Prevalence Of Pregnancy Related Illness Of Women Attending Antenatal Care
Nigeria accounts for a considerable proportion of maternal deaths that occur annually worldwide. The study investigated the prevalence of pregnancy related illness of women attending antenatal care at health facilities in Awka South Local Government Area, Anambra State. The study adopted cross-sectional research design. The population comprised 3,207 registered pregnant women from January to September 2012. The sample for the study consisted of 650 pregnant women. A pre-tested questionnaire was administered by the interviewers to women who had attended antenatal care services within six months prior to the date of data collection. Malaria (66.6%), morning sickness (58.0%), hyperemesis gravidarum (39.7%), sexually transmitted infections (28.6%), gestational diabetes (23.8%), pre-eclampsia and eclampsia (23.0%) and anaemia (15.8%) were the common illnesses in women. It was concluded that the interplay of several factors is responsible for the incidence of pre-pregnancy and pregnancy-related illnesses in women. Identification of these factors is expedient while scaling up of maternal health interventions; improved access and uptake of facility-based care hopefully, will drastically reduce morbid conditions in women and improve maternal and newborn outcomes.
Table of Content
- 1.1 Background of the study
- 1.2 Statement of the problem
- 1.3 Objective of the study
- 1.4 Research questions
- 1.5 Significance of the study
- 1.6 Scope of the study
- 1.7 Limitation of the study
- 1.8 Definition of terms
- 1.9 Organizations of the study
Review of Literature
- 2.1 Conceptual framework
- 2.2 Theoretical Framework
- 2.3 Empirical review
- 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
Data Presentation and Analysis
- 4.1 Data Presentation
- 4.2 Analysis of Data
- 4.3 Answering Research Questions
- 4.4 Interpretation of Result
Summary, Conclusion and Recommendation
- 5.1 Summary
- 5.2 Conclusion
- 5.3 Recommendation
1.1 Background to the Study
Illnesses during pregnancy portend severe threats to maternal and fetal health with adverse maternal, fetal and newborn health outcomes. The status of maternal health in poor countries is often described in terms of maternal mortality alone, despite the evidence that far more women suffer from morbidities/disabilities relating to pregnancy and childbirth (Filippi et al., 2007). About 289,000 maternal deaths occur annually worldwide, and Nigeria accounts for about 14% of these preventable deaths (United Nations, 2010). About 20 million women suffer from acute severe obstetric complications, including haemorrhage, obstructed/prolonged labour, preeclampsia/ eclampsia, puerperal sepsis, and septic abortion (Glasier et al., 2006; Hogan et al., 2010). The burden of maternal ill-health extends beyond these complications and includes different short- and long-term morbid conditions that can result from acute obstetric complications or poor management at delivery (Gulmezoglu et al., 2004; Zwart et al., 2008; Lindquist et al., 2013). In Nigeria, the estimated maternal mortality ratio (MMR) of 576 deaths per 100 000 live births reported in 2013 was higher than the 545 deaths per 100,000 live births recorded in 2008 (National Population Commission-NPC and ICF International 2013) and fell far short of the Millennium Development Goal of 250 deaths per 100,000.
Hospital records according to Federal Ministry of Health (FMoH, 2013) and National AIDS and Reproductive Household Survey (NARHS) in 2012 have shown that for many years, illnesses are the major causes of maternal mortality with variations between women in urban and rural communities (Doctor et al., 2011; Ajayi and Osakinle, 2013). Vanderkruik et al. (2013) asserted that complications of pregnancy, childbirth, and the postpartum period may lead to death or cause a continuum of morbidities that affect a woman‟s health for short or long-term periods during and after pregnancy, and even throughout her life. Community-based studies conducted in various countries have reported that women suffer significant morbidity both during pregnancy and postnatal period (Wall, 1998; Zishiri et al., 1999; Walraven et al., 2001; Bang et al., Filippi, 2004).
Such morbidities are also associated with poor fetal and newborn outcomes. Defining maternal morbidity poses serious challenges because there are diverse definitions, identification and classifications of maternal morbidity in literature. Currently, there is a lack of an agreed-upon definition for maternal morbidity (Vanderkruik et al., 2013). Existing work on maternal morbidity includes an array of conditions, both short- and long-term in varying combinations (Waterstone et al., 2003; Chersich et al., 2009; Ukachukwu et al., 2009). Three major issues have limited valid, routine, and comparable measurements of maternal morbidity to date. These include lack of a common definition and identification criteria for maternal morbidity, lack of standardized assessment tools especially at community or primary health care level, and lack of common indicators to measure morbidity (Vanderkruik et al., 2013).
To guide this study, the authors used a well-defined term- illness, Parsons (1951) viewed illness as a human response to the disease process or to the perception by an individual that he has some form of impairment. It is an abnormal process in which the person‟s level of functioning is changed. Illness is described as feelings experienced by an unwell person. A person may feel „ill‟ without a disease being evident or diagnosed (Alpert et al., 1967). Illness has been conceptualized as the patient‟s experience of ill-health and comprises his/her impaired sense of well-being, the perception that something is wrong with the body and various symptoms of pain, distress, and disablement (Abanobi, 2003). Existing literature includes an array of methods for identifying and classifying maternal illness. Maternal morbidities or illnesses have been grouped under various categories such as direct obstetric morbidity, indirect obstetric morbidity and psychological obstetric morbidity (Reed et al., 2000) or obstetric complications, pre-existing medical conditions (Danel et al., 2003; Berg et al., 2009) or categories of obstetric morbidity that occur during pregnancy, during delivery, or after delivery (Zurayk et al., 1993). In addition to the wide range of how maternal morbidity conditions are categorized, the methodology for detecting a maternal morbidity varied across studies as well, including interview-based diagnosis and hospital records (for example birth/hospital discharge data) (Stewart et al., 1996; Roberts et al., 2009). This study explored a few typologies of maternal morbidity/illness. Two typologies of illnesses associated with pregnancy have been identified in the literature (Arkutu, 1995). These are illnesses caused by pregnancy such as ectopic pregnancy, hyperemesis gravidarum, miscarriage, pre-eclampsia, eclampsia, sepsis and haemorrhage and pre-existing illnesses or medical conditions which anybody can suffer but which are made worse in pregnancy. These include malaria, anaemia, diabetes, essential hypertension, backache and sexually transmitted infections (STIs). Another category of illnesses in pregnancy as identified in literature (Elaine, 2000; Nursing and Midwifery Council of Nigeria, 2006) include: malaria, anaemia, diabetes, essential hypertension, pulmonary tuberculosis, sickle cell disease, urinary tract infection, cardiac disease, asthma, sexually transmitted infections (STIs), renal problems as well as backache and headache. This study investigated typologies of illnesses in pregnancy based on literature, which include: illnesses that are caused by pregnancy such as backache, pre-eclampsia, hyperemesis gravidarum, gestational diabetes (GDM); hypertensive disorders (pre- eclampsia and eclampsia) and pre-pregnancy illnesses which are made worse in pregnancy such as malaria, anemia, diabetes, hypertension, STIs, tuberculosis and depression.
1.2 Statement of the Problem
Studies have indicated associations between severe maternal morbidity and factors such as advanced maternal age, pre-existing medical conditions and obesity (Bouvier-Colle et al., 1997; Zhang et al., 2005). However, these factors are unable to explain entirely the differences in maternal morbidity found between different populations of women both within and between countries (Lindquist, 2013). Nevertheless, this study explored differences in pre-pregnancy and pregnancy-induced illnesses in women according to maternal factors (maternal age and education). Primary health centres (PHCs) in the study area offer ANC services amidst challenges such as shortage of vaccines and essential drugs, logistic problems, skilled health personnel, and unstable power supply, which hinder effective service delivery. The interplay of all or some of these variables may influence pregnant women‟s access to ANC services with attendant consequences for maternal and neonatal outcomes. This situation accentuates the need for the choice of the study area. In addition, studies have indicated that severe maternal morbidity may be a valid indicator of the quality and effectiveness of obstetric care than mortality alone (Mantel et al., 1998; Koeberle et al., 2000). There is paucity of data on incidence of pre- pregnancy and pregnancy-related illnesses among pregnant women accessing ANC at PHCs in Awka South LGA, Anambra State, Nigeria. In view of high maternal mortality rates in Nigeria, and potential complications inherent sub-standard care for pregnancy- related illnesses among women in Nigeria, this study was carried out.
1.3 Objective of the Study
The main objective of this study is evaluate the prevalence of pregnancy related illness of women attending antenatal care in Awka, south-east, Nigeria.
Specifically, the study aims;
- To examine the socio-demographic characteristics of pregnant women
- To investigate the prevalence of pre-pregnancy illnesses by pregnant women
- To evaluate the prevalence of pregnancy-related illnesses by pregnant women
1.4 Research Question
The following research questions will be answered in this study:
- What is the socio-demographic characteristics of pregnant women ?
- What is the prevalence of pre-pregnancy illnesses by pregnant women ?
- What is the prevalence of pregnancy-related illnesses by pregnant women?
1.1 Significance of the Study
The study will be significant to ministry of health as this will expose them to the need of creating awareness on pregnant-related illness and also training health care personnel on knowledge, practice and attitude of patients and how to treat and handle patients especially pregnant women with pregnant-related illnesses.
This study will be significant to the academic community as it will contribute to the existing literature.
1.2 Scope of the Study
This study focuses on the prevalence of pregnancy related illness of women attending antenatal care in Awka, south-east, Nigeria. Specifically, this study focuses on determining the rate at which pregnant related illness is prevalent in pregnant women, examining if pregnant women have knowledge on the management of the illnesses, determining the factors that leads to the illnesses in pregnant women, examining the effects in pregnancy and proffering ways in which illness in pregnant women can be prevented. Selected pregnant women in Awka, south-east, Nigeria will serve as the respondents for the survey of this study.
1.3 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.
1.4 Definition of Terms
In epidemiology, prevalence is the proportion of a particular population found to be affected by a medical condition at a specific time.
A condition in which the force of the blood against the artery walls is too high.
Usually hypertension is defined as blood pressure above 140/90, and is considered severe if the pressure is above 180/120.
High blood pressure often has no symptoms. Over time, if untreated, it can cause health conditions, such as heart disease and stroke.
Eating a healthier diet with less salt, exercising regularly and taking medication can help lower blood pressure.
Pregnant women: Pregnant woman means a woman determined to have one or more embryos or fetuses in utero.
Summary, Conclusions and Recommendations:
This chapter summarizes the findings on the prevalence of pregnancy related illness of women attending antenatal care in Awka, south-east, Nigeria. The chapter consists of limitation of the study, conclusions, and recommendations.
The findings of this study will be useful to policy makers, healthcare professionals and public health experts. This study thus showed high prevalence of malaria, morning sickness and low prevalence of STIs, anaemia, pre- eclampsia and nausea/severe vomiting (hyperemesis gravidarum) in women. The incidence of these illnesses was significantly higher among pregnant women when compared to studies from other climes. The higher occurrence of pre-pregnancy and especially pregnancy- related illnesses in our study may partly be due to poor access or uptake of ANC services and data assessment identifying more cases by using standardised definition in a large population. The disparity in occurrence of maternal morbidities may also be attributed to the general level of development and poor maternal health care delivery services. Scaling-up of integrated maternal and child health (IMCH) services; access to high quality facility care; use of health systems approach in maternal health services provision are likely to provide a holistic improvement in the quality of care in the study area. This in turn will substantially reduce mortality and morbidity from these conditions. In addition, early identification and management of pregnancy-related complications, particularly pre-eclampsia, haemorrhage, premature rupture of membranes and STIs, identification and treatment of underlying or concurrent illnesses in pregnancy such as malaria, gestational diabetes, anaemia, STIs among others are vital to improved maternal and fetal outcomes in Nigeria.
With respect to the findings and the aim of this study, the researchers therefore recommend that;
- Primary care physicians should effectively assume their role so as ensure the early identification and management of hypertension during early antenatal care.
- Pregnant women should endeavour to seek for the services of a physician when having Anaemia, and not rely on self medication and traditional treatments.
- The strategies outlined above on how malaria can be managed should be effectively put into practice.
5.4 Limitations of the study
Some inaccuracies in the classification of certain morbidities may be expected due to the use of admission diagnoses. Data collection did not extend to the medical wards as well as postpartum period. Therefore, data collected did not include postpartum obstetric conditions. Recall bias was another potential limitation because information on maternal morbidities based on recall spanned across pre-pregnancy period, pregnancy and perinatal and some women might not remember when they specifically had such morbidities. It is expected that inclusion of women around perinatal, childbirth and postpartum period may help minimize the effect of recall bias as recall period is shorter compared to using pre- pregnancy and early pregnancy periods. Furthermore, information that was obtained relied on women‟s self- report and pregnant women may under report illnesses due to social desirability bias; hence, the observed occurrence of maternal illnesses may be underestimated. The incidence of maternal morbidity in this study may depict the iceberg phenomenon. Thus, reported maternal morbidities may not be a true reflection of the burden of this problem in the sub-population as only a third of delivery takes place at the health facilities. Some women with these morbidities may not have access to PHCs or private or mission health facilities for several reasons, which include lack of transportation, ignorance, poverty, influence of traditional/religious beliefs and perceived negative attitude of health workers.
Prevalence Of Pregnancy Related Illness Of Women Attending Antenatal Care
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