Demographic and Socio-economic Factors Influencing Utilization of Maternal Health Services in Selected Rural Communities in Igbo-etiti Local Government Area, Enugu State Nigeria
Chapter One
Purpose of the Study
The purpose of this study is to examine the demographic and socio-economic factors influencing utilization of maternal health services among women of childbearing age (15-49 years) in selected rural communities in Igbo-Etiti Local Government Area of Enugu State.
Objectives
The specific objectives are to:
- determine the demographic characteristics of the respondents that influence the use of maternal health services.
- determine the socioeconomic characteristics of the respondents that influence the use of maternal health services.
- determine levels of utilization of maternal health services among women of childbearing age in Igbo-Etiti Local Government Area
CHAPTER TWO
LITERATURE REVIEW
This chapter presents a review of relevant literature on demographic and socio-economic factors influencing the utilization of maternal health services. Relevant studies in both developed and developing nations were reviewed from journals, books, abstracts from published and unpublished university libraries as well as internet materials under the following headings: Conceptual Review (maternal health, concept of maternal health services); demographic factors influencing utilization of maternal health services (age, parity, women education); socio-economic factors influencing utilization of maternal health services (employment status, family income, husband education and occupation); theoretical review (health behavioral model); empirical studies and summary of literature review.
Conceptual Review
Concept of Maternal Health
Maternal health (MH) refers to the health of a woman during pregnancy, childbirth and the postpartum period (WHO, 2011). It simply means maintaining the health and the general wellbeing of women from pregnancy through birth and six weeks after childbirth. It should include preconception education, family planning services, abortion services, provision of obstetric emergencies and referral services (UNFPA, 2004).
The importance of improving the health outcomes for women and children received increasing recognition since the International Conference on Safe Motherhood Initiative held in 1987; the World Summit for Children in 1990 that adopted antenatal care as a specific goal
“Access by all pregnant women to prenatal care, trained attendants during childbirth and referral facilities for high risk pregnancies and obstetric emergencies (UNFPA, 2004). Similar aims were voiced in other major International Conference on Population and Development (ICPD) in 1994; the Fourth World Conference on Women in 1995, their five years follow up evaluations of progress and the United Nations Assembly General Session on children in 2002. Besides, the Millennium Summit which calls for a 75% reduction by 2015 in the maternal mortality ratio from 1990 level (Millennium Development Goals Progress Report, 2007).
However, increasing attention given to maternal health has not yielded much in improving maternal health status. Globally in 2009, estimated 358,000 women died annually due to complications developed during pregnancy and childbirth (WHO, UNICEF, UNFPA and World Bank, 2010). For every woman who dies, at least 20 more suffer injury, infection or disability from maternal causes- approximately 7 million women every year (WHO Report 2005). About 75% of maternal deaths occur during childbirth and the postpartum period and majority of these deaths and injuries are avoidable when women have access to health care before, during and after childbirth (MDGs Progress Report, 2007)
In developing world, 99% of maternal deaths occur; complications of pregnancy and childbirth are among the leading cause (Fathalla, 2009). The chances of a woman dying in pregnancy or childbirth is 1 in 14 in Somalia and 1 in 31 in sub-Saharan African, compared with just 1 in 15,200 in Italy, and 1 in 4,200 in Europe, (WHO, UNICEF, UNFPA, and World Bank, 2010).
In Nigeria over 40% of pregnant women experience pregnancy related problems during or after childbirth; while 15% suffers serious, long term complications (UNFPA, UNICEF, DFID and PATHS, 2005 – 2008). Nigeria has about 2% of the world’s population but contributes almost 10% of the world maternal deaths (FMOH, 2005). In recognition of the poor health status of women, the Federal government as a part of its commitment to improve maternal health, reduce morbidity and mortality developed the National Reproductive Health Policy and Strategic Framework (NRHPF) for its implementation and was launched in 2002 (UNFPA, UNICEF, DFID and PATHS, 2005 – 2008). The document is one of her commitment to implementation of the ICPD declaration in 1994. Among the objectives of the document includes to increase by 80% the number of pregnant women that attend antenatal care at least four times spread in the three trimester and increase by 50% women who are able to recognize warning signs of complications in pregnancy and seek prompt medical attention by end of 2008 (UNFPA, UNICEF, DFID and PATHS 2005-2008).
Data from the 2008 Nigeria Demographic and Health Survey (NDHS) revealed that the use of antenatal care in the last five years preceding the survey was 53%, while 36% did not receive antenatal care at all; though variations existed in the use of antenatal care among zones. South East and South West exhibit the highest use of antenatal care (87%) each while North West is the least 31% (National Population Commission and Macro International Calverton, 2009). It further posits that only 46% of women in the rural area use antenatal care; 35% of the deliveries took place in health facilities while 39% of the deliveries were attended by skilled delivery attendants. The maternal health services of interest in this study include antenatal care and place of delivery.
Concept of Maternal Health Services
The provision of special care for pregnant women during pregnancy and delivery through public health services was a relatively late development in modern obstetrics. It was until late 1930s that United Kingdom of Great Britain and Northern Ireland authorities decide that all women should be offered regular check-ups during pregnancy as an integral part of maternity care.
During the second half of the 20th century, international awareness grew of the dimensions of the maternal mortality; the national governments collaborated with technical assistance and donor agencies to ensure that pregnant women in the developing counties had access to maternity care. As a result many programmes focused attention on providing antenatal care. Unfortunately antenatal care interventions alone do not address the main causes of maternal mortality that result from complications arising during labor and delivery period. Many unexpected complications which may require emergency obstetric care could only be provided in the health facilities. Hence campaign to health facility delivery began and pregnant mothers started to deliver in hospitals. However this did not completely eradicated maternal deaths due to other factors that are not within the scope of this study.
CHAPTER THREE
RESEARCH METHOD
This chapter presents the research design, area of study, population of study, sample, inclusion criteria, sampling procedure, instrument for data collection, validity of instrument, reliability of instrument, ethical consideration, procedure for data collection and method of data analysis.
Research Design
A cross-sectional descriptive survey design was used for the study. The design obtains information from population regarding distribution and interrelations of variables within the population. It also describes and documents aspect of a situation as it naturally occurs. There is no manipulation of any kind as the respondents were met in their natural environment. Data collection was done as a single observation. Researchers like Zeine, Mirkuzie and Shimeles (2010) used this method successfully in their study of factors influencing antenatal care services utilization, therefore, it was deemed fit for this study.
Area of the Study
Igbo-Etiti Local Government Area is one of the local government areas in Enugu State. It created in 1976 from the former Nsukka Division with its headquarters located at Ogbede. It shares boundaries with Nsukka local government area in the North, Enugu East in the East, Udi local government area in South and Uzo-Uwani local government area in the West. The local government area is made up of thirteen communities namely Aku, Diogbe, Ekwegbe, IKolo, Ochima, Ohebedim, Ohodo, Onyoho, Ozalla, Udume, Ukehe, Umunko and Umunna. There is one comprehensive health center, one cottage hospital, sixteen health centers, and twenty two health posts.
The four communities studied were Diogbe, Ikolo, Ohebedim and Umunko. The first two communities were located at hinterlands while the last two were located along Enugu Nsukka express way. The communities have health facilities but were underutilized. The people are predominantly subsistence farmers, bus drivers, wine tappers and traders. The main agricultural produce includes yam, cassava and vegetables.
Population of the Study
The population of the study consisted of childbearing mothers age (15-49years) in the four randomly selected communities studied. The projected populations of women of childbearing age (15-49years) in the four communities were five thousand and ninety (5090) (Department of Planning, Research and Statistics Ministry of Health Enugu State, 2012).
CHAPTER FOUR
PRESENTATION OF RESULTS
This chapter dealt with presentation of results of the study. Three hundred and seventy (370) copies of questionnaires were administered to women of childbearing age (15-49 years) while three hundred and fifty four (354) were duly completed and returned, giving a return rate of 96%. Their responses were tallied and presented in frequency tables and percentages according to the research questions. Data were analyzed using descriptive statistics-frequencies, percentages and mean in answering the research questions. Association between categorical variables were done using chi square. All tests were considered significant at P<0.05 level of significance. Results were presented in tables and chart.
Chapter Five
Summary of Study
The main purpose of the study was to determine the factors influencing utilization of maternal health services in selected rural communities in Igbo-Etiti Local Government Area. Three research questions were answered and two hypotheses tested. Relevant literatures were reviewed and health behavioral model was used to anchor the study. Systematic random sampling was used to sample 370 women of childbearing age from Ikolo, Ohebedim, Diogbe and Umunko communities. Cross-sectional descriptive survey design was used. Researcher developed questionnaire was also used to elicit information for the study. The questionnaire was validated by experts. Reliability of the instrument was tested with cronbach alpha which yielded a co-efficient of 0.81. Data were analyzed using statistical package for social sciences (SPSS) version 20. Data was subjected to descriptive statistics (frequencies and percentages and mean) test of association was carried out using chi square. All tests were considered significant at P<0.05 level of significance. Results were presented in tables and chart. The findings of the study have shown that maternal age and education were predictors to utilization of maternal health services. The study recorded large number of women between 21- 30 years utilized maternal health services more than those above 30 years of age, mothers with secondary or tertiary level of education made good use of the maternal health services than those who had primary or no formal education. Thus, as their educational level increased their level of utilization of the maternal health care services also increased. The use of maternal health services was high in this study. However a quarter of the women delivered at traditional birth attendant homes. Significance association (P <0.05) was found between age, education and use of maternal health services. No significance association (P < 0.05) was found between socioeconomic status, parity and use of maternal health services. Small proportion of the mothers registered at first trimester while a quarter delivered at traditional birth attendants’ homes. Therefore continuous sensitization of the rural communities to promote early booking and increase the numbers of deliveries in the health institutions were recommended.
Implication of the Study to Nursing Practice
The result of this study found that utilization of maternal health services decrease with age after 30 years. This has a big implication because many women experience more births after 30 years. Therefore to improve their utilization, adequate information, education and communication through health education sessions on use of maternal health services and its benefits must be explored by nurses. This will enable them to have correct information and knowledge thus increase awareness, acceptance and use.
Since education serve as a proxy to use of maternal health services, families, societies and public should also be sensitized to empower the females academically since knowledge confers power. Nurses as service providers should be available and accessible to clients to give correct information, clarify misconceptions, myths and false rumours that may have negative impact on health of mothers and use the of available services.
Recommendations
The following recommendations were made based on the study:
– Efforts should be made by federal and state government to empower women academically by providing functional educational facilities since education increases utilization.
- Behavior change communications (BCC) and monitoring programs should be initiated to aid in awareness creation on the consequences of none or poor utilization as well as to check for negligence among women of child bearing age.
- The health workers in the antenatal clinics should have well planned health education schedules for pregnant women for the year and these schedules should be followed throughout the year so that the pregnant women will be well informed. However client individual differences and needs must be recognized and attended to by providers
Limitation of the Study
- This study was carried out in only one Local Government in Enugu State, hence cannot be generalized for the whole nation.
Suggestions for further study
The following areas were recommended for further research
- Utilization of maternal health services in the other rural communities in Nigeria.
- Factors that promote the patronage of traditional birth attendants in rural areas.
REFERENCES
- AbouZahr, C.L. & Wardlaw, T.M. (2003). Antenatal care in developing countries promises, achievements and missed opportunities: An analysis of trends, levels and differentials 1990 – 2001. WHO/UNICEF, Geneva.
- Adamu, H.S. (2011). Utilization of maternal care services in Nigeria: An analysis of regional differences in the patterns and determinants of maternal health care use. Unpublished master’s thesis, University of Liverpool.
- Ahmed, S., Creanga, A.A., Gillespie, D.G. & Tsui, A.O. (2010).Economic status, education and empowerment: Implication for maternal health services utilization in developing countries. Plos one 5 (6), doic.10.137/Journal pone.0011120.g001
- Andersen, R.M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36 (1).
- Anju, M., Rohini, P. & Caren, G.(2003). Impact of investments in female education on gender equality. International Centre for Research on Women Commissioned by the World Bank Gender and Development Group.
- Aregay, A., Alemayehu, M., Assefa, H. & Terefe,W. (2014). Factors associated with maternal health care services in Enderta district Tigray northern Ethiopian: A cross sectional study. American Journal of Nursing Science 3(6)
- Asghar, K., Ashfag, A.M., Naimatullah, H.M., Igbal, Z., Tanvir, A. & Samina, K. (2009). Socio-demographic determinants of married women’s attitude towards reproductive health rights in Punjab, Pakistan. Pak Journal Agricultural Science, 46 (I)
- Babalola, S. & Fatusi, A. (2009). Determinants of use of maternal health services in Nigeria: looking beyond individual and household factors. BMC Pregnancy and Childbirth, 9 (43) doi 10.1186/1471-2393-9-43
