ATTITUDE OF MOTHERS ATTENDING ANTENATAL CLINICS AT GENERAL HOSPITALS IN ANAMBRA STATE TOWARDS CESAREAN DELIVERY

Table of Contents
Title Page i
Approval Page ii
Certification iii
Dedication iv
Acknowledgements v
Table of Contents vi
List of Tables viii
List of Figures ix
Abstract x
CHAPTER ONE: Introduction 1
Background to the Study 1
Statement of the Problem 8
Purpose of the Study 9
Research Questions 9
Hypotheses 9
Significance of the Study 10
Scope of the Study 11
CHAPTER TWO: Review of Related Literature 12
1.Conceptual Framework; 12
•Concept of attitude, cesarean delivery, mothers, antenatal
clinics and general hospital 14
•Demographic factors associated with attitude of women
towards Cesarean delivery 18
2.Theoretical Framework; 22
•Theory of cognitive dissonance (TCD) 22
•Theory of reasoned action (TRA) 23
3.Empirical Studies on Attitude of Women Towards Cesarean delivery 24
4.Summary of Reviewed Literature. 31
CHAPTER THREE: Methods 33
Research Design 33
Area of the study 33
Population for the Study 34
Sample and Sampling Techniques 34
Instrument for Data Collection 34
•Validity of the instrument. 35
•Reliability of the instrument. 35
Method of Data Collection 35
Method of Data Analysis 35
CHAPTER FOUR: Results and Discussion 37
Results 37
Summary of Major Findings 60
Discussions 62
•Attitude of mothers towards cesarean delivery 62
•Differences in the attitudes of mothers towards cesarean delivery 65

CHAPTER FIVE: Summary, Conclusions and Recommendations 67
Summary 67
Conclusions
Recommendations 69
Suggestions for Further Study 69
References 69
Appendices
Appendix A: General hospitals in Anambra State and the population of pregnant mothers registered for antenatal care 76
Appendix B: Letter of introduction 77
Appendix C: Attitude to Cesarean Delivery Questionnaire 78
Appendix D: Correlations 80
Appendix E: Analysis 82
Appendix F: The validated instruments 89

List of Tables
Tables Page

1. Mean ratings of the attitude of the women towards accepting C-delivery. 37
2. Mean ratings of the attitude of the women towards those who undergo C- delivery. 38
3. Mean ratings of the attitude of the women towards the medical staff that execute C-delivery. 39
4. Mean ratings of the attitude of the women towards C-delivery according to age. 41
5. Mean ratings of the attitude of the women towards C-delivery according to age. 42
6. Mean ratings of the attitude of the women towards C-delivery according to age. 43
7. Mean ratings of the attitude of the women towards C-delivery according to parity . 44
8. Mean ratings of the attitude of the women towards C-delivery according to parity . 45
9. Mean ratings of the attitude of the women towards C-delivery according to parity. 46
10. Mean ratings of the attitude of the women towards C-delivery on the basis of 47
    educational attainment.
11. Mean ratings of the attitude of the women towards C-delivery on the basis of educational 48 attainment.
12. Mean ratings of the attitude of the women towards C-delivery on the basis of educational 49 attainment.
13. Mean ratings of the attitude of the women towards C-delivery based on previous mode 50 of delivery.
14. Mean ratings of the attitude of the women towards C-delivery based on previous mode 51 of delivery.
15. Mean ratings of the attitude of the women towards C-delivery based on previous mode of delivery. 52
16. Summary of Anova analysis testing the Null Hypothesis of No Significant Difference 53
    in the attitude of young and older women with regard to C-delivery.
17. Summary of Anova analysis testing the Null Hypothesis of No Significant Difference 55
    in the attitude of the women towards C-delivery according to parity.
18. Summary of Anova analysis testing the Null Hypothesis of No Significant Difference 57
    in the attitude of women towards C-delivery according to educational attainment.
19. Summary of Anova analysis testing the Null Hypothesis of No Significant Difference in the attitude of women towards C-delivery according to previous mode of delivery. 59
20. Conceptual framework——————26
21. Schematic representation of the theoretical framework—————-29

Abstract

The study was conducted to find out the attitude towards cesarean delivery among mothers attending antenatal care at the general hospitals in Anambra State. Seven specific objectives with seven corresponding research questions and four null-hypotheses were postulated to guide the study. The cross-sectional survey research design was used for the study. The population for the study was 3,256 mothers while the sample for the study consisted of 326 mothers. Random sampling technique of balloting without replacement and systematic random sampling technique were used to draw the sample for the study. A two-sectioned researcher designed questionnaire was the instrument used for data collection. The instrument was validated by five experts from the department of Health and Physical Education, University of Nigeria, Nsukka. Mean was used to analyze the data obtained while ANOVA was used in testing all the hypotheses at .05 level of significance. The results of the study showed that the overall attitude of mothers towards accepting cesarean delivery (2.20) and towards the medical staff that executes cesarean delivery (2.42) were negative while their attitude towards those who undergo cesarean delivery were positive (2.50). The independent variables (age, parity, educational attainment and previous mode of delivery) had no significant influence at .05 level of significance on attitude of mothers towards C-delivery. Following from the findings, discussion and conclusion of the study, four recommendations were made among which is that community health education about the benefits of cesarean delivery when indicated at primary care level is needed for the women’s and community’s understanding of the necessity of cesarean delivery. This will go a long way to reduce the number of women declining cesarean delivery and the morbidities and mortalities associated with such an action and improve the pregnancy outcome.

CHAPTER ONE
Introduction
Background to the Study
The trend of acceptability and the rate of cesarean delivery have been on the increase in the developed countries in the last three decades due to the current safety of the procedure (Sunday-Adeoye and Kalu 2011), conversely, in the developing countries, the change in cesarean delivery rate has been less dramatic during the same period. While developed countries are dealing with the ethical and legal issues associated with caesarean delivery on maternal request, developing countries are still struggling with issues of refusal of caesarean delivery even in the face of obviously defined risks of maternal and perinatal morbidity and mortality. Kwawukume (2001) stated that in developed countries women often accept caesarean delivery because of their improved understanding of its role and safety, and the increasing importance of the right to self decision making regarding mode of delivery. By contrast, in developing countries women are reluctant to accept cesarean delivery, which may be as a result of many factors such as their traditional beliefs and socio-cultural norms as well as financial problems. Cesarean delivery is still being perceived as an abnormal means of delivery by some women in the developing countries. Sunday-Adedoye and Kalu (2011) affirmed that among women in the developing countries, cesarean delivery is still being perceived as a curse on an unfaithful women and the lot of weak women. They further noted that cesarean delivery was viewed with suspicion, aversion, misconception, fear, guilt, misery and anger.
In developed countries court-ordered caesarean deliveries are performed on mentally competent women on their refusal to the procedure. It was carried out when a woman refused the operation in circumstances where it was considered to be essential for the safety of herself, her baby or both, and following a court application made by doctors or hospital administrators (Chigbu & Iloabuchi, 2007). Unfortunately, no such order exists in most developing countries particularly in Nigeria where there is prevalence of this refusal of cesarean delivery.
Studies have established that maternal aversion to caesarean delivery is prevalent in developing countries especially in Sub-Saharan Africa. According to Behaque (2000) in Nigeria, as in most Sub-Saharan African countries, it has been suggested that women accept cesarean delivery reluctantly even in the face of obvious clinical indications. Thus, Awoyinka, Ayinde and Omigbodun (2006) noted that despite the well-documented record of safety of cesarean delivery, there are strong aversion of women in sub-Saharan Africa to the procedure (cesarean delivery), even in the presence of life-threatening indications. Okonta, Okali, Otoide and Twomey (2002) affirmed that refusal of life cesarean delivery is not uncommon among women in urban settings in Sub- Saharan Africa particularly in a country like Nigeria which is a leading contributor to both local and regional burden of maternal mortality.