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, Limitation 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. 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?
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 is no significant relationship between cultural beliefs and practice as a factor that influences the perception of Antenatal Mother in Enugu State PHC.
- H1: There is significant relationship between cultural beliefs and practice as a factor that influences the perception of Antenatal Mother in Enugu State PHC.
Hypothesis Two
- H0: There is no significant relationship between the fear of death and a complication of surgery is a factor that influences the attitude of Enugu State women towards C/S.
- H1: There is significant relationship between the fear of death and a complication of surgery is a factor that influences the attitude of Enugu State women towards C/S.
1.7 Significance of Study
This study is significant because it will help the women understand the need for C/S 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 this research is focused on the Quality of Care Rendered in Primary Health Care Facilities and the Perspective of Antenatal Mother in Enugu State Primary Health Care (PHC) Service.
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.
- Establishment Policies: Establishment policies posed a serious limitation as most staffs are not ready to release information needed for this project 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.
- 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
Anaesthesia: The state in which one is unable to feel anything especially pain by injecting drug into the body.
Attitude: The way one behaves towards somebody or something that shows how you think or feel.
Cesarean Section: It is an operative technique by which a fetus is delivered through an abdominal and uterine incision and the indications can either be maternal or fetal.
Dystocia: It implies any form of abnormalities in pregnancy or any deviation from normal during pregnancy.
Knowledge: To have information about something because you have experience or because you have learned it or be told.
