Assessing Knowledge, Practice and Factors Influencing Birth Preparedness and Complication Readiness Among Couples in Selected Rural Communities in Oji River Local Government Area of Enugu State
CHAPTER ONE
Objective Of Study
The specific objectives of the study are to :-
- determine knowledge of birth preparedness and complication readiness among couples in the communities under study.
- determine couple’s practice of birth preparedness and complication
- Identify factors that hinder the practice of birth preparedness and complication readiness.
- establish the relationship between couple’s socio-economic status and their practice of birth preparedness and complication
CHAPTER TWO
LITERATURE REVIEW
This chapter presents the review of related academic materials from books, journals, published and unpublished articles sourced from the University library and the internet. The literature review has been organized under conceptual, theoretical and empirical reviews. Summary of the literature is also highlighted.
Conceptual Review Concept of BP/CR
Women and newborns need timely access to skilled care during pregnancy, childbirth, and the post-partum/newborn period. However, too often, their access to care is impeded by delays — delays in deciding to seek care, delays in reaching care, and delays in receiving care (WHO, 2009). These delays have many causes, including logistic and financial concerns, unsupportive policies, and gaps in services, as well as inadequate community and family awareness and knowledge about maternal and newborn health issues.
These delays include
Delays in deciding to seek care may be caused by failure to recognize signs of complications, failure to perceive the severity of illness, cost considerations, previous negative experiences with the health care system and transportation difficulties.
Delays in reaching care may be created by the distance from a woman’s home to a health facility or provider, the condition of roads and a lack of emergency transportation.
Delays in receiving care may result from unprofessional attitudes of providers, shortages of supplies and basic equipment, a lack of health care personnel, and poor skills of health care providers. The causes of these delays are common and predictable. However, in order to address them, women and families and the communities, providers, and health facilities that surround them — must be prepared in advance and ready for rapid emergency action.
Birth preparedness and Complication Readiness (BP/CR)
BP/CR is the process of planning for normal birth and anticipating the actions needed in case of an emergency (Department of Community Medicine, 2009). Responsibility for BP/CR must be shared among all safe motherhood stakeholders – policy makers, facility managers, providers, communities, families and women- because a coordinated effort is needed to reduce the delays that contribute to maternal and new born deaths. Each stakeholder has an important role to play – from creating appropriate policies to strengthening facilities and providers to implementing effective community systems to adopting informed practices at home.
Together, stakeholders can plan for the care that women and newborns need during pregnancy, childbirth and the post-partum/newborn period, prepare to take action in emergencies, and build an enabling environment for maternal and newborn survival.
Birth preparedness can do much to improve maternal health outcomes. Birth preparedness helps ensure that women can reach professional delivery care when labour begins. In addition, birth preparedness can help reduce the delays that occur when women experience obstetric complications, such as recognizing the complication and deciding to seek care, reaching a facility where skilled care is available and receiving care from qualified providers at the facility (Family Care International, FCI, 2013).
According to The Skilled Initiative (FCI, 2013), the key elements of birth preparedness comprise attending antenatal care at least four times during pregnancy; identify a skilled provider and making a plan for reaching the facility during labour, setting aside personal funds to cover the costs of traveling to and delivering with a skilled provider and any required supplies; recognizing signs of complications; knowing what community resources-emergency transport, funds, communications, etc; are available in case of emergencies; having a plan for emergencies; i.e. knowing what transport can be used to get to the hospital, setting aside funds; identifying person(s) to accompany to the hospital and/or to stay at home with family; and identifying a blood donor.
CHAPTER THREE
RESEARCH METHOD
This chapter presents the research design, area of study, population of study, sample and sampling technique, instrument for data collection, reliability and validity of instrument, ethical consideration, procedure for data collection and method of data analysis.
Research Design
The research design that was adopted for this study was the descriptive cross-sectional survey design. This design was successfully used by scholars for similar studies (Iliyasu, et. al., 2010 and Ibrahim et. al., 2013), therefore the researcher deems it fit, since similar variables are being measured in the study. This design was thus adjudged suitable for this study because it involved the description of some characteristics from a given population as it exists.
Area of Study
This study was carried out in Oji River LGA of Enugu State. Oji River is a LocalGovernment Area of Enugu State, Nigeria to the south bordering Anambra State and Abia State. Its headquarters are in the town called Oji River. The towns within Oji River LGA are: Awlaw, Achi Uno, Achi Agu, Oji Urban, Ugwuoba, Inyi and Akpugo-Eze. It has an area of approximately 403 km². The main occupation is farming and trading but the literate ones are mainly civil servants.
Oji River has one general hospital and one Joint hospital run by the mission. Each community has at least a health centre or a health post. Social amenities like electricity, good water supply, phone services, recreational centres and many markets are available. Most of the main access roads that lead into each community are tarred and connected. However, the roads that lead into the villages are fairly motor able.
Population of Study
The total population of Oji River LGA is 126,587 at the 2006 census (NPC, 2006). However, the target population of the study (population of couples in Oji River LGA) is unknown as there is no statistical evidence of population of couples in Oji River LGA. Hence, the population of the study is unknown.
CHAPTER FOUR
PRESENTATION OF RESULTS
This chapter focused on the presentation results from data analysis. Out of a total number of 470 questionnaires administered, 390 were correctly filled giving a response rate of 82.98%.
Table 1 above presents the frequency distribution of the demographic characteristics of the study participants. The first four demographic variables of the couples were presented differently as the responses of the male respondents differed from their and female counterparts. The last two were presented based on their responses as a couple. Out of the 390 participants, no woman was above 40 years of age while 19(4.9%) of the male respondents were below 30 years. Most of the women 327(83.3%) were within the same age bracket. The modal age bracket for the male respondents was above forty years of age. This was followed by those within ages 30 – 40 years. The occupation of the respondents reveals that the modal occupation for husbands was trading 136(34.9%), while the wives were civil servants 190(48.7%).
The male respondents were predominantly secondary school certificate holders 276(70.8%), while 64(16.4%) and 9(2.3%) of them had tertiary and post tertiary degrees. Twenty percent of females (78) were graduates while 192(49.2%) had secondary school certificates. According to average monthly income amongst the respondents, no female earned above N60, 000 per month, but most of them 271(69.5%) earned less than N20,000. On the other hand, less than 10% of the males earned above N60, 000 per.
CHAPTER FIVE
DISCUSSION
This chapter discussed the major findings of the study. It also presented conclusions, recommendations, limitations of the study, summary and suggestions for further studies.
Discussion of major findings
Knowledge of birth preparedness and complication readiness at Oji River LGA, Enugu
The knowledge of birth preparedness and complication readiness among the study participants was relatively high. The study revealed that 307(78.7%) couples had good knowledge of birth preparedness and complication readiness based on the assessment scores earned from Section B in the study questionnaire. In the same vein, less than 25% of them scored below 70% and as such were classified as having fair to very poor knowledge of the subject matter. The danger signs during pregnancy were well known by more than 60% of the study participants. The modal frequencies for the right knowledge of danger signs during pregnancy were for convulsions and Anaemia. The reason for the good knowledge level amongst respondents may be attributable to the fact that these were very obvious danger signs that are also traditionally recognizable in the study area. Bleeding was also widely known as danger signs that could lead to complications if left unattended. The danger signs during or after childbirth were also examined.
Conclusion
Based on the findings of this study, the following conclusions have been made.
- Most of the couples 307(78.7%) had good knowledge of birth preparedness and complication
- Knowledge did not translate to practice as less than 20% of the couples actually practiced the acceptable level of practice of birth preparedness and complication readiness.
- Financial constraint was the most critical factor that hindered couples’ practice of birth preparedness and complication
- All the socio-economic variables examined were associated with couples’ practice of birth preparedness and complication readiness. Educational exposure, income and number of years together had significant positive associations with the subject matter while age and occupation were not significant.
Implication to Nursing
Birth preparedness and complication readiness is an important factor in reduction of maternal morbidity and mortality as well as infant morbidity and mortality. Therefore, there is need to assess the knowledge, practice and factors influencing birth preparedness and complication readiness among couples in the rural communities so that nurses can channel health education to the appropriate areas during community outreach programmes to reduce morbidity and mortality of both mothers and children.
Recommendations
Based on the findings, the following recommendations are made.
- There is a need for slight shift in focus on maternal and child care projects of Investments in improving awareness on danger signs appear to have paid off, however improving access by lowering financial requirements is imperative.
- There is also a need to improve transportation facilities suitable for pregnant women at the rural communities. This will significantly improve outcomes especially when emergencies occur and the need for referrals
- Non-governmental Organizations (NGOs) and Faith-Based Organizations (FBOs) should focus on improving access to cheaper medical services for majority of low income earners in rural
Limitations of Study
The researcher encountered certain difficulties in the course of this research and they include:
- The challenging terrain to access the communities
- Some of the responses given by the respondents may have been estimations or even exaggerations. This has also been reported in similar
Summary
This study assessed the knowledge, practice and factors that influenced birth preparedness and complication readiness amongst couples in selected communities in Oji River LGA, Enugu state. The study was designed to:
- Determine the knowledge of birth preparedness and complication readiness in the communities under study;
- Determine couples’ practice of birth preparedness and complication readiness in the communities under study;
- Identify factors that hinder couples’ practice of birth preparedness and complication readiness in the study area; and
- Establish the relationship between couples’ socio-economic status and their practice of birth preparedness ad complication
Literature was reviewed under conceptual review and empirical studies which were based on the objectives and research questions raised. Descriptive survey research design was employed and a sample of 390 was drawn from the study population. Validated questionnaire was administered to the respondents and their responses were analyzed using descriptive and inferential statistics. The study revealed that although most couples had good knowledge of birth preparedness and complication readiness, knowledge only translated to practice for less than 20% of the study participants.
Suggestion for further studies
This study showed that financial constraint was responsible for the gap between knowledge and practice among couples in the study area. There is a need to further investigate if similar situations exist in other local government areas, especially those with similar socio-economic statuses. This will significantly improve the ability of the state government to improve on maternal and child health outcomes through the design of apposite programmes.
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