Pattern of Utilization of Maternity Services by Women in Selected Primary Health Care Facilities in Ilorin-east, Kwara State
CHAPTER ONE
AIM AND OBJECTIVES OF THE STUDY
The aim of this study is to examine the spatio-temporal variation in pattern of utilization of maternity services among women in Ilorin-East local government area, Kwara state. This aim was achieved through the following specific objectives; that Identify and characterize the type of maternity services available to women in Ilorin-East Local Government Area.
- examine the awareness of knowledge and type of maternity services facilities
- examine the effect of physical and economic distance on utilization of maternity services in the study area
- evaluate user’s perception of adequacy attitude of maternity services personnel
- evaluate the associated community benefits of maternity services.
CHAPTER TWO
CONCEPTUAL ISSUES AND RELATED LITERATURE REVIEW
CONCEPTUAL ISSUES
Concept of Maternity services
Maternity services refers to the regular medical and nursing care recommended for women during pregnancy. Maternity services is a type of preventative care with the goal of providing regular check-ups that allow doctors or midwives to treat and prevent potential health problems throughout the course of the pregnancy while promoting healthy lifestyles that benefit both mother and child (Ahmed and Mosely 2002). During check-ups, women will receive medical information over maternal physiological changes in pregnancy, biological changes, and prenatal nutrition including prenatal vitamins. Recommendations on management and healthy lifestyle changes are also made during regular check-ups. The availability of routine prenatal care has played a part in reducing maternal death rates and miscarriages as well as birth defects, low birth weight, and other preventable health problems Acharya and Cleland (2000).
Becker, Peter and Black (2003), posits that Maternity services is medical attention given to the expectant mother and her developing baby. It also involves the mother’s caring for herself by following her health care provider’s advice, practicing good nutrition, getting plenty of rest, exercising sensibly, and avoiding things that could harm her or her baby. Afari et al (2005), observed that pregnant girls and women are referred to maternity services or Midwife Obstetric Units (MOUs) in urban areas and satellite or fixed clinics in the rural areas. MOUs are birthing units run by midwives in the community for primary healthcare patients.
It’s advisable for expectant mothers to book their first visit to the clinic before 20 weeks or as soon as possible thereafter.
Some concepts that are the main determinants of maternity care are pertinent to this study which needs to be examined. Several studies concentrate on demography and fertility topics, such as the Demographic and Health Surveys (DHS). Recent DHS-based studies on the use of maternity care are available for rural Nigeria, Ghana (Addai, 2000), Kenya (Magadi, Madise and Rodrigues, 2000), Peru (Elo, 1992) and Thailand (Raghupathy, 1996). Similar surveys focusing on demography and fertility are used recently in studies on the use of maternity care in Jamaica (McCaw-Binns et al, 1995), Nepal (Acharya and Cleland, 2000), and the Metro Cebu area in the Philippines (Becker et al., 1993). The DHS and similar surveys are rich in detail on demography and fertility, but less detailed in economic factors such as costs for maternity care and household living standard. A somewhat older study on maternity care use based on a survey that covered both demographic as economic topics concerns also the Metro Cebu area in the Philippines (Wong et al., 2017). By using more precise information on income level and maternity care costs, our estimations for the effects of these other factors will be less biased.
CHAPTER TWO
LITERATURE REVIEW
The need for Maternity services in Nigeria.
Pregnancy is a natural process and women with some experience might consider maternity care less necessary. Accordingly, Elo (1992) and Raghupathy (1996) a higher number of previous pregnancies is associated with less use of maternity care, while Magadi, Madise and Rodrigues (2000) and McCaw-Binns, La Grenade and Ashley (1995) negative association between a higher number of previous pregnancies and early attendance to maternity care. However, the latter also report that complications experienced during earlier pregnancies have a positive association with early attendance to maternity care, suggesting that earlier problems with pregnancies make women more aware of the need for maternity care.
The demand for and utilization of maternal health services depends on numerous factors, many beyond a woman’s direct control, including the physical accessibility of facilities to her home; direct and indirect costs of obtaining services including not only fees for medication, transportation, feeding and accommodation charges but also the convenience of opening hours and average waiting times, the extent to which staff are competent, providing quality care and demonstrating cultural sensitivity to her needs, and the availability of other needed key health care inputs including essential drugs and food supplements (Lashman, 2010).
In addition to these services, quality factors and access to the facility has been adversely affected by the introduction of cost recovery schemes, including user fees for antenatal and delivery services in most states of the country. The impact of these fees on service utilization is particularly severe among the poor and vulnerable groups, who have resorted to the use of traditional medical practitioners and spiritual healers as alternative providers of health care (El-Sefly, 2019 and Mairiga (2003). Utilization is the way and manner in which people use or utilize a particular thing(s), product(s) or service(s) because of the belief that it is important or serves a very vital functional and significant role in their well being, society at large, and the very survival of the human race. In this study, it means the way and manner in which married women of child bearing age – pregnant women and nursing mothers patronize Maternal Health Care clinic due to the belief and acceptance of the advantages and importance associated with the use of the facility.
An estimated 500,000 women die each year throughout the world from complications of pregnancy and childbirth. About 55,000 of these deaths occur in Nigeria. Nigeria, with only 2% of the world’s population therefore accounts for over 10% of the world’s maternal deaths. In 2003, the World Health Organization and the Federal Ministry of Health of Nigeria reported that about 145 women die everyday in Nigeria as a result of causes related to childbirth (WHO, 2005).
In terms of absolute numbers, Nigeria ranks second globally to India in number of maternal deaths. The risk of a woman dying from child birth is 1 in 18 in Nigeria, compared to 1 in 61 for all developing countries, and 1 in 29,800 for Sweden (WHO, 2005).
Jones (2000), posits that maternal mortality in Nigeria is not uniform across the country but varies markedly across geographical zones. This has been attributed to differences in a range of factors such as wealth indices, educational level, cultural practices, and healthcare coverage and utilization. According to WHO (2005), the main causes of maternal mortality in Nigeria are obstetric haemorrhage, accounting for 23% of deaths, post-partum infections accounting for 17%, and the trio of eclampsia, obstructed labour and complications of abortion each accounting for about 11% of deaths. Other indirect causes of maternal deaths include malaria and anaemia in pregnancy.
With a neonatal mortality rate of 48/1000 live births, and over 700 newborn deaths each day Nigeria ranks seventh among the ten African countries where newborns have the highest risk of dying Lavy and qugley’s (2002). Neonatal deaths in Nigeria account for a quarter of under five mortality. Infectious conditions such as septicaemia, pneumonia and meningitis account for the greatest proportion (42%) of deaths within the first month of life. Delivery- related complications, chiefly asphyxia and birth trauma account for 32%, and pregnancy-related complications such as eclampsia, malaria, anaemia, and malnutrition for the remaining 26% of neonatal deaths Nyonator et al (2004).
According to the Multiple Indicator Cluster Survey of 2007, the Infant Mortality Rate in Nigeria is 86 per 1000 live births. As with maternal mortality, this figure varies widely from one geographical zone to another with the highest rates in the Northwest (101 per 1000 live births) and the lowest in the Southwest (68 per 1000 live births). The major medical conditions leading to infant mortality in Nigeria are acute respiratory infections, diarrheal diseases, measles and malaria. Deaths of neonates constitute about a quarter of all infant deaths in Nigeria.
There are several underlying factors that contribute to the high maternal and infant mortality rates in Nigeria. These include lack of maternity care, a low proportion of women attended to by skilled birth attendants, and delays in the treatment of complications of pregnancy. In the case of post-neonatal mortality, malnutrition is a major factor, underlying about half of all infant deaths. Other indirect factors that affect both maternal and infant mortality rates include maternal educational level, cultural practices, and poverty. There is a strong relationship between infant mortality and socio-economic status. Across Africa, the neonatal mortality rate per 1000 live births is 59 in the lowest income quintile and 23 in the highest income quintile. The Nigeria MICS 2007 data showed a similar relationship. The IMR in the highest income quintile was 54 per 1000 live births while in the lowest income quintile it was 101 per 1000 live births, with a clear trend of decreasing mortality as wealth index increases.
CHAPTER THREE
RESEARCH METHODOLOGY
Reconnaissance Survey
A Reconnaissance Survey was carried out in order to be well acquainted with the study area and the selected wards. This helped the researcher to have a better view of the study area, localities and other relevant information.
Sources of Data
Primary source of data
This was obtained from some structured of questionnaire administered through oral interviews and FGDs. The questionnaire was designed to elicit information on the following types of data:
- Basic demographic data: sex, age, marital status, household size, level of education, socialand economic characteristics: poverty, spousal income, occupation, number of children every born, women’s education, contraceptive use, availability, accessibility ad utilization of Maternity services by the women in the area, staffing, drug routine, health counseling and equipment
CHAPTER FOUR
DATA PRESENTATION AND ANALYSIS
INTRODUCTION
This chapter deals with the analysis, interpretation and discussion of the data collected from a research work on “pattern of utilization of maternity services”, the data were analyzed and presented using sample frequencies and percentages. Although 382 questionnaires were administered, only 333 were completely filled and valid for analysis. The result is therefore based on 333 respondents
CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATIONS
INTRODUCTION
The study of “pattern of utilization of maternity services” in Ilorin-East local government area could be said to be important in the life of women most especially pregnant women in order to bring about a better way of living among women and pregnant mothers. What contained in this chapter is summary of findings, conclusion, recommendation as well as suggestion for future research.
SUMMARY OF FINDINGS
Considering the purpose of this research it has been observed that wellbeing of women most especially pregnant women is very important in the society. To achieve sound health by women in the society, there is the need for women to understand the level of their health and if pregnant the level of the baby’s health. They should understand how to live in perfect health, take care of themselves to prevent the spread of disease and also at the course of delivery there will be no course for alarm.
CONCLUSION
Based on the outcome of the study, the following conclusions were made:
- Lack of proper accessibility of antenatal facility have an influence on pregnant women in Ilorin-East local
- The proper funding of maternity care center have brought about the development of the locality, and an improvement in the standard of living of the people.
- Islam, the predominant religion in the northern states, strongly supports education of both boys and To this end, traditional and religious leaders can serve as key partners, as can organizations currently working in education. Antenatal education, especially when combined with postnatal education using a set of different interventions, is effective for increasing the breastfeeding initiation rate and prolonging exclusive breastfeeding (Elbourne 1992., Stockley 2005.,Tedstone, Duce andAviles 1998).
RECOMMENDATIONS
Based on the findings of this study and its limitations, the researcher recommends the followings:
- Pregnant women should be offered information based on the current available evidence together with support to enable them to make informed decisions about their care. This information should include where they will be seen and who will undertake their care, this should be done in order to avoid improper knowledge on their health
- Women with any risk factor should be properly checked and treated in order to bringabout a sound
- Inadequate health centers can cause great effect on the wellbeing of women mostespecially pregnant mothers, so therefore, health care center should be provided in various local governments in order to avoid distance as being an excuse of location of health care center, or if possible vehicles be provide to various local government to bring about efficient transportation to the health care centers.
- In relation to the ill-equipped health care facilities, it is recommended that all healthcare center should be replaced with new ones by the center or by government, in order to help the health workers to effectively deliver their For effective delivery of services, health care centers should try and employ more staffs if short of staff, this will help in attending to patient in time without
- Also contentiousness of staff to patients should be advocated by maternity services management so that more pregnant women (particularly young mothers) will be encourage to patronize maternity services.
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