Introduction Many urban residents in low- and middle-income countries live in unfavorable conditions with few healthcare facilities, calling to question the long-held view of urban advantage in health, healthcare access and utilization. We explore the patterns of healthcare utilization in these deprived neighborhoods by studying three such settlements in Nigeria. Methods The study was conducted in three slums in Southwestern Nigeria, categorized as migrant, indigenous or cosmopolitan, based on their characteristics. Using observational data of those who needed healthcare and used in-patient or out-patient services in the 12 months preceding the survey, frequencies, percentages and odds-ratios were used to show the study participants’ environmental and population characteristics, relative to their patterns of healthcare use. Results A total of 1,634 residents from the three slums participated, distributed as 763 (migrant), 459 (indigenous) and 412 (cosmopolitan). Residents from the migrant (OR = 0.70, 95%CI: 0.51 to 0.97) and indigenous (OR = 0.65, 95%CI: 0.45 to 0.93) slums were less likely to have used formal healthcare facilities than those from the cosmopolitan slum. Slum residents were more likely to use formal healthcare facilities for maternal and perinatal conditions, and generalized pains, than for communicable (OR = 0.50, 95%CI: 0.34 to 0.72) and non-communicable diseases (OR = 0.61, 95%CI: 0.41 to 0.91). The unemployed had higher odds (OR = 1.45, 95%CI: 1.08 to 1.93) of using formal healthcare facilities than those currently employed. Conclusion The cosmopolitan slum, situated in a major financial center and national economic hub, had a higher proportion of formal healthcare facility usage than the migrant and indigenous slums where about half of families were classified as poor. The urban advantage premise and Anderson behavioral model remain a practical explanatory framework, although they may not explain healthcare use in all possible slum types in Africa. A context-within-context approach is important for addressing healthcare utilization challenges in slums in sub-Saharan Africa.

Background: The global community is racing to slow down and eventually halt the spread of COVID-19. The success of the ongoing battle against this pandemic all over the world depends on community knowledge and perception. The objective of this study was to assess risk communication, knowledge and community attitudes to COVID-19 outbreaks in southwestern Nigeria. Methods: Community based descriptive cross-sectional study of risk communication, knowledge and community attitude to COVID-19 prevention and control among 1200 community persons selected using multistage sampling methods. Research instrument was a semi-structure interviewer administered questionnaire, and data analyzed using the IBM SPSS software version 23.0. Findings: Mean age of respondents was 36.0 ± 12.1 years, 735 (61.3%) were females and 465 (38.8%) were males. Majority of the respondents (97.5%) had heard about COVID-19, with the radio (65.2%) and television (60.4%) being the major sources of information. Only 455 (37.9%) think that they can get COVID-19, 738 (61.5%) said they were ready to willingly observe staying indoors or lockdown, only 525 (43.8%) have been putting on face mask. Respondents with good knowledge of COVID-19 transmission, symptoms and prevention were 39.6%, 88.7% and 94.5% respectively, while for good perception towards COVID-19 was 72.2%. Predictors of good knowledge of transmission and symptoms of COVID were respondents being above 19 years, being a male and having education level above secondary school. Predictors of good knowledge and perception of prevention and control measures of COVID were respondents being above 19 years, being a female and having education level above secondary school. Conclusion: Good awareness and poor knowledge of COVID-19 transmission, but good knowledge of prevention and good perception were reported among communities in Southwestern Nigeria. Only few believed they could get the disease. This calls for enlightenment campaign and good communication messages directed at the general population.

Background: The global community is racing to slow down and eventually halt the spread of COVID-19. The success of the ongoing battle against this pandemic all over the world depends on community knowledge and perception. The objective of this study was to assess risk communication, knowledge and community attitudes to COVID-19 outbreaks in southwestern Nigeria. Methods: Community based descriptive cross-sectional study of risk communication, knowledge and community attitude to COVID-19 prevention and control among 1200 community persons selected using multistage sampling methods. Research instrument was a semi-structure interviewer administered questionnaire, and data analyzed using the IBM SPSS software version 23.0. Findings: Mean age of respondents was 36.0 ± 12.1 years, 735 (61.3%) were females and 465 (38.8%) were males. Majority of the respondents (97.5%) had heard about COVID-19, with the radio (65.2%) and television (60.4%) being the major sources of information. Only 455 (37.9%) think that they can get COVID-19, 738 (61.5%) said they were ready to willingly observe staying indoors or lockdown, only 525 (43.8%) have been putting on face mask. Respondents with good knowledge of COVID-19 transmission, symptoms and prevention were 39.6%, 88.7% and 94.5% respectively, while for good perception towards COVID-19 was 72.2%. Predictors of good knowledge of transmission and symptoms of COVID were respondents being above 19 years, being a male and having education level above secondary school. Predictors of good knowledge and perception of prevention and control measures of COVID were respondents being above 19 years, being a female and having education level above secondary school. Conclusion: Good awareness and poor knowledge of COVID-19 transmission, but good knowledge of prevention and good perception were reported among communities in Southwestern Nigeria. Only few believed they could get the disease. This calls for enlightenment campaign and good communication messages directed at the general population.

Urban slum residents have access to a broad range of facilities of varying quality. The choices they make can significantly influence their health outcomes. Discrete Choice Experiments (DCEs) are a widely-used health economic methodology for understanding how individuals make trade-offs between attributes of goods or services when choosing between them. We carried out a DCE to understand these trade-offs for residents of an urban slum in Ibadan, Nigeria. We conducted 48 in-depth interviews with slum residents to identify key attributes influencing their decision to access health care. We also developed three symptom scenarios worded to be consistent with, but not pathegonian of, malaria, cholera, and depression. This led to the design of a DCE involving eight attributes with 2–4 levels for each. A D-efficient design was created, and data was collected from 557 residents between May 2021 and July 2021. Conditional-logit models were fitted to these data initially. Mixed logit and latent class models were also fitted to explore preference heterogeneity. Conditional logit results suggested a substantial Willingness-to-pay (WTP) for attributes associated with quality. WTP estimates across scenarios 1/2/3 were N5282 / N6080 / N3715 for the government over private ownership, N2599 / N5827 / N2020 for seeing a doctor rather than an informal provider and N2196 / N5421 /N4987 for full drug availability over none. Mixed logit and latent class models indicated considerable preference heterogeneity, with the latter suggesting a substantial minority valuing private over government facilities. Higher income and educational attainment were predictive of membership of this minority. Our study suggests that slum residents value and are willing to pay for high-quality care regarding staff qualifications and drug availability. It further suggests substantial variation in the perception of private providers. Therefore, improved access to government facilities and initiatives to improve the quality of private providers are complementary strategies for improving overall care received.