COMPLETE SCHOOL PROJECT TOPICS & MATERIALS :
CHAPTERS: Chapter 1-5
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ABSTRACT
The purpose of this study was to examine the maternal health care seeking behaviour and pregnancy outcome of pregnant women in two rural communities in Enugu State. The objectives of study were to: (i) determine the gestational age at which pregnant women book for Antenatal Care(ANC) in Udi and Abiacommunities, (ii)determine how often pregnant women attend Antenatal Care(ANC)during the third trimester, (iii) ascertain the facilities utilized by pregnant women with complications for care and (iv) ascertain their pregnancy outcome. Cross-sectional survey design was adopted for the study. A sample size of 207 respondents was drawn from a population of 586 pregnant women. The instrument for data collection was the researcherdeveloped questionnaire that was used as an interview guide. Observation guide was also used to corroborate the findings of the questionnaire. The design of the study was descriptive crosssectional survey. Convenience sampling was used to select a sample size of 207 respondents from a population of 586 pregnant women. Collected data wereanalysed using descriptive statistics of frequencies and percentages. Chi-square was used to test for significant association atsignificancelevel of 0.05.
Major findings show that most of the respondents (79.7%) booked for ANC during the first trimester. On frequency of ANC during the third trimester, 81.1% maintained weekly attendance while 100% of the respondents with complications accessed care from health facilities especially the general hospital under skilled healthcare providers. On pregnancy outcome, 84.5% of the babies cried vigorously at birth and 0.5% did not cry at all. On maternal delivery outcome, 83.1% were strong to take care of self and baby after delivery. There was no significant association (p > 0.05) between the respondents’ demographic variables (age and educational status) and their healthcare seeking behaviour. There was no significant association (p > 0.05) between maternal healthcare seeking behaviour and mothers’ delivery outcome (women that were strong to take care of self and baby and those that were weak to take care of self and baby after delivery). There was significant association (p < 0.05) between maternal healthcare seeking behaviour and babies’ birth outcome (number of babies that cried vigorously at birth and those that did not cry at all).
CHAPTER ONE
INTRODUCTION
Background to the Study
A woman’s health care seeking behaviour during pregnancy depends a great deal on her beliefs, culture, experience, educational level, financial status, attitude towards pregnancy, as well as herautonomy and decision making power. Adele (2010)suggests issues of importance to include information about pregnancy the woman’s family communicated to her as a child and whether the pregnancy was planned or unplanned. Garba, Hellandendu, andAjayi (2011) further explained that long before the advent of modern scientific medicine, most cultures have among their patterns of life, a body of beliefs and practices that centre on the recognition and treatment of complications of pregnancy and conduct of deliveries. Thus, an understanding of appropriate health care seeking behaviour is very important in achieving the desired pregnancy outcome. Negativebehaviour is highly implicated in increased morbidity and mortality of mother and baby.
Osubor, Fatusi, and Chiwuzie(2006),suggests Maternal Health Care Seeking Behaviour (MHCSB) to include the number of visits made to antenatal clinic (ANC) by pregnant women and their preference for place of delivery.Jain, Nandan and Misra (2006) defined health seeking behaviour as “a complex outcome of many factors operating at individual, family and community levels including their biosocial profile, past experiences with health services, availability of alternative health care providers, and the people’s perception regarding the efficacy and quality of the services”.
Adele (2010) explains health seeking behaviour to be those activities undertaken by individuals in response to any discomfort felt. He further stated that in the developed countries like United States of America (USA), most women visit ANC early in pregnancy, comply with prenatal directives and are attended to by skilled health care providers when in labour. He also suggests that in the developing countries, especially in the rural sub-Saharan Africa, most women consider pregnancy a natural process and the services of skilled health care providers deemed not necessary. Rastogi (2012) observed low utilization of ANC among rural women in India due to lack of means of transportation, also because the women were often shy when discussing their health problems before a male professional. Rastogi suggests that women who had formal education up to secondary school level sought health care from skilled providers.
Jayaraman, Chandrasekhar and Gebreselassie (2008),stated that most of the pregnant women deliver at home without skilled health care providers, while only a few receive up to three antenatal visits.Woldemicael(2008) suggests that due to lack of transportation some pregnant women may not utilize ANC and other delivery services by skilled care providersin health facilities and therefore seek help from diverse fields.
Adamu (2011) suggests that MHCSB is the way mothers take care of their health and the unborn child so that they will reach the end of pregnancy very healthy with positive outcome.Yubia (2011) opined that in Nigeria, maternal health care seeking behaviour is similar to that of other developing countries where negative health seekingbehaviours shown by most mothers often lead to poor use of maternal health care services provided by skilled health care attendants with eventual negative pregnancy outcome. Yubiafurther explained that poor treatment seeking behaviours predispose them to complications that could be properly managed if detected early during ANC. The number of women attending ANC in southern Nigeriais higher than in the north.NDHS (2008) suggests that the percentage of births attended to by skilled health care providers range from 81.8% in the South East (SE) to9.8% in the North West (NW). Similarly, 90.1% of women in the NW are more likely to give birth at home compared to 22.5% in the South West (SW).Adamu (2011) suggests that this high attendance is associated with educational and economic empowerment of more women in the southern than in the northern Nigeria. The number of visits to ANC is a key determinant of whether a woman giving birth seeks institutional care or care at home under a skilled health care provider as against delivery at home under unskilled birth attendant.Adamu (2011)stated that a woman who attends ANC is more likely to deliver in a health facility. Young mothers (below 35years) are also more likely to make decisions on seeking health care than older mothers (above 35years) and to have institutional delivery. On the other hand, older mothers especially multipara who have never had any complications in pregnancy believe that safe delivery is a natural process so may not seek health care under skilled health care providers. Yubia (2011) opined that such women rely on their experience and help from fellow older mothers for care and delivery.
Rastogi(2012) suggests that pregnant women do not develop much complicationif a skilled health care provider regularly visits them at home.Babalola and Fatusi (2009) suggest that the majority of maternal deaths and disabilities can be prevented through early and timely access to and utilization of quality maternal health care services.WHO(2007) stated that complications of pregnancy and childbirth are leading causes of maternal morbidities and mortality for women of reproductive age (15 – 49 years) in developing countries. Nigeria accounts for 10% of global maternal deaths and has the second highest mortality rates in the world. It also reported that for every woman that dies from pregnancy – related causes, 20 – 30 more will develop short-and long-term damage to their reproductive organs resulting in disabilities such as obstetric fistula, inflammatory diseases, and ruptured uterus. In view of all these, this study examined the health care seeking behaviour of the pregnant women in Udi and Abia communities and their pregnancy outcome.
Statement of the problem
Yubia (2011) suggests that maternal deaths occur due to poverty, cultural beliefs and practices of the people, ignorance and lack of basic maternal health services. He further explained that the situation is worse in developing countries due to poor health seeking behaviour of the mothers such as poor utilization of health services, ignorance and the people’s illness behaviour.
NDHS (2008) shows that in Nigeria, only 58% of women attended at least one ANC during pregnancy, 39% of births were attended to by a skilled health care provider, 35% of deliveries took place in a health facility and 43.7% received postnatal care.Osubor, Fatusi, and Chiwuzie (2005) added that, it is a common practice in Nigeria for a pregnant woman to register in the antenatal clinic and at the same time register with a traditional birth attendant in the community where she may finally deliver her baby leading to complications like sepsis, post-partum haemorrhage or even the death of the mother, the child or both. According to WHO (2007)this situation is common in most rural communities in Nigeria,Enugu stateinclusive where most of the pregnant women report to health facilities only in extreme emergencies, and/or when illness becomes prolonged and life threatening. According to WHO (2014), the most often tracked indicator forassessing theachievement of the MDGs for the reduction of MMR is the proportion of births attended to by skilled health care providers globally.
From researcher’s clinical experience in Udi,an aunt lost her life during childbirth in one of the TBAs homes because she insisted on having her baby where her other two co-wives delivered their own babies to avert village gossip which is based on ignorance. Unfortunately, her own delivery got complicated and theTBA didnot know what next to do and still did not transfer her out. This shows that maternal health care seeking behaviours is implicated in the high maternal morbidity and mortality prevalent in developing countries especially in rural communities.Thus the need to examine the maternal health care seeking behaviours and pregnancy outcome of pregnant women in Udi and Abia communities of Enugu State.
Purpose of the Study
The purpose of this study is to examine the health care seeking behaviour of pregnant women and their pregnancy outcome in Udi and AbiacommunitiesinEnugu State.
Specific objectives of the study are to:
- Determine the gestational age at which pregnant women book for ANC in Udi and Abia communities.
- Determinehow often the pregnant women go for ANC in third trimester.
- Ascertain the facility utilized bypregnant women with complication(s) for care.
- Ascertain the pregnancyoutcome of the pregnant women in the study area.
Research Questions
- At what gestationalage dopregnant womenbook for ANC in Udi and Abia communities?
- How often do pregnant women go for ANC in third trimester?
- Which facility do pregnant women with complication(s) during pregnancy utilize for care?
- What is the pregnancy outcome of the pregnant women in the study area?
Hypothesis
- There is significant association between mother’s age, educational level and parity and maternal health care seeking behaviour.
- There is significantassociation betweenmaternal health care seeking behaviour and pregnancy outcome(babies’ birth outcome).
- There is significant association between maternal health care seeking behaviour and pregnancy outcome (mothers’ delivery outcome).
Significance of the Study:
Findings from the study will generateempirical data on how mothers in Udi and Abiatowns of Enugu State seek routine health care during pregnancy,whether they book for ANC,their time of booking,where they book, where they go to seek care especially when faced with problems in pregnancy, where they prefer to deliver, their preferred healthcare provider andtheir pregnancy outcome. These, when communicated, will serve as basis for empowering pregnant women among nurses, midwives, and other health workers with a view to improving maternal health and reducing maternal morbidity and mortality through improved maternal health care services utilization through evidence based health education.
Findings when published and utilizedby health workers will help nurses to create more awareness on maternal health care services utilization among mothers. Maternal health care services when adopted by mothers will help themto maintain optimal health during pregnancy as well as timely management of any identified problem.
Findings when published will also help policy makers to see the need to enforce full implementation of plans and actions geared towards improving maternal health care seeking behaviour through proper utilization of maternal health care services. When these plans and actions are effectively utilized by mothers, there will be reduction in maternal morbidity and mortality. This in turn will go a long way in reducing the burden associated with maternal morbidity and mortality.
Scope of the study
The study is delimited to maternal health care seeking behaviour and pregnancy outcome. Other variables in the study are whenpregnant womenbook for ANC,how oftenpregnant women go tofor antenatal care in third trimester, where pregnant women go to for care when they experience health problems in pregnancy, as well as the pregnancy outcome of the pregnant women in the study area. The study is also delimited to Udi and Abia communities in Enugu State.
Operational definition of Terms
Maternal health care seeking behaviourrefers to booking at a health facility, time of booking in the health facility, the number of visits made forAntenatal Care(ANC) before delivery, and delivery at a health facility under a skilled care provider.
Pregnancy outcome: The state mother and baby after delivery, which could be positive or negative. Outcome include mother being strong or weak to take care of self and baby after delivery, or very weak and drowsy/ baby’s cry at birth (cried very well, cried weakly or did not cry at all after delivery).
Positive pregnancy outcome:birth of ahealthy baby (cried very well at birth),and a healthy mother (strong after delivery).
Negative pregnancy outcome:babydid not cry at birth and respondent very weak and drowsy after delivery.