Effect Of Home Delivery On Maternal And Child Health Outcome Among Women Of Child Bearing Age

Project and Seminar Material for Nursing (Science)

Abstract

This study was carried out on the effect of home delivery on maternal and child health outcome among women of child bearing age in Owo, Ondo State. The survey design was adopted and the simple random sampling techniques were employed in this study. The population size comprise of women of child bearing age in Owo, Ondo State. In determining the sample size, the researcher conveniently selected 70 respondents and all validated. Self-constructed and validated questionnaire was used for data collection. The collected and validated questionnaires were analyzed using frequency tables, and mean scores. While the hypotheses were tested using chi-square statistical tool. The result of the findings reveals that the prevalence of home delivery among women of child bearing age in OWO, Ondo state is high. The study also revealed that home delivery has a negative effect on mother and child health outcome in OWO, Ondo state. Furthermore, the study revealed that the reasons home delivery is used among women of child bearing age in OWO, Ondo state include; no transport access during labor, fear of surgical procedures, urgent labour, perceived quality of service of the nearest HI, and lack of financial support. Therefore, it is recommended that health workers should create awareness on institutional delivery and on preparedness to deliver at HI even on the sudden onset of labor. And They also should give special attention and follow mothers whose partners are farmers, merchants and for mothers who delivered at home previously. To mention but a few.

Table of Content

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 Hypotheses
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

Home delivering is a common traditional belief that child birth is a natural process which does not require any medical attention and should be conducted at home by the family who is a well known and trusted figure for the family, is easily available and is not very expensive.

Home deliveries by traditional birth attendant are a cultural norm in Nigeria. This is true both for rural areas as well as urban slums. This attitude coupled with poverty, illiteracy and ignorance regarding complication of delivery is responsible for the majority of women preffering to deliver at home in Nigeria (Abebe et al, 2012).

World wide, an estimated 529,000 maternal deaths occur every year almost all of them in developing countries e.g. Nigeria, Chad, is an inverse relationship between the proportion of deliveries assisted by a skilled attendant and the maternal mortality ratio in these countries.

According to WHO (2006), immediate and effective professional care at the time of delivery can make the difference between life and death for both women and their new born. Furthermore, this care should be available close to where people live, but at the same time safe with a skilled professional able to act immediately when unpredictable complications occurs during home delivery (whether trained or not) have not been included among the skilled birth attendants by the WHO. Since their training has not shown any reduction in maternal mortality. However, it has been suggested that home delivery could perform the role of the skilled attendants where required with some training. As they may be the only source of care for some women. In addition they may also serve to provide emotional support and health education to pregnant women at the local level (Vedam 2003).

According to the latest Nigeria Demographic and Health Survey (DNHs) 2007, the maternal mortality ratio of Nigeria is 276/100,000 live births and the three major killers are post partum hemorrhage, puerperal sepsis and eclampsia. This survey, the largest household survey ever conducted in Nigeria also showed that 65% of deliveries are conducted at home. Traditional birth attendants assisted almost 79% of home deliveries followed by relatives or friends in 11%. According to this survey, the most frequent reason (stated by 57% of women) for not delivering in a facility was the belief that it was not necessary. The next most common reason (stated by 38% of women) was that the cost is too much (WHO 2006).

Home delivery is a practice of childbirth in a nonclinical setting that takes place in residence than in Hospitals or Birth Center. In developed nations, it is attended by midwife or attendant with experience, but in developing nations, where women may not be able to afford medical Care, then home birth may be the only option available.
There are many factors that affect the place of delivery in developing countries including Nigeria. Some of the major ones are a lack of information and adequate knowledge about danger signs during pregnancy and labor; cultural/ traditional practices, quality of services, site service utilized and previous experience. The highest number of maternal deaths occurs on the first day after delivery highlighting the critical need for good quality care during delivery. The presence of skilled delivery service utilization can significantly reduce the maternal mortality and morbidity (Vedam 2003).

Delivery service to pregnant women is the most important component of reproductive health care, to handle high-risk deliveries. In spite of the national and global efforts for reducing maternal morbidity and mortality, there is no significant reduction in maternal morbidity and mortality in developing countries. Globally, in 2013, about 800 women died daily due to complications of pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. In Nigeria, maternal mortality and morbidity levels are among the highest in the world. Maternal mortality ratio is currently 676 per 100,000 live births. The majority of maternal deaths is due to obstetric complications that could have been prevented with adequate medical care by skilled attendants during and after delivery. Globally, one-third of births take place at home without the assistance of skilled attendants. In Africa, less than 50% of births are attended by skilled health workers (WHO 2004a).

According to EDHS 2011, the proportion of institutional delivery in Nigeria in general and in the southern region, in particular, was 10% and 6.2% respectively. The United Nations Children’s Fund UNICEF (2000) estimates that yearly about 515,000 women die of pregnancy and childbirth complications. It is also estimated that 1600 women across the world die each day as a result of pregnancy and childbirth related problems and the greater proportion of these deaths occur in developing countries. In Nigeria, maternal mortality and morbidity levels are among the highest in the world. One explanation for this poor health outcome among women is low use of the available modern health services by a sizable proportion of women in Nigeria.

1.2 Statement of the Problem

Many studies dictated the socio demographic, socioeconomic and obstetric factors of home delivery (Abebe et al, 2012). But cultural and traditional factors were not addressed in detail. Therefore, the purpose of this study was to assess prevalence of home delivery and associated factors among women in child bearing age, who gave birth in the preceding two years. This study will be helpful for the relevant stakeholders in the planning and implementation of intervention activities to improve the delivery service utilization through significant reduction of giving birth at home.

1.3 Objectives of the Study

The overall aim of this study is to critically examine the effect of home delivery on maternal and child health outcome among women of child bearing age in Owo, Ondo State. Hence, the study will be channeled to the following specific objectives;

Determine the prevalence of home delivery among women of child bearing age in OWO, Ondo state.
Determine whether home delivery has an effect on mother and child health outcome in OWO, Ondo state.
Examine the reasons home delivery is used among women of child bearing age in OWO, Ondo state.

1.4 Research Question

The study will be guided by the following questions

What is the prevalence of home delivery among women of child bearing age in OWO, Ondo state?
Does home delivery have a negative effect on mother and child health outcome in OWO, Ondo state?
What are the reasons home delivery is preferred among women of child bearing age in OWO, Ondo state?

1.5 Research Hypotheses

Ho: Home delivery does not have an effect on mother and child health outcome.
Ha: Home delivery have an effect on mother and child health outcome.

1.6 Significance of the Study

The significance of the study is to create awareness among pregnant women especially those of child bearing age in Nigeria.

Also to help people to know the importance of health care facility delivery in order to prevent complication that may arise at home such as post haemorrhage, maternal mortality.

1.7 Scope of the Study

This study focuses on the effect of home delivery on maternal and child health outcome among women of child bearing age. Specifically, this study focuses on determining the extent home delivery takes place among women of child bearing age in Nigeria, determining whether home delivery has an effect on women of child bearing age in Nigeria and examining the reasons home delivery is used among women of child bearing age in Nigeria.

1.8 Limitations 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.

Moreover, the case study method utilized in the study posed some challenges to the investigator including the possibility of biases and poor judgment of issues. However, the investigator relied on respect for the general principles of procedures, justice, fairness, objectivity in observation and recording, and weighing of evidence to overcome the challenges.

1.9 Definition of Terms

Maternal Mortality:

Death rate of women as a result of complication.

Home Delivery:

Traditional Birth Attendant

Post Haemorrhage:

Is the loss of more than 500ml – 1000ml of blood within the first 24hours following child birth.

Bleeding:

Is the loss of blood from the body as a result of injury.

Puerperal Sepsis:

Is a condition that occurs after child birth as a result of infection.

1.10 Organization of the Study

The study is categorized into five chapters. The first chapter presents the background of the study, statement of the problem, objective of the study, research questions and hypothesis, the significance of the study, scope/limitations of the study, and definition of terms. The chapter two covers the review of literature with emphasis on conceptual framework, theoretical framework, and empirical review. Likewise, the chapter three which is the research methodology, specifically covers the research design, population of the study, sample size determination, sample size, and selection technique and procedure, research instrument and administration, method of data collection, method of data analysis, validity and reliability of the study, and ethical consideration. The second to last chapter being the chapter four presents the data presentation and analysis, while the last chapter(chapter five) contains the summary, conclusion and recommendation.

Chapter Five

Summary, Conclusions and Recommendations:

5.1 Introduction

This chapter summarizes the findings on the effect of home delivery on maternal and child health outcome among women of child bearing age in Owo, Ondo State. The chapter consists of summary of the study, conclusions, and recommendations.

5.2 Summary of the Study

In this study, our focus was onthe effect of home delivery on maternal and child health outcome among women of child bearing age in Owo, Ondo State.The study is was specifically set to determine the prevalence of home delivery among women of child bearing age in OWO, Ondo state, determine whether home delivery has an effect on mother and child health outcome in OWO, Ondo state, and examine the reasons home delivery is used among women of child bearing age in OWO, Ondo state.

The study adopted the survey research design and randomly enrolled participants in the study. A total of 70 responses were validated from the enrolled participants where all respondent arewomen of child bearing age in Owo, Ondo State.

5.3 Conclusions

In the light of the analysis carried out, the following conclusions were drawn.

The prevalence of home delivery among women of child bearing age in OWO, Ondo state is high.
Home delivery has a negative effect on mother and child health outcome in OWO, Ondo state.
The reasons home delivery is used among women of child bearing age in OWO, Ondo state include; no transport access during labor, fear of surgical procedures, urgent labour, perceived quality of service of the nearest HI, and lack of financial support.

5.4 Recommendation

The following recommendations were proffered with respect to the findings of the study;

Area health office should facilitate ambulance service.
Health workers should create awareness on institutional delivery and on preparedness to deliver at HI even on the sudden onset of labor.
The health worker should give special attention and follow mothers whose partners are farmers, merchants and for mothers who delivered at home previously.