MATERNAL HEALTH CARE SEEKING BEHAVIOR AND PREGNANCY OUTCOME OF PREGNANT WOMEN OF AMUZUKWU COMMUNITY IN ABIA STATE.

Abstract

The purpose of this study was to examine the maternal health care seeking behaviour and pregnancy outcome of pregnant women Azumukwu community in Abia state. The objectives of study were to: (i) determine the gestational age at which pregnant women book for Antenatal Care(ANC) in Azumukwu community, (ii)determine how often pregnant women attend Antenatal Care(ANC)during the third trimester, (iii) ascertain the facilities utilized by pregnant women with complications for care and (iv) ascertain their pregnancy outcome. Cross-sectional survey design was adopted for the study. A sample size of 207 respondents was drawn from a population of 586 pregnant women. The instrument for data collection was the researcher-developed questionnaire that was used as an interview guide. Observation guide was also used to corroborate the findings of the questionnaire. The design of the study was descriptive cross-sectional survey. Convenience sampling was used to select a sample size of 207 respondents from a population of 586 pregnant women. Collected data were analysed using descriptive statistics of frequencies and percentages. Chi-square was used to test for significant association at significance level of 0.05. Major findings show that most of the respondents (79.7%) booked for ANC during the first trimester. On frequency of ANC during the third trimester, 81.1% maintained weekly attendance while 100% of the respondents with complications accessed care from health facilities especially the general hospital under skilled healthcare providers. On pregnancy outcome, 84.5% of the babies cried vigorously at birth and 0.5% did not cry at all. On maternal delivery outcome, 83.1% were strong to take care of self and baby after delivery. There was no significant association (p > 0.05) between the respondents’ demographic variables (age and educational status) and their healthcare seeking behaviour. There was no significant association (p > 0.05) between maternal healthcare seeking behaviour and mothers’ delivery outcome (women that were strong to take care of self and baby and those that were weak to take care of self and baby after delivery). There was significant association (p < 0.05) between maternal healthcare seeking behaviour and babies’ birth outcome (number of babies that cried vigorously at birth and those that did not cry at all).

Chapter one

Introduction

1.1Background of the study

The way a woman seeks medical attention when pregnant is greatly influenced by her beliefs, culture, experience, education, financial situation, attitude toward pregnancy, autonomy, and capacity for decision-making. According to Adele (2010), important considerations include whether the pregnancy was planned or unplanned and the details of the pregnancy that the woman’s family told her when she was a youngster. Garba, Hellandendu, and Ajayi (2011) went on to say that most cultures had a set of beliefs and practices that were centered on the identification and management of pregnancy issues as well as the conduct of deliveries even before the development of contemporary scientific medicine. Thus, recognizing the proper behavior for seeking medical attention is crucial to getting the pregnancy you want. Negative behaviour is highly implicated in increased morbidity and mortality of mother and baby.

Maternal Health Care Seeking Behavior (MHCSB) should take pregnant women’s antenatal clinic visits and preferred delivery location into account, according to Osubor, Fatusi, and Chiwuzie (2006). Health seeking behavior was described as “a complex outcome of many factors operating at individual, family, and community levels, including their biosocial profile, previous experiences with health services, availability of alternative health care providers, and the people’s perception regarding the efficacy and quality of the services” by Jain, Nandan, and Misra in 2006.

Adele (2010) defines health seeking behavior as the actions people do in reaction to any discomfort they may be experiencing. He added that in industrialized nations like the United States of America (USA), the majority of pregnant women see ANC early in their pregnancies, abide by prenatal instructions, and receive treatment from trained medical professionals when they go into labor. He further asserts that most women in poor nations, particularly in rural Sub-Saharan Africa, view pregnancy as a natural process and do not view the need for the services of qualified medical professionals as vital.

Rastogi (2012) found that rural women in India used ANC less frequently than urban women, perhaps as a result of both a shortage of transportation and the women’s tendency to be hesitant around male healthcare professionals. According to Rastogi, women who had completed at least their secondary education sought medical attention from qualified professionals.

According to Jayaraman, Chandrasekhar, and Gebreselassie (2008), only a small percentage of pregnant women have up to three antenatal consultations, and the majority of them give birth at home without the assistance of qualified medical personnel. According to Woldemicael (2008), some pregnant women may not use ANC and other delivery services provided by professional care providers at health facilities due to a shortage of transportation and may instead seek assistance from a variety of professions.

According to Adamu (2011), MHCSB is the method moms take care of their health and the health of the unborn child so that they will have a healthy pregnancy and a successful delivery. According to Yubia (2011), maternal health care seeking behavior in Nigeria is comparable to that of other developing nations, where the majority of mothers frequently exhibit poor health seeking behaviors that result in inefficient use of maternal health care services provided by skilled health care attendants and ultimately negative pregnancy outcomes. Yubia went on to say that their poor treatment-seeking behaviors make individuals more likely to develop problems that, if caught early enough during ANC, may be effectively controlled.

In southern Nigeria, there are more women attending ANC than in the north. According to NDHS (2008), the number of births attended by qualified medical personnel varies by region, from 81.8 percent in the South East (SE) to 9.8 percent in the North West (NW). Similarly, compared to 22.5 percent in the South West, 90.1% of women in the NW are more likely to give birth at home (SW). According to Adamu (2011), this high attendance is related to the fact that more women in southern Nigeria than in the north have access to education and economic opportunity.

An important factor in determining whether a woman giving birth chooses institutional care or care at home with a qualified health care provider rather than delivery at home with an untrained birth attendant is the number of trips to ANC. According to Adamu (2011), a woman who attends ANC is more likely to give birth in a medical facility. Young moms (those under the age of 35) are also more likely than older mothers (those over the age of 35) to choose to give birth in a hospital. On the other hand, older mothers, particularly multipara who have never experienced any issues in pregnancy, may not seek medical attention from qualified medical professionals because they believe that a safe birth is a natural procedure. Yubia (2011) opined that such women rely on their experience and help from fellow older mothers for care and delivery

According to Rastogi (2012), pregnant women who receive frequent home visits from a qualified healthcare professional do not have many complications. According to Babalola and Fatusi (2009), early and timely access to and utilization of high-quality maternal health care services can help prevent the majority of maternal fatalities and impairments. According to WHO (2007), maternal morbidities and mortality among women of reproductive age (15-49 years) in developing countries are primarily caused by problems during pregnancy and childbirth. Nigeria has the second-highest mortality rates in the world and is responsible for 10% of all maternal fatalities worldwide. It further stated that 20 to 30 additional women would experience short- and long-term damage to their reproductive systems, leading to disabilities such obstetric fistula, inflammatory illnesses, and ruptured uterus, for every woman who passed away from pregnancy-related causes. In view of all these, this study examined the health care seeking behaviour of the pregnant women in Amuzukwu community in Abia state and their pregnancy outcome.

Statement of the problem

According to Yubia (2011), maternal deaths are caused by poverty, societal cultural norms, ignorance, and a lack of essential maternal health services. He continued by saying that the issue is worse in underdeveloped nations as a result of mothers’ poor health-seeking behaviors, such as underutilizing medical services, ignorance, and people’s illness-related behaviors.

According to NDHS (2008), only 58 percent of pregnant women in Nigeria attended at least one ANC, 39 percent of births were attended by a qualified medical professional, 35 percent of deliveries occurred in a health institution, and 43.7 percent received postnatal care. According to Osubor, Fatusi, and Chiwuzie (2005), it is customary in Nigeria for pregnant women to register with both a traditional birth attendant and an antenatal clinic. This practice can result in complications like sepsis, postpartum hemorrhage, or even the mother, child, or both dying while giving birth. According to WHO (2007), this condition is prevalent in the majority of rural communities in Nigeria, including Abia state, where the majority of pregnant women only visit medical facilities in the event of a serious emergency or when their disease becomes protracted and life-threatening. The percentage of newborns attended by qualified health care professionals globally is the most often monitored indicator for evaluating the performance of the MDGs for the reduction of MMR, according to WHO (2014).

According to the researcher’s clinical observations in Amuzukwu, an aunt who insisted on having her kid where her other two co-wives delivered their own children in order to avoid ignorant local rumors perished during childbirth at one of the TBAs homes. Unfortunately, her delivery became complex, and the TBA was unsure of what to do next, so they continued to keep her in. This demonstrates how maternal health care seeking behaviors, particularly in rural populations, contribute to the high rates of maternal morbidity and mortality that are present in developing countries.

Thus the need to examine the maternal health care seeking behaviours and pregnancy outcome of pregnant women of Amuzukwu community of Enugu State.

Objective of the study

The purpose of this study is to examine the health care seeking behaviour of pregnant women and their pregnancy outcome in Amuzukwu community in Abia State.

Specific objectives of the study are to:

1. Determine the gestational age at which pregnant women book for ANC in Amuzukwu community.
2. Determine how often the pregnant women go for ANC in third trimester.
3. Ascertain the facility utilized by pregnant women with complication(s) for care.
4. Ascertain the pregnancy outcome of the pregnant women in the study area

Research Questions

The following research questions were formulated

1. At what gestational age do pregnant women book for ANC in Amuzukwu community?
2. How often do pregnant women go for ANC in third trimester?
3. Which facility do pregnant women with complication(s) during pregnancy utilize for care?
4. What is the pregnancy outcome of the pregnant women in the study area?

Research hypotheses

The following research hypotheses were formulated;

H1: There is significant association between mother’s age, educational level and parity and maternal health care seeking behaviour

H2: There is significant association between maternal health care seeking behaviour and pregnancy outcome (babies’ birth outcome).

H3: There is significant association between maternal health care seeking behaviour and pregnancy outcome (mothers’ delivery outcome).

Significance of the study

Findings from the study will generate empirical data on how mothers in Amuzukwu community seek routine health care during pregnancy, whether they book for ANC,their time of booking, where they book, where they go to seek care especially when faced with problems in pregnancy, where they prefer to deliver, their preferred healthcare provider and their pregnancy outcome. These, when communicated, will serve as basis for empowering pregnant women among nurses, midwives, and other health workers with a view to improving maternal health and reducing maternal morbidity and mortality through improved maternal health care services utilization through evidence based health education.

Findings when published and utilized by health workers will help nurses to create more awareness on maternal health care services utilization among mothers. Maternal health care services when adopted by mothers will help them to maintain optimal health during pregnancy as well as timely management of any identified problem.

Findings when published will also help policy makers to see the need to enforce full implementation of plans and actions geared towards improving maternal health care seeking behaviour through proper utilization of maternal health care services. When these plans and actions are effectively utilized by mothers, there will be reduction in maternal morbidity and mortality. This in turn will go a long way in reducing the burden associated with maternal morbidity and mortality.

Scope of the study

The study is delimited to maternal health care seeking behaviour and pregnancy outcome. Other variables in the study are when pregnant women book for ANC, how often pregnant women go to for antenatal care in third trimester, where pregnant women go to for care when they experience health problems in pregnancy, as well as the pregnancy outcome of the pregnant women in the study area. The study is also delimited to Amuzukwu community of Abia State.

Operational definition of Terms

Maternal health care seeking behavior refers to booking at a health facility, time of booking in the health facility, the number of visits made forAntenatal Care(ANC) before delivery, and delivery at a health facility under a skilled care provider.

Pregnancy outcome: The state mother and baby after delivery, which could be positive or negative. Outcome include mother being strong or weak to take care of self and baby after delivery, or very weak and drowsy/ baby’s cry at birth (cried very well, cried weakly or did not cry at all after delivery).

Positive pregnancy outcome: birth of ahealthy baby (cried very well at birth),and a healthy mother (strong after delivery).

Negative pregnancy outcome: baby did not cry at birth and respondent very weak and drowsy after delivery.

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