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.
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.
Malaria remains a globally one of the most important parasitic disease of man (Uneke, 2007). Flor, Claudio and Wilson (2005) pointed out that pregnant women are more attractive to mosquitoes. They explained that pregnancy is accompanied by physiological and immunological changes, which modify the resistance to infections and diseases pathogenesis. They also added that the prevalence of malaria in highly endemic areas is higher among pregnant women than in other groups. Uneke (2007) described malaria as a disease of poverty and underdevelopment and it remains a complex and overwhelming health problem with 300 to 500 million cases and 2 to 3 million deaths per year. He noted that about 90 per cent of all deaths attributable to malaria occur in Sub-Saharan Africa and two factors are highly responsible: first, the majority of infections are caused by plasmodium falciparum, the most dangerous of the four human malaria parasites and secondly: the most effective malaria vector-Anopheles mosquito is the most wide spread in the area and the most difficult to control. Arkutu (1995) and Opere- Addo and Odo (2002) reported that malaria is a common disease in many parts of Africa that is caused by plasmodium parasite, transmitted through mosquito bite. Khamis (2004) explained that pregnant women are more susceptible to malaria, which is associated with serious adverse effects on pregnancy. Malaria attack on a pregnant woman can result to abortion, premature labour, anaemia, stillbirth or an underweight baby (Clerk, 1996).
Anaemia is another existing illness that is made worse in pregnancy. Ojo and Briggs (1992) noted that anaemia is the reduction below normal in the number of red blood corpuscles per cubic millimeter, the quantity of haemoglobin and the volume of red blood corpuscles per 100ml of blood. It is caused by iron deficiency in the diet or due to lack of absorption of iron in the diet. Arkutu (1995) explained that not all the iron ingested and absorbed daily from the small intestine is needed immediately. The excess is usually stored in the bone marrow so that, during periods of physical stress, it can be used to increase the rate of formation of haemoglobin to satisfy increased need. One of such period of physical stress is pregnancy. Growth and development of the foetus and other changes taking place in the expectant mother leads her to an increase in the demand for many nutrients, especially iron and folic acid. Anderson (2005) saw anaemia in pregnancy as haemoglobin concentration of less than 11 gram per deciliter when peripheral blood is examined. Any patient with haemoglobin of less than 11gm/di to 11.5 gm/dl at the start of pregnancy will be regarded as anaemic. They added that as pregnancy progresses, the blood is diluted. Severe anaemia in pregnancy can cause heart failure, abortion, premature labour, stillbirth and intra-uterine death of the foetus (Ojo & Briggs; 1992 & Arkutu, 1995).
Diabetes also posses another threat to pregnant mothers and thus an illness that is related to pregnancy. It is a disease marked by the presence of sugar in the urine and blood (Kessier, Singer, Kalk & Schlesing, 1993). Kristine and Kay (2006) observed that diabetes is one of the most common metabolic abnormalities encountered during pregnancies and it affects approximately 3 per cent of pregnancies. Arkutu (1995) opined that diabetes is a condition where sufficient amounts of insulin are either not produced or the body is unable to use the insulin that is produced. Dunn (2003), and Adams (2005) acknowledged that a special type of diabetes called “gestational diabetes” occur only in pregnancy when a mother who has no previous history of diabetes develops high sugar level during pregnancy. Kristine and Kay (2006) defined gestational diabetes as carbohydrates intolerance with onset or first recognition during pregnancy. Gestational diabetes is not caused by insulin, but by blocking effects of other hormones on the insulin that is produced. Diabetes in pregnancy or gestational diabetes can lead to the birth of a baby who is larger than normal. It can as well cause birth injury, hypoglycemia and respiratory distress on the baby (Arkutu, 1995 & Dunn, 2003). Kristine and Kay (2006) maintained that diabetes in pregnancy significantly increases the risk of maternal and foetal complications such as diabetic retinopathy, pyelonephritis, as well as pregnancy-induced hypertension.
Essential hypertension is also a medical condition that is made worse in pregnancy. Derek (1985) noted that essential hypertension is a disease, which is probably of hereditary origin. Essential hypertension is also considerably influenced by emotional and environment factors. It is encountered most commonly in women over 30 years and more severe in younger women below 17 years of age (Derek, 1985 & Ojo & Briggs, 1992). Clayton (2004) pointed out that essential hypertension is characterized as high blood pressure with no known identifiable cause. He explained that the disease has many hypothesized explanations, including alterations in nitric metabolism, oxidative stress in relation to endothelial dysfunction and changes in the rein-angiotension-aldosterone system. When the disease is not properly handled, it can result to a serious complication known as induced hypertension in pregnancy and it is characterized by protein in urine and a very high blood pressure. Ojo and Briggs (1992) added that protenuria and very high blood pressure in pregnancy are symptoms of pre-eclampsia and toxemia and the most severe case can lead to eclampsia. Essential hypertension can also cause maternal mortality.
STI(s) also poses threat to pregnant mothers and thus an illness that can cause complications in pregnancy. STIs is defined by Arkutu (1995) and Mckesson (2005) as infections that are passed from one person to another by sexual intercourse. Mckesson (2004) opined that STIs usually affected gentital area such as penis and vagina. Sexual contact of STIs includes vaginal intercourse, anal intercourse, oral-genital contact, skin-to-skin contact in the genital area, kissing and the use of sex toys such as vibrators. It constitutes one of the major health problems facing the world and can be devastating both to the mother and the foetus. Dunn (2003) acknowledged that young pregnant women have been found to have high rates of STIs, most of which have no symptoms but carry serious health risks for the woman and babies. Myles (1985); Daler (1990); Ojo and Briggs (1992), Arkutu (1995); Dunn (2003); and Mckesson (2005) identified the most common STIs as chlamydia, hepatitis B and C, genital herpes, genital warts, gonorrhoea, trichomoniasis, Syphilis and HIV/AIDS. Kwawukume (2002) noted that pregnant women with STIs have an increased risk of preterm labour, premature rupture of membrane and uterine infection. Dunn (2003) is of the opinion that STIs such as chlamydia and gonorrhoea could cause pneumonia, ectopic pregnancy, pelvic inflammation, preterm labour, pelvic pain, bleeding and infertility in the woman and eye infection in the new born babies.
Backache is also one of the illnesses that poses threat in pregnancy. Arkutu (1995) pointed out that as the baby grows heavier and a woman’s balance changes, her lower back is put under increasing strain. Okeke (2005) explained that during pregnancy, the pregnancy hormone, especially progesterone softens the ligament and fibrous tissue that normally hold the spine and pelvic joints firmly together. This is done to allow the pelvis to expand at the moment of birth and so facilitate straightforward delivery. However, the loosening of the joint also has an adverse effect on the woman making her more susceptible to strain.
Inadequate management of pregnancy-related illnesses can result to a lot of complications. The illnesses can mar the health of both the pregnant woman and the foetus and can well cause the following complications abortion, placenta praevia, abruption placenta, hyperemesis gravidarum, pre-eclampsia, eclampsia to mention but few. It could be in realization of the above, that Arkutu (1995); Chamberlain (1996), and Derek (2000) reported that a good antenatal care is necessary during pregnancy to ensure that both the mother and the foetus are in safe hands.
Ojo and Briggs (1992) referred to antenatal care as the advice, supervision and attention a pregnant woman receives to ensure good health, a pleasant childbearing experience and a healthy baby at the end of pregnancy. Antenatal care in the context of this work is the care and education given to pregnant women. Agboola (1988); Arkutu (1995) and Derek (2000) suggested that women whose pregnancy conditions have been confirmed or those suspecting pregnancy should visit antenatal clinic for antenatal care and confirmation of pregnancy respectively. Antenatal care should commence from the time pregnancy is diagnosed until the safe delivery of the woman (Ojo & Briggs, 1992). Arkutu (1995) reported that the main goal of antenatal care is to ensure that the mother and the foetus are in good health, and that any problem during pregnancy is diagnosed and treated. A thorough history is usually taken during antenatal visits and physical examination is also carried out (Myles, 1985; Thomson, 1990 Ojo and Briggs, 1992 & Arkutu, 1995).
The findings of the physical examinations and the history taken are used to assess how healthy the woman is during pregnancy; to identify potential pregnancy problems of the mother and that of the foetus and also to record the effects of whatever treatment she has received (Arkutu, 1995). The woman’s data is recorded in the folder. Chen (2006) defined folder as the basic building blocks of a content area. The main purpose of folders is to organize and cross reference item in such a way that it is easy for the end users to find what they are looking for. Folder in the context of this work is a file that contains information about a person. Antenatal clinic takes place at the health facilities.
