1.1 Introduction
Antenatal care is an evidence based intervention that improves maternal and perinatal outcome. Assessment and re-assessment of its utilization by rural and urban women in Nigeria is necessary for planning healthcare programmes and interventions. Nigeria has high maternal and infant mortality. In recent years the country has embarked on measures to reform the healthcare system, including maternal healthcare (MHC) delivery, in a bid to attain Millennium Development Goals (MDGs) (Mrisho et al., 2009 and Hutchinson et al., 2011). Most health reform efforts have been geared towards increasing availability of healthcare services, without commensurate increase in quality (Osariemen, 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, Limitations of the Study and Definition of technical terms.
1.2 Background of Study
Antenatal Care (ANC) service utilization exists in Nigeria and most third world countries with low utilization rates among rural women (FMOH, 2005; Prb, 2005). In addition, pregnancy must be supervised by a trained health personnel and labour attended by a skilled birth attendant. Also, pregnant women on their part are expected to book early and attend adequate number of ANC prior to delivery. Although ANC attendance has been measured on proportion of women who have attended ANC at least once during pregnancy, WHO recommends that pregnant women should attend ANC at least four times starting from the first trimester.
In Nigeria, the provision of ANC is in transition from the traditional approach to the FANC approach. The new schedule of visits is as follows: The first visit should occur by the end of 16 weeks of pregnancy; the second visit takes place between 24 and 28 weeks of pregnancy; the third visit is at 32 weeks; and the fourth visit takes place at 36 weeks. However, women with complications, special needs, or conditions beyond the scope of basic care may require additional visits (NPC, 2008).
Despite all efforts to improve maternal and child health indices and attain the millennium development goals (MDGs) 4 and 5, utilization of ANC services is still low in some parts of the country. Reports from 2008 Nigerian National Survey revealed that only 58% of women aged 15-41 received antenatal care from a skilled provider (doctor, nurse/midwife) during their last pregnancy.
Thirty percent of women received ANC services from a Nurse or midwife, while 23 percent received ANC services from a doctor. Three percent of women received ANC services from traditional birth attendants (TBA) and 39% did not receive ANC visiting antenatal clinics at least four times during pregnancy, and 8 percent reported two or three visits during pregnancy; while 2 percent of women had just one antenatal visit. The median number of months of pregnancy at the first ANC visit was five months (NPC, 2008). Differences do not vary much by urban and rural residence. Suffice to note that there was no substantial change in proportion of women receiving no antenatal care between the 2003 (37%) and the 2008 (39%) national survey, and the median gestational age at first visit has remained the same, 5 months over 5 years period (NPC, 2003; FMOH, 2008). Increasing the percentage of births delivered in health facilities is an important factor in reducing deaths arising from the complications of pregnancy. However, despite proven reports about this, 65% of births in Nigeria takes place at home and only 35% of births in Nigeria are delivered in a health facility; 20% occur in public sector facilities while 15% occur in private facilities. Women in urban areas are more than twice as likely to deliver in a health facility as their rural counterparts (NPC, 2003; FMOH, 2008).
Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the Factors that Influence Utilization of Skill Providers in Antenatal Care Services in Rural Communities of Northern Community Rescue Service (CRS).
1.3 Statement of Problems
Nigerian has been rated the third country with the highest mortality rate after India and Sierra Leone with over 40,000 dths of pregnant women 2012 (WHO 2013). Unfortunately, despite the well documented record of safety, the strong aversion of women in sub-Saharan Africa tot eh procedure especially in the presence of life threatening indications is a great concern (Awoyinka BS, 2006). Hence the researcher wants to assess the Quality of Care Rendered in Primary Health Care Facilities and the perception of patients at the antenatal clinic to know if it is accepted or not and the factors that influences their attitudes towards cesarean section.
Effects on Mothers: It has been estimated that 25 percent of maternal deaths occur during pregnancy, with variability between countries depending on the prevalence of unsafe abortion, violence, and disease in the area.
Effects on Babies: In sub-Saharan Africa, an estimated 900,000 babies die as stillbirths during the last twelve weeks of pregnancy. It is estimated that babies who die before the onset of labour, or antepartum stillbirths, account for two-thirds of all stillbirths in countries where the mortality rate is greater than 22 per 1,000 births – nearly all African countries. Antepartum stillbirths have a number of causes, including maternal infections – notably syphilis – and pregnancy complications, but systematic global estimates for causes of antepartum stillbirths are not available. Newborns are affected by problems during pregnancy including preterm birth and restricted fetal growth, as well as other factors affecting the baby’s development such as congenital infections and fetal alcohol syndrome.
1.4 Aim and Objectives of Study
The aim of the study is to examine the Factors that Influence Utilization of Skill Providers in Antenatal Care Services in Rural Communities of Northern Community Rescue Service (CRS). In achieving this aim, the following specific objectives were laid out as follows:
- To investigate the factors influence the utilization of Skill Providers in Antenatal Care Services in Rural Communities
- To assess the perception of Antenatal Mother during Antenatal Care Services in Rural Communities,
- To determine the attitude of health care worker towards Antenatal Mother,
- To assess the antenatal care service attendees’ perception of quality of maternal healthcare (MHC) services in Oyo State
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:
- Are there factors influencing the utilization of Skill Providers in Antenatal Care Services in Rural Communities?
- What is the perception of Antenatal Mother during Antenatal Care Services in Rural Communities?
- What is the attitude of health care worker towards Antenatal Mother?
- What is the antenatal care service attendees’ perception of quality of maternal healthcare (MHC) services in Oyo State?
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.
Hypothesis One
- H0: There are no significant factors influencing the utilization of Skill Providers in Antenatal Care Services in Rural Communities
- H1: There are significant factors influencing the utilization of Skill Providers in Antenatal Care Services in Rural Communities
1.7 Significance of Study
This study is significant because it will help the women understand the need for Skill Providers in Antenatal Care Services especially when a vaginal delivery seem threatening to their health and that of their fetus. It will also help in debunking their various belief and taboo about the procedure which has been one of the reasons why they have been levistant to approve of it so that the rate of maternal and fetal mortality will be reduced to the bearest minimum.
This study will be of immense benefit to other researchers who intend to know more on this study and can also be used by non-researchers to build more on their research work. This study contributes to knowledge and could serve as a guide for other study.
1.8 Scope of Study
The scope of the research is focused on the Factors that Influence Utilization of Skill Providers in Antenatal Care Services in Rural Communities of Northern Community Rescue Service (CRS) in Oyo State.
1.9 Limitations of the Study
During the course of this study, many things militated against its completion, some of which are:
- 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.
- Research material: availability of research material is a major setback to the scope of the study.
- Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
- 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).
1.10 Operational Definition of Terms
Attitude: The way one behaves towards somebody or something that shows how you think or feel.
Knowledge: To have information about something because you have experience or because you have learned it or be told.
Perception: To notice something in a particular way or hold a view about something.
Macrosomia: Large babies weighing more than 40kg at birth especially in diabetic mothers.
Mortality: The number of death in a particular situation or period of time.
