TABLE OF CONTENTS.
Title page i
Approval ii
Certification iii
Dedication iv
Acknowledgements v
Table of Contents. vii
List of Tables ix
List of Figures x
Abstract xi
CHAPTER ONE: INTRODUCTION 1
Background to the Study 1
Statement of Problem 3
Purpose of the Study 4
Research questions 5
Significance of the Study 5
Scope of the study 5
Operational definition 6
CHAPTER TWO: LITERATURE REVIEW 7
Conceptual review 7
Concept of birth place 7
The concept of health care provider 7
The traditional medical practitioner or traditional healer 8
Healthcare providers during delivery 9
Skilled birth attendant 9
Consequences of delivering in non-health facility 15
Determinants of choice of healthcare provider during delivery among women 16
Socio-Cultural Factor 16
Socio-cultural factors considered here are: 16
Wanted or Unwanted pregnancy 21
Review of Related Theories 25
Anderson’s Model Of Health Services Utilization 25
Relating the theoretical framework to this work: 27
Primary determinants: 27
Health system 28
External environment 29
Health Behaviour 29
Health Outcome 29
Empirical Review 30
Summary of Literature Review 39
CHAPTER THREE: METHODOLOGY 40
Introduction 40
Research Design 40
Area of study 40
Target population 42
Sample 41
Instrument for data collection 41
Validity of Instrument 41
Reliability of Instrument: 42
Ethical Consideration 42
Procedure for data collection 42
Method of data analysis: 42
CHAPTER FOUR: PRESENTATION OF RESULTS 43
Test of Hypotheses 53
Summary of Finding 57
CHAPTER FIVE: DISCUSSION OF FINDINGS 58
Objective one 58
Objective two 59
Objective Three 61
Objective four 62
Conclusion 67
Nursing implication 67
Recommendations 68
Limitations of the study 69
Suggestions for further studies. 69
Summary 69
References 71
Appendix i 75
LIST OF TABLES
Table 1 showing the socio-demographic profile of the respondents 44
Table 2: Where the respondents had their last baby. 46
Table
3: Responses on reasons for
women’s choice of birth places. 47
Table 4: Responses
on who took the delivery of the last baby 48
Table
5: Factors that influence women’s use of
birth attendants during delivery. 49
Table 6: Reasons
for wanting to use the same birth place for delivery in future.
51
Table 7: Reasons for not wanting to use the same birth place for delivery in future. 52
Table 8: Relationship between primiparous and multiparous women in the use of birth attendants during delivery. 53
Table
9: Age cross tabulated with
place of delivery 54
Table
10: Place of delivery cross
tabulated with marital status 55
Table
11: Level of education cross
tabulated with place of delivery 55
Table
12: Parity of respondents
crosstabulated with place of delivery 56
LIST OF FIGURES
Figure 1 on whether the respondents will want to use
the same birth place in future 50
ABSTRACT
Birth place and birth attendants during delivery are crucial factors
in reducing maternal and newborn morbidity and mortality. This study
investigated the choice of birthplace and use of birth attendants during
delivery and also the factors influencing these choices among child bearing
women in Akanu, Ohafia community of Abia State. The need for this study arose
because women attend antenatal clinic during pregnancy but do not come to the health
facility to deliver their babies; they are only seen when complications
arose. Four objectives were set: To determine women’s choice of birth places
in Akanu Ohafia, elicit reasons for their choice of birth places, identify
women’s use of birth attendants during delivery and the factors influencing the
use of birth attendants. Cross sectional descriptive survey design was adopted
for the study. Total population of 313
women who gave birth between January and December 2012 were used for the study.
Data were collected using researcher developed structured questionnaire. Data
analysis was done using frequency counts and simple percentages and data
presented in tables and pie chart. Mean and standard deviation were used for
analysis of the demographic characteristics while Fishers exact test was
employed in testing the two null hypotheses at 0.05 level of significance. The
findings on choice of birthplace
revealed that, hospital/health
centre ranked highest with 67.6%, TBAS place 13.7%, church and spiritual homes 10.2 % and
home 8.6%%. On the reasons for choice of birth place,
respondents chose their places of delivery based on different reasons. For
hospital/health centre the major reasons indicated are availability of
qualified staff 93.4%, convenience 88.9% and availability of services 85.8%. On
choice of TBAs place their reasons were cost 93.0%, availability 93.0% and
convenience 81.4%. Reasons for using the church include availability 71.9%,
labour starting at night 68.8% and charge low 62.5% while the major reason for
delivering at home was that labour started at night 81.4%, Use of birth attendants during delivery showed that
Nurse Midwives 70.6% is the highest and that there is reduction in the
number of deliveries taken by the TBAS 15.0% and other people compared with results from other researchers. The women gave
reasons which include: Provider knows her work, provider treats people with
respect, the provider charges low and provider is always available as driving
use of birth attendants during delivery.
Two hypotheses were formulated; (i) there is no significant difference
in the use of birth attendants during delivery between primiparous and
multiparous women. (ii) there is no significant difference between some women’s
socio demographic characteristics (age, marital status, educational level of
respondent and parity) on choice of birth place. Based on the findings there
should be more campaigns for mothers to use the health facilities with skilled
health personnel to avert maternal death. Health services should be made
available 24hours for easy access; TBAS should undergo some training to equip
them for management of simple cases.
Health services should be subsidized to reduce direct cost of health
services on childbearing women.
CHAPTER
ONE
INTRODUCTION
Background to the Study
The choice of birthplace and use birth
attendant during delivery is very important for women and their families
because it determines to a large extent the outcome of pregnancies and child
births. Access to
quality healthcare during pregnancy and in particular, during delivery is a
crucial factor in explaining the huge disparity in maternal and perinatal morbidity and mortality between developing and the industrialized world.
(Gayawan,2012)
Every year, 3.3 million
babies are stillborn and maternal deaths have also continued unabated. More
than half a million women die of pregnancy related complications with
ninety-nine percent (99%) of these deaths occurring in developing regions
particularly Africa and Asia.
(WHO 2005). The implication is that every minute, at
least a woman dies from pregnancy and childbirth in these regions. . Comparing
with other regions of the world, the lifetime risk of maternal deaths in sub
Saharan Africa is 1 in 22 mothers. North Africa has 1 in 210, 1 in 62 for
Oceania, 1 in 120 for Asia, and 1in 290 for Latin America and the Caribbean
(WHO, 2005).
According
to the World Health Organization (WHO) (2005), the history of success in
reducing maternal death and newborn mortalities show that skilled professional
care during and after childbirth can make the difference between life and death
for both women and their newborn babies.
The converse is true as well; a breakdown of access to skilled care may
rapidly lead to increased unfavourable outcomes. Yanagisawa, Oum
and Wakai (2006), assert that obstetric complications are the leading cause of
death among women of reproductive age in many developing countries. Globally,
more than 200 million women become pregnant each year and 40% are estimated to
experience pregnancy related health problems with 15% experiencing serious or
long term complications and 1.7% developing fatal complications. The lifetime
risk of deaths due to pregnancy related complications is 250 folds higher among
women in developing countries. It is estimated that 88 – 98% of these deaths
are avoidable and 70% are related to five direct obstetric complications:- postpartum haemorrhage, puerperal
pre –eclampsia and eclampsia, obstructed labour and abortion. AbouZahr,
(2003) ; in Yanagisawa et al (2006) stated that the prevention and management of these
complications is the key to improving
maternal health. It is estimated that 97% of pregnant women in developed
countries receive antenatal care ANC services and 99% use skilled obstetric
services during delivery. In developing
countries, 65% and 53% of women use ANC and skilled obstetric care respectively
(Uzochukwu, Onyeukwu and Okpala 2004.) Acquiring the
service of skilled attendants during delivery to improve the management of
pregnancy and related complications is an effective means to reduce maternal
mortality.
Iyaniwure and Yusuf
(2009) observed that it is not enough to receive ANC only. This is because majority of the
complications that cause maternal death occur during or shortly after
delivery. It is therefore important that
pregnant women have skilled obstetric attendance during delivery because
pregnancy related complications are a leading cause of death among women of
reproductive age in developing countries. According to joint
WHO/UNFPA/UNICEF/World Bank statement(1999),skilled obstetric care or
attendance refers to the process by which a pregnant woman and her infant are
provided with adequate care during pregnancy, labour, birth, postpartum and
immediate newborn period, whether the place of delivery is the home or
hospital. In order for this process to
take place, the attendant must have the necessary skills and must be supported
by an enabling environment at various levels of the healthcare system. For the
world’s 60million non facility based births, addressing who is currently
attending these births and what effects
they have on birth outcomes is a key starting point towards improving care
during delivery.( Darmstadt et al 2009).
A skilled birth attendant refers exclusively
to people with midwifery skills (e.g. doctors, midwives, nurses) who have been
trained to proficiency in the skills necessary to manage normal deliveries and
diagnose, manage or refer obstetric complications. They must be able to recognize the onset of complications, perform essential
interventions, start treatment and supervise the referral of mother and baby
for interventions that are beyond their competence or not possible in a
particular setting.
In Nigeria, the National HIV/AIDS and Reproductive Health
Survey (2003) showed that 62% of women who gave birth a
year before the study received ANC while 34% had skilled attendance
during delivery. In Abia state, it was recorded that TBA’S attend to 80% of
births and skilled midwives attend to 20% of births(Health statistics,
2012) In developing countries,
conditions are not favourable enough to encourage women living in rural and
remote areas to deliver at home. When
home deliveries occur, some go well and others lead to complications and death
. the later often occurs when the family is not prepared to refer the woman to a health facility or cannot recognize the signs of complications.
Barely 6 months to 2015
– the year targeted for achieving the
global reduction in maternal mortality, the continuing high rate of maternal
mortality remained worrisome. According
to the United Nation’s and World Bank statistics an estimated 144 women die
each day in Nigeria from pregnancy
related complications making her one of the worst countries for women to
deliver babies in the world (Okeibunor, Onyeneho and Okonofua, 2010). The
situation of maternal and child health in Nigeria is among the worst in Africa
and has not improved substantially while
in some areas of the country, it has worsened over the past decade. The
maternal mortality ratio ranges between 800-1,500 per 100,000 live births. Nigeria is second to India in terms of
absolute number of maternal deaths and regrettably despite abundant resources,
contributes to more than 10% of all global maternal and under five deaths (NHS
2003 in Ladipo 2009). Choice of birth
place and birth attendants among childbearing women during delivery is very
important for women and their families since this is a very critical period, a
period when almost all the complications that bring about maternal morbidity
and mortality occur. Women need not die
in childbirth; for optimum safety, every
pregnant woman without exception needs professional skilled care when
giving birth. This can avert, contain or
mitigate many of the life threatening problems during childbirth and reduce
maternal morbidity and mortality to a significant low level. This study therefore intends to find out the choice of birth place and use of birth attendants during delivery among women of child bearing age in Akanu community of Ohafia L.G.A., Abia
State.
Statement of Problem
CHOICE OF BIRTHPLACE AND USE OF BIRTH ATTENDANTS AMONG CHILD BEARING WOMEN IN AKANU, OHAFIA LOCAL GOVERNMENT AREA, ABIA STATE NIGERIA
