FACTORS INFLUENCING LOW USE OF MOTHER AND CHILD HOSPITAL, AKURE FOR DELIVERY SERVICES AMONG WOMEN WHO REGISTERED AT THE ANTE-NATAL CLINIC

Abstract

A significant period in the lives of women and their relatives is pregnancy and childbirth. Skilled Birth Attendants (SBA) offer significant interventions that improve maternal and child health consequently reducing mortality. However, despite provision of appropriate modern equipment, skilled health personnel, and free health services put in place by the Government of Ondo State at the Mother and Child Hospital (MCH) Akure, pregnant women who registered at the MCH still failed to deliver there. Alternatively, they preferred the services rendered by unskilled staff in missions, Traditional Birth Attendants (TBAs), and Homes. While previous studies have largely focused on the utilisation of skilled and unskilled birth attendants for delivery, this study was exclusively aimed at investigating the factors preventing women who registered at the MCH, Akure from delivering their babies in the facility. Lwanga and Lemeshow sample size formula was used to determine the sample size of 417 with p at 40% based on the 2013 Nigeria Demographic and Health Survey estimate. A purposive sampling technique was used to select 417 consenting women who had registered at the MCH but failed to deliver there and the women were assessed through contact tracing. A descriptive cross-sectional survey was conducted among 417 respondents who had registered at the MCH to determine factors that prevented them from delivering in the facility. For qualitative information an In-Depth Interview (IDI) was conducted among 3 consenting respondents (health worker, one mother who had used a Mission, and another a TBA facility).Thematic approach was used to analyse the IDI data. Quantitative data was collected from the 417 respondents using a questionnaire that was administered by me and six (6) trained field assistants. Each respondent was given an interviewer- administered pre-coded questionnaire to obtain information on respondents’ socio-demographic characteristics, information received by registered pregnant women on importance of using Health Facility (HF) for delivery, perceptions and experiences of respondents, and health service-related factors that prevented them from using the HF at delivery. Quantitative data were analysed using, descriptive statistics and Chi-square test at p < 0.05 level of significance. Respondents’ age was 31.7 ± 6.4 years. (80.7%) believe that MCH promotes foetal and maternal wellbeing. The chosen place of next delivery was Mission Home (51.6%), MCH

(30.5%), TBAs Home (14.1%) and respondent’s Home (3.8%). There was significant association between parity, educational attainment and utilization of MCH. Factors preventing the use of MCH for delivery included: lack of privacy in wards (72.2%), waiting period (68.8%), unfriendly attitude of health workers (64.0%), disrespect for mothers (60.0%) and overcrowded delivery ward (56.6%). The main factors for low use of MCH for delivery were lack of privacy in wards and unfriendly attitude of health workers. Therefore, the government and management should train MCH staff on work ethics and behavior through regular workshops, monitoring and supervision and updating infrastructural facilities. Disseminating workshop should be carried out for the government and relevant stakeholders.