ADMITTANCE TO INFORMATION BY PRIMIGRAVIDA ON MATERNAL HEALTH FACILITIES IN FATIMA VILLAGE IN ZARIA LOCAL GOVERNMENT AREA OF KADUNA STATE

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ADMITTANCE TO INFORMATION BY PRIMIGRAVIDA ON MATERNAL HEALTH FACILITIES IN FATIMA VILLAGE IN ZARIA LOCAL GOVERNMENT AREA OF KADUNA STATE 

ABSTRACT

This study investigated access to information by primigravida on maternal health services in Fatima Village in Zaria Local Government Area of Kaduna State. The problem identified by the researcher is the under utilization of maternal healthcare services when there is a high rate of maternal mortality in Nigeria especially in the rural areas of northern Nigeria, hence the interest in Fatima village. The researcher focused on primigravida (first time pregnant women or women that delivered their first babies are less than forty two days). The aim of the study is to determine access to information on maternal healthcare services by these women. The objectives of this study are to identify the type of maternal healthcare services primigravida in Fatima village know about, to ascertain the sources of information on maternal health accessed by primigravida in Fatima village, to find out how primigravida in Fatima village accessed information on maternal health service, to find out the experiences of primigravida in Fatima villageand to identify barriers to access to maternal health services to primigravida in Fatima village in Zaria Local Government Area of Kaduna State. The research answered four questions:1. What are the experiences of primigravida in Fatima village on access to information on maternal health? 2. What maternal health services do primigravida in Fatima village know about? 3. What are the sources of information on maternal health services available to primigravida in Fatima village? 4. What are the barriers to primigravida in Fatima village to access to maternal health services? The methodology used for the research is hermeneutics (phenomenology) which investigated direct conscious experiences of phenomena as free as possible without theories, preconceptions and presuppositions. The population of the study is all reproductive women in Fatima village. Snowball sampling technique was used to find and recruit ten (10) primigravidas willing to participate in the study in their natural settings. The instruments for data collection were in-depth interview. An iterative analysis method was employed for coding the narratives which was manually done. This produced sixteen (16) categories, thirty- eight (38) sub-categories and ninety-three (93) open codes from the analysis. The study found out that primigravidas had challenges like irregular menstruation, spotting, cravings, altered sense of smell, morning sickness and frequent urination. Primigravida accessed information on maternal health services through informal sources which are their social networks and believed maternal health service are services accessed when there is complication in delivery. They rely on traditional birth attendants (TBAs) to deliver their babies and believed that maternal health services are for the elite. Sources of information on maternal health service they prefer are their social network and it is the only source they have access to. A major barrier to access to information on maternal health service that this study revealed is that primigravida do not know the benefits of maternal health services. The study recommended the use of information and communication technology (ICT) tools and posters by the ministry of health to disseminate information on the benefits of maternal health services to primigravidas in the rural areas.

 

TABLE OF CONTENTS

Title Page                                                                            Error! Bookmark not defined.

Declaration                                                                                                                           ii

Certification                                                                                                                         iii

Dedication                                                                                                                            iv

Acknowledgements                                                                                                              v

Table of Contents                                                                                                               vii

List of Appendices                                                                                                                x

Abstract                                                                                                                                xi

 

CHAPTER ONE: INTRODUCTION

1.1        Background to the Study                                                                                            1

1.2        Statement of the Problem                                                                                           4

1.3        Research Questions                                                                                                    5

1.4        Objectives of the Study                                                                                              6

1.5        Significance of the Study                                                                                           6

1.6        Scope of the Study                                                                                                     6

1.7        Operational Definition of Terms                                                                               7

CHAPTER TWO: REVIEW OF RELATED LITERATURE

2.1        Introduction                                                                                                                8

2.2        Concept of Maternal Health                                                                                       8

2.3        Significance of Information on Maternal Health                                                     11

2.3.1         Maternal Health Services                                                                                     13

2.4        Types of Maternal Information Services                                                                 29

2.5        Awareness of Information on Maternal Health                                                       30

2.6        Sources on Maternal Health Information                                                                 33

2.7        Access to Information on Maternal Health                                                              39

2.8        Barriers to Information on Maternal Health                                                            42

2.9        Summary of the Review                                                                                           45

CHAPTER THREE: RESEARCH METHODOLOGY

3.1        Introduction                                                                                                              46

3.2        Research Method Adopted                                                                                       46

3.2.1         Research Design                                                                                                   46

3.3        Population of the Study                                                                                            47

3.4        Sample and Sampling Techniques                                                                           48

3.5        Instrument for Data Collection                                                                                49

3.6        Procedure for Data Collection                                                                                 50

3.7        Procedure for Data Analysis                                                                                    50

3.8        Rigor in quality research                                                                                          52

3.8.1         Trustworthiness of the Study                                                                                52

3.8.2         Credibility                                                                                                             52

3.8.3         Member checking                                                                                                 52

3.8.4         Transferability                                                                                                      53

3.8.5         Dependability                                                                                                       53

3.8.6         Confirmability                                                                                                      53

3.8.7         Ethical Considerations                                                                                         53

CHAPTER      FOUR:       DATA      PRESENTATION,      ANALYSIS      AND

DISCUSSION OF RESULTS

4.1        Introduction                                                                                                              54

4.2        Interview Analysis                                                                                                   54

4.3        Description of Interview Participants                                                                      55

 

4.4        Description of the Emergent Categories.                                                                 55

4.4.1        Experiences of Primigravida in Fatima Village on Access to Information

on Maternal Health Services                                                                                   55

4.4.2                Sources of Information on Maternal Health Services Available to

Primigravida in Fatima                                                                                           59

4.4.3                  Access and Use of Information on Maternal Health Services by

Primigravida in Fatima                                                                                           61

4.4.4         Barriers to Access to Maternal Health Services Against Primigravida in

Fatima                                                                                                                     67

4.5        Implication of Findings                                                                                            70

CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS

5.1        Introduction                                                                                                              74

5.2        Summary of the Study                                                                                              74

5.3        Summary of the Major Findings                                                                              75

5.4        Contributions to Knowledge                                                                                    75

5.5        Conclusion                                                                                                               76

5.6        Recommendations                                                                                                    77

References                                                                                                              78

Appendices                                                                                                             86

 

CHAPTER ONE

INTRODUCTION

1.1        Background to the Study

One of the characteristics of human beings is reproduction. In the process of reproduction, young ones are either reproduced successfully or not. Women who do not successfully give birth to babies, in many instances, end up having diseases (morbidity) due to massive bleeding which results to anemia (lack of quality or quantity of blood) while some end up in death (mortality). Morbidity, according to Merriam Webster Dictionary is a complication, a diseased state or symptom. Maternal mortality is defined by the World Health Organization (2012) as the death of women while pregnant or within forty-two (42) days of termination of pregnancy irrespective of the duration and site of the pregnancy from any cause related to, or aggravated by the pregnancy or its management but not from accidental or incidental causes. The maternal mortality rate (MMR) is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy (World Fact Book 2010).

Maternal health is related not only to the health of a woman, it also has a direct bearing on the health of her newborn specifically and the society at large. In developing countries, when all pregnant women experience life-threatening complications as a result of their pregnancy, mortality can be prevented or minimized with early detection of problems and appropriate interventions. With international focus on decreasing maternal morbidity and mortality, there has been a shift from the emphasis placed on some traditional maternal health interventions to the use of modern maternal health services in recent years. The use of quality maternal health services (MHS) is central to the achievement of the millennium development goals (MDGs), especially MDGs 5, which seeks to: (a) reduce the maternal mortality ratio by three quarters between 1990 and 2015 and (b) achieve universal access to reproductive health services by 2015 (Babalola, 2014).

According to WHO (2014), the maternal mortality ratio in developing countries is unacceptably high (240 per 100 000 births versus 16 per 100 000) in developed countries. Nigeria ranks second in the world, after India, on the scale of maternal mortality with the rate of 560 deaths per 100,000 live births (World Bank, 2014) in 2010. An estimated 40,000 Nigerian women died during childbirth (Cooke and Tahir, 2013). Annually, an estimated 52, 900 Nigerian women die from pregnancy related complications out of a total of 529,000 global maternal deaths (United Nations Children‘s Fund Factsheet, UNICEF Factsheet, (2017). Cooke and Tahir (2013) affirm that the country accounts for an estimated 14 percent of the maternal deaths worldwide. A scenario aptly captured in the ratio of deaths in Nigeria where 1 out of 13 women die of pregnancy and childbirth related complications compared with 1 in 5000 births? in developed countries and only about 40% of the deliveries are attended to by skilled birth attendants ( Leo and Okafor, 2015). Nigeria remains one of the ten most dangerous countries in the world for a woman to give birth (World Bank, 2012).

Significant disparity exists among regions in Nigeria. There are higher maternal mortality rates in the Northern Nigeria than in the Southern part of the country, perhaps because the southern region is wealthier and has abundant mineral and natural resources than the northern region. According to Abimbola et al (2012), the extremely poor North East has an estimated maternal mortality rate of 1, 549 and this is believed to be more than five times the global average. It is also believed that poverty, lack of investment in health systems, low educational levels and poor infrastructure have each contributed to this disparity. Cultural factors in northern Nigeria gives women limited mobility and contact with the formal health care system in household and personal decision making unlike in most of Nigeria‘s southern states hence the interest in northern Nigeria.

Primigravida are the concern of the researcher because they are the most vulnerable and have not experienced childbearing at all as they are in the first stage of motherhood. Women of reproductive age are the direct consumers of these maternal health services and it is expected that pregnant women, especially the illiterate rural dwellers where maternal mortality is the highest when compared to the literate urban areas should be encouraged to enjoy maternal healthcare services.

But to achieve that, all interventions will have to be targeted by Health Care Service providers(Stakeholders and health care workers) to know how funds and resources are efficiently utilized in information dissemination to save a lot of lives, it is necessary that a full understanding of the socio-cultural practices, information access and use by the ―primigravida‖ towards maternal health services are ensured. This will provide a policy that will guide the dissemination of information on available services that are culturally acceptable, religiously conscious and gender sensitive in order to achieve equitable service delivery system. In order to curb the menace of high maternal mortality, there is the need to understand the socio-cultural factors that hinders ―primigravida‖ from utilizing maternal health services information.

Given the magnitude of the problem and the available intervention, much still needs to be done, hence the concern of the researcher to find out the experiences of primigravida (women who are pregnant for the first time or delivered babies that are less than forty-two days old) with regards to access to information on maternal health services because the researcher observed that most of the primigravidas do not utilize available maternal health services.

1.2        Statement of the Problem

Motherhood is often a positive and fulfilling experience, however, for so many women, it is associated with suffering, ill-health condition and even death. The major causes of maternal death include hemorrhage, infection, high blood pressure, unsafe abortion, and obstructed labor (Onasoga et al, 2014). Maternal death stems from absence, inadequacy or underutilization of the maternal healthcare systems. Maternal healthcare services are underutilized particularly among those who are in the greatest need, pregnant women in the rural areas in spite of the fact that there are available information on maternal health services in most of the hospitals in Nigeria.

In rural areas of many developing countries such as Kenya, Ghana, Senegal, Mali and Nigeria, over 80 percent of the deliveries occur at home, assisted by older household women and traditional birth attendants. This is exactly the situation in Fatima village. The researcher observed that women in Fatima village do not even attend antenatal clinics to obtain services. The unhygienic conditions under which rural deliveries usually occur often lead to infection in mothers and their newborns.

Even though facilities such as primary healthcare centers which provide basic healthcare and information to its immediate population exist, the researcher observed that the overwhelming majority of the people of Fatima are ignorant of the benefits of the services that are provided by the centers. The consequence of their ignorance is their nonuse of the services leading to a high percentage of the death of child-bearing women between the ages of 13 and 49 years. According to Oyewole (2015), statistics has shown that mortality rate is higher among women in the rural areas than in the urban areas. The women in the rural areas are also at a higher risk of losing their lives during gestation period, childbirth or after birth of their children.

Furthermore, Adisse (2003) observed that women often lack access to relevant information. The lack of relevant health information and enlightenment result to poor health and high mortality rates. The researcher also observed that cultural attitude and practices impede women’s use of available maternal services in their areas. According to Corraggio (2011) ―Studies show that dissemination of health information to the public is often uncoordinated.‖ Even though there are new technologies to assist in disseminating health information, the new products of the communication revolution have not equally reached the rural and more disadvantaged populations such as the rural areas (Case, 2007).

UNICEF (2015) documented that Nigeria is on the verge of not meeting the 5th millennium development goals (MDGs 5) of reducing maternal deaths by three quarter in 2015. According to the Global Health Council, ―The health of families and communities are tied to the health of women – the illness or death of a woman has serious and farreaching consequences for the health of her children, family and community.‖ Yet every 100 seconds, a woman dies in pregnancy or during childbirth. Therefore, this research intends to investigate, first-hand, the challenges primigravidas encounter and how they access information to overcome the challenges, the sources of information they use and the barriers (if any) to their utilization of maternal health services with the view to finding lasting solutions to the problem thereby drastically reducing maternal mortality. The researcher targeted the primigravidas in Fatima village.

1.3        Research Questions

The study answered the following questions:

  1. What maternal health services do primigravida in Fatima know about?
  2. What are the available sources of information on maternal health services to primigravidas in Fatima?
  3. How do primigravida access information on maternal health services?
  4. What are the experiences of primigravida in Fatima?
  5. What are the barriers to access to maternal health services primigravida in Fatima?

1.4        Objectives of the Study

The objectives of the study are to:

  1. identify the type of maternal health services the primigravida in Fatima know about?
  2. determine the sources of information on maternal health accessed by primigravida in Fatima village.
  3. find out how primigravida in Fatima access information on maternal health services.
  4. ascertain the experiences of primigravida in Fatima.
  5. find out the barriers (if any) to information on maternal health services to primigravida in Fatima.

1.5       Significance of the Study

The study will be of immense benefit to government health ministries, departments and agencies, healthcare service providers, non-governmental organizations (NGOs) and other bodies that are concerned with healthcare delivery. It will be a reference material to students and researchers in addition to the contribution it will make to the growing literature in the field of phenomenology (hermeneutics) using information.

1.6        Scope of the Study

The Study in on the awareness and utilization of information on maternal health services among ―primigravida‖ in Fatima in Zaria Local Government Area of Kaduna State. It only covered phenomenology and primigravida. It is not extended to pregnant women generally neither is it extended beyond hermeneutics using information. It therefore, does not accord any priority attention to other aspects of health care service other than maternal health care service information delivery system.

1.7        Operational Definition of Terms

  1. Awareness of information: Awareness refers to the information seeker being aware of various aspects of the searching and sense-making processes, including the task and its context, past and present actions, and various attributes of the information objects and the system
  2. CHWs: community health workers

3         Information access: Information access includes the ability to obtain information and use the information obtained.

  1. Primigravida: A woman who is pregnant for the first time or delivered her first child that is not more than forty-two days old.
  2. Traditional birth attendants (TBAs): Women who help pregnant women to

deliver their babies without the western professional skill or training.

 

ADMITTANCE TO INFORMATION BY PRIMIGRAVIDA ON MATERNAL HEALTH FACILITIES IN FATIMA VILLAGE IN ZARIA LOCAL GOVERNMENT AREA OF KADUNA STATE 

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