ABSTRACT
The purpose of this study was to examine the maternal health care seeking behaviour and
pregnancy outcome of pregnant women in two rural communities in Enugu State. The
objectives of study were to: (i) determine the gestational age at which pregnant women
book for Antenatal Care(ANC) in Udi and Abiacommunities, (ii)determine how often
pregnant women attend Antenatal Care(ANC)during the third trimester, (iii) ascertain the
facilities utilized by pregnant women with complications for care and (iv) ascertain their
pregnancy outcome. Cross-sectional survey design was adopted for the study. A sample
size of 207 respondents was drawn from a population of 586 pregnant
women. The instrument for data collection was the researcher-developed questionnaire
that was used as an interview guide. Observation guide was also used to corroborate the
findings of the questionnaire. The design of the study was descriptive cross-sectional
survey. Convenience sampling was used to select a sample size of 207 respondents from
a population of 586 pregnant women. Collected data wereanalysed using descriptive
statistics of frequencies and percentages. Chi-square was used to test for significant
association atsignificancelevel of 0.05.
Major findings show that most of the respondents (79.7%) booked for ANC during the
first trimester. On frequency of ANC during the third trimester, 81.1% maintained
weekly attendance while 100% of the respondents with complications accessed care from
health facilities especially the general hospital under skilled healthcare providers. On
pregnancy outcome, 84.5% of the babies cried vigorously at birth and 0.5% did not cry at
all. On maternal delivery outcome, 83.1% were strong to take care of self and baby after
delivery. There was no significant association (p > 0.05) between the respondents’
demographic variables (age and educational status) and their healthcare seeking
behaviour. There was no significant association (p > 0.05) between maternal healthcare
seeking behaviour and mothers’ delivery outcome (women that were strong to take care
of self and baby and those that were weak to take care of self and baby after delivery).
There was significant association (p < 0.05) between maternal healthcare seeking
behaviour and babies’ birth outcome (number of babies that cried vigorously at birth and
those that did not cry at all).
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CHAPTER ONE
INTRODUCTION
Background to the Study
A woman’s health care seeking behaviour during pregnancy depends a great deal on her
beliefs, culture, experience, educational level, financial status, attitude towards pregnancy,
as well as herautonomy and decision making power. Adele (2010)suggests issues of
importance to include information about pregnancy the woman’s family communicated to
her as a child and whether the pregnancy was planned or unplanned. Garba, Hellandendu,
andAjayi (2011) further explained that long before the advent of modern scientific
medicine, most cultures have among their patterns of life, a body of beliefs and practices
that centre on the recognition and treatment of complications of pregnancy and conduct of
deliveries. Thus, an understanding of appropriate health care seeking behaviour is very
important in achieving the desired pregnancy outcome. Negativebehaviour is highly
implicated in increased morbidity and mortality of mother and baby.
Osubor, Fatusi, and Chiwuzie(2006),suggests Maternal Health Care Seeking Behaviour
(MHCSB) to include the number of visits made to antenatal clinic (ANC) by pregnant
women and their preference for place of delivery.Jain, Nandan and Misra (2006) defined
health seeking behaviour as “a complex outcome of many factors operating at individual,
family and community levels including their biosocial profile, past experiences with health
services, availability of alternative health care providers, and the people’s perception
regarding the efficacy and quality of the services”.
Adele (2010) explains health seeking behaviour to be those activities undertaken by
individuals in response to any discomfort felt. He further stated that in the developed
countries like United States of America (USA), most women visit ANC early in
pregnancy, comply with prenatal directives and are attended to by skilled health care
providers when in labour. He also suggests that in the developing countries, especially in
the rural sub-Saharan Africa, most women consider pregnancy a natural process and the
services of skilled health care providers deemed not necessary. Rastogi (2012) observed
low utilization of ANC among rural women in India due to lack of means of
transportation, also because the women were often shy when discussing their health
problems before a male professional. Rastogi suggests that women who had formal
education up to secondary school level sought health care from skilled providers.
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Jayaraman, Chandrasekhar and Gebreselassie (2008),stated that most of the pregnant
women deliver at home without skilled health care providers, while only a few receive up
to three antenatal visits.Woldemicael(2008) suggests that due to lack of transportation
some pregnant women may not utilize ANC and other delivery services by skilled care
providersin health facilities and therefore seek help from diverse fields.
Adamu (2011) suggests that MHCSB is the way mothers take care of their health and the
unborn child so that they will reach the end of pregnancy very healthy with positive
outcome.Yubia (2011) opined that in Nigeria, maternal health care seeking behaviour is
similar to that of other developing countries where negative health seekingbehaviours
shown by most mothers often lead to poor use of maternal health care services provided by
skilled health care attendants with eventual negative pregnancy outcome. Yubiafurther
explained that poor treatment seeking behaviours predispose them to complications that
could be properly managed if detected early during ANC. The number of women attending
ANC in southern Nigeriais higher than in the north.NDHS (2008) suggests that the
percentage of births attended to by skilled health care providers range from 81.8% in the
South East (SE) to9.8% in the North West (NW). Similarly, 90.1% of women in the NW
are more likely to give birth at home compared to 22.5% in the South West (SW).Adamu
(2011) suggests that this high attendance is associated with educational and economic
empowerment of more women in the southern than in the northern Nigeria. The number of
visits to ANC is a key determinant of whether a woman giving birth seeks institutional
care or care at home under a skilled health care provider as against delivery at home under
unskilled birth attendant.Adamu (2011)stated that a woman who attends ANC is more
likely to deliver in a health facility. Young mothers (below 35years) are also more likely to
make decisions on seeking health care than older mothers (above 35years) and to have
institutional delivery. On the other hand, older mothers especially multipara who have
never had any complications in pregnancy believe that safe delivery is a natural process so
may not seek health care under skilled health care providers. Yubia (2011) opined that
such women rely on their experience and help from fellow older mothers for care and
delivery.
Rastogi(2012) suggests that pregnant women do not develop much complicationif a skilled
health care provider regularly visits them at home.Babalola and Fatusi (2009) suggest that
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the majority of maternal deaths and disabilities can be prevented through early and timely
access to and utilization of quality maternal health care services.WHO(2007) stated that
complications of pregnancy and childbirth are leading causes of maternal morbidities and
mortality for women of reproductive age (15 - 49 years) in developing countries. Nigeria
accounts for 10% of global maternal deaths and has the second highest mortality rates in
the world. It also reported that for every woman that dies from pregnancy - related causes,
20 - 30 more will develop short-and long-term damage to their reproductive organs
resulting in disabilities such as obstetric fistula, inflammatory diseases, and ruptured
uterus. In view of all these, this study examined the health care seeking behaviour of the
pregnant women in Udi and Abia communities and their pregnancy outcome.