Choice of birth place among antenatal clinic attendees in rural mission hospitals in Ebonyi State, South-East Nigeria

PLoS ONE, Volume 14, No. 11, Year 2019

Interpretation

Background Low utilization of health facilities for delivery by pregnant women poses a public health challenge in Nigeria. Aim To determine the factors that influence the choice of birth place among antenatal clinic attendees. Methodology This was a cross-sectional study of the eligible antenatal clinic attendees recruited at Mater Misericordiae Hospital, Afikpo and Saint Vincent Hospital, Ndubia in Ebonyi State from February 1, 2016 to June 30, 2016. Analysis was done using EPI Info 7.21 software (CDC Atlanta Georgia). Results A total of 397(99.3%) completely filled questionnaires were collated and analysed. Approximately 71% of the health facilities closest to the respondents had maternity services. It took at least 1 hour for 80.9% of the respondents to access health facilities with maternity services. Most (60.2%) of the respondents had at least one antenatal clinic attendance and majority of them did so at public hospitals. Approximately 43.8% of the respondents were delivered by the skilled birth attendants. The respondents’ age and the couple’s educational level, history of antenatal clinic attendance, distance of the health facility and availability of transport fare had a significant effect on delivery by skilled birth attendants. The common determinants of birth place were nearness of the health facilities, familiarity of healthcare providers, improved services, sudden labour onset and cost. Also 61.7% of the respondents chose to deliver in public health facilities due to favourable reasons but this could be hampered by the rudeness of some healthcare providers at such facilities. A significant proportion of private health facilities had unskilled manpower and shortage of drugs. Conclusion A greater proportion of women will prefer to deliver in health facilities. However there are barriers to utilization of these facilities hence the need to address such barriers. Mater Misericordiae Hospital, Afikpo was founded in 1946 by the St Patrick Missionaries, a Roman Catholic based religious group. It is a secondary hospital that serves Afikpo community, the neighboring communities in Ebonyi and other surrounding States of Abia, Akwa Ibom, Cross River, Enugu and Imo. Majority of the patients treated in this hospital are low income earners and rural dwellers. Saint Vincent’s Hospital, Ndubia is also a secondary hospital located in Izzi Local Government Area of Ebonyi State. The hospital was established in the early 1960 by the Catholic missionaries. The hospital serves the rural population in Izzi, Ikwo, Ezza and neighbouring states of Cross River and Benue. Most of the patients are rural dwellers and are predominantly farmers. This was a cross-sectional study in which interviewer-administered semi-structured questionnaires were used to extract information from the consenting antenatal clinic attendees who had history of previous delivery prior to the index pregnancy. The questionnaires were administered by the researchers and trained research assistants. Prior to this study, the questionnaires were pre-tested on 20 antenatal clinic attendees at the Federal Teaching Hospital, Abakaliki. Each of the questionnaires had six sections and these sections comprised the participants’ socio-demographic characteristics, accessibility to healthcare services, previous antenatal and delivery history, rating of public and private health facilities, the pregnancy risks and recommendation for good maternal and perinatal outcome. The number of study participants recruited from each centre was based on the proportion of antenatal clinic attendees in each of the study centres. The study participants were consecutively recruited until the number allocated to each centre was completed. The eligible participants in this study were antenatal clinic attendees who had history of delivery within 3 years prior to the index pregnancy and those who gave consent to participate in the study. However, the exclusion criteria comprised participants whose questionnaires were incompletely filled, nulliparous women and women who, despite adequate counseling, declined to participate in the study. The minimum sample size for the study was calculated using the sample estimation formula for cross sectional studies,[17] P = prevalence of delivery in Nigerian health facilities = 38%[4]; 1-p = number of deliveries outside established health facility = 1–0.38 = 0.62 e = standard error = 5% and Z = standard normal variance = 1.96 at 95% confidence interval. Adding a 10% attrition rate, n was 398 Data were analyzed with EPI Info 7.21 software (CDC Atlanta Georgia). The ethical clearance for this study was obtained from the Ethics Committee of the Federal Teaching Hospital, Abakaliki. Institutional Permission was also obtained from Mater Misericordiae Hospital, Afikpo and St. Vincent Hospital, Ndubia before the commencement of this study. Confidentiality was achieved on all the study participants through the use of anonymous questionnaires and the information was individually obtained from each of the participants.

AI Digest

Study Justification:

The study aimed to investigate the factors influencing the choice of birth place among antenatal clinic attendees in rural mission hospitals in Ebonyi State, South-East Nigeria. This research is important because low utilization of health facilities for delivery by pregnant women is a public health challenge in Nigeria. Understanding the factors that influence women’s decision-making regarding birth place can help inform strategies to improve maternal and neonatal health outcomes.

Highlights:

– The study found that approximately 71% of the health facilities closest to the respondents had maternity services.
– It took at least 1 hour for 80.9% of the respondents to access health facilities with maternity services.
– Most of the respondents had at least one antenatal clinic attendance, with the majority choosing public hospitals.
– Approximately 43.8% of the respondents were delivered by skilled birth attendants.
– Factors such as the respondents’ age, couple’s educational level, history of antenatal clinic attendance, distance to the health facility, and availability of transport fare significantly influenced delivery by skilled birth attendants.
– Common determinants of birth place included nearness of the health facilities, familiarity of healthcare providers, improved services, sudden labor onset, and cost.
– While 61.7% of the respondents chose to deliver in public health facilities due to favorable reasons, the rudeness of some healthcare providers at such facilities could hamper this preference.
– Private health facilities were found to have unskilled manpower and shortages of drugs.

Recommendations:

Based on the study findings, the following recommendations are made:

1. Address barriers to utilization of health facilities for delivery by pregnant women.
2. Improve the availability and quality of maternity services in health facilities, particularly in rural areas.
3. Provide training and support to healthcare providers to improve their interpersonal skills and reduce rudeness towards patients.
4. Strengthen private health facilities by addressing the shortage of skilled manpower and ensuring an adequate supply of drugs.

Key Role Players:

1. Ministry of Health: Responsible for policy development and implementation of strategies to improve maternal and neonatal health.
2. Mission Hospitals: Provide healthcare services and can collaborate with the government to implement recommended interventions.
3. Healthcare Providers: Need to be trained and supported to improve their skills and attitudes towards pregnant women.
4. Community Leaders: Can play a role in promoting the use of health facilities for delivery and addressing community-level barriers.
5. Non-Governmental Organizations (NGOs): Can provide support and resources to implement interventions aimed at improving maternal and neonatal health outcomes.

Cost Items for Planning Recommendations:

1. Training Programs: Budget for training healthcare providers on interpersonal skills and best practices in maternity care.
2. Infrastructure Improvement: Allocate funds for improving the infrastructure and equipment in health facilities to ensure the availability of quality maternity services.
3. Drug Supply: Budget for ensuring a consistent supply of essential drugs in both public and private health facilities.
4. Community Sensitization: Allocate funds for community outreach programs to raise awareness about the importance of utilizing health facilities for delivery.
5. Monitoring and Evaluation: Set aside resources for monitoring and evaluating the implementation and impact of the recommended interventions.
Please note that the cost items provided are general categories and should be further detailed and tailored to the specific context and needs of the study area.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study utilized a cross-sectional design and collected data from a significant number of participants. The analysis was done using appropriate software. However, the abstract does not provide information on the sampling method used or the representativeness of the sample. Additionally, the abstract does not mention any limitations of the study. To improve the evidence, the authors could provide more details on the sampling method and address any limitations of the study in the abstract.

Abstract

Mater Misericordiae Hospital, Afikpo was founded in 1946 by the St Patrick Missionaries, a Roman Catholic based religious group. It is a secondary hospital that serves Afikpo community, the neighboring communities in Ebonyi and other surrounding States of Abia, Akwa Ibom, Cross River, Enugu and Imo. Majority of the patients treated in this hospital are low income earners and rural dwellers. Saint Vincent’s Hospital, Ndubia is also a secondary hospital located in Izzi Local Government Area of Ebonyi State. The hospital was established in the early 1960 by the Catholic missionaries. The hospital serves the rural population in Izzi, Ikwo, Ezza and neighbouring states of Cross River and Benue. Most of the patients are rural dwellers and are predominantly farmers. This was a cross-sectional study in which interviewer-administered semi-structured questionnaires were used to extract information from the consenting antenatal clinic attendees who had history of previous delivery prior to the index pregnancy. The questionnaires were administered by the researchers and trained research assistants. Prior to this study, the questionnaires were pre-tested on 20 antenatal clinic attendees at the Federal Teaching Hospital, Abakaliki. Each of the questionnaires had six sections and these sections comprised the participants’ socio-demographic characteristics, accessibility to healthcare services, previous antenatal and delivery history, rating of public and private health facilities, the pregnancy risks and recommendation for good maternal and perinatal outcome. The number of study participants recruited from each centre was based on the proportion of antenatal clinic attendees in each of the study centres. The study participants were consecutively recruited until the number allocated to each centre was completed. The eligible participants in this study were antenatal clinic attendees who had history of delivery within 3 years prior to the index pregnancy and those who gave consent to participate in the study. However, the exclusion criteria comprised participants whose questionnaires were incompletely filled, nulliparous women and women who, despite adequate counseling, declined to participate in the study. The minimum sample size for the study was calculated using the sample estimation formula for cross sectional studies,[17] P = prevalence of delivery in Nigerian health facilities = 38%[4]; 1-p = number of deliveries outside established health facility = 1–0.38 = 0.62 e = standard error = 5% and Z = standard normal variance = 1.96 at 95% confidence interval. Adding a 10% attrition rate, n was 398 Data were analyzed with EPI Info 7.21 software (CDC Atlanta Georgia). The ethical clearance for this study was obtained from the Ethics Committee of the Federal Teaching Hospital, Abakaliki. Institutional Permission was also obtained from Mater Misericordiae Hospital, Afikpo and St. Vincent Hospital, Ndubia before the commencement of this study. Confidentiality was achieved on all the study participants through the use of anonymous questionnaires and the information was individually obtained from each of the participants.

Materials

https://efashare.b-cdn.net/materials/c1288e299345a1bbdfd66094fc3ea51cde318e8d3e23438ab9da153ea53a7927/pone.0211306.s001.docx

Innovations

Based on the provided information, here are some potential innovations that can be used to improve access to maternal health:

1. Mobile health clinics: Implementing mobile health clinics that can travel to rural areas and provide maternal health services, including antenatal care and skilled birth attendance. This can help overcome the barrier of distance and improve access to healthcare for rural dwellers.

2. Telemedicine: Introducing telemedicine services that allow pregnant women in remote areas to consult with healthcare providers through video calls or phone calls. This can provide access to medical advice and support, especially for women who are unable to travel long distances to health facilities.

3. Community health workers: Training and deploying community health workers in rural areas to provide basic maternal health services, such as antenatal care and health education. These workers can also serve as a bridge between the community and formal healthcare facilities, helping to increase awareness and utilization of available services.

4. Improving infrastructure: Investing in the improvement of healthcare infrastructure in rural areas, including the construction and renovation of health facilities with maternity services. This can help ensure that there are adequate and well-equipped facilities available for safe deliveries.

5. Addressing healthcare provider attitudes: Implementing training programs and interventions to address the issue of rudeness and unprofessional behavior among healthcare providers. This can help create a more supportive and respectful environment for pregnant women, encouraging them to seek care at health facilities.

6. Public-private partnerships: Collaborating with private healthcare providers to improve access to maternal health services. This can involve subsidizing services or providing incentives to private facilities to offer affordable and quality care to pregnant women in rural areas.

7. Health education and awareness campaigns: Conducting targeted health education and awareness campaigns to increase knowledge and understanding of the importance of skilled birth attendance and utilization of health facilities for delivery. This can help address misconceptions and cultural beliefs that may hinder access to maternal health services.

It’s important to note that the specific context and needs of the community should be taken into consideration when implementing these innovations.

AI Innovations Description

Based on the information provided, here is a recommendation that can be used to develop an innovation to improve access to maternal health:

1. Improve accessibility to health facilities: Since the study found that the distance to health facilities and availability of transport fare were significant factors influencing the choice of birth place, it is important to focus on improving accessibility. This can be done by implementing mobile health clinics or outreach programs that bring healthcare services closer to rural communities. Additionally, providing affordable transportation options or subsidies for pregnant women to access health facilities can also help improve accessibility.

2. Enhance the quality of healthcare services: The study highlighted that some healthcare providers at public health facilities were perceived as rude, which could discourage women from delivering in these facilities. To address this issue, it is crucial to invest in training programs for healthcare providers to improve their interpersonal skills and ensure respectful and compassionate care. Additionally, addressing the shortage of drugs and unskilled manpower in private health facilities is essential to provide quality maternal healthcare services.

3. Increase awareness and education: The study found that the respondents’ age and educational level had a significant effect on the choice of birth place. Therefore, it is important to focus on increasing awareness and education about the benefits of delivering in health facilities, especially among younger women and those with lower educational levels. This can be achieved through community-based education programs, antenatal care sessions, and partnerships with local community leaders and organizations.

4. Address financial barriers: Cost was identified as one of the determinants of birth place. To overcome financial barriers, innovative financing models can be explored, such as community-based health insurance schemes or conditional cash transfer programs that provide financial incentives for women to deliver in health facilities. Additionally, ensuring that essential maternal healthcare services are covered by existing health insurance schemes can also help reduce financial barriers.

5. Strengthen collaboration and coordination: To effectively improve access to maternal health, it is important to strengthen collaboration and coordination between different stakeholders, including government agencies, healthcare providers, community leaders, and non-governmental organizations. This can be achieved through regular meetings, joint planning, and implementation of integrated maternal health programs that address the identified barriers.

By implementing these recommendations, it is possible to develop innovative solutions that can improve access to maternal health and ultimately contribute to better maternal and perinatal outcomes in rural areas.

AI Innovations Methodology

Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Improve transportation infrastructure: Enhancing the accessibility of health facilities by improving roads and transportation systems can reduce the time it takes for pregnant women to reach maternity services.

2. Increase availability of skilled birth attendants: Ensuring that health facilities have an adequate number of skilled birth attendants can improve the quality of care and encourage more women to deliver in health facilities.

3. Enhance healthcare provider training: Addressing the issue of rudeness among healthcare providers can be achieved through training programs that focus on improving communication skills and patient-centered care.

4. Strengthen private health facilities: Private health facilities should be supported with resources, such as skilled manpower and essential drugs, to provide quality maternal health services.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Determine the key indicators that will be used to measure access to maternal health, such as the percentage of women delivering in health facilities, average travel time to the nearest health facility, and availability of skilled birth attendants.

2. Collect baseline data: Gather data on the current status of access to maternal health in the target area, including the number of women delivering in health facilities, travel times, and availability of skilled birth attendants.

3. Introduce the recommendations: Implement the recommended interventions, such as improving transportation infrastructure, increasing availability of skilled birth attendants, and enhancing healthcare provider training.

4. Monitor and collect data: Continuously monitor the implementation of the recommendations and collect data on the indicators identified in step 1. This can be done through surveys, interviews, and data collection from health facilities.

5. Analyze the data: Analyze the collected data to assess the impact of the recommendations on access to maternal health. Compare the baseline data with the data collected after the interventions to determine any changes or improvements.

6. Evaluate the results: Evaluate the results of the analysis to determine the effectiveness of the recommendations in improving access to maternal health. Identify any challenges or areas for further improvement.

7. Adjust and refine interventions: Based on the evaluation results, make any necessary adjustments or refinements to the interventions to further enhance access to maternal health.

By following this methodology, it will be possible to simulate the impact of the recommendations on improving access to maternal health and make informed decisions on how to address barriers and improve maternal healthcare services.

Authors & Co-Authors

Statistics:

Citations: 4

Authors: 8

Identifiers:

DOI: 10.1371/journal.pone.0211306

Research Areas:

Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Workforce

Study Countries:

Nigeria

Study Design:

Cross Sectional Study

Study Approach:

Quantitative

Participants Gender:

Female