The rural aged and the challenges of access to rural healthcare: the situation in Southeast Nigeria and its implication to rural and sustainable development

Titolo Rivista SOCIOLOGIA URBANA E RURALE
Autori/Curatori Samuel O. Okafor, Sebastian O. Onah, Christy N. Obi-keguna, Onyinyechi E. Ibeabuchi, Uchenna Nwokoma, Kanayo C. Ayogu
Anno di pubblicazione 2024 Fascicolo 2024/134
Lingua Inglese Numero pagine 23 P. 132-154 Dimensione file 362 KB
DOI 10.3280/SUR2024-134007
Il DOI è il codice a barre della proprietà intellettuale: per saperne di più clicca qui

Qui sotto puoi vedere in anteprima la prima pagina di questo articolo.

Se questo articolo ti interessa, lo puoi acquistare (e scaricare in formato pdf) seguendo le facili indicazioni per acquistare il download credit. Acquista Download Credits per scaricare questo Articolo in formato PDF

Anteprima articolo

FrancoAngeli è membro della Publishers International Linking Association, Inc (PILA)associazione indipendente e non profit per facilitare (attraverso i servizi tecnologici implementati da CrossRef.org) l’accesso degli studiosi ai contenuti digitali nelle pubblicazioni professionali e scientifiche

L’articolo esplora i fattori associati all’accesso e all’utilizzo delle strutture e dei servizi di assistenza sanitaria primaria tra gli anziani nelle aree rurali del sud-est della Nigeria, applicando il disegno di indagine su un campione di 1625 anziani (60+). Per la raccolta dei dati è stato utilizzato un questionario basato sulle sei dimensioni di accesso alle strutture e ai servizi sanitari di Saurman (2015). I dati raccolti sono stati analizzati con statistiche descrittive e inferenziali. Secondo i risultati dello studio, fattori predittivi della soddisfazione per le strutture sanitarie rurali sono il genere, la distanza, la cultura/tradizione, l’accessibilità economica, la disponibilità di un’assicurazione sanitaria e la frequenza di utilizzo delle strutture sanitarie (*p<.05, ** p<.01, *** p<.000, R2 = 70,7); fattori predittivi per l’utilizzo delle strutture e dei servizi di assistenza sanitaria primaria tra gli anziani nelle aree rurali sono il genere, l’età, la disponibilità di un’assicurazione sanitaria, la consapevolezza dei pacchetti sanitari per gli anziani, la disponibilità di strutture e servizi sanitari speciali rivolti agli anziani, nonché l’accesso alle strutture sanitarie primarie rurali (*p<.05, ** p<.01, *** p<.000, R2 = 84,2).

Keywords:salute rurale, invecchiamento della popolazione, salute degli adulti, accesso all’assistenza sanitaria, sviluppo rurale, sviluppo sostenibile.

  1. Abdi S., Spann A., Borilovic J., Hawley M. (2019). Understanding the care and support needs of older people: a scoping review and categorisation using the WHO international classification of functioning, disability and health framework (ICF). BMC Geriatrics, 19: 195.
  2. Aboderin I., Ferreira M. (2008). Linking Ageing to Development Agendas in Sub-Saharan Africa: Challenges and Approaches. Journal of population ageing, 1(1): 51-73.
  3. Abubakar I., Dalglish S.L., Angell B., Sanuade O., Abimbola S., Adamu A.L., Adetifa I.M.O., Colbourn T., Ogunlesi A.O., Onwujekwe O., Owoaje E.T., Okeke I.N., Adeyemo A., Aliyu G., Aliyu M.H., Aliyu S.H., Ameh E.A., Archibong B., Ezeh A., Gadanya M.A., Ihekweazu C., Ihekweazu V., Iliyasu Z., Chiroma A.K., Mabayoje D.A., Sambo M.N., Obaro S., Yinka-Ogunleye A., Okonofua F., Oni T., Onyimadu O., Pate M.A., Salako B.L., Shuaib F., Tsiga-Ahmed F., Zanna F.H. (2022). The Lancet Nigeria Commission: investing in health and the future of the nation. Lancet, 399(10330): 1155-1200. DOI: 10.1016/S0140-6736(21)02488-0
  4. Adams J., Sibbritt D., Lui C.W. (2011). The urban-rural divide in complementary and alternative medicine use: a longitudinal study of 10,638 women. BMC Complementary and Alternative Medicine, 11: 2. DOI: 10.1186/1472-6882-11-2
  5. Adedini S.A., Odimegwu C., Bamiwuye O., Fadeyibi O., De Wet N. (2014). Barriers to accessing health care in Nigeria: implications for child survival Global health action, 7: 23499.
  6. Adisa O. (2015). Investigating determinants of catastrophic health spending among poorly insured elderly households in urban Nigeria. International Journal for Equity in Health, 14: 79.
  7. Adogu P.O., Egenti B.N., Ubajaka C., Onwasigwe C., Nnebue C.C. (2014). Utilization of maternal health services in urban and rural communities of Anambra State, Nigeria. Nigerian Journal of Medicine, 23: 61-69.
  8. Afshar N., English D.R., Milne R.L. (2019). Rural-urban residence and cancer survival in high-income countries: a systematic review. Cancer; 125(13): 2172-2184.
  9. Aggarwal R., Chiu N., Loccoh E.C., Kazi D.S., Yeh R.W., Wadhera R.K. (2021). Rural-urban disparities: diabetes, hypertension, heart disease, and stroke mortality among black and white adults, 1999-2018. Journal of the American College of Cardiology, 77(11): 1480-1481.
  10. Akintayo-Usman N.O., Usman S.O. (2021). Comparative analysis of ageing in Nigeria and United Kingdom using life course approach: the implication for the Nursing profession in Nigeria. The Pan African medical journal, 38: 411.
  11. Ani J.I. (2015). Care and Support for the Elderly in Nigeria: A Review. The Nigerian Journal of Sociology and Anthropology, 12(1): 9-27. DOI: 10.36108/NJSA/4102/12(0110).
  12. Animasahun V.J., Chapman H.J. (2017). Psychosocial health challenges of the elderly in Nigeria: a narrative review. African health sciences, 17(2): 575-583.
  13. Arbore P. (2019). Suicide prevention among rural older adults. Generations, 43(2): 62-65.
  14. Assunção M., Pinto S., Jose H. (2020). Public and health policy for the aged in Africa to the South of Saara. Revista Brasileira de Enfermagem, 73 (Suppl. 3). DOI: 10.1590/0034-7167-2019-0313
  15. Azevedo M.J. (2017). Historical Perspectives on the State of Health and Health Systems in Africa, Volume II: The Modern Era. Cham: Palgrave Macmillan.
  16. Bloom D.E., Canning D., Fink G. (2010). Implications of population ageing for economic growth. Oxford Review of Economic Policy, 26(4): 583-612.
  17. Boateng R., Yawson A.E., Adoma P.O. (2023). Rural-urban and socio-demographic differentials in perceived health state among aging population in Ghana. Journal of Health, Population and Nutrition, 42: 92.
  18. Burns E., Kakara R. (2018). Deaths from falls among persons aged≥ 65 years-United States, 2007-2016. Morbidity and Mortality Weekly Report, 67(18): 509.
  19. Butkus R., Rapp K., Cooney T.G., Engel L.S. (2020). Envisioning a better US health care system for all: reducing barriers to care and addressing social determinants of health. Annals of Internal Medicine, 172: S50-59.
  20. Cadmus E.O., Adebusoye L.A., Owoaje E.T. (2022). Rural-urban differences in quality of life and associated factors among community-dwelling older persons in Oyo state, South-Western Nigeria. Quality & Quantity, 56: 1327-1344.
  21. Cao X., Hou Y., Zhang X., Xu C., Jia P., Sun X., Sun Li, Gao Y., Yang H., Cui Z., Wang Y., Wang Y.A. (2020). A comparative, correlate analysis and projection of global and regional life expectancy, healthy life expectancy, and their GAP: 1995-2025. Journal of Global Health, 10(2): 020407.
  22. Cervellati M., Sunde U. (2011). Life expectancy and economic growth: the role of the demographic transition. Journal of Economic Growth, 16(2), 99-133.
  23. Chandak A., Nayar P., Lin G. (2019). Rural-urban disparities in access to breast cancer screening: A spatial clustering analysis. The Journal of Rural Health, 35(2): 229-235.
  24. Chen X., Orom H., Hay J.L., Waters E.A., Schofield E., Li Y., Kiviniemi M.T. (2019). Differences in rural and urban health information access and use. The Journal of Rural Health, 35(3): 405-417.
  25. Chukwudozie A. (2015). Inequalities in Health: The Role of Health Insurance in Nigeria. Journal of public health in Africa, 6(1), 512.
  26. Clarke J.A., Despotis A.M., Ramirez R.J., Zevallos J.P., Mazul A.L. (2020). Head and neck cancer survival disparities by race and rural-urban context. Cancer Epidemiology, Biomarkers & Prevention, 29(10):1955-1961. DOI: 10.1158/1055-9965.EPI-20-0376
  27. Cohen S.A., Greaney M.L. (2023). Aging in Rural Communities. Current epidemiology reports, 10(1): 1-16.
  28. Coombs N.C., Campbell D.G., Caringi J.A. (2022). Qualitative study of rural healthcare providers’ views of social, cultural, and programmatic barriers to healthcare access. BMC Health Services Research, 22: 438.
  29. Cross S.H., Mehra M.R., Bhatt D.L., Nasir K., O’Donnell C.J., Califf R.M., Warraich H.J. (2020). Rural-urban differences in cardiovascular mortality in the US, 1999-2017. JAMA., 323(18): 1852-1854.
  30. Damman M., Henkens K., Kalmijn M. (2013). Late-Career Work Disengagement: The Role of Proximity to Retirement and Career Experiences. The Journals of Gerontology: Series B, 68(3): 455-463.
  31. Dassah E., Aldersey H., McColl M.A., Colleen D. (2018). Factors affecting access to primary health care services for persons with disabilities in rural areas: a “best-fit” framework synthesis. Global Health Research and Policy, 3: 36.
  32. Etemadi M., Hajizadeh M. (2022). User fee removal for the poor: a qualitative study to explore policies for social health assistance in Iran. BMC Health Services Research, 22: 250.
  33. Federal Ministry of Health (2014). Federal Republic of Nigeria National Health Act 2014. Government Notice No. 208. Federal Republic of Nigeria Official Gazette, 101: A139.
  34. Fentie E.A., Asmamaw D.B., Negash W.D., Belachew T.B., Baykeda T.A., Addis B., Tamir T.T., Wubante S.M., Endawkie A., Zegeye A.F., Kidie A.A., Fetene S.M. (2023). Spatial distribution and determinants of barriers of health care access among female youths in Ethiopia, a mixed effect and spatial analysis. Scientific Reports, 13: 21517.
  35. Figueira M.C.S., Silva W.P., Silva E.M. (2018). Integrative literature review: access to primary healthcare services. Revista Brasileira de Enfermagem, 71(3):1178-1188. DOI: 10.1590/0034-7167-2017-0441
  36. Fong M.C., Russell D., Gao O., Franzosa E. (2023). Contextual forces shaping home-based healthcare services between 2010 and 2020: Insights from the social-ecological model and organizational theory. Gerontologist, 63(7): 1117-1128.
  37. Ganguly E., Sharma P.K. (2014). Client Satisfaction with Quality of Health Care in a Rural area in Southern India. Journal of public health and epidemiology, 6(8): 239-245. DOI: 10.5897/JPHE2014.0625
  38. Gao Q., Liu M., Peng L., Zhang Y., Shi Y., Teuwen D.E., Yi H. (2022). Patient satisfaction and its health provider-related determinants in primary health facilities in rural China. BMC Health Services Research, 22: 946.
  39. Gizaw Z., Astale T., Kassie G.M. (2022). What improves access to primary healthcare services in rural communities? A systematic review. BMC Primary Care, 23: 313.
  40. Gómez-Olivé F.X., Thorogood M., Clark B., Kahn K., Tollman S. (2013). Self-reported health and health care use in an ageing population in the Agincourt sub-district of rural South Africa. Global health action, 6, 19305.
  41. Greenwood-Ericksen M.B., Kocher K. (2019). Trends in emergency department use by rural and urban populations in the United States. JAMA Network Open, 2(4): e191919.
  42. Guisan M.C., Exposito P. (2016). Life expectancy, education and development in african countries 1980-2014: improvements and international comparisons. Applied Econometrics and International Development, 16(2): 87-108
  43. Gyuse A.N., Ayuk A.E., Okeke M.C. (2018). Facilitators and barriers to effective primary health care in Nigeria. African Journal of Primary Health Care & Family Medicine 10(1): e1-e3.
  44. Harasty C., Ostermeier M. (2020). Population ageing: Alternative measures of dependency and implications for the future of work. ILO Working Paper 5. ILO: Geneva.
  45. Henning-Smith C. (2020). The unique impact of COVID-19 on older adults in rural areas. Journal of Aging & Social Policy, 32(4-5): 396-402. DOI: 10.1080/08959420.2020.1770036
  46. Henriquez-Camacho C., Losa J., Miranda J.J, Cheyne N. (2014). Addressing healthy aging populations in developing countries: unlocking the opportunity of eHealth and mHealth. Emerging Themes in Epidemiology, 11(136).
  47. Herrmann M. (2014). The Economic Challenges of Population Aging in Emerging Markets. Modern Economy, 5(2): 161-173.
  48. Hirko K.A., Kerver J.M., Ford S., Szafranski C., Beckett J., Kitchen C., Wendling A.L. (2020). Telehealth in response to the COVID-19 pandemic: Implications for rural health disparities. Journal of the American Medical Informatics Association, 27(11): 1816-1818.
  49. Ikpae B.E., Amadi E.S. (2021). Disease profile among the elderly in a rural community in Nigeria. Yenagoa Medical Journal, 3(4): 212-219.
  50. Izquierdo M., Merchant R.A., Morley J.E., Anker S.D., Aprahamian I., Arai H., Aubertin-Leheudre M., Bernabei R., Cadore E.L., Cesari M., Chen L.K. (2021). International exercise recommendations in older adults (ICFSR): expert consensus guidelines. The Journal of nutrition, health and aging, 25(7): 824-853.
  51. Jackson W.A. (1991). Dependence and Population Ageing. In Hutton J., Hutton S., Pinch T., Shiell A. (eds.). Dependency to Enterprise. London: Routledge.
  52. Jaul E., Barron J. (2017). Age-Related Diseases and Clinical and Public Health Implications for the 85 Years Old and Over Population. Frontiers in public health, 5: 335. https://doi.org/10.3389/fpubh.2017.00335
  53. Jensen L., Monnat S.M., Green J.J., Hunter L.M., Sliwinski M.J. (2020). Rural Population Health and Aging: Toward a Multilevel and Multidimensional Research Agenda for the 2020s. American journal of public health, 110(9): 1328-1331. DOI: 10.2105/AJPH.2020.305782
  54. Jesien S., Marmitt L.P., Meucci R.D. (2022). Blessing as a health resource: cross-sectional study with elderly residents of rural areas. Revista De Saúde Pública, 56: 72.
  55. Johnston K.J., Wen H., Joynt Maddox K.E. (2019). Lack of access to specialists associated with mortality and preventable hospitalizations of rural Medicare beneficiaries. Health Affairs, 38(12): 1993-2002.
  56. Kaplan R.M., Spittel M.L., Zeno T.L. (2014). Educational Attainment and Life Expectancy. Policy Insights from the Behavioral and Brain Sciences, 1(1): 189-194. DOI: 10.1177/2372732214549754
  57. Khairat S., Haithcoat T., Liu S., Zaman T., Edson B., Gianforcaro R., Shyu C.R. (2019). Advancing health equity and access using telemedicine: a geospatial assessment. Journal of the American Medical Informatics Association, 26(8-9): 796-805.
  58. Khan M.S., Kumar P., Sreenivasan J., Khan S.U., Nasir K., Mehra M.R., O’Donnell C., Warraich H.J. (2021). Rural-urban differences in mortality from ischemic heart disease, heart failure, and stroke in the United States. Circulation: Cardiovascular Quality and Outcomes, 14(4): e007341. DOI: 10.1161/CIRCOUTCOMES.120.007341
  59. Kosar C.M., Loomer L., Ferdows N.B., Trivedi A.N., Panagiotou O.A., Rahman M. (2020). Assessment of rural-urban differences in postacute care utilization and outcomes among older US adults. JAMA Network Open, 3(1): e1918738.
  60. Lagarde M., Palmer N. (2011). The impact of user fees on access to health services in low- and middle-income countries. Cochrane Database of Systematic Reviews, 4. DOI: 10.1002/14651858.CD009094
  61. Le K.H., La T.X.P., Tykkyläinen M. (2022). Service quality and accessibility of healthcare facilities: digital healthcare potential in Ho Chi Minh City. BMC Health Services Research, 22: 1374.
  62. Leider J.P., Meit M., McCullough J.M., Resnick B., Dekker D., Alfonso Y.N., Bishai D. (2020). The State of Rural Public Health: Enduring Needs in a New Decade. American journal of public health, 110(9): 1283-1290. DOI: 10.2105/AJPH.2020.305728
  63. Liao R., Liu Y., Peng S., Feng X.L. (2021). Factors affecting health care users’ first contact with primary health care facilities in north eastern China, 2008-2018. BMJ Global Health, 6: e003907.
  64. Lin R.T., Chen Y.M., Chien L.C., Chang-Chuan C. (2012). Political and social determinants of life expectancy in less developed countries: a longitudinal study. BMC Public Health, 12: 85. DOI: 10.1186/1471-2458-12-85
  65. Loccoh E.C., Joynt Maddox K.E., Wang Y., Kazi D.S., Yeh R.W., Wadhera R.K. (2022). Rural-urban disparities in outcomes of myocardial infarction, heart failure, and stroke in the United States. Journal of the American College of Cardiology, 79(3): 267-279.
  66. Mbada C.E., Adeyemi T.L., Adedoyin R.A., Badmus H.D., Awotidebe T.O., Arije O.O., Omotosho O.S. (2015). Prevalence and modes of complementary and alternative medicine use among peasant farmers with musculoskeletal pain in a rural community in South-Western Nigeria. BMC Complementary and Alternative Medicine, 15: 164.
  67. McLaren Z., Ardington C., Leibbrandt M., (2013). Distance as a barrier to health care access in South Africa. A Southern Africa Labour and Development Research Unit Working Paper, Number 97. Cape Town: SALDRU, University of Cape Town.
  68. Mehmet N., Karapınar Y., Uludağ A. (2020). Patient satisfaction with primary healthcare services in a rural area of Hadim county, Konya. Turkish Journal of Public Health, 18(3): 133-142.
  69. Miladinov G. (2020). Socioeconomic development and life expectancy relationship: evidence from the EU accession candidate countries. Genus, 76: 2.
  70. Moeti T., Mokhele T., Weir-Smith G., Dlamini S., Tesfamicheal S. (2023). Factors Affecting Access to Public Healthcare Facilities in the City of Tshwane, South Africa. International Journal of Environmental Research and Public Health., 20(4): 3651.
  71. Monteith L.L., Holliday R., Brown T.L., Brenner L.A., Mohatt N.V. (2020). Preventing suicide in rural communities during the COVID‐19 pandemic. The Journal of Rural Health, 37(1): 179-184.
  72. Moreland B., Kakara R. & Henry A. (2020). Trends in nonfatal falls and fall-related injuries among adults aged≥ 65 years - United States, 2012-2018. Morbidity and Mortality Weekly Report, 69(27): 875-881.
  73. Nnadi H.C., Ezeh P.J. (2023). Psycho-Social Experiences and Healthcare Delivery for Older Adults in Nigeria. SAGE Open, 13(2). DOI: 10.1177/21582440231166646
  74. Nordin N., Nordin N., Ahmad N. (2015). The Effects of the Ageing Population on Healthcare Expenditure: A Comparative Study of China and India. In Proceedings of the International Conference on Economics and Banking 2015. Atlantis Press.
  75. Obeng-Gyasi S., Timsina L., Bhattacharyya O., Fisher C.S., Haggstrom D.A. (2020). Breast cancer presentation, surgical management and mortality across the rural-Urban Continuum in the National Cancer Database. Annals of Surgical Oncology, 27(6): 1805-1815.
  76. Odahowski C.L., Zahnd W.E., Eberth J.M. (2019). Challenges and opportunities for lung cancer screening in rural America. Journal of the American College of Radiology, 16(4): 590-595.
  77. Ogben C., Ilesanmi O. (2018). Community based health insurance scheme: Preferences of rural dwellers of the federal capital territory Abuja, Nigeria. Journal of public health in Africa, 9(1): 540.
  78. Ojagbemi A., Bello T., Luo Z., Gureje O. (2017). Living Conditions, Low Socioeconomic Position, and Mortality in the Ibadan Study of Aging. The Journals of Gerontology: Series B, 72(4): 646-655.
  79. Okafor S.O., Ugwuibe C.O. (2020). The Ageing Population and the Challenges of Health Management: A Study of Retirees of Public Institutions in South East Nigeria. World Journal of Social Science, 7(1): 31-45.
  80. Oladipo J.A. (2014). Utilization of health care services in rural and urban areas: a determinant factor in planning and managing health care delivery systems. African health sciences, 14(2): 322-333.
  81. Oleribe O.O., Momoh J., Uzochukwu B.S., Mbofana F., Adebiyi A., Barbera T., Williams R., Taylor-Robinson S.D. (2019). Identifying Key Challenges Facing Healthcare Systems In Africa And Potential Solutions. International journal of general medicine, 12: 395-403. DOI: 10.2147/IJGM.S223882
  82. Omotara B., Yahya S., Wudiri Z., Amodu M., Bimba J., Unyime J. (2015). Assessment of the Determinants of Healthy Ageing among the Rural Elderly of North-Eastern Nigeria. Health, 7: 754-764.
  83. Oyekale A.S. (2017). Assessment of primary health care facilities’ service readiness in Nigeria. BMC Health Services Research, 17: 172.
  84. Oyekale A.S. (2017). Assessment of primary health care facilities’ service readiness in Nigeria. BMC Health Services Research, 17: 172.
  85. Pekarek S. (2018). Population aging and economic dependency ratio: comparative study of the czech republic and slovakia. ECOFORUM, 7(14): 69-77.
  86. Penchansky R., Thomas J.W. (1981). The Concept of Access: Definition and Relationship to Consumer Satisfaction. Medical Care, 19(2): 127-140. DOI: 10.1097/00005650-198102000-00001
  87. 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.
  88. Rahman M., White E.M., Thomas K.S., Jutkowitz E. (2020). Assessment of rural-urban differences in health care use and survival among medicare beneficiaries with Alzheimer disease and related Dementia. JAMA Network Open, 3(10): e2022111.
  89. Saka S., Oosthuizen F., Nlooto M. (2019). National Policies and Older People’s Healthcare in Sub-Saharan Africa: A Scoping Review. Annals of Global Health; 85(1): 1-7.
  90. Sealy-Jefferson S., Roseland M.E., Cote M.L., Lehman A., Whitsel E.A., Mustafaa F.N., Booza J., Simon M.S. (2019). Rural-urban residence and stage at breast cancer diagnosis among postmenopausal women: the Women’s Health Initiative. Journal of Women’s Health, 28(2): 276-283.
  91. Seidu A.A. (2020) Mixed effects analysis of factors associated with barriers to accessing healthcare among women in sub-Saharan Africa: Insights from demographic and health surveys. PLoS ONE, 15(11): e0241409.
  92. Siconolfi D., Shih R.A., Friedman E.M., Kotzias V.I., Ahluwalia S.C., Phillips J.L., Saliba D. (2019). Rural-urban disparities in access to home-and community-based services and supports: stakeholder perspectives from 14 states. Journal of the American Medical Directors Association, 20(4): 503-508.
  93. Singh G.M., Becquart N., Cruz M., Acevedo A., Mozaffarian D., Naumova E.N. (2019). Spatiotemporal and demographic trends and disparities in cardiovascular disease among older adults in the United States based on 181 million hospitalization records. Journal of the American Heart Association, 8(21): e012727. DOI: 10.1161/JAHA.119.012727
  94. Smith J.G., Plover C.M., McChesney M.C., Lake E.T. (2019). Isolated, small, and large hospitals have fewer nursing resources than urban hospitals: implications for rural health policy. Public Health Nursing, 36(4): 469-477.
  95. Steinbrook E., Min M.C., Kajeechiwa L., Wiladphaingern J., Paw M.K., Pimanpanarak M.P.J., Hiranloetthanyakit W., Min A.M., Tun N.W., Gilder M.E., Nosten F., McGready R., Parker D.M. (2021). Distance matters: barriers to antenatal care and safe childbirth in a migrant population on the Thailand-Myanmar border from 2007 to 2015, a pregnancy cohort study. BMC pregnancy and childbirth, 21(1): 802.
  96. Strasser R., Kam S.M., Regalado S.M. (2016). Rural Health Care Access and Policy in Developing Countries. Annual Review of Public Health, 37: 395-412.
  97. Stypińska J., Nikander P. (2018). Ageism and Age Discrimination in the Labour Market: A Macrostructural Perspective. In Ayalon L., Tesch-Römer C. (eds.). Contemporary Perspectives on Ageism. Cham: Springer.
  98. Tanou M., Kishida T., Kamiya Y. (2021). The effects of geographical accessibility to health facilities on antenatal care and delivery services utilization in Benin: a cross-sectional study. Reproductive health, 18(1): 205.
  99. Tanyi P.L., André P., Mbah P. (2018). Care of the elderly in Nigeria: Implications for policy. Cogent Social Sciences, 4(1): 1555201. DOI: 10.1080/23311886.2018.1555201
  100. Ugo O., Ezinne E.A., Modupe O., Nicole S., Winifred E., Kelechi O. (2016). Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria: Successes and Challenges. Health services research and managerial epidemiology, 3: 2333392816662581. DOI: 10.1177/2333392816662581
  101. Umukoro N. (2012). Governance and Public Health Care in Nigeria. Journal of Health Management., 14(4): 381-395. DOI: 10.1177/0972063412468970
  102. United Nations Economic Commission for Africa (2022). The third review and appraisal cycle of the implementation of the Madrid international plan of action on ageing in Africa for the period 2012- 2017. Final report.
  103. Uzochukwu B., Onwujekwe O., Mbachu C. (2015). Implementing the Basic Health Care Provision Fund in Nigeria: a framework for accountability and good governance. London, UK: RESYST (Resilient and Responsive Health Systems) Research Consortium.
  104. Watson S.I., Wroe E.B., Dunbar E.L., Mukherjee J., Squire S.B., Nazimera L., Dullie L., Lilford R.J. (2016). The impact of user fees on health services utilization and infectious disease diagnoses in Neno District, Malawi: a longitudinal, quasi-experimental study. BMC Health Services Research, 16: 595.
  105. WHO (2015). Health systems: health workforce. Geneva: WHO.
  106. Xu W.Y., Jung J., Retchin S.M., Li Y., Roy S. (2022). Rural-urban disparities in diagnosis of early-onset dementia. JAMA Network Open; 5(8): e2225805.
  107. Yang S., Liu L., Wang C., Wang D. (2023). Elderly people’s preferences for healthcare facilities in Shanghai: gender features and influencing factor analysis. BMC Public Health, 23: 356.
  108. Yaya S., Bishwajit G., Ekholuenetale M.S., Kadio B., Udenigwe O. (2017). Urban-rural difference in satisfaction with primary healthcare services in Ghana. BMC Health Services Research, 17: 776.
  109. Yu L., Sabatino S.A., White M.C. (2019). Peer reviewed: rural–urban and racial/ethnic disparities in invasive cervical cancer incidence in the United States, 2010-2014. Preventing Chronic Disease, 16.
  110. Zgodic A., Zahnd W.E., Advani S., Eberth J.M. (2022). Low-dose CT lung cancer screening uptake: A rural-urban comparison. The Journal of Rural Health, 38(1): 40-53.
  111. Zhang X., Lin H. (2021). Disengagement Theory. In Gu D., Dupre M.E. (eds.) Encyclopedia of Gerontology and Population Aging. Cham: Springer.

Samuel O. Okafor, Sebastian O. Onah, Christy N. Obi-keguna, Onyinyechi E. Ibeabuchi, Uchenna Nwokoma, Kanayo C. Ayogu, The rural aged and the challenges of access to rural healthcare: the situation in Southeast Nigeria and its implication to rural and sustainable development in "SOCIOLOGIA URBANA E RURALE" 134/2024, pp 132-154, DOI: 10.3280/SUR2024-134007