Knowledge, Attitude And Factors Influencing The Traditional Birth Attendance Preference To Hospital Services Among Pregnant Women In Ujoelen, Ekpoma, Edo State
Knowledge, Attitude And Factors Influencing The Traditional Birth Attendance Preference To Hospital Services Among Pregnant Women In Ujoelen, Ekpoma, Edo State
Abstract
INTRODUCTION: In 2010 WHO defined a Traditional based attendants (TBA) as a person who provides basic health care, support and advice during and after pregnancy and childbirth based on experience and knowledge acquired informally through traditions and practices of communities. In Nigeria the policy towards TBAs shifted according to WHO and safe mother initiative of SBAs whose definition excluded TBAs leading to suspension of previously existing partnership between government and TBA across the country.
STUDY OBJECTIVE: The aim of this study was to assess the factors influencing utilization of TBAs among mothers in Ekpoma ahead of hospital facilities
METHODS: To attain this, a total of 52 mothers were considered and a random sampling method was used where all those who came to the area within time of study were also considered and elderly participating in this study was considered to provide relevant information. Data collected was analyzed using quantitative method in line with study objectives to achieve the aim of the study and presented in tables and pie charts.
RESULTS: When the participants were asked about services offered by TBAs , 23(44.2%) responded that TBAs take their time and offer advice both before and after delivery and pertaining perception on TBAs, 14(26.9%) said that TBAs are highly experienced in handling deliveries.
CONCLUSION: The study concludes that services offered by TBAs are giving advice both before and after delivery plus good care. On perception of mothers about TBAs, mothers believe that TBAs are highly experienced in handling delivery and are still important.
RECOMMEDATION: The study recommends that TBAs should be trained and equipped with modern medical knowledge by the government so as to easily handle uncomplicated deliveries
Chapter One
Introduction
This chapter gives the overview of the study. It includes the background of the study, problem statement, justification, research questions, general objectives and specific objectives
1.1 Background of the Study
In 2010 the WHO defined a TBA as a person who provides basic health care, support and advice during and after pregnancy and childbirth, based primarily on experience and knowledge acquired informally through the traditions and practices of the communities (WHO, 2010). TBAs are also known as traditional midwives, community midwife or lay midwife. TBAs provide the majority of primary maternity care in many developing countries and may function within specific communities in developed countries. TBAs are often older women, respected in their communities. They consider themselves as private health care practitioners who respond to requests for service. They usually work in rural, remote and other medically underserved areas. TBAs may not receive formal education and training in health care provision, and there are no specific professional requisites such as certification or licensure (Sibleyet al, 2012)
In 2004, the WHO, International Confederation of Midwives (ICM) and the International Federation of Gynecology and Obstetrics (FIGO) jointly define SBA as an accredited health professional such as a midwife, doctor or nurse who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management of complications in women and newborns (Maine D, et al, 2011). According to the definition of SBA, traditional birth attendants (TBAs), either trained or not, are excluded from the category of SBAs. SBAs can administer interventions to prevent and manage life-threatening complications or refer the mother to the higher level of care if required. However, the definition of SBA is context based. In Bangladesh doctor, nurse, midwife, CSBA, and Family Welfare Visitor (FWV) are considered as SBA (WHO, 2000). For this study the later definition of SBA is used.
In Nigeria, the policy towards TBAs shifted according to the recommendation of the WHO and safe motherhood initiative promotion of SBAs whose definition excluded TBAs leading to the suspension of previously existing partnership between the government and TBAs across the country (Abouzahrc, 2015). The Nigeria government recommended terminating collaboration between NGOs and TBAs as well. It held that the trained TBAs would be included in the newly formed village health teams if their respective communities selected them(Buttiens et al., 2004).
1.2 Problem Statement
Delivery in health facilities is still challenging in developing countries in which higher number of women attend antenatal clinic but about half of them deliver at home without assistance of skilled professional.
Low delivery in health facilities as a result of many factors leads to high morbidity and maternal mortality therefore proper interventions must be taken to increase delivery in health facilities. Home delivery if not conducted by professionals increase the risk of transmission of HIV/AIDS to relatives or traditional birth attendants who conduct deliveries without protective equipment. Several studies have been done Worldwide including Nigeria regarding factors affecting delivery in health facilities. The factors that have been studied include socio demographic factors, socio economic factors, availability of health services, accessibility, behavior and attitudes of health care providers and socio cultural issues (Moore, 2011).
It is argued that differential access to health care facilities between the rural-urban areas is an important factor for lower maternal healthcare services particularly for institution delivery assistance by health personnel in rural areas. (Lewin, 2009).
No study has been done in Ekpoma to explain why they have low prevalence of delivery in health facilities. This study is therefore meant to find out factors that hinder delivery in health facilities’ and knowing these factors will help to improve delivery in health facilities at Ekpoma.
1.3 Justification of the Study
Having worked in the study area and noticed that the women’s uptake of skilled reproductive health services especially delivery was low, the study set out to provide information on current utilization of unskilled birth attendants‟ services. This was stimulated even more by the 2007 HF policy that had been adopted which had intended for all to utilize skilled HF services. It was necessary therefore for the study to show the proportion of women in Edo State who were utilizing UBA services as a concurrent control indicator of policy implementation. Many studies had focused on utilization of UBA services during the antenatal and delivery periods but this study went a step further to shed light on utilization of FP and PNC services as well, which are important aspects of HF.
The services that were being offered to women by TBAs in the area were also studied, again having in mind the roles that were designated to TBAs in the policy document. This would inform on the extent the unskilled attendants have deviated from the policy recommendations and also provide information on the safety of UBA services. It was also important to find out if the women and TBAs were aware that TBAs were not to be recognized as skilled HF services‟ providers given that they are directly affected by such a policy action.
There is evidence of factors that influenced women to seek unskilled services. This study determined which among the likely factors significantly influenced the women’s utilization of unskilled services in Edo State, hence providing information that would assist HF stakeholders in prioritizing policy actions
1.4. Purpose of the Study
The purpose of the study is to assess the knowledge, attitude and factors influencing the traditional birth attendance preference to hospital services among pregnant women in Ujoelen, Ekpoma, Edo State.
1.5 Objectives of the Study
- To assess the services offered by traditional birth attendants in Ekpoma.
- To determine the perception of pregnant mothers on traditional birth attendants in Ekpoma compared to Hospital services
1.6 Research Questions
- What are the services offered by traditional birth attendants in Ekpoma?
- What are the perceptions of pregnant mothers on traditional birth attendants Ekpoma compared to Hospital services?
1.7 Limitation of the Study
Time was not enough to obtain information from wide range respondents. This was overcome by working beyond office hours.
The researcher faced financial difficulties as a student with no external funding and therefore used the available financial resources sparingly and sought financial help from friends, relatives and well-wishers.
1.8 Organization of the Study
This study is organized into five chapters. Chapter one included the background of the study, research problem, research objectives and questions as well as limitation of the study. Chapter two contains the literature review. Chapter three includes the methodology and study area. Chapter Four contains the results and discussion of key findings of the study. Chapter Five finally looks at the summary, conclusions, and recommendations based on the findings.
1.9 Definitions of Terms
Maternal Health:
Refers to health of a woman during delivery, childbirth and postpartum period.
Maternal Mortality Rate:
Maternal death is defined as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.”
Recent Delivered Women:
In this study mean women who had a deliver within the period of 2 years during the period of data collection.
Skilled Attendants:
Refer to people with midwifery skills (midwives, doctors and nurses with additional midwifery education) who have been trained to proficiency in the skills necessary to manage normal deliveries and diagnose, manage or refer obstetric complications’ (WHO Utilization: means the extent to which a given group of people uses particular service in a specific period of time.
Chapter Five
Discussion, Conclusion and Recommendation
5.0 Introductions
This research study was aimed at assessing the factors influencing utilization of TBAs by mothers in Ekpoma, Edo State. This chapter is divided into three sections thus discussion, conclusion and recommendations.
5.1 Discussion
5.1.1 Demographic and social economic characteristics associated use of Traditional Birth Attendants
From the study conducted, out of the 52 respondents who participated in the study, 9(17.3%), 27(51.9%) had attained at least a primary level of education while 16 (30.8) had attained at least a post primary educational level , here the majority had attained primary education, a low educational level is usually associated with poor modern health seeking practices and therefore this is also a reflection of what other scholars put forth in their studies, because according to a study by Duong and others in 2004, they observed that Low Educational level of women also affects their ability to seek the most appropriate health care services. A lot of Free Medical program have been provided for use still it is difficult to access them due to their level of exposure. Ignorance of the availability of the services provided for their use.
Considering the parity of the respondents, of the 52 respondents who participated in the study 6(11.5%) of the respondents were giving their birth for the first time, 28 (53.8%) of the respondents were having between 2 to 4 children while 18 (34 .6%) of the respondents had more than 4 birth , the number of parity is usually associated with increased knowledge on affairs of delivery as compare to prime gravid mothers, this means a a decreased trend usually occur of seeking services from TBA usually occurs as the number of parity increases with women in related studies Duong et al 2004 cited that Lack of knowledge about symptoms which require medical care and attention can lead to delays in recognition and treatment of severe complications contributing to maternal death.
Also to note is that from the study findings, 41(78.8%) of the respondents were married, 4 (7.7%) of the respondents had been divorced by the time of delivery while only 7(13.5%) were not married and from the study conducted, 13 respondents out of 52 were below twenty years making 25%, 25(48%) were between 20 to 30 years whereas 14 (27%) of the respondents were above 30 years.
5.1.2 Services offered by TBAs to mothers
When asked which services mothers always seek from TBAs, 12 (23.1%) mothers acknowledged that most mothers go to TBAs because they offer social support to mothers, 23(44.2%) mothers responded that mothers go to TBAs because they take their time and offer advice both before and after delivery while 17(32.7%) mothers said many mothers choose TBAs because they offer generally good care these findings correlate with published literature about same study by WHO in 2010, where they noted that, traditional birth attendants provide the majority of primary maternity care in many developing countries, and may function within specific communities in developed countries. They provide basic health care, support, advice during and after pregnancy and childbirth, based primarily on experience and knowledge acquired informally through the traditions and practices of the communities where they originated.
5.1.3 Perception of mothers on the TBAs
From the study conducted on the perception of mothers over the services offered by Traditional birth Attendants, 14 (26.9%) of the respondents said that TBAs are highly experienced in handling deliveries, 10 (19.2%) that TBAs are highly knowledgeable on delivers, 6 (11.5%) said TBAs are tolerant and patient while conducting their deliveries, 5(10%) said that TBAs are effective in conducting deliveries and 11(21.2%) said TBAs are soft spoken and caring while the other 6(11.5%) are said that TBAs highly respected in the communities.
5.2 Conclusion
Regarding serves offered by TBAs to mothers, the study concludes that the most identified services offered betas are offering social support to mothers, taking their time and offer advice both before and after delivery and offering generally good care and that’s why its preferred to hospital. facilities
Considering the perception of mothers on the TBAs, it can be concluded that the majority still believe that TBAs are still very important in handling delivery affairs of mothers as some cited that TBAs are experienced in handling deliveries, knowledgeable, and patient, and effective in conducting deliveries and others cited that TBAs are soft spoken and caring and are highly respected in the communities.
On reasons for preference of TBAs over modern health facilities the study concludes that mothers seek for TBAs services offer cheap services which everyone can afford, as others said that they are always available when needed , others said TBAs are easily accessible from their homes, said they are accepted in the community as better options for conducting deliveries, the other two also said that TBAs are caring during deliveries .Also TBAs are preferred because they match their social standards while the rest because it its usually a family requirement and preference.
5.3 Recommendations
- Traditional birth attendants should be trained with modern medical knowledge so as to safely handle deliveries.
- Health workers should avail themselves in health centres all the time mothers need them and government should provide many equipped health units with maternity departments.
- Pregnant mothers should be health educated on components of birth preparedness and complication readiness so that they can seek modern facilities for delivery in case of complications
- Mothers who attend antenatal visits should be greatly health educated about a need to deliver from health centres and also to encourage others to deliver from health centers.
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