Knowledge and Attitude Towards Preconception Care Among Women of Reproductive Age in Ife Central Local Government, Osun State

Knowledge and Attitude Towards Preconception Care Among Women of Reproductive Age in Ife Central Local Government, Osun State

Chapter One

Objectives of the Study

Main Objective

The overall objective that guided the investigations was to determine the Level of Knowledge on Preconception Care, asses the attitude of women toward PCC& Uptake of PCC by Women of Child Bearing Age attending Reproductive Health Clinic at Nigeria National Hospital

Specific Objectives

The Specific objectives of the study were to:

Determine the level of knowledge on preconception among women at the reproductive health clinic in NNH.
Assess the attitude of women towards PCC given to women at RH clinic
Determine the uptake of preconception care given to women at RH clinic
Assess the association between socio-cultural characteristics of women and the uptake of the preconception care at the clinic.

CHAPTER TWO

LITERATURE REVIEW

Preconception Care

Preconception care refers to care provided to women in the child bearing age before the pregnancy, to have a safe motherhood and healthy baby (Rogers, 2005). The practise entails measures that can be taken prior to conception to promote the welfare of the expectant mother and her child. A significant link has been discovered between individuals’ health at birth, infancy, and early childhood and their later-life health, educational attainment, and overall well-being, according to research from a range of aspects. Preconception care includes risk analysis, promotion of health, health education, and intervention (Blencowe et al., 2010). It is a key opportunity for preventing congenital disorders.

Preconception care visit includes the following, Comprehensive Medical Examination and Risk assessment. Comprehensive Medical Examination includes screening for Body Mass Index(BMI) that is a measure of risk for Cardiovascular diseases, Blood Pressure, Laboratory tests BGRhesus factor,Haemoglobin level testing, Random blood sugars,Urine analysis, Clinical Breast examination, Breast self-examination, Oral Health screening

Risk assessment. such as Genetic counseling in case of pregnancy outcomes with autosomal trisomy, congenital anomalies in general. Identified mothers may have to be referred for specialized care for further investigations and genetic counseling in specialized centers (Liu et al., 2004). The role of the health staff is to ask, assess, advise, assist and provide for preconception health needs tailored to the individual woman (Botto et al., 2004).

Importance of Preconception Care

Preconception care can take various forms, e.g., general individual preconception care or specialized individual preconception care. PCC care is associated with improved pregnancy outcomes and makes a useful contribution to reducing maternal and childhood mortality and morbidity.

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Pre conception care optimizes general health and risk awareness in high-income countries. It has been documented by (Botto et al., 2004) that preconception care addresses the relatively higher levels of maternal and childhood mortality and morbidity in socially marginalized and economically deprived families and communities Similar effects may also be achieved to alarger extend in a low income countries. Identification of risk factors that could potentially affect peri natal outcome will be done, and the woman is advised of her risks (Ray et al., 2004). Preconception care was linked to a lower risk of preterm labor (OR = 0.298; P =.009; 95 percent CI = 0.120-0.743), low birth weight (OR = 0.406; P =.043; 95 percent CI = 0.169-0.971), maternal irregularity (OR = 0.399; P =.001; 95 percent CI = 0.241-0.663), and neonatal complications (OR = 0.460; P =.003; 95% CI = 0.275-0.771) Jourabchi Z et al.,, (2019).

CHAPTER THREE

METHODOLOGY

Research Design

This was carried out using descriptive cross-sectional way and utilized a quantitative method. It involved a one-time interaction with groups of people (cross-sectional study). It is intended to present facts concerning the nature and status of a situation, as it would exists at the time of the study.

The study aimed to discover and explain the relationship between women of reproductive age’s knowledge level, attitude, and socio-cultural characteristics and their association with PCC uptake. The data was examined, and p-values less than 0.05 were deemed significant.

Research Variables

Independent Variables

These included; knowledge level among women, attitude towards preconception and socio-cultural characteristics.

Dependent Variables

Preconception care uptake

Target Population

The investigations centered on women of reproductive age (from 15 to 49 years) who were clients at the Nigeria National Hospital’s reproductive health clinic.

CHAPTER FOUR

RESULTS

Introduction

The chapter presents the research outcomes and possible interpretations. Specifically, the findings in the subsequent sections include response rate, background information and the objectives, presented in descriptive and inferential statistics.

CHAPTER FIVE

DISCUSSION, CONCLUSION AND RECOMMENDATIONS

Discussion

Knowledge on Preconception

In the study, majority of the respondents (69%) were not aware about preconception care whereas 12% were not sure. Only 19% were aware about preconception care and yet majority had attained college education (40%). The study findings contrast the findings of Mtondera Munthali et al., 2021, which realised that 136 (54%) Malawian respondents were aware of the preconception care. On the other hand, the results on poor awareness was supported by studies in Nigeria in Usmanu Danfodiyo University Teaching Hospital by Amina G. Umar et al., (2019) and among mixed ethnic origin, participating in nine focus groups,2013in India .The team were studying Opportunities and challenges for enhancing preconception health in primary care with women from ethnically diverse communities This is consistent with (Khalid et al., 2013, Sudan, Ayalew et al., 2017- Ethiopia, Contrary to PRUCE CE et al., 2012, USA Atlanta.

Another study supporting the findings was done in Ruiru, which realized that (61.7%) had no information on PCC, and the hospital setting was the main source of PCC information, as indicated by 66.3% of the study respondents. Among the respondents, (47%) of those who responded were not aware of the importance of preconception care This is Contrary, Files et al., (2009), Arizona & Krishma Giri et al.,2018, Nepal.

Small proportion received the screening during health promotion practices for major disorders like blood pressure (44.4%), Random blood sugar (13%) to rule out gestational diabetes, Urinalysis (24%), Hb testing (22.2%). HIV screening was the major test done for the majority (53.7%), owing to the vigorous campaigns for HIV prevention hence early management and prevention of vertical transmission of H.I.V. Notably significant proportions had preexisting medical conditions that required screening: 24.1% had hypertension, whereas 12% had diabetes mellitus among several other conditions that should have been screened for. It appears that a considerable proportion do not benefit from health promotion practices. Due to lack of awareness, majority of the respondents were not screened for the major pregnancy risk medical conditions. Majority (81.5%) were not assessed for pregnancy outcomes with hereditary disease, for congenital anomalies (66.7%), Genetic counseling (90.7%), and specialized care (59%). Other than HIV and blood pressure, and all the other medical examinations were reported by less than 40% of the women. The findings correlate with the study done by Joyce (2016), in which 64.9% of the subjects had been screened for HIV and all the other tests fell below 30%, epilepsy being the least prior to conception. Few women encountered pregnancy outcome with hereditary disease but also significant number of women had hereditary issue that affected their pregnancy.

Genetic risk assessment helps couples make informed choices based on genetic predisposition of the future children. Every year, 300,000 infants are born with major haemoglobin disorders, (Buhi and Goodson, 2007). Likewise, in this study, (40.7%) had congenital anomalies in their infants and good proportions (55.6%) were referred for the genetic counseling in the specialized centers. This correlates with the study done by Aaelfs et al (2013) who found that majority of the General practitioners s were in favour of genetic counseling and 31% cases were referred for genetic counseling although 40% of the cases were initiated by the patients themselves.

Majority of the women (62%) were aware that own health condition affects child bearing. This contrary to the study done McGowan et al., 2020 while exploring preconception health beliefs amongst adults of childbearing age in the UK, where he revealed unawareness on preconception health and its importance. There is need to highlight the importance of raising awareness among the respondents.

Majority of the women stated that the source of information about their own health is the clinics (84%). This correlate well with the study done by (Joyce, 2017) where major source of information about preconception care was found to be health workers in the hospital. Ayelew et al 2017, noted that health institutions were the major sources of information at 69 (51.5%) while 9 (6.7%) of them heard it from friends.

A few of the respondent also reported low awareness on the risks associated with social habits and health conditions on pregnancy. Further, 30% admitted to be exposed to domestic violence, a finding that was similarly realized by Ayelew et al 2017, which showed that the GBV cases among pregnant mothers was 15.6%. In this study, we found that 67% of the women were not aware that domestic violence affects their pregnancy. 63% were aware that alcohol and smoking (51.9%), obesity (29.6%), Mental conditions (22.2%) were health risks to the pregnancy. This is in agreement with Esposito, et al (2025) study on knowledge and attitude assessment towards maternal risk factors in Italy, where 42% of the respondents understood alcohol, smoking, passive smoking and obesity as the main maternal risk factors in pregnancy.

It was not surprising that a significant proportion (66.7%) had not received any counseling services in this regard. On knowledge score, majority (69%) had adequate knowledge few (32%) had inadequate knowledge contrary Rosnani K. et al., 2016, Malaysia. Consistent with Keith et al., (2006) study which acknowledged that many reproductive women were not informed on PCC. Moreover, the Ayalew et al., 2016 research that assessed the knowledge levels of PCC among the Ethiopia. women of Adet, equally released that only 27.5% were knowledge of the concept and related factors, which was generally low.

In this study , the Knowledge score is 79.63%, the higher score being in the area of Folic acid administration ,avoidance of recreational drugs and alcohol and importance of maintaining of good health at all times .This in agreement with the study done by Conrod, et al., 2009 where the average knowledge was 76%.

Mean score for the knowledge among the respondents was 30.86 (SD-12.97), contrary to Rosnani K. et al., (2016) where score was 11.37(± 3.94) in Malaysia. Majority, respondents were aware that their health condition can affect child bearing, consistent with Zayed F. et al., (2025), but contrary to Rosnah Kassim et al, (2016). Majority of the Nigerian respondents are not sure that domestic violence may affect pregnancy outcome (Salami and Efetie, (2009). In the worldwide view, about 35% of women are exposed to gender based violence, perpetrated by intimate partner or non-partner. The WHO notes that the prevalence of violence against women in the developing worlds in African, Eastern Mediterranean and South-East Asia regions is on average higher.

Relationship between Knowledge Level and Uptake of PCC

The relationship between knowledge level and uptake of PCC is highly significant with chi-square value of 18.562, df = 1 and p (0.000). Consistent with Owofadeju et al., 2025; in the study done in Nigeria (X²=24.76, df=3, p=0.001. Also in agreement with the study done by Fekene, D.B., Woldeyes, B.S., Erena, M.M. et al. on knowledge of PCC is significantly associated with uptake of PCC. A woman who was a good knowledge of PCC is 4.3 times more likely to utilize PCC than women who have poor knowledge of PCC.

The Attitude of Women towards Preconception Care

The present study has shown that majority of women attending the clinic in NNH (91.7%) had good attitude towards preconception care. 89.8% of the respondents would consider preconception care in their plans for future pregnancy and this correlate with the study by Hamda, (2016) on knowledge attitude and practice on PCC in Erbil, Iraq, where, 84.7% of the women were found to have good attitude about preconception care, while Denkta et al., 2012, noted interviewed women expressed a positive attitude but hesitant about seeking preconception. Similarly, Files et al., (2009), concluded that the majority of women understood the importance of preconception health but did not discuss these issues with their physician.

Majority of the respodents (89.8%), would consider preconception care in their plans in future, contrary to Khalid, (2025)-49% less than the half of the respondenst, intended to seek preconception care in their subsequent pregnancy- Sudan. Lack of time and resources is not usually a barrier to seeking preconception care according to the study because many women (58.5%) thought it would improve the chances of having a healthy baby In addition, (31.9%) did not know about the things to avoid during pregnancy that could hurt the baby and they think pregnancy is a natural occurrence that one need not prepare for.

The Uptake of Preconception Care

Uptake of PCC was generally low. This is consistent with Joan Okemo et al. (2020) in her study on determinants’ of PCC utilization in Rural and urban Nigeria. In this study 23.1% of the respondents reported ever using PCC but contrary to the study done in Machakos by Washington et al, (2018) found out (14.6%) utilized the services and contrary to the study done in Ethiopia on Mothers’ utilization and associated factors in preconception care by Asresu et al, 2019, where only 18.5% received the care and Ninety-seven (14.5%) women have utilized PCC services, by Fekene, D.B., Woldeyes,et al 2020. In this study 92.7% of the respondents have been taken health profile in clinic attendance where women were given information on how their health conditions would affect their future child bearing. Most women (92%) had a strong desire to achieve the best outcome possible for their baby and as such were very motivated to access information and engage in preventive care.

The Association between Socio-cultural Background and Uptake of PCC

According to this study there were no cultural issues preventing the women from seeking preconception care. Most women (84%) prefer visiting clinic with their husbands although contrary to this, Chimatiro, (2018) stated that the majority of the men would decline for fear of being tested for HIV.

There were no beliefs that prevented women in the study (91.9%) from seeking preconception care; consistent with POELS, et al., (2016) study who found out benefits as one of the most imperative facilitators for the uptake of PCC, although to the contrary the same women feel that the process of getting pregnant should be surrounded by natural and romantic values and should not become artificial. However, awareness of PCC improve chances of having a healthy baby had a statistically significant association with uptake. (χ2=12.498, df = 2 and p = 0.000 contrary to study by Bonareri 2018 p- value of 0.294>0.05 had no influence on preconception care uptake.

Association between Knowledge Level and the Uptake of PCC (Hypothesis testing)

The findings reveal that their exists an association between knowledge and utilization of PCC services among women of reproductive age seeking reproductive healthcare services at NNH. clinic. In this regard, the investigations reject the null hypothesis which stated otherwise. Those with high Knowledge about preconception care were most likely to consider PCC uptake. This is Consistent with Owofadeju et al., 2025; in the study done in Nigeria (X²=24.76, df=3, p=0.001).

Conclusions

The findings and the discussions in the study, implores the researcher to make the following conclusions:

Women attending NNH reproductive clinic have limited knowledge on PCC and most of them receive information on PCC from the clinic, whereas a significant proportion have pre-existing medical conditions that would affect their pregnancy was erratic
Utilization of medical services provided before pregnancy was practices
Most of the women have good attitudes towards preconception care but they have poor preconception care practices.
The uptake of Preconception Care by the women was poor
There was no statistically significant association between most of the socio- cultural practices and uptake of PCC. However, the only influence of the uptake of PCC was, awareness that PCC improve chances of having a healthy baby. (χ2=12.498, df = 2 and p = 0.000

Recommendations

Recommendation from the Study

There is need for Provision of Health Education on Preconception care to Women attending reproductive clinics to improve awareness and creation of systems for screening comprehensively for pre-existing medical conditions that would affect their pregnancy
Formulation of Health Policies to enhance utilization of PCC services tobe provided before pregnancy
This study may contribute to the bulk of PCC knowledge and awareness in order to inform policies and practices.

Recommendation for Further Research

More studies to identify barriers to PCC uptake and identify ways of enhancing preconception care practices.

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