Assessment Of Quality Of Antenatal Care Services In Primary Health Centers In Abia State

Project and Seminar Material for Nursing (Science)

Abstract

This study focused on the assessment of quality of antenatal care services in primary health centers in Abia state as case study. The study is was specifically focused on determining the magnitude of quality of antenatal care at selected primary health centers in Abia state, identifying factors associated with quality of antenatal care at selected primary health centers in Abia state and making suggestion on how to improve the magnitude of quality of antenatal care at selected primary health centers in Abia state. The study adopted the survey research design and randomly enrolled participants in the study. A total of 100 responses were validated from the enrolled participants where all respondent are pregnant women in primary health centers in Abia state.

Table of Content

Title Page
Certification
Dedication
Acknowledgement
Table of Content
List of Tables
Abstract

Chapter One:

Introduction

1.1 Background of the Study
1.2 Statement of the Problem
1.3 Objective of the Study
1.4 Research Questions
1.5 Research Hypothesis
1.6 Significance of the Study
1.7 Scope of the Study
1.8 Limitation of the Study
1.9 Definition of Terms
1.10 Organisations of the Study

Chapter Two:

Review of Literature

2.1 Conceptual Framework
2.2 Theoretical Framework
2.3 Empirical Review

Chapter Three:

Research Methodology

3.1 Research Design
3.2 Population of the Study
3.3 Sample Size Determination
3.4 Sample Size Selection Technique and Procedure
3.5 Research Instrument and Administration
3.6 Method of Data Collection
3.7 Method of Data Analysis
3.8 Validity of the Study
3.9 Reliability of the Study
3.10 Ethical Consideration

Chapter Four:

Data Presentation and Analysis

4.1 Data Presentation
4.2 Analysis of Data
4.3 Answering Research Questions
4.4 Test of Hypotheses

Chapter Five:

Summary, Conclusion and Recommendation

5.1 Summary
5.2 Conclusion
5.3 Recommendation
References
APPENDIX
QUESTIONNAIRE

Chapter One

Introduction

1.1 Background of the Study

Antenatal care (ANC) is a care given to a pregnant woman to promote and maintain optimal health of the mother throughout her pregnancy(Tadesse Berehe and Modibia, 2020).It includes recording medical history, advice and guidance on pregnancy, assessment of individual needs, screening tests, education on self-care, delivery and identification of conditions detrimental to health during pregnancy, first-line management and referral service if necessary(Tadesse Berehe and Modibia, 2020). The service (ANC) is a vital health service which senses and sometimes lessens the risk of coverage and quality, has been associated with adverse pregnancy outcomes(Zegeye, Bitew and Koye, 2013).

Antenatal care is asignificant opportunity for attaining pregnant women with number of interventions complications among pregnantwomen(Nwaeze et al., 2013). The success of ANC depends on its policy formulation and implementation(Zegeye, Bitew and Koye, 2013). It also depends on functional and operational continuum of care with affordable, accessible, high quality care during and after pregnancy and childbirth. For ANC program to be effective, important components of ANC must be inadequate ANC, both in terms that may be vigorous to their health, well-being and that of their infants aiming that ANC used to optimize maternal and fetal health, to make medical or social interventions available to women where indicated, to offer women maternal and fetal screening, to improve women’s experience of pregnancy and birth and to prepare women for motherhood whatever their risk status(In and Fulfillment, 2017).The lower quality of ANC service the higher maternal mortality rate.Globally, the Maternal mortality rate (MMR) fell by nearly 44% over the past 25 years, to an estimated 216 maternal deaths per 100 000 live births in 2015, from an MMR of 385 in 1990. Developing regions account for approximately 99% (302 000) of the global maternal deaths in 2015, with sub-Saharan Africa alone accounting for roughly 66% (201 000), followed by Southern Asia (66 000).The estimated lifetime risk of maternal mortality in high-income countries was 1 in 3300 in comparison with 1 in 41 in low-income countries showing many mothers in low- income countries are at more risk(Kaewkiattikun, 2017).

Moreover, majority of the countries with the highest maternal mortality are in sub-Saharan Africa, including Ethiopia. In Ethiopian Demographic and Health Survey (EDHS 2016), the maternal mortality ratio in Ethiopia was estimated at 412 deaths per 100,000 live births. Ethiopia as one of the Sub-Saharan countries, in which maternal care is extremely very poor. According to EDHS 2011 and 2016 only 34% and 62 % of women who gave birth in the five years preceding the survey received antenatal care from a skilled provider respectively one woman in every five (19%) made four or more antenatal care visits during the course of her pregnancy (CSA of Ethiopia, 2016).

1.2 Statement of the Problem

Effectiveness of antenatal care outcome relies on the quality of care provided during each ANC visit on health promotion, disease prevention, complication readiness and birth preparedness plan(Tadesse Berehe and Modibia, 2020).Although there is no consensus on the indicators for quality of ANC care, skill of ANC providers, staff motivation, budgetary provisions, integration with other health program and availability of consumables, drugs and basic equipment can seriously impact on the quality of ANC services. The clients also compliant as they face long waiting time and providers’ interaction and way of approaching has a problem since they are busy or because of other reasons(Fagbamigbe and Idemudia, 2017).

Globally, about 25 percent of maternal deaths occur during pregnancy. Every day, approximately 830 women die from preventable cause related to pregnancies and child birth that can be avoided if women could have accesses to high quality maternity care. Insufficient care during this time interrupts a critical link in the continuum of care and affects both the mother and their babies(Fagbamigbe and Idemudia, 2017).

Low utilization of antenatal care accompanied with low quality of ANC will worsen the high maternal and per-natal mortality rate in developing countries including Nigeria. The quality of care received by pregnant mothers are great concern to public health policy makers worldwide and in sub-Saharan Africa, and these mothers often complain about poor quality of services in public health care facilities, especially poor client care, unhealthy environment and apathy of health service. Despite the efforts of different stakeholders to improve quality health care delivery, still there are perceived unsatisfactory services rendered by the staff of public hospitals in areas of care and treatment, relationship between patients and care givers, sanitation of working environment, access to basic information about their rights, consent and confidentiality of patients, among others (Govender, Reddy and Ghuman, 2018).

Based on many reports from nigeria and in other developing countries the health care delivery system not only falls short of reaching the majority of the people but also its quality is often compromised(Tadesse Berehe and Modibia, 2020).These services raise awareness of the danger signs during pregnancy, delivery, and the postnatal period. They also improve the health-seeking behavior of the client, orient the client to birth preparedness issues, and provide basic preventive and therapeutic care. Provision of quality ANC service requires the presence of, pertinent infrastructure, adequately trained health workers, infection control facilities, diagnostic equipment, supplies and essential drugs(Fagbamigbe and Idemudia, 2017). Furthermore, the antenatal care process requires the practice of guidelines that health providers should follow while offering care to ensure prevention, diagnosis and treatment of complications(Fagbamigbe and Idemudia, 2017).

This study assessed the quality of antenatal care services in primary health centers in Abia state. And this had been proved that different studies had shown that the problem was existed.

1.3 Objectives of the Study

To assess the quality of antenatal care services in primary health centers in Abia state, Nigeria. To this end, the specific objectives of this study will be to:

To determine the magnitude of quality of antenatal care at selected primary health centers in Abia state.
To identify factors associated with quality of antenatal care at selected primary health centers in Abia state.
To make suggestion on how to improve the magnitude of quality of antenatal care at selected primary health centers in Abia state

1.4 Research Questions

The basic research questions that this study intends to answer are:

To what extent do pregnant women get quality ANC?
What are the factors associated with quality of ANC?
How can improve the magnitude of quality of antenatal care at selected primary health centers in Abia state ?

1.5 Research Hypothesis

Ho: There are no significant factors affecting attitude of pregnant women on antenatal care utilization in primary health centers in Abia state.
Hi: There are significant factors affecting attitude of pregnant women on antenatal care utilization in primary health centers in Abia state.

1.6 Significance of the Study

This study was conducted among pregnant women who were attending antenatal care at primary health centers in Abia state where quality of ANC service was still a major public health problem in developing countries including Nigeria. Therefore, the findings of this study would help the hospitals, Federal Ministry of Health (FMOH), policy makers and researchers to have clear the existing challenges in the hospitals on quality of ANC service and its associated factors. It specially would generate a better clue for the client satisfaction. It would also generate essential data that could be used as an input for further studies that could be conducted on same topic.

1.7 Scope of the Study

The study is an assessment of quality of antenatal care services in primary health centers in Abia state. Spatially, the study was enclosed into two randomly selected primary health centers in Abia state. Temporally, the research was a cross sectional and methodologically, it was conducted using mono approach, quantitative cross-sectional study design.

1.8 Limitation of the Study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. However, the researcher were able to manage these just to ensure the success of this study.

1.9 Definition of Terms

Quality of Services:

Antenatal care services provided according to the set WHO standards and national guidelines, based on Evidence-Based Medicine, and meeting client needs.

Quality of Care:

The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge

Standards:

Statements or an expression that spells out the best practice and gives some ideas on how the level of care is to be achieved.

Guidelines:

Systematically developed statements, which assist in making decisions about appropriate health care for specific conditions based on evidence or research.

Clients:

Pregnant Women in the antenatal clinics seeking for Focused antenatal Care services.

Maternal Mortality:

Maternal deaths due to pregnancy and childbirth complications.

Satisfaction:

Sensitive to and meeting the needs of clients in terms of quality, privacy and confidentiality, meeting clients needs in a culturally acceptable way.

1.10 Organization of the Study

This research work is organized in five chapters, for easy understanding, as follows.

Chapter one is concern with the introduction, which consist of the (overview, of the study), historical background, statement of problem, objectives of the study, research hypotheses, significance of the study, scope and limitation of the study, definition of terms and historical background of the study.
Chapter two highlights the theoretical framework on which the study is based, thus the review of related literature.
Chapter three deals on the research design and methodology adopted in the study.
Chapter four concentrate on the data collection and analysis and presentation of finding.
Chapter five gives summary, conclusion, and recommendations made of the study.

Chapter Five

Summary, Conclusions and Recommendations:

5.1 Introduction

This chapter summarizes the findings on the assessment of quality of antenatal care services in primary health centers in Abia state as case study. The chapter consists of summary of the study, conclusions, and recommendations.

5.2 Summary of the Study

In this study, our focus was on the assessment of quality of antenatal care services in primary health centers in Abia state as case study. The study is was specifically focused on determining the magnitude of quality of antenatal care at selected primary health centers in Abia state, identifying factors associated with quality of antenatal care at selected primary health centers in Abia state and making suggestion on how to improve the magnitude of quality of antenatal care at selected primary health centers in Abia state.

The study adopted the survey research design and randomly enrolled participants in the study. A total of 100 responses were validated from the enrolled participants where all respondent are pregnant women in primary health centers in Abia state.

5.3 Conclusions

With respect to the analysis and the findings of this study, the following conclusions emerged;

This study showed that facilities which had good healthcare providers, supplies and infrastructures were more likely to give quality ANC service utilization to the study participants than those who didn’t have likewise a study conducted in Bishoftu town in public health facilities. In this study, only one in three of the pregnant women were satisfied with the information provided by the healthcare provider. Whereas, two in five of the respondents believed that they have received the care they were seeking in a manner they were expecting it.

Thus, an overwhelming number of clients who were attending ANC at health facilities return back home dissatisfied with the service provided.

The rooms for the two hospitals where the ANC services were given had variations when observed using a checklist. Upgrading of the laboratory services in the health facilities is very important. Clients have variety of piece of information.

Inadequate quality of care and the loss of health professionals’ motivation and user’s trust in the health care system would vary the overall satisfaction of the clients. Thus, to deliver a quality ANC service, MOH, managements of the health facilities and other stakeholders had better give special attention to ANC service to all pregnant women. Strong leadership is mandatory for the enhancement of the quality service towards ANC service to all pregnant women. We suggest supportive supervision of health care providers geared towards building trust and mutual respect to protect maternal and infant health.

5.4 Recommendation

Based on the findings the researcher recommends that;

Based on the findings of this study, it is recommended that to improve the knowledge and attitudes of pregnant women regarding ANC, materials such as pamphlets or brochures and other forms of media (television, radio) should be made available to pregnant women to enhance their knowledge and raise awareness about the importance of ANC services; health education regarding ANC services must be given to women every day in the waiting areas of healthcare facilities, thus, the healthcare workers should promote the active participation of pregnant women during the health education sessions and provide opportunities to ask questions so that they can identify the level of the women’s knowledge; workshops and training should be conducted for healthcare workers to improve those observed weaknesses which were barriers to the utilisation of ANC services; and that traditional practitioners should be involved in maternal healthcare programmes so that they can be equipped with information to improve their skills needed for maternal care.

It is recommended that health education programs should be undertaken by communities to improve women’s awareness of ANC and that the Ministry of Health should provide ANC services such as mobile health care and home care visits for remote villages or those difficult to reach. At the same time, ANC services should be affordable, especially for poor pregnant women.

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