ABSTRACT
Background: Maternal mortality is an enormous public health burden in developing countries of the world. Birth preparedness and emergency readiness is the process of planning for safe delivery and anticipating the actions needed in case of emergencies. When a woman is adequately prepared for normal childbirth and possible complications, she is more likely to access the skilled and prompt care she needs to protect her overall health and possibly save her life and that of her baby. This descriptive study assessed the birth preparedness and emergency readiness of antenatal clinic attendees in a secondary health facility in Awka, South eastern
Nigeria.
Methodology: This is a cross-sectional descriptive study carried out among pregnant women attending antenatal clinic at Amaku
General Hospital Awka. The data was collected from the pregnant women using semi-structured interviewer administered questionnaire.
Findings: The mean age of the respondents was 27.9 years with a standard deviation of 4.5 years. The proportion of the respondents who were birth prepared was 56% as against 6% who were emergency ready. Up to 59.8% of the respondents of gestational age >=20weeks were birth prepared compared to 12.5% of the respondents of gestational age
Conclusion: Most pregnant women make arrangements in anticipation of normal delivery but the same cannot be said for emergencies.
Key words: Birth prepared, emergency ready, pregnant women, antenatal.
CHAPTER ONE
1.0INTRODUCTION
Pregnancy is the physical condition of a woman carrying unborn offspring inside her body, from fertilization to birth. Child birth is the process of having a baby emerge from the womb. Pregnancy and child birth, under normal conditions is not a disease but a physiological process.1 It is a blessing and a thing of joy. There is, therefore, no need for any woman to die as a result of pregnancy or child birth.1 Unfortunately, many women in developing countries of the world face increased risk of morbidity and mortality from pregnancy and other pregnancy related issues. 1
Birth preparedness and emergency readiness involves active, definite preparation and decisions made by a pregnant woman for birthing including arrangements made for emergencies that may arise at any time in pregnancy, during delivery or after delivery.2 This planning has the potential to reduce morbidity and mortality during pregnancy, delivery and post-partum by
ensuring faster access to care.2
Birth preparedness and emergency readiness is also a comprehensive strategy to improve the use of skilled providers at birth, the key intervention to decrease maternal mortality.3 The concept of birth preparedness and emergency readiness includes the following elements: (a) knowledge of danger signs; (b) plan for where to give birth; (c) plan for a birth attendant; (d) plan for transportation; (e) plan for saving money; and (f) identifying a blood donor in case of an obstetric emergency. 4
Birth preparedness and emergency readiness is therefore a key strategy in safe motherhood programmes, a global effort that aims to reduce deaths and illnesses among women especially in developing countries. 5,6 Specifically aimed at reducing maternal mortality, these programmes are being developed in the wider context of health services for women’s reproductive health. 6
According to the World Health Organisation (WHO), maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.7 As stated by the 2005 WHO report “Make Every Mother And Child Count” the major causes of maternal death are: severe bleeding/haemorrhage (25%), infections (13%), unsafe abortions (13%), eclampsia (12%), obstructed labour (8%), other direct causes (8%), and indirect causes (20%) 7. Indirect causes such as malaria, anaemia, HIV/AIDS and cardiovascular disease, complicate pregnancy or are aggravated by it. 7
1.1 STATEMENT OF THE PROBLEM
Maternal mortality is a substantial public health burden in developing countries. The World Health Organisation estimates that approximately 536,000 women die from pregnancy and childbirth-related complications each year with 95% of these deaths occurring in sub-Saharan Africa and Asia.8 Africa has the highest burden of maternal mortality in the world and sub-Saharan Africa is largely responsible for the dismal maternal death figure for that region, contributing approximately 98% of the maternal deaths for the region.8 The lifetime risk of maternal death in sub-Saharan Africa is 1 in 22 mothers compared to 1 in 210 in Northern Africa, 1 in 62 for Oceania, 1 in 120 for
Asia, 1 in 290 for Latin America and the Caribbean, and 1 in 29,800 for
Sweden.8
Nigeria is a leading contributor to the maternal death figure in sub-Saharan Africa, not only because of the hugeness of her population but also because of her high maternal mortality ratio. Nigeria has a maternal mortality ratio of 545 per 100,000.9 With an estimated 59,000 maternal deaths annually, Nigeria which has approximately 2% of the world’s population contributes 10% of the world’s maternal deaths.10 The only country that has a higher absolute number of maternal deaths is India, with 136,000 maternal deaths each year. 11 Maternal mortality ratios in Nigeria vary considerably between various states in the country and between rural and urban areas. It is considerably higher in rural than urban areas and worse in the Northeast and Northwest geopolitical zones than in the Southwest and Southeast zones. 12
Maternal morbidity, defined as chronic and persistent ill health occurring due to complications of pregnancy, labour, delivery, and postpartum ,11 is an important indicator of maternal health. Available evidence indicates that for every woman who dies during childbirth in Nigeria, another 30 suffer short and long-term disabilities, 11 such as chronic anaemia, maternal exhaustion or physical weakness; obstetric fistula, stress incontinence; chronic pelvic pain, pelvic inflammatory disease, infertility, ectopic pregnancy; and emotional depression etc. UNFPA estimates that 2 million women are affected by obstetric fistula in the developing world, out of which 800,000 (40%) occur in Nigeria, particularly in the north. 13
The tragic issue of maternal deaths has received global attention and different strategies have been designed for its reduction to date.14 The Safe Motherhood initiative was launched in Nairobi Kenya in 1987. In 1990, Safe Motherhood conference took place in Abuja , Nigeria. Another Safe Motherhood conference took place in Colombo, Sri Lanka in 1997. In 1998 the World Health Day theme was: “ Pregnancy is Special: Let us Make it Safe”. Still in an attempt to address the issue of maternal deaths, the UN General Assembly, in 1999, recommended increasing the proportion of births assisted by Health Professionals to 80%. The magnitude, developmental and Human Rights nature of the issue gave it prominence at the United Nations summit in 2000 where one of the three health-related Millennium Development Goals (MDGs) was devoted to reducing, by 75%, maternal mortality rate by 2015. 14,15
1.2 RATIONALE FOR THE STUDY
The strategies for the Safe Motherhood initiative launched in 1987 include: provision of family planning services, provision of post-abortal care, improve antenatal care services, skilled attendant during labour and delivery, Emergency
Obstetric care (EmOC) and address adolescent reproductive health issues. 16 Despite over two decades of promotion of the Safe Motherhood Initiative globally, maternal deaths continue to rise in most developing countries. 2
Data from the Nigerian Demographic and Health surveys indicate that among pregnant Nigerian women, only about 64% receive antenatal care from a qualified health care provider. 17, 24 There are wide regional variations, with only about 28% of women in the Northwest Zone and 54% in the Northeast zone receiving antenatal care from trained health providers. The rest either do not receive antenatal care at all or receive care from untrained traditional birth attendants, herbalists, or religious diviners. Nigerian women are more likely to receive antenatal care from a trained provider if they have secondary or higher levels of education, and if they are economically advantaged. Urban women are more likely to receive antenatal care than rural women.
Only about 37% of deliveries in Nigeria take place in health institutions, while 57% of deliveries take place at home. 18, 24, 29 With such a large number of deliveries taking place at home, when women suffer complications such as haemorrhage, prolonged labour, and eclampsia, there is often delay in bringing them to health facilities where they can be treated. Thus, it is not the complication per se that causes these deaths but the delay in obtaining emergency treatment for the complications that cause death among Nigerian women. 11 Such delays have been eliminated or substantially reduced in many developed countries, hence the lower rates of mortality among pregnant women. By contrast, delays remain the defining feature of maternity care in Nigeria. 11 Since it is not possible to predict which women will experience life-threatening obstetric complications that lead to maternal mortality, receiving care from a skilled provider (doctor, nurse, or midwife) during childbirth has been defined as the single most important intervention in Safe Motherhood .19
However the use of skilled providers in developing countries remains low.
Three types of delays that influence the provision and use of obstetric services in obstetric complications/emergencies to prevent maternal mortalities have been identified. 20, 21 The first is delay in deciding to seek care if complication occurs. The second is delay in reaching care while the third is delay in receiving care at the health facility. The results of a detailed analysis of maternal deaths in Nigeria indicate that 40% of delays associated with maternal deaths were due to the first type of delay, 20% were due to the second, while the third accounted for 40% of cases. 22 Scientific evidence has clearly established the inverse relationship between skilled attendants at birth and the occurrence of maternal deaths. 23 Thus, the considerable variation in the maternal mortality estimates between different locations within the same region can be attributed, to a large degree, to access to modern maternal health services. 10
Fully equipped health facilities with skilled attendants (doctors, nurses, and midwives) are not the only means to reducing maternal mortality. It is only when the services provided are effectively utilised by pregnant women that positive results can be achieved. Pregnant women need to adequately plan and prepare for labour and delivery in the presence of a skilled attendant. They should also anticipate and prepare for possible complications and emergencies. Birth preparedness and emergency readiness is a concept that will significantly contribute to reduction of maternal mortality and morbidity. This study will provide information for informed Public Health actions targeted towards reduction of maternal mortality and morbidity. It will also contribute to research in the area of improvement of maternal health.
1.3 AIM AND OBJECTIVES
AIM: To assess the birth preparedness and emergency readiness of antenatal clinic attendees in Amaku General Hospital Awka , Anambra State.
SPECIFIC OBJECTIVES
1. To assess the plans for delivery of pregnant women attending antenatal clinic in Amaku General Hospital Awka, Anambra State.
2. To assess the preparedness of the pregnant women for emergencies during pregnancy, delivery, and post-delivery.
To ascertain sociodemographic and other factors influencing adequate planning for delivery and emergency by the pregnant women.