A comparative cross-sectional study of urban and rural disparities in knowledge and perception of preventive health screening and routine medical checkups among adults in Nigeria

Imagine the human body as a high-tech car. You wouldn't wait for the engine to smoke or the tires to blow out before checking the oil or the brakes, right? That's the basic idea behind preventive health screening and routine medical check-ups. Instead of waiting for a "check engine" light to flash (which usually means a disease has already started), these are the regular tune-ups doctors suggest to catch tiny problems before they become big, scary breakdowns. In the world of public health, scientists are constantly asking: "Do people know about these tune-ups? Do they think they are important? And does it matter where they live?"

This question is especially tricky in places where the road conditions vary wildly. In some neighborhoods, the "garage" (the hospital) is right around the corner, and the mechanic (the doctor) is easy to talk to. In others, the garage is miles away, the road is bumpy, and the mechanic might be hard to find. This study dives into that exact gap. It looks at how living in a busy city versus a quiet countryside changes what people know about health check-ups and how they feel about them. The researchers aren't just guessing; they are measuring the difference in "health literacy" (how much you know) and "health perception" (how much you care) between two very different groups of people in Nigeria.

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The Great City vs. Countryside Health Showdown

Think of Nigeria as a massive stage with two very different sets: the bustling Urban set (the city) and the quiet Rural set (the countryside). The researchers, Elias Chikee Aniwada and Chika Nwanma Onwasigwe, decided to run a massive "health trivia and attitude contest" across these two sets. They didn't just ask a few people; they interviewed 1,558 adults (people aged 18 and up) to see who knew the most about health check-ups and who thought they were the coolest idea ever.

They used a clever trick to find their players. Instead of waiting for people to come to a clinic, the researchers went to where people already hang out—like church services, community meetings, and public markets. They picked two city neighborhoods (Enugu East and Enugu North) and two countryside neighborhoods (Nkanu East and Udi) to make sure they got a fair mix of everyone.

The Scoreboard: Who Knows What?

When the results came in, the city dwellers were winning the trivia round, but not by a landslide. It was a clear victory, though.

• The Knowledge Gap: About 60.7% of the city folks had "good knowledge" about what a routine check-up involves. In the countryside, that number dropped to 51.9%.
• The Awareness Gap: Even more telling was who had heard of these check-ups at all. A massive 90.4% of city residents knew screening existed, compared to 83.0% of rural residents.

It's like the city team had a better coach and more practice time. They knew that check-ups aren't just for sick people. In fact, 54.8% of city people correctly said that everyone (sick or healthy) should get checked, while a larger chunk of the rural team (35.5%) still thought you only needed a check-up if you were already feeling sick. That's a big difference in mindset!

The city folks also knew more about the specific "tools" in the health toolbox. They were much more likely to know about things like the Mantoux test (for tuberculosis) and PSA tests (for prostate health). For example, 19.2% of city people knew about the Mantoux test, while only 9.1% of rural people did. It seems the city residents had more access to the "instruction manuals" for their health.

The Attitude Check: Who Thinks It's a Good Idea?

Knowing the facts is one thing; thinking they are important is another. This is where the "perception" part of the study comes in.

• The City Vibe: 66.9% of city residents had a "positive perception." They believed check-ups were important, could save lives, and should be mandatory.
• The Country Vibe: 57.0% of rural residents felt the same way.

The city team was more likely to say, "Yes, we should do this every year!" and "It helps us stay healthy." The rural team, while still mostly positive, was a bit more skeptical or unsure. Interestingly, the rural team was more likely to say that these services should be "readily available" (easy to get). This suggests they might be thinking, "We know it's a good idea, but we really need to be able to get to the garage easily!"

The Secret Weapons: What Makes the Difference?

The researchers didn't just stop at the scores; they wanted to know why the city team was winning. They looked at the players' backgrounds: age, job, education, and family history.

1. Education is the Superpower: This was the biggest finding. In both the city and the country, education was the strongest predictor of knowing and caring about health.

   • In the city, people with tertiary education (university level) were 8 times more likely to have good knowledge than those with only primary school education.
   • In the country, the same pattern held true. University-educated folks were 3 times more likely to have good knowledge than those with primary education.
   • Analogy: Think of education as the "user manual" for the body. The more pages you've read, the better you understand how the machine works.

2. The City Job Advantage: In the city, your job mattered. Civil servants (government workers) knew the most. They probably get regular health checks as part of their job or have better access to health info at work. In the countryside, age and marriage were the big factors. Older people and married people knew more, perhaps because they've been around the block a few times or have a spouse reminding them to stay healthy.

3. The "Sick Family" Factor: If you have a family member who has been sick, you are more likely to know about check-ups. It's like having a friend who went through a car repair; you learn a lot about what to watch out for. This was true for both city and country folks.

What the Study Didn't Find (and Why That Matters)

The researchers were careful not to overpromise. They found that smoking and drinking alcohol didn't seem to change how much people knew about check-ups in the countryside. Also, while they found huge differences in knowledge and attitude, they didn't actually measure how many people went to the doctor. Knowing you should get a check-up is step one; actually going is step two, and that's a different story.

The Takeaway: Fixing the Road to the Garage

So, what's the final verdict? The study confirms that there is a real gap between the city and the countryside in Nigeria. The city folks are better informed and more positive about preventive health, largely because they have more education and better access to information.

But the rural team isn't lost; they just need a better map. The researchers suggest that to fix this, we need to bring the "user manuals" to the countryside. This means:

• More Education: Teaching people about health in schools and communities.
• Better Access: Making sure the "garage" (health clinics) is closer and easier to reach for rural folks.
• Targeted Messaging: Using the people who are already trusted (like married couples or older community members) to spread the word.

The study doesn't say the problem is solved, but it points the finger at the right place: Education and Access. If we can level the playing field so that a farmer in the countryside has the same "user manual" as a city worker, maybe the whole country can get better at keeping their engines running smoothly.