EXTENT OF UTILIZATION AND STRATEGIES FOR ENHANCEMENT OF MATERNAL AND CHILD HEALTHCARE SERVICES UTILIZATION AMONG CHILDBEARING MOTHERS
The purpose of the study was to determine the extent of utilization and strategies for enhancement of maternal and child health care services utilization among child bearing mothers in Okigwe LGA of Imo State. In order to accomplish this purpose, eight specific objectives were posited and corresponding research questions were posed to guide the study. Four null hypotheses were postulated and tested at .05 level of significance. The descriptive survey research design was adopted for the study. The study population comprised of 36,269 mothers of child bearing age in Okigwe LGA of Imo State. The multistage sampling procedure with simple random sampling technique without replacement was used to select 380 CBMs. The researcher designed questionnaire-EUSMCHQ was the instrument for data collection. Five experts in the department of health and physical education, University of Nigeria Nsukka validated the instrument. Tool for data analysis of reliability is spilt half.. Frequency and percentages, means and standard deviations were used for answering research questions while ANOVA and Chi square statistics were used to test the hypotheses. Out of 380 copies of questionnaire, 376 were used for the analysis. The finding of the study were as follows: moderate utilization of ANC services (x =2.7, SD=1.12); moderate utilization of delivery care services (46%); Postnatal care services were highly utilized (78.7%); moderate utilization of immunization services (50.3%); very low utilization of family planning services (7.5%); moderate utilization of food supplementation services (56.3%). Availability of health personnel, nearness to the health center, attitude of health personnel among others were factors that encouraged utilization of MCH (x=3.22, SD=.758). Lack of money, unavailability of MCH clinic, non availability of health personnel, non availability of drugs and supplies were factors that discouraged utilization of MCH (x=3.06, SD=.764). Health education of mothers; building of more health center, making health centers functional, employing more health workers among others are the strategies that enhance maternal and child health care services utilization (x=3.04, SD=.675). Further results showed that there was significant difference on the extent of utilization of ANC (F=2.73, P=0.007<0.05) based on maternal age, ANC (F=9.76, P=0.001<0.05) based on parity, PNC (x2=9.88, P=0.025<0.05) based on maternal level of education, IMM (x2=30.04, P=0.040<0.05) based on maternal level of education, FPS (X2=11.88, P=0.003<0.05) based on maternal level of education, FSS (X2=8.18, P=0.041<0.05) based on maternal level of education. Also there was no significant difference on the extent of utilization of ANC (F=2.16, P=0.361>0.05) based on maternal occupation, DCS (X2=4.04, P=0.370>0.05) based on maternal occupation, PNC (X2=5.80, p=0.224>0.05) based on maternal occupation, 1MM (X2=3.76, P=0.445>0.05) based on maternal occupation, FPS (X2=3.60, P=0.464>0.05) based on maternal occupation, FSS (X2=3.27, P=0.417) based on maternal occupation, DCS (X2=4.65, P=0.399>0.05) based on parity, PNC (X2=4.04, p=0.301>0.05) based on parity, IMM (X2=3.22, P=0.416>0.05) based on parity, FPS (X2=4.45, P=0.365>0.05) based on parity, FSS (X2=8.82, P=0.781>0.05) based on parity .DCS (X2=5.89, P=0.161>0.05) based on maternal age, PNC (X2=4.59, P=0.060>0.05) based on maternal age, IMM (X2=6.86, p=0.089>0.05), FPS (X2=5.57, P=0.122>0.05), FSS (X2=5.14, P=0.150>0.05) based on maternal age, ANC (F=2.20, p=0.851>0.05) based on maternal level of education and DCS (X2=3.01, P=0.513>0.05) based on maternal level of education. Based on the findings of this study, the researcher recommended among other things that health education and campaign on adequate utilization MCH should be intensified by public health educators and other health professionals.
Background to the Study
Women and children all over the world are experiencing life threatening problems and deaths due to pregnancy and childbirth. This may be attributed to the availability, accessibility and extent of utilization of maternal and child healthcare services among them. Adamu (2011) opined that the extent of utilization of maternal and child healthcare services is the proximate factor behind the high rate of maternal and child morbidity and mortality. The high rate of maternal and child morbidity and mortality has become a serious challenge to the global public health especially in developing countries like Nigeria (Babalola & Fatusi, 2009).This is why all nations around the world have decided to sign up under Millennium Development Goals to reduce maternal and child mortality by at least 2/3 and ¾ by the year 2015 respectively through improving maternal and child health. Maternal and child health refers to the health of mothers and their children. World Health Organization WHO (2000) defined maternal and child health as referring to the health of women during pregnancy, childbirth and the postpartum period and the health of their children. It is the health of women of child bearing age and their children who include under five children, school age children and adolescents. Mothers and children constitute about two-third of the whole population and they are vulnerable to many adverse conditions which may be as a result of pregnancy, childbirth and infectious diseases. Therefore these mothers and children need special consideration to maintain optimal health; this can be achieved through adequate provision and effective utilization of maternal and child health care services.
Maternal and child healthcare service is defined by Baba, Kaul and Heena (2003) as health service meant to improve the health of mothers and children in any given society. The aim of maternal and child health care services according to the above authors is to provide quality health care and reduce maternal and infant mortality. Baba, Kaul and Heena maintained that it helps to ensure access to preventive and curative child care services as well as rehabilitation services for certain children. World Health Organization WHO (2000) defined maternal and child health care as an aspect of modern health services specifically designed for women of child bearing age and children for the promotion of their health. Maternal and child healthcare services also provide a channel through which medical and health care services can be organized to improve the health and wellbeing of mothers and children. United Nations’ Children Fund UNICEF (2007) stated that maternal and child healthcare services are designed to revitalize primary health care in every local government. This is to reduce maternal, newborn and under five mortality in line with 4th and 5thMillennium Development Goals target. Maternal and child health care services (MCH) in this study can therefore be defined as services designed to improve maternal and child health and to reduce maternal and child morbidity and mortality. Maternal and child healthcare service has different components.
Components of MCH according to Chandihouk (2006) include family planning, antenatal services, delivery care service, malaria prophylactic, iron and foliate supplement, children screening, immunization, growth monitoring, school health services and adolescent health care. Adamu (2011) listed some components of MCH to include antenatal care, skilled birth attendants, post natal care, family planning, immunization and iron supplements. This study adopted Adamu’s components which include antenatal care service (ANC), delivery care services (DCS), post natal care services (PNC), family planning service (FPS), immunization service (IMS) and food supplementation services (FSS). The adoption of these is based on the fact that they are the functional ones at the study area.
Antenatal care (ANC) is a type of health care service rendered to a woman during the period of pregnancy. National Population Commission (2004) asserts that ANC is the care for effective prevention of negative pregnancy outcomes when it is sought early in pregnancy and continues throughout delivery. Antenatal care service according to Elo (1992) is the care given to pregnant mothers so that they will have safe pregnancy and healthy babies. Babalola and Fatusi (2009) suggested that ANC gives opportunities for providing health care services, such as prophylactic treatment of malaria, and immunization against neonatal tetanus. They further stated that ANC are those cares given to pregnant women to help prevent or minimize complications of pregnancy so as to have healthy babies. Ajaegbu (2006) noted that ANC is very necessary because it helps in the diagnosis and treatment of complications that could endanger the life of mother and child during pregnancy and delivery. In this study, antenatal care can be defined as care given to a pregnant woman throughout the period of pregnancy to ensure safe delivery and to have a healthy baby. Antenatal care service also helps in identifying women with problem, treating them, counseling and educating them about their own health and that of their babies till the time of delivery.
Delivery care service (DC) is the care at the onset of labour till time of delivery. Chaudihouk (2006) defined delivery care as the care aimed at promoting clean delivery to reduce complications and death. Navaneetham and Dharmalingam (2000) view delivery care service as a very important component of reproductive health care services which is aimed at providing skilled birth attendant during delivery to safe guard the life of the mother and the baby. Nwogu (2001) stated that delivery care is the assistance given to a woman during labour, delivery and immediately after delivery. This assistance can be given by the skilled birth attendants who include the doctors, nurses, or some trained traditional birth attendants.
Skilled birth attendants (SBAs) are professionals that take care of pregnant mothers. They are trained to recognize the signs of complication early enough, to intervene and manage the situation and make quick referral to higher levels of care (Bell, Curtis & Alayon, 2004) as may be indicated. World Health Organization WHO (2004) stated that the provision of skilled birth attendant for delivery along with equipments, drugs and supplies is necessary for effective management of obstetric complications. WHO also stated that the use of SBAs has been described as the single most important factor in preventing maternal deaths. Delivery or obstetric care services are given to monitor the women during delivery and since there is no reliable way to predict which woman will develop complications during delivery, it is therefore very necessary for it to be within the reach of the pregnant woman for easy access during delivery and postnatal period. In the context of this study, delivery care can be seen as services rendered to pregnant woman during labour and delivery so as to avoid complications, avoid death and have healthy babies. These services range from hospital delivery, delivery by SBAs, forceps delivery to vacuum extractor. This variable is very necessary in this study because it is a very important strategy to reduce complications and death that occurs during the time of delivery.
Post natal or post partum care services (PNC) are assistance given at the end of delivery service. Navaneetham and Dharmalingam (2000) opined that post natal care is a care given to mothers during the post partum period (from the first day after delivery and up to six weeks after delivery). Post natal care according to Adamu (2011) is the care given immediately after birth and up to 40 days after delivery. Adamu affirmed that PNC is very important for mothers as it has been observed that more than 60 percent of maternal deaths take place during post natal period due to hemorrhage, infections and hypertensive disorders. Gill, Pande and Mathotra (2007) noted that during the post-natal period, mothers and children are being taken care of by observing them physically for early sign of complications, giving them advice and support for exclusive breastfeeding, teaching on the need for child spacing through family planning, health education on how to care for their babies, food preparation and weaning. Some other services rendered during post natal care are maternal and child nutrition, hygiene and sanitation, education, prevention and treatment of infectious diseases including HIV and other sexually transmitted infections (STIs) and immunization services (United State Agency for International Development USAID 2009). Post natal services can therefore be defined as services given to the mother and child after delivery to reduce post partum complications and to improve the health of mother and child. During this period, proper examination of the mother and the baby is carried out. Thus, it becomes imperative for every mother to utilize the service to reduce death and maintain an optimal health.
Immunization service (IMM) is a very important aspect of maternal and child healthcare services. Onuzulike (2008) defined immunization as a deliberate simulation of the body defenses against a specific harmful germ or bacteria. Immunization of babies, pregnant women and even adults is very important as its guides the body against infectious disease. World Health Organization WHO (2004) defined immunization as a process whereby a person’s immune system is made to be resistant to an infectious disease, typically by administration of a vaccine. Vaccines stimulate the body’s immune system to protect the person against subsequent infection or disease. It is estimated that 2-3 million deaths occur each year due to infectious disease such as measles, mumps, rubella, hepatitis B, polio, diphtheria, tetanus and pertusis (whooping cough) (WHO, 2004). WHO (2004) affirmed that immunization is a proven tool for controlling and eliminating these life threatening infectious diseases. Immunization in this study is therefore a process by which an individual’s immune system is fortified to fight against infectious diseases
Family planning service (FPS) is a plan intended to determine the number and spacing of one’s children through effective method of birth control. WHO (2013) defined family planning as a programme that allows individual or couples to anticipate and attain their desired number of children and the spacing and timing of births. Onuzulike (2008) averred that family planning is a large umbrella that caters for the wellbeing of family members as concerns their feeding, daily care and housing. Some different methods of family planning are as follows; the natural, the artificial and the permanent contraceptives. The natural family planning includes breastfeeding, abstinence, withdrawal, billings or ovulation method. The artificial is the hormonal, mechanical and chemical methods while the permanent contraceptive is female and male sterilization. Onuzulike noted that family planning has been proved to be an effective way to decrease fertility thus reducing population growth and also reducing maternal death by spacing and preventing pregnancy. Some of the contraceptives are pills, injectables, intra uterine devices, female condom among others. These contraceptives are liable to reduce unwanted pregnancies if properly used as well as reducing untimely death. Therefore family planning in this study is a way of helping couples to space their children, decide on the number to have and help infertile couples to have children.
Food supplementation by Quespie and Hadad (2003) means improving nutrition by increasing access to healthful nutritious food and essential micronutrients and supplements that improves and saves lives. WHO (2004) observed that more than half of all maternal and child deaths are associated with malnutrition, poor diet and inadequate attention, these weaken the mothers and children body resistance and predispose them to suffer some complications. McCarthy and Maine (1992) observed that malnourished mothers face potential complications during childbirth and a high likelihood of low birth weight babies. However, improvement in feeding and nutrient supplementation can prevent this malnutrition and save the lives of mothers and children.
Food supplementation ranges from vitamins supplement, iron supplements and distribution of nutritious food among others. Adamu (2011) opined that the integration of food supplementation into maternal and child health services would decrease the prevalence of acute and chronic under-nutrition and severe anemia among children and pregnant mothers. Onuzulike (2008) opined that Vitamin supplements are introduced to ensure that the women and children get enough quantity of vitamins needed by their body for effective activities. These vitamins according to Onuzulike are distinguished as water soluble and fat soluble. The water solubles are vit B complex, vit. C & bioflavonoid while the fat solubles are vit A, D, E & K. Vitamin A helps in building of strong bones and teeth, in formation of rich blood and maintenance of good sight. Food supplementation in this study is referred to as services designed to improve the nutritional status of mothers and children by providing essential food and micro-nutrient supplements to the mothers and their children.
Utilization according to Onah, Ikeakor and Iloabuchi (2006) is the use of something especially for practical purposes. Hornby (2006) defines utilization as a means of putting something in good use or making adequate use of something. Utilization of healthcare services involves people’s participation in modern health programmes and attitude thereof. Healthcare service utilization is used to determine how a healthcare system produces health in a given population. Studies have indicated that adequate utilization of maternal and child healthcare services is related to improved maternal and child health outcome (Navaneetham & Dharmalingan 2000; Mekonen & Mekonen, 2002; Babalola & Fatusi, 2009). Utilization of MCH helps to access the effectiveness of these services thereby when they are well utilized they will be able to achieve their aim which is to reduce complications and eliminate maternal and child mortality.
Fosu (2011) revealed that without effective utilization of health facilities and services, eradication of disease may be a “chasing of the wind” even when such facilities for eradication are provided. Fosu divided utilization into two; low utilization and effective utilization. Low utilization is when less than fifty percent women use the services and effective is when more than fifty percent use the services. In this study, the extent of utilization of maternal and child healthcare services is the measure of the way or the rate by which MCH available are utilized. This study will help to determine whether the available MCH are underutilized or effectively utilized by the childbearing mothers (CBMs) in Okigwe Local Government Area. However, the extent of utilization of MCH is influenced by many factors which may enhance the use or posse a barrier.
Ajaegbu (2013) noted that poor MCH utilization could be due to long distance which makes it inaccessible to the clinic, non-availability of staff, non-availability of equipment, household behavior, worker’s attitude, cost of providing services and low status of women. The above factors have the potential of restricting or enhancing the usage of MCH which will in turn affect the health of these women and that of their children. Other factors include demographic factors (age, parity, and, location), social factors as religion, level of education culture, availability and accessibility (Awusi, Anyanwu and Okeke, 2009). In this study, the factors investigated are age, parity, level of education and maternal occupation.
Age is a demographic variable that can affect or determine the utilization of healthcare services among childbearing mothers. The childbearing age ranges from 15-49 year. Within these age range, there are variations and different problems according to their ages. Women of earlier stage of 15-20 are the premature and the highest risk group. Those from 21-30 are at better age and lesser risk and have greater chance of having more children. Those from 31-40 have lesser chance of conceiving because fertility tends to decrease after 30 and those after 40 are more likely to experience miscarriages and have children with chromosomal defects than younger women (Maggie, 2001). Mccathy and Maine (1992) stated that mothers’ age sometimes act as a proxy for women accumulated knowledge of health care facilities and services which may have positive influences on the health care utilization. Onah, Ikeakor and Iloabuchi (2006) observed that development of modern medicine and educational opportunities for women in recent years have made younger women to have enhanced knowledge of modern health care and place more emphasis on the values of modern health care. It is pertinent to note that women of younger age are more exposed to modern facilities which facilitate their utilization of health care services more than the older women. Furthermore, the older women may decrease their use of health care services due to some reason like having had enough of health care experiences, no complication in previous pregnancy or being conversant with these conditions which may be in relation with their parity.
Parity refers to the number of children a woman has whether death or alive. Parity can also be referred to as birth order. Several studies (Adamu, 2011; Chakraboty, Islam, Chowdhury, Bari & Hanum, 2003; and Elo, 1992) found out that a strong association exists between birth order and utilization of health care services. Chakraboty, Islam, Chowdhury, Bari & Hanum, (2003) observed that women in the first order that is the primigravida are more likely to seek health care than the multigravida (women with two or more pregnancies or children). Navaneetham (2000) opined that women with large number of children underutilize available health services because many demands on their time force them to forgo health services. Similarly most multigravida and grand gravid (women with more than five pregnancies) think that because they have had several experiences, they do not need the service any longer.
Education is another important variable that determines utilization of health care services. Dharmalingam (1999) stated that illiteracy among women leads to underutilization of M&CHS. He argued that educated women have a greater decision power on health related matters and also attach higher values to their welfare and their health. Navaneetham (2000) stated that educated women tend to use modern health care services more than their non -educated counterparts because they are more knowledgeable on the need for health care use. Furthermore, educated mothers will have more confidence in partaking in any health activities and have the ability and willingness to travel outside to seek medical services. Educated mothers are more aware of their health problem, know more about the available services and use the information more efficiently to maintain and achieve good health. However there seems to be moderate level of education among the childbearing mothers in Okigwe local government area where this study is situated.
Maternal occupation is one of the socio- economic status that can affect maternal and child health service utilization. This socioeconomic status ranges from family income, husband level of education, mothers occupation to residential area. Maternal occupation is referred to as the occupation of the mother which may be correlated with the mother’s level of education. Maternal occupation can be reflected in the family income and time to go for these services utilization. It is well noted that increased family income can positively affect MCH utilization. Anderson and Newman (2008) stated that family income reflects economic status, health insurance coverage and location of residence. They also put it that family income is an important enabling factor as it determines the amount of funds available to cover health or health related costs e.g. physician consultation, drugs, transportation etc. The cost of seeking health services which include cost of medications and other supplies, cost of transportation, users fee (official or unofficial) can affect the use of MCH by the childbearing mothers (Elo, 1992). It is noted that women from poor families or those with limited resources may have difficulties accessing health services and in paying hospital bills. According to the report of FMH (2000) one of the main reason for the low utilization rates of public sector clinics has been the poor standard of facilities and care, user charges also are perceived as high. This was illustrated by Mccarthy and Maine (1992) who noted that hospital birth or delivery drastically reduced in Nigeria following the introduction of user fee in 1980s. Studies also indicated that women whose husbands have higher economic status and occupation are more likely to utilize MCH, likewise women with good jobs or occupation (Adamu,2011, Fotso, Ezeh,& Essendi, 2009). This is because such occupation is usually associated with greater wealth which makes it easier for them to bear the cost of healthcare. These variables (age, parity, level of maternal education and maternal occupation) investigated on the extent of utilization of maternal and child healthcare services will help to device some strategies that will help to improve maternal and child health care services.
Strategy can be defined as intervention procedures that would help to improve the quality of any programme. (Hornby, 2005). Campbell and Graham (2006) argue that strategy is about shaping the future and is the human attempt to get desirable ends with available means. Many studies made some suggestions that would help to enhance and to improve maternal and child health services (Nteta et al 2010, Sweet & Appelbuam 2004, Ajaegbu 2013). When these strategies are adopted and implemented, they will help to increase utilization of M&CHS by the child bearing mothers in Okigwe LGA of Imo State, thereby reducing the rate of maternal and child morbidity and mortality.
Childbearing mothers (CBMs) are women of childbearing age (15-49 years of age). They are the most vulnerable in the society because of the life threatening problems and death associated with pregnancy and childbirth. Berg (2005) noted that CBMs are the most vulnerable population in the society that need genuine caring as unique individuals because of the complications and risks apparent in childbearing. Childbearing however is defined as the period during pregnancy, childbirth and early post partum phase. Pregnancy and child birth has become a thing of concern to this group of people because every one of them is expected to go through the ordeal of pregnancy to answer a woman. Thus, they are exposed to all sorts of complications which can equally affect their children.
The study will be anchored on three theories; Anderson health seeking behavioral theory (AHBT), health belief model (HBM) and protection motivational theory (PMT). Anderson health seeking behavioral theory was proposed by Anderson and Newman (Anderson and Newman 1973). The theory proposed that the use of health care services is a function of three sets of individual characteristics which include the predisposing characteristics, the enabling characteristics and the need characteristics. The study is anchored on this model because for a CBM to seek for health services and utilize them all these characteristics such as demographic factors include age, sex, parity etc, social structural factors which is a reflection of the individual social standing or status and is measured by characteristics such as educational attainment and occupation of the head of the family and attitudinal beliefs of the individual (demographic and socio-economic variables) must be reflected and there must be need characteristics such as characteristics of illness, perceived health status and expected benefit from treatment. These will make her to seek health services and utilize them.
The health belief model (HBM) is a psychological model propounded by Rosenstock (1974). The theory explains health behavior. The health belief model is based on the assumption that a person will take health related action and uses health services if he feels that a negative health condition can be avoided, if he has a positive expectation that by taking a recommended health action the condition can be abated. In this study, health belief model is useful because there are some personal characteristics of the CBM that make her to be aware and believe that pregnancy and childbirth posses negative conditions, thus she will try to avoid these negative conditions by seeking MCH and utilizing them effectively.
Protection motivational theory is propounded by Rogers (1983). The theory describes adaptive and maladaptive coping with a health threat which is as a result of two appraisal processes: a process of threat appraisal and a process of coping appraisal. The threat appraisal assesses the severity of the situation while the coping appraisal is how one respond to the situation. In this study, this model will help to understand the severity of pregnancy condition as a threat to ones life and the need to cope with the situation by adequate utilization of MCH by the CBMs. Therefore, these models are useful in this study to ascertain the extent of utilization of MCH by CBMs in Okigwe Local Government Area of Imo state.
Okigwe LGA is one of the local governments in Imo state, southeast state of Nigeria. It is the second largest city in Imo state. It lies between Port Harcourt, Enugu and Maiduguri link. It has grown into a major cattle transit town for southeast and south sub-region. Okigwe has a population of 164,134 (see Appendix C). Most of the population is made up of immigrant workers from other states because it was the primary host of Abia state university and one of the unity schools. It also has various tourist and historical sites. The indigenes are mostly peasant farmers and traders that deal on farm produce especially the women who are mostly house wives while others are petty traders, peasant farmers and hair dressers. Okigwe has 15 political/health wards but only 12 wards are functional with 20 primary health centers that offer maternal and child healthcare services but the extent of utilization of these services has become its major public health concern. Child bearing mothers in Okigwe LGA seem to be underutilizing the available MCH in their health facilities. This might be as a result of their busy schedules due to the type of business they do, non- functioning of some primary health centers, non accessibility to the health facilities due to bad roads and no access to transportation and their poor socio economic status. It is therefore against the backdrop of safety and health of the CBMs and their children that the researcher was prompted to investigate on the extent of utilization of MCH among CBMs in Okigwe LGA Imo state and to suggest some strategies that will help to enhance maternal and child health care services. This represents the need for this study.
Statement of the Problem
Pregnancy and childbirth is a period of joy and happiness to the woman and the entire family. It is an experience that every woman wishes to go through but the challenges of complications and mortality that accrue from it make it a thing of concern in the society. It is noted that the extent of utilization of maternal and child healthcare services is a major determinant of maternal and child morbidity and mortality. It is also observed that women who adequately utilize these services are relatively free from traumas of pregnancy and child birth and also have children that will be free from childhood problems. The millennium development goals (MDGs) have aimed at reducing maternal and child mortality by 3/4 and 2/3 by the year 2015 and this can be achieved through provision of maternal and child healthcare services. These services are provided to all areas even to the grassroots through primary health care delivery system to meet the MDGs target. All these services have been provided for easy access and for adequate utilization by the child bearing mothers.
Regrettably it seems that most of the CBMs are not utilizing these services effectively. This may have resulted in many of them experiencing one complication and another during pregnancy and childbirth which can lead to their death and that of their children thereby increasing the country’s rate of mortality.
Okigwe LGA seems to be experiencing a marked underutilization of available MCH as there is still high rate of pregnancy complications and child deaths as the researcher observed. This may be attributed to their level of education coupled with poor socio-economic status and their occupation. However, most of the previous studies conducted on maternal and child health focused on availability, pattern, and provision of MCH in other areas. There seems to be no published work on extent of utilization and strategies for enhancement of MCH among childbearing mothers in Okigwe LGA of Imo State. This is the crux of the present study.
Purpose of the Study
The purpose of the study was to ascertain the extent of utilization of MCH among CBMs in Okigwe LGA Imo state and to suggest some strategies for enhancement of MCH. Specifically, the study sought to:
- ascertain the extent of utilization of ante natal care services among child bearing mothers in Okigwe LGA;
- ascertain the delivery care services utilized by the child bearing mothers in Okigwe LGA;
- determine the post natal care services utilized by child bearing mothers in Okigwe LGA;
- find out the immunization services adopted by child bearing mothers in Okigwe LGA;
- find out the family planning practices among child bearing mothers in Okigwe LGA;
- find out the food supplementation services of child bearing mothers in Okigwe LGA;
- find out the factors associated the utilization of MCH among CBMs in Okigwe LGA.
- Find out some strategies for enhancement of maternal and child health care services.
To guide this study, the following research questions were posed.
- What is the extent of utilization of ante natal care service among child bearing mothers in Okigwe LGA?
- What are the delivery care services utilized by child bearing mothers in Okigwe LGA?
- What are the post natal care services utilized by child bearing mothers in Okigwe LGA?
- Which immunization services are adopted by child bearing mothers in Okigwe LGA?
- Which family planning practices are utilized by child bearing mothers in Okigwe LGA?
- Which food supplementation services are utilized by Child bearing mothers in Okigwe LGA?
- What are the factors associated with the utilization of MCH among childbearing mothers in Okigwe LGA?
- What are the strategies for enhancement of maternal and child health care services?
The following null hypotheses were postulated to guide the present study. Each null hypothesis was tested at 0.05 levels of significance at the appropriate degree of freedom.
- There is no significant difference on the extent of utilization of maternal and child health care services based on maternal age.
- There is no significant difference on the extent of utilization of maternal and child health care services based on parity.
- There is no significant difference on the extent of utilization of maternal and child health care services based on maternal level of education.
- There is no significant difference on the extent of utilization of maternal and child health care services based on maternal occupation.
Significance of the Study
The findings from this study will be of great benefit to doctors, nurses, community health workers, public health educators, childbearing mothers, reproductive health planners, government and the general public. Data generated on the extent of utilization of ANC will help the service providers, the government, reproductive health planners and the community health workers to know the ANC services that are mostly utilized and the extent they are being utilized by the CBMs thus helping them to plan for the ones that are not available and improve on the ones that are underutilized. It will help the health educators to intensify effort in educating the women on the need for effective utilization of ante natal care services.
Data from the extent of utilization of DCS will help doctors, nurses and community health workers to know the DCS available in the health facilities to know whether the obstetric material are enough for the CBMs and be able to provide the ones that are not available and also to plan how to give more training to the skilled birth attendants to improve on the rate of utilizing them. The health educators will equally benefit by going to the grass root to educate and to make sure the women seek for skilled birth attendants during labour till delivery.
Data generated on the extent of utilization of PNC will be beneficial to health educators and community health workers so that they will always organize programmes that most women will likely benefit especially in Okigwe where most of the women are peasant farmers that hardly have their own time to engage in anything especially after delivery. It will also guide the reproductive health planners to formulate policy that will take care of women immediately after delivery and also to make sure that these women receive PNC either at home or through mobile clinic. Similarly, the CBMs will know the importance of PNC services and be able to utilize them more effectively.
The result on the extent of utilization of IMM will provide the government, health planners, health service providers and health educators with adequate information on the women that utilize IMS and the extent to which they utilize them, thus helping them to put available measures that will help the women to utilize immunization services irrespective of any factor that may hinder them. It will help the health planners and the government to provide more vaccines that will be enough for CBMs and their children. Also the women and the general public will know the importance of IMS thereby encouraging them to utilize these facilities and services no matter the odds.
Data generated on the extent of utilization of FPS will be of benefit to health educators and health workers to mount up campaign for all women to encourage them on the need for proper utilization of FPS no matter the number of pregnancies or children. It will equally help the reproductive health planners and the government to put more effort on provision of family planning devices to minimize and control the number of children to have and to help infertile couples. Women and the general public will also benefit in knowing the available family planning devices and be able to use them effectively.
Most data generated on the extent of utilization FSS services will be beneficial to government, health educators, parents and women as this may help the government to plan and implement policy on provision of sufficient food and vitamin supplements thus helping to reduce general malnutrition among women and children. The health educators will educate on the need for nutritious food and teach on how to prepare them. Similarly the women will be more exposed on the need for nutritious food and how to prepare some.
The data on factors that influence utilization of M&CHS will be of benefit to the government and health planners to make these services available and accessible to all the CBMs by increasing the number of primary health centers in their political wards and by making them functional. It will help the service providers to reduce the cost of the services and as well give them free of charge so that all will benefit no matter their socioeconomic level. It will also help the community health workers and public health educators to mount up campaigns to educate on the need for proper utilization of these services no matter the cultural and religious influences. The general public will as well appreciate the need for women autonomy, financial support and empowerment on reproductive matters. This study will be a source of empowerment and encouragement on the reproductive health and several health policies in the country. It will appraise the need for women’s education and girl child education will be emphasized. The study will provide the health educators with necessary knowledge to organize seminars, workshop and symposium to educate women from different location (urban or rural) to utilize M&CHS. More so all the women should know the need for effective utilization of M&CHS no matter their age, number of previous pregnancies, and their level of education.
Data generated on the strategies for enhancement of M&CHS will be of benefit to the health care providers, the policy makers, health educators, child bearing mothers and the general public. To the health care provider they will help to encourage the government on the provision of adequate maternal and child services to the grass root. The health educators through this study will help to mobilize the government and the entire public to contribute to the improvement of maternal and child health services. The policy maker will as well revise the policy to accept these strategies and provide means for their implementation. The child bearing mothers through these will know that when these strategies are adopted it has become their duty to utilize the services effectively. The general public will also be aware of these strategies and contribute their quota to the provision and their implementation.
Finally, the study was anchored on Anderson behavioral theory, health belief model and protection motivational theory. The study will help to verify the relevance of these theories with regards to the extent of utilization of M&CHS among CBMs of Okigwe LGA of Imo State because these theories reflected all the characteristics of the childbearing mothers and all the factors that predispose and encourage them to utilize maternal and child health care services.
Scope of the Study
The study was delimited to childbearing mothers of Okigwe LGA of Imo State. The maternal and child healthcare service investigated were antenatal care services, delivery care services, post-partum care services, immunization services, family planning services and food supplementation services. Variables studied were age, parity, level of education and maternal occupation.
Review of Related Literature
Many literatures abound on utilization of maternal and child healthcare services in general. Most of these literatures are focused on Nigeria, Africa and other countries. The chapter is organized under the following subheadings:
- Conceptual Framework
- Maternal and child healthcare services and its components
- Utilization of MCH
- Factors influencing utilization of MCH
- Strategies for enhancement of MCH
- Theoretical Framework
- Anderson health seeking behavioral model (AHBM)
- Health belief model (HBM)
- Protection motivational theory (PMT)
- Empirical Studies on Utilization of MCH