ABSTRACT
Women die from a wide range of
complications in pregnancy, childbirth or after delivery, and amidst these
complications is pre-eclampsia, which is one of the major causes of maternal
death and disability in Nigeria. To improve maternal health, barriers that
limit access to quality maternal health services must be identified and
addressed for any intervention program to be effective. The objective of the
study was to investigate the factors associated with the health care-seeking
behaviours regarding pre-eclampsia among pregnant women attending antenatal
centres in Sagamu, Ogun State, Nigeria.
The study designwas cross-sectional,
utilizing a pre-tested 42-item questionnaire (Cronbach’s alpha of 0.81) to
collect information about knowledge regarding pre-eclampsia, perceived
susceptibility, seriousness, and perceived benefits of good health care-seeking
behaviour among pregnant women attending maternity centres in Sagamu, Ogun
State, Nigeria. Four hundred participants recruited from eight antenatal
centres in randomly selected eight communities in Sagamu, participated in the
study. Pearson’s bivariate correlation was used to examine relationships
between independent and dependent variables while multiple regression was
adopted to test for the hypothesis.
Results showed that Knowledge about
pre-eclampsia as an important pregnancy complication measured on a 16-point
scale recorded a mean score of 6.82 (±3.53)and perception of pre-eclampsia
considered in three sub-domains of susceptibility, seriousness and benefit,
measured on a 30-point scale, similarly recorded a mean score of 13.41 (±5.39);
while health care-seeking behavior, measured on a 30-point scale, showed that
participants in the study recorded a mean scored of 9.96 (±8.11). Knowledge
about pre-eclampsia was below average (42.6%), perceived susceptibility,
seriousness and benefit measured was 39.3%, 50.7%, and 49% respectively, as
well as their health care-seeking behaviour (33.2%). There is a significant
relationship between the variables and health care-seeking behaviour regarding
pre-eclampsia (P=0.0001). However, perception domain regarding pre-eclampsia
predicts health care-seeking behaviour more significantly (R – 0.57 = 57%; R2
= 0.33; F-value = 194.44; β = 0.86; P-value = 0.0001 < 0.0005)
In conclusion, there is poor health
care-seeking behaviour among respondents regarding pre-eclampsia in the study
area which according to the finding, is as a result of low level of knowledge
about the disease with low perception level about the condition. Therefore, in
order to correct this, there should be an aggressive health promotion
intervention designed toempower women with the required knowledge and thereby,
increasing their perception level regarding pre-eclampsia, especially perceived
susceptibility to pre-eclampsia, that will prompt good health care-seeking
behaviour. This will in turn make future interventions effective.
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.
1.2 Statement of the Problem
Illness and death related to pregnancy and
childbirth are significant health problems in the world especially in
developing countries. Nigeria is among the countries with the greatest burden
of maternal mortality in the world with 15% (45, 000) of global maternal deaths
(Singh, Ahmed, Egondu, & Ikechukwu, 2015), and a high maternal mortality
ratio of 814/100,000 live births was recorded for Nigeria (WHO, 2015).According to the United
Nations Population Fund (UNFPA,
2016) this is equivalent to about one woman every two minutes and for every
woman who dies 20 or 30 encounter complications with serious or long-lasting
consequences.
Pre-eclampsia is a problem in Nigeria. A recent
statistics carried out in Nigeria shows that, approximately 37, 000 women die
annually due to pre-eclampsia and its complications(Adeosun, Ayebatonyo,
Ogundahunsi, & Ogunlewe, 2015). In
Sagamu, Ogun State, a high maternal mortality ratio of 7, 480/100,000 live
births was recorded and pre-eclampsia contributed to about 60% of these deaths.
(Olukoya & Sodipo, 2015)
Pre-eclampsia is associated with high risks of
maternal complications such as abruption placenta, premature delivery,
disseminated coagulopathy, pulmonary oedema, acute renal failure, eclampsia,
liver failure, haemorrhage, and maternal death. It is also associated with
higher risks of adverse perinatal outcomes such as low birth weight,
intrauterine foetal growth restriction, hypoxia-neurologic injury and foetal
death. Pre-eclampsia also impacts the social and economic life of a pregnant
woman. In addition, infants who are born after a pregnancy complicated by
preeclampsia are at increased risk of metabolic syndrome, stroke and
cardiovascular disease later in life (Brown, et al., 2013; Raymond & Peterson, 2011).
The recognition of pre-eclampsia today is largely
healthcare provider dependent, which as a result, the disease still remains
essentially unpreventable. Low pre-eclampsia knowledge and lack of information
on pre-eclampsia signs and symptoms are closely linked to delay in decision to
seek care and ultimately compromises the survival of the mother and expected
new-born because they have not understood the need to utilize health care
facility for quality care (Adekanle, Adeyemi, Olowookere, & Akinleye,
2015).To improve maternal health, barriers that limit access to quality
maternal health services must be identified and addressed at all levels of
health system.
Therefore, the purpose of this study is to
investigate individual perceptions, and modifying factors associated with
health care-seeking behaviour regarding pre-eclampsia among pregnant women
attending ANC in Sagamu, Ogun State, Nigeria, and to determine the extent to
which their knowledge, perception of seriousness and susceptibility to pre-eclampsia
may contribute to present situation of health care-seeking behaviour.
1.3 Objective of the Study
The main objective of this study is to investigate
the factors associated with the health care-seeking behaviours regarding
pre-eclampsia among pregnant women attending antenatal centres in Sagamu, Ogun
State, Nigeria. The specific objectives are to;
1.
assess the level of
knowledge of pregnant women in the study area about pre-eclampsia.
2.
determine the
perceptions of pregnant women attending maternity centres in Sagamu Ogun State
about pre-eclampsia.
3.
identify the health
care-seeking behaviours regarding pre-eclampsia among pregnant women attending
maternity centres in Sagamu, Ogun State.
4.
examine the
relationship between knowledge of pre-eclampsia and health care-seeking
behaviours forperceived pre-eclampsia among pregnant women attending maternity
centres in Sagamu, Ogun State.
5.
examine the
relationship between perceptions of pre-eclampsia and health care-seeking
behaviours for perceived pre-eclampsia among pregnant women attending maternity
centres in Sagamu, Ogun State.
6.
determine the variables
that will predict the health care-seeking behaviour of pregnant women more
significantly.
1.4 Research Questions
1.
What is the level of
knowledge about pre-eclampsia among pregnant women attendingmaternity centres
in Sagamu Ogun State?
2.
What is the perceptions
of pre-eclampsia and its warning signs and symptoms among pregnant women
attending maternity centres in Sagamu Ogun state?
3.
What are the health
care-seeking behaviours regarding pre-eclampsia among pregnant women attending
maternity centres in Sagamu, Ogun State?
4.
Is there a relationship
between knowledge of pre-eclampsia and health care-seeking behaviours for
perceived pre-eclampsia among pregnant women attending maternity centres in
Sagamu, Ogun State?
5.
Is there a relationship
between perceptions of pre-eclampsia and health care-seeking behaviours for
perceived pre-eclampsia among pregnant women attending maternity centres in
Sagamu, Ogun State?
6.
Which of thevariableswill
predict the health care-seeking behaviour more significantly?
1.5 Justification for the Study
Women die from a wide range of complications in
pregnancy, childbirth or after delivery especially in the developing world, and
amidst these complications is pre-eclampsia, which is one of the major causes
of death and disability in Nigeria (Gharoro & Onakewhor, 2008).
Although number of studies and interventions (Akeju
et al., 2016; Furuta & Salway,
2006; McClure, Saleem, Pasha, & Goldenberg, 2009; Osungbade & Ige,
2011; Shah, 2009; Titaley & Dibley, 2010), have been carried out in Nigeria
to treat and manage pre-eclampsia, the problem still persists and little is
known about pregnant women’s individual perceptions towards pre-eclampsia and
the modifying factors that are associated with their pattern of health
care-seeking behaviour. Therefore, this study will reveal pregnant women level
of knowledge about pre-eclampsia, their perceptions, and pattern of health
care-seeking regarding pre-eclampsia, thereby equipping them with appropriate
knowledge, adequately motivated and encouraged to develop better health
care-seeking behaviour for good maternal and perinatal outcome.
In recent years, safe motherhood programs was initiated
to focus on improving recognition of complications by family members and
traditional providers, as well as facilitating use of skilled care for women
with complications, and strengthening the availability and quality of obstetric
care. Programs were developed to disseminate
messages on recognition of warning signs that may indicate life-threatening
complications, planning for transportation to a selected secondary facility if
a complication occurs, and saving money to pay for care. Unfortunately, there is no evidence that
these strategies work, and care is typically sought too late or not at all (Khlat
& Ronsmans, 2009). This study will focus on pregnant women for these
interventions to work effectively.
The practice of good health care-seeking behaviour
by pregnant women is important as it will help in prompt diagnosis, management,
and treatment of any underlying health problem especially pre-eclampsia, which
will reduce or halt maternal and perinatal mortality and morbidity. Hence,
pregnant women’s individual perceptions regarding pre-eclampsia and modifying
factors associated with their pattern of health care-seeking behaviour needs to
be explored using the Health Belief Model, so as to identify relevant areas that
will facilitate designing appropriate intervention programmes. This constitutes
the focus of this study in Sagamu, Ogun State, Nigeria.
During pregnancy, child-birth, or after delivery,
women die from several complications. Most of these deaths are avoidable if
women are able to identify pre-eclampsia signs, and seek timely and appropriate
emergency obstetrics care (Killewo, Anwar, Bashir, Yunus, & Chakraborty, 2006; Mwilike, 2013). The information
obtained from this study will give an insight on pregnant women individual
perceptions regarding pre-eclampsia and modifying factors (which include
socio-demographics and knowledge) associated with health care-seeking
behaviour, which will be beneficial to the following;
Pregnant women – This study will reveal their level
of knowledge about pre-eclampsia, perceptions, and pattern of health
care-seeking, thereby equipping them with appropriate knowledge, adequately
motivated and encouraged to develop better health care-seeking behaviour for
good maternal and perinatal outcome
Family and Community – Complications from pre-eclampsia
affects not only the woman but her family and community at large. When the
woman is healthy, the family is happy, and she can contribute her resources to
the growth of the community.
Policy Makers – This study might enable policy
makers to effectively plan how to combat the avoidable factors in this study
that militate against good health care-seeking behaviours among pregnant women.
Public Health – This study might enable the planning
of intervention program to be administered to reduce pre-eclampsia related
maternal and perinatal mortality and morbidity. The intervention program will
include the development of training materials and posters that emphasize
information about pre-eclampsia, training of volunteers to provide health
education within the community about pre-eclampsia and the importance of health
care-seeking early enough to prevent complications.
1.6 Hypotheses
The following research hypotheses were tested for
the study;
H01:
There is a significant relationship between the knowledge of pre-eclampsia and
health care-seeking behaviours among pregnant women attending maternity centres
in Sagamu, Ogun State.
H02:
There is a significant relationship between perceptions about pre-eclampsia and
health care-seeking behaviours among pregnant women attending maternity centres
in Sagamu, Ogun State.
H03:
There is a significant difference in the health care-seeking behaviour
regarding pre-eclampsia across variables of study.
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