Knowledge, and Practices of Safe Motherhood Among Women in Nkpor Urban in Anambra State

Knowledge, and Practices of Safe Motherhood Among Women in Nkpor Urban in Anambra State

Chapter One

Objectives

To assess the level of knowledge of pregnant women attending ANC in Nkpor LGA on factors that influence safe motherhood
To determine the frequencies of factors that influence safe motherhood among pregnant women attending ANC in
To determine safe motherhood among pregnant women attending ANC in Nkpor LGA
To determine the relationship between the risks factors and poor safe motherhood.

CHAPTER TWO

LITERATURE REVIEW

Factors influencing safe motherhood

Maternal Age

Extreme of maternal age has since been recognized as a potential risk factor for poor safe motherhood. Maternal age below 18 years and above 35 years are associated with higher level of LBW, Prematurity, Perinatal and neonatal mortality and even maternal deaths especially in developing countries where health care services especially in the rural settings are poor and level of poverty high. A study in Ilorin found that anaemia, toxeamia of pregnancy and low birth weight was commoner among teenage mothers than adult mothers; however, hypertension was commoner among adults than adolescents¹⁷. Another study in Iran found that Preterm labor and placenta previa were significantly higher in less-than 18 years group and that maternal age in the two extremes affected safe motherhood¹⁸. Another study in Canada reports that adolescents were more likely to have a preterm delivery and lower CS (Caesarean section) delivery compared to older women. Older maternal age, higher pre-pregnancy BMI (Body mass index), increased weight gain during pregnancy, and pre-delivery anemia were all independent risk factors for CS. Smoking was the most influential factor in predicting infant birth weight. Adolescents had significantly more low birth weight infants than adults but gestational age rather than young maternal age was the most significant risk factor for low birth weight. After controlling for smoking status, adolescents were 2.5 times more likely than adults to be anemic at 26 to 35 weeks‟ gestation and pre-delivery¹⁹.

Maternal parity

Parity has been used as a risk marker with nulliparous and grand multiparous women classified as at higher risk of pregnancy complications. Nulliparous women are considered to be at risk of pregnancy-induced hypertension and fetopelvic disproportion leading to operative delivery, whereas the grand multiparous are considered to be at risk for haemorrhage, malpresentation, anaemia, uterine rupture and complications associated with chronic medical problems such as diabetes and hypertension. Grandmultiparity has been described as an independent risk factor for a variety of obstetric complications, especially in developing countries with inadequate health facilities. High parity is still common with dire consequences to the foetus, the family and the society. Pregnancy after the fifth delivery is viewed with anxiety, especially by Obstetricians in developing countries working with inadequate facilities. The problem of high parity in developing countries is further compounded by a high prevalence of low socio-economic status, poor female literacy, and social deprivation, as well as poor utilization of contraceptive services

A study conducted in southeastern Nigeria reported that Diabetes mellitus; hypertension, heart disease, anaemia, multiple pregnancy, antepartum haemorrhage, foetal malpositionings and malpresentations, cephalopelvic disproportion, congenital malformations and macrosomia were significantly associated with grandmultiparae²⁰.

CHAPTER THREE

METHODOLOGY

Sampling and sample size

The sampling frame for the study was the LGAs within the selected clusters in Nkpor. Sampling involved a two stage cluster sampling approach. In the first stage, one cluster was randomly selected among PATHS2supported clusters within each state prior to the commencement of the SMID intervention. In the second stage, eighteen rural communities were purposively selected from within each cluster as sites for the SMID intervention. In each of the eighteen communities, women who had recently delivered i.e. delivered within the last two years, were selected for the survey and interviewed using structured questionnaires. The minimum sample size required was estimated using Cochran’s sample size formula for categorical data:

n = D(Zα)2 P(1 ‐ P)/d2; Where n is the sample size, D represents the design effect (taken as 2).

Zα is the standard normal deviate set at 1.96 (for 95% confidence level).

d is the desired degree of accuracy (taken as 0.05).

P is the estimate of the proportion of mothers with knowledge of safe motherhood, taken to be 8.5% [19].

The sample size required was estimated as ~240 per cluster; however factoring a 10% attrition or non-response rate; the estimated sample size per cluster is ~264.

Data collection

The structured questionnaire for the survey was designed in English but the data collectors were trained using a combination of English and the local Hausa language. The training of data collectors and supervisors lasted for one full day within each state. The questionnaires were translated and back translated for the purpose of training the data collectors/supervisors. The questionnaires were pilottested within one of PATHS2’s clusters in Anambra State and the necessary changes were made to finalize the study questionnaire in preparation for the survey.

CHAPTER FOUR

Results

Socio-demographic distribution of respondents

The median age of participants in both states and among 540 female respondents was 25 (range: 15 – 49); mean age was 26.9 years. Table 2 shows that more than 50% of women in both states were aged between 21 and 34 years old.

CHAPTER FIVE

CONCLUSION AND RECOMMENDATIONS

Conclusion

Most women (62%) attending antenatal care have adequate knowledge of factors that influence safe motherhood, the level of knowledge is related to the mother‟s level of education, increasing age and parity. The prevalent factors that could adversely affect safe motherhood in the area are early marriage with associated teenage pregnancy and delivery, low socioeconomic status, high maternal parity, inadequate antenatal care and unsupervised home deliveries while those that could lead to good outcomes are good social practices such no consumption of alcohol or cigarette smoking, good birth spacing, being married, and low prevalence of medical conditions such as hypertension, diabetes and HIV. The prevalence of low birth weight was 11.7%, the perinatal mortality rate was 34/ 1000 total births and neonatal mortality rate was 14/ 1000 live births. Low birth weight was associated with preterm delivery while perinatal and neonatal mortality was associated with extreme of maternal age and HIV positive status respectively.

Recommendation

Knowledge about risk factors for poor safe motherhood should be widely disseminated to pregnant women, their families and the community at large by the LGA with support from the state Behavior-change communication strategies would facilitate any new way of providing antenatal care maternity services or demandside subsidies by increasing awareness and demand for safe care during delivery. Radio and television messages can provide channels for mass communications and have the better chance of reaching the most remote people. It may provide an avenue to ensure that pregnant women have skilled attendant at delivery and also access to support and services for all routine as well as emergency care during pregnancy, delivery and post partum.
Educational programs should be put in place by the local and state government to ensure the girl child is enrolled and retained in school to at least completion of senior secondary
Interpersonal skills and communication strategies capacity building for the health workers could facilitate improvement in the quality of care to the pregnant woman especially during labour, and could improve the proportion of hospital delivery.
Women empowerment through gainful employment, vocational training and provision of a micro credit facility to reduce their dependence on their
Increased political will and commitment through a health insurance policy at the state and local government levels similar to the NHIS, to make healthcare services available and accessible to all irrespective of economic or social

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