Maternal Awareness and Accessibility of eHealth Technologies for Child Healthcare in Rural Nasarawa State, Nigeria: A Community-Based Assessment

Abstract

Maternal and child mortality remain critically high in rural Nigeria, with Nasarawa State recording maternal mortality ratios between 814 and 1,047 per 100,000 live births. Digital health (eHealth) technologies, particularly mobile health (mHealth) interventions, have been promoted to bridge access gaps. However, the success of these technologies depends on two interrelated factors: maternal awareness and accessibility. This study assessed the types of eHealth technologies used, the level of awareness among rural mothers, and the level of accessibility, including multidimensional barriers. A descriptive cross-sectional mixed-methods design was conducted in four rural Local Government Areas of Nasarawa State (Awe, Nasarawa Eggon, Kokona, Doma). Using multistage sampling, 394 women of reproductive age (15–49 years) completed a structured questionnaire (response rate 95%). Facility checklists documented available technologies, and 25 key informant interviews were conducted with health workers and community leaders. Quantitative data were analysed using descriptive statistics and one-sample t-tests (p<0.05). Qualitative data underwent thematic analysis. Voice/audio messages (63.9%) and SMS reminders (57.4%) were the most frequently used technologies; video-based education (19.1%) and USSD services (19.9%) had very low uptake. Mothers demonstrated statistically significant awareness of eHealth technologies (mean=18.65, t=2.36, p=0.018), with 65.9% having received health messages or calls. However, overall accessibility was not statistically significant (mean=21.57, t=1.86, p=0.064). Key accessibility barriers included low literacy (39.1% with no formal education; mean reading SMS=2.85/4), inability to use mobile apps (mean=2.72), unaffordability of smartphones/data, unreliable electricity and network coverage, and socio-cultural factors (need for husband’s permission, mean=3.63; privacy concerns, mean=3.51). Qualitative findings confirmed these barriers, with 18 of 25 key informants citing gender restrictions and infrastructure deficits. Rural mothers in Nasarawa State are significantly aware of eHealth technologies but face multidimensional accessibility barriers that prevent effective use. The awareness-accessibility gap undermines the potential of digital health interventions. Policy and practice must prioritize voice-based, literacy-adapted solutions, invest in rural infrastructure, provide data subsidies, and engage communities to address socio-cultural constraints. Without these measures, eHealth will continue to benefit the digitally privileged, widening existing health inequities.