ASSESSING KNOWLEDGE, PRACTICE AND FACTORS INFLUENCING BIRTH PREPAREDNESS AND COMPLICATION READINESS AMONG COUPLES IN SELECTED RURAL COMMUNITIES
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 socio- economic 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 socio- economic 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.
TABLE OF CONTENTS
Title page
i
Declaration
ii
Certification
iii
Dedication
iv
Acknowledgement
v
Table of Content vi
List of Tables
ix
Abstract
x
Chapter One: INTRODUCTION
Background to the Study
1
Statement of the Problem 3
Purpose of the Study
5
Research Questions
5
Hypotheses
6
Significance of the Study 6
Scope of the Study
7
Operational Definition of Terms 7
Chapter Two: LITERATURE REVIEW
Conceptual Review
8
Concept of Birth Preparedness and Complication Readiness (BP/CR) 8
Male Involvement in BP/CR 10
Couple’s Birth Preparedness Information Needs 15
Key Implications for Birth Preparedness and Complication Readiness 18
Theoretical Review
20
Conceptual Framework
24
The BP/CR Matrix 25
Empirical Review 26
Summary of Literature Review 36
CHAPTER THREE RESEARCH METHOD
Design
37
Area of Study
37
Population of the Study
38
Sample
38
Sampling Procedure
40
Instrument for Data collection 40
Validity of the Instrument 41
Reliability of the Instrument 41
Ethical Consideration
42
Procedure for Data Collec6ion 42
Method of Data Analysis 43
CHAPTER FOUR PRESENTATION OF RESULTS 41
Demographic Characteristics of the Nurses 44
Hypothesis Testing 53
CHAPTER FIVE DISCUSSION OF FINDINGS 51
Discussion of Major Findings 54
Conclusion 57
The implication to Nursing 58
Recommendation 58
Limitation of Study 59
Summary 59
Suggestion for further studies 60 References
61
Appendices 68
Questionnaire 68
The BP/CR Matrix 71
Cronbach Alpha Reliability analysis result for research questionnaire 79
Informed consent 80
Introductory Letter 81
Ethical Clearance Certificate 82
Administrative Permit from Local Government 83
LIST OF TABLES
Table 1: Demographic characteristics of the respondents 44
Table 2: Distribution of couple’s responses on their knowledge of BP/CR 46
Table 3: Summary of respondent’s knowledge of BP/CR 48
Table 4: Distribution of couple’s responses on their practice of BP/CR 49
Table 5: Summary of respondent’s practice of BP/CR 49
Table 6: Factors that hinder couple’s practice of BP/CR 50
Table 7: Summary of Spearman’s correlation of couple’s socio-economic status and their practice of BP/CR
51
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).
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 decision- making 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 post- natal 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
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
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).
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?
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.
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.
.