PREVALENCE OF PREGNANCY-RELATED ILLNESSES OF WOMEN ATTENDING ANTENATAL CLINIC AT OWERRI WEST LOCAL GOVERNMENT AREA OF IMO STATE

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ABSTRACT
Health care for pregnant women is an important component of public health services. The study examine the prevalence of pregnancy-related illnesses among women attending antenatal clinic in Owerri West L.G.A. with a view of ascertaining the variables that influence the prevalence. In line with the objectives of the study, nine research questions and three corresponding hypotheses were formulated. Related literature were also reviewed and ex-post facto research design was adopted for the study. The accessible population for the study consisted of all the women who registered for antenatal care from 2001-2007 in the fifteen randomly drawn public health facilities in Owerri West L.G.A. of Imo State. A total of 5617 folders of women who registered for antenatal care for this period of seven years were sampled. Multi-stage sampling procedure of (clustering, simple random sampling, stratification and systematic sampling) were used in selecting the health facilities and the folders of the respondents. A researcher’s constructed proforma was used for data collection. Face validity of the instrument was ensured through constructive criticism of many lecturers. Data collected from 4876 folders of women who were affected by the illnesses under study and were analysed using descriptive statistics of frequency and percentages and inferential statistics of chi-square (c2). Chi-square statistics was employed to determine the difference in the prevalence of pregnancy-related illnesses of women under the following variables: age, parity and location. The three hypotheses were tested at .05 level of significance using the Statistical Package for the Social Sciences (SPSS batch system). The finding among others showed that significant differences existed in the prevalence of pregnancy-related illnesses among women of different age groups, parity status and location. Based on the findings, conclusions were drawn and it was recommended among others that community leaders should mobilize members during meetings and educate them through resource persons on pregnancy-related illnesses and their control strategies.

TABLE OF CONTENTS

Title Page
Abstract

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
Pregnancy
Pregnancy-related illnesses
Antenatal clinic
Prevalence
Theoretical Framework
Agent-host-environment model of health
Pregnancy-related illnesses and their consequences
Factors associated with pregnancy-related illnesses
Empirical Studies on Pregnancy-Related Illnesses
Summary of Literature

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

CHAPTER FOUR
Summary, Conclusions and Recommendations
Results and Discussion
Summary of Major Findings
Discussion of Findings
Prevalence of pregnancy-related illnesses
Differences in the Prevalence of Pregnancy-related Illnesses
Socio-demographic Factors Associated with Pregnancy-Related Illnesses

CHAPTER FIVE
Summary
Conclusions
Recommendations
Suggestions for Further Studies
References
Appendices

CHAPTER ONE

Introduction

Background to the Study

Pregnancy is the beginning of a new life. It is a normal life event and a very special period in a woman’s life. It is a natural phenomenon, which occurs at a stage in human development, when the body is fully matured and ready to procreate offspring of its kind and nature. Derek (2000) and Roper (2000) defined pregnancy as the state of carrying an unborn baby in the womb from conception to parturition. Isidro and Herminia (2004) stated that pregnancy is a normal part of life, which starts with the inception of embryo and continues through the development of the foetus and finally ends at birth. Pregnancy in the context of this work is defined as the presence of a developing embryo in the womb. Pregnancy is a time of emotional and physical changes during which the various systems of the body are fashioned for the role they will have to fulfill in supporting and eventually expelling the embryo. Certain steps are involved in the development of pregnancy.

Agboola (1988); Arkutu (1995), Chamberlain (1996) and Derek (2000) identified five steps that are involved in the development of pregnancy to include; menstruation, ovulation, fertilization, implantation, and growth and development of the foetus. Menstruation is a process during which the tissue linning the inside of the womb comes out and passes out through the vagina with some blood. It occurs once every month or twenty-eight day in the life of every woman of child bearing age. Ovulation is the release of an egg or ovum from one of the woman’s ovaries each month. Fertilization is the union or fusion of the male sperm cell with the female egg cell to form a zygote. Implantation is the process in which the fertilized egg reaches and attaches itself to the lining of the uterine wall and begins to develop. Growth and development of the foetus involve the formation of organs, nerves, muscles and bones that make up the body. Pregnancy is recognized by the signs it produces pregnancy.


Agboola (1988) and Adjayi (1989) opined that a missed period is probably the first sign to suspect pregnancy, if a woman had regular period, had sexual intercourse recently without using contraception and has not had her period on time. Myles (1985), Daler (1990) and Hahn and Payne (1994) identified three categories of signs of pregnancy as presumptive, probable and positive signs of pregnancy. Presumptive signs involve amenorrhea after unprotected intercourse the previous day, nausea on awakening, breast swelling and tenderness, increased frequency of urination and dusky discoloration of the vaginal mucosa. Probable signs are uterine enlargement, change in the consistency of the bladder and uterus and positive test for pregnancy. Positive signs requires that the uterus itself be detected and the signs are determination of foetal heartbeat, quickening and observation of the foetus by ultra sound. Other signs include dizziness, vomiting, vaginal engorgement and blueness, morning sickness, constipation, uterine contraction; softening of the uterus, increase in abdominal size and foetal movement (Arkutu, 1995; Chamberlain, 1996, Derek, 2000; Sidro & Herminia, 2004). Pregnancy is in trimesters or stages.

According to Master, Johnson and Colodny (1982) and Hahn and Payne (2003) pregnancy encompasses three trimesters: The first trimester (first three months) is a time of enormous changes with the following signs; fatigue, nausea, frequent urination (irregular bowel movement), breast swelling and tenderness, thirst and hunger (Master et al; 1982). They opined that the second trimester (4-6 months) is a period of many physical changes for the woman. The changes are: bulging of the waist, protruding abdomen, expansion of burstline, indigestion, nose bleeding, oedema, increase in the size of the breast with nipple becoming large and more deeply pigmented, haemorrhoids and foetal movement. Lasswell and Lasswell (1987) reported that the second trimester marks the beginning of the mother’s awareness of the foetal movement. Hyde (1979) pointed out that in the third trimester (7-9 months) the uterus is very large and hard and its extreme size put pressure on a number of organs of the woman thereby causing discomforts. Master et al., (1982) added that in the third trimester, the woman’s center of gravity is altered because the uterus is increasing in size and firmness. They contended that it may cause the woman to walk with her head and shoulder trusted backwards. The duration of pregnancy in human species is 280 days, counting from the first day of the last menstrual period (Isioro & Herminia, 2004). This is equivalent to 40 weeks of lack of period or menstruation or 38 weeks of gestation. During pregnancy, certain illnesses or condition may occur which may be due to the pregnancy or some factors behind pregnancy. These illnesses or conditions are termed pregnancy-related illnesses.

Pregnancy- related illnesses as defined by Myles (1985) and Elaine (1990) are diseases that are associated with pregnancy. Centre for Disease Control and Prevention-CDC (2003) referred to pregnancy- related illnesses as any physical or psychological condition resulting from pregnancy that has an adverse effect on the woman’s health. The Organization explained that any medical condition in pregnancy, which affects the pregnancy or makes the woman take time off work, is pregnancy-related. Some medical conditions are partly related to pregnancy and sometimes pregnancy makes existing condition worse (Arkutu, 1995; CDC, 2003). Arkutu (1995) identified two types of pregnancy-related illnesses to include problems that are caused by pregnancy such as ectopic pregnancy, hyperemesis, miscarriage, among others and existing problems or illnesses which any body can suffer but they are made worse in pregnancy such as malaria, anaemia, diabetes, essential hypertension, backache and sexually transmitted infections (STIs). Isiodro and Herminia (2004) identified the components of pregnancy-related illnesses to include: Obstetric problems and medical problems. For the purpose of the present study, only the existing conditions that are made worse in pregnancy will be studied.

CDC (2003) gave an illustration that where a condition such as allergy or backache could normally be treated with drugs, such as paracentamol under normal conditions, this medication may not be safe during pregnancy. Thus the woman may need to take time off work to see her doctor, whereas if she was not pregnant she could take medication and continue to work normally. In this circumstance, headache or backache may become pregnancy-related. Pregnancy-related illnesses are serious public health problems for reproductive age women (RAW). They can be severe and life-threatening and always require medical attention. Pregnancy–related illnesses (existing illnesses that are made worse in pregnancy) as identified by Myles (1985), Elaine (1990); Arkutu 1995) and Dunn (2003) and Nursing and Midwifery Council of Nigeria (2006) are: malaria, anaemia, diabetes, essential hypertension, pulmonary tuberculosis, sickle cell disease, urinary tract infection, cardiac disease, asthma, sexually transmitted infections (STIs), renal problems as well as backache or headache. For the purpose of this study only malaria, anaemia, diabetes, essential hypertension, backache and STIs will be studied.....

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