ABSTRACT
This study examined the empirical relationship
between knowledge awareness of postpartum haemorrhage among women of
reproductive age in labour ward at FMC Abeokuta Ogun state. The research
specifically examined three objectives assessing the level of awareness of
post-partum hemorrhage among women of reproductive age in labour ward at FMC
Abeokuta Ogun state, assessing the knowledge of post-partum hemorrhage among
women of reproductive age at FMC Abeokuta Ogun state and determining the causes
of post-partum hemorrhage among women of reproductive age at FMC Abeokuta Ogun
state. The study adopted a descriptive research design. The study population
consist of all registered women of reproductive age in FMC Abeokuta Ogun state.
The sample size for this study is 32
registered women of reproductive agein FMC Abeokuta Ogun
state. Data were collected via
structured questionnaires and a descriptive analysis was employed with the aid
of Statistical Package for Social Science (SPSS).The study found that there is
an acceptable level of
awareness of post-partum hemorrhage among women of reproductive age at FMC
Abeokuta Ogun state. It also proved that that there is an acceptable level of awareness of post-partum hemorrhage among women of
reproductive age at FMC Abeokuta Ogun state. Based on the results, the study concluded that the
studied women of reproductive age at FMC Abeokuta Ogun state has an acceptable
level of awareness and utilization of misoprostol in the treatment of
post-partum hemorrhage.From the findings,
the study recommends that early recognition of potential risks for
pregnancy-related complications, and following all suggested guidelines for
interventions are key actions to decrease the probability of getting PPH.
Further study is recommended with a consideration of factors related to the
health system, service providers, and cultural aspects.
Keywords: Knowledge, Awareness, Postpartum Haemorrhage Women of
Reproductive Age, FMC, Abeokuta Ogun State
TABLE OF CONTENTS
Title Page
i
Declaration Page
ii
Certification iii
Dedication
iv
Acknowledgement vi
Table of Contents
vii
List of Tables ix
Abstract x
CHAPTER ONE: INTRODUCTION
1.1 Background to
the Study
1
1.2 Statement of
the Problem
3
1.3 Purpose of
the Study 4
1.3.1 Objectives of
the Study 5
1.4 Research Questions
5
1.5 Research
Hypothesis 5
1.6 Significance
of the Study
6
1.7 Scope of
Study
6
1.8 Operational
Definition of Terms 6
CHAPTER TWO: LITERATURE REVIEW
2.0 Introduction 7
2.1 Conceptual
Review
7
2.1.1 Postpartum
Hemorrhage
7
2.1.2 Women of
reproductive age 8
2.1.3 Knowledge of
postpartum Hemorrhage among women of reproductive age 10
2.1.4 Awareness of postpartum Hemorrhage among women of
reproductive age 11
2.2 Theoretical Framework 13
2.2.1 Health Believe
Model 13
2.2.2 Application of the Theory 14
2.3 Empirical Review
15
2.4 Summary of
Literature Review 18
CHAPTER THREE: METHODOLOGY
3.0 Introduction 20
3.1 Research
Design
20
3.2 Research
Setting
20
3.3 Research
Population 21
3.4 Sampling Size 21
3.5 Sampling
Techniques 21
3.6 Instrument
for Data Collection 21
3.7 Validity of the
Research Instrument 22
3.8 Reliability
of instrument 22
3.9 Method of
Data collection 22
3.10 Method of Data
analysis 23
3.11 Ethical
Consideration 23
CHAPTER FOUR: RESULT AND INTERPRETATION OF FINDINGS
4.1 Data presentation 24
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1 Discussion of
Findings
30
5.2 Implication
to nursing 33
5.3 Limitation of
the study 33
5.4 Summary of
Findings 34
5.5 Conclusion
34
5.6 Recommendation
35
5.7 Suggestion
for Further Research 35
REFERENCES 36
APPENDIX
41
LIST OF TABLE
4.1 Presentation of Data 25
CHAPTER
ONE
INTRODUCTION
1.1 Background to the study
Postpartumhaemorrhage
(PPH) is the major cause of maternal mortality and morbidity (Ogunbiyi, 2018).
It is estimated that post-partumhaemorrhage is the common cause ofmost maternal
deaths across the globe, responsible for more than 25% deaths annually. Postpartumhaemorrhage
is the leading cause of maternal mortality worldwide with a 6% prevalence
recorded (WHO, 2021).
Post-Partum
Haemorrhage (PPH) is the number one cause of maternal mortality in developing
countries and is the cause of 25 percent of maternal deaths worldwide (WHO,
2020). It is a common maternal morbidity in high resource countries and is
trending upward (International Postpartum Haemorrhage Collaborative Group,
2019). The American College of Obstetricians and Gynecologists (ACOG, 2019)
defines early postpartum haemorrhage as at least 1,000 mls total blood loss or
loss of blood coinciding with signs and symptoms of hypovolemia (that is,
decrease in the volume of circulating blood) within 24 hours after delivery of
the fetus or intrapartum loss. PPH is when the woman bleeds more than the ‘expected
amount' from the vagina and/or uterus after the baby is born. It can also
include an excessive amount of blood loss during and/or after a Caesarean
operation. Postpartum haemorrhage happens after the baby has been born, either
before or after the placenta has been expelled from the uterus. Postpartum
haemorrhage can be classified as primary, which may occur before the delivery
of the placenta and within 24 hours after delivery of the fetus, or secondary,
which occurs 24 hours to 12 weeks postpartum. Primary PPH is more common than
secondary PPH (Unicef, 2019).More than 303,000 women are estimated to have
diedglobally during, and following, pregnancy and childbirth in 2015 (WHO, 2019).Most
of these deaths are preventableand are a result of women in remote rural areas
in particular, having limited access to basic essential obstetrical care
(Prata, Gessessew & Abraha, 2019).
Due to the high
prevalence of anemia among pregnant women in low-resource settings, the outcome
of PPH is often worsened, resulting in detrimental health outcomes from
relatively moderate loss of blood (Mobeen et al., 2018). Despite the high
number of deaths due to PPH, it is largely preventable with active management
of the third stage of labor (AMTSL). Components of AMTSL include administration
of an oxytocic immediately following birth (usually oxytocin), placental
delivery by controlled cord traction, and uterine massage (Mobeen et al., 2018).
As many maternal deaths from PPH occur in women without identifiable risk
factors, all women should have access to AMTSL, including the use of an
oxytocic (Mobeen et al., 2018). Oxytocin however, requires skilled
administration by injection, access to cold-chain storage, and medical
disposables, making it unfeasible in many low resource settings (Mobeen et al.,
2018). In low-resource settings where access to oxytocin is not possible,
misoprostol provides a low-cost, heat-stable oxytocic that can be taken orally,
providing a practical alternative for preventing PPH (Mobeen et al., 2018).
In Africa and Asia
where most maternal deaths occurred, post partumhaemorrhage accounts for more
than 30% of all maternal deaths (WHO, 2021). However, the proportion of
maternal deaths attributable to post partumhaemorrhage varies considerably
between developed and developing countries (WHO, 2021).
Death as a consequence
of pregnancy remains an important cause of premature mortality worldwide. Every
year, some 3 million girls aged 15 to 19 undergo unsafe delivery. Babies born
to adolescent mothers face a substantially higher risk of dying than those born
to women aged 20 to 24 (Olowokere, 2018). About 500,000 women estimated to have
died from this potentially preventable cause each year occurring as a result of
haemorrhage within few hours of delivery. Moreover, there is a high prevalence
of anaemia indeveloping countries which complicates postpartumhaemorrhage (WHO,
2021). In Nigeria, maternal mortality
ratio is between 546 per 100,000 live births with haemorrhage accounting for
23% of all maternal deaths in some year back has increase in 2018 (23.8%) (Olowokere,
2018). However, Olowokereet al (2018) reported that prior booking of
pregnant women for antenatal care was associated with lower prevalence of PPH
(3.4%) as higher prevalence was recorded among un-booked clients in the primary
health care institutions.
Studies in Tanzania,
Nigeria, and Papua New Guinea, for example, have shown that misoprostol can be
successfully distributed at the community level and administered by women
themselves or non-medical providers following basic training and support (Hashima
Nahar, Mamun, Afsana & Byass, 2019). Based on the quality and depth of
evidence, both the World Health Organization (WHO) and the International
Federation of Gynecology and Obstetrics (FIGO) guidelines for the prevention of
PPH now include a recommendation for misoprostol (600μg orally) administered
during the third stage of labor by community health workers in contexts where
women are unable to access facility-based birthing (WHO, 2021).
1.2
Statement of Problem
According to the World
Health Organization, heavy bleeding after childbirth, often known as postpartum
haemorrhage (PPH), is the biggest cause of maternal death worldwide. PPH
affects around 14 million women each year, accounting for over 70,000 maternal
deaths worldwide. Even if women survive, they frequently require immediate
surgical intervention to control the bleeding and may be left with permanent
reproductive impairments (Varney et al. 2014).
Globally, the
prevalence of postpartum hemorrhage (PPH) is estimated to be between 6 and 11
percent. The rates vary depending on the data source, country, and assessment
method. Objective appraisal of blood loss shows a prevalence of 10.6 percent,
while subjective techniques indicate a prevalence of 7.2 percent. According to
the review study, the prevalence of PPH in Africa is estimated to be 10.5% in
cases of 500 mL or more of blood loss, and 8.9% in other regions (Calvert et
al. 2012). Postpartum haemorrhage (PPH) is responsible for 38% of maternal
mortality in India, according to FOGSI. Most of these fatalities happen within
four hours of delivery. In worldwide, PPH is the primary cause of maternal
mortality. According to FOGSI, 5.8% of women will experience PPH in their first
pregnancy, while 4-5% of women will experience PPH for the first time in a
second or third pregnancy (Nigussie et al. 2016).
1.3 Objectives of the Study
The
objectives of the study were:
1.
To assess the level of awareness of post-partum
hemorrhage among women of reproductive age in labour ward at FMC Abeokuta Ogun
state.
2. To
assess the knowledge of post-partum hemorrhage among women
of reproductive age in labour ward at FMC Abeokuta Ogun state.
1.4
Research Questions
1.
What the level of awareness of post-partum
hemorrhage among women of reproductive age in labour ward at FMC Abeokuta Ogun
state.
2.
What is the level of knowledge of post-partum
hemorrhage among women of reproductive age in labour ward at FMC Abeokuta Ogun
state.
3.
What is the cause of post-partum
hemorrhage among women of reproductive age in labour ward at FMC Abeokuta Ogun
state?
1.5 Research Hypothesis
H₀: There is no significant level of
awareness of postpartum hemorrhage among women of reproductive age at FMC
Abeokuta, Ogun State.
H₁: There is a significant level of
awareness of postpartum hemorrhage among women of reproductive age at FMC
Abeokuta, Ogun State.
1.6
Significance of the Study
As with any health
intervention, community distribution of misoprostol for the prevention of PPH
is complex, mainly due to the required timing of distribution and ensuring
correct use. Given this, the purpose of this study was to gather the necessary
data to design and implement a program to support community distribution of
misoprostol to prevent PPH in cases where women are unable to deliver in a
healthcare facility. In addition to the above, the study will provide future
scholars and researchers information regarding knowledge, attitude and utilization
of misoprostol in the treatment of post-partum hemorrhage among women of
reproductive age. The findings may also help inform policy maker to put the
necessary measures in place to address the problem of misoprostol in the
treatment of post-partum hemorrhage among women of reproductive age. The
research may also be useful to future researchers on the topic and serve as
reference materials in the libraries.
1.7 Scope of Study
This study covers knowledge
and awareness of postpartum haemorrhage it causes among women of reproductive
age. Geographically, the study will focus on women of reproductive age at FMC
Abeokuta Ogun state.
1.8
Operational Definitions of Term
· Knowledge of Postpartum Hemorrhage
(PPH): The understanding or awareness that women in the labor ward have
regarding the causes, symptoms, prevention, and treatment options for
postpartum hemorrhage, as assessed through a structured questionnaire.
· Awareness of Postpartum Hemorrhage
(PPH): The level of recognition among women in the labor ward that PPH is a
serious, potentially life-threatening complication of childbirth. This may
include awareness of the term "postpartum hemorrhage," its general
risks, and the importance of seeking medical help.
· Women of Reproductive Age: Women
aged 15–49 years who are capable of becoming pregnant and are admitted to the
labor ward of the Federal Medical Centre, Idi-Aba, Abeokuta, Ogun State.
· Labor Ward: The hospital unit
within the Federal Medical Centre, Idi-Aba, where women give birth and receive
immediate postpartum care. It serves as the setting for data collection in this
study.
· Federal Medical Centre, Idi-Aba,
Abeokuta: A tertiary healthcare facility located in Abeokuta, Ogun State,
Nigeria, providing specialized medical services, including maternity and labor
ward services.
·
Postpartum Hemorrhage (PPH): Excessive bleeding of 500
milliliters or more following vaginal delivery, or 1,000 milliliters or more
following cesarean delivery, occurring within the first 24 hours post-delivery,
as defined by World Health Organization (WHO) standards.
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