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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.
