A Critical Investigation Of Birth Preparedness And Emergency Readiness Plans Of Antenatal Clinic Attendees In General Hospital Enugu State

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A Critical Investigation Of Birth Preparedness And Emergency Readiness Plans Of Antenatal Clinic Attendees In General Hospital Enugu State


Abstract


This study was carried out to assess birth preparedness and emergency readiness plans of antenatal clinic attendees in general hospital Enugu state. The objectives of the study were to determine knowledge of birth preparedness and emergency readiness in the communities studied, practice of birth preparedness and emergency readiness, identify factors that hinder practices of birth preparedness and emergency readiness and establish the relationship between socioeconomic status and their practice of birth preparedness and emergency readiness. A cross-sectional descriptive survey research design was used for the study in selected seven communities of Oji River L.G.A. Snowball non probability sampling technique was used to select subjects for the study. A sample of 470 was determined using the formula by Surish & Chandrashekera.

Descriptive and inferential statistics were used to analyze data at 0.05 level of significance. Results were presented in tables, frequencies, means and standard deviations. Findings revealed that majority of the respondents 120 (78.7%) were knowledgeable on birth preparedness and emergency readiness, knowledge did not translate to practice as less than 20% actually practiced the acceptable level of birth preparedness. Financial constraint was the significant factor that hindered respondents practice of birth preparedness and emergency readiness. All the socioeconomic variable examined were associated with practice of birth preparedness and emergency readiness.

There was significant difference (P < 0.05) in the average monthly income and educational qualification of the respondents and their practice of birth preparedness and emergency readiness. In conclusion, although most of the respondent had good knowledge of birth preparedness and emergency readiness, knowledge still did not translate to practice as few of them actually practiced the acceptable level of birth preparedness and emergency readiness. Based on the findings, the recommendations that there is a need for slight shift in focus of maternal and child care projects of governments and need to improve transportation facilities suitable for pregnant women at rural communities which will improve outcomes in emergencies were made.


Table of Content


Chapter One:

Introduction

  • 1.1 Background to the Study
  • 1.2 Statement of the Problem
  • 1.3 Purpose of the Study
  • 1.4 Objectives of the Study
  • 1.5 Research Questions
  • 1.6 Hypothesis
  • 1.7 Significance of the Study
  • 1.8 Scope of Study:
  • 1.9 Operational Definition of Terms
  • 1.10 Organization of the Study

Chapter Two:

Literature Review

  • 2.1 Conceptual Review
  • 2.2 Theoretical Review
  • 2.3 Empirical Review
  • 2.4 Summary of Literature Review

Chapter Three:

Research Methodology

  • 3.1 Research Design
  • 3.2 Area of Study
  • 3.3 Population of Study
  • 3.4 Sample
  • 3.5 Sampling Procedure
  • 3.6 Instrument for Data Collection
  • 3.7 Validity of Instrument
  • 3.8 Reliability of Instrument
  • 3.9 Ethical Consideration
  • 3.10 Procedure for Data Collection
  • 3.11 Method of Data Analysis

Chapter Four:

Data Analysis and Result Presentation

  • 4.1 Introduction
  • 4.2 Answering Research Question
  • 4.3 Test of Hypothesis
  • 4.4 Discussion of major findings

Chapter Five:

Summary, Conclusion and Recommendation

  • 5.1 Conclusion
  • 5.2 Implication to Nursing
  • 5.3 Recommendations
  • 5.4 Summary
  • 5.5 Suggestion for further studies
  • REFERENCES
  • APPENDIX 

Chapter One


Introduction

1.1 Background to the Study

It is true that birth of baby precedes celebration but it equally poses source of concern as pregnancy and childbirth is sometimes a perilous journey especially in the developing countries, where the risk of a woman dying from pregnancy and related complications is almost 40 times greater than that of her counterparts in developed countries (Benson & Yinger, 2002). Maternal mortality remains a public health challenge worldwide, and the global maternal mortality ratio of 525 per 100,000 live births annually is still unacceptably high (Hogan, 2010). A disproportionately high burden of these maternal deaths is borne by developing countries including Nigeria, with a maternal mortality ratio of 500– 1,000 per 100,000 live births (World Bank, 2013). These deaths arise from pregnancy, childbirth or postpartum complications. According to WHO (2009), maternal deaths are thought to occur in developing countries due to delay in deciding to seek appropriate care, delay in reaching an appropriate health facility, and delay in receiving adequate emergency care once at a facility. These delays may be reduced if pregnant women and their families are prepared for birth and its complications. Birth preparedness and emergency readiness strategy is therefore, very relevant in this regard. This strategy can reduce the number of women dying from complications due to such delays by making a birth plan that constitutes birth-preparedness and complication-readiness measures for pregnant women, their spouses and their families (McPherson, Khadka, Moore & Sharma, 2006).

Birth-preparedness and emergency-readiness is a comprehensive package aimed at promoting timely access to skilled maternal and neonatal services. It is a safe motherhood strategy whose objective is to promote the timely use of skilled maternal and neonatal care during childbirth or obstetric emergencies by reducing delays at the first, second and third levels (Maternal and Neonatal Health Program, 2007). It entails making plans prior to birth to ensure that a pregnant woman is prepared for normal birth and complications. The birth-preparedness package promotes active preparation and decision-making for delivery by pregnant women and their families. (McPherson, et al, 2006). Decision are made and documented on such issues as desired place for birth, the preferred skilled birth attendant, items required for birth, birth companion, getting a compatible blood donor and arranging in advance for transport. This stems from the fact that every pregnant woman faces risk of sudden and unpredictable life threatening complications that could end in death or injury to herself or to her baby (JHPIEGO, 2006).

Other elements of birth preparedness include knowledge of expected date of delivery, signs of labour, dangers signs, HIV testing, mobilising resources to pay for services, arranging for someone to take care of the family during delivery. Importance of postnatal care, importance of exclusive breast feeding and contraception (Maternal and Neonatal Health Program 2003). In addition, a potential blood donor and a decision maker (in case of emergencies) need to be identified (Kaye, Mirembe, Azigy, Namuelema, 2003).

Approximately 15% of pregnant women develop life-threatening complications hence need for emergency obstetric care. These complications are unpredictable and may progress rapidly to a fatal outcome (Rogo & Aloo, 2011). Knowledge of danger signs of obstetric emergencies and appreciation of the need for rapid and appropriate response when emergencies occur may reduce delay in decision making and in reaching health facilities. Such signs in pregnancy are vaginal bleeding, severe headache, severe vomiting, swelling of hands and face, difficulty in breathing, fits, fever, reduction or absent fetal movement and drainage of liquor (WHO, 2009). Therefore, this package is a very important strategy in developing countries, where obstetric services are poor. Birth plan should be discussed on the first clinic visit, reviewed in subsequent visits and finalized by 32 weeks (Barbara & Gomez, 2007).

One of the key roles of antenatal care is to provide health education on danger signs of pregnancy and delivery, preparation of a birth plan and to encourage delivery under a skilled attendant. WHO (2009) now recommends that pregnant women should receive focused antenatal care in which birth preparedness and emergency readiness is a key component (WHO, 2009), Ministry of Health, Kenya, (2012). In order to address this disturbing trend, the International Conference on Population and Development (ICPD) urged that special efforts should be made to emphasise men’s shared responsibility and promote their active involvement in maternity care (JHPIEGO, 2006). In spite of this, pregnancy and childbirth continue to be regarded as exclusively women’s affairs in most African countries, especially in the rural settings (Mullick, Kunene, & Wanjiru, 2005).


1.2 Statement of the Problem

In sub-Saharan Africa, pregnancy and childbirth continues to be viewed as solely women’s issues (JHIPIEGO, 2006). A male companion at antenatal care is rare and in many rural communities, it is unthinkable to find male companions accompany a woman to the labour room during delivery (Mullick, Kunene & Wanjiru, 2005; Babalola & Fatusi, 2009). This posture of men towards BP/CR depicts lack of knowledge of their role in pregnancy and child birth. Yet, men have social and economic power, especially in Africa including Enugu State. They also, have tremendous control over their partners, so they decide the timing and conditions of sexual relations, family size and whether their spouse will utilize available health care services (Iliyasu, 2010). This situation makes male partner involvement critical if improvement in maternal health and reduction of maternal morbidity and mortality is to be realized. His engagement in maternity care seems to be lacking in developing countries especially rural communities. Male involvements will enable men to support their spouses to utilize emergency obstetric services early and the respondent would adequately prepare for birth and get themselves ready for complications. This does not seem to be the case in developing countries including Nigeria and Enugu state. Birth preparedness and emergency readiness is an issue that concerns both male and female (respondents) for better outcome of pregnancy and delivery, but it seems to be viewed as women’s responsibility. This poses a big problem. There is therefore the need to assess the knowledge, practice and factors that influence birth preparedness and emergency readiness in selected rural communities in Enugu State since there are documented evidence that maternal mortality is higher in rural communities than in the urban settings (WHO, 2014).


1.3 Purpose of the Study

The purpose of this study is to assess birth preparedness and emergency readiness plans of antenatal clinic attendees in general hospital Enugu state.


1.4 Objectives of the Study

  1. Determine knowledge of birth preparedness and emergency readiness among respondents in the communities under study.
  2. Determine practice of birth preparedness and emergency readiness.
  3. Identify factors that hinder the practice of birth preparedness and emergency readiness.
  4. Establish the relationship between socio-economic status and their practice of birth preparedness and emergency readiness.

1.5 Research Questions

  1. What is the knowledge of respondents about birth preparedness and emergency readiness?
  2. What is the practice of birth preparedness and emergency readiness?
  3. What are the factors that hinder respondents’ practice of birth preparedness and emergency readiness?.
  4. What is the relationship between respondents’ socio-economic status and their practice of birth preparedness and emergency readiness?

1.6 Hypothesis

The alternate hypothesis to guide the study is:-

  • H0 There is no association between respondents’ socio-economic status and their practice of birth preparedness and emergency readiness.
  • H1 There is association between respondents’ socio-economic status and their practice of birth preparedness and emergency readiness.

1.7 Significance of the Study

This study has relevance to the general public, nurse practitioners, nurse administrators and nurse educators. It will be significant to the general public as findings from this study will show the need for respondents and the general public to be prepared for birth and any complications that may arise, thereby reducing the risk/incidences of maternal and infant mortality. Findings from the study will equip the respondents with invaluable information on birth preparedness and emergency readiness, which will go a long way, if applied to ensure better and safer maternal health for the mothers.

This study will also be relevant to the nurse practitioners as they will be equipped with the findings from this study, which will enable them adequately prepare the respondents for birth and possibly avoid any complication that may arise. Findings from this study can be utilized by nurse administrators who will ensure that the necessary environments are provided that will enable the nurse oversee the adoption of birth preparedness and emergency readiness. This study will also provide evidence based information with respect to birth preparedness and emergency readiness in rural communities which is an imperative for improving health education initiatives in rural Nigeria including Oji River L.G.A of Enugu State.


1.8 Scope of Study:

This study is delimited to respondents living in seven selected communities in Oji River LGA. It will focus particularly on the knowledge, practice and factors that influence respondents towards birth preparation and emergency readiness activities and the relationship that exists between the knowledge and their practice of birth preparedness and emergency readiness as well as the relationship that exist between respondents’ socio-economic status and their practice of birth preparedness and emergency readiness.


1.9 Operational Definition of Terms

Birth Preparedness and Emergency Readiness:

This is a comprehensive strategy that focuses on promoting the timely utilization of skilled maternal and neonatal health care and includes attending antenatal care at least four times during pregnancy, identifying a skilled provider and making a plan for reaching the facility during labour, setting aside personal funds to cover the costs of traveling to and delivering with a skilled provider and any required supplies, recognizing signs of complications, knowing what community resources (emergency transport, funds, communications, etc), are available in case of emergencies and having a plan for emergencies, obstetric care and referral system for Emergency Obstetric Case.

Respondent:

Those who are legally married or co-habiting with children.

Knowledge:

The information and understanding gained through education.

Practice:

Action taken by respondents towards BP/CR.


1.10 Organization of the Study

The study is organized into five chapters.

  • Chapter one covers; background to the study, statement of the problem, general objective of the study, specific objectives of the study, research hypotheses, significance of the study, limitation of the study, delimitations of the study, operational definition of terms and organization of the study.
  • Chapter two covers review of related literature.
  • Chapter Three covers research methodology which includes: introduction, research design, target population, sampling techniques and sample size, data collection instruments, validity and reliability of research instruments, data collecting procedures, data analysis techniques and ethical considerations.
  • Chapter four covers research results of the study.
  • Chapter five covers discussions and interpretations of research findings.

Chapter Five


Summary, Conclusion and Recommendation

5.1 Conclusion

Based on the findings of this study, the following conclusions have been made.

  1. Most of the respondents 307(78.7%) had good knowledge of birth preparedness and emergency readiness.
    Knowledge did not translate to practice as less than 20% of the respondents actually practiced the acceptable level of practice of birth preparedness and emergency readiness.
  2. Financial constraint was the most critical factor that hindered respondents’ practice of birth preparedness and emergency readiness.
  3. All the socio-economic variables examined were associated with respondents’ practice of birth preparedness and emergency readiness. Educational exposure, income and number of years together had significant positive associations with the subject matter while age and occupation were not significant.

5.2 Implication to Nursing

Birth preparedness and emergency readiness is an important factor in reduction of maternal morbidity and mortality as well as infant morbidity and mortality. Therefore, there is need to assess the knowledge, practice and factors influencing birth preparedness and emergency readiness in the rural communities so that nurses can channel health education to the appropriate areas during community outreach programmes to reduce morbidity and mortality of both mothers and children.


5.3 Recommendations

Based on the findings, the following recommendations are made.

  1. There is a need for slight shift in focus on maternal and child care projects of government. Investments in improving awareness on danger signs appear to have paid off, however improving access by lowering financial requirements is imperative.
  2. There is also a need to improve transportation facilities suitable for pregnant women at the rural communities. This will significantly improve outcomes especially when emergencies occur and the need for referrals arise.
  3. Non-governmental Organizations (NGOs) and Faith-Based Organizations (FBOs) should focus on improving access to cheaper medical services for majority of low income earners in rural communities.

5.4 Summary

This study assessed the knowledge, practice and factors that influenced birth preparedness and emergency readiness amongst respondents in selected communities in Oji River LGA, Enugu state. The study was designed to:

  1. Determine the knowledge of birth preparedness and emergency readiness in the communities under study;
  2. Determine respondents’ practice of birth preparedness and emergency readiness in the communities under study;
  3. Identify factors that hinder respondents’ practice of birth preparedness and emergency readiness in the study area; and
  4. Establish the relationship between respondents’ socio-economic status and their practice of birth preparedness ad emergency readiness.

5.5 Suggestion for Further Studies

This study showed that financial constraint was responsible for the gap between knowledge and practice among respondents in the study area. There is a need to further investigate if similar situations exist in other local government areas, especially those with similar socio-economic statuses. This will significantly improve the ability of the state government to improve on maternal and child health outcomes through the design of apposite programmes.


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