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.
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