ABSTRACT
This study was carried out to assess knowledge, practice and factors influencing
birth preparedness and complication readiness among couples in selected rural
communities in Oji River. The objectives of the study were to determine
knowledge of birth preparedness and complication readiness among couples in the
communities studied, couple’s practice of birth preparedness and complication
readiness, identify factors that hinder couples practices of birth preparedness and
complication readiness and establish the relationship between couple’s socioeconomic
status and their practice of birth preparedness and complication
readiness. A cross-sectional descriptive survey research design was used for the
study in selected seven communities of Oji River L.G.A. Snowball non
probability sampling technique was used to select subjects for the study. A sample
of 470 was determined using the formula by Surish & Chandrashekera.
Descriptive and inferential statistics were used to analyze data at 0.05 level of
significance. Results were presented in tables, frequencies, means and standard
deviations. Findings revealed that majority of the couples 120 (78.7%) were
knowledgeable on birth preparedness and complication readiness, knowledge did
not translate to practice as less than 20% actually practiced the acceptable level of
birth preparedness. Financial constraint was the significant factor that hindered
couples practice of birth preparedness and complication readiness. All the socioeconomic
variable examined were associated with couple’s practice of birth
preparedness and complication readiness. There was significant difference (P <
0.05) in the average monthly income and educational qualification of the couples
and their practice of birth preparedness and complication readiness. In conclusion,
although most of the couple had good knowledge of birth preparedness and
complication readiness, knowledge still did not translate to practice as few of
them actually practiced the acceptable level of birth preparedness and
complication readiness. Based on the findings, the recommendations that there is
a need for slight shift in focus of maternal and child care projects of governments
and need to improve transportation facilities suitable for pregnant women at rural
communities which will improve outcomes in emergencies were made.
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CHAPTER ONE
INTRODUCTION
Background to the Study
It is true that birth of baby precedes celebration but it equally poses source of concern as
pregnancy and childbirth is sometimes a perilous journey especially in the developing
countries, where the risk of a woman dying from pregnancy and related complications is
almost 40 times greater than that of her counterparts in developed countries (Benson &
Yinger, 2002). Maternal mortality remains a public health challenge world wide, and the
global maternal mortality ratio of 525 per 100,000 live births annually is still
unacceptably high (Hogan, 2010). A disproportionately high burden of these maternal
deaths is borne by developing countries including Nigeria, with a maternal mortality ratio
of 500– 1,000 per 100,000 live births (World Bank, 2013). These deaths arise from
pregnancy, childbirth or postpartum complications. According to WHO (2009), maternal
deaths are thought to occur in developing countries due to delay in deciding to seek
appropriate care, delay in reaching an appropriate health facility, and delay in receiving
adequate emergency care once at a facility. These delays may be reduced if pregnant
women and their families are prepared for birth and its complications. Birth preparedness
and complication readiness strategy is therefore, very relevant in this regard.This strategy
can reduce the number of women dying from complications due to such delays by
making a birth plan that constitutes birth-preparedness and complication-readiness
measures for pregnant women, their spouses and their families (McPherson, Khadka,
Moore & Sharma, 2006).
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Birth-preparedness and complication-readiness is a comprehensive package aimed at
promoting timely access to skilled maternal and neonatal services. It is a safe
motherhood strategy whose objective is to promote the timely use of skilled maternal and
neonatal care during childbirth or obstetric emergencies by reducing delays at the first,
second and third levels (Maternal and Neonatal Health Program, 2007). It entails making
plans prior to birth to ensure that a pregnant woman is prepared for normal birth and
complications. The birth-preparedness package promotes active preparation and decisionmaking
for delivery by pregnant women and their families. (McPherson, et al, 2006).
Decision are made and documented on such issues as desired place for birth, the
preferred skilled birth attendant, items required for birth, birth companion, getting a
compatible blood donor and arranging in advance for transport. This stems from the fact
that every pregnant woman faces risk of sudden and unpredictable life threatening
complications that could end in death or injury to herself or to her baby (JHPIEGO,
2006).
Other elements of birth preparedness include knowledge of expected date of delivery,
signs of labour, dangers signs, HIV testing, mobilising resources to pay for services,
arranging for someone to take care of the family during delivery. Importance of postnatal
care, importance of exclusive breast feeding and contraception (Maternal and
Neonatal Health Program 2003). In addition, a potential blood donor and a decision
maker (in case of emergencies) need to be identified (Kaye, Mirembe, Azigy,
Namuelema, 2003).
Approximately 15% of pregnant women develop life-threatening complications hence
need for emergency obstetric care. These complications are unpredictable and may
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progress rapidly to a fatal outcome (Rogo & Aloo, 2011). Knowledge of danger signs of
obstetric emergencies and appreciation of the need for rapid and appropriate response
when emergencies occur may reduce delay in decision making and in reaching health
facilities. Such signs in pregnancy are vaginal bleeding, severe headache, severe
vomiting, swelling of hands and face, difficulty in breathing, fits, fever, reduction or
absent fetal movement and drainage of liquor (WHO, 2009). Therefore, this package is a
very important strategy in developing countries, where obstetric services are poor. Birth
plan should be discussed on the first clinic visit, reviewed in subsequent visits and
finalized by 32 weeks (Barbara & Gomez, 2007).
One of the key roles of antenatal care is to provide health education on danger signs of
pregnancy and delivery, preparation of a birth plan and to encourage delivery under a
skilled attendant. WHO (2009) now recommends that pregnant women should receive
focused antenatal care in which birth preparedness and complication readiness is a key
component (WHO, 2009), Ministry of Health, Kenya, (2012). In order to address this
disturbing trend, the International Conference on Population and Development (ICPD)
urged that special efforts should be made to emphasise men’s shared responsibility and
promote their active involvement in maternity care (JHPIEGO, 2006). In spite of this,
pregnancy and childbirth continue to be regarded as exclusively women’s affairs in most
African countries, especially in the rural settings (Mullick, Kunene, & Wanjiru, 2005).
Statement of the Problem
In sub-Saharan Africa, pregnancy and childbirth continues to be viewed as solely
women’s issues (JHIPIEGO, 2006). A male companion at antenatal care is rare and in
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many rural communities, it is unthinkable to find male companions accompany a woman
to the labour room during delivery (Mullick, Kunene & Wanjiru, 2005; Babalola &
Fatusi, 2009). This posture of men towards BP/CR depicts lack of knowledge of their role
in pregnancy and child birth. Yet, men have social and economic power, especially in
Africa including Enugu State. They also, have tremendous control over their partners, so
they decide the timing and conditions of sexual relations, family size and whether their
spouse will utilize available health care services (Iliyasu, 2010). This situation makes
male partner involvement critical if improvement in maternal health and reduction of
maternal morbidity and mortality is to be realized. His engagement in maternity care
seems to be lacking in developing countries especially rural communities. Male
involvements will enable men to support their spouses to utilize emergency obstetric
services early and the couple would adequately prepare for birth and get themselves
ready for complications. This does not seem to be the case in developing countries
including Nigeria and Enugu state. Birth preparedness and complication readiness is an
issue that concerns both male and female (couples) for better outcome of pregnancy and
delivery, but it seems to be viewed as women’s responsibility. This poses a big problem.
There is therefore the need to assess the knowledge, practice and factors that influence
birth preparedness and complication readiness among couples in selected rural
communities in Enugu State since there are documented evidence that maternal mortality
is higher in rural communities than in the urban settings (WHO, 2014).
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Purpose of the Study
The purpose of this study is to assess the knowledge, practice and factors that influence
birth preparedness and complication readiness among couples in selected rural
communities in Oji River LGA, Enugu State.
The specific objectives of the study are to :-
1. determine knowledge of birth preparedness and complication readiness among
couples in the communities under study.
2. determine couple’s practice of birth preparedness and complication readiness.
3. Identify factors that hinder the practice of birth preparedness and complication
readiness.
4. establish the relationship between couple’s socio-economic status and their
practice of birth preparedness and complication readiness.
Research Questions
1. What is the knowledge of couples about birth preparedness and complication
readiness?
2. What is the couple’s practice of birth preparedness and complication readiness?
3. What are the factors that hinder couples’ practice of birth preparedness and
complication readiness?.
4. What is the relationship between couples’ socio-economic status and their
practice of birth preparedness and complication readiness?
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Hypothesis
The alternate hypothesis to guide the study is:-
1. There is association between couples’ socio-economic status and their practice
of birth preparedness and complication readiness.
Significance of the Study
This study has relevance to the general public, nurse practitioners, nurse administrators
and nurse educators. It will be significant to the general public as findings from this
study will show the need for couples and the general public to be prepared for birth and
any complications that may arise, thereby reducing the risk/incidences of maternal and
infant mortality. Findings from the study will equip the couples with invaluable
information on birth preparedness and complication readiness, which will go a long way,
if applied to ensure better and safer maternal health for the mothers.
This study will also be relevant to the nurse practitioners as they will be equipped with
the findings from this study, which will enable them adequately prepare the couples for
birth and possibly avoid any complication that may arise. Findings from this study can
be utilized by nurse administrators who will ensure that the necessary environments are
provided that will enable the nurse oversee the adoption of birth preparedness and
complication readiness. This study will also provide evidence based information with
respect to birth preparedness and complication readiness in rural communities which is an
imperative for improving health education initiatives in rural Nigeria including Oji River
L.G.A of Enugu State.
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Scope of Study:
This study is delimited to couples living in seven selected communities in Oji River
LGA. It will focus particularly on the knowledge, practice and factors that influence
couples towards birth preparation and complication readiness activities and the
relationship that exists between the couple’s knowledge and their practice of birth
preparedness and complication readiness as well as the relationship that exist between
couples’ socio-economic status and their practice of birth preparedness and complication
readiness.
Operational Definition of Terms
For the purpose of this study, the following terms are defined operationally.
Birth Preparedness and Complication Readiness: This is a comprehensive strategy
that focuses on promoting the timely utilization of skilled maternal and neonatal health
care and includes attending antenatal care at least four times during pregnancy,
identifying a skilled provider and making a plan for reaching the facility during labour,
setting aside personal funds to cover the costs of traveling to and delivering with a skilled
provider and any required supplies, recognizing signs of complications, knowing what
community resources (emergency transport, funds, communications, etc), are available in
case of emergencies and having a plan for emergencies, obstetric care and referral system
for Emergency Obstetric Case.
Couple: Those who are legally married or co-habiting with children.
Knowledge: The information and understanding gained through education.
Practice: Action taken by couples towards BP/CR.