TITLE:
Factors Associated with Health Service Utilization in the Commune of Abomey, Zou Department, Benin, in 2025
AUTHORS:
Carlos Eny, Damien Barikissou Georgia, Ignace C. N. Tokpanoude, Izraphil Moussa, Lorens Senan Zinsalo, Benoît Sêdégnon Agossoukpe, Sègnon Eurydice Elvire Djossou, Blaise Choki, Badirou Aguemon
KEYWORDS:
Health Service Utilization, Care-Seeking, Self-Medication, Trust, Financial Accessibility, Benin, Mixed-Methods Study
JOURNAL NAME:
Health,
Vol.18 No.10,
October
22,
2026
ABSTRACT: Introduction: Effective use of health services remains a major public health challenge in Benin, despite improvements in the availability of health infrastructure. It is influenced by economic, sociocultural, geographic, and organizational factors. This study aimed to estimate the frequency of health service utilization and to identify the factors associated with it in the commune of Abomey, Zou department, in 2025. Methods: An analytical cross-sectional mixed-methods study was conducted from October to December 2025 among adult residents of the commune of Abomey. The quantitative component used two-stage cluster sampling and included 1162 participants. The qualitative component comprised three focus group discussions bringing together the general population, community and religious leaders, and stakeholders from the Zou Departmental Hospital Center (CHDZ). Associations were examined using binary logistic regression accounting for the survey design and sampling weights. Qualitative data were analyzed thematically and triangulated with the quantitative findings. Results: Of the 1162 participants, 67.2% reported having been ill or injured in the past two years. Among these participants (n = 781), 82.8% [95% CI: 80.2 - 85.5] had consulted a health service during their most recent episode, corresponding to 55.7% of all participants surveyed. Public health centers were the main source of care (57.3%), followed by public hospitals (23.7%). Self-medication was very common (87.0%), and 47.3% of participants reported having previously forgone care for financial reasons. In the multivariable model, men had lower odds of using health services than women (adjusted odds ratio [aOR] = 0.46; 95% CI: 0.22 - 0.97; p = 0.042). Self-medication before seeking care was also associated with lower service utilization (aOR = 0.25; 95% CI: 0.10 - 0.58; p = 0.003). Similarly, lack of trust in the health system was associated with lower utilization (aOR = 0.50; 95% CI: 0.27 - 0.94; p = 0.033). The qualitative data further highlighted the importance of reception, interpersonal quality of care, availability of services and medicines, and cost of care in care-seeking pathways. Conclusion: Among participants who reported an episode of illness or injury in the two years preceding the survey, 82.8% had consulted a health service during their most recent episode, corresponding to 55.7% of all participants surveyed. However, self-medication, male sex, and lack of trust in the health system were associated with lower service utilization.