KNOWLEDGE AND AWARENESS OF POSTPARTUM HAEMORRHAGE AMONG WOMEN OF REPRODUCTIVE AGE IN LABOUR WARD AT FEDERAL MEDICAL CENTRE IDI-ABA ABEOKUTA OGUN STATE

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No of Pages: 56

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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

 H: There is no significant level of awareness of postpartum hemorrhage among women of reproductive age at FMC Abeokuta, Ogun State.

 H: 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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