1.1 Introduction
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. Studies have shown that increased availability of service does not always translate to increased access to healthcare (Osariemen, 2011). Hence, for these interventions to deliver optimally there is need to ensure that quality of service is taken into consideration in the provision of maternal health (MH) services.
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, Limitations of the Study and Definition of technical terms.
1.2 Background of Study
Pregnancy as a physiologic state is expected to lead to a process of delivery within thirty six weeks (36) of gestation in a normal delivery but due to the different reasons such as variation in human body, sizes, races, external factors e.t.c, it can be a very unpleasant experience as women may have difficulties in being delivered of the pregnancy they have carried over many weeks. Hence, to save the life of both mother and child in some cases, a cesarean section. A cesarean section also known as C/S is an operation technique by which a fetus is delivered through an indications can either be maternal or fetal. The trend of acceptability and the rate of C/S has been on the increase in the developed countries in the past two decades. In the United State of America, it has revolved off a 32.8% in 2010 and 2011 (Hamilton BE, Martin JA, Ventura SJ, 2010). Several cesarean sections are sometimes done for justifiable medical and non-medical indications sequently the rate of C/S in Europe and North America have been increasing (Declercq ER, Sakela C, Corry MP, 2013).
Conversely, in the developing countries, the change in C/S rate has been dramatic during the same period. This results from negative perception of C/S among women in the developing countries. C/S is still being perceived as an abnormal means of delivery by some women in developing countries, hence C/S rate in Sub-Saharan African Country like Burkina Faso and Niger is as low as 2% (Sunday Adeoje I, Kalu CA, 2011). Among women in the developing countries, C/S is still being perceived as a curse on an unfruitful women and the lot of weak women. In a study among Yoruba women of south western Nigeria, C/S was viewed with suspicious, aversion, misconception, fear, guilt misery and anger. (Sunday-Adeoje et al, 2011).
In Nigeria, as in most sub-Saharan African countries, it has been suggested that women reluctantly accept C/S even in the face of obvious clinical indications. Also, negative view and perception of C/S by women in the developing country has led to gross underathizetlien of the procedure compared to the large burden of obstetric morbid requiring resolution by C/S (AzikenMicheal, Lawrence Omo-Aghoja 2010).
Therefore, in Enugu State Primary Health Care (PHC) where the research was carried out, the activities that was conducted is to know the Quality of Care Rendered in Primary Health Care Facilities; Perspective of Antenatal Mother.
1.3 Statement of the Problem
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 the Study
This aim of the study is to determine the Quality of Care Rendered in Primary Health Care Facilities and the Perspective of Antenatal Mother using Enugu State Primary Health Care as a case study. In achieving this aim, the following objectives were laid out as follows:
- To assess the perception of Antenatal Mother in Enugu State Primary Health Care Service,
- To determine the attitude of health care worker towards Antenatal Mother,
- To assess the possible factors that influence their perception and attitude of Antenatal Mother.
- To assess the antenatal care service attendees’ perception of quality of maternal healthcare (MHC) services in Enugu 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:
- What is the perception of Antenatal Mother in Enugu State Primary Health Care Service?
- What is the attitude of health care worker towards Antenatal Mother?
- What are the factors that influence their perception and attitude of Antenatal Mother?
- Does Antenatal Care offer an opportunity to develop a birth and emergency preparedness plan?
- Does an Antenatal Care visit provide opportunities to promote lasting health, offering benefits that continue beyond the pregnancy period?
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