TITLE:
Socioeconomic, Environmental, and Health-System Factors Associated with Healthcare-Seeking in Natitingou Municipality, Benin: A Cross-Sectional Study in 2025
AUTHORS:
M’po Florent Yeni, David Houeto, Ignace Coovi Nonwanou Tokpanoude, Zinsalo Senan Lorens, Sègnon Eurydice Elvire Djossou, Hilaire Enangnon Akpovi, Georgia Damien Barikissou, Géraud Padonou, Badirou Aguemon
KEYWORDS:
Healthcare-Seeking, Access to Care, Social Health Inequalities, Geographic Accessibility, Equity, Trust, Natitingou, Benin
JOURNAL NAME:
Health,
Vol.18 No.10,
October
20,
2026
ABSTRACT: Introduction: Socioeconomic, environmental, and health-system inequalities can each shape health service utilization. In Benin, despite ongoing efforts to improve access to care, disparities persist, particularly in rural and peripheral areas. This study set out to identify the sociodemographic, socioeconomic, environmental, and health-system factors associated with healthcare-seeking in Natitingou municipality in 2025. Methods: We conducted a descriptive and analytical cross-sectional study from November 22 to December 23, 2025, among 510 households in Natitingou municipality, Benin. Sampling followed a two-stage cluster design: 30 clusters were selected through systematic probability-proportional-to-size sampling, after which 17 households were selected within each cluster using systematic, equal-probability sampling from updated householdlists. Analyses accounted for the cluster structure of the design. Bivariate associations were assessed using the Rao-Scott χ2 test, followed by binary logistic regression and a Firth penalized-likelihood sensibility analysis. Results: Overall, 72.35% of households had used a health facility during their most recent illness episode. After adjustment for the cluster design, three factors remained significantly associated with healthcare-seeking. Households more than 60 minutes from a health facility had lower odds of seeking care than those within 30 minutes (aOR = 0.31; 95% CI: 0.10 - 0.98; p = 0.046). Households reporting distrust of health facilities had higher odds of seeking care (aOR = 9.13; 95% CI: 2.32 - 35.89; p = 0.003). Households perceiving the distribution of health resources as inequitable had markedly lower odds of seeking care than those perceiving it as equitable (aOR = 0.02; 95% CI: 0.005 - 0.089; p Conclusion: In Natitingou, healthcare-seeking was associated with geographic accessibility, trust in health facilities, and perceived equity in the distribution of health resources. Only a travel time exceeding 60 minutes remained significantly associated with lower care-seeking after adjustment, whereas the 30 - 60-minute category was not statistically significant. The observed associations, particularly those involving trust and perceived equity, should be interpreted cautiously given the cross-sectional design and the sparseness of certain categories.