ABSTRACT
This study was carried out to examine the perception of parturient (newly delivered) mothers on the utilization of health care
services in the Esan West local government area of Edo State. Four research
questions were raised to guide the study towards achieving the specific
objectives of the study as outlined in the introductory chapter of this report.
The population of the study consisted of parturients mothers in Ekpoma, Esan
West Local Government Area of Edo State, between the ages of 18 to 40 years.
The sample size for the study was 50 participants purposively selected from the
entire population. The method of data collection was through the use of
interviews. The data was analysed using thematic analysis. The study also found that the level of care and attention
met out by the staff in these facilities had a lot to do with influencing the
perception and consequently the utilization of health facilities by these
mothers. The negative areas identified in these health facilities were poor
electricity, drug unavailability, and inadequate facilities, and equipment.
Following these observations the study
recommends that the government and any capable non-governmental
organization should render much-needed help in the renovation of dilapidated
health facilities as well as supply modern equipment for effective health
service delivery in public health centres, Also, the hospital management
should make effective use of budgetary allocations in ensuring the improvement
of electricity supply across health facilities in the local government, There
should be closer supervision of drugs and hospital materials supplied during
special interventions to avoid the mismanagement of these materials or even
unapproved sales to external vendors or pharmacists, and finally that
apart from supplies during special interventions, the Ministry of Health should
ensure that there is continuous supply and restocking of hospital stores with
necessary drugs and materials needed for effective service delivery in public
hospitals
TABLE
OF CONTENTS
Title page i
Declaration iii
Certification iv
Abstract
v
Dedication vi
Acknowledgement vii
Table of Contents viii
List of Table x
CHAPTER
ONE
1.1
Background to the study 1
1.2 Statement of the Problem 3
1.3 Objective of the Study 4
1.4 Research Questions
5
1.6 Scope of the Study
6
1.7 Operational Definition of Terms
6
CHAPTER
TWO
2.0 Introduction
2.1. Conceptual Review
7
2.1 Concept of health 7
2.2.2 Concept of Primary Health
Care 9
2.2.3 Primary
Health Care as a Global Health Care 9
2.2.4 Quality of Health Care
services 10
2.2.5 Concept of Maternal and
Child Health Care Services 11
2.2.6.
Health Care Service Utilization 12
2.2.7. Utilization of Health Care Services among Pregnant Women 13
2.2.8. Factors Influencing the Utilization of Health Care Services 16
2.2.9 Attitude of Midwives to
Women in Labour Care 18
2.2.10 Dimensions for Describing
Quality of Health Care in Primary Health Centres. 20
2.2.11 Patient Perceptions versus
Patient Satisfaction 21
2.3.0 Theoretical Frameworks 21
2.3.1 Expectation Theories 21
2.2.3 Attribution Theory 22
2.4. Empirical
Review 23
2.5. Summary
of Review 26
CHAPTER
THREE
3.0 Introduction 27
3.1 Research Design 28
3.2 Setting of the Study 28
3.3 Target Population 29
3.4. Sample Size Determination 30
3.5 Sampling Technique 30
3.6 Instrument for Data Collection 31
3.7 Validity of Instrument 31
3.8 Reliability of Instrument 32
3.11 Ethical Consideration 32
3.9 Method of Data Collection 32
3.10 Method of Data Analysis 33
CHAPTER
FOUR
4.1 Presentation of Result 34
4.2. Specific findings of the study 41
CHAPTER
FIVE
5.1 Identification of key Findings 43
5.2 Discussion of Findings 43
5.3 Implication of Findings to Nursing Practice 44
5.4
Limitations of the Study 48
5.5
Summary 48
5.6
Conclusion 49
5.6 Recommendation 50
5.7 Suggestions for Further Studies 51
REFERENCES 52
INTERVIEW QUESTIONS 55
APPENDIX 1 56
CHAPTER
ONE
INTRODUCTION
1.1 Background of Study
Healthcare
in low-resource areas or settings has continually been a public health problem
and healthcare management is different in rural areas than in urban areas
(Lahariya, 2013). These Problems such as poor access to maternal and child
health services leading to high maternal and child mortality rates, access to
good health facilities, unavailability of skilled workers, poor governmental
funding, limited number of staff present in clinics, inadequate power supply,
inadequate supply of essential drugs etc. have been a major problem in health
care services in low resource settings.
However,
maternal morbidity and mortality remain a great public health and humanitarian
concern (Mohamed et al, 2021). The World Health
Organisation (2019) estimated that 810 mothers die every day due to pregnancy
or childbirth-related causes and an additional 6500 newborn babies die globally
daily, which is unacceptably high. Most of these causes are preventable.
There
is a considerable gap in maternal mortality across countries around the
world. Around 94% of all maternal deaths
occur in low and lower-middle-income countries, which reflects access and
utilization inequalities between rich and poor communities. For instance, the
Maternal Mortality Ratio (MMR) average in very low-income countries is 462 per
100,000 live births compared to 11 per 100,000 live births in high-income
countries of the world (World Health Organisation, 2019).
Access
to health facilities in health centres is a big problem and this has led to
increased maternal mortality and morbidity rates. This can be in either
financial or distance access to health centres. Modern facilities and
techniques for health services tend to be centralized in urban or high-resource
settings or areas while rural communities or low-resource settings are often
devoid of practical assistance, the next nearest facility is only available at
specific times. (Union of International Association, 2020)
Globally,
the unavailability of skilled staff or birth attendants in health centres has
resulted in 75% of deaths around the world, the responsibilities and workloads
of existing staff members increase, which leads to mistakes and other
inefficiencies and negatively affects individual performance, client care and
ultimately health care performance. In the developed world, because of the
availability of skilled health workers in countries like America, and Britain,
death-related skilled birth has been reduced by 20% as last recorded in 2019.
In the USA, because of the unavailability of skilled health workers, about
1,205 women died of maternal cases in 2021, compared with 861 in 2020 and 754
in 2019. The maternal mortality rate for 2021 was 32.9 deaths per 100,000 live
births, compared with a rate of 23.8 in 2020 and 20.1 in 2019. (Driscoll et al, 2022). However, in developing
countries, or in resource settings where there are an inadequate numbers of
skilled birth attendants, the mortality death rate is still on the increase.
According
to the United Nations Population Fund (UNFPA) in Kenya, the maternal mortality
ratio stands at 355 deaths per 100,000 live births. Given the current annual
births, this means that there are nearly 5,000 women and girls dying annually
due to pregnancy and childbirth complications. While access to skilled birth
attendance has improved from 62% to about 70% over the last seven (7) years,
over 80% of maternal deaths are attributed to poor quality of care.
Additionally, many more women and girls survive with severe morbidity including
obstetric fistula and mental health complications.
According
to the World Health Organisation (2015), Nigeria’s estimated maternal mortality
rate of 814 per 100,000 live births is one of the world’s highest and is partly
attributable to the low use of skilled professionals for care delivery. Also,
poor governmental funding at health centres in resource settings in Nigeria has
resulted in an inadequate supply of essential drugs, lack of consistent power
supply, inadequate water supply, and inadequate supply of delivery equipment
such as hand gloves, antiseptic agents, delivery instruments and this has
resulted to increased maternal complications and mortality.
Due
to all these concerns or views, the researcher needs to examine these views or
problems so that they can effectively be handled or properly solved in this
research study.
1.2
Statement of the Problem
Maternal
and child health services are essential and have resulted in numerous positive outcomes
of care and putting smiles and joy in the faces of parturients as they come to
deliver as reported in empirical research. However, where there are delimited
resources or a lack of equipment and amenities to aid this care, many
parturients are discharged from the clinic with further traumatic experiences.
Despite
the efforts of the government to build health facilities in this community, and
employ skilled and qualified doctors, nurses and other health workers in the
community, parturients are known to arrive at the health centres with rarely
any skilled health attendant present or available. More so, even when there are
skilled birth attendants, factors such as access (that is, distance or/and
finance) to the health centres or the time contraction commences have been
documented to contribute to parturient experience either positively or
negatively.
The
researcher observed during her community health posting experience at Uromi,
Esan North East Local Government Area, Edo State, in March 2022, that these
services to health care were not effectively rendered to parturients or newly
delivered mothers, there was no adequate electricity supply, lack of detergents
and antiseptic agents, poorly trained staffs, poor practice aseptic techniques,
unavailability or limited number of midwives and nurses. Hence, the purpose of
this research in health centres in Esan West Local Government Area, Edo State,
is to determine the positive or negative views, outcomes or beliefs regarding
the utilization of primary health care services among parturients in a low
resource setting.
Similar
research has been done on this topic in Ghana (Kpodotsi et al, 2021), and
Nigeria, in Ado-Ekiti, Ekiti State (Tunrayo et al, 2023 Mar). However, there
has not been research related to the phenomenon under study in Esan West Local
Government Area, Edo State. Taking cognisance of all these gaps, the researcher
seeks to document the parturient’s perception of the utilization of primary
health care services in Esan West Local Government Area, Edo State. Hence the
need for this research.
1.3 Research Objectives
The
general objectives of this study seek to evaluate parturients' perception of
the utilization of primary health care services among parturients or newly
delivered mothers in Esan West Local Government Area, Edo State.
The
specific objectives seek to achieve the following:
1.
To determine the
positive views or outcomes in the utilization of primary health care services
among parturients or newly delivered mothers in Esan West Local Government
Area, Edo State.
2.
To determine the
negative views or outcomes in the utilization of primary health care services
among newly delivered mothers in Esan West Local Government Area, Edo State.
3.
To determine the
beliefs associated with the use of the health care setting among newly
delivered mothers in Esan West Local Government Area, Edo State.
4.
To support ways to
enhance the positive experience and outcome of care among newly delivered
mothers in Esan West Local Government Area, Edo State.
1.5 Research Questions
The
following research questions will guide the study;
1. What are the positive views or outcomes
in the utilization of primary health care services among parturients or newly
delivered mothers in Esan West Local Government Area, Edo State?
2. What are the negative views or outcomes
in the utilization of primary health care services among parturients or newly
delivered mothers in Esan West Local Government Area, Edo State?
3. What are the beliefs associated with
the use of the health care setting among newly delivered mothers in Esan West
Local Government Area, Edo State?
4. What are the ways to enhance the
positive outcome of care among newly delivered mothers in Esan West Local
Government Area, Edo State?
1.5 Scope of Study
The
study seeks to evaluate the satisfactory (positive) or unsatisfactory
(negative) views, outcomes or beliefs regarding the utilization of primary
health care services and the ways to enhance these outcomes of care. The study
is limited to women who are parturients or newly delivered mothers between
ages 18 to 40 and/or above in Esan West Local Government Area, Edo State.
1.6 Operational Definition of Terms
Perception: refers
to satisfactory (positive) or unsatisfactory (negative) views, beliefs
and/or outcomes experienced by parturients as a result of the nature of care.
Utilization of Primary
Health Care Services: refers
to maternal and child health services that are geared towards delivery and
immediate postpartum care such as delivery care, maternal care, child care, and
maternal and child mortality in low resource settings.
Inquiry among
Parturients:
refers to a face-to-face interview between the researcher and the mother who
has just delivered her baby as regards information towards the level of
satisfaction and outcome of care received.
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