The impact of public health services on mortality: A study of mortality differentials in a rural area of Nigeria

Summary An attempt was made to measure the effect of providing health services in rural Nigeria by selecting two communities matched so as to be as similar as possible in culture, socio-economic characteristics, the supply of water and the disposal of human wastes, but contrasting in the provision of health services. One centre had enjoyed the services of a doctor and a well-staffed hospital for over a decade, while the other was over ten kilometres from even the nearest maternal health centre or shop selling pharmaceutical products. A sample of households in each village was interviewed about morbidity, mortality and the treatment employed for sickness. A substantial difference in the use of modern medical services was reflected in a wide mortality differential largely explained by very great differences in mortality under five years of age. It was concluded that mortality decline during the last half century may be almost wholly explained by introduced modern health services, and that the mortality decline even in areas far from health centres has probably resulted largely from campaigns against infectious disease, some employment of the distant health facilities together with the use of certain Pharmaceuticals and perhaps mosquito nets. Continued mortality decline depends primarily on the provision of a denser network of medical facilities.