Socioeconomic barriers to safe motherhood among booked patients in rural Nigerian communities

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Study Justification:
This study aims to investigate the socioeconomic barriers that prevent booked patients in rural Nigerian communities from accessing safe motherhood services. The high number of avoidable obstetric emergencies and maternal deaths in the study area highlights the urgent need to address these barriers. By understanding the reasons behind late presentation and the patients’ perspectives, this study provides valuable insights for developing effective interventions to improve maternal and perinatal health outcomes.
Study Highlights:
– The study found that financial constraints were the main reason for late presentation among booked patients, with 85.1% of participants citing this as a barrier.
– Other barriers included poor access to hospitals and transportation difficulties (33.5%), objection to hospital admission by relatives (23.0%), aversion to caesarean section (21.7%), and negative attitudes towards hospital staff (8.1%).
– Obstetric complications such as obstructed labor, postpartum hemorrhage, puerperal sepsis, eclampsia, and retained second twin were common among the patients.
– The study identified a high maternal mortality rate (1467/100,000 births) and a perinatal mortality rate of 290/1000 total births.
Recommendations for Lay Readers and Policy Makers:
1. Reduce the economic burden associated with hospital fees: Implement measures to make maternal healthcare services more affordable, such as subsidizing fees or providing financial assistance to low-income families.
2. Improve access to hospitals and transportation: Enhance transportation infrastructure and services in rural areas to ensure that pregnant women can easily reach healthcare facilities.
3. Encourage family support: Raise awareness about the importance of family support during pregnancy and childbirth, and promote community initiatives that provide assistance to pregnant women and their families.
4. Address aversion to caesarean section: Conduct educational campaigns to dispel misconceptions and fears surrounding caesarean section, emphasizing its potential life-saving benefits for both mother and baby.
5. Improve attitudes and communication among hospital staff: Implement training programs for healthcare providers to enhance their interpersonal skills and promote respectful and compassionate care.
Key Role Players:
1. Ministry of Health: Responsible for developing and implementing policies and programs to improve maternal healthcare services.
2. Healthcare Facilities: Should collaborate with the Ministry of Health to ensure the availability of affordable and accessible maternal healthcare services.
3. Non-Governmental Organizations (NGOs): Can play a crucial role in providing financial support, transportation services, and community-based initiatives to address the identified barriers.
4. Community Leaders and Traditional Birth Attendants: Important stakeholders in raising awareness and promoting positive attitudes towards safe motherhood practices.
Cost Items for Planning Recommendations:
1. Subsidies for hospital fees: Budget allocation for providing financial assistance to low-income families accessing maternal healthcare services.
2. Transportation infrastructure improvement: Funds for road construction, maintenance, and provision of ambulances or other transportation services.
3. Educational campaigns: Budget for developing and implementing awareness campaigns targeting the community, healthcare providers, and pregnant women.
4. Training programs for healthcare providers: Allocation for organizing training sessions and workshops to improve communication and interpersonal skills.
5. Community-based initiatives: Funding for supporting community-led initiatives that provide assistance to pregnant women and their families.
Please note that the above cost items are estimates and should be further evaluated and adjusted based on the specific context and resources available.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study provides specific data on the number and types of obstetric complications observed, as well as the reasons for late presentation. However, the study is limited to a specific geographic area and a small sample size. To improve the evidence, future studies could include a larger and more diverse sample, as well as a broader geographic scope to increase generalizability.

This study examines the socioeconomic barriers to safe motherhood in booked patients in the Ife-Ijesha health administrative zone, Nigeria. During the period of study (January 1998 to December 1998), 161 booked patients of Ife State Hospital, Ile-Ife and Wesley Guild Hospital, Ilesha presented with an avoidable obstetric emergency. Seventeen (10.6%) presented during the antenatal period, while 89 (55.3%) and 55 (34.2%) presented in labour and postpartum respectively. The patients presented with obstetric complications such as obstructed labour (24.2%), postpartum haemorrhage (21.1%), puerperal sepsis (24.2%), imminent eclampsia and eclampsia (15.5%), retained second twin (9.3%). Three maternal deaths occurred (MMR 1467/100,000 births) and the perinatal mortality rate was 290/1000 total births. The adduced reasons for late presentation included, financial constrains (85.1%), poor access to hospital/transportation difficulties (33.5%), objection to hospital admission by relatives (23.0%), aversion to caesarean section (21.7%) and attitude to hospital staff (8.1%). The patients were of the opinion that reducing the economic burden associated with hospital fee, provision of transportation, encouraged family support and reduction of operation rate would lead to reduction in late presentation.

Based on the findings of the study titled “Socioeconomic barriers to safe motherhood among booked patients in rural Nigerian communities,” several recommendations can be developed into innovations to improve access to maternal health:

1. Community-based health insurance program: Develop a community-based health insurance program specifically for maternal health services. This program would provide affordable and accessible health insurance coverage for pregnant women in rural Nigerian communities, reducing the financial constraints associated with hospital fees.

2. Transportation infrastructure and services improvement: Improve transportation infrastructure in rural areas to address the difficulties faced by pregnant women in accessing hospitals. This can include initiatives such as providing ambulances or other means of transportation for pregnant women in need of emergency care. Additionally, establish community outreach programs to provide transportation assistance to pregnant women who have difficulty accessing healthcare facilities.

3. Family support and education promotion: Promote family support during pregnancy and childbirth through community-based education programs. These programs can raise awareness about the importance of skilled birth attendance, the benefits of hospital delivery, and the potential risks associated with home births or delayed presentation. By changing attitudes and beliefs surrounding childbirth, families can be encouraged to support pregnant women in seeking timely and appropriate medical care.

4. Strengthen healthcare provider-patient relationships: Improve the quality of care provided by healthcare providers by implementing training on patient-centered care, empathy, and effective communication. Building trust and positive relationships between healthcare providers and pregnant women can help overcome hesitations or negative perceptions that may discourage women from seeking care.

By implementing these innovations, it is expected that access to maternal health services in rural Nigerian communities can be improved, leading to a reduction in late presentation, obstetric complications, and maternal and perinatal mortality rates.
AI Innovations Description
Based on the findings of the study titled “Socioeconomic barriers to safe motherhood among booked patients in rural Nigerian communities,” the following recommendation can be developed into an innovation to improve access to maternal health:

1. Develop a community-based health insurance program: To address the financial constraints faced by pregnant women in rural Nigerian communities, a community-based health insurance program can be established. This program would provide affordable and accessible health insurance coverage specifically for maternal health services. By reducing the economic burden associated with hospital fees, more women would be able to afford and access necessary prenatal, delivery, and postnatal care.

2. Improve transportation infrastructure and services: Poor access to hospitals and transportation difficulties were identified as barriers to safe motherhood. To address this, efforts should be made to improve transportation infrastructure in rural areas, including the availability of ambulances or other means of transportation for pregnant women in need of emergency care. Additionally, community outreach programs can be established to provide transportation assistance to pregnant women who have difficulty accessing healthcare facilities.

3. Promote family support and education: Encouraging family support during pregnancy and childbirth can help overcome objections to hospital admission by relatives and aversion to caesarean sections. Community-based education programs can be implemented to raise awareness about the importance of skilled birth attendance, the benefits of hospital delivery, and the potential risks associated with home births or delayed presentation. This can help change attitudes and beliefs surrounding childbirth and encourage families to support pregnant women in seeking timely and appropriate medical care.

4. Strengthen healthcare provider-patient relationships: The study identified attitude towards hospital staff as a barrier to timely presentation. To address this, efforts should be made to improve the quality of care provided by healthcare providers, including training on patient-centered care, empathy, and effective communication. Building trust and positive relationships between healthcare providers and pregnant women can help overcome any hesitations or negative perceptions that may discourage women from seeking care.

By implementing these recommendations, it is expected that access to maternal health services in rural Nigerian communities can be improved, leading to a reduction in late presentation, obstetric complications, and maternal and perinatal mortality rates.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be used:

1. Baseline Data Collection: Gather data on the current state of maternal health access in rural Nigerian communities, including information on hospital fees, transportation infrastructure, family support, and healthcare provider-patient relationships. This can be done through surveys, interviews, and analysis of existing data.

2. Design and Implementation of Interventions: Develop and implement the recommended interventions, including the establishment of a community-based health insurance program, improvement of transportation infrastructure and services, promotion of family support and education, and strengthening of healthcare provider-patient relationships. Ensure that these interventions are tailored to the specific needs and context of rural Nigerian communities.

3. Data Collection Post-Intervention: Collect data on the impact of the interventions on access to maternal health services. This can include information on the number of women enrolled in the health insurance program, improvements in transportation infrastructure, changes in attitudes and beliefs surrounding childbirth, and feedback from pregnant women on their experiences with healthcare providers.

4. Analysis of Data: Analyze the collected data to assess the impact of the interventions on access to maternal health services. This can involve comparing pre- and post-intervention data to identify any changes or improvements. Quantitative analysis can be conducted to determine the extent to which the interventions have reduced financial constraints, improved transportation access, increased family support, and enhanced healthcare provider-patient relationships.

5. Evaluation and Recommendations: Evaluate the effectiveness of the interventions based on the analysis of data. Identify any challenges or limitations encountered during the implementation process. Based on the findings, provide recommendations for further improvements or modifications to the interventions to maximize their impact on improving access to maternal health.

By following this methodology, it will be possible to simulate the impact of the main recommendations on improving access to maternal health in rural Nigerian communities. The findings can inform future interventions and policies aimed at reducing maternal mortality and improving maternal health outcomes.

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