Perception Of A Pregnant Woman Towards The Utilization Of Health Facility And Booking Registered For The Antenatal Care Service (A Case Study Of Egbedore LGA In Osun State)

Project and Seminar Material for Nursing (Science)

Perception Of A Pregnant Woman Towards The Utilization Of Health Facility And Booking Registered For The Antenatal Care Service (A Case Study Of Egbedore LGA In Osun State)

Abstract

Introduction; According to WHO antenatal care is care received during pregnancy from skilled health personal’s such as the goal oriented model recommended by the WHO which includes 4 to 5 visits for pregnant women who are not having medical problems. Antenatal care utilization is 65% in developing countries which is low as compared to the developed countries at 97%(WHO, 2007).

Objective; to assess the utilization of health facility and booking registered for the antenatal care service by pregnant women at Egbedore Health Centre, Osun State.

Methodology; A descriptive cross-sectional study was carried out at Egbedore Health Centre from January to April in Osun State and 100 respondents were used, data was presented in form of graphs, pie-charts and tables.

Results; Findings showed that of the 100 respondents 92% had utilized ANC services and 8% had not utilized any ANC service. Results further showed that there was an association between obstetric factors and utilization of ANC with 54.5% of those with gravidity >4 having utilized ANC late and 78.6% of those with gravidity 1-2 utilized ANC early, further there was an association between distance and utilization of ANC with those in a range of 0-5km having 75% utilizing ANC early and 5% of those in a range >10km utilized ANC late. Results also showed that majority (65%) of the pregnant women book for antenatal services at the second through to the third trimester of pregnancy

Conclusion; From the study the major reason for late ANC utilization was financial difficulties and distance to the health facility which highly made the utilization of ANC services inadequate.

Recommendation; The study recommends women empowerment through support groups so as to enhance on their income levels so as to solve their financial constraints to enable early decision making on issues concerned with their pregnancies so as avoiding male over dependence.

Table of Content

Chapter One:

Introduction

  • 1.1 Background to the Study
  • 1.2 Problem Statement
  • 1.3 Purpose of the study
  • 1.4 Objectives of the Study
  • 1.5 Research Questions
  • 1.6 Study Justification
  • 1.7 Scope of the Study
  • 1.8 Definition of Terms
  • 1.9 Limitations for the Study
  • 1.10 Organization of the Study

Chapter Two:

Literature Review

  • 2.1 Conceptual Review
  • 2.2 Theoretical Review
  • 2.3 Empirical Review
  • 2.4 Chapter Summary

Chapter Three:

Research Methodology

  • 3.1 Study Design
  • 3.2 Study Setting
  • 3.3 Study Population
  • 3.4 Sample Size Determination
  • 3.5 Sampling Procedure
  • 3.6 Selection Criteria
  • 3.6.1 Inclusion Criteria
  • 3.6.2 Exclusion Criteria
  • 3.7 Definition of Variables
  • 3.8 Research Instruments
  • 3.9 Data Collection Procedures
  • 3.11 Ethical Considerations
  • 3.12 Plans for data Dissemination

Chapter Four:

Data Analysis and Result Presentation

  • 4.0 Introduction:
  • 4.1 Presentation of Results

Chapter Five:

Conclusion and Recommendation

  • 5.1 Conclusion
  • 5.2 Summary
  • 5.3 Recommendations
  • 5.4 Implications to Nursing Practice
  • REFERENCES
  • APPENDIX 

Chapter One

Introduction

1.1 Background of the Study

According to WHO antenatal care is care received during pregnancy from skilled health personal’s such as the goal oriented model recommended by the WHO which includes 4 to 5 visits for a pregnant woman who are not having medical problems. Antenatal care utilization is 65% in developing countries which is low as compared to the developed countries at 97%(WHO, 2007).

As it has been mirrored by WHO antenatal care is an important determinant of maternal mortality rates and one of the basic components of maternal care on which the lives of mothers and babies depend so a minimum of 4 visits by pregnant mothers should be made with one or more visits to a trained person during the pregnancy (WHO, 2010).
Although antenatal care is not its self very effective in reducing maternal mortality, according to WHO it presents an important opportunity for identifying threats to the mother and unborn baby`s health, as well as for counseling on nutrition, birth preparedness, delivery care and family planning options after birth (WHO, 2009).

In case of sub-Sahara Africa as stated by WHO, a model of antenatal care separates pregnant women into two groups; those likely to need only routine antenatal care (some 75% of the total population of pregnant women), and those with specific health condition or risk factors that necessitates special care (25% of pregnant women). For this case or group additional visits should be conducted in addition with required special care (Edward Bbaaleetal, 2011)
ANC interventions have been shown to be effective for the detection, treatment or prevention of conditions associated with serious morbidity or mortality and monitoring of chronic conditions such as anemia, screening for and treatment of infections including sexually transmitted infections and prevention of mother-to-child transmission of HIV (PMTCT) plus the use of insecticide treated bed nets (ITNs) and intermittent preventive treatment of malaria (IPTs) with sulfadoxine-pyrimethamine (SP).The risk is highest during too early (under 20years) and too late ages over 40 years (47 and 51 per 1000 pregnancies) respectively ( Tann et al., 2007).

In most rural areas of sub-Saharan Africa, poor maternal health remains a major issue since health facilities do not provide full range of primary health care services, undermining access to reproductive health services which include basic and comprehensive Emergency Obstetric Care (EMOC) services (Tawiah, 2011; Magadi et al., 2003; Monir et al., 2009; Pearson et al., 2005; Lester et al., 2010) and For instance, approximately all Level II health centres (located at Parish level) promote, provide preventive and curative services in Nigeria but do not provide adequate maternity services of which ANC is the care rendered during pregnancy (Ekabua&Njoku, 2011). In developing countries including Nigeria, several factors prevent accessibility, including cost of services, distance to health services, lack of available transportation, high transportation costs, poor road conditions and uneven distribution of health care facilities and lack of independence by women to make decision on matters that directly affect their health .All of these factors increase travel time and the difficulty in accessing health service facilities. In rural Nigeria, physical accessibility and acceptability remains a significant challenge to health care service delivery (David Okutu, 2012).
The initiation of antenatal care (“booking”) is universally recommended in the first trimester (WHO, 2011).

However, existing evidence from developing countries including Nigeria indicates that few women seek antenatal care at early stage of their pregnancy (Patel et al., 2015).

The definition of late booking varies between studies, some define it as booking after 12 weeks (Sunil et al., 2010), 13 weeks (Oladokunet al., 2010; Daniels et al., 2006), 14 weeks (Ndidi&Oseremen, 2010, Okunlolaet al., 2006), 16 weeks (Mrishoet al., 2009), 18 weeks or 20 weeks (Alderliestanet al., 2007). In this study late antenatal booking will be defined as going to the clinic for the first time at or after 20weeks (five months) of pregnancy.

According to Nigeria clinical guidelines of 2010, for normal(uncomplicated) pregnancies, four routine antenatal care visits are recommended as follows: the first visit between10–20 weeks of pregnancy; the second visit between20–28 weeks of pregnancy; the third antenatal care visit between 28–36 weeks and fourth antenatal care visit after 36 weeks (Ministry of health, 2010). The guidelines also recommend more frequent visits and early antenatal care visits for mothers with pregnancy complications, or those with identifiable risk factors for such complications, such as complications in a prior pregnancy (Ministry of health, 2010).

Early antenatal care attendance during the first three months of gestation plays a major role in detecting and treating some complications of pregnancy and forms a good basis for appropriate management during delivery and after childbirth. Failure to attend antenatal care early results in the potential for complications during pregnancy, delivery, and puerperium (Benage, 2015).

Therefore, late initiation of ANC may lead to undetected or late detection of maternal health problems and subsequently unmanaged complication among pregnant women and thus contributes to maternal mortality. To reduce child mortality and improve maternal health, a good understanding of factors that influence late booking of antenatal services by pregnant women is important.

1.2 Problem Statement

Although antenatal care (ANC) is not itself very effective in reducing maternal mortality, it provides an entry for interventions which give health workers the opportunity to detect risky conditions and therefore refer them for early management leading to better maternal outcomes, despite the importance of ANC visits, a study showed that only 17% of pregnant women initiated their first visits during the first three months of pregnancy (UBOS, 2007).

According to Asiimwe (2010), it was found out that in western Nigeria, the ability of a woman to afford antenatal care (ANC) services has a significant association to the number of ANC visits she is likely to make. Women in rural areas of Nigeria are two times less likely to attend ANC than the urban women. Most women in Nigeria have registered late ANC attendance, averagely at 5.5 months of pregnancy and do not complete the required four visits.

The inadequate utilization of ANC is greatly contributing to persisting high rates of maternal and neonatal mortality in Nigeria. (Kawungezi et al, 2015). Therefore the need to assess the level of utilization of antenatal care services by pregnant women and determine whether the interventions made are efficient enough to reduce the maternal mortality rates recorded at Egbedore Health Centre, Osun State.

According to the study conducted by Teddy Kyomuhangi, SamwiriIranezeza and Biraro in 2015 in Egbedore sub- count indicated that the in depth interviewers with mothers established that out of 99 mothers, 71(72%) were aware of the benefits of the ANC, but high knowledge did not correlate with the level of attendance . Mothers attendance at 4 ANC visits was low, only 42/99 (42%) despite intervention by VHTS. The majorities (51/99; 52%) of mothers were aware of the benefits of delivery in health facility but only 35% had done so.

Delayed access to antenatal care has been linked to increased mortality and morbidity for mother and baby (Jones et al., 2011; Nigeria Bureau of Statistics, 2011).

The Confidential Enquiry into Maternal Deaths in the UK (2007) found that 17% of the women who died from Direct or Indirect causes booked for maternity care after 22 weeks gestation (Jones et al., 2011).The findings of the Nigeria Demographic and Health survey 2011 showed that only 21% of women made their first antenatal care visit before the fourth month of pregnancy implying that 79%of pregnant women come late for their first antenatal care visit (Nigeria Bureau of Statistics, 2011). Pregnant women who came late for antenatal care in Mulago hospital, Nigeria were not well-informed about the right gestation age at which they should make their first antenatal care visit (72.7%) and/or of the importance of early attendance at antenatal care (53.3%) (Kisuuleet al., 2013). In the months of April, May and June 2016, 1410 (91%) of the pregnant women booked for antenatal care after the first trimester. However, there is limited data about studies done to asses factors associated with late ANC booking in Osun State particularly Egbedore Health Center and this compelled me to conduct study ‘factors contributing to late antenatal booking among pregnant women at Egbedore Health Center.

1.3 Purpose of the Study

To determine the perception of a pregnant woman towards the utilization of health facility and booking registered for the antenatal care service

1.4 Objectives of the Study

  1. To describe common antenatal care practices utilized by pregnant women at Egbedore Health Centre, Osun State.
  2. To determine the factors associated with the early utilization of ANC services by pregnant women at Egbedore Health Centre, Osun State.
  3. To determine the factors associated with late utilization of ANC services by pregnant women at Egbedore Health Centre, Osun State.

1.5 Research Questions

  1. What are the common antenatal care practices utilized by women of reproductive at Egbedore Health Centre, Osun State?
  2. What are the factors associated with early utilization of ANC services by pregnant women at Egbedore Health Centre, Osun State?
  3. What are the factors associated with inadequate utilization of ANC services by pregnant women at Egbedore Health Centre, Osun State?

1.6 Study Justification

Despite the huge international efforts to promote and provide ANC, there has been little improvement in these statistics over the past decade. Almost 50% of women in LMICs don’t receive adequate ANC services of which women’s views can offer important insights into this problem and since the level of ANC utilization is still low at 42% at Egbedore health centre this study will help stake holders on how to implement effective ANC utilization (Teddy Kyomuhangi et al, 2015).The study will also be used for planning purposes and mobilization of mothers for the utilization of ANC services which in return will help in the improvement of health of pregnant women in Egbedore Community

1.7 Scope of the Study

The study concentrated more on describing ANC service utilization factors associated with early ANC utilization and the factors associated with inadequate ANC utilization plus the common ANC practices utilized by pregnant women at Egbedore Health Centre.

The study was conducted at Egbedore Health Centre in Osun State in western Nigeria and respondents included pregnant women who were utilizing their ANC services at the health centre.

1.8 Definition of Terms

Pregnant Women:

Has been defined according to WHO as those between 15-49.

Maternal Health:

Refers to the health of the mother during pregnancy, childbirth and the postpartum period (WHO 2014).

Gravidity:

Refers to pregnancy status and order of the current pregnancy.

Parity:

Refers to the pregnancy that has exceeded 28 weeks of gestation regardless of the outcomes.

Early Utilization:

Denotes attendance of ANC in the first trimester.

Late Utilization:

Denotes first attendance of ANC after the first trimester.

Trimester:

Refers to the different time intervals in which ANC visits should be conducted in and can be in terms of months or weeks as stipulated below: –

  • First trimester; runs from 1-3 months.
  • Second trimester; runs from 4-6 months.
  • Third trimester; runs from 7-9 months.

1.9 Limitations for the Study

  1. The study only considered those pregnant women leaving out those >49years of which they may also provide information as concerned to the topic under study.
  2. The study was sensitive and some of the respondents may not accept to answer some questions. To overcome this, the researcher gave thorough explanation to the participants before administering the questionnaires.

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, 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

Conclusion, Summary and Recommendation

5.1 Conclusion

Late antenatal care attendance remains high among pregnant women indicating that the importance of early initiation is yet to be appreciated. A number of factors were found to contribute to this problem. Socio-demographic factors associated with late ANC booking included maternal age, marital status, residence, educational level, gravidity and parity, and history of previous uneventful pregnancy/delivery. Religion was not associated with late ANC booking. The socioeconomic factors included unemployment coupled with financial constraints and long distance to the health facility.

Therefore, an approach that involves all stakeholders should be used to address the matter at hand. Resources could be effectively utilized if efforts to increase early antenatal attendance are focused on identified high risk groups.

5.2 Summary

According to the study ANC attendance of pregnant women at Egbedore Health Centre was low at 92% of which 52% had utilized less than 4 visits and 40% had utilized more or equal to the four visits.

Mothers who attended ANC early gave reasons that they knew the timing and the results also showed positive association with increase in maternal educational level. Those who did not attend gave reasons for using TBA’s and they delivered at home safely without complications.

The women in this study are aware of the need for ANC services, although the existing challenge remains that avialabity of health facilities does not necessarily transform into optimal utilization. This therefore, calls for improvement in the quality of care at the health facility with subsequent innovative approaches to increase demand and utilization. However, the challenges of making pregnancy safer and addressing inequalities are not just new technologies or new knowledge about effective interventions but rather how to deliver these services and scale-up the coverage and utilization particularly to those who are vulnerable, hard to reach, marginalized and excluded.
Based on the findings of this study, It is evident that although women faced complexed challenges at individual, family and the health care system levels, they managed their health to the best of their ability. But the free Antenatal Care Services introduced in Ghana and the current voucher system being initiated in Nigeria will further boost utilization of maternal health care facilities. This further increases their access to resources. They will then be able to make decisions on matters that directly affect their health.

Further research on women’s health should be done on beliefs system, attitudes, experiences, also families and provider’s perception about care received and health care delivery at all levels.

Information Education and Communication (IEC) programs should as well target and involve men them in reproductive health matters.

5.3 Recommendations

The study has provided information on the various aspects of late antenatal attendance. Therefore, the following recommendations if implemented may improve timely accessing of health services and the quality of service provided;

  1. Ministry of health and District Medical Offices need to provide continuous health education on the importance of timely accessing of ANC services through the media and community sensitization meetings. The focus should be on promotion of booking in the first trimester, the value of early antenatal care.
  2. Egbedore Health Center should extend antenatal care services to the communities that are far from the health care unit by creating ANC outreach services.
  3. Furthermore, government through Ministry of Health should construct more
    health facilities to improve availability and accessibility especially in rural areas.

5.4 Implications to Nursing Practice

To ensure appropriate design and effective delivery of ANC, attention should be paid to the on the-ground implementation of ANC and women’s understanding of these local forms of ANC at health facilities, how women deal with reproductive uncertainty and the efforts that women make to care for themselves and their pregnancies.
Information, education and communication strategies promoting health seeking behaviors should be enhanced both at health facility and community level. Some of the issues to be intensified should be dispelling myths associated with pregnancy, informing communities that any pregnant woman is at risk and requires medical attention during the entire pregnancy period. Communities should further be informed that regardless of age of the woman and parity all pregnant women must be supported to initiate ANC early.

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