For labor analgesia, epidural anaesthesia is the preferred and gold standard treatment. However, in our context, this strategy is underutilized. The goal of this study is to analyze pregnant women’s perceptions of this approach for labor analgesia in a Nigerian tertiary hospital setting in order to recommend strategies to improve its use.
Goals and Objectives
In antenatal clinics, evaluate women’s knowledge and perceptions of epidural analgesia for labor.
Role of immunization on prevention of disease among children 0-59 months of ages in Nigeria
Childhood immunization of children between 0-5 years is a cost effective public health strategy. Expanded Programme on immunization (EPI) services have been provided in Sapale local government area of Delta State mainly through the health facilities in the LGA. The objective of this survey was to assess vaccination coverage and its determinants in this rural suburb in Nigeria. A cross-sectional survey was conducted in October 2010, which included the use of interviewer-administered questionnaire to assess knowledge of mothers of children aged 0-5years on childhood immunization and vaccination coverage of the children. Survey participants were selected using a multistage sampling method. Vaccination coverage was assessed by vaccination card and material history. A child was said to be fully vaccinated if he or she had received all the following vaccines: a dose of BCG, three doses of OPV and DPT, and one dose of measles by the time he or she was enrolled in the survey. Person chi-square (x2) test was performed to identify determinants of full immunization status. 250 mothers and 250 children (each mother had one eligible child) were included in the survey. 80 (32%) of the children were fully immunized while 112 (44.8%) were not immunized from the vaccination cards while with maternal history 86 (34.4%) were fully immunized, though this difference was not statistically significant P = 0.210 45 (26.5%) of 170 children who defaulted had visited a health facility since their last vaccination or since they attained appropriate age. Majority of the children 109 (43.6%) received their vaccination in Public health facilities. Chi-square test showed that mothers educational status (P = 0.004), religious denomination (P = 0.019) and child’s problem after immunization P = 0.012 were significantly associated with under immunization.
It is therefore concluded that despite all the efforts made by the government, the vaccination coverage in this rural suburb is still at a level that does not provide high protection (80%) against DPT/ OPV and even measles.
To improve on the low immunization coverage, attention should be paid to female education, health education, capacity building of the immunization service providers and supportive supervision.
CHAPTER ONE INTRODUCTION
Immunization remains one of the most important public health interventions and a cost effective strategy to reduce both the morbidity and mortality associated with communicable diseases. Over two million deaths are prevented through immunization each
year worldwide1. Despite this, vaccine preventable diseases remain the most common cause of childhood mortality with an estimated 3 million deaths each year2. Uptake of vaccination services depends
not only on provision of the services but also on other factors
including knowledge and attitude of mothers3,4, density of health
workers5, accessibility of vaccination centres and availability of safe needles and syringes.
Nigeria like many countries in Africa is making efforts to strengthen its health system especially routine immunization so as to reduce disease burden from vaccine preventable diseases (VPDs).
In 1979, Nigeria’s Expanded Programme on Immunization (EPI) was initiated6 (though created in 1974 by WHO, UNICEF and Rotary International as partners). It was relaunched in 1984 due to
poor coverage7. In 1996 it became the National Programme on Immunization (NPI). Following a review of EPI Decree 12 of 1997, NPI was made a parastatal.
36 states and Federal Capital Territory (FCT). In Delta State, private or NGO providers are the source of up to one
third of RI in Delta State8.
Public sector provision is by health staff based at facilities run by the 21 Local Government areas (LGAs), the General hospitals run by the state government and the tertiary institution run by the federal government.
There is also supplemental immunizations done periodically in the state in the form of National Immunization days (NIDs), local immunization days (LIDs), immunization plus days (IPDs) and
child health week all aimed at boosting immunization coverage and mopping up and reaching every child (including those not already reached) irrespective of their immunization status
Family planning is a cost-effective strategy for achieving population development. Family planning uptake is low in sub-Saharan Africa, including Nigeria. We assessed the perception, pattern of use, partner support and determinants of uptake of family planning methods among married women of reproductive age in rural communities of Ebonyi state.
This is part of a baseline report of a quasi-experimental study. A total of 484 married women of reproductive age were recruited using multistage sampling method. Four focus group discussions (men and women) and pre-tested semi-structured interviewer-administered questionnaires were used to collect information from the participants. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20 software and thematic analysis. Chi-square test and logistic regression were carried out at 5% significance level.
Abstract
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.
CHAPTER ONE
Introduction
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:
Research Questions
To guide this study, the following research questions were posed.
Hypotheses
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.
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.
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:
CHAPTER ONE
INTRODUCTION
This chapter presents the background of the study related to the context of Nigeria and Nigeria’s health system, and the quality of patient record-keeping. It outlines the problem statement related to the quality of patient record-keeping, and the aim and objectives of the study. It also describes the significance of the study and gives operational definitions of terms. Lastly, an outline of the thesis is presented.
Keeping patient records accurately provides a correct account of the treatment and care given to patients; this allows for good communication between nurses and midwives as a team in their daily activities (Stevens & Pickering, 2010). Patients’ daily records, including the nursing records, are considered legal documents and must accurately and honestly reflect nursing actions carried out for the patients (Maharaj, 2015). Poor documentation potentially negatively affects patient care, professional accountability, and organisational risk (Blair & Smith, 2012). In addition, future improvement of nursing care depends on precise nursing information in the patient’s records; it is thus essential that nursing records be completed comprehensively and accurately. However, many countries across the world are experiencing problems in decision making, planning processes, and performance evaluation of healthcare programmes due to the poor quality of health data recording (Corrao et al., 2009).
The United States Department of Health and Human Services in 2006 reported that the ratio for missing medical records was 1:7 in health services institutions, which means that for every 7 patients one medical file is missing, due to the lack of quality patient record-keeping (Marutha,
2011). Problems of poor-quality health data, a low level of health information use and poor management of health information systems have also been reported in a systematic review of health data quality management and best practices at community and district levels in low- and middle-income countries (LMIC) (Ndabarora, Chipps & Uys, 2014).
Keeping a clear and accurate nursing record for each patient is one of a nurse’s day-to-day duties, as this is only one method to support a nurse to remember everything that has been done during a shift, in order to facilitate a clear and complete handover of patient information to the next team of nurses and midwives (Stevens & Pickering, 2010).
According to the law in many countries, if care or treatment given to a patient is not accurately recorded, it can be taken that it has not been done (Stevens & Pickering, 2010). Records provide for accountability by offering a basis for continuity of care, evidence of changes in the patient’s condition and proof that care has occurred (McIntosh, 2008).
The South African Nursing Council (SANC) states that “the quality of nursing practice is founded on timely, accurate and complete recording of the care provided to patient” (McIntosh, 2008, 3 ). Furthermore, the South African Nursing Council Act 33 of 2005 indicates that a nurse may be disciplined if found negligent for not recording details of his or her nursing care (Mtsha, 2009).
Evidence in the literature has shown that poor record-keeping leads to failure of the healthcare system to deliver an efficient service (Marutha, 2011). Similarly, a study by Ngoepe (2012) revealed that poor record-keeping is one of the major factors contributing to negative audit reports.
In South Africa studies by Marutha (2011) and Chinyemba (2011) identified that many institutions in public health sectors in Limpopo Province and some other provinces are experiencing the same problems of poor quality of patient record-keeping.
According to Jefferies et al (2010: 113) study, state that traditionally nurses and midwives communicate information more verbally about their patients, more so than confirming it in writing. In Tanzania a study conducted by Mamseri (2012, 107) on ‘The nursing process as a means of improving patient care’ revealed that nurses and midwives often use verbal communication rather than written communication while reporting their patients’ care and conditions. The study identified that among 120 respondents, 31 (26%) agreed that they always use verbal communication, 59 (49%) indicated that nurses and midwives sometimes use written communication, 18 (15%) reported that they rarely take care about written communication, and 12 (10%) were not at all if they always use verbal communication or sometimes use written communication.
In a study by Olivier (2010), revealed that there is an evidence correlation between the length of time following completion of training and reluctance to keep records. It means that with the more time lapsed, the least likely nurses and midwives are to keep adequate records, and this should be the result of the lack of the current knowledge regarding nurse’s attitude related to terminology and record- keeping.
According to Saranto and Kinunen (2009: 465) study, standardised terminology is a pre-requisite for consistent communication, therefore certain skills and knowledge are essential to achieve this effective communication among health care providers. The action of record-keeping requires skills and knowledge as information is recorded in line with the steps of the nursing process of
assessment, planning, implementation and evaluation (Mamseri, 2012).
However in Maharaj (2015) study, conducted in three hospitals in the Umgungudlovu District of KwaZulu-Natal, South Africa, confirmed that a shortage of nurses and midwives , non-use of support staff per nursing unit, bed occupancy rate and type of unit, including type of hospital, are the greatest barriers hindering the quality of patient information recording and processing. Other major factors are lack of awareness about the proper filing systems, lack of training and of knowledge, and practical skills of nursing staff in patient information record-keeping (Marutha, 2011)
Nigeria is experiencing nurses and midwives ’ complaints about workload (Carlsson et al., 2014) and has a continuously decreasing investment in education and research activities (Klopper & Gasanganwa, 2015). There is limited information regarding the quality of patient information recording in clinical settings in Nigeria.
Maternal mortality continues to be a global burden worldwide. Each year, more than 200 million women become pregnant and a large number of mothers die as a result of complications of pregnancy or childbirth. Nigeria is still one of those developing countries with high maternal mortality ratio and child mortality rate, estimated at 340/100,000 and 21/1000 live births respectively. The World Health Organisation (WHO) has recommended the use of partograph to monitor labour and delivery, in order to improve healthcare and reduce maternal and foetal mortality rate.
The study examined the effect of training midwives on the utilisation of panrtograph in general hospitals in Ogun east senatorial districts; quasi-experimental design was used for the study. The study used two groups- intervention and control groups using right inclusion and exclusion criteria. The entire population comprised of 45 midwives providing obstetric care in the labour ward. A structured questionnaire which contained close ended questions was used to elicit information from the participants. Face and content validity of the instrument were determined while their reliability indices of 0.75 and 0.86 respectively were established using split-half test and spearmen brown’s formula. Statistical package for the social sciences (SPSS) version 22.0 was used for the statistical analysis and a coding of variables in this quantitative research was utilised for better interpretation of results. Descriptive analysis (frequency, percentage, mean and standard deviation) was used to analyze the demographic characteristics of the participants. t-test was used to determine the difference in mean score of pre and post-test of the sampled midwives in the selected general hospitals.
The study showed that 45(100.0%) of the participants where all female midwives, (82.2%) of the participants where within the ages of 30 and 49, 27(60.0%) of the participants where registered midwives. The t-test result indicate that there is no statistically significant difference between intervention group and control group prior to partograph training intervention (t=-2.375; p>.05). It also indicate that there is a statistically significant difference between intervention group and control group immediately after partograph training intervention (t=-1.5.46; p<.0.5).
It was concluded that intervention training enhanced the knowledge and skills midwives in the use of partograph. Therefore it was recommended that midwives should be exposed to regular in-service training on the use of partograph to monitor the progress of labour. Hence, it is important that nurses and midwives are empowered with necessary knowledge and skills that are linked to job responsibilities and roles.
Globally, labour has been defined as a physiological process characterized by an increase in myometrial activity resulting in cervical effacement and dilatation; followed by the expulsion of the foetus from the uterus to the outside world. It is therefore imperative for midwives to monitor the woman in labour utilising a partograph in order to have a safe delivery; and to avoid obstructed and prolonged labour (Ratchliffe, 2010).
A partograph is an effective clinical tool used during labour surveillance for early diagnosis of complications. The partograph is a simple chart that, when used routinely for every birth, aids the monitoring of labour and provides early warning of the need for intervention so health workers can provide prompt, appropriate care (World Health Organisation, 2014). Partograph was developed by an obstetrician named Friedman, which he tagged as cervicograph as a result of its usefulness to monitor cervical dilatations. Furthermore, cervicograph was adopted by Philpott in 1972 and he redesigned it as partograph to serve as a practical device in the documentation of all intrapartum observations and not only to monitor cervical dilatation, hence, the phrase “Philpott’s partograph”. This new document contains action lines and alert lines which are used to determine cases of prolonged labour.
In 1988, Safe Motherhood Initiative established the adoption of partograph as a global practical device that is of high quality to monitor labour and avert prolonged labour. Furthermore, extensive examination was conducted in 2014 by WHO and the organisation established a scientific based rationale for the use of partograph as the aversion of maternal morbidity and prolonged labour. However, when correctly implemented, partograph minimize cases of obstructed and prolonged labour as well assist in identifying heart abnormalities which can have intrapartum foetal hypoxia as its consequences.
(Cronje and Grobler, 2012; Dangal, 2011) described the partograph as a graphical representation of progressive stages of labour, related situations or parameters on pregnant mother and foetus, displaying all investigation made during the first stage of labour in a manner that will enable midwives and medical practitioners to analyse, interpret and recognise if the pregnant woman has moved into a high risk category and to respond decisively to the identified problems.
With reference to the World Health Organisation (2014), the utility of partograph to observe pregnant women in labour does not serve as an alternative for proper assessment of conditions that needs instant reference of pregnant women on the arrival at the labour unit. World Health Organisation (2014) further states that the partograph is developed for timely identification of abnormal progress of labour and the aversion of prolonged labour which would significantly reduce the risk of postpartum hemorrhage and sepsis as well eradicate obstructed labour, prolonged labour, uterine rupture and its sequelae. The organisation further affirm that the purpose of the use of partograph to examine pregnant women in labour is to lessen morbidity and mortality rate of pregnant women globally, to develop the level of care of pregnant women during labour session, to develop the observational abilities and skills of the midwives, to assist in the advancement of team work in a bid to ease the referral to specialist units and promote timely referral from the primary health units.
A randomized study was conducted on 434 women in Mexico in 1966 to test for the effectiveness of the utilisation of the partograph during labour using Friedman’s partograph and a non-graphical descriptive chart. The women were randomized to either Friedman’s partograph or a non-graphical descriptive chart. The study revealed that those who were not put on the partograph had more operative deliveries and more babies with low Apgar scores at 5 minutes. Another study conducted in Karachi by Bhutta, Javed, and Shoaib, (2010) tested the role of the partograph in preventing prolonged labour, the objective of the study was to determine the effect of the partograph on the frequency of prolonged labour, augmentation of labour, operative deliveries and appropriate interventions based on the partograph to reduce maternal and perinatal complications. A case-controlled prospective and interventional study on 1000 women in labour was carried out in the obstetric units of Jinna Postgraduate Medical Centre, Karachi. Five hundred (500) women were studied before and after the introduction of the partograph. The results showed that there was a reduction in both the duration of labour and the number of augmented labour and vaginal examinations. It was concluded that by using the partograph to monitor pregnant women in labour reduced the frequency of prolonged labour, augmented labour, postpartum hemorrhage, ruptured uterus, puerperal sepsis and perinatal morbidity and mortality rates.
In spite of the continual use of the partograph in the health care industry; and wide record keeping of its effectiveness (Chongsuvivatwong & Fahdhy 2015; Fawole & Fadare, 2010)
recorded variation attainable with the use of partograph across health care facilities in Nigeria. It was revealed that in two separate tertiary hospitals, 84% of midwives had good knowledge on partograph and average of 31% of partograph graphs was correctly filled. Hindrances in the effective utilisation of partograph were discovered by Opiah on cases such as absence on the use of partograph charts (30.3%), and under-staff (19.4%). The absence of knowledge and the use of partograph were discovered by (Fawole et al. (2010); Daniel, Oladapo, & Olatunji, 2016) among different levels of maternity health providers in all three levels of health care. A report was also submitted showing that previous training significantly improved the knowledge and accurate use of partograph.
Researchers also indicated that tertiary health workers employs partograph unlike their counterparts in secondary and primary level health workers. Furthermore, research also indicates that just 33.7% cases of 1,319 deliveries were monitored with the effective use of partograph which influenced decision making as well as associated positive labour result available among low and high risk cases. However the extent of which partograph is being employed neither attitude of midwives as a means to attainment of effective or non-utilisation of partograph is not available in literature. The aim of the utilisation of partograph is to empower midwives with plotting, analysis and interpretation skills when monitoring pregnant women in labour.
In the study conducted by Chongsuvivatwong & Fahdhy (2015), it is stated that the partograph was introduced in Indonesia in 1998, and the new version of the World Health Organisation (WHO) partograph was brought into Indonesia in 2000. The aim of the study was to assess the effectiveness of promoting the utilisation of the partograph by midwives caring for women in labour. Previously, before research, it was however discovered that utilisation of partograph was not carried out by midwives because complains were given that partograph’s completion is highly complicating. It was however observed that utilisation of partograph was as a result of midwives education, training and supervision which led to notable reduction in the number of vaginal assessment, augmentation of labour, obstructed labour, poor Apgar score and increased transfer to mention but a few. Furthermore Alfirevic, Lavendor and Walkinshaw (2016) support that if progress of labour crossed the action line; a diagnosis of prolonged labour was made and managed according to protocol. The results of this study showed that the use of the 4 hour action line partograph improved the maternal and neonatal outcomes.
The use of partograph as a device for intrapartum assessment by midwives in sub-Saharan Africa is still a challenge, a notion supported by the study conducted in South West Nigeria by Adekanle, Fawole and Hunyinbo (2008) who found that a partograph is commonly not employed to monitor pregnant women in Nigerian as a result of insufficient idea about partograph.
Furthermore, the authors concluded that the maternal mortality rate in Nigeria is a major public health issue and continues to rise since a partograph is not effectively used as a tool for monitoring labour. Nakkazi (2010) indicates that midwives often feel that completing the partograph is an additional time-consuming task, and they do not always understand how the utilisation of the partograph to monitor pregnant women in labour can be life-saving. Thus, some midwives take the partograph lightly as they plot the partograph when pregnant women who were in labour have already delivered. Midwives often argue that they do not have time to plot the partograph during the monitoring of pregnant women in labour. The National Department of Health (2010) further states that all midwives should employ the partograph when assessing pregnant women in labour so that problems identified during monitoring of labour can be attended to promptly by both the midwife and the attending doctor. Therefore, utilisation of the partograph increases the analysis and interpretation skills of midwives, the monitoring of pregnant women in labour and thus aids in providing standardized fetal and maternal care, and accordingly improves midwifery care.
Researchers ascertained that to effectively use the partograph, requires knowledge and skills. Therefore, education, training and supervision of the midwives will results in a higher rate of the utilisation of the partograph which will reduce the number of virginal examinations, prolonged labour, augmented labour, poor apgar score at first minute, obstructed labour and increased referral.
The focus of this research therefore is to identify midwives’ knowledge on the use of the partograph as a tool to monitor labor, comparatively assess the use of the partograph among midwives in the hospital, assess level of deployment of partograph as a device in each center, identify barriers to its use, determine the existing relationship with the length of years of experience and knowledge of the use of the partograph in the hospitals.
A number of research studies revealed that there are challenges associated with the correct and consistent use of the partograph (Lester, 2010; Magon, 2011; Mathibe-Neke, 2009; Opiah, 2011). The findings from these studies reveal that there is poor utilisation of the partograph, which were largely related to the midwives’ lack of competence and knowledge on the use of the partograph. They submit further that non- availability of the partograph, shortage of staff, lack of in-service training and the number of years of experience in intrapartum care are also some of the contributory factors associated with the poor utilisation of the partograph.
(Magon, 2011; Ogwang et al. (2009); Opiah, 2011) argued that caregivers may regard filling of the partograph as an additional chore. The study conducted by Lavender, Lee, Mathai, Omoni and Wakasiaka (2011) also revealed that partographs were filled in retrospectively, and done only as a defensive practice to avoid being reprimanded by the matrons. The researcher has also observed from clinical practice that midwives do not utilise the partograph appropriately when monitoring pregnant women in labour either by not plotting or incompletely plotting the activities and also not interpreting the findings as appropriate. Consequently, labour cases which carry impending dangers to both mother and the foetus are not usually discovered and managed accordingly. These have often led to an increase maternal/foetal mortality, morbidity and irreversible damages on their lives. The purpose of this study, therefore, is to examine the Effect of training midwives on the utilisation of partograph in General Hospitals in Ogun East Senatorial District.
The main objective of this study is to evaluate the effectiveness of training midwives on the utilisation of partograph in General Hospitals in Ogun East Senatorial District. The specific objectives are to:
The research questions focus on providing answers to the following concerns;
Ho1 There is no significant difference in pre-test utilisation of partograph of trained and untrained midwives.
Ho2 There is no significant difference in post-test utilisation of partograph of trained and untrained midwives.
This study evaluated the effect of training midwives to improve their knowledge on utilization of partograph in general hospitals in Ogun east senatorial district.
This research is essential to influence the reduction of maternal and neonatal mortality and morbidity rates, which are on the increase in Nigeria. By creating innovative and other methods on how to use the partograph, it can increase confidence and facilitate supervision of junior and learner midwives working in the labour ward so that the partograph is used correctly and consistently and thus benefit these categories of staff (Fistula Care and Maternal Health Task Force, 2012). This could contribute to lifelong learning for all practitioners working in a labour ward. The barriers and challenges identified in the study could influence policy making and create an enabling environment for midwife practitioners in the operational field. Managers have knowledge from the research on how to plan pre and in-service training of the clinical staff, making them confident and competent. The most significant benefit would be the improved health care provided to the mother and child by improved support for the practitioner at the grassroots level. Confidence and competence in rendering care to the mother during labour would boost the confidence of the client in the health care system, and thus also improve its reputation.
The major determinant to the expansive inconsistency level in care and the outcome of reproductive health between the advanced and developing countries is based on maternal mortality ratio. This observation is supported by the global maternal mortality pattern in which annual loss of more than 515,000 maternal deaths from complications of pregnancy and childbirth occurring in developing countries. Among those who survive childbirth at least 8 million develop serious morbidities and a further 50 million suffer minor complications. Therefore, the partograph should be used for all women admitted in established labour as it serves as an “early warning system” and assists in early decision on transfer, augmentation and termination of labour. It also increases the quality and regularity of all observations on the fetus and the mother in labour and aids early recognition of problems.
Maternal morbidity rate increases because of insufficient facilities in the health care settings, inadequate attitude and knowledge of plotting the interventions in the partograph. Therefore, midwives need adequate knowledge regarding the partograph and its use to reduce the maternal mortality and morbidity rate. Partograph knowledge helps to improve good attitude and practice in the clinical performance. Hence, there is a need to assess the knowledge, attitude and practice of partograph among midwives.
Operational definition was used to describe the following terms:
Utilisation – To put to use especially to make profitable or effective use of an approach, in this study utilisation refers to plotting the partograph correctly and making appropriate decisions.
Partograph – in this study a partograph refers to the labour graph provided by Ogun State Ministry of Health.
Midwife –in this study, midwife refers to a person trained to assess, monitor, analyse and interpret labour and conduct delivery of pregnant women.
Effect – it refers to the extent to which the structured teaching program on partograph has achieved the desire effect in improving the knowledge of midwives as an evidenced by gain in knowledge scores.
Training- it refers to planned teaching programme regarding proper use of Partograph
Background: Low back pain (LBP) has been documented to be a common occupational health problem among health care workers. A cross sectional study was carried out in a health facility in South – South Nigeria to determine the prevalence and risk factors of low back pain among the workers. Materials and Methods: Data was collected using a self designed, interviewer assisted, semistructured questionnaire. Information obtained included socio-demographic characteristics, work history of respondents, prevalence and factors predisposing to low back pain. The tool was administered during the different shifts of the health workers. Frequencies were calculated and Fishers exact test was used to test the significance of association between different variables. Level of significance was set at 0.05. Results: A total of 50 out of 53 workers participated in the study. The mean age of the respondents was 36.59±8.6 years with a male to female ratio of 2:3. The overall prevalence of LBP
This dissertation reports results of a study that was carried to assess Job satisfaction among Nurses in National hospital Abuja..Determinants selected for the study were socio-demographic characteristics such as sex, gender, marital status, work experience and level of education. A sample of 286 nurses was conveniently drawn from a population of 683 nurses at the hospital. Data was collected through a structured questionnaire. Independent two-sample t-test and one way ANOVA statistical techniques were used in the analysis. The results reveal that about half of the nurses at NHA are satisfied with their job. Of the hygiene factors job independence, supervision independence, co-workers relationship and working conditions ranked higher; while from the motivators job authority, job security and job responsibility ranked higher. The results also report statistically significant differences in the job satisfaction scores between age and marital status as well as among the work experience categories. No significant differences in job satisfaction were found between gender and level of education categories. It is recommended that management should ensure further improvement in the working environment and have human resource policies that foster job authority, job independence, good working relationship, clear responsibility and job security. On the job training as well as mentorship programmes are highly encouraged. Life skills that would encourage family life are also welcome.
This study is on Knowledge, attitude and awareness of antinatal and maternity health care service among women of child bearing age. The objectives of the study were ;To establish the influence of the presence of Traditional Birth Attendant, investigate the extent to which level of awareness influences attendance to antenatal care by the Nigeria women, investigate how cultural beliefs towards modern reproductive services affect antenatal seeking behavior among the Nigeria and find out how economic status contribute to the number of Nigeria women who seek antenatal care. The target population was all Nigeria women living in Lagos state.Data collection was carried out by the researcher over a period of four weeks by use of self administered questionnaires from respondents who could read and write and also with the assistance of a research assistant for the illiterate respondents. All questionnaires were edited and responses coded before data was entered into the computer by the use of the Statistical Program for Social Scientists (SPSS), version 11.5. Cross tabulation was the main method used for data analysis. After analysis, data was summarized and presented in form of frequency tables, percentages and proportions. Majority respondents were within the active ages of reproduction with a majority 72% practicing Islam while 50.8% had no formal education. The study established great need of awareness programmes geared towards enlightening the Nigeria women with 63.6% of the respondents unaware since most of them were illiterate. The study recommended that women be encouraged to undertake entrepreneurial activities since there was high relationship of economic status and attendance to antenatal clinics.
INTRODUCTION
Antenatal care service is an important goal concerning in the health status of the pregnant women during their reproductive period and its health beneficial accounting for nearly one quarter of all pregnant worldwide Terry TL (1942)
Through the antenatal care service attempts have been made to identify pregnant women not at risk and those at risk group based on their previous pregnant or currently historical or clinical factors and steps are planned to prevent it in this allegedly high-risk group of women to reduce adverse pregnancy outcomes Lincetto et al (2013).
Unfortunately, adverse pregnancy outcome can occur even in women without identifiable risk factors. Numerically, more pregnant women without risk factors have seen to end up with serious adverse outcome compared to those with risk factors during the attendance of antenatal care service Villar J, bergsj P (2002). In order to prevent pregnancy adverse outcome world wide as well as in developing countries, interventions should therefore be targeted at all pregnant women attending antenatal care service and during childbirth Dowswell T, et al. (2013).
Early attendance intervention at the antenatal care service in those with and without risk group pregnant women seems to beneficially in relation of their health and this intervention that has been promoted as an effective intervention in preventing adverse pregnant outcome Adewoye KR, Musa IO, Atoyebi OA, Babatunde OA (2013).
The need of implementing knowledge, attitude and practice of ANC intervention in pregnant women it has been showed that as a package comprising the following interlocking system includes interventions, early screening, administration of a preventive prophylactic therapy and curative of the various detected risk conditions effectively on the basis of reduced maternal complications Zegey AM, Bitew BD, Koye DN (2013).
Additionally, antenatal care service is not a single intervention; instead, it represents a series of assessments and interventions over time that is not uniformly applied effectively by different health care providers found in developing countries Hajela S (2014).
Although not only the “quantity” of antenatal care service is relatively easy to measure through the required timing and number of visits adjusted for gestational age at delivery but also the “quality” of antenatal care service and the effectiveness of individual components on outcome are quite difficult to measure. However, the major goal of antenatal care service is to ensure the birth of a healthy baby with minimal risk for the mother.
Despite high ANC attendance in Nigeria, only 14% of pregnant women start ANC during the first trimester as per the national guidelines. The median number of months that women are pregnant at their first visit is 5.4 months. One third of women do not seek ANC until their sixth month or later Tekelab T, Berhanu B (2014). However, early booking has an advantage for proper pregnancy information sharing and pregnancy monitoring
In spite of the fact that exercise programs during pregnancy and after childbirth are designed to minimize impairment and help the woman maintain or regain function while she is preparing for the arrival of the baby and then caring for the infant, it is submitted that women are not meeting the exercise recommendations of the previous studies. A myriad of factors not limited to beliefs and attitudes of women with respect to exercise in pregnancy, level of knowledge, level of education, safety concern of the pregnant woman and her physician , race/ethnicity, and previous involvement in regular exercise have been implicated as important factors predisposing to exercise engagement or phobia among pregnant women.Some identifying factors that affect beliefs and behaviors would objectively encourage a change in attitude. Therefore, an assessment of knowledge and attitude about exercise in pregnancy may help to determine whether or not women will participate in exercise during and after pregnancy. This study was designed to assess knowledge and attitude of Nigerian pregnant women towards antenatal exercises.
The main objectives of this study is to investigate the Knowledge, attitude and awareness of antinatal and maternity health care service among women of child bearing age.
The study have the following specific objectives;
Objectives: Low back pain is a major occupational problem especially among nursing staff. The objectives of our study are to evaluate the prevalence of low back pain among nurses and to look for physical and psychosocial risk factors. Methods: It is a cross-sectional study based on a self-administered question-naire destined for all nurses working in National Hospital Abuja
Results: Our study included 203 nurses with an average age of 39.8 years. The prevalence of low back pain over the last twelve months was 58.1%. The factors that are significantly associated to low back pain were: high BMI, number of pregnancies, arthritis, poor physical condition, daily fre-quency of inappropriate posture for the activity being performed, and the layout of materials in the workplace. Conclusion: Our study evidenced the high prevalence of LBP among nurses and allowed bringing to light the role of individual and ergonomic physical factors in the genesis of LBP. Such identifications permits to undertake targeted preventive actions. The association between psychosocial factors and LBP was not emphasized
