KNOWLEDGE AND PRACTICE OF HEPATITIS B PREVENTION STRATEGIES AMONG WOMEN OF CHILD BEARING AGE IN NKANU WEST LOCAL GOVERNMENT AREA OF ENUGU STATE.

Assessment of knowledge and utilization usage of non pneumatic anti shock garment in the management of postpartum hemorrhage among midwives in federal medical centre gusau

ABSTRACT

Background: Non-pneumatic anti-shock garment (NASG) is a first-aid lower-body pressure device that reverses hypovolaemic shock and decreases obstetric hemorrhage thereby decreasing maternal morbidity and mortality due to post-partum haemorrhage (PPH).This study assessed the knowledge and utilization of non-pneumatic anti shock garment in the management of postpartum hemorrhage among midwives in selected health care facilities in Bayelsa state.

Methods: This is a descriptive cross-sectional study in which a sample size of 112 nurses were selected using purposive sampling technique. The instrument for data collection was questionnaire and data collected were analyzed using descriptive and inferential statistics.

 Results: The study revealed that majority of the respondents regardless of their educational level had good knowledge of the description, mechanism of action, and uses of NASG. It was also revealed that majority of the respondents do not use NASG in their centers and its application in management of post-partum hemorrhage was not part of the protocols in these centers, which was a clear indication of underutilization of the NASG in the primary health care centers. There was no significant association found between years of working experience of respondents and their utilization of NASG with (X2 = 8.577, df = 2, P = 0.114) as well as between the level of knowledge of midwives and their utilization of the NASG with (X2 = 0.387, df = 1, P = 0.534).

Conclusions: It was recommended that non-pneumonic antishock garment should be made available by government and its utilization should be included in all health care centers policy as a management protocol for post-partum hemorrhage.

Utilization of Pain Management Tools Among Nurses Working In Acute care Units in mater Misericordia hospital afikpo

INTRODUCTION/BACKGROUND

Maintaining an optimal level of comfort is a universal goal  for physicians and nurses because pain is one of the major experiences that can minimize patients’ comfort. These patients experience pain from  preexisting  diseases, invasive procedures, or trauma Arif and Grap, (2009). Pain management is the first step in proper pain relief, an important goal in patients’ care Gelinas et al., (2006). According to the International Association for the Study of Pain (IASP) (2010), pain is a sensory and emotional experience associated with actual or potential damage or described in terms of such damage. It is a sensation that is strictly subjective in nature. McAffery (2010) defined pain as whatever the experiencing person says it is, existing whenever the experiencing person says it does. This exemplifies the importance of the patient’s perspective and input, which supports the individual’s self-report as the  single most reliable indicator of the existence and severity  of pain Pasero, (2009). Pain management is crucial if pain management is to be effective and nurses are in a unique position to assess pain as they have the most contact with the patient and their family in hospital. Failing to assess  pain may affect quality of life, and increase the length of  stay of hospitalized clients Zanolin et al., (2007). There are several validated assessment tools in the literature to assess the intensity of pain; for example, the Numeric  Rating Scale (NRS), Visual Analog Scale (VAS), Verbal Descriptor Scale (VDS), and Wong-Baker Faces Scale (WBFS) ACCN, (2013); Pasero and McCaffery, (2010). For critically ill adults who cannot communicate properly, there are also several validated tools including the, Behavioral Pain Scale (BPS), Critical-Care Pain Observation Tool (CCPO), and Face, Legs, Activity, Cry, and Consolability (FLACC) pain scale ACCN, (2013). Nurses play a pivotal role in pain management and management Suha et al., (2014). Untreated and undertreated pain has debilitating effects and significantly interferes with the patient’s  physical, emotional and spiritual well-being thus can alter  the patient’s quality of life Ho et al., (2013; Alexandrina de Jesus and Jacinta, 2013). Lui et al. (2008), reported that pain is a common symptom in patients in medical units and effective pain management using the right scale/tools is a senaquel to effective management strategies. It has been established that nurses assess patient pain using these  tools infrequently Rose, et al, (2011), and studies have shown that the reasons for the inadequacies in pain management, include inadequate knowledge on pain management tool/scale, lack of utilization, monitoring, and pharmacological treatment of pain especially frequently  used opioids Bernardi et al., (2007), Pediaditaki et al., (2010). In a cross sectional study conducted by Gregory  and Richard, (2014) on the use of pain management tools in clinical practice in school of Nursing Midwifery and Social Work, University of Manchester, UK using 132 healthcare professionals. The result shows that the numerical rating scales and the verbal descriptor scale were used by the majority of nurses. Behavioral pain management scale such as Abbey pain management scale were used by 42% of the respondents. It also indicates that verbal self-report pain management scales appear to be embedded into clinical practice, but the use of observational  pain  assessment tools for people with communication difficulties have not been adopted by the majority of organizations represented. Also a cross-sectional descriptive study conducted by  Ogwa, and Ndie, (2005), on the use of pain management tools among 450 nurses randomly selected at federal teaching hospital, Abakiliki. The result shows that majority  of the nurses use mainly patient’s verbal report of pain (87%) and simple descriptive pain intensity scale (57%) as their pain management tools. It revealed that  nurses  only use the subjective method to assess their patient’s  pain. In a descriptive study conducted by Ojong, Ojong-Alasia and Nlumanze (2014) on nurses on use of pain  assessment tools and management of pain among surgical patients in secondary health facility in Calabar Metropolis, Cross River State, Nigeria. The result shows methods of pain management tools recorded thus: patient self report of pain 72%, observation of behaviour 78.9% and assessment of pain site and location. Records of pain management tools used and management were deficient in the wards.

Similarly a participatory research conducted by Gregory (2012) on how to identify a pain management tools for  people with communication difficulty at University of Manchester, UK shows that several behavioral pain management tools available but are not used in everyday practice, but numerical pain management tool appeared  to be suitable for acute care but in practice and when compared to other tools it was not useful.

Furthermore, Niamh, (2011) in a study of  knowledge  and attitude regarding pain among surgical nurses, uses a descriptive cross-sectional design. It was find out that more than half (57.4%) of the sample always used a pain management tool (PAT), a further 38.3% used a pain management tool (PAT) frequently, with the remaining 4.3% of respondents rarely or occasionally using a pain management tool (PAT). Kizza and Muliira,  (2016)  in  a study aimed at describing the knowledge and practices related to pain management, and perceived barriers among nurses caring for critically ill – adult patients (CIAP) also reported that Nurses have poor pain management practices, including lack of use of pain management tools and guidelines, which were significantly associated  with workload and the low priority set to pain management and management. Similarly, Torvik et al., (2015), in a study to explore the use of pain management strategies (verbal, numeric, and observation rating scales and standardized questions) in home care and nursing homes. It was  revealed that pain management tools were not used frequently in nursing homes and home care. Verbal and numeric rating scales were used significantly more frequently in home care than in nursing homes. Registered nurses (RNs) in nursing homes used standardized  questions significantly more often than did RNs in home care. RNs and social educators in home care self-reported less competence in treating the patients’ total pain experience than did those in nursing homes..

Consequently, Taylor and Stanbury, (2009) shows that busy units, inadequate staffing, limited time, inappropriate attitude or focus on other imperatives, inadequate knowledge on assessment tools, poor communication, inadequate staff training were factors affecting utilization of pain management tools. Rose et al, (2011) relate factors like hemodynamic instability and inability to communicate have specifically influence pain management. Findings of a study showed that level of education qualification  and  the  number of topics covered during ongoing professional education did not influence reported perceptions on important of pain management tools Prose et al., (2011). Similar findings were reported by a study in Hong  Kong were educational level was how  significantly  associated with knowledge and utilization Lui et al., (2008).

Shurgarman and Colleague, (2010) also reported that educational level was not found to be associated with nursing staff utilization of pain management  tools  like Normal Rating Scale (NRS). Ashley, (2009), reported that social attitude and cultural beliefs of both  the  person  in pain and practitioners prevail and can limit effective utilization of pain management tools. Also absence of protocols and guidelines on pain management tools has  been cited to hinder effective utilization of pain management tools Kituyi et al., (2011).

It is on this plethora of background to the study that the work seeks to investigate the Utilization of Pain management tools among nurses working in acute care units in mater Misericordia hospital afikpo

Statement of problem

The cornerstone to adequate pain relief among patient is systematic and consistent use of pain management tool and documentation of right assessment tool used and this will enable the health care provider to know the accurate treatment for the patient in pain. Therefore it is imperative that health care provider assess pain accurately and document the right pain management tools used Arif-Rahu and Grap, (2010). The questions is did nurses use pain management tool in management of their patient pain? Research related to nurses knowledge and practices regarding utilization of pain management tools in clinical setting remain limited despite the increase  awareness  of the significance of pain among patients Shannon and Bucknall, as cited in Mohommed, (2010). Though study  exist that assess the nurses knowledge of pain management, there dearth of empirical study on nurse’s utilization of pain management tools especially in these part of the country. Hence this study is conducted to assess nurse’s use of pain management tool in university of Benin teaching hospital.

KNOWLEDGE AND PERCEPTION OF HEALTH WORKERS ON TRANSMISSION AND PREVENTION OF CORONAVIRUS

INTRODUCTION

1.1  Background to the Study

Health related infections are the major problems of public health in many nations of the world, which ultimately cause an increase in the morbidity, mortality, and additional costs in health care settings (Mauldin et al 2010; Defez et al, 2008 and Llata et al, 2009). Ensuring hand hygiene is therefore one of the basic means preventing the spread of such infections. In 1983, Semmelweis highlighted that cleansing of contaminated hands with antiseptic products before and after contact with patients may reduce health related infections (Semmelweis I. 1988). Thereafter, Centre for Disease Control and Prevention published the first formal guidelines on hand washing practices in hospitals (Garner JS, Favero MS. 1986), followed by guidelines from the Association for Professionals in Infection Control and Epidemiology (APIC) (Larson et al, 1995).

corona viruses are common viruses that most people get sometime in their life and may also infect animals. Human coronaviruses (hCoV) which has been globally trending for over a month now usually causes upper respiratory tract illnesses. Severe Acute Respiratory Syndrome (SARS-CoV) that occurred way back in 2003 served as a reminder to this newly emerging zoonotic coronaviruses which has the potential to transmit from person to person and to cause severe human illnesses. Novel coronavirus (nCoV), described as Middle East Respiratory Syndrome coronavirus (MERS-CoV), is a particular strain different from any other known hCoV with a possibility of zoonotic transmission. However, Centre for Disease Control and Prevention (2014) revealed that investigations was carried out to figure out the reservoir and source of infection, route of transmission to humans, symptoms, prevention, severity and clinical effects with gradually increasing number of reported cases on daily basis.

There has been a rapid international response following the news of this new virus from Wuhan, China on the 12^th of February 2020 which has now spread to every nook and cranny of the world. An interim case definition was developed rapidly by WHO to ensure that a systematic approach is followed for appropriate identification and investigation of suspected cases. The body has also made arrangement for disbursing huge amount of money for the prevention and cure of this pandemic disease now known as COVID-19 to the high risk affected nations of the world.

Understanding the knowledge, attitudes, and perception of health workers on transmission and prevention of COVID-19 is essential to bring forth a sustained change in behaviors of individuals and institutions and to improve such practices when designing interventions. This is why health workers and the government are clamouring for hand hygiene. This can be achieved by frequently washing of the hands. Several factors are involved in hand hygiene behavior such as attitude, perceived social norm, perceived behavioral control, perceived risk for infection, hand hygiene practices, perceived role model, perceived knowledge, and motivation (Larson et al, 2000). Despite the number of published studies on hand hygiene, many questions concerning attitudes and knowledge of health care workers (HCWs) remain unanswered. This is particularly true in primary care settings where the volume of patients and complexities of cultural, institutional, and health policy factors can influence the practice of hand washing. Various studies have confirmed an inverse relation between intensity of patient care and adherence to hand hygiene practice (Pittet et al, 2004; Harbarth et al, 2001 and Arenas et al, 2005). Additionally, the current burden of the spreading Middle East respiratory syndrome coronavirus (MERS-CoV) implied an action to review our basic strategies in hand hygiene practice. In a descriptive study (47 cases), MERS-CoV was found to be associated with substantial mortality in admitted patients who have medical co morbidities. This brings about adequate infection control measures among health workers, for example, hand hygiene. Hence, knowledge, attitudes, and perception of hand hygiene will continue to be a major concern and are important to examine to bridge the theory practice gap.

The discovery of this new virus mandates it for China to demonstrate to rest of the world how vigilant and prepared they are to prevent the global spread of a new infection and protect both global health and the wellbeing of their own peoples. The countries of the region need to be vigilant and put in place enhanced public health surveillance plan for identifying suspected cases using WHO’s recommended case definition and investigation protocol (Malik et al., 2012). The US, UK, Germany, Italy and even Nigeria are currently battling with COVID-19 pandemic. It has taken a great concern at the governmental and public levels as it led to a number of human infections and deaths. Since February 12, to March 26, 2020; the total number of infected cases with COVID-19, as reported by worldometers, reached 478,446 of global cases of which 21,524 cases have died and a total of global recovery stands at 115,668.

We need to better understand the public health implication of emergence of this new respiratory virus from China to understand the exposure risks. The current situation in Nigeria needs to be carefully monitored by our health workers as there is a fear from increased number of human infections and deaths recording on daily basis. Till now, no COVID-19 cases have been confirmed in some states in Nigeria, however, in south western part of Nigeria, as at 26^th of March, 2020, Lagos State has recorded 32 cases, while Ogun has recorded 3, Ekiti, Osunand Oyo (the case study for this research work) has recorded 1 case each. Thus, the concern over the possibility of an outbreak in Oyo State should not be taken lightly. The problem of COVID-19 pandemic becomes more complicated in absence of any prophylactic vaccines, curative treatment and lack of experience in control measures (Al-Ahdal et al., 2012). It is against this backdrop that the study sets to examine the attitude, knowledge and perception of health workers on transmission and prevention of COVID-19 by using health workers in the outpatient department of University College hospital Ibadan as a case study.

1.2  Statement of the Problem

Once again, the world is currently experiencing a global viral COVID-19 pandemic. As of March 26, 2020 confirmed cases of coronavirus disease (COVID-19) has been reported to be 478,446 and 21,524 deaths had been reported in more than 30 countries of the world. The majority of cases as at the time of writing have been from China which is closely followed by Italy, US, UK, Germany and Spain. Most countries in the world have made efforts to halt transmission through shutting down transport, quarantining entire cities, regular washing of the hand with soap and sanitizer and enforcing the use of face masks. International flights have been cancelled in Nigeria and other African nations have been following suites and affected cruise ships quarantined. This has been having effects on the economy of the world.

The effects of COVID-19 pandemic outbreak to the economy of the world will surely be discussed in its aftermath. The initial response in China to contain the virus has been applauded by WHO and considered much improved compared with its response to the 2003 SARS-CoV epidemic. Internationally, we have seen rapid generation and sharing of knowledge to the benefit of the outbreak response, but also counterproductive actions by some countries, including limiting trade and shutting of borders, to its detriment. With the increasing frequency of zoonotic spillovers leading to human infections and transmission, it is apparent that pandemic preparedness has become a priority for the global health agenda. It is on this claim that this study aims to examine the attitude, knowledge and perception of health workers on transmission and prevention of COVID-19 by using health workers in the outpatient department of University College hospital Ibadan as a case study.

1.3 Objectives of the Study

The objective of this study is to examine the attitude, knowledge and perception of health workers on transmission and prevention of COVID-19 by using health workers in the outpatient department of University College hospital Ibadan as a case study. However, the specific objectives are:

i) To understand the attitude, knowledge and perception of health workers to the general public towards the prevention of COVID-19  in Oyo State

ii) To determine the strategies used by health workers in the State to stop the general spread COVID-19

iii) To study the effects of COVID-19  on the economic status of the world

iv) To establish the symptoms of COVID-19 and the steps to take when these symptoms occur

1.4 Research Questions

The following questions were generated during the course of this study:

i)  What are the attitude, knowledge and perception of health workers to the general public towards the prevention of COVID-19 in Oyo State?

ii)What are the strategies used by health workers in the State to stop the general spread COVID-19?

iii) What are the effects of COVID-19 on the economic status of the world?

iv)What are the symptoms of COVID-19 and the steps to take when these symptoms occur?

1.5       Significance of the Study

Theoretically, this study stands to provide additional knowledge to the body of existing literature on the spread this pandemic disease to the world and of particular reference to Nigeria. The result of this study will serve as good base or guide for future reference and it will also encourage further research on the importance of staying healthy. Furthermore, this study will provide relevant information on the reasons for the spread of this disease from China to the rest of the world.

Practically, the findings of this study will reveal the reasons for regular health check up for the benefit of staying healthy at all times. The result from this research will also help health workers to design relevant, persuasive health messages that will help change the people’s attitude on the utilization of hospitals and create more awareness on the situation of health care services in the country. This study will be of great significant to the medical professionals who have defaulted in carrying out their duties to their patients

1.6       Scope of the Study

This study focuses mainly on the attitude, knowledge and perception of health workers on transmission and prevention of COVID-19 of health workers in the outpatient department of University College hospital Ibadan. It will therefore, be carried out among the students and health workers in the outpatient department of University College hospital Ibadan.

1.7       Limitations of the Study

            The time frame was not enough for the researcher to delve into the issue as comprehensively as would have been desired. This also informed the decision to focus on one department so the time would be invested in identifying and evaluating all possible aspects of the subject matter so as to make the study as comprehensive as possible. The use of a case study arguably has many limitations, however it allows for a level of research that was commensurate with the nature of results expected

AWARENESS OF PREGNANT WOMEN ON GOOD NUTRITION A STUDY OF PANKSHIN

ABSTRACT

The main purpose of this study was to assess Awareness Of Pregnant Women On Good Nutrition A Study Of Pankshin. Specifically, the study sought to describe the general characteristics of pregnant women in rural and urban areas of Plateau State, to assess the nutrition knowledge of the respondents; assess their dietary practices and their perception of the effect of poor nutrition on pregnancy outcome in rural and urban areas of Plateau state; determine the mortality rate of neonates in the study area; determine the nutritional status of the respondents and anthropometric indices of their neonates; determine the effect of mother’s nutrition knowledge and nutritional status  on pregnancy outcome in Plateau State. The population for this study was made up of all the pregnant women attending antenatal clinics in hospitals and maternity homes in Plateau State.  Plateau state was stratified into three strata. Simple random sampling was used to draw four hundred pregnant women who participated in the study. A structured questionnaire was used for data collection. Information from focus group discussion was used to produce the questionnaire. A three day weighed food intake was conducted on a sub-sample of 60 respondents. Their height and weight were also taken and compared with standards. Anthropometric indices of neonates and haemoglobin status of the respondents were collected from their hospital folders (records). Data collected were analysed using mean, standard deviation, correlation and regression analyses. Findings revealed that 70.4% of the respondents were from rural community, while 29.6% were from urban; 22.5% were adolescents, 76.2% were middle aged, while 1.3% were older women. All the respondents were Christians. Majority (90.6%) were married while 9.4% were single. About 86.6% of the respondents were fairly educated. More than half of the respondents (66.5%) were farmers, traders and artisans, while 14.5% were government workers. About  64.5% earned between N30,000 – N100,000; 26.8% and 26.3% earned high and low income, respectively. Twenty percent (20%), 32.9% and 47.1% had poor, fair and good knowledge respectively of the foods that make up an adequate diet; 90.4% and 9.6% had poor and fair knowledge of nutrient sources and deficiencies.  More rural respondents skipped their meals because they were not hungry; 98.5% of the respondents ate snacks, while  52.2%, 66.3% and 50.8% ate more in the first, second and third trimesters of their pregnancies. Weight gain was normal for  32.7% while 61.5%  of the respondents gained  above normal weight. About 86.1% and 13.9% had normal and poor haemoglobin status, respectively. LBW rate was 4.8% (urban 8.5% and rural 3.2%); 95.2%, 63.5%, 79%, 99.1%, 89.9% and 89.9% of the neonates had normal birth weight, birth length, head circumference, chest circumference, abdominal circumference, and placental weight. There was a significant (p= <0.05) relationship between haemoglobin status and placental size; and also between calcium, protein and iron intake and neonatal birth weight and placental weight. Maternal protein intake and riboflavin intake were associated with neonatal abdominal circumference and maternal haemoglobin status, respectively. Maternal nutrition knowledge did not affect neonatal weight. In conclusion, the low prevalence of low LBW  recorded in this study is an indication of the effectiveness of maternal and child care programme in Plateau State. Also, the early registration and regular antenatal checkups, the use of supplements and some pregnancy adaptations must have contributed to the normal weight gain and Hb levels. The positive relationship between calcium intake and LBW needs to be carefully considered, while the negative relationship protein and riboflavin intakes and LBW need further investigation. The findings of this study support the reactivation and expansion of the mother and child health pragramme and free antenatal care in the State.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CHAPTER ONE

INTRODUCTION

1.1 Background to the study

Nutrition is a major intrauterine environmental factor that alters expression of the foetal genome and may have life long consequences (Guoyao, Fuller, Timothy, Cynthia & Thomas, 2005). Alterations in foetal nutritional status may result in developmental adaptations that permanently change the structure, physiology and metabolism of the offspring, thereby predisposing individuals to metabolic, endocrine, and cardiovascular diseases in adult life (Guoyao et al., 2005). Maternal nutrition comprises of anthropometric factors such as pre-pregnancy weight for height  (body mass index (BMI) and gestational weight gain which partly reflects the balance between energy intake and energy expenditure, but also includes increases in body water, as well as intake of protein and micronutrients (Tannys, Pat, Francesca & Leah, 2006). Of the pregnancy outcomes that might be affected by maternal nutrition, the one encountered most often in research literature is low birth weight. Other outcomes are deformities, morbidity and mortality rate (Kramer, 1998).

Low birthweight is defined as a body weight at birth of less than 2500g . There are two main causes of low birth weight: prematurity and intrauterine growth retardation (IUGR). Infants born with low birth weight suffer from extremely high rates of morbidity and mortality from infectious disease, and are underweight, stunted and wasted beginning in the neonatal period through childhood (ACC/SCN, 2000). The causes and effects of low birth weight are complex and best considered withins the lifecycle conceptual framework. Poor nutrition often begins in the intrauterine environment and extends throughout the lifecycle. Low birthweight is an intergenerational problem where low birthweight infants grow up to be undernourished and stunted children and adolescents and, ultimately undernourished women of child bearing age, and undernourished pregnant women who deliver low birthweight infants. This amplifies risk to the individual’s and perpetuates the cycle of poverty, undernutrition and disease. This is especially so when adolescents become pregnant before their own growth is completed, leaving little to fulfil their own or their infant’s nutritional requirement (ACC/SCN, 2000).

Any successful pregnancy requires the net deposition of tissue within the mother, the placenta and the foetus. Thus, there is a fundamental relationship between the nutritional status of the mother and her ability to transfer nutrients to the foetus at the appropriate time during pregnancy. The mother’s ability to achieve effective and timely transfer may however be constrained by factors other than her immediate dietary intake or overall nutritional status. The mother may have her own demands for nutrients that compete with the needs of the foetus. In a younger woman, the needs to complete her own growth and development have to be satisfied (Alan, Zulfiqar & Pisake, 2003).

Sub-optimal foetal growth is associated with higher foetal mortality, neonatal morbidity and mortality. Small size at birth is associated with greater susceptibility to infection and both altered postnatal growth and neuro cognitive development (Alan et al., 2003). Nutrition, acting either directly, or through specific endocrine mechanism is a major determinant of the pace and balance of foetal growth, with effects that have adverse consequence later in infancy and childhood. Modest changes in maternal diet, from very early in pregnancy, or even in the preconception period, can have marked effect on the ability of the foetus and newborn to withstand other infective or physical environmental stresses (Alan et al., 2003).

High rates of pregnancy-related mortality and morbidity persist in the poorer countries of the world (including Nigeria) with maternal mortality rates reaching over 1000 per 100,000 live births in some countries, and millions of infants are born too early, too small or with serious infections (ACC/SCN, 1993). Poor maternal nutritional status leads to many other complications for the mother and baby in both the short and long term. From nutritional status stems maternal weight gain, which strongly influences birth weight (Tannys et al., 2006).

Maternal under nutrition during gestation reduces placental and foetal growth of both domestic animals and humans. Available evidence suggests that foetal growth is most vulnerable to maternal dietary deficiencies of nutrients (such as protein and micronutrients) during the peri-implantation period and the period of rapid placental development (Wu et al., 2005). Under nutrition in pregnant women may result from low intake of dietary nutrients owing to either a limited supply of food or severe nausea and vomiting as hyperemesis gravidarum. This life threatening disorder occurs in 1-2% of pregnancies and generally extends beyond the 16^th week of gestation. Pregnant women may also be at increased risk of under nutrition because of early or closely spaced pregnancies (Vause, Martz, Richard, & Gramlich, 2006).

When the mother has little control over family fund, dietary arrangement may become difficult. A woman’s access to and control over income and assets would be a major determinant of her nutrient intake (Mulokozi, 1999). Women’s occupation is such that they control fewer productive assets at every socio-economic level. In spite of the fact that they are responsible for meeting the family needs, they earn less income. This makes them resort to labour intensive jobs which add to their nutritional risk particularly for the pregnant women. Heavy workload for women might lead to poorer diets not only for their children and other members of the family but also for the women themselves (Mulokozi, 1991).  The risk of improper nutrient intake and nutritional inadequacy during the periods of heavy physical work is high (Mozie, 2000).

Nutritional imbalance could cause detrimental effects to the pregnant woman, influence pregnancy outcome, and impair breast milk composition (Kontic-Vucinic, Sulovic & Radunovic, 2006). It is a well-known fact that foetal growth and development is strongly linked with maternal supply of essential nutrients e.g. vitamins. It is estimated that up to 30% of pregnant women suffer from a nutrient deficiency (Kontic-Vucinic et al., 2006). Without supplementation, about 75% would show a deficit of at least one nutrient (especially vitamins). Moreover, multi-nutrient deficit combinations often co-exist, and sub clinical depletions are probably common; consequences could be severe (Barasi, 1997; Kontic-Vicinic et al., 2006).

Maternal dietary imbalances at critical periods of development in utero can trigger an adaptive redistribution of foetal resources, including growth retardation. Such adaptations affect foetal structure and metabolism in way that predispose the individual to later cardiovascular and endocrine diseases. The correlation between low birth weight and later cardiovascular diseases and diabetes may arise from the fact that nutritional deprivation in utero programmes a newborn for a life of scarcity. Problems arise when the child’s system is later confronted by a world of plenty (ACC/SCN, 2000). Recent studies have shown a link with immune system development and subsequent risk b b of infection related mortality in adulthood. Analyses of over a thousand deaths in one community has shown that infants born in the wet season were ten times more likely than infants born in the dry season to die prematurely in adulthood, mainly from infection. The difference was manifested only after adolescence. This phenomenon may be due to abnormal growth of the thymus gland (immune cell producer) or the lymph system (immune cell transporter) during pregnancy (Barasi, 1997).

From the information enumerated above the importance of the nutritional status of women/mothers cannot be overemphasized. The consequences of inadequate nutrition and its impact on the unborn child are grave hence priority should be given to research in this area.

1.2       Statement of the Problem

     Across the world, there is a high prevalence of adverse outcomes of pregnancy, which can be life threatening for both the mother and her baby. One of such outcomes is low birth weight (LBW). LBW is a major determinant of mortality, morbidity and disability in neonates, infants and children and also has a long-term impact on health outcomes in adult life.  It accounts for up to 70% of neonatal deaths in some countries (Ross & Naeye 1999). Poor maternal nutrition and the resulting low birth weight (LBW) infants remain the single most important cause of infant morbidity and mortality in the world. Babies whose birth weight is low because of undernourishment face a greatly increased risk of death during the first months and years of life (ACC/SCN, 2000). The evidence also suggests that those children who do survive may be more likely to experience health problems throughout their lives; these include impaired cognitive development, as well as diabetes and coronary disease in adulthood (Bhargava, Sachdev, Fall, Osmond, Lakshmy & Baker, 2004).

In majority of LBW infants, the seed of death is sown much earlier before they are born. According to UNICEF (2012) infant mortality rate in Nigeria in 1990 was 126 per 1000 live births while in 2010 it was 88 per 1000 live births. Neonatal mortality was also estimated at 40 per 1000 live births. Current data from the Nigeria Demographic health Survey (NPC & ICF Macro, 2009) shows infant mortality to be 75 per 1000 live births, indicating a 25% drop from the value of 99 deaths /1000 live births recorded in 2003; while neonatal death remains at 40 per 1000 live births. Although these values are decreasing, they are still higher than the African average of 71/1000 live births of 2010 and almost equal to the Sub-Saharan average of 76/1000 in the same year in 2010 for infant mortality (UNICEF, 2012). Maternal mortality stands at 545 deaths/100,000 live births (NPC & ICF Macro, 2009).

There is significant variation in the incidence of low birth weight across regions. According to UNICEF (2012) data, values range from 6-27%, with South Asia having the highest incidence, while East Asia/Pacific has the lowest.  India is home to nearly 40 per cent of all low-birth weight babies in the developing world. In Sub-Saharan Africa (including Nigeria) 13 per cent and in the Middle East/North Africa 11 per cent of infants are born with low weight. In Nigeria the prevalence of low birth weight is estimated at 12% (UNICEF, 2012). Report from Plateau State Ministry of Health indicates that pregnancy outcome in terms of maternal mortality and neonatal birth weight is not quite different from what is obtainable in other developing countries (Igboji, 2005). Based on hospital records collected from 1997-2000, a prevalence of low birth weight of 49.9% was recorded in Plateau State (Mozie, 2000). There is however a dearth of information on low birth weight rate presently in Plateau State.

Low birth weight in developing countries occurs primarily because of poor maternal health and nutrition. In addition, diseases such as diarrhea, malaria and respiratory infection, which are common in many developing countries, can significantly impair foetal growth when women become infected during pregnancy (ACC/SCN, 2000). More than 96 per cent of low birth weight occurs in the developing world, reflecting the higher likelihood of these babies being born in poor socio-economic conditions, where women are more susceptible to poor diet and infection and more likely to undertake physically demanding work during pregnancy (UNICEF & WHO, 2004). It reflects, further, a generational cycle of under nutrition, the consequences of which are passed along to children by mothers who are themselves in poor health or undernourished.

In a study conducted by Mozie (2000), she observed that women in Plateau State tend to work very hard; that theoretically, their husbands are looked upon as the bread-winners of the family but in practice the women are. This makes the women to work as hired labourers in quarries and in farms. They do domestic work, work in their own farms, do petty-trading and other strenuous jobs in order to feed the family and survive. Their level of physical exertion, lack of opportunity to rest and exposure to dangerous chemicals may be a contributing factor to low nutritional status and adverse pregnancy outcome.

Poor nutrition knowledge leads to superstition and misconceptions about food requirements and nutritive value of food, a very common condition in developing countries of the world (Mozie, 2000). Due to their level of poverty, poor educational background, and nature of their work, Mozie (2000) observed that Plateau women fed more or less on foods such as dried bread, roasted or boiled yam with little or no oil, occasionally and foo-foo with watery type soup devoid of vegetable in the midst of work. In other words, their feeding is predominantly starchy foods. This is also a major determinant of nutritional status, and pregnancy outcome.

Teenage pregnancy has been observed in some studies in Nigeria. Ene-Obong, Enugu & Uwaegbute (2001) found the mean age (in years) at marriage for less educated women (farmers and traders) to be 16.5 ±4.0 and 17.1± 4.0, respectively. Since pregnant teenage mothers are themselves growing, they compete with their own foetuses for nutrients. Low birth weights and pre-term delivery in adolescent pregnancies is almost three times higher than for adult pregnancies (Kontic-Vucinic et al., 2006). Bases on hospital records collected from 1997-2000, a  prevalence of low birth weight of 50% was found among mothers of reproductive age and 75% for mothers below 20 years of age (Mozie, 2000). No wonder the government of Plateau State mounted various Mother and Child health programme in order to solve some of the problems enumerated. This study is therefore an attempt at determining the prevalence of low birth weight and identifying the factors that determine the birth weight of neonates.

1.3       Objectives of the study

            The general objective of the study was to determine the effect of awareness of pregnant women on good nutrition a study of  Pankshin Central . The specific objectives included to:

(1)        describe the general characteristics of pregnant women in rural and urban areas of  Pankshin, Plateau State;

(2)        assess the nutrition knowledge of pregnant women in rural and urban areas of Pankshin ,Plateau State;

(3)        assess the dietary habits of pregnant women in rural and urban areas of Pankshin ,Plateau State;

(4)        assess mothers’ perception of the effect of poor nutrition on pregnancy outcome in rural and urban areas of Pankshin, Plateau State;

(5)        determine the mortality rate of neonates in rural and urban areas of  Pankshin ,Plateau State;

(6)        determine the nutritional status of pregnant women in urban and rural areas in Plateau State using their hemoglobin status, nutrient intake and weight gain during pregnancy;

(7)        determine the birth weight and anthropometric indices of neonates; and

(8)        determine the effects of mothers’ nutrition knowledge, nutritional status and nutrient intake on pregnancy outcome in Plateau State.

 

 

1.4       Significance of the study

It will be recalled that in 2007, the Government of Plateau State mounted a programme on maternal and child health (MCH) to reduce maternal and child mortality in the State. This will provide baseline information on the prevalence of low birth weight, nutrition knowledge, dietary practices and nutritional status of pregnant women, as well as on the relationship between maternal nutrition and pregnancy outcome among pregnant women in Plateau State. Such information will be necessary for the evaluation of some of the nutrition intervention programmes mounted by the government of Plateau State. The results of this study could help policy makers review existing and future policies and programmes regarding maternal and child health. Furthermore, this study will help in assessing progress so far made towards the achievemment of Goal 4 and Goal 5 of the Millennium Development Goals (MDGs) – which are reduction of child mortality and improvement of maternal health, respectively.

Nutritionists and health practitioners will use the result of this study to design nutrition educate packages for mothers and would be mothers on the importance of promoting optimal nutrient intake so as to ensure optimal foetal development, which will in turn reduce the risk of chronic diseases in adults. Students of human nutrition and other related fields of study will be motivated by the result of this study to engage more on studies pertaining to maternal and child health.

 

1.5       Research questions

(1)        What is the general characteristics of pregnant women in rural and urban areas of Plateau State.

(2)    What nutrition knowledge do the respondents possess in relation to successful pregnancy outcome?

(3)        What dietary habits are prevalent among pregnant women in rural and urban areas of Plateau State?

(4)        What do mothers know and perceive as effect of poor nutrition on pregnancy outcome in Plateau State?

(5)        What is the mortality rate of neonates in rural and urban areas of Plateau State?

(6)     What is the nutritional status of pregnant women in urban and rural areas of Plateau State?

(7)        What is the average birth weight and anthropometric indices of neonates in the State?

(8)        What are the effects of mothers’ nutrition knowledge, nutrient intake and nutritional status on pregnancy outcome in Plateau State?

 

1.6       Research Hypotheses

The following null hypotheses were tested –

(1)        There is no significant difference between the nutrition knowledge of pregnant mothers in rural and urban areas in Plateau State.

(2)        There is no significant difference between the nutritional status of rural and urban mothers.

(3)        There is no significant relationship between the nutrition knowledge and nutritional status of the respondents.

(4)        There is no significant relationship between the nutrient intake and the nutritional status of the pregnant women.

(5)        There is no significant relationship between the nutrition knowledge, nutrient intake, nutritional status and pregnancy outcome of the respondents