CHAPTER ONE
INTRODUCTION
- Background to the study
Globally, the number of women dying due to complications during pregnancy and childbirth decreased by nearly 50% from 1990 to 2013 but the number of deaths remains unacceptably high especially in low-income countries where 99% of these deaths occur (Bustreo, Say, Koblinsky, Pullum, Temmerman, Pablos-Méndez; WHO, 2014). The SDG goals include reducing maternal and neonatal mortality and morbidity worldwide (Bhuttaet al., 2015). The strategies used to achieve these goals include family planning, skilled attendance during pregnancy (Antenatal Awareness) and safe delivery, and access to emergency obstetric care (UNFPA, 2010). Antenatal care (ANC) refers to the care of pregnant women using evidence-based interventions that are considered beneficial. WHO consider it essential that all women are offered tetanus toxoid immunization, screening and treatment of anemia and syphilis, and are examined for pregnancy related complications such as hypertensive disorders and mal-presentations. HIV screening is recommended in as a situational intervention, i.e. in endemic areas by (WHO, 2009). Client provider-interaction remains the core of clinical practice and a medium to enhance antenatal awareness and the care offered should be acceptable for both the health care professional and the client (Langer et al., 2002; Wilkinson & Callister, 2009). Clients’ health care seeking behavior worldwide has been assumed to be the result of clients’ individual characteristics, patients’ identified needs, health status, patients’ satisfaction, the structure of the health care system, and the external environment such as the infrastructure (Trinh et al., 2007; Bruce, 2007). Strengthening the competence of midlevel providers and improving communicative skills can improve the quality of maternal health care and the response of expecting mothers towards antenatal (Jibril, 2017).
The world today is currently undergoing changes towards a more market-oriented provision of health care. In most countries of the world today antenatal care (ANC) is free and mainly provided at thecommunity health stations (CHS). The World Health Organization’s recommends three ANC visits during pregnancy (Trinh et al., 2007). According to WHO statistics (2009) About 88% percent of women are assisted by a skilled attendant at birth.
Most countries of the world enjoy low maternal mortality ratio and neonatal mortality rate (WHO, 2009). The maternal mortality ratio in Nigeria is estimated to 630 per 100 000 live births; the infant mortality is estimated to be 75 per 1000 live births (WHO, 2014). Two-thirds of infants’ deaths are estimated to be attributed to the neonatal Period, indicating suboptimal care at birth and the first Week of life.
Antenatal care refers to pregnancy-related care. Services usually include screening and treatment for medical conditions, and identification of and interventions for behavioral risk factors associated with poor birth outcomes, such as smoking or poor nutrition (Adhikari, Sahu, Nair, Saha, Sharma, & Pandey, 2016). Beginning prenatal care within the first trimester and receiving the recommended number of prenatal care visits is essential to reducing the likelihood of maternal complications and premature deliveries.
Complications and premature births can result in long-term health problems for the child. While most prevention efforts are focused on the pregnancy, post-delivery is also a very critical time for the health of the mother and the newborn baby (Abbas, Rabbea, Abdel Hafiz, & Ahmed, 2017). Problems or conditions may arise, that if not treated promptly, can lead to complications (Abbas, Rabbea, Abdel Hafiz, & Ahmed, 2017).
Antenatal care utilization is associated with a number of socio-demographic and economic factors such as age of the woman, education, work status, parity, media exposure, household income, awareness and knowledge regarding antenatal care services, cultural beliefs, woman’s autonomy, availability and access to health care, prior experience of delivery complications and motivation by either health care provider or family nutrition (Adhikari, Sahu, Nair, Saha, Sharma, & Pandey, 2016; Shah & Belanger, 2011).
Therefore, this study targeted pregnant women attending antenatal clinics in Ekpoma, Esan West Local Government Area, to assess the awareness and use of antenatal care services.
- Statement of problem
Antenatal, as the name implies Ante- means “prior to” and -natal related to “delivery” so therefore antenatal is the care given to a pregnant woman prior to delivery during the period of pregnancy. Conversely, antenatal neglect among pregnant women is alarming (Adhikari, Sahu, Nair, Saha, Sharma, & Pandey, z2016).
Studies revealed that a greater proportion of maternal death in Nigeria was due to complications at pregnancy. Such complications include bacterial infection, anaemia, haemorrhage; pregnancy induced hypertension and its consequences (severe pre-eclampsia and eclampsia), induced abortion, still birth and obstructed labour (Aboyejiet al., 2007; Royston & Armstrong, 1989). However, such complications that led to maternal mortality occur mostly among women that did not receive antenatal care at pregnancy (Dairo&Owoyokun, 2010). Thus, poor use of antenatal care among Nigerian women has been a great concern to public health because of its life threatening and other negative consequences to the health of mothers and the child (WHO 2007; Aboyejiet al., 2007). The antenatal awareness of pregnant women during pregnancy has a great influence on life expectancy ratio such as. Maternal mortality ratio, Neonatal mortality rate among others.
In addition, a few studies done on antenatal care in Nigeria have helped to identify that there is a need for antenatal care but the awareness of pregnant women towards antenatal have not been revealed in most studies. However, this study seeks to assess the antenatal Awareness of pregnant women in Esan West Local Government and likely measures to improve them.
- Objectives of the study
- To assess the awareness of pregnant women in Esan West Local Government Area on antenatal care.
- To assess the level of utilization of antenatal care services among pregnant women in Esan West Local Government Area.
- To identify the determinants of the use of antenatal care among pregnant women in Esan West Local Government Area towards antenatal care.
- Research questions
- What is the level of awareness of pregnant women in Esan West Local Government on antenatal care?
- What is the level of utilization of antenatal care services among pregnant women in Esan West Local Government Area?
- What are the determinants of the use of antenatal care among pregnant women in Esan West Local Government Area towards antenatal care?
- Significance of the study
This study will help to create awareness about the importance of antenatal care, identify facilitators/barriers involved in getting antenatal care and also to suggest possible ways to improve antenatal awareness.
Thefindingsofthisstudywillbeusefultomaternalhealthcareproviderswhoarekey stakeholders in the realization of Sustainable Development Goals (SDGs) in relation to the antenatal care of Nigerian pregnant women.
The MinistryofHealth and otherhealthinstitutions can alsousethisstudyto clearly understandthe antenatal needs of Nigerian women.
Tothe academia this will add to existing literatures on the awareness and use of antenatal care in the study area.
- Scope of the study
This study only involves pregnant women irrespective of their marital status in selected health centers in Esan West Local Government area of Edo state.
- Operational definition of terms
Ante-natal.Health care, including screening tests and counselling, provided to women during pregnancy. Also referred to as prenatal care.
Awareness.Been adequately concern about and well-informed interest in a particular situation or development.
Family planning.The conscious effort of couples or individuals to plan the number of their children and to regulate the spacing and timing of their births through contraception, as well as the treatment of involuntary infertility.
Maternal health.The health of women during pregnancy, childbirth, and the postpartum period.
Maternal morbidity.Any injury, condition or symptom that results from, or is worsened by pregnancy.
Maternal mortality rate.The number of maternal deaths during a given time period per 100,000 women of reproductive age (15 to 49) during that same time period.
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