HEALTH CARE-SEEKING BEHAVIOUR DURING PREGNANCY AMONG WOMEN OF AKINYELE LOCAL GOVERNMENT AREA, OYO STATE, NIGERIA

Abstract

The problems of maternal morbidity and mortality have been associated with inappropriate health care seeking behaviour in pregnancy and childbirth. As a result, WHO and UNICEF established the Safe Motherhood initiative with a major focus on pre-natal care which includes early presentation at antenatal clinic (ANC) where risk factors can be identified and managed, and a safe delivery can be ensured. The purpose of this study was to learn the details of prenatal health care seeking and the social and cognitive rectors (e.g perceived social supports attitude and self-efficacy) that influence these choices in eight villages that comprise the town of Moniya in Akinyele Local Government Area (LGA) of Oyo State and to discuss the implications of the findings for health education. Women who had delivered a baby in the previous year constituted the population of the study. Sampling covered all eight communities in Moniya Ward of Akinyele of LGA. Effort was made to interview 50 women in each community. In smaller villages, all homes were visited and all eligible women present were interviewed. In the larger settlements, systematic sampling was used. When 50 women were not found in some smaller settlements, additional women were sampled in the the larger ones. A questionnaire was developed from Focus Group Discussion responses and pretested in a nearby Ibadan North LGA. Women of child bearing age were trained as interviewers. A total of 405 women were interviewed. Their ages ranged between 18 and 50 with a mean of 27 years. For 121 (29.9%) responded that the most recent pregnancy was their first. Most (84.9%) had registered for ANC during the most recent pregnancy. The median age of pregnancy at the time of registration was 20 weeks with 6.0% registering in the first trimester, 64.8% in the second trimester and the remainder registering in the last trimester. After registration women attended a median of 6.0 ANC sessions, which was more than the five sessions recommended by WHO. Regression analysis showed that registration at ANC was found to be associated with higher educational level, higher levels of perceived self-efficacy, more positive attitudes toward ANC, and parity as defined by having had at least one child prior to the present pregnancy. Registration for ANC increased with education from 61.4% no education to 84.7% with at least primary education and 91.3% with secondary or higher education registered. Mean attitude score on a scale that ranged from 6-30 points for those who registered was 24.6 points compared to 22.1 for those who did not. Although the mean social support score for registration at ANC was higher for those who registered (20.9) compared to those who did not (15.8), this factor did not show an association in the regression analysis. This respondents reported that they avoided certain foods during

pregnancy, most commonly walnut, snail, snake, yellow yam and cassava products (fufu and garri). These Foods were avoided to prevent feeling heavy, stomach pain and because of other people's advice. Activities they avoided included carrying heavy loads, trekking long distances, street hawking, drawing water, walking about at midday or midnight, and breaking firewood. The Iast reported act of health care seeking during pregnancy was choosing a place to deliver. The largest proportion of women (193 or 47.7%) delivered at a LGA maternity centre, 73 (18.0%) went to a private or mission hospital, 43 (10.6%) stayed at home, 41 (10.1%) attended a government hospital, 33 (8.1%) went to a church or spiritual home, 15 (3.7%) delivered at a TBA's house, while two (0.5%) delivered on the farm and five (1.2%) gave no response. In summary, most deliveries were attended to by trained personnel Women who delivered at home or with a TBA tended to be older, and those who delivered at a spiritual home tended to be younger than those who delivered at an orthodox health facility. Use of an orthodox facility also increased as educational level rose. Those who delivered at home or with a TBA had higher parity, while those who delivered at a spiritual home had lower parity than those delivering at an orthodox facility. Women who were married in polygamous unions were more likely to deliver at home or with a TBA, while single mothers or those in monogamous marriages were more likely to use orthodox facilities.