Table of contents
Title page………………………………………………………
Approval page…………………………………………………
Declaration..……………………………………………………i
Dedication……………………………………………………..ii
Acknowledgements …………………………………………..iii
Table of contents………………………………………………iv
List of Tables……………………………………………………vi
List of figures and Appendices………..………………………viii
Abstract…………………………………………………………1
CHAPTER ONE
Introduction …………………………………………………….4
Rationale for the study……………………………………..……9
Aim and Objectives……………………………………………12
CHAPTER TWO
Literature Review……………………………………………13
v
CHAPTER THREE
Methodology……………………………………………..26
Limitations of the Study…………………………………33
CHAPTER FOUR
Results……………………………………………………34
CHAPTER FIVE
Discussion…………………………………..……………57
CHAPTER SIX
Conclusion.…………………………………..…………..63
Recommendations…………………..……………………64
References…………………………………..……………66
Appendices………………………………………………75
vi
LIST OF TABLES
Table 1: Socio-demographic characteristics of
respondents……………………………………..…..34
Table 2: Registration for ANC and plans for
delivery………………………………………………36
Table 3: Plans for delivery and emergencies.………37
Table 4: Knowledge of signs of severe conditions in
pregnancy or labour………………………………..38
Table 5: Prophylaxis and preparation for delivery and
emergencies……………………………………………….40
Table 6: Birth preparedness in relation to age…….43
Table 7: Emergency readiness in relation to age…..44
Table 8: Birth preparedness in relation to parity….45
Table 9: Emergency readiness in relation to parity..46
Table 10: Birth preparedness in relation to educational
level…………………………………………………47
Table 11: Emergency readiness in relation to
educational level……………………………………48
vii
Table 12: Birth preparedness in relation to
occupation…………………………………..…….49
Table 13: Emergency readiness in relation to
occupation………………………………………….50
Table 14: Birth preparedness in relation to
religion……………………………………………51
Table 15: Emergency readiness in relation to
religion…………………………………………….52
Table 16: Birth preparedness in relation to gestational
age…..…………………………………………….53
Table 17: Emergency readiness in relation to gestational
age…..…………………………………………….54
Table 18: Birth preparedness in relation to
socioeconomic status……………………………..55
Table 19: Emergency readiness in relation to
socioeconomic status……………..………………56
viii
LIST OF FIGURES
Figure I: Birth preparedness of respondents…………41
Figure II: Emergency readiness of respondents………42
LIST OF APPENDICES
Appendix I: Informed consent…………………………75
Appendix II: Questionnaire…………………………..78
Appendix III: Copy of ethical clearance by the Nnamdi
Azikiwe University Teaching Hospital Ethical
Committee……………………………………………87
1
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
2
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 <20weeks (p=0.027). As much as
67.9% of the respondents of parity one to three were birth
prepared compared to 46.9% of the respondents who were
primiparous and 25% of the respondents of parity greater than or
equal to four (p=0.011). Whereas 85% of the respondents knew at
least one danger sign in pregnancy, labour and post-partum, 12%
knew four or more while 3% were completely ignorant of the
danger signs. As much as 97% of the respondents were on routine
drugs, 84% had received tetanus toxoid but only 26% had received
3
malaria prophylaxis (intermittent preventive treatment with
sulphadoxine and pyrimethamin IPTsp).
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.
4
CHAPTER ONE
1.0 INTRODUCTION
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
5
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
6
“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
7
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
8
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
9
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.
10
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
11
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.
12
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.
3. To ascertain sociodemographic and other factors influencing adequate
planning for delivery and emergency by the pregnant women.
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