1.1 Introduction
Antenatal care (ANC) is defined as the routine health care provided to pregnant women to ensure the well-being of both the mother and the developing fetus throughout pregnancy. It encompasses a series of scheduled visits to health care facilities, during which medical assessments, preventive interventions, and health education are provided to detect and manage potential complications early (World Health Organization, 2016). In Nigeria, maternal and neonatal morbidity and mortality remain a significant public health challenge, with preventable complications such as hypertensive disorders in pregnancy, anemia, infections, and gestational diabetes contributing substantially to adverse outcomes (Oladapo et al., 2011).
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitation of the study and Definition of terms.
1.2 Background of Study
Antenatal care (ANC) has evolved over time as an essential aspect of maternal and child health, aimed at reducing pregnancy-related complications and improving neonatal outcomes. Historically, antenatal care was informal, with pregnant women relying on traditional birth attendants, family members, or community elders for guidance and support during pregnancy. According to Oladapo et al. (2011), this form of care often lacked standardized medical assessment, limiting early detection of pregnancy-related complications such as hypertension, anemia, infections, and gestational diabetes.
Antenatal care (ANC) is a cornerstone of maternal and neonatal health, providing preventive, diagnostic, and educational interventions to ensure safe pregnancies and healthy birth outcomes. According to the World Health Organization (2016), ANC involves scheduled visits by pregnant women to qualified health personnel for monitoring maternal and fetal well-being, identification of potential complications, and provision of health education and counselling. Regular ANC attendance is essential for reducing maternal and neonatal morbidity and mortality, particularly in low- and middle-income countries where preventable pregnancy-related complications are prevalent.
Oladapo et al. (2011) reported that inadequate ANC utilisation is strongly associated with adverse maternal and neonatal outcomes, including preterm birth, low birth weight, hypertensive disorders, and increased risk of maternal and neonatal deaths. They asserted that timely and adequate ANC is crucial for early detection and management of conditions such as gestational diabetes, anemia, and infections, which otherwise may go unnoticed until severe complications arise. Adekanle and Isawumi (2008) stated that late booking for ANC and irregular attendance are common challenges among Nigerian women, with socio-economic status, educational level, and cultural beliefs identified as significant determinants of ANC utilisation.
Fagbamigbe and Idemudia (2015) affirmed that women from lower socio-economic backgrounds and rural areas are less likely to complete the recommended number of ANC visits, exposing them and their neonates to higher health risks. They contend that health system factors, including long waiting times, cost of services, distance to facilities, and perceived quality of care, further influence ANC utilisation patterns in Nigeria. On the other hand, studies conducted in tertiary health institutions such as Lagos University Teaching Hospital indicate that accessible and high-quality ANC services contribute to improved maternal and neonatal health outcomes, reducing the incidence of complications and enhancing preparedness for delivery.
Moreover, research has highlighted the broader implications of ANC utilisation on neonatal health. According to Adekanle and Isawumi (2008), consistent ANC attendance promotes maternal education on proper nutrition, hygiene, and immunisation, which in turn improves neonatal survival and reduces morbidity. Oladapo et al. (2011) reported that facilities with structured ANC programs record lower rates of neonatal intensive care admissions and perinatal mortality compared to settings where ANC is irregular or inadequately accessed. This study is set against the backdrop of the persistent challenges in ANC utilisation in Nigeria, particularly at tertiary health institutions such as Lagos University Teaching Hospital, where patterns of service use and their impact on maternal and neonatal health require thorough assessment.
1.3 Statement of Problems
Investigation revealed that the utilisation of antenatal care (ANC) remains a pressing concern in maternal and neonatal health, particularly within the context of the Lagos University Teaching Hospital (LUTH). Studies in Lagos have shown relatively high awareness and utilisation of ANC services, with up to 81% of pregnant women at LUTH reporting good levels of utilisation and identifying accessibility and affordability as key influencing factors. On the other hand, significant gaps remain: women often book late in pregnancy, attend fewer visits than recommended, and socioeconomic inequalities persist across utilisation patterns.
Furthermore, poor ANC utilisation is linked with worse maternal and neonatal outcomes. For mothers, inadequate ANC contributes to delayed or missed diagnosis of pregnancy related complications, which increases the risk of morbidity and mortality. For neonates, insufficient ANC is associated with low birth weight, prematurity, neonatal admission, and increased risk of neonatal death. Meta-analyses in Nigeria have found that ANC is significantly associated with a reduction in neonatal mortality risk. It is against this backdrop that this study seeks to investigate the assessment of antenatal care utilisation and its impact on medical conditions in women and neonates.
1.4 Aim and Objectives of Study
The study aims to assess the utilisation of antenatal care services and determine its impact on the medical conditions of women and neonates at Lagos University Teaching Hospital. To achieve this aim, the study has the following objectives:
- To examine the level of antenatal care utilisation among pregnant women at LUTH.
- To identify factors that influence antenatal care utilisation in LUTH.
- To evaluate the impact of antenatal care utilisation on maternal health outcomes.
- To assess the impact of antenatal care utilisation on neonatal health outcomes.
- To provide recommendations for improving ANC services to reduce maternal and neonatal complications.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- What is the level of antenatal care utilisation among pregnant women at LUTH?
- What factors influence the utilisation of antenatal care services at LUTH?
- How does antenatal care utilisation affect maternal health outcomes at LUTH?
- What is the effect of antenatal care utilisation on neonatal health outcomes at LUTH?
- What measures can be implemented to enhance ANC services and reduce maternal and neonatal complications at LUTH?
1.6 Research Hypothesis
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
- H0: There is no significant relationship between antenatal care utilisation and the medical conditions of women and neonates at Lagos University Teaching Hospital.
- H1: There is a significant relationship between antenatal care utilisation and the medical conditions of women and neonates at Lagos University Teaching Hospital.
1.7 Significance of Study
It is believed that at the completion of the study, the findings will provide insights into the patterns and challenges of antenatal care utilisation, which will guide interventions to improve maternal and neonatal health outcomes. The research will also serve as a reference for future studies in maternal and child health within tertiary institutions and similar healthcare settings.
Furthermore, policymakers will be informed on areas that require policy intervention to enhance ANC accessibility and quality. In addition, pregnant women and the general community will benefit from increased awareness about the importance of timely and regular ANC attendance.
Lastly, researchers and academicians will have a foundation for further studies in maternal and neonatal health in Nigeria. Also, health institutions will be guided in optimizing resource allocation and designing interventions to reduce maternal and neonatal complications.
1.8 Scope of Study
The scope of the research is focused on the assessment of antenatal care utilization and its impact on medical conditions in women and neonates. The study limited to Lagos University Teaching Hospital in Lagos State, Nigeria, and involves pregnant women who attend ANC services at this facility.
1.9 Limitations of the Study
During the course of this study, there were some problems encountered which stood as limitations to the research work. Some of the limitations include:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Establishment Policies: Establishment policies posed a serious limitation as most staffs are not ready to release information needed for this research work. There were lots of information needed from the staffs of this establishment to enhance the study which took them time to release or they did not release at all for security purposes, hence the scope was reduced.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
- Initial Cooperation Delay from Respondents: A particular limitation of this work came as a result of the respondent refusal to offer their cooperation at the initial time they were contacted. This contributed in making the success of this research study difficult.
1.10 Definition of Terms
Antenatal Care (ANC): According to the World Health Organization (2016), antenatal care is the routine healthcare provided to pregnant women to monitor and improve the health of the mother and fetus, identify and manage complications, and educate women on pregnancy and neonatal care.
Maternal Health: Refers to the health status of women during pregnancy, childbirth, and the postpartum period, including physical, mental, and social well-being (Oladapo et al., 2011).
Neonatal Health: Refers to the health status of newborns within the first 28 days of life, including birth weight, incidence of disease, and survival outcomes (Adekanle & Isawumi, 2008).
Utilisation: In the context of this study, utilisation refers to the frequency, timeliness, and consistency of pregnant women's attendance and engagement with antenatal care services.
Medical Conditions: Refers to any maternal or neonatal health complications, including hypertensive disorders, anemia, infections, low birth weight, prematurity, and neonatal morbidity or mortality (Fagbamigbe & Idemudia, 2015).
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