KNOWLEDGE AND PRACTICE OF SAFE MOTHERHOOD INITIATIVE AMONG CHILDBEARING MOTHERS ATTENDING MCH CLINICS IN NSUKKA HEALTH DISTRICT

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ABSTRACT


Unprecedented maternal mortality and morbidity rates, foetal deaths, pregnancy and birth complications emanating from dearth of knowledge and practice of safe motherhood among childbearing mothers due to non-attendance of MCH clinics culminate into a monumental public health problem in many developing nations of the world including Nigeria. Considerable variations in the magnitude of this quandary exist within and between states and regions of Nigeria including Enugu State. Consequently, the present study was an attempt to investigate knowledge and practice of safe motherhood initiative among childbearing mothers attending MCH clinics in Nsukka Health District. Well-completed 363, self-designed Childbearing Mothers Knowledge and Practice of Safe Motherhood Questionnaire-CMKPSQ (that consisted of three sections A, B, and C) returned by childbearing mothers of four out of five functional randomly selected MCH clinics in Nsukka Health District were analyzed. Split-half was used to determine reliability of instrument (CMKPSQ) while Spearman-Brown Prophecy (correction) Formula was used to establish reliability co-efficient of the sub-scales. Cronbach’ s (1951) alpha was utilized to established inter-item correlation co-efficient of items in Section B, which elicited data on KOPC of childbearing mothers while factor analysis statistic was employed to determine sub-scale reliability co- efficient of Section B. Kuder-Richardson-21 formula was used to determine internal consistency of Section C of CMKPSQ which comprised dichotomously-scored items of ‘Yes’ or ‘No’. Percentages using a slightly modified version of Okafor’s (1997) modified Ashur’s (1977) criteria for describing level of knowledge were utilized for answering the principal research questions while T -test statistic was adopted to verify null hypotheses one and five, Chi-square ( c 2) was utilized for verification of postulated null hypotheses two, four and six while ANOVA was employed to analyze null hypothesis three. Results revealed that childbearing mothers had high knowledge of various components of safe motherhood initiative while childbearing mothers also practised safe motherhood. The independent variables (age, level of education and location) considered had significant influence, at .05 level of significance on knowledge and practice of safe motherhood among childbearing mothers.


TABLE OF CONTENTS

Title Page
Table of Contents
List of Tables
Abstracts

CHAPTER ONE: Introduction
Background to the Study
Statement of the Problem
Purpose of the Study
Research Questions
Hypotheses
Significance of the Study
Scope of the Study

CHAPTER TWO: Review of Related Literature
Conceptual Framework
Components of Safe Motherhood
Measurement of Safe Motherhood and Practice
Demographic Variables Influencing Knowledge and Practice of Safe Motherhood
Theoretical Framework
Empirical Studies on Knowledge and Practice of Safe Motherhood

CHAPTER THREE: Methods
Research Design
Population for the Study
Sample and Sampling Techniques
Instrument for Data Collection
Validity of instrument
Reliability of instrument
Method of Data Collection
Methods of Data Analysis

CHAPTER FOUR: Results and Discussion
Summary of Major Findings
Discussion of Findings
Implications for the Study

CHAPTER FIVE: Summary, Conclusions and Recommendations
Summary
Conclusions
Limitation of the Study
Recommendations
Suggestions for further studies
References
Appendices

CHAPTER ONE

Introduction

Background to the Study

Women of Sub-Sahara Africa face the highest risk of maternal mortality and morbidity than any other region in the world. At least 150,000 African women die of pregnancy-related complications every year, and the number of maternal deaths continues to rise each year in many countries. The population of women of childbearing age is now larger than it was in 1989, and the number of women who die each year from pregnancy-related causes has increased even though there have been a slight decline in the risks of pregnancy (Greenwood, 1991; World Bank, 1993). Of all human development indicators, maternal mortality rates represent the greatest disparity between industrialized and sub-Saharan Africa countries (World Bank, 1993).

World Health Organization-WHO (1999), WHO, United Nations Children’s Fund-UNICEF and United Nations Population Fund-UNFPA (2002) reported that out of the estimated 27 million women of reproductive age, one in thirteen dies due to causes related to pregnancy. Royston and Armstrong (1989) reported that the maternal mortality ratio (MMR) is 800/100,000 live births in Nigeria. However, there are wide regional disparities in the statistics. Whereas the Southwest region reports an MMR of 165, the Northeast region reports 1,549. Maternal mortality rates are twice as high in rural settings as they are in urban ones. Of the annual 3 million pregnancies in Nigeria, approximately 170,000 result in death that is mainly due to complications during pregnancy and childbirth. The main causes of maternal mortality in Nigeria are haemorrhage, which accounts for about a quarter of all maternal deaths, sepsis fifteen per cent, complications of unsafe abortion thirteen per cent, hypertensive diseases of pregnancy twelve per cent and obstructed labour eight per cent.


Only thirty per cent of Nigerian women are in the adult work force according to the United Nations’ World Women Report 2000, which ranks Nigeria at 151 on the gender-related development index among 174 countries. Reasons for this are the low social status and inequality of women which limits their access to education and ultimately, economic resources. This in turn limits their ability to make decisions about their reproductive health (Federal Ministry of Health, 1999; WHO, 1998). Approximately thirty-five per cent of Nigerian women experience their first pregnancy by the age of 19. The 1999 Nigerian Demographic Health Survey further states that only fifteen per cent of married women are currently using contraception, of which only eight and half per cent are using modern methods such as condoms and birth control pills (FMH, 1999).

WHO (1998) further reported that only sixty per cent of women receive antenatal care and approximately thirty-one per cent of all deliveries take place in a health care facility. Moreover, only one-third of all deliveries are handled by skilled attendants in Nigeria. A study conducted by WHO (1999) in the northern part of the country indicated that twenty-five percent of all deliveries take place in the home with no assistance or attendant present. Health care facilities including antenatal care, prenatal care, post-partum and obstetric care facilities in the country are generally in poor condition with chronic shortages of essential equipment, drugs and human resources. The most severe is the lack of adequate skilled attendants, which are the most essential element of quality health care, because they usually migrate to the private sector, or move to other facilities due to lack of resources or proper remuneration (Awosika-Olumo, 2001).

Efforts to reduce maternal mortality and morbidity rates are a top priority, not only because of the scale of preventable suffering, but also because prenatal care and delivery services are among the most cost-effective intervention available to governments to improve maternal and child health (World Health Organization, 1998). This realization informed the establishment of Safe Motherhood Initiative (SMI).

Safe Motherhood is achieved through a programme of inter-linked steps which strive to provide: family planning services to prevent unwanted pregnancies; safe abortions (where abortion is legalized couple with efficient management and treatment of complications of unsafe abortions are accessible); prenatal and delivery care at the community level with quick access to first-referral services for complications; and postpartum care, including family planning services, promotion of breastfeeding, immunization and nutrition services. Safe motherhood services must be integrated into the health delivery system and the necessary inputs such as drugs, equipment, facilities, and properly trained staff-supplied (Daly et al. 1993).
Jatau (2000) defined safe motherhood as a means of saving the lives of women and improving the health of millions of others. He added that safe motherhood initiative (SMI) is aimed at preventing maternal and perinatal mortality and morbidity.
He further asserted that SMI aims at enhancing the quality and safety of women’s lives through the adaptation of combination of health and non-health strategies.

Price (2002) conceptualized safe motherhood as a means of ensuring women’s accessibility to needed care through antenatal programmes in order to facilitate their safety and optimal health throughout pregnancy and childbirth. He further affirmed that safe motherhood is a vital economic and social investment. Also, he emphasized the need that all national development (Nigeria inclusive) plans and policies should include safe motherhood initiative in recognition of the enormous cost that women’s death and disability imposed on national health care systems, the labour force, communities and families.

Nigerian Partnership for Safe Motherhood-NPSM (2003) defined safe motherhood as concerted collective efforts by a pregnant woman herself her immediate and extended family members, her community and all health personnel at the primary, secondary and tertiary levels of health care system to ensure safety of a pregnant woman and her baby during pregnancy, delivery and after delivery.

Partnership for Transforming Health Care System (2005) asserted that safe motherhood comprises pre-natal care, nutrition and personal hygiene, clean and safe delivery, postpartum care including family planning, emergency obstetric care and child care, sexually transmitted infections, prevention of mother to child transmission (PMTCT) of HIV/AIDS and post-abortion care.

Maclean (1994) attested that efforts to save women’s lives through safe motherhood initiative focused on three key areas, namely: expanding and strengthening maternal health services; increasing access to family planning services and improving the status of women through improved cultural and legal status; women’s access to educational and economic opportunities. He further reiterated that SMI is a global effort to reduce drastically maternal mortality and morbidity rates.


Women most especially childbearing mothers (15-49 years) should be the important target in any government’s policy formulation and implementation with reference to SMI because the maintenance of adequate health particularly of infants, children and mothers is critical to attainment of optimum maternal health and national development. Also, women form the backbone of African economies. They produce most of the food necessary for a household, cook for the family, fetch water, clean the house and care for the children, the sick and the elderly at home. The death of a women results in both economic and social hardship for the family and community.....

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