Perception and socio-cultural barriers to the acceptance of caesarean delivery in a tertiary hospital in Abakaliki, South East Nigeria

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Study Justification:
– The study aimed to investigate the level of awareness and socio-cultural barriers to the acceptance of caesarean delivery (CS) in a tertiary hospital in Abakaliki, South East Nigeria.
– The study is important because globally, CS has contributed to improved obstetric outcomes in situations where vaginal delivery is not possible. However, in low-income countries, there is resistance to the procedure.
– Understanding the reasons behind the aversion to CS can help in developing strategies to address these barriers and improve maternal health outcomes.
Study Highlights:
– All respondents in the study were aware of CS as an operative abdominal procedure for delivery.
– Over one-tenth of the respondents had previously undergone CS.
– The majority of those who had a previous CS were well-informed about the indications.
– However, about one-fifth of the respondents did not accept CS for various reasons.
– The major barriers to acceptance were being considered a reproductive failure by peers, high cost, and religious beliefs.
– The study highlights the need for adequate health education, female empowerment, access to free or affordable antenatal care services, and the elimination of harmful religious and cultural beliefs regarding caesarean delivery.
Recommendations for Lay Reader and Policy Maker:
– Increase health education efforts to improve awareness and understanding of CS among pregnant women and the general population.
– Empower women by providing them with information and support to make informed decisions about their reproductive health, including the acceptance of CS.
– Ensure access to free or affordable antenatal care services to reduce financial barriers to CS acceptance.
– Address harmful religious and cultural beliefs and myths surrounding caesarean delivery through community engagement and awareness campaigns.
– Implement strategies to reduce the stigma associated with CS and promote a supportive environment for women who choose this delivery method.
Key Role Players:
– Healthcare providers: Responsible for providing accurate information and counseling to pregnant women regarding CS.
– Community leaders and religious leaders: Play a crucial role in dispelling myths and addressing cultural and religious barriers to CS acceptance.
– Government health agencies: Responsible for implementing policies and programs that promote access to affordable antenatal care services and address socio-cultural barriers.
– Non-governmental organizations (NGOs): Can support health education initiatives and community engagement activities to promote CS acceptance.
Cost Items for Planning Recommendations:
– Health education materials: Printing and distribution of brochures, posters, and pamphlets.
– Training programs: Conducting workshops and training sessions for healthcare providers on counseling and communication skills.
– Community engagement activities: Organizing awareness campaigns, community meetings, and focus group discussions.
– Access to affordable antenatal care services: Budgeting for subsidies or financial support for pregnant women who cannot afford the cost of antenatal care and CS.
– Research and evaluation: Allocating funds for monitoring and evaluating the effectiveness of interventions aimed at addressing socio-cultural barriers to CS acceptance.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study conducted a cross-sectional survey among 344 parturients, providing quantitative data on the level of awareness and socio-cultural barriers to the acceptance of caesarean section (CS) in a specific hospital in Nigeria. The study utilized a self-administered questionnaire and analyzed the data using SPSS. The results indicate that all respondents were aware of CS, with a significant proportion having experienced the procedure previously. The study also identified barriers to acceptance, such as societal perceptions, cost, and religious beliefs. The conclusions suggest the need for health education, female empowerment, and addressing cultural and religious beliefs to improve acceptance of CS. To improve the strength of the evidence, future studies could consider a larger sample size, include qualitative data to provide a deeper understanding of the barriers, and conduct a multi-center study to enhance generalizability.

Objectives: Globally, caesarean section (CS) has immensely contributed to improved obstetric outcome in circumstances where vaginal delivery is not feasible. However, in some low-income countries, there is aversion to the procedure. The aim of this study was to determine the level of awareness and socio-cultural barriers to the acceptance of CS. Materials and Methods: A cross-sectional study was conducted among 344 parturients at Federal Teaching Hospital in Abakaliki, from October 1 to November 30, 2016. Data were collated using a self-administered questionnaire and was analyzed using SPSS version 20.0 and conclusions were drawn by means of descriptive statistics. Results: All the respondents were aware of CS as an operative abdominal procedure for delivery; of these, over one-tenth (14.0%; 48/344) had experienced the procedure previously. Over four-fifths (82.3%; 283/344) of those who have had a previous CS were well-informed about the indications. About one-fifth (20.3%; 70/344) did not accept CS for any reasons. The major barriers to acceptance were being considered by peers as a reproductive failure (29.2%; 7/24), high cost (20.8%; 5/24) and religious beliefs (12.5%; 3/24). Conclusions: Majority of antenatal attendees had a significant awareness of CS and the indications. Moreover, a vast majority had morbid aversion towards it; due to numerous, non-evidence based socio-cultural reasons. Therefore, adequate health education, female empowerment, access to free or affordable antenatal care service, elimination of harmful, religious/cultural beliefs and myth regarding caesarean delivery are necessary to curb this ugly trend if we hope to achieve the sustainable development goals related to maternal health.

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Innovation 1: Health Education
Develop a mobile application or online platform that provides comprehensive information on caesarean section (CS) to pregnant women and their families. This platform can include videos, infographics, and interactive modules that explain the benefits, indications, and safety of CS. It can also address common myths and misconceptions surrounding the procedure. The platform should be accessible in local languages and easily navigable for users with low literacy levels.

Innovation 2: Female Empowerment
Establish community-based women’s empowerment centers that provide education and training programs for pregnant women. These centers can offer vocational training, entrepreneurship courses, and workshops on reproductive health and decision-making. Additionally, create mentorship programs where successful women who have undergone CS can share their experiences and provide guidance to pregnant women facing similar decisions.

Innovation 3: Affordable Antenatal Care
Develop a public-private partnership to establish a subsidized health insurance program specifically for maternal healthcare services, including CS. This program can be funded by the government, private sector, and international organizations. It should provide financial support for antenatal care, delivery, and postnatal care, ensuring that all pregnant women have access to affordable CS services. Additionally, improve infrastructure and healthcare systems to enhance the quality and availability of antenatal care services.

Innovation 4: Addressing Socio-cultural Beliefs
Create a community engagement program that involves religious leaders, traditional birth attendants, and community influencers. This program should focus on organizing awareness campaigns, workshops, and dialogues to challenge harmful socio-cultural beliefs and myths surrounding CS. Provide evidence-based information on the safety and benefits of CS, and encourage open discussions to address concerns and misconceptions. Collaborate with local media outlets to disseminate accurate information through radio programs, television shows, and social media platforms.
AI Innovations Description
The study titled “Perception and socio-cultural barriers to the acceptance of caesarean delivery in a tertiary hospital in Abakaliki, South East Nigeria” provides valuable insights into the barriers faced in accessing caesarean section (CS) for maternal health. Based on the findings, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Health Education: Implement comprehensive health education programs targeting pregnant women and their families to increase awareness and understanding of CS. This should include information on the benefits, indications, and safety of the procedure, dispelling myths and misconceptions.

2. Female Empowerment: Promote women’s empowerment through education and economic opportunities, enabling them to make informed decisions about their reproductive health. This can be achieved through vocational training, entrepreneurship programs, and initiatives that promote gender equality.

3. Affordable Antenatal Care: Ensure access to free or affordable antenatal care services, including CS, for all pregnant women. This can be achieved by strengthening healthcare systems, improving infrastructure, and providing financial support or health insurance coverage for maternal healthcare services.

4. Addressing Socio-cultural Beliefs: Collaborate with community leaders, religious institutions, and traditional birth attendants to challenge harmful socio-cultural beliefs and myths surrounding CS. Conduct awareness campaigns and engage in dialogue to promote evidence-based information and dispel misconceptions.

By implementing these recommendations, it is possible to improve access to maternal health, reduce aversion towards CS, and work towards achieving the sustainable development goals related to maternal health.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be employed:

1. Study Design: Conduct a pre- and post-intervention study design to assess the impact of the recommendations. Select a sample population of pregnant women attending antenatal care at the tertiary hospital in Abakaliki, South East Nigeria.

2. Baseline Assessment: Collect baseline data on the level of awareness, acceptance, and barriers to caesarean section (CS) among the pregnant women using a self-administered questionnaire similar to the one used in the original study.

3. Intervention Implementation: Implement the recommendations outlined in the abstract, including health education programs, female empowerment initiatives, affordable antenatal care services, and addressing socio-cultural beliefs. These interventions can be implemented over a specified period, such as six months or one year.

4. Post-Intervention Assessment: After the intervention period, collect data using the same questionnaire to assess any changes in awareness, acceptance, and barriers to CS among the pregnant women.

5. Data Analysis: Analyze the data using appropriate statistical methods, such as descriptive statistics and chi-square tests, to compare the pre- and post-intervention results. This analysis will help determine the impact of the recommendations on improving access to maternal health.

6. Evaluation: Evaluate the findings to determine the effectiveness of the recommendations in improving access to maternal health. Assess the changes in awareness, acceptance, and barriers to CS and identify any significant improvements or areas that still need attention.

7. Recommendations: Based on the evaluation, provide recommendations for further improvements or modifications to the interventions implemented. These recommendations can help refine the strategies and ensure sustained improvements in access to maternal health.

By following this methodology, researchers can assess the impact of the recommendations outlined in the abstract and make informed decisions on how to improve access to maternal health in the context of caesarean section in Abakaliki, South East Nigeria.

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