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Comparative Assessment of Utilisation of Maternal and Child Healthcare Services in Two Rural Communities in the Federal Capital

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Comparative Assessment of Utilisation of Maternal and Child Healthcare Services in Two Rural Communities in the Federal Capital COMPARATIVE ASSESSMENT OF UTILISATION OF MATERNAL AND CHILD HEALTHCARE SERVICES IN TWO RURAL COMMUNITIES IN THE FEDERAL CAPITAL TERRITORY, ABUJA, NIGERIA A DISSERTATION SUBMITTED BY DR. ESOMONU, SABASTINE NDUBISI MBBS (ABSU) DEPARTMENT OF COMMUNITY MEDICINE UNIVERSITY OF NIGERIA TEACHING HOSPITAL, ENUGU TO THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA IN PART FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF THE FINAL FELLOWSHIP OF THE MEDICAL COLLEGE IN PUBLIC HEALTH (FMCPH) MAY, 2017 1 DECLARATION I hereby declare that this dissertation titled “COMPARATIVE ASSESSMENT OF UTILISATION OF MATERNAL AND CHILD HEALTHCARE SERVICES IN TWO RURAL COMMUNITIES IN THE FEDERAL CAPITAL TERRITORY, ABUJA, NIGERIA.” is my original and individual work. It was written under the supervision of Dr. Emmanuel A. Nwobi. I also declare that this dissertation has not been submitted anywhere else in part or in full for any other examination or any publication. _________________________ Dr. ESOMONU, SABASTINE NDUBISI Department of Community Medicine University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu. 2 CERTIFICATION I hereby state that this dissertation was written by Dr. Esomonu, Sabastine Ndubisi under my direct supervision in the Department of Community medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu. Supervisor: __________________________________ DATE: ______________________ Dr. Emmanuel A. Nwobi Department of Community Medicine, UNTH, Ituku-Ozalla, Enugu. Head of Department: _________________________________ DATE: _________________ Prof. Chika Onwasigwe Head of Department, Community Medicine, 3 UNTH, Ituku-Ozalla, Enugu. ACKNOWLEDGEMENT I wish to thank my supervisor, Dr. Emmanuel A. Obi, for his guidance and support throughout my residency training and for taking the pains to go through this project at all stages of its development. I am also indebted to the Head of Department of Community Medicine at the University of Nigeria Teaching Hospital, Enugu, Professor BSC Uzochukwu for his encouragement, and to other senior fellows in the department, including Prof. Chika Onwasigwe, Prof. Christopher Obionu, and Prof. M. N. Aghaji. I would like to appreciate Dr. Mathew Ashikeni, Dr. Hadiza Balarabe, Dr. Rilwanu Mohammed, and Dr. Daniel Gazama at the Federal Capital Territory Primary Healthcare Board, Abuja, who laid good foundations for my residency training and continued to support me throughout the training. I wish to also thank my employers and colleagues at the FCT Health Department, Abuja, especially Dr. Mike Aghahowa and Dr. Frank Alu for being instrumental to my release to undergo residency training at Enugu and for their immense support and guidance throughout the years. I cannot forget the wonderful assistance and co-operation I received from the leaders of the two communities, the heads of health department at the two area councils, the health facility managers, my research assistants, and all the participants in this study. I thank my dear wife, Mrs. Ijeoma Appolonia Esomonu, and my children for their endurance, love, and steadfastness all through the years of my training out of Abuja. Finally, I give all honour and glory to the Almighty God who saw me through it all. 4 DEDICATION This dissertation is dedicated to my lovely wife, Mrs Ijeoma Appolonia Esomonu and my children, Obinna, Chidozie, Chinenye and Ifeoma. 5 TABLE OF CONTENTS Title Pages Title page i Certificaion ii Declaration iii Acknowledgement iv Dedication v Table of contents vi List of Tables viii List of acronyms ix Summary x Definition of Terms xii CHAPTER ONE (INTRODUCTION) 1 1.1 Background Information 1 1.2 Problem Statement 4 1.3 Justification 5 1.4 Research Questions 6 1.5 General and specific objectives 6 1.6 Hypothesis 6 6 CHAPTER TWO (LITERATURE REVIEW) 7 2.1 Goals of MCH and indicators for monitoring services 7 2.2 Determinants and utilisation of MCH services 7 2.3 Perception of women on maternal and child healthcare services 12 CHAPTER THREE (MATERIALS AND METHODS) 14 3.1 Description of study Area 14 3.2 Study design 16 3.3 Study Population 16 3.4 Sample size determination 16 3.5 Sampling technique 17 3.6 Data collection tools 18 3.7 Method of data collection 18 3.8 Data management 19 3.9 Ethical considerations 20 3.10 Limitations 20 CHAPTER FOUR (RESULTS) 21 4.1 Socio-demographic characteristics of women in the study area 21 4.2 Perception of MCH services among women in the study area 24 4.3 Utilisation of MCH services among women in the study area 26 4.4 Factors associated with utilization of MCH services among women in the 34 study area 4.5 Predictors of utilization of MCH services among women in the study area 46 CHAPTER FIVE (DISCUSSION) 51 CHAPTER SIX (CONCLUSIONS AND RECOMMENDATIONS) 57 REFERENCES 58 7 APPENDICES 72-82 - Participant information sheet - Informed consent form - Questionnaire for the women - Ethical clearance - MAP of FCT showing the study area LIST OF TABLES Table 1 Socio-demographic characteristics of women in the study area 21-22 Table 2 Basic items owned by household women in the study area 23 Table 3 Perception of MCH services among women in the study area 24 Table 4 Utilisation of ANC among women in the study area 26 Table 5 Utilization of delivery/post-natal services among women in the study area 27 Table 6 Utilisation of family planning services among women in the study area 29-31 Table 7 Utilisation of child OPD services among women in the study area 32 Table 8 Utilisation of Immunization services by children of women in the study area 33 Table 9 Factors associated with utilization of ANC among women in the study area 34 Table 10 Factors associated with utilization of delivery services among women in the study area 36 Table 11 Factors associated with utilization of post natal services among women in the study area 38 Table 12 Factors associated with utilization of family planning services among women in the area 40 Table 13 Factors associated with utilization of child OPD services among women in the study area 42 Table 14 Factors associated with utilization of immunization services by children of women in the 44 study area Table 15 Predictors of utilization of delivery services among women in Kuchimbuyi community 46 Table 16 Predictors of utilization of post natal services among women in Kilankwa community 47 8 Table 17 Predictors of utilization of family planning services among women in Kuchimbuyi 48 community Table 18 Predictors of utilization of family planning services among women in Kilankwa 49 community Table 19 Predictors of utilization of immunization services by children of women in Kuchimbuyi 50 community LIST OF ACRONYMS AIDS Acquired Immuno-Deficiency Syndrome ANC Ante Natal Clinic CEOC Comprehensive Emergency Obstetric Care CHEW Community Health Extension Worker CHO Community Health Officer DHS Demographic and Health Surveys DPT3 Diphtheria/Pertussis/Tetanus Toxoids immunization (3) EMONC Emergency Obstetric and Neonatal Care FCT Federal Capital Territory FGD Focused Group Discussion HEACM Health Advocacy and Community Mobilization HIV Human Immuno-Deficiency Syndrome IEEC Information & Education for Empowerment & Change IMCI Integrated Maternal, Newborn and Childhood Illnesses JCHEW Junior Community Health Extension Worker MCH Maternal and Child Healthcare MDGs Millennium Development Goals 9 MSS Midwives Services Scheme NPI National Programme on Immunization NDHS National Demographic and Health Survey OPD/POPD Out-Patient Department/Paediatric Out-Patient Department PENTA3 Pentavalent Vaccine (3) PHC Primary HealthCare PHCB Primary Health Care Board SVCT Standard clinic-based Voluntary Counselling and Testing SURE-P Subsidy Re-investment and Empowerment Programme TBAs Traditional Birth Attendants TT Tetanus Toxoids UNICEF United Nations Children’s Fund VCT Voluntary counselling and Testing WHO World Health Organization SUMMARY Maternal and Child Health (MCH) refers to the broad means of providing promotive, preventive, curative and rehabilitative health care for mothers and children. Due to the fact that the health status of the mother is vital to the survival and well being of children and the family, there is the need for integration of maternal and child health care programmes. The objective of the study was to assess and compare the utilization of MCH services among women in two rural communities in the Federal Capital Territory of Nigeria. The study employed community-based comparative cross-sectional design to assess and compare the utilization of MCH services among women in two rural communities. Four hundred women from the two communities were selected using a multistage sampling technique and data was collected using a pre-tested, interview-administered questionnaire. The study showed that women in both study communities had good and comparable perception of MCH services. They however had low and variable levels of utilization of MCH services; these 10 include use of ante natal, delivery, post natal, family planning and child health services. The utilization of MCH services significantly associated with age groups, religion, marital status, occupation, income and education of women in the two study groups. Sustained public enlightenment of rural dwellers (particularly women) on benefits of utilizing health facilities is required to enable them make better use of available health services. Relevant stakeholders should also develop modalities to overcome the social-cultural factors that inhibit optimal utilization of MCH services in rural communities. Furthermore, the findings
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