Medical, socioeconomic, and geographic disparities in primary health care access and utilization: a population-based study of 8038 individuals aged one year and older in rural Uganda.

Abstract

Background: There is limited data on trends in primary health care (PHC) access and utilisation in rural sub-Saharan Africa, with a particular lack of knowledge on disparities beyond geographic barriers.

Methods: A cross-sectional study was conducted within the community-based cohort, SchistoTrack. 2191 households were randomly sampled from 52 rural villages in Pakwach, Buliisa, and Mayuge Districts in Uganda. All household members aged one year and older were surveyed between 2022-2024, resulting in 8038 individuals with baseline health access information. Key outcomes included any care sought within the month preceding the study, type of care sought, and usual source of care. Using logistic regressions with standard errors clustered by household and village, we examined a comprehensive and diverse set of medical, socioeconomic, and geographic determinants.

Results: Only 8.2% (659/8038) of participants sought any care, with only 67.5% (445/659) of those participants seeking PHC. Having current symptoms, a previously diagnosed disease, older age, and being female were positively associated (Odds ratios (ORs) 1.02-2.85) with higher odds of seeking any care in the past month. Among participants who sought care, living in a Western district (Pakwach or Buliisa) was associated with higher odds (ORs 9.40-10.77) of seeking care from PHC centres than living in the Eastern study district (Mayuge). Current alcohol use among adults aged 20 years and older was associated with lower odds of seeking PHC (OR 0.43). Distance to a PHC centre and living in the Western districts were negatively (OR 0.72) and positively associated (ORs 4.70-5.64) with having PHC as the usual source of care for the household.

Conclusions: Medical and demographic factors influenced the decision to seek any care, but PHC usage was largely determined by regional and spatial disparities suggesting different avenues for targeted interventions seeking to increase general health access vs PHC usage.