CHAPTER ONE

INTRODUCTION

1.1       Background of the Study

Antenatal care refers to the care that is given to a pregnant women woman from the time that conception is confirmed until the beginning of labour. This is also viewed as an important point of contact between health workers and women and an opportunity for provision of health education including how to detect pregnancy complications and development of a birth plan to ensure delivery at a health facility. The purpose of antenatal care is to monitor and improve the wellbeing of the mother and the foetus, for this reason the benefits of antenatal care cannot be over emphasized. Antenatal care is one of the important measures used in reducing maternal morbidity. Moreover, antenatal is a type of preventive healthcare, with the goal of providing regular checkups that allow doctors and midwives to treat and prevent potential health problems throughout the course of the pregnancy while promoting healthy lifestyles that benefit mother and child.

The concept of antenatal care (ANC) as an effective public health strategy is credited to the dramatic improvements in maternal and prenatal outcomes witnessed in Europe in the last century, but the impact of antenatal care in these settings has not recorded the desired results. Whereas acceptance of antenatal care in industrialized countries is near universal, in developing countries, the uptake is less, and a large proportion of women deliver outside the health care system. About 63.6% of Nigerian mothers receive antenatal care, while trained personnel attend 41.6% of births. Consequently, high maternal mortality figures and rising perinatal mortality rates are the norm (Fawole, Okunlola &Adekunle, 2008). Nwaeze, Enabor, oluwasola and Aimakhu (2013) further reported that the proportion of Nigerian women that receive antenatal care and those that are delivered by skilled birth attendants have however remained far from acceptance.

 

The World Health Organization (WHO) reported in 2015 that around 830 women died every day from problems in pregnancy and childbirth. The WHO recommends that pregnant women should all receive 4 antenatal visits to spot and treat problems and give immunization. Although antenatal care is important for improving the health of the mother and the baby, Nigeria unfortunately is among the countries worst hit by maternal death challenges. According to the World Health organization (WHO, 2007) report, Nigeria is the 2^nd in the world after India in terms of maternal and infant deaths. The international community has committed to improving maternal health by 2015 with millennium development goal number 5, which aims to reduce maternal mortality by three quarters and reach universal access to reproductive health care. According to WHO, a maternal mortality ratio in 2013 was estimated to be 230 per 100,000 live births in developing countries to 16 per 100,000 live births in developed countries. Even with this commitment, many countries have failed to implement effective programs to reduce maternal morbidity and women continue to suffer from the complications of pregnancy and childbirth.

Many countries have made targeted efforts to ensure the provision and utilization of timely and adequate ANC (Bbaale, 2011). The most common indicators of health and reproductive behavior include utilization rates of antenatal care, age when women give birth, pregnancy order and birth spacing. These factors can be modified if the services can be made accessible and affordable to women and their families.The role of timely and adequate antenatal care visits in ensuring maternal and neonatal health cannot be underestimated. Early antenatal care visits facilitates the follow up and monitoring of fetal growth and maternal health by physicians (Bbaale, 2011). During antenatal care visits, mothers can be informed about the warning signs and symptoms during pregnancy, preventive care and treatment strategies, proper nutrition, breastfeeding, use of contraceptive methods for family planning, prevention of mother to child transmission of HIV (PMTCT), use of SulfadoxinePyrimethamine (IPTp) (Bbaale, 2011). Overall the mentioned issues show the critical need for early initiation of antenatal care (ANC).

Women’s perception of antenatal visits significantly influence their assessment of quality services and are widely recognized as a tool to improve health services in many developed countries. Women’s perceived quality is defined as subjective and dynamic perception of the extent to which expected health care is received by the person. Since the perceived quality invariably affects mothers’ behaviour, a mother may choose not to return and may result in adverse outcome to the mother and child and also result in poor utilization of antenatal care services. Satisfied women are likely to come back for the services and recommend services to others (Wijesinghe and Fernado, 2014). Various factors including attitude of staff, cost of care time spent at the hospital and doctor’s communication have been found to influence patient satisfaction.

           

1.2       Statement of Problem          

Annually, an estimated 529,000 women die from complications of pregnancy and childbirth globally. Ninety nine percent (99%) of these antenatal deaths occur in the developing countries and one percent (1%) in the developed countries. This means that every year, close to nine (9) million women suffer some type of injury from pregnancy or childbirth that can have profound effect on their lives and families. Since Nigeria is regarded as a developing country and one of the major sectors of the economy is health which looks to take care of the health status of the people, progress in improving antenatal care, disparities on access to antenatal care remain significant. Women that are with tertiary education are likely to have antenatal care and report four or more antenatal visit as women with secondary or no education. All these are indications that despite the high antenatal coverage, some registrants may not be deriving maximum benefit from the services. Based on these, the researcher intends to find the perception of pregnant women towards antenatal care services and their level of satisfaction.

 

1.3       Objective of the Study

The main objective of this study was to determine the perception and satisfaction of women towards the quality of antenatal care services in Nnamdi Azikiwe University Teaching hospital (NAUTH), Nnewi while the specific objectives were to:

1. To determine the perception of pregnant women towards the quality of antenatal care services in Nnamdi Azikiwe University Teaching Hospital, Nnewi
2. To examine providers’ processes of care in delivering antenatal services in Nnamdi Azikiwe University Teaching Hospital, Nnewi.
3. To determine the level of client satisfaction with antenatal services provided in Nnamdi Azikiwe University Teaching Hospital, Nnewi.

 

1.4       Significance of the Study:

The findings of this study when communicated will:

To the pregnant women: Alleviate the complications resulting from maternal and child mortality rate in Nigeria especially in Anambra State.

To nurses and midwives: Assist in planning and educating pregnant women attending antenatal clinic in NAUTH on the importance of antenatal care services in Nigeria

To the researcher: Acts also as a guide for further studies

           

 

1.5       Research Questions

1. What is the perception of pregnant women towards the quality of antenatal care services in Nnamdi Azikiwe University Teaching Hospital, Nnewi?
2. What are the providers’ processes of care in delivering antenatal services in Nnamdi Azikiwe University Teaching Hospital, Nnewi?
3. What is the level of client satisfaction with antenatal services provided in Nnamdi Azikiwe University Teaching Hospital, Nnewi?

           

 

1.6       Scope of the Study

This study is to determine the perception and satisfaction of pregnant women towards the quality of antenatal care services in Nnamdi Azikiwe University Teaching Hospital Nnewi, Anambra state.

 

1.7       Operational Definition of Terms

Antenatal: before birth

Pregnancy: the condition from conception to the expulsion of the foetus

Foetus: the term used eight (8) weeks after conception until birth.

Client: pregnant women receiving advice and treatment in the hospital/ antenatal clinic

Perception: an overview of a pregnant woman’s thought, belief, idea and ability to understand the true meaning and impact antenatal care would make towards health, baby, family and entire populace at large.

Quality Antenatal Care: the ability of pregnant women to receive 4 or more antenatal care visits with all necessary care rendered during the visits.

Satisfaction: the extent to which specific needs of pregnant women on antenatal care are met.