31–  
40.  
23. Nxumalo N. Utilization patterns in South African PHC facilities. S Afr Med J. 2011;101(6):378–82.  
24. Abodunrin O et al. Referral system performance in Nigeria. Ann Afr Med. 2010;9(4):203–8.  
25. Bayo H. Determinants of PHC utilization in Guinea. Afr J Health Sci. 2012;22(3):150–6.  
26. Onah HE. Barriers to maternal health service utilization. Afr J Reprod Health. 2006;10(3):47–53.  
27. WHO. Primary Health Care in sub-Saharan Africa. Geneva; 2015.  
28. Adedokun B. Utilization of PHC facilities in rural communities. Int J Public Health. 2013;58:55–62.  
29. Nnebue C. Challenges in PHC delivery in Nigeria. Niger J Med. 2014;23(2):134–40.  
30. Ezeanolue E. Distance and PHC use in rural Nigeria. BMC Health Serv Res. 2017;17:1–8.  
31. Osungbade K. Review of PHC performance in southwestern Nigeria. Afr J Prim Health Care Fam Med.  
2014;6(1):1–9.  
32. Prakash B. Patient satisfaction as an indicator of quality. J Cutan Aesthet Surg. 2010;3(3):151–5.  
33. Aftab M. Predictors of patient satisfaction in PHC. J Family Med Prim Care. 2018;7(3):555–60.  
34. Weber E. Factors affecting satisfaction in PHC. Int J Qual Health Care. 2005;17(2):123–9.  
35. Merkouris A. Patient satisfaction and quality of care. Int J Nurs Stud. 2004;41:349–58.  
36. Alahmadi H. Patient satisfaction in Saudi PHC. Saudi Med J. 2006;27(3):386–92.  
37. Idris A. Determinants of client satisfaction in African PHC settings. Afr Health Sci. 2018;18(2):391–  
405.  
38. Rakhshani F. Socioeconomic and demographic factors of satisfaction. East Mediterr Health J.  
2012;18(7):644–50.  
39. Fomba S. Community PHC satisfaction in Mali. Health Serv Res. 2010;45(4):1234–46.  
40. Al-Ateeq M. Quality of PHC services in Riyadh. J Family Community Med. 2016;23(2):87–92.  
41. Qadri S. Patient satisfaction in primary care in Iraq. Iraq J Med Sci. 2014;12(2):150–7.  
42. Rahman S. Cultural influences on maternal health service use. BMC Pregnancy Childbirth. 2012;12:1–  
9.  
43. Kamal N. Traditional healer preference among rural populations. Int J Health Plann Manage.  
2015;30:166–79.  
44. Lagarde M, Palmer N. The effect of user fees on utilization. Bull World Health Organ. 2008;86(11):839–  
48.  
45. Nguyen H. Access and utilization of PHC in Vietnam. Health Policy Plan. 2012;27:552–63.  
46. Khan M. Maternal health-seeking behavior in Pakistan. J Public Health. 2012;34:523–9.  
47. Ebeigbe P. Socio-cultural determinants of PHC use in southern Nigeria. Niger Med J. 2013;54(5):325–  
30.  
48. Peters DH. Overcoming barriers to access in low-income countries. Lancet. 2008;372:864–75.  
49. Kruk M. Quality gaps in PHC systems in Africa. Lancet Glob Health. 2018;6:e100–7.  
50. Bitton A. Strengthening primary care to improve outcomes globally. BMJ. 2017;356:j654.  
51. Nigeria Meteorological Agency. Climatic characteristics of southeastern Nigeria. NIMET; 2020.  
52. Cochran WG. Sampling Techniques. 3rd ed. New York: John Wiley & Sons; 1977.  
53. Mchunu G, et al. Patterns of primary care use in South Africa. S Afr Med J. 2018;108(4):322–8.  
54. Olatunji AO, et al. Demographic characteristics of PHC users in Western Nigeria. Niger J Clin Pract.  
2019;22(3):345–51.  
55. Ibrahim M, et al. Primary health care utilization in Kwara State. Afr J Prim Health Care Fam Med.  
2018;10(1):1–7.  
56. Adepoju OE, et al. Utilization trends in Osun State PHC facilities. J Community Med Prim Health Care.  
2016;28(1):35–44.  
57. Mofokeng T. PHC uptake in Tshwane region, South Africa. BMC Health Serv Res. 2017;17:1–10.  
Page 4039  
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue X October 2025  
58. Khan A, et al. Utilization of primary health care services in Pakistan. Int J Health Plann Manage.  
2016;31(2):131–40.  
59. World Health Organization. Global maternal and immunization service coverage. WHO; 2020.  
60. Ezeanolue EE, et al. Barriers to PHC use in Nigeria. BMC Health Serv Res. 2017;17:1–12.  
61. Uzochukwu B, et al. Health-seeking behaviour and PHC utilization. Health Policy Plan. 2004;19(1):31–  
40.  
62. Peters DH, et al. Barriers to accessing health services in low-income countries. Lancet. 2008;372:864–  
75.  
63. Marshall M, et al. Perceptions of hospital versus primary care quality in the UK. Br J Gen Pract.  
2002;52:926–33.  
64. Al-Ateeq M, et al. Determinants of PHC satisfaction in Saudi Arabia. J Family Community Med.  
2016;23(1):1–7.  
65. Shabila NP, et al. Patient satisfaction with primary care in Iraq. BMC Health Serv Res. 2012;12:1–9.  
66. Prakash B. Patient satisfaction as an indicator of quality. J Cutan Aesthet Surg. 2010;3(3):151–5.  
67. Idris A, et al. Socioeconomic influences on patient satisfaction in Africa. Afr Health Sci. 2018;18(2):391–  
405.  
68. Adebayo AM, et al. PHC system challenges in Nigeria. Niger J Clin Pract. 2012;15(3):302–10.  
Disclosures and declarations  
Ethics approval and consent to participate: The ethical approval for this study was gotten from the Research and  
Ethical Clearance Committee of Imo State University Teaching Hospital.  
Availability of data and materials: Data and material are available  
Competing interests: The authors declare that they have no competing interests  
Funding: There is no external funding for the research  
Page 4040