Evaluating Religious Influences on the Utilization of Maternal Health Services among Muslim and Christian Women in North-Central Nigeria

BioMed Research International, Volume 2016, Year 2016

Ukuhunyushwa

Introduction. Uptake of antenatal services is low in Nigeria; however, indicators in the Christian-dominated South have been better than in the Muslim-dominated North. This study evaluated religious influences on utilization of general and HIV-related maternal health services among women in rural and periurban North-Central Nigeria. Materials and Methods. Targeted participants were HIV-positive, pregnant, or of reproductive age in the Federal Capital Territory and Nasarawa. Themes explored were utilization of facility-based services, provider gender preferences, and Mentor Mother acceptability. Thematic and content approaches were applied to manual data analysis. Results. Sixty-eight (68) women were recruited, 72% Christian and 28% Muslim. There were no significant religious influences identified among barriers to maternal service uptake. All participants stated preference for facility-based services. Uptake limitations were mainly distance from clinic and socioeconomic dependence on male partners rather than religious restrictions. Neither Muslim nor Christian women had provider gender preferences; competence and positive attitude were more important. All women found Mentor Mothers highly acceptable. Conclusion. Barriers to uptake of maternal health services appear to be minimally influenced by religion. ANC/PMTCT uptake interventions should target male partner buy-in and support, healthcare provider training to improve attitudes, and Mentor Mother program strengthening and impact assessment. The venues for this qualitative study were one urban community and 6 periurban and rural Primary Healthcare Centers (PHCs) located in the Federal Capital Territory (FCT) and Nasarawa State in North-Central Nigeria. The 6 sites were selected from a list of 26 study-eligible PHCs assessed for a large implementation research study conducted in rural and hard-to-reach areas of the aforementioned states (see Section 2.2). The 2006 National Census survey reported populations for FCT and Nasarawa at 1,406,239 and 1,869,377, respectively [23]. As of 2013, the population of Nasarawa comprised 56.7% Christians and 41.1% Muslims [8], while FCT comprised 68.0% Christians and 27.4% Muslims [7]. General population HIV prevalence in Nasarawa and FCT is 8.1% and 7.5%, respectively [7]. The most recent antenatal HIV seroprevalence survey reported 7.5% for Nasarawa and 8.6% for FCT, against a national antenatal seroprevalence of 4.1% [24]. Study population included pregnant ANC attendees, HIV-positive women, and young women of childbearing age. Focus Group Discussions (FGDs) were conducted as part of the MoMent Nigeria study, a Canadian government-funded and World Health Organization-supported PMTCT implementation research project under the 6-study, 3-country INSPIRE initiative [25]. MoMent Nigeria investigates the impact of trained peer HIV-positive counselors (Mentor Mothers) on PMTCT outcomes for HIV-positive women and HIV-exposed infants [26]. MoMent’s formative aspect explored barriers to PMTCT access and uptake, and acceptability of Mentor Mothers as a viable intervention [26]. Participants from the PHCs were first approached as they attended clinic or were contacted by phone by PHC healthcare workers and briefly informed of the study. Young females were recruited from the National Youth Service Corps; they were providing 12 months of community service in FCT and in Nasarawa. Given the staff profiles of the study PHCs and other healthcare facilities in the surrounding study communities, all study participants had been exposed to both male and female Sexual and Reproductive Health or maternal service providers. Women 18 years of age and over were recruited on a rolling basis according to the target focus group, for example, ANC attendees or HIV-positive women; no other specifications were applied for recruitment. Recruitment was stopped once a target of 10 women had been reached for each FGD. Interested participants showed up for the FGD on the appointed date. The study was fully explained and consent sought by study staff. Written participant consent was obtained prior to initiation of all the FGDs. Participants received refreshments and reimbursements commiserate with transport costs applicable to the day of the FGD only. The qualitative study time period was December 2012 to April 2013. Ethical approval was granted by the Institutional Review Boards of the Institute of Human Virology Nigeria and the University of Maryland, Baltimore. Two FGDs were conducted among Mentor Mothers, 2 among pregnant ANC clinic attendees, 2 among mother-to-mother (M2M) HIV support group members, and 1 with young women, totaling 7 FGDs. An interviewer-administered form was used to capture participants’ sociodemographic information such as religious affiliation, age, place of residence, marital status, and parity. Religious affiliation data was collected only after consent was provided and as such the focus groups were a mixture of both Muslim and Christian women. The FGDs were guided by semistructured questionnaires organized thematically as follows: barriers to uptake of ANC services (cost, distance, quality of ANC service, and attitude of healthcare providers), women’s views and experiences as members of M2M groups, and/or being Mentor Mothers, use of unconventional healthcare services or remedies, stigma related to HIV+ status, gender preference for a healthcare provider, and acceptability of Mentor Mother services. FGD facilitators comprised two Social Science professors as well as health professionals (doctors, nurses) and graduate students trained to conduct FGDs. A moderator and comoderator facilitated all FGDs along with at least one observer documenting synergistic group effects and nonverbal cues. Sessions were conducted in English and/or Hausa (the dominant language of the study communities). Bilingual (English and Hausa) facilitators were involved in the conduct, transcription, and analysis of all the FGDs. To maintain anonymity and establish a conducive atmosphere for discussion, participants used self-chosen aliases for each FGD. Each FGD was audio-recorded and lasted approximately 60–90 minutes. Audio recordings were transcribed verbatim; Hausa sessions were transcribed into English by bilingual study staff. FGD transcripts were assigned to 4 groups of 2 coders each. Coders were the same trained individuals who facilitated and transcribed the FGDs. Each group member independently hand-coded their assigned transcript by reviewing each line, phrase, and paragraph to identify the initial key themes. Subsequently, each coding group met separately and then with all other groups, for review and merging of independently analyzed and coded transcripts into a final document. This stage was succeeded with a joint review of each of the 5 groups’ finalized transcripts by the entire team (a panel of 10 researchers from the 4 groups, facilitated by two Social Science professors). In this validation process, codes and themes were examined for content within the context of the document and thematically in relation to the overall interview guide. The resultant data were combined into one matrix to develop visual charts of the words and phrases that represented the themes discovered during analysis. In order to protect the privacy of the respondents and organizations, names of persons and institutions were deleted in the final report.

I-AI Digest

Study Justification:

– The study aimed to evaluate the religious influences on the utilization of maternal health services among Muslim and Christian women in North-Central Nigeria.
– The study was conducted because the uptake of antenatal services in Nigeria is low, and the indicators in the Christian-dominated South have been better than in the Muslim-dominated North.
– Understanding the religious influences on maternal health service utilization can help in developing targeted interventions to improve access and uptake of these services.

Study Highlights:

– The study included 68 women, with 72% being Christian and 28% Muslim.
– No significant religious influences were identified as barriers to maternal service uptake.
– All participants expressed a preference for facility-based services.
– The main limitations to uptake were distance from the clinic and socioeconomic dependence on male partners, rather than religious restrictions.
– Both Muslim and Christian women did not have provider gender preferences; competence and positive attitude were more important.
– Mentor Mothers were found to be highly acceptable by all women.

Recommendations for Lay Reader and Policy Maker:

1. Target male partner buy-in and support: Interventions should focus on engaging male partners in supporting maternal health service utilization.
2. Healthcare provider training: Training programs should be implemented to improve the attitudes of healthcare providers towards pregnant women and improve the quality of care provided.
3. Strengthen and assess the impact of the Mentor Mother program: The Mentor Mother program should be strengthened and its impact on improving maternal health service utilization should be assessed.

Key Role Players:

– Healthcare providers: They play a crucial role in providing quality care and should be trained to improve their attitudes towards pregnant women.
– Male partners: Engaging male partners is important for supporting maternal health service utilization.
– Mentor Mothers: They are an important resource for providing support and guidance to pregnant women and should be strengthened in their role.

Cost Items for Planning Recommendations:

– Training programs for healthcare providers: Budget should be allocated for organizing training programs to improve the attitudes and skills of healthcare providers.
– Community engagement activities: Funds should be allocated for community engagement activities to involve male partners and raise awareness about the importance of maternal health services.
– Mentor Mother program strengthening: Resources should be allocated to strengthen the Mentor Mother program, including training and support for Mentor Mothers.
– Impact assessment: Budget should be allocated for conducting an impact assessment of the interventions implemented to improve maternal health service utilization.

Amandla Obufakazi

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is strong because it provides a clear description of the study design, methods, and results. The study population is clearly defined, and the data collection and analysis procedures are explained. The abstract also presents the main findings and conclusions of the study. However, to improve the evidence, the abstract could include more specific details about the sample size, recruitment process, and data analysis techniques used. Additionally, providing information about the limitations of the study would further strengthen the evidence.

Abstract

The venues for this qualitative study were one urban community and 6 periurban and rural Primary Healthcare Centers (PHCs) located in the Federal Capital Territory (FCT) and Nasarawa State in North-Central Nigeria. The 6 sites were selected from a list of 26 study-eligible PHCs assessed for a large implementation research study conducted in rural and hard-to-reach areas of the aforementioned states (see Section 2.2). The 2006 National Census survey reported populations for FCT and Nasarawa at 1,406,239 and 1,869,377, respectively [23]. As of 2013, the population of Nasarawa comprised 56.7% Christians and 41.1% Muslims [8], while FCT comprised 68.0% Christians and 27.4% Muslims [7]. General population HIV prevalence in Nasarawa and FCT is 8.1% and 7.5%, respectively [7]. The most recent antenatal HIV seroprevalence survey reported 7.5% for Nasarawa and 8.6% for FCT, against a national antenatal seroprevalence of 4.1% [24]. Study population included pregnant ANC attendees, HIV-positive women, and young women of childbearing age. Focus Group Discussions (FGDs) were conducted as part of the MoMent Nigeria study, a Canadian government-funded and World Health Organization-supported PMTCT implementation research project under the 6-study, 3-country INSPIRE initiative [25]. MoMent Nigeria investigates the impact of trained peer HIV-positive counselors (Mentor Mothers) on PMTCT outcomes for HIV-positive women and HIV-exposed infants [26]. MoMent’s formative aspect explored barriers to PMTCT access and uptake, and acceptability of Mentor Mothers as a viable intervention [26]. Participants from the PHCs were first approached as they attended clinic or were contacted by phone by PHC healthcare workers and briefly informed of the study. Young females were recruited from the National Youth Service Corps; they were providing 12 months of community service in FCT and in Nasarawa. Given the staff profiles of the study PHCs and other healthcare facilities in the surrounding study communities, all study participants had been exposed to both male and female Sexual and Reproductive Health or maternal service providers. Women 18 years of age and over were recruited on a rolling basis according to the target focus group, for example, ANC attendees or HIV-positive women; no other specifications were applied for recruitment. Recruitment was stopped once a target of 10 women had been reached for each FGD. Interested participants showed up for the FGD on the appointed date. The study was fully explained and consent sought by study staff. Written participant consent was obtained prior to initiation of all the FGDs. Participants received refreshments and reimbursements commiserate with transport costs applicable to the day of the FGD only. The qualitative study time period was December 2012 to April 2013. Ethical approval was granted by the Institutional Review Boards of the Institute of Human Virology Nigeria and the University of Maryland, Baltimore. Two FGDs were conducted among Mentor Mothers, 2 among pregnant ANC clinic attendees, 2 among mother-to-mother (M2M) HIV support group members, and 1 with young women, totaling 7 FGDs. An interviewer-administered form was used to capture participants’ sociodemographic information such as religious affiliation, age, place of residence, marital status, and parity. Religious affiliation data was collected only after consent was provided and as such the focus groups were a mixture of both Muslim and Christian women. The FGDs were guided by semistructured questionnaires organized thematically as follows: barriers to uptake of ANC services (cost, distance, quality of ANC service, and attitude of healthcare providers), women’s views and experiences as members of M2M groups, and/or being Mentor Mothers, use of unconventional healthcare services or remedies, stigma related to HIV+ status, gender preference for a healthcare provider, and acceptability of Mentor Mother services. FGD facilitators comprised two Social Science professors as well as health professionals (doctors, nurses) and graduate students trained to conduct FGDs. A moderator and comoderator facilitated all FGDs along with at least one observer documenting synergistic group effects and nonverbal cues. Sessions were conducted in English and/or Hausa (the dominant language of the study communities). Bilingual (English and Hausa) facilitators were involved in the conduct, transcription, and analysis of all the FGDs. To maintain anonymity and establish a conducive atmosphere for discussion, participants used self-chosen aliases for each FGD. Each FGD was audio-recorded and lasted approximately 60–90 minutes. Audio recordings were transcribed verbatim; Hausa sessions were transcribed into English by bilingual study staff. FGD transcripts were assigned to 4 groups of 2 coders each. Coders were the same trained individuals who facilitated and transcribed the FGDs. Each group member independently hand-coded their assigned transcript by reviewing each line, phrase, and paragraph to identify the initial key themes. Subsequently, each coding group met separately and then with all other groups, for review and merging of independently analyzed and coded transcripts into a final document. This stage was succeeded with a joint review of each of the 5 groups’ finalized transcripts by the entire team (a panel of 10 researchers from the 4 groups, facilitated by two Social Science professors). In this validation process, codes and themes were examined for content within the context of the document and thematically in relation to the overall interview guide. The resultant data were combined into one matrix to develop visual charts of the words and phrases that represented the themes discovered during analysis. In order to protect the privacy of the respondents and organizations, names of persons and institutions were deleted in the final report.

Izinto zokwakha

N/A

Emisha

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

1. Male partner involvement: Develop interventions that target male partners and emphasize the importance of their support in accessing maternal health services. This could include educational campaigns, community outreach programs, and support groups specifically for male partners.

2. Healthcare provider training: Implement training programs for healthcare providers to improve their attitudes and competence in providing maternal health services. This could involve workshops, continuing education programs, and mentorship opportunities to enhance their skills and knowledge.

3. Mentor Mother program strengthening: Strengthen and expand the Mentor Mother program, which involves trained peer HIV-positive counselors providing support to HIV-positive women and HIV-exposed infants. This program has been found to be highly acceptable and effective in improving PMTCT outcomes. Enhancements could include increasing the number of Mentor Mothers, providing ongoing training and support, and conducting impact assessments to measure the program’s effectiveness.

4. Addressing socioeconomic barriers: Develop strategies to address socioeconomic barriers to accessing maternal health services, such as distance from clinics and socioeconomic dependence on male partners. This could involve establishing mobile clinics or transportation services, providing financial assistance or incentives for women to access services, and promoting economic empowerment programs for women.

5. Community engagement: Engage the community in promoting and supporting maternal health services. This could include community awareness campaigns, involving community leaders and religious institutions in advocating for maternal health, and establishing community-based support groups or networks for pregnant women and new mothers.

These recommendations aim to address the specific barriers identified in the study and improve access to maternal health services in the North-Central region of Nigeria.

AI Innovations Description

Based on the description provided, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Target male partners: The study found that one of the main barriers to accessing maternal health services was the socioeconomic dependence on male partners. To address this, an innovation could be developed to specifically target male partners and involve them in the maternal health process. This could include educational campaigns, community outreach programs, and support groups specifically designed for male partners to raise awareness about the importance of maternal health and encourage their involvement in supporting their partners.

2. Healthcare provider training: The study found that competence and positive attitude of healthcare providers were more important than provider gender preferences. Therefore, an innovation could focus on training healthcare providers to improve their attitudes towards pregnant women and create a supportive and welcoming environment. This could include training programs, workshops, and continuous professional development opportunities for healthcare providers to enhance their knowledge and skills in providing quality maternal health services.

3. Strengthen and assess Mentor Mother program: The study found that Mentor Mothers were highly acceptable and could be a viable intervention to improve access to maternal health services. An innovation could involve strengthening and expanding the Mentor Mother program, which involves trained peer HIV-positive counselors providing support and guidance to pregnant women and mothers. This could include increasing the number of Mentor Mothers, providing them with additional training and resources, and conducting regular assessments to measure the impact and effectiveness of the program.

Overall, these recommendations can be used as a basis for developing innovative approaches to improve access to maternal health services, particularly in areas with religious influences like North-Central Nigeria.

AI Innovations Methodology

Based on the provided description, here are some potential recommendations for improving access to maternal health:

1. Target male partners: Since the study found that limitations in accessing maternal health services were mainly due to distance from clinics and socioeconomic dependence on male partners, interventions should focus on engaging and educating male partners. This could include awareness campaigns, community outreach programs, and involving male partners in decision-making processes related to maternal health.

2. Improve healthcare provider attitudes: The study found that competence and positive attitude were more important to women than the gender of the healthcare provider. Therefore, training programs should be implemented to improve healthcare provider attitudes towards pregnant women and create a supportive and respectful environment for maternal health services.

3. Strengthen and assess the impact of Mentor Mother programs: The study found that Mentor Mothers were highly acceptable to all women. Therefore, efforts should be made to strengthen and expand Mentor Mother programs, which involve trained peer HIV-positive counselors supporting HIV-positive women and HIV-exposed infants. Additionally, impact assessments should be conducted to measure the effectiveness of Mentor Mother programs in improving access to 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: Identify specific indicators that will be used to measure the impact of the recommendations. For example, indicators could include the percentage of male partners involved in maternal health decision-making, the percentage of healthcare providers with positive attitudes towards pregnant women, and the percentage of women accessing maternal health services.

2. Collect baseline data: Gather data on the current status of the indicators before implementing the recommendations. This could involve surveys, interviews, or analysis of existing data.

3. Implement interventions: Roll out the recommended interventions, such as awareness campaigns targeting male partners, training programs for healthcare providers, and strengthening Mentor Mother programs.

4. Monitor and evaluate: Continuously monitor the implementation of the interventions and collect data on the indicators. This could involve regular surveys, interviews, or analysis of existing data.

5. Analyze the data: Analyze the collected data to assess the impact of the interventions on the indicators. This could involve statistical analysis, comparison of pre- and post-intervention data, or qualitative analysis of feedback from participants.

6. Draw conclusions and make recommendations: Based on the analysis of the data, draw conclusions about the effectiveness of the interventions in improving access to maternal health. Make recommendations for further improvements or adjustments to the interventions based on the findings.

7. Repeat the process: Continuously repeat the monitoring and evaluation process to assess the long-term impact of the interventions and make further adjustments as needed.

Umbhali

Dima Health

Statistics:

Citations: 28

Identifiers:

DOI: 10.1155/2016/3645415

ISSN: 23146133

Research Areas:

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

Study Countries:

Nigeria

Study Design:

Cross Sectional Study, Exploratory Study, randomised-control-trial

Study Approach:

Mixed-methods, Qualitative, Quantitative

Participants Gender:

Male & Female

Yabelana ngalokhu: