CHAPTER ONE

INTRODUCTION

1.1       Background to Study

Safe maternity with improved neonatal outcomes is predicated on proper antenatal care services. Exercise has become a fundamental aspect of women’s lives and an important constituent of antenatal care. Wang and Apgar submitted that empirical data on the impact of exercise on the mother, the fetus, and the course of pregnancy are still limited and results of the few studies in humans are often equivocal or contradictory. However, the American Congress of Obstetricians and Gynaecologists recommended that pregnant women can exercise moderately for 30 minutes on most days of the week. In accordance with these recommendations, irrespective of the pregnant woman’s physical fitness level, exercise should be low-impact, moderate-intensity, and regular.

The number of deaths and morbidities of newborn babies globally is still high. WHO (2012) noted that every year, 4 million newborn infants die and millions more are disabled because of poorly managed pregnancies and deliveries. Requejo (2013) indicated that 43 per cent of child deaths occur during the first month of life. In 2011 alone, 6.9 million children under the age of five died (United Nations Children Fund-UNICEF, 2012). The trend of maternal and child mortality and morbidity appears to be worse in the developing countries.

Some countries in the developing world record low maternal mortality rates while others rate high. Nigeria has been named as one of the countries in Sub-Saharan Africa with very high MMR. Nigeria constitutes 10 per cent of the world’s maternal and child deaths (Kusiako, Ronsmans&VanDer, 2000). According to Hill, Thomas, AbouZahr. Say, Inoue and Suzuki (2007), Nigeria’s maternal and child mortality ratio of 1,100 is higher than the regional average. Okonofua (2010) reports that Nigeria has been ranked as the number two country (after India) with the highest absolute number of maternal deaths in the world. The foregoing reports indicate that MMR is very high in Nigeria. Underneath the foregoing statistics lies the pain of human tragedy, for thousands of families who have lost their children and/or mothers especially in developing economy, including Nigeria. Maternal mortality has far reaching socio-economic implications.

It seems that there are insufficient maternal and child health services and programmes in the developing world. WHO (2012) observe that poor women in remote areas are the least likely to receive adequate health care. WHO maintain that this is especially true for regions with low numbers of skilled health workers, such as Sub-Saharan Africa. According to the above report, while levels of antenatal care have increased in many parts of the world during the past decade, only 46 per cent of women in low-income countries benefit from skilled care during childbirth. This means that millions of births are not assisted by a midwife, a doctor or a trained nurse. In low-income countries including Nigeria, Just one third of all pregnant women have the recommended four antenatal care visits and only 31 per cent of all deliveries take place in a health care facility (WHO, 2012). A study conducted by WHO (2013) in northern Nigeria indicated that 25 per cent of all deliveries took place at home with no assistance or attendant present. The report further revealed that facilities including antenatal care, prenatal care, post-partum and obstetric care facilities in the country were generally in poor condition with chronic shortages of essential equipment, drugs and human resources. This problem has created an emergency need for programmes and policies aimed at accelerating progress towards addressing the menace. One of such programmes is ExerciseInitiative.

 

1.2       Statement of the Problem

Studies have recommended that women should initiate or continue exercise in most pregnancies as it is safe for mother and not harmful to the foetus. The health benefits of regular physical exercise in pregnancy include maintenance and improvement of physical fitness and cardiovascular endurance, prevention of excessive gestational weight gain and glucose intolerance, conditioning of the muscles needed to facilitate labour, and improvement in psychological adjustment to changes in pregnancy. Furthermore, exercise in pregnancy is correlated with a decrease in many common problems of pregnancy and the stress of exercises produces certain adaptation such as healthier placenta and increased ability to deal with short decrease in oxygen.

In spite of the fact that exercise programs during pregnancy and after childbirth are designed to minimize impairment and help the woman maintain or regain function while she is preparing for the arrival of the baby and then caring for the infant, it is submitted that women are not meeting the exercise recommendations of the previous studies. A myriad of factors not limited to beliefs and attitudes of women with respect to exercise in pregnancy, level of knowledge, level of education, safety concern of the pregnant woman and her physician, race/ethnicity, and previous involvement in regular exercise have been implicated as important factors predisposing to exercise engagement or phobia among pregnant women. Thornton et al. submitted that identifying factors that affect beliefs and behaviors would objectively encourage a change in attitude. Therefore, an assessment of knowledge and attitude about exercise in pregnancy may help to determine whether or not women will participate in exercise during and after pregnancy. This study was designed to assess knowledgeandattitudeof Nigerian pregnant women towards postnatal and prenatal exercises.

 

1.3       Purpose of the Study

The purpose of this study is to determine the knowledge and attitude of pregnant women towards prenatal and postnatal exercise in Madonna University Teaching Hospital (MUTH), RiversState. Specifically, this study will determine the:

1. Knowledge and attitude of pregnant women to prenatal and postnatal exercise;
2. Practiceof prenatal and postnatal exercise among pregnant women in MUTH;
3. Influence of age, education, and income level on prenatal and postnatal exercise in MUTH;

 

1.4       Research Questions

The following research questions were posed to guide the present study.

1. What is the level of knowledge and attitude of pregnant women to prenatal and postnatal exercise in MUTH?
2. What are the practicesof prenatal and postnatal exercise among pregnant women in MUTH?
3. What is the influence of age, education, and income level on prenatal and postnatal exercise in MUTH?

 

1.5       Research Hypotheses

The following null hypotheses were postulated to guide the present study. Each of them was tested at .05 level of significance.

1. There is no significant difference in the pregnant women’s knowledge and attitude to prenatal and postnatal exercise in MUTH based on age, education and income level.
2. There is no significant difference in the childbearing women’s practices to prenatal and postnatal exercise in MUTHbased on age, education and income level.

 

1.6       Significance of the Study

The present study will generate data on the knowledge, attitude and practices of prenatal and postnatal exercise for exerciseamong women of child-bearing age in Madonna University Teaching Hospital. The findings of the study will be of immense benefit to the government at all levels, families, health educators, researchers, health care providers.

Findings from the knowledge and attitude to components of prenatal and postnatal exercise among mothers will also be useful to the governments, UNICEF and WHO. If mothers are found to have negative attitude to of prenatal and postnatal exercise for safe motherhood, the government, UNICEF and WHO may be prompted to strengthen their campaigns, workshops, adverts and every other programmes. With this in place, the child-bearing mothers may be attracted and they may begin to develop positive attitude to of prenatal and postnatal exercise. The health educators will also find this an opportunity to educate mothers on the benefits of practices for safe motherhood. With this, mothers may begin to develop healthy attitude.

Findings from the practices for exerciseamongmothers will be very important to governments, health educators, WHO and UNICEF who are interested in propagating the principles of safe motherhood. The government may strengthen the Free Maternal and Child Health Services (MCHS) so that more mothers will have access to health care and may be able to optimally practice safe motherhood. These findings may spur health educators to intensify the teaching of the benefits of practices for safe motherhood. WHO and UNICEF may use the findings to evaluate the SMI practices so far and then institute strategies for improvement.

 

1.7       Scope of the Study

This study was delimited to Madonna University Teaching Hospital, Rivers State. It focused on all the childbearing mothers attending health facilities in the area. It also investigated the knowledge, attitude and practices of prenatal and postnatal exercise forexerciseamong this population. The study covered level of education, age and level of income which were the socio-demographic factors that impinged on and influencing knowledge, attitude and practices of prenatal and postnatal exercise for exerciseamong childbearing mothers.

 

 

 

1.8       Operational Definition of Terms

Attitude: is a hypothetical construct that represents an individual’s degree of like or dislike for something which in turn influences his/her behaviour to that thing. Hornby (2005) defined attitude as the way that you think and feel about somebody or something which influences the way you behave to the person or the thing.

Practice: means doing a particular thing over and over again. According to Hornby (2005), practice means doing something regularly as part of one’s normal behaviour. Merriam-Webster (2012) adds that to practice means to do or perform often, customarily, or habitually. In this study, practice refers to the habitual actions (prenatal and postnatal exercises) applied by childbearing mothers which are directed towards ensuring that they and their babies do not face the risk of mortality or morbidity in their pregnancies, child births, and post partum periods.

Postnatal:relating to or denoting the period after childbirth.Postnatal means happening after and relating to the birth of a baby

Prenatal:refers to the period before birth; during or relating to pregnancy.Prenatal care is the regular health care women should receive from an obstetrician or midwife during pregnancy.

Exercise:refers to anactivity requiring physical effort, carried out to sustain or improve health and fitness.It also refers to physical activity that is done in order to become stronger and healthier.