Showing papers on "Rural area published in 2017"

Fifty Shades of Green: Pathway to Healthy Urban Living.

Abstract: Currently half the world population lives in cities, and this proportion is expected to increase rapidly to 70% over the next years. Over the years, we have created large, mostly grey cities with many high-rise buildings and little green space. Disease rates tend to be higher in urban areas than in rural areas. More green space in cities could reduce these rates. Here, we describe the importance of green space for health, and make recommendations for further research. Green space has been associated with many beneficial health effects, including reduced all-cause and cardiovascular mortality and improved mental health, possibly through mediators, such as reduced air pollution, temperature and stress, and increased physical activity, social contacts, and restoration. Additional studies are needed to strengthen the evidence base and provide further guidelines to transport planners, urban planners, and landscape architects. We need more longitudinal studies and intervention studies, further understanding of the contribution of various mechanisms toward health, and more information on susceptible populations and on where, when, how much, and what type of green space is needed. Also needed are standardized methods for green space quality assessments and evaluations of effectiveness of green prescriptions in clinical practice. Many questions are ideally suited for environmental epidemiologists, who should work with other stakeholders to address the right questions and translate knowledge into action. In conclusion, a growing evidence base supports the hypothesis that greener cities are healthier cities.

The Urban Heat Island: Implications for Health in a Changing Environment.

Abstract: The Urban Heat Island (UHI) is a well-studied phenomenon, whereby urban areas are generally warmer than surrounding suburban and rural areas. The most direct effect on health from the UHI is due to heat risk, which is exacerbated in urban areas, particularly during heat waves. However, there may be health benefits from warming during colder months. This review highlights recent attempts to quantitatively estimate the health impacts of the UHI and estimations of the health benefits of UHI mitigation measures. Climate change, increasing urbanisation and an ageing population in much of the world, is likely to increase the risks to health from the UHI, particularly from heat exposure. Studies have shown increased health risks in urban populations compared with rural or suburban populations in hot weather and a disproportionate impact on more vulnerable social groups. Estimations of the impacts of various mitigation techniques suggest that a range of measures could reduce health impacts from heat and bring other benefits to health and wellbeing. The impact of the UHI on heat-related health is significant, although often overlooked, particularly when considering future impacts associated with climate change. Multiple factors should be considered when designing mitigation measures in urban environments in order to maximise health benefits and avoid unintended negative effects.

Cities and Mental Health.

Abstract: BACKGROUND More than half of the global population currently lives in cities, with an increasing trend for further urbanization. Living in cities is associated with increased population density, traffic noise and pollution, but also with better access to health care and other commodities. METHODS This review is based on a selective literature search, providing an overview of the risk factors for mental illness in urban centers. RESULTS Studies have shown that the risk for serious mental illness is generally higher in cities compared to rural areas. Epidemiological studies have associated growing up and living in cities with a considerably higher risk for schizophrenia. However, correlation is not causation and living in poverty can both contribute to and result from impairments associated with poor mental health. Social isolation and discrimination as well as poverty in the neighborhood contribute to the mental health burden while little is known about specific interactions between such factors and the built environment. CONCLUSION Further insights on the interaction between spatial heterogeneity of neighborhood resources and socio-ecological factors is warranted and requires interdisciplinary research.

Health-related behaviors by urban-rural county classification — United States, 2013

Abstract: Persons living in rural areas are recognized as a health disparity population because the prevalence of disease and rate of premature death are higher than for the overall population of the United States. Surveillance data about health-related behaviors are rarely reported by urban-rural status, which makes comparisons difficult among persons living in metropolitan and nonmetropolitan counties.

Rural–Urban Differences in Cancer Incidence and Trends in the United States

Abstract: Background: Cancer incidence and mortality rates in the United States are declining, but this decrease may not be observed in rural areas where residents are more likely to live in poverty, smoke, and forego cancer screening. However, there is limited research exploring national rural-urban differences in cancer incidence and trends.Methods: We analyzed data from the North American Association of Central Cancer Registries' public use dataset, which includes population-based cancer incidence data from 46 states. We calculated age-adjusted incidence rates, rate ratios, and annual percentage change (APC) for: all cancers combined, selected individual cancers, and cancers associated with tobacco use and human papillomavirus (HPV). Rural-urban comparisons were made by demographic, geographic, and socioeconomic characteristics for 2009 to 2013. Trends were analyzed for 1995 to 2013.Results: Combined cancers incidence rates were generally higher in urban populations, except for the South, although the urban decline in incidence rate was greater than in rural populations (10.2% vs. 4.8%, respectively). Rural cancer disparities included higher rates of tobacco-associated, HPV-associated, lung and bronchus, cervical, and colorectal cancers across most population groups. Furthermore, HPV-associated cancer incidence rates increased in rural areas (APC = 0.724, P < 0.05), while temporal trends remained stable in urban areas.Conclusions: Cancer rates associated with modifiable risks-tobacco, HPV, and some preventive screening modalities (e.g., colorectal and cervical cancers)-were higher in rural compared with urban populations.Impact: Population-based, clinical, and/or policy strategies and interventions that address these modifiable risk factors could help reduce cancer disparities experienced in rural populations. Cancer Epidemiol Biomarkers Prev; 27(11); 1265-74. ©2017 AACR.

Suicide Trends Among and Within Urbanization Levels by Sex, Race/Ethnicity, Age Group, and Mechanism of Death - United States, 2001-2015.

Abstract: PROBLEM/CONDITION Suicide is a public health problem and one of the top 10 leading causes of death in the United States. Substantial geographic variations in suicide rates exist, with suicides in rural areas occurring at much higher rates than those occurring in more urban areas. Understanding demographic trends and mechanisms of death among and within urbanization levels is important to developing and targeting future prevention efforts. REPORTING PERIOD 2001-2015. DESCRIPTION OF SYSTEM Mortality data from the National Vital Statistics System (NVSS) include demographic, geographic, and cause of death information derived from death certificates filed in the 50 states and the District of Columbia. NVSS was used to identify suicide deaths, defined by International Classification of Diseases, 10th Revision (ICD-10) underlying cause of death codes X60-X84, Y87.0, and U03. This report examines annual county level trends in suicide rates during 2001-2015 among and within urbanization levels by select demographics and mechanisms of death. Counties were collapsed into three urbanization levels using the 2006 National Center for Health Statistics classification scheme. RESULTS Suicide rates increased across the three urbanization levels, with higher rates in nonmetropolitan/rural counties than in medium/small or large metropolitan counties. Each urbanization level experienced substantial annual rate changes at different times during the study period. Across urbanization levels, suicide rates were consistently highest for men and non-Hispanic American Indian/Alaska Natives compared with rates for women and other racial/ethnic groups; however, rates were highest for non-Hispanic whites in more metropolitan counties. Trends indicate that suicide rates for non-Hispanic blacks were lowest in nonmetropolitan/rural counties and highest in more urban counties. Increases in suicide rates occurred for all age groups across urbanization levels, with the highest rates for persons aged 35-64 years. For mechanism of death, greater increases in rates of suicide by firearms and hanging/suffocation occurred across all urbanization levels; rates of suicide by firearms in nonmetropolitan/rural counties were almost two times that of rates in larger metropolitan counties. INTERPRETATION Suicide rates in nonmetropolitan/rural counties are consistently higher than suicide rates in metropolitan counties. These trends also are observed by sex, race/ethnicity, age group, and mechanism of death. PUBLIC HEALTH ACTION Interventions to prevent suicides should be ongoing, particularly in rural areas. Comprehensive suicide prevention efforts might include leveraging protective factors and providing innovative prevention strategies that increase access to health care and mental health care in rural communities. In addition, distribution of socioeconomic factors varies in different communities and needs to be better understood in the context of suicide prevention.

Racial/ethnic health disparities among rural adults -- United States, 2012–2015

Abstract: PROBLEM/CONDITION: Rural communities often have worse health outcomes, have less access to care, and are less diverse than urban communities. Much of the research on rural health disparities examines disparities between rural and urban communities, with fewer studies on disparities within rural communities. This report provides an overview of racial/ethnic health disparities for selected indicators in rural areas of the United States. REPORTING PERIOD: 2012-2015. DESCRIPTION OF SYSTEM: Self-reported data from the 2012-2015 Behavioral Risk Factor Surveillance System were pooled to evaluate racial/ethnic disparities in health, access to care, and health-related behaviors among rural residents in all 50 states and the District of Columbia. Using the National Center for Health Statistics 2013 Urban-Rural Classification Scheme for Counties to assess rurality, this analysis focused on adults living in noncore (rural) counties. RESULTS: Racial/ethnic minorities who lived in rural areas were younger (more often in the youngest age group) than non-Hispanic whites. Except for Asians and Native Hawaiians and other Pacific Islanders (combined in the analysis), more racial/ethnic minorities (compared with non-Hispanic whites) reported their health as fair or poor, that they had obesity, and that they were unable to see a physician in the past 12 months because of cost. All racial/ethnic minority populations were less likely than non-Hispanic whites to report having a personal health care provider. Non-Hispanic whites had the highest estimated prevalence of binge drinking in the past 30 days. INTERPRETATION: Although persons in rural communities often have worse health outcomes and less access to health care than those in urban communities, rural racial/ethnic minority populations have substantial health, access to care, and lifestyle challenges that can be overlooked when considering aggregated population data. This study revealed difficulties among non-Hispanic whites as well, primarily related to health-related risk behaviors. Across each population, the challenges vary. PUBLIC HEALTH ACTION: Stratifying data by different demographics, using community health needs assessments, and adopting and implementing the National Culturally and Linguistically Appropriate Services Standards can help rural communities identify disparities and develop effective initiatives to eliminate them, which aligns with a Healthy People 2020 overarching goal: achieving health equity. Language: en

Access To Obstetric Services In Rural Counties Still Declining, With 9 Percent Losing Services, 2004–14

Abstract: Recent closures of rural obstetric units and entire hospitals have exacerbated concerns about access to care for more than eighteen million women of reproductive age living in rural America. Yet th...

Factors Influencing Residents’ Perceptions toward Tourism Development: Differences across Rural and Urban World Heritage Sites

Abstract: This article compares the effects of factors influencing residents’ perceptions toward tourism development in urban and rural World Heritage Sites (WHSs). This study has been conducted in the rural...

Reducing Potentially Excess Deaths from the Five Leading Causes of Death in the Rural United States

Abstract: In 2014, the all-cause age-adjusted death rate in the United States reached a historic low of 724.6 per 100,000 population (1). However, mortality in rural (nonmetropolitan) areas of the United States has decreased at a much slower pace, resulting in a widening gap between rural mortality rates (830.5) and urban mortality rates (704.3) (1). During 1999–2014, annual age-adjusted death rates for the five leading causes of death in the United States (heart disease, cancer, unintentional injury, chronic lower respiratory disease (CLRD), and stroke) were higher in rural areas than in urban (metropolitan) areas (Figure 1). In most public health regions (Figure 2), the proportion of deaths among persons aged <80 years (U.S. average life expectancy) (2) from the five leading causes that were potentially excess deaths was higher in rural areas compared with urban areas (Figure 3). Several factors probably influence the rural-urban gap in potentially excess deaths from the five leading causes, many of which are associated with sociodemographic differences between rural and urban areas. Residents of rural areas in the United States tend to be older, poorer, and sicker than their urban counterparts (3). A higher proportion of the rural U.S. population reports limited physical activity because of chronic conditions than urban populations (4). Moreover, social circumstances and behaviors have an impact on mortality and potentially contribute to approximately half of the determining causes of potentially excess deaths (5).

Political Polarization along the Rural-Urban Continuum? The Geography of the Presidential Vote, 2000–2016:

Abstract: This article documents the diversity of political attitudes and voting patterns along the urban-rural continuum of the United States. We find that America’s rural and urban interface, in terms of political attitudes and voting patterns, is just beyond the outer edges of large urban areas and through the suburban counties of smaller metropolitan areas. Both Barack Obama and Hillary Clinton performed well in densely populated areas on the urban side of the interface, but they faced increasingly difficult political climates and sharply diminished voter support on the rural side of the interface. The reduction in support for Clinton in 2016 in rural areas was particularly pronounced. Even after controlling for demographic, social, and economic factors (including geographic region, education, income, age, race, and religious affiliation) in a spatial regression, we find that a county’s position in the urban-rural continuum remained statistically significant in the estimation of voting patterns in presidential ...

Urban-rural differences in the association between access to healthcare and health outcomes among older adults in China

Abstract: Studies have shown that inadequate access to healthcare is associated with lower levels of health and well-being in older adults. Studies have also shown significant urban-rural differences in access to healthcare in developing countries such as China. However, there is limited evidence of whether the association between access to healthcare and health outcomes differs by urban-rural residence at older ages in China. Four waves of data (2005, 2008/2009, 2011/2012, and 2014) from the largest national longitudinal survey of adults aged 65 and older in mainland China (n = 26,604) were used for analysis. The association between inadequate access to healthcare (y/n) and multiple health outcomes were examined—including instrumental activities of daily living (IADL) disability, ADL disability, cognitive impairment, and all-cause mortality. A series of multivariate models were used to obtain robust estimates and to account for various covariates associated with access to healthcare and/or health outcomes. All models were stratified by urban-rural residence. Inadequate access to healthcare was significantly higher among older adults in rural areas than in urban areas (9.1% vs. 5.4%; p < 0.01). Results from multivariate models showed that inadequate access to healthcare was associated with significantly higher odds of IADL disability in older adults living in urban areas (odds ratio [OR] = 1.58–1.79) and rural areas (OR = 1.95–2.30) relative to their counterparts with adequate access to healthcare. In terms of ADL disability, we found significant increases in the odds of disability among rural older adults (OR = 1.89–3.05) but not among urban older adults. Inadequate access to healthcare was also associated with substantially higher odds of cognitive impairment in older adults from rural areas (OR = 2.37–3.19) compared with those in rural areas with adequate access to healthcare; however, no significant differences in cognitive impairment were found among older adults in urban areas. Finally, we found that inadequate access to healthcare increased overall mortality risks in older adults by 33–37% in urban areas and 28–29% in rural areas. However, the increased risk of mortality in urban areas was not significant after taking into account health behaviors and baseline health status. Inadequate access to healthcare was significantly associated with higher rates of disability, cognitive impairment, and all-cause mortality among older adults in China. The associations between access to healthcare and health outcomes were generally stronger among older adults in rural areas than in urban areas. Our findings underscore the importance of providing adequate access to healthcare for older adults—particularly for those living in rural areas in developing countries such as China.

The economic burden of dementia in China, 1990-2030: implications for health policy.

Abstract: Introduction According to the 2013 Alzheimer's Disease International report, about 44.4 million people were living with dementia in 2013 and this number is expected to reach an estimated 75.6 million by 2030. (1) In China, which has the largest population of people with dementia, the prevalence of dementia appears to have increased steadily between 1990 and 2010. (2,3) However, this trend might be partly attributed to temporal variations in the methods used to estimate such prevalence. (4) The results of a national survey in 2008-2009 indicated that dementia was more common in rural areas than in urban settings. (5) Given the rapid growth of the elderly population in China, (6) dementia is expected to pose tremendous challenges to the national health-care system and to the sustainable development of the national economy. Most cost-of-illness studies for dementia have been carried out in high-income countries such as Sweden, the United Kingdom of Great Britain and Northern Ireland and the United States of America. (7-11) The economic costs of dementia in China --which have yet to be investigated in detail--are likely to differ, both in magnitude and type, from those in such distant high-income countries. In this study, we sought to estimate and predict the costs of dementia in China for the periods 1990-2010 and 2020-2030, respectively. It was hoped that, by quantifying the economic costs of dementia, Chinese policy-makers would be motivated to develop a nationwide action plan, prioritize policies on dementia-related care and research and reduce the economic and societal burdens of dementia in China. Methods In this cost-of-illness study, we used a prevalence-based, bottom-up approach to quantify or predict the costs of dementia in China between 1990 and 2030, from a societal perspective. We categorized all the costs into three classes: (11,13) (i) direct medical costs, that is goods and service costs related to the diagnosis and treatment of inpatients and outpatients with dementia; (ii) direct non-medical costs, that is transport costs and costs related to formal care in nursing homes or informal care at home; and (iii) indirect costs resulting from dementia-attributable loss of productivity. Data sources We used multiple data sources for all estimates. We used age-specific prevalence of dementia in China, for the period 1990-2010, derived from a comprehensive systematic review. (3) From the electronic health records of the facilities, we collected cost data for patients with diagnosed dementia who were admitted either to the Shandong Centre for Mental Health--the only provincial psychiatric hospital in the eastern province of Shandong--between 1 January 2005 and 31 March 2014 or to the Daizhuang Psychiatric Hospital--one of the oldest psychiatric hospitals in China and also in Shandong province --between 1 January 2012 and 30 September 2014. The routine electronic health records include sociodemographic data and data on clinical diagnosis and disease classification, itemized costs, e.g. for drugs, examinations and beds. In each of the two study facilities, dementia was diagnosed and defined according to the International statistical classification of diseases and related health problems, 10th revision. (14) We excluded 26 patients with dementia who were diagnosed as having other chronic conditions that needed treatment, e.g. anxiety, diabetes or hypertension, leaving data from the records of 146 patients with dementia in our analysis. We also searched the China National Knowledge Infrastructure, Pub Med and Wan fang bibliographic databases for studies, on the use of health resource by people with dementia in China, published between 1 January 1990 and 31 July 2015. The search terms included "Alzheimer's disease", "China", "cost burden", "dementia", "economic burden", "formal care" and "informal care". We obtained costs for outpatient visits and transportation from a published study. …

Gender and Regional Differences in Sleep Quality and Insomnia: A General Population-based Study in Hunan Province of China.

Abstract: Insomnia and the inability to sleep affect people’s health and well-being. However, its systematic estimates of prevalence and distribution in the general population in China are still lacking. A population-based cluster sampling survey was conducted in the rural and urban areas of Hunan, China. Subjects (n = 26,851) were sampled from the general population, with a follow-up using the Pittsburgh Sleep Quality Index (PSQI) for interview to assess quality of sleep and Insomnia (PSQI score >5). While the overall prevalence of insomnia was 26.6%, and little difference was found between males (26.3%) and females (27.0%); the mean PSQI score was 4.26 (±2.67), and significant higher in females (4.32 ± 2.70) than males (4.21 ± 2.64, p = 0.003). Individuals in the rural areas tended to report a higher PSQI score (4.45 ± 2.81) than urban residents did (4.18 ± 2.60) (p < 0.001) and the estimates of prevalence of insomnia was 29.4% in the rural areas, significant higher than 25.5% in the urban areas (p < 0.001). Multiple logistic regression analysis showed that female gender, older age, higher level of education, being unmarried, living in the rural area, cigarette smoking and alcohol drinking were associated with insomnia. Our study may provide important information for general and mental health research.

Household Livelihood Strategies and Implication for Poverty Reduction in Rural Areas of Central Nepal

Abstract: Understanding household livelihood strategies is pivotal to minimize rural poverty in the least developed countries like Nepal. This study is an attempt to assess livelihood strategies pursued by rural households, investigate the most remunerative strategy, and identify the factors that influence a household’s choice of better strategies in rural Nepal. Primary data collected in 453 households from three villages of central Nepal are analyzed quantitatively within a sustainable livelihood framework. This study categorized households into five main livelihood strategy groups. The results showed that the majority (61%) of the households diversified their income to non-farm sources. Livelihood diversification to business/enterprise strategies adopted by 16% of the households is the most remunerative strategy followed by commercial farming that includes 13% of the sample and are more relevant to poverty reduction. Land holding, education, agriculture and skill training, access to credit, and proximity to the road and market center are the major influencing factors on the adoption of higher returning livelihood strategies. Stimulating poor households to follow market-oriented farm and non-farm activities by improving access to education, vocational training, rural credit, and rural infrastructures is momentous for reducing poverty in the rural areas of central Nepal.

Cancer incidence and mortality: A cohort study in China, 2008–2013

Abstract: The National Central Cancer Registry of China (NCCR) was the only available source of cancer monitoring in China, even though only about 70% of cancer registration sites were qualified by now. In this study, based on a national large prospective cohort-the China Kadoorie Biobank (CKB), we aimed to provide additional cancer statistics and compare the difference of cancer burden between urban and rural areas of China. A total of 497,693 cancer-free participants aged 35-74 years were recruited and successfully followed up from 2004 to 2013 in 5 urban and 5 rural areas across China. Except for traditional registration systems, the national health insurance system and active follow-up were used to determine new cancer incidents and related deaths. The mortality-to-incidence ratio (MIR) was used to compare the differences of cancer burden between urban and rural areas of China. We found that cancer mortality coincided well between our cohort and NCCR, while the incidence was much higher in our cohort. Based on CKB, we found the MIR of all cancers was 0.54 in rural areas, which was approximately one-third higher than that in urban areas with 0.39. Cancer profiles in urban areas were transiting to Western distributions, which were characterized with high incidences of breast cancer and colorectal cancer; while cancers of the esophagus, liver and cervix uteri were still common in rural areas of China. Our results provide additional cancer statistics of China and demonstrate the differences of cancer burden between urban and rural areas of China.

Residence in Rural Areas of the United States and Lung Cancer Mortality. Disease Incidence, Treatment Disparities, and Stage-Specific Survival

Abstract: Rationale: There is increased lung cancer mortality in rural areas of the United States. However, it remains unclear to what extent rural–urban differences in disease incidence, stage at diagnosis, or treatment explain this finding.Objectives: To explore the relationship between smoking rates, lung cancer incidence, and lung cancer mortality in populations across the rural–urban continuum and to determine whether survival is decreased in rural patients diagnosed with lung cancer and whether this is associated with rural–urban differences in stage at diagnosis or the treatment received.Methods: We conducted a retrospective cohort study of 348,002 patients diagnosed with lung cancer between 2000 and 2006. Data from metropolitan, urban, suburban, and rural areas in the United States were obtained from the Surveillance, Epidemiology, and End Results program database. County-level population estimates for 2003 were obtained from the U.S. Census Bureau, and corresponding estimates of smoking prevalence were obt...

Substance Use in Rural Central Appalachia: Current Status and Treatment Considerations

Abstract: The burden of substance use and especially the unmatched rates of overdoses in rural Central Appalachia highlight the need for innovative approaches to curb the initiation to drug misuse and to address current substance use disorders. Effective substance use interventions involve a thorough understanding of the region. In Central Appalachia, many of the barriers to treatment are shared with other rural and impoverished areas, including a lack of access to health care and lack of health care providers with specialized training. Parts of Appalachia also present their own considerations, including the challenges of fostering trust and encouraging treatment-seeking in communities with dense, long-term, place-based social and family networks. Current policies and interventions for substance use have been largely inadequate in the region, as evidenced by continued increases in substance use and substance-related deaths, especially related to nonmedical prescription drug use and increasing heroin use. The authors discuss ways in which rural life, poverty, identity, and values in Appalachia have influenced substance use and treatment and propose strategies and interventions to improve outcomes.

Bringing 5G into Rural and Low-Income Areas: Is It Feasible?

Abstract: Nowadays, at least two billion people are experiencing a complete lack of wireless cellular network coverage. These users live in rural areas and low-income regions, where network operators are not keen to invest, mainly due to high capital expenditure and operational expenditure costs, as well as the scarcity of electricity from the grid. We tackle this challenge by proposing a 5G network explicitly designed to serve rural and low-income areas. Our solution investigates the possibility of mounting remote radio heads on top of unmanned aerial vehicles, as well as large cells (LCs) to increase the coverage range. In addition, 5G nodes are powered by solar panels and batteries. Preliminary results, obtained over three representative case studies located in Italy, Cook Islands, and Zimbabwe, show that providing connectivity in rural and low-income areas by means of the proposed 5G architecture is feasible. At the same time, we also show that the monthly subscription fee paid by the users can be kept sufficiently low, that is, less than €1/month in low-income areas, and around €11/month in rural regions.

Women's decision-making autonomy and utilisation of maternal healthcare services: results from the Bangladesh Demographic and Health Survey.

Abstract: Objectives The aim of this study was to determine the association between women’s decision-making power and utilisation of maternal healthcare services (MHS) among Bangladeshi women. Settings This is a nationally representative survey that encompassed Dhaka, Rajshahi, Rangpur, Chittagong, Khulna, Barisal and Sylhet in Bangladesh. Sample households were selected by a two-stage stratification technique. First, 207 clusters in urban areas and 393 in rural areas were selected for 600 enumeration areas with proportional probability. In the second stage, on average 30 households were selected systematically from the enumeration areas. Finally, 17 989 households were selected for the survey of which 96% were interviewed successfully. Participants Cross-sectional data on 4309 non-pregnant women were collected from Bangladesh demographic and health survey 2014. Decision-making status on respondent9s own healthcare, large household purchases, having a say on child’s healthcare and visiting to family or relatives were included in the analysis. Results Prevalence of at least four antenatal attendance, facility delivery and postnatal check-up were respectively 32.6% (95% CI 31.2 to 34), 40.6% (95% CI 39.13 to 42.07) and 66.3% (95% CI 64.89 to 67.71). Compared with women who could make decisions alone, women in the urban areas who had to decide on their healthcare with husband/partner had 20% (95% CI 0.794 to 1.799) higher odds of attending at least four antenatal visits and those in rural areas had 35% (95% CI 0.464 to 0.897) lower odds of attending at least four antenatal visits. Women in urban and rural areas had respectively 43% (95% CI 0.941 to 2.169) and 28% (95% CI 0.928 to 1.751) higher odds of receiving postnatal check-up when their health decisions were made jointly with their husband/partner. Conclusion Neither making decisions alone, nor deciding jointly with husband/partner was always positively associated with the utilisation of all three types of MHS. This study concludes that better spousal cooperation on household and health issues could lead to higher utilisation of MHS services.