Background to the Study
High maternal and infant morbidity and mortality rate is a huge public health problem in developing countries of the World, Nigeria inclusive. According to the World Health Organisation (2014), approximately 800 women die from preventable causes related to pregnancy and childbirth everyday globally and 99% of all the maternal deaths occur in developing countries. More than half of these deaths occur in sub Saharan Africa (62%) and almost 1/3 occur in south Asia (24%). The National Demographic Health Survey (2013) recorded that Nigeria accounts for about 13% of the global maternal death rates with an estimated 36,000 women dying in pregnancy or child birth each year. It is also reported that for every woman that dies from pregnancy related causes, 20 to 30 more will develop short and long term damage to their reproductive organs resulting in disabilities such as fistula, pelvic inflammatory disease, ruptured uterus (World Health Organisation, 2007).
According to the World Health Organisation(WHO),(2013), 6.3 million children under age five die annually, globally and nearly 17,000 die every day. The risk of a child dying before completing five years of age is still highest in the African region (55 per 1000 live births), 4.5 million of these deaths occur within the first year of life (WHO, 2015). Nigeria has about 260,000 neonatal deaths annually, 13% of which can be prevented with life saving interventions such as provision of required maternal health medicines and supplies
Maternal Health Care is the care given to mothers to ensure healthy mothers which covers antenatal care, intrapartum care, postnatal care in the antenatal clinic, labour ward, postnatal ward and infant welfare clinic (Fraser & Cooper, 2009). Sanders, (2012) opined that Maternal health care services embrace services for mothers throughout the child bearing age (18-49 years), while child health care covers the services from conception through adolescence and these services include promotive services, preventive services, curative services and rehabilitative services.
Reducing child mortality and improving maternal health occupy a prominent space in the millennium Development goals (MDG), 4 and 5 (Chopra & Baron, 2009). Programmes of action of the international conference on population and development along with the millennium development goal (MDGs) and safe motherhood initiative call for concerted action to reduce maternal and infant mortality, promote maternal and child health and empower women with knowledge so that they are more useful to themselves, their families and communities (World Health Organi[sation, United Nation Population fund, United Nations Children Fund (UNICEF), 2005). In order to move towards achieving these MDG goals, adequate knowledge of maternal and child health is a pre-requisite. Higher education is strongly correlated with improved maternal health knowledge (Yarzever & Said, 2013). Currently 57 million children of primary school age are estimated to be out of school, of these, 33million are in sub-Saharan Africa and more than half (55%) are girls
(MDG report 2015).
Despite the existence of these national programs for improving maternal and child health, maternal mortality and morbidity continue to be high. Studies have suggested that the majority of these deaths can be prevented or reduced if women had access to or visited maternal health services during pregnancy, childbirth and the first month after delivery (WHO, 2004; FMH, 2005).
Babalola and Fatusi (2009) stated that many women in developing countries do not have access to maternal and child health care services and the use of such services remain low in sub-Saharan Africa including Nigeria. The WHO (2012) reported that in sub-Saharan Africa, only 58% of women attended at least one antenatal visit during pregnancy, 39% of births are attended to by a skilled professional, 35% of deliveries take place in a health facility and 43.7% receive postnatal care.
According to Ochako, (2011), in order to reduce the risk of maternal and infant morbidity and mortality, especially in places where the general socio-economic status is low, access and utilization of the obstetric services is an effective means. Dramstadt (2005) is of the opinion that accessibility of health services has been shown to be an important determinant of utilization of health services in developing countries. In most rural areas in Africa, one in three women lives more than five kilometers away from the nearest health facility and the scarcity of vehicles especially in remote areas and poor road conditions can make it extremely difficult for women to reach relatively nearby health facilities (World Bank, 2012). Moreover, lack of access to appropriate obstetric care especially during labour compounds the risk of adverse fetal outcomes such as disability or death (Lule, 2005). According to the WHO (2007), the immediate cause of maternal and child death is the absence, inadequacy or underutilization of the health care system. Many women especially in the rural areas are not empowered to make decisions on skilled birth attendance owing to socio-economic status of women. Adequate knowledge on maternal and child health services has a well known effect in fertility. If women have the knowledge that if they get pregnant less often and bear fewer children, they are less at risk of maternal death, then maternal and infant morbidity and mortality will be reduced. Women social status, self image and decision making powers may all be increased through education which may be key in attending maternal health services, educated women may have more knwoeldge of the physiology of reproduction and be less disposed to accept complications and risks of pregnancy as inevitable than illiterate and uneducated women. Education has been described as a medication against fatalism (Behague et al, 2008).
Ram & Singh (2006), stated that the utilization of maternal and child health services is influenced by perceived socio-cultural, economic and health system outcomes operating at the community, household and individual level as well as within the larger social and political environment and health care infrastructure. Other factors include poverty, inadequate services, distance, lack of information and cultural practices (WHO, 2012 & UNICEF, 2012).
Maternal and child morbidity and mortality rates are higher in rural areas than in Urban areas (National Demographic Health Survey 2008).The WHO (2007) contends that the immediate cause of maternal and child death is the absence, inadequate or underutilization of the health care system. Inorder to increase women’s utilization of maternal and child health services, it is imperative to understand the individual and community’s knowledge and factors or barriers that influence women’s health care seeking behaviours.
Statement of problem
According to the WHO (2009), over 600,000 maternal deaths occur worldwide annually with 99% of these maternal deaths occurring in developing countries and Nigeria accounts for about 13% of maternal deaths globally. On the other hand, 6.3 million children die annually before their fifth birthday, (WHO, 2013). Low level of utilization of maternal and child health services is a major factor contributing to high maternal and infant mortality. The NDHS, (2008) reported that mortality rates are higher in rural areas than in urban areas.
The researcher observed that the area of study has only one health post which is mostly deserted. While the Primary healthcare centre is very far from the community and women find it difficult to go to the primary health centre due to a combination of ignorance of maternal and child health services, scarcity of vehicles and bad roads. According to Lambo (2006), the scarcity of vehicles especially in remote areas and poor road conditions can make it extremely difficult for women to reach even relatively nearby facilities, walking is the primary mode of transportation even for women in labour. It was also observed that majority of the women do not even seek maternal health care in the health post in the community, they deliver their babies at home and in most cases the women are left with various complication like puerperal sepsis and post partum haemorrhage. Most of the babies are delivered as fresh still births due to fetal distress from prolonged labour, moreover most of the children are not immunized against the killer diseases. The WHO (2007) stated that the immediate cause of maternal and child death is the absence, inadequacy or underutilization of the health care system. The question is, are these women ignorant of the existence of the health post in the community, if they have the knowledge of the existence of the health post, why are they not utilizing the services despite the beneficial impact. The researcher therefore hopes to ascertain the knowledge and the barriers to the utilization of maternal and child health care services among women of child bearing age in Nkume community of Enugu State.
Purpose of the Study
The purpose of this study is to determine the knowledge about Maternal and child Health services and barriers to their utilization among women of child bearing age in Nkume Community of Enugu State.
Objectives of the study are to;
- Determine the knowledge of women of child bearing age about maternal and child health care services in Nkume community.
- .Identify the maternal and child health services provided at the maternal and child health centres in Nkume community.
- Ascertain the adequacy of utilization of maternal and child health care services among the women of child bearing age who have had two pregnancies in Nkume community.
- Determine the factors affecting the use of Maternal and child health services among women of child bearing age in Nkume community.
- Do women of child bearing age in Nkume community know about maternal and child health services?
- What are the maternal and child health services provided at maternal and child health centres in Nkume community?
- Do women in Nkume Community utilize the maternal and child health care services in their community?
- What are the barriers to the utilization of maternal and child health care services by women of child bearing age in Nkume Community?
- There is no significant relationship between the level of education of women and knowledge of maternal and child care services.
- There is no significant difference between accessibility to health care centres and utilization of maternal and child health services.
Significance of the Study
The findings from this study will provide information on the knowledge and barriers to the utilization of maternal and child health care services, the perception of mothers towards maternal and child health care services will be greatly improved. The findings from the study will also help to identify the barriers to the utilization of maternal and child health care services. The knowledge of the barriers will help the government to map out strategies to reduce the incidence of maternal and child morbidity and mortality in the area through improving maternal and child health care services. Lastly, the findings from this study will also add to the existing body of knowledge which may be of value to future researchers in related studies.
Scope of the Study
This study is delimited to women of child bearing age in Nkume community in Uzo-Uwani Local Government Area of Enugu State.
Operational definition of terms
Knowledge of maternal and child Health services:- This refers to what the women of child bearing age understand as maternal and child health service.
Barriers to Utilization of Maternal and Child Health Services:- These are the factors influencing/hindering the utilization of Maternal and Child Health Services. Examples include transportation, distance, finance, clinic days, attitude of the health care staff. The utilization of Maternal and Child Health Services include the number of antenatal care visits by the women whether pregnancy immunizations like tetanus toxoid were completed, whether the women registered for antenatal care, whether the women report early in labour and at what stage in labour, whether the women go for postnatal visits at 6 weeks etc.
Women of child bearing age:- These are the women between the ages of 15-49years, who are either pregnant at the time of the study or who have had two pregnancies within the last fives years and has been residing in that community for at least one year before the delivery.
Utilization of maternal and child health care services: The act of making use of maternal and child health care services e.g whether pregnancy immunizations were completed such as tetanus toxoid immunization,when she registered for antenatal care.number of antenatal services made,when she reported in labour(stage of labour),postnatal visits and family planning services.
Accessibility to health care centre: The ability of the women to gain entry into maternal and child health centres where they can receive needed services from the health care providers like antenatal care services ,safe delivery services, postnatal services and family planning services etc.