ABSTRACT
Good antenatal care and delivery
services are pivotal towards effective reduction of maternal morbidity and
mortality. Although studies have been reported concerning the health seeking
behaviour of women during pregnancy, literature is virtually devoid of such
information in respect of pregnant women in Nnewi, South East Nigeria. This
study was a descriptive survey of childbearing women in Nnewi, Anambra State,
South East Nigeria to assess their health care seeking behaviour during
antenatal and delivery. Multi-stage sampling technique was used to draw a
sample of 420 women of childbearing age. Using interviewer administered
questionnaire, data generated were analyzed with descriptive and inferential
statistics and presented in tables and charts. Findings reveal that 58.1% were aged
between 25 and 34; 53.8% had secondary education; majority (89.0%) were
married; 26.9% fell under poorest socio-economic status (SES) group compared to
24.3% that fell under the least poor SES group; higher proportion (61.4%)
attended antenatal clinic 6 times and above; mean gestational age for first
antenatal visit was 4th month; greatest proportion of the
respondents (44.8%) sought antenatal and delivery care in private hospitals.
Age, marital status, level of education and socio-economic status were found to
have significant relationships with respondents’ antenatal clinic attendance: respondents aged 25 -34 years were most
likely to go for antenatal clinic (P = 0.009); married respondents were most
likely to attend antenatal clinic (P = 0.000); respondents with tertiary
education were most likely to attend antenatal clinic (P = 0.000); the least
poor group of SES (P = 0.003) attended antenatal clinic most. Similarly,
levels
of education, SES and age have significant relationship with respondents’
choice of facilities: respondents
with tertiary education were most likely to utilize teaching hospital (P =
0.014); those with only secondary education were most likely to utilize PHC (P
= 0.019) and those with no formal education were most likely to utilize
maternity homes; similarly respondents under the poorest group were most likely
to utilize PHC (P= 0.000) while the least poor group were most likely to
utilize teaching hospital (P= 0.000) and private hospital (P = 0.048).The
middle age (25 – 34 years) childbearing women were most likely to deliver in
teaching hospital (P = 0.001) while younger childbearing women (15 -24 years)
were most likely to deliver in primary health centre (P = 0.002).
TABLE OF CONTENTS
Title page i
Approval page ii
Certification page iii
Dedication iv
Acknowledgement v
Abstract vi
Table of Contents vii
List of Tables ix
List of Figures                                                                                                x
CHAPTER ONE: INTRODUCTION
Background to the Study 1
Statement of Problem 3
Purpose of the Study 4
Specific Objective 4
Research Questions 5
Significance of the Study 5
Scope of the Study 6
Operational Definition of Terms 6
CHAPTER TWO: LITERATURE REVIEW
Conceptual Review 7
Categories of Health Care Provision in Rural Community               8        Â
Theoretical Framework 15
Empirical Studies 18
Summary 22
CHAPTER THREE: RESEARCH METHODS
Research Design 23
Area of Study 23
Target Population 24
Sample Size 25
Sampling Technique 26
Instrument for Data Collection 26
Validation of Instrument 26
Reliability of Instrument 27
Ethical Considerations 27
Procedure for Data Collection 28
Method of data analysis 29
CHAPTER FOUR: DATA ANALYSIS AND PRESENTATION
Summary of major findings 47
CHAPTER FIVE: DISCUSSION OF FINDINGS
Discussion of the Findings 48
Research Question One 48
Research Question Two 49
Research Question Three 50
Implication of the Study 55
Limitations of the Study 55
Conclusion 56
Recommendations 56
Suggestion for Further Studies 57
Summary 57
Reference 59
Appendix I 65
Appendix ii 66
Appendix iii 69
Appendix iv 70
Appendix v 70
LIST OF TABLES
Table1: Socio-Demographic Characteristics of Respondents              31                      Â
Table 2: Respondents’ Socio-Economic Status 32
Table 3: Respondents health care seeking during delivery              36      Â
Table 4: A cross tabulation of Demographic characteristics in their SES 37
Table 5: Cross tabulation of the influence of age on respondents’ antenatal seeking behaviour using chi-square                                 38      Â
Table 6: Cross tabulation of age of the respondents and their health seeking for delivery services.                                                             39      Â
Table 7: Respondents’ marital status and their antenatal care seeking behaviours .                                                                 40
Table 8: Respondents’ marital status and their health seeking during delivery.                                                                     41
Table 9: Cross tabulation of the influence of educational levels of the respondents on antenatal care seeking behaviour using chi square.                                                                42      Â
Table 10: Respondents level of education and their health seeking
during delivery                                                                              43      Â
Table 11: Respondents’ socio-economic status and their antenatal seeking behaviour                                                            44      Â
LIST OF FIGURES
Figures i: Percentage ANC Visit 33
Figures ii: Gestational age in month at first ANC visit 34
Figures iii: Percentage of facilities registered with 34
Figures vi: Facilities registered with number responses 35
CHAPTER ONE
INTRODUCTION
Background to the study
Health has been given a wide interpretation because it covers everything from mental and social wellbeing of an individual to his physical soundness, adequate spiritual state, adequate occupation and environment. The widely accepted definition is that of WHO, defined as a state of complete physical, mental & social well-being and not merely the absence of disease or infirmity (WHO, 1948). Health in itself is of great value as it enables people to enjoy their potential as human beings. Therefore, it is important to protect health through healthcare services (WHO, 2009). Health care refers to the prevention, treatment and management of illness and preservation of mental and physical well-being through the services offered by medical, nursing and allied health professions (WHO, 2010) as well as care received in the family nexus.
This study focuses on the health care seeking behaviour of women during pregnancy and delivery. Uzochukwu and Onwujekwe, (2004) viewed health care seeking behaviour as activities undertaken by individuals who perceive they have a health problem or are ill for the purpose of finding an appropriate remedy. It also focuses on specific steps taken in response to illness and what is done and why (Gotsadze, Bennett, Ranson and Gzirishvili, 2005). Maternal health care is defined as the promotive, preventive, curative and rehabilitative health care for mothers during pregnancy, childbirth and 42 days after childbirth (Park, 2002). Childbirth is one of the important events affecting the health of a woman, especially in developing countries like Nigeria (Raj, 2005). In many Nigerian communities, utilization of maternal health services is often influenced by factors like traditional health seeking behaviour, access and attitude of the health care providers (Garba, Hellanden, Ajayi, Suleyman and Oluwabamide, 2011).This results in seeking maternal health services from traditional healers, traditional birth attendants and unskilled family members with resultant consequences such as maternal and child morbidity and mortality. Maternal mortality is an important indicator of maternal health and wellbeing in any country (Ogujuyigbe & Liasu, 2007). Consequently, the reduction of maternal mortality level is a key Millennium Development Goal, and efforts to improve women’s health in the country have been undertaken by local, national and international organizations (Palto, 2008).
Globally, health care seeking behaviour of women is poor. Baroon (2007) noted that in some part of United States, women receive little or no prenatal care. Keily and Kogan (2008) indicate that most women who receive prenatal care do that late and many do not complete four antenatal visits. According to Azuogu, Azuogu and Nwonu (2011), the health care seeking behaviuor of Nigerian women remains poor and possess one of the greatest challenges to maternal mortality reduction in the country. UNICEF (2008) reveals that in Nigeria, skilled birth attendants attend to only 42 percent of birth. According to Oladapo and Osiberu (2008), many pregnant women in Nigeria avoid seeking care until they go into labour. Ufford and Menkiti (2008) note that about 37% of all deliveries take place in health care facility with less than half of the deliveries attended to by skilled attendants. Statistics from Monitoring and Evaluation Unit of Nnewi North for a three-year evaluation period revealed that for the year 2007, the average number of women that visited antenatal clinic was one hundred and forty three (143). Among the 143 women that attended antenatal clinic, 46 (38%) visited once while only 27 (19%) delivered in the health facilities with the assistance of trained health workers; for the year 2008, an average of one hundred and thirty seven (137) women attended antenatal clinic, 47(34%) attended once and 29 (21%) delivered in the health facilities. Similarly in 2009, an average of one hundred and forty-eight (148) pregnant women visited antenatal clinic, 54 (36%) visited once while only 28 (18%) delivered in the health facilities and with assistance of trained health workers. Hence this study was geared towards the health care seeking behaviour of women during pregnancy and delivery.
Statement of Problem
