CHI-SQUARE ANALYSIS ON THE EFFECT OF INADEQUATE HEALTH CARE OF PREGNANT WOMEN IN NIGERIA

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CHAPTER ONE

1.0 Introduction

Maternal and child health are crucial measures of progress in developing nations especially in the monitoring and evaluation of various developmental agenda such as Millennium Development Goals 4 and 5 (MDG-4 & MDG-5). Poor maternal health remains a major concern in sub-Saharan Africa with Nigeria occupying a position among the countries with the highest maternal and child mortality rates in the world. The effect of inadequate care on maternal health in the face of poor provision of amenities, illiteracy, poverty and infrastructural decay ravaging developing countries, particularly those of sub-Saharan Africa, have seldom been recognized as important factors in maternal health. Non-Governmental Organizations (NGOs), government health ministries and international organizations such as WHO, have adopted many strategies in an attempt to improve maternal health outcomes around the world. These have mainly been through the provision of maternal and child health (MCH) programmes, aimed at improving primary prevention through education and services, early detection and treatment. Specific programme interventions include emphasizing prenatal attention, clean and safe deliveries, postnatal care, family planning, and essential obstetric care (Fadeyi, 2007; Lubbock & Stephenson, 2008). While these programmes encourage women’s access to maternal health services, women continue to be susceptible to health complications due to some extraneous social and cultural factors.

Inadequate health care of pregnant women is not a problem common to only the rural areas often dominated by illiterate women without adequate access to social amenities and infrastructures as many would assume. Various studies have increasingly pointed out that urban health conditions are not as rosy as many people may assume (Friel et al, 2011; Takano, 2003). Takano (2003) specifically noted that urbanization triggers new problems and issues bearing on multiple aspects of urban life, including food security, housing, living environment, health of future generations, etc. The conditions of the diverse health determinants in urban areas are becoming increasingly complex especially in developing nations. On the whole, the varied health problems challenging cities are intricately interrelated with the background of general urban problems. The fast pace of urban growth has affected different groups of people in different ways. Urban life is most fascinating but it is also demanding especially on pregnant women who do not only contend with their own health but also with the life they are foisted to carry for nine months.

Endemic maternal health has been a major concern in Nigeria as the country has one of the highest poor maternal health care and maternal & infant/child mortality rates in the world. Although there are Health care facilities and services available in Nigeria, but hospitals do not necessarily improve people’s health. For example, Maternal mortality rate in Lagos State – hosting some of the biggest and most equipped hospitals in Nigeria –  was put at 650 per 100,000 live births in 2012 and this high rate is a source of concern to the government. Health care is about identifying the health problems of a population and designing an integrated health policy to improve the challenge (National Mirror, 2012; Radio Lagos 2009).

The health of a pregnant woman could be compromised by a wide range of factors. However, these factors differ among the urban and rural areas. A common factor which affects women in the urban areas includes:

1. Economic Factors: On one hand, economic pressures on the households have led more women to seek paid work. Many households find that two incomes are required in order to sustain a desired lifestyle (Giddens, 2002). Countless women lack access to decent work and work in unsafe conditions that would enable them to rise above poverty. Many women workers have traditionally been concentrated in poorly paid, routine occupations many of which fall outside traditional legal and social protection systems that safeguard against vulnerability and provide access to health care (ILO, 2010). Regions in which the highest rates of pregnancy related disease and maternal mortality are reported have more than 80 percent of women workers considered to be working in precarious and vulnerable conditions, mainly; either in the informal economy, lacking maternity protection at work, or certain industries that are always predominantly staffed with women. The nature of these jobs is part time and they are such that women work longer hours for less pay. The need to bring in or supplement family income forces women to submit to these conditions and this is nothing but double exploitation (Cheeqitita, 1999; ILO, 2010). This unfavourable work conditions exposes these women to various health challenges which become doubly evident on the pregnant women who are more susceptible to stress and diseases then their non pregnant counterparts.

The condition of poverty has forced women to increase the number of hours in extra-domestic activities and household task. The International Labour Organization (ILO) has noted that, while most attention to maternal health and mortality has justifiably focused on health services and family planning, mothers are also workers, with particular need of support to protect their health while working and to ensure their economic security during pregnancy and after childbirth (ILO, 2010). Available evidence shows that in many developing countries, women, on the average, work more hours per week than men when unpaid work and household activities are taken into account (United Nations, 1991; Basu, 2001). The problems associated with maternity and child birth are closely linked to ignorance, poor hygiene, poverty, inadequate working conditions and gender inequality (ILO, 2010).

For instance, for a working class woman in a typical urban area, work demands more time and the more the time spent at work the less the time available for family life and rest.

Where women have paid jobs, and companies are attempting to become more efficient and streamlined, jobs are cut or ‘downsized’ and many employees experience anxiety about the security of their positions (Giddens, 2002). High expectations for job performance (either self-imposed or imposed from above) mean that employees have to work harder and put in longer hours. The stress on the individual behaviour of women tends to create unrealistic expectations for mothers and can result in increased demands on their time.

The importance of paid work in the lives of so many makes the quality of working conditions paramount to the reproductive health of women as well as men (ILO, 2010). Hostile working environment affects both men and women workers. However, there are gender specific dangers to which women workers, because of their biological makeup, are exposed. These dangers severely affect their physical and reproductive health. Women work in environments and conditions that threaten pregnancy (Cheeqitita, 1999). Indeed, poor working condition; such as low wage, long working hours and lack of adequate weekly and annual rest; in addition to unhealthy and hazardous workplaces and lack of social protection, can have negative effects on maternal health.

Poor utilization of health facilities: Poor utilization of health facilities during delivery by pregnant mothers is still a major cause of maternal and childhood morbidity and mortality in Nigeria.

1. Unhealthy Life Style: Oxaal and Baden (1996) have observed that the last three months of pregnancy should be a time when the mother rests and gains weight. However, many women in developing countries continue with their full workload until the time of labour and resume work shortly after giving birth. This is considered to be extremely detrimental to their health and even the baby.

Life style determines health and the environment in which one finds him/herself determines the lifestyle. Most pregnant women in urban areas do not have a healthy life style. Urban areas are often unhealthy places to live in because they are characterized by heavy traffic, pollution, noise and violence (WHO, 1991). According to the United Nations (1991), women who become pregnant in developing regions face a risk of death due to pregnancy.

The reasons are that there are few backup services for pregnancy while malnutrition is endemic among pregnant women. Apart from the fact that many do not seek antenatal care, taking time to rest and eating balanced diet which are essential to safe pregnancy are absent (Lanre-Abass, 2008).

The Word Health Organization’s definition of health suggests a holistic interpretation of health linking the complex interrelationships between social, economic, political and cultural health determinants with the natural environment (Rattle and Kwiatkowski, 2003). Thus, it is evident that day-to-day activities in an imperfect environment have the potential to create significant human health impact, especially for pregnant women whom by virtue of pregnancy are already exposed to risk of health complications.

Common factors which affect women in the rural areas include:

• Non utilization of health facility for delivery
• Long distance to health facility
• Onset of labour at night,
• Unavailability of means of transportation,
• Lack of money for transportation,
• Unsatisfactory services at health facility,
• Unfriendly attitude of staff of the health facility
• Unavailability of staff at health facility,
• Lack of urgency at health facility

Indications are that maternal morbidity and mortality and other related effects of inadequate health care globally every year, reaches over half a million (WHO; 2006). Most of these related conditions are found in urban and rural areas of developing countries (Chiwuzie,Braimoh, Unuige 1985).

Diseases and deaths in pregnant women in Nigeria are among the world highest, ranging from 800-1500 per 10,000 lives births. Despite the observation that traditional societies appear to have accepted the high maternal morbidity and mortality and other maternal diseases as unavoidable, researchers have shown that maternal morbidity and mortality and other pregnancy related problems are preventable (Royston and Armstrong 1989).

In the same vein, many researchers have analyzed the issue of maternal diseases, and problems attributed to child bearing both in developed and developing countries. The conclusions are that they are preventable.

In a bid to find a lasting solution to increasing rate of maternal diseases, governments, international agencies such as (WHO), United Nations Children’s Fund, (UNICF), and non- governmental organisations (NGOs) lunched the worldwide Safe Motherhood Initiative (SMI) at the International Conference in Nairobi in 1987(Onuzulike, 2006).

The components of safe and healthy motherhood initiatives are prenatal care, ante-natal care, nutrition, family planning, personal hygiene during pregnancy, essential obstetric care, emergency care, postpartum care, post abortion care, prevention of sexually transmitted infections (STI’s), prevention of mother – to- child transmission (PMTCT) of HIV and AIDS, child care and the pregnant women’s attitudes towards  based on level of education.

The effects of inadequate health care include;

Toxemia : Swelling of feet, hand, face, with headache, dizziness, and sometimes blurred vision, high blood pressure, sudden weight gain.

Edema: This is an abnormal accumulation of fluid in the interstitium, which are locations beneath the skin or in one or more cavities of the body. It is clinically shown as (swelling of the leg).

Anaemia: is usually defined as a decrease in amount of red blood cells (RBCs).It is clinically show as( weakness, or fatigue, general malaise, and sometimes poor concentration).

Malaria for the baby: When the mother is infected during pregnant and it is not treated then the child will be affected as well. Clinically shown as (fever in baby)

Mal-nutrition for the baby after delivery: If the mother is not well nourished there will be sign of mal-nutrition in the baby. Clinically show as (tiny hand and leg, swelling tummy)

Still birth: This is death of baby after birth or seven days after birth.

Miscarriage: Is the natural death of an embryo or foetus in the womb .clinically show as (vaginal bleeding).

1.2 Statement of the Problem

Nigeria, the most populous country in Africa, has the largest number of maternal morbidity and mortality in the world (Udeinya, 1995 and WHO, 1980), and this is a resultant effect of inadequate health care of its pregnant women. According to them, the death is responsible for a total of approximately 80,000 per year (Udeinya, 1995).These figures are of grave concern to a developing country like Nigeria. Maternal morbidity and mortality (a resultant effect of inadequate health care) results in deficient infant care, infant malnutrition and increased infant mortality. These health concerns in pregnant women are indeed the motivation or problem of this study.

The high MMM rate indicates that pregnant women lack Safe Motherhood Initiative positive attitude. Nigeria contributed about 10 per – cent to the world’s annual estimates of maternal death (NASPM, 2003). Earlier high MMM has been identified as a result from poor attitude towards the components of Safe Motherhood Initiative in both urban and rural areas of Nigeria (Onuzulike, 2006).

1.3 Purpose of the Study

`           The purpose of this study was to investigate the effect of inadequate health care on pregnant women and to examine the attitude of pregnant women towards safe motherhood initiatives in Eruwa, Oyo state.

Specifically; the study ascertained the:

1. Causes of Inadequate health care among pregnant women
2. Roles of public enlightenment on importance of good health care of pregnant women
3. The role of the government in providing and ensuring adequate health care of pregnant women
4. The role of families in ensuring adequate health care in pregnant women
5. Required measures to reduce diseases and health related problems among pregnant women.
6. Attitude of the pregnant woman towards prenatal/ante-natal care;
7. Attitude of the pregnant woman towards nutrition;
8. Attitude of the pregnant woman towards personal hygiene while pregnant;
9. Attitude of the pregnant women towards essential care;
10. Attitude of the pregnant woman towards child care and;
11. The pregnant women’s attitude towards safe motherhood initiative based on level of education.

1.4 Research Questions

The following research questions were posed to guide the study in Eruwa, Oyo state.

1. What is the attitude of the pregnant women towards prenatal/ante-natal care?
2. What is the attitude of the pregnant women towards nutrition?
3. What is the attitude of the pregnant women towards personal hygiene while pregnant?
4. What is the attitude of the pregnant women towards essential obstetric care?
5. What is the pregnant women’s attitude towards safe motherhood initiative based on level of education?

1.5 Hypothesis

A null hypothesis was postulated and verified at .05 alpha levels.

1. The pregnant women’s attitude towards safe motherhood initiative components is not dependent on their level of education.

1.6 Significance of the Study

The present study shows the level of awareness on the effects of inadequate health care on pregnant women and attitude of pregnant women towards safe motherhood initiatives in Eruwa of Oyo state Nigeria. The anticipated data on effect of inadequate health care and attitude of pregnant women towards Safe Motherhood Initiative that emerged from the present study are significant not only to child bearing woman but also Oyo State ministries of Health and Information, Oyo State hospitals Management Board, Policy makers, health educators and all female reproductive health intervention researchers and pregnant women to adapt to SMI positive attitude.

Data generated will help child bearing women and Oyo State ministries of health to educate the pregnant women on the need to ensure priority is given to their health and to know the appropriate place to seek medical help and attention for their pregnancy complication. In addition, the data generated will help the pregnant women to go to hospitals with skilled personals ,equipments and facilities on time for essential obstetric care immediately they noticed pregnancy complication danger signs at appropriate time without any delay for appropriate action

Pregnant women should inculcate attitude of going to hospitals with skilled personals, equipments and facilities on time for essential obstetric care immediately they noticed pregnancy complication danger signs at appropriate time without any delay for appropriate action and child care. This will help to prevent health related problems and infant mortality and morbidity rate in Eruwa, Oyo state.

Again, the data generated on effect of inadequate health care and attitude of pregnant woman towards safe motherhood initiative based on level of education will be useful to the Ministry of Health and Information to have sufficient centres for the management, care and support for the orphans, motherless, people living with HIV and AIDS and host of others in the urban areas.

The data generated will enable the policy makers to have a policy that can withstand the light of the day for better performance of those that are vulnerable and disable by pregnant complication. This will also help the government to extend their hand of fellowship to them.

Data on attitude of pregnant women on prenatal/ante-natal care from pregnant women attending MCH and TBA centre in Eruwa will ever remain a reference point. This is because they denote the first concerted effort to empirically elucidate pregnant women’s attitude on prenatal/ ante- natal care as one of the basic components of SMI in Maternal and Child Health (MCH) clinics and traditional birth attendants (TBA) clinics in Eruwa.

Furthermore, this study considered very significant because data that will emanate from the study will be relevant and useful to adolescent and female reproductive health workers and researchers to educate pregnant woman with low level of education to inculcate positive SMI attitude ensuring they seek adequate health care during pregnancy. Pregnant women who may eventually utilize child bearing women’s acquisition of attitude of benefits inherent in

SMI components, attitudinal change and eventually eradication of reproductive health hazards among child bearing women attending various MCH and TBA clinics in Nigeria and  Eruwa in particular. The significance of such initiatives attitude cannot be overemphasized because it specifically aims at upgrading pregnant woman’s attitude towards SMI components like nutrition, personal hygiene while pregnant, essential obstetric care, child care and pregnant women attitude based on level of education. This will help them to improve their life style and way of life.

The data generated will help health educators in teaching the pregnant women to know how to attend for their personal hygiene for their healthful living and longevity. It will also help them to shun all the misconceptions about SMI negative attitude which contrast with the ideal.

In addition, the data generated on the attitude towards essential obstetric care will help the pregnant women attending MCH and TBA’s only to go to hospitals with skilled personals ,equipments and facilities on time for essential obstetric care immediately they noticed pregnancy complication danger signs at appropriate time without any delay for appropriate action

The study is also significant to child bearing women as an operational models in the sense that some theories and findings of the present study, such theory will be incorporated and adopted as operational model in the positive attitude and care due to its relevancy in Nigerian context.

Finally, within the field of public health education, maternal and child health, reproductive health in general and female reproductive health in particular, the data generated on attitude of pregnant women towards SMI and socio demographic factors like influence of level of education on pregnant women attitude towards SMI will be useful to all health educators, researchers, ministries of health and information and will augment the pool of available data in the field of reproductive health.

1.7 Scope of the Study

The study focused on effects of inadequate health care of pregnant women in Eruwa, Oyo state. The study examines the attitude of pregnant women towards Safe motherhood initiatives Eruwa. The study was limited to pregnant women in Eruwa only .The high MMM are more in rural communities. The location of Health facilities are far to their homes .Due to logistics problems they seem to patronized MCH and TBA’s closer to their homes only. They are quiet ignorant of the benefit of both secondary and tertiary institutions and the importance of difference between skilled and unskilled personal. They have little or no interest in attending teaching or federal medical centres which have skilled personals, equipments and facilities. Their attitude of patronising both TBA’s and MCH more leaves them with the negative interest to SMI, fate, high rate of MMM and attitude very contrast with the ideal are inimical to SMI positive attitude

The pregnant women were those who attended hospitals, Maternal and Child Health (MCH) and TBA’s clinics in Eruwa, Oyo Sate Nigeria .

The components of health care and safe motherhood initiative which are covered include: prenatal/antenatal care, nutritional care, personal hygiene while pregnant, essential obstetric care, child care, attitude towards SMI based on level of education and null hypothesis postulated to verify pregnant women attitude towards SMI.

1.8 Research Methodology

In this research, the use of primary data (questionnaire) will be adopted.

Chi-Square statistics is used to investigate whether distributions of categorically variable differ from one and other. It will be deduced that there is significant difference in the effect of inadequate health care on pregnant women in our society which will affect us positively.

Chi-Square will be used in measuring the discrepancies between observed end expected values. This hypothesis shows that Chi-square analysis will enhance the significant difference in our society positively (+)

1.9 RELEVANT TERMS:

HEALTH CARE: Health care is a service provided to people or community by agents of the health service or profession for the purpose of promoting, maintaining, monitoring or restoring health.

MATERNAL HEALTH: This is the health of women during pregnancy, childbirth, and the post partum period.