CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Pregnancy and delivery for most women, include physiological and psychosocial changes in the body constituting a major life event. Pregnancy throughout the world is regarded as a perfect normal stage, mile stone to motherhood, and a moment of celebration. However to many, especially in the developing Countries, it is a moment of sadness, pain, disability, and death (Zhianian, Zareban, Ansari, & Rahimi, 2015).
Globally, approximately 830 women die from pregnancy or childbirth-related complications around the world every day and about 99% occur in developing countries (World Health Organization [WHO], 2015).Nearly 80% of the maternal deaths are caused by the five direct obstetric causes namely haemorrhage, hypertension, sepsis, obstructed labour and complications of abortion (WHO, 2015). Hypertensive diseases of pregnancy (pre-eclampsia and eclampsia) are considered to be common causes of maternal deaths world-wide, contributing to 18% of the deaths, being the second after haemorrhage as the most common cause of maternal deaths (WHO, 2015).Pre-eclampsia is one of the leading causes of maternal mortality and morbidity worldwide (WHO, 2014).
In both developed and developing countries, preeclampsia continued to be a significant public health issue contributing to maternal and perinatal mortality and morbidity. However, the effect of the disease is felt more severely in developing countries where, unlike hemorrhage and sepsis, medical interventions may be ineffective due to late presentation of pre-eclampsia cases (Osungbade & Ige, 2011).
In Nigeria, pre-eclampsia is one of the leading causes of maternal mortality and morbidity due to late presentation of women at hospital (Onakewhor & Gharoro, 2008). Furthermore, there are frequent severe cases of pre-eclampsia, following delays in identification/management at the community level and further delays in referral and transportation of women to higher facilities when necessary (Onakewhor & Gharoro, 2008).
The opinion pregnant women have toward the cause of their health problems varies, while some view it as a result of traditional black magic or spiritual attack, others have no clue of the cause of their health problem in their pregnant state. These opinion of theirs therefore have effect on their health care-seeking behaviour (Egbuniwe, Egboka, & Nwankwo, 2016). Furthermore, Martina and Franklin (2015), contributed that maternal and perinatal mortality and morbidity constitutes a major challenge around the world especially in the developing countries. These are associated with inappropriate health seeking behaviour during pregnancy (Martina & Franklin, 2015).
The Millennium Development Goals (MDGs) which was adopted by the international community in 2000, had ‘improving maternal health’, as one of the eight MDGs. Under MDG five, there have been compliance in reducing maternal mortality by 3 quarters between 1990 and 2015 globally. However, in 2015, despite the significant gains in reduction, an estimated 303,000 maternal deaths occur globally, representing a decline of only 43 % since 1990 (estimated 535,000 maternal deaths) and a similar reduction since the adoption of the MDGs in 2000,(estimated 529,000 deaths) which is still far from the target of 75 % reduction (WHO, 2015).In the Sustainable Development Goals, the achievement of the new targets which is to end preventable maternal and new-born mortality, will require universal access to improved delivery of evidence-based solutions for preventable maternal conditions, such as hypertensive disorders of pregnancy (Bhutta et al., 2014).
Utilization of health care facility by pregnant women include antenatal care (ANC), which is the care a pregnant woman receives during her pregnancy through a series of consultations with trained health care workers such as midwives, nurses, and sometimes a doctor who specializes in pregnancy and birth (Nigeria Demographic and Health Survey [NDHS], 2013). However, an analytical review of recent world health statistics showed that ANC coverage in Nigeria is low and is indirectly correlated with the high maternal mortality ratio recorded. The poor maternal health outcome in Nigeria could be a result of poor utilization of maternal health care services (WHO, 2014).
Most studies of pre-eclampsia (McClure, Saleem, Pasha, & Goldenberg, 2009; Osungbade & Ige, 2011; Shah, 2009) focus on management and treatment of preeclampsia, while few others focus generally on determinants of health care seeking behaviour in pregnancy (Akeju, et al., 2016; Furuta & Salway, 2006; Titaley & Dibley, 2010). However, understanding the individual perceptions, and modifying factors associated with health care-seeking behaviour of women regarding pre-eclampsia is critical in addressing this problembecause even though efforts to minimize and cure the complication of pre-eclampsia have been recorded, additional steps are need to be taken to achieve the preventive goal.
