AN EVALUATION OF KNOWLEDGE OF HEALTH IMPLICATIONS OF PRENATAL CARE ON MOTHER AND CHILD AMONG CLIENTS OF PRIMARY HEALTH CARE SERVICES IN LAGOS

ABSTRACT

This study investigated the evaluation of knowledge of health implications of prenatal care on mother and child among clients of primary health care services in Lagos State. The study employed a descriptive survey research design. An instrument titled: An Evaluation of Knowledge of Health Implications of Prenatal care on Mother and child among Clients of Primary Health care Services (EKHIPCMCCPHCS) was used to collect relevant data for the study. Two Primary Health care Centres were used.120 participants were selected based on simple random sampling technique and the statistical tools employed to analyse the data collected were percentages, meand and standard deviation while the inferential statistics of chi-square(x²) and T-test were used to test the stated hypotheses at 0.05 level of significance. 4 research questions and 3 research hypotheses were designed and formulated for the purpose of the study. The study revealed that there is a significant effect of knowledge of health implications of prenatal care on mother and child. It also revealed that there is a significant difference between mothers and babies that properly undergo prenatal medical care from those that did not. The study further revealed that there is a significant difference between well-nourished mothers during their prenatal care from mother that were not nourished. Based on the findings of this study, recommendations and suggestions were made for Mothers, Health Care Providers and Government and relevant agencies for further research.

TABLE OF CONTENTS

Title page                                                                             i          

Certification                                               ii

Dedication                                                                     iii        

Acknowledgments                                                     iv        

Abstract                                                           v

Table of content                                                          vi

CHAPTER ONE: INTRODUCTION

Background of the Study                                             1

Statement of Problem                                                        6

Purpose of the Study                                            9

Research Question                                                                   9

Research Hypotheses                                                              9

Significance of the Study                                                       10

Scope of the Study                                                              10

Definition of Terms                                                                   11

CHAPTER TWO: LITERATURE REVIEW

Introduction                                                         11

Concept of Prenatal Care                                                  12

Knowledge of Health Implications on Prenatal Care               15

Antenatal Booking and Antenatal Care                          16

Knowledge of Health Implications of Prenatal Care on Mother and Child      16

For the Love of Pregnant Mothers, Nursing Mothers and Children   17

Barriers to utilization of maternal health care services among reproductive women  18

Importance of Prenatal Care Services to Pregnant Women          24

Extent of Utilization of Prenatal Care Services among Childbearing Mothers          30

CHAPTER THREE: RESEARCH METHODOLOGY

Research Method                                                         33

Area of Study               33

Population                                                                  34

Sample and Sampling Techniques                                         34

Research Instruments                                                    34

Reliability and Validity of Instruments                              34

Procedure for Data Administration                                         35

Data Analysis                                                             35

CHAPTER FOUR: PRESENTATION AND DATA ANALYSIS

Introduction                                                     36

Presentation of Demographic Data                       36

Analysis of Research Questions                                 44

Testing of Hypothesis                                           48

Summary of Findings                                     50

Discussion                                         51

CHAPTER FIVE:    DISCUSSION OF FINDINGS, SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

Introduction                                             55

Summary of the Study                                         55

Conclusion                                                 56

Recommendations                                                57

Suggestion for Further Studies                        58                              

References                                59

Appendix                 62

CHAPTER ONE

INTRODUCTION

Background of the Study

Maternal health care services in health systems constitute a large range of curative and preventive health services of particular importance to the health of women of reproductive age and their infants. It includes population based services such as behaviour change and health communication (e.g., promotion of antenatal care) (Uzochukwu , Onwujekwe, & Akpala, 2005).

Maternal health care services aims at reducing maternal mortality and morbidity by ensuring that pregnant women remain healthy throughout pregnancy, deliver safely to healthy babies and recover fully from the physiological changes that occur during pregnancy (Osariemen, 2011).

According to the World Health Organization, "quality health care is defined as that care which consists of the proper performance according to standards." (Nikiema, Kameli, Capon, Sondo & Martin-Prével, 2010). Therefore, maternal health care service quality is the application of those necessary multisectoral services required to ensure a state of physical, mental, social, and perhaps spiritual well-being of mothers in the community, and their offsprings. This includes services required to minimize the noxious consequences of preexisting or concurrent health hazards or conditions, and upgrade the health and social functioning of those women who require it. (Mrisho & Obrist, 2009).

Prenatal care is the sequential care provided for pregnant mother before delivery to prepare them for successful labour, delivery and after birth care.

According to World Health Organisation (2005), prenatal care, also known as antenatal care, is a type of preventive healthcare. Its goal is to provide regular check-ups that allow doctors or midwives to treat and prevent potential health problems throughout the course of the pregnancy and to promote healthy lifestyles that benefit both mother and child. During check-ups, pregnant women receive medical information over maternal physiological changes in pregnancy, biological changes, and prenatal nutrition including prenatal vitamins. Recommendations on management and healthy lifestyle changes are also made during regular check-ups. The availability of routine prenatal care, including prenatal screening and diagnosis, has played a part in reducing the frequency of maternal death, miscarriages, birth defects, low birth weight, neonatal infections and other preventable health problems (WHO, 2005).

The World Health Organization (WHO) reported that in 2015 around 830 women died every day from problems in pregnancy and childbirth.

Prenatal care service is an umbrella term used to describe the medical procedures and care carried out during pregnancy. Antenatal care is a pregnancy related services provided to pregnant women by health professionals, is among the Millennium Development Goal (MDGs) 4 and 5, the major interventions which is aimed at preventing Neonatal death and maintaining the health of the women during pregnancy (Rooney, 2012). Prenatal care has many components such as laboratory investigation, referral, health education etc. Prenatal care is very important to pregnant women as it helps prevent mother and child mortality, prevent complications help foster a good relationship between the husband and wife, mother and child and father and child. 84.7% of pregnant women have at least one prenatal care contact with skilled personnel.

Prenatal care also provides women and their families with appropriate information and advice for a healthy pregnancy, safe childbirth, and postnatal recovery, including care of the newborn, promotion of early, exclusive breastfeeding, and assistance with deciding on future pregnancies in order to improve pregnancy outcomes. An effective prenatal care package depends on competent health care providers in a functioning health system with referral services and adequate supplies and laboratory support. Prenatal care improves the survival and health of babies directly by reducing stillbirths and neonatal deaths and indirectly by providing an entry point for health contacts with the woman at a key point in the continuum of care. A new analysis done for this publication using previously published methodology 10 suggests that if 90 percent of women received Prenatal care, up to 14 percent, or 160,000 more newborn lives, could be saved in Africa.

During prenatal care visit, pregnant women are educated on the following important topics: nutrition, medication, lifestyle, exercise, personal and environmental hygiene, safety in the environment, etc. The extend to prenatal care service underutilization by pregnant women is based at the individual and family level, the crucial factors are; employment of the women, education of the women and spouse, marital status, house hold income, exposure to media, obstetrical complications, parity, age, religious belief, culture, and pre-conception of pregnancy. Among the social – demographic factors, the odds for underutilizing prenatal care services increased significantly for mothers with low educational attainment and from households with a low wealth index (Darmstadt & Bhuttta, 2005).

WHO (2012), suggested that pregnancy is the term used to describe the period in which a fetus develops inside a woman’s womb or uterus. A typical pregnancy lasts 40 weeks from the first day of your last menstrual period (LMP) to the birth of the baby. It is divided into three stages, called trimesters: first trimester, second trimester, and third trimester. Conception to about the 12th week of pregnancy marks the first trimester. The second trimester is weeks 13 to 27, while the third trimester starts about 28 weeks and lasts until birth (WHO, 2012).

Pregnancy care involves care for the pregnant mothers and their unborn baby. The broad goal of contemporary pregnancy care is to promote the health of the mother, child, and family through the pregnancy, delivery, and the child’s development (Kirkham, Harris & Grzybowski, 2005).

Labour and delivery, is the ending of a pregnancy by one or more babies leaving a woman's uterus by vaginal passage or C-section.  In the developed world most deliveries occur in hospital, while in the developing world most births take place at home with the support of a traditional birth attendant.

The most common way of childbirth is a vaginal delivery. It involves three stages of labour: the shortening and opening of the cervix, descent and birth of the baby, and the delivery of the placenta. The first stage typically lasts twelve to nineteen hours, the second stage twenty minutes to two hours, and the third stage five to thirty minutes. The first stage begins with crampy abdominal or back pains that last around half a minute and occur every ten to thirty minutes. The crampy pains become stronger and closer together over time. During the second stage pushing with contractions may occur. In the third stage delayed clamping of the umbilical cord is generally recommended. A number of methods can help with pain such as relaxation techniques, opioids, and spinal blocks (Rooney, 2012).

Postnatal care is a period which begins immediately after the birth of a child and extends for about six weeks, as the mother's body, including hormone levels and uterus size, returns to a non-pregnant state. Less frequently used are the terms puerperium or puerperal period. The World Health Organization (WHO, 2012) describes the postnatal period as the most critical and yet the most neglected phase in the lives of mothers and babies; most deaths occur during the postnatal period. Following childbirth the woman and newborn should be examined within 24 hours by a health worker. At this time also discuss with the woman and family the timing of subsequent visits and the immunization schedule for the baby. WHO recommends that the mother and baby be visited at home by a trained health worker, preferably within the first week after birth. If the facility does not carry out home visits, it is important to discuss with the mother how she will come to the facility or local clinic for these scheduled visits. These visits early in the postnatal period are important for the mother and baby. It is also an important opportunity to ensure the establishment of breastfeeding and address any difficulties with attachment and positioning.

Medical care for a nursing mother involves the following: within one week after delivery, it is necessary to make an appointment with your obstetric provider for a follow-up visit. The healthcare provider generally will schedule a follow-up visit within 4 to 6 weeks after delivery. Some healthcare providers might want to see the nursing mother sooner, such as 2 weeks after delivery. As opined by Langer, Villar and Romero (2012), it is important to continue to do perineal care, as advised by your healthcare provider, until you see your healthcare provider at your first check-up.

Financial barriers are preventative care for which pregnant women are charged user fees according to the cost recovery scheme meanwhile the state heavily subsides the majority of prenatal care components.

Cultural belief and ideas about pregnancy also had an influence pregnancy on prenatal care use in that they may lead to attending prenatal care late or not attending at all. Parity had a statistically significant negative effect on adequate attendance, where by women of a high parity tend to attend late for the first prenatal care visit or have few prenatal care visit. Globally, over 10% of all women do not have access to or are not using an effective method of contraception. It is estimated that satisfying the unmet need for the family planning alone could cut the number of maternal deaths by almost a third. The UN Secretary-General’s Global strategy for Women’s and Children’s Health aims to prevent 33millions unwanted pregnancy and childbirth, including unsafe abortion.

 Antenatal clinic, are a key strategy to decreasing maternal mortality in low income resource settings and it is important to pregnant women as it help prevent maternal and child mortality as well as pregnancy complications. Despite improvement in maternal and infant mortality, there are other factors which hinder these women from using prenatal care services such as religion/cultural beliefs, poverty. Thus about 9,000 women lose their life during childbirth every year in Cameroon.

Therefore it is necessary to explore pregnant women knowledge on the importance of prenatal care services so as to come to a better understanding on the factors that hinders these pregnant women from attending prenatal care services.

Statement of Problem

Inadequate capacity in the maternity care system often used by low-income pregnant women constitutes a second barrier to use of prenatal care. Two closely related aspects of the capacity issue are: first, inadequate numbers of, and long waiting times for appointments at, facilities such as Community Health Centers and health department clinics—settings that have traditionally provided prenatal care to those unable or unwilling to use the private care system; and second, problems concerning the availability of maternity care providers including the uneven distribution of physicians nationally, the unwillingness of some physicians to care for Medicaid-enrolled pregnant women, and the malpractice problem.

Women with limited financial resources, especially women with neither public nor private health insurance, frequently seek prenatal care in so-called "organized settings," as distinct from private physicians in office-based practices. These settings include hospital outpatient departments, Community Health Centers and public health departments, Maternity and Infant Care projects, and school-based prenatal services.

Several national surveys confirm that these settings are important sources of care for poor women and for young, unmarried women—the same groups at risk for inadequate use of prenatal care.

Studies have documented the socio-demographic and other factors affecting prenatal care use. Lincentto (2010) identified inability to pay for prenatal care services or prescribed treatment as an important barrier to utilization of prenatal care service. In situations where prenatal care uptake requires travel and long waiting hours, pregnant women and their families experience huge opportunity costs, such as the loss of income in order to attend services. Long distances to health facilities as well as insufficient number of prenatal care providers at various prenatal care clinics negatively affect prenatal care utilization.

The higher prenatal care services coverage in urban areas than in rural areas worldwide has been ascribed to inequities in the number of accessible health facilities. In Nigeria, urban bias in public health expenditure, inadequate financing coupled with difficulties in attracting health workers to and retaining them in rural areas have limited government’s ability to create an accessible community-based health care system which could reduce inequities in rural–urban health facilities. This scenario also occurs in other developing countries.

Family members of pregnant women as well as the community and primary health care services, have roles to play in prenatal care attendance. Their involvement in prenatal care utilization or otherwise affects use of prenatal care services. Families and communities often consider pregnancy as a natural process of life and therefore, underestimate the importance of prenatal care. Misunderstandings, conflict or poor communication among formal and informal health care providers and with health service seekers may cause low utilization of prenatal care services in certain communities. Unprofessional practices, attitudes and behaviours of prenatal care providers may further increase the non-utilization of prenatal care services. Unprofessional conduct may include failure to respect the privacy, confidentiality, and traditional beliefs of the health seekers.

Affordability, availability, and accessibility of prenatal care providers are the most common problems facing utilization of prenatal care in Nigeria. Poor, rural women with limited education in particular face challenges in these. Joint efforts should be deployed to making prenatal care services attractive to and reachable by pregnant women and nursing mothers. These efforts should address financial and cultural barriers to prenatal care use, quality improvement to increase prenatal care services utilization and satisfaction, and maximal contacts between the woman, the service providers and the health services.

Implementation of a free prenatal care policy, the establishment of more prenatal care public health facilities within a 15 km radius of every woman across Nigeria, and an emphasized focus on the WHO public health guidelines on prenatal care are the surest ways to overturn the low prenatal care coverage in Nigeria. The health facilities should be supplied with adequate drugs, manned by skilled health workers and the workers re-orientated to be professionals so as to win confidence and patronage of women and their partners. Priority must be given to recruitment and to efforts in retaining skilled health workers, and to their adequate supervision, training, knowledge and skills acquisition, and motivation in addition to establishment of health facilities, availability of drugs, equipment and other consumables.

Purpose of the Study

The purpose of this study is to investigate the extent of knowledge of health implications of prenatal care on mother and child among clients of primary health care services in Lagos. Other specific objectives of the study will include:

1.      To determine the extent of knowledge of health implications of prenatal care on mother and child.

2.      To difference between mothers and babies that properly undergo prenatal medical care from those that did not see any reason for prenatal medical care including immunization.

3.      To determine the barrier to utilization of prenatal health care services.

4.      To determine the difference between well-nourished mothers during their prenatal care from mother that were not nourished.

Research Question

1.      What is the extent of knowledge of health implications of prenatal care on mother and child?

2.      What is the difference between mothers and babies that properly undergo prenatal medical care from those that did not?

3.      What is the level of barrier to utilization of prenatal health care services?

4.      What is the significant difference between well-nourished mothers during their prenatal care from mother that were not nourished?

Research Hypotheses

1.      There is no significant effect of knowledge of health implications of prenatal care on mother and child.

2.      There is no significant difference between mothers and babies that properly undergo prenatal medical care from those that did not.

3.      There will be no significant difference between well-nourished mothers during their prenatal care from mother that were not nourished.

Significance of the Study

The findings of the study educate the government and health care providers to provide high quality services to the women and their unborn babies.

It will help to reduce health complications on both mother and their babies.

In this regard, this study is a contribution to deliberation aiming at the availability and applicability of prenatal care services to pregnant women and to reduce some complication in pregnancy by providing adequate information to pregnant women during prenatal care visit.

Therefore this study will also help educate mothers of our urban area and lower class families how important the proper prenatal care is on the health of both the mother and their unborn babies.

Scope of the Study

This study is to investigate the extent of knowledge of health implications of prenatal care on mother and child among clients of primary health care services in Lagos. The study will be limited all women of child bearing age in Ikosi Primary Health Centre (PHC) and  Ikosi-Isheri Maidan HealthCare Centre local Government area of Lagos state.

Definition of Terms

Prenatal Care:  is a type of preventive healthcare. Its goal is to provide regular check-ups that allow doctors or midwives to treat and prevent potential health problems throughout the course of the pregnancy and to promote healthy lifestyles that benefit both mother and child.

Pregnancy: is the term used to describe the period in which a fetus develops inside a woman’s womb or uterus

Primary Healthcare: refers to "essential health care" that is based on "scientifically sound and socially acceptable methods and technology, which make universal health care accessible to all individuals and families in a community. It is through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.

Labour and Delivery: is the ending of a pregnancy by one or more babies leaving a woman's uterus by vaginal passage or C-section.  

Postnatal Care: is a period which begins immediately after the birth of a child and extends for about six weeks, as the mother's body, including hormone levels and uterus size, returns to a non-pregnant state.

Saunas: is a type of bath in which you sit or lie in a small room which has been heated to a very high temperature by burning coal or wood or steam.