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Comparative Study of Utilization of Maternal and Child

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COMPARATIVE STUDY OF UTILIZATION OF MATERNAL AND CHILD HEALTH SERVICES IN URBAN AND RURAL COMMUNITIES IN ANAMBRA STATE. BY DR. BIBIANA NONYE EGENTI (MBBS) DEPARTMENT OF COMMUNITY MEDICINE NNAMDI AZIKIWE UNIVERSITY TEACHING HOSPITAL, NNEWI ANAMBRA STATE A DISSERTATION SUBMITTED TO THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF THE FELLOWSHIP IN PUBLIC HEALTH NOVEMBER 2009 1 DECLARATION I hereby declare that this study is original and that any assistance received is fully acknowledged. I also declare that I have not previously submitted this dissertation in part or in full for any examination or publication. ------------------------------------------------ Dr. Bibiana Nonye Egenti Department of Community Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State. NOVEMBER 2009 2 DEDICATION To my parents Chief Aloysius I. Obiagwu and Dr. Clara O. Obiagwu, who gave me the benefits of Western Education and to my husband Chike, and children Kene, Uzo, Chigo and Ike for their love and encouragement throughout the period of my residency programme and this work in particular. Thank you all for being there for me. 3 CERTIFICATION We certify that we supervised this work carried out by Dr. Bibiana Nonye Egenti of the Department of Community Medicine, Nnamdi Azikiwe University Teaching Hospital Nnewi, Anambra state. -------------------------------- ----------------------------- Prof. C. N. Obionu Dr. E. U. Ebenebe MBBS, FWACP, FMCPH MBBS, FMCPH 4 ACKNOWLEDGEMENT I am particularly grateful to my supervisors Prof. C. N. Obionu and Dr. E. U. Ebenebe who despite their busy schedule gave me purposeful guidance and support in making this work become a reality. I greatly appreciate Dr. B.S.C. Uzochukwu who has played a major role in the course of my training as a Public Health Physician. I wish to thank Drs.U.U. Onyeonoro, Chika Ubajaka and Prosper Adogu for their encouragement, support and constructive criticisms in the course of carrying out this work and in the final shaping of the work. My profound gratitude goes to Prof. Chika Onwasigwe who helped with the statistical calculations and analysis. Uju Okeke deserves special mention for always being willing to type the manuscript whenever the need arose. I thank all the mothers of under fives in Nnewi North and Dunukofia Local Government Areas for the willingness and cooperation they exhibited in the course of my carrying out the study. My research assistants were quite commendable; particular thanks go especially to nurse educator; Mrs. Oluchukwu Ifele who led the team. Extra special thanks to my family; fantastic in every way. To my mother, Dr. C. O. Obiagwu who patiently listen to my moans, read and corrected my work and also helped in gathering materials for the work. Most especially, I am grateful to Almighty God for everything. 5 ABSTRACT Introduction/Objective: Maternal and child health is an aspect of primary health care that seeks to promote both the health of the mother particularly through the child bearing period and also the health of the child. This study determined and compared the level and pattern of utilization of MCH services in urban and rural communities in Anambra State and identified factors influencing them. Design and Method: A comparative cross-sectional descriptive study was carried out in two Local Government Areas in Anambra State; Nnewi North (urban) and Dunukofia (rural). The study was conducted between January-March 2009. A total of three hundred and thirty eight (338) mothers with children aged 0-59 months in each of the two LGAs selected by multistage cluster sampling technique were studied. Data was collected from them using a semi-structured, pre-tested, interviewer administered questionnaire. This was complemented with a 2 year retrospective review of public health facility records in the study communities on antenatal care, delivery services and postnatal care services utilization and routine immunization of children. SPSS version 13 software package was used for data analysis. The data collected was analyzed using statistical means, chi-Square test and percentages and the p-value was set at 0.05. Results: Majority of the women were aged between 25–34 years of age, married and educated in both communities. However, women in the rural area had higher fertility rate (t=4.53, p<0.05) and more children alive (t=4.79,p<0.05) but the urban women were more educated and were of higher socioeconomic status. Knowledge of MCH 6 service utilization was high among the respondents although higher in the urban area. Also, ANC, maternity and post natal services utilization rate was high in both communities but level and pattern of utilization differed in both localities. Majority in the urban areas utilized the services of the private hospitals while the majority of the rural women patronized the maternity homes and had less access to skilled birth attendants. Average ANC attendance and booking in the first trimester of the pregnancy were statistically significant in both areas (χ2 = 7.52, p < 0.05 and χ2 = 8.96, p < 0.05 respectively). Only 16% of women in the rural areas were involved in decision making of their health issues as against 12.1% of women in the urban areas. Physical and economic access, in addition to quality of service and family decision making process were the factors influencing MCH service utilization particularly in the rural women. Also, health facility assessment also revealed low MCH service utilization in the rural than in urban area. Conclusion: The study demonstrated obvious difference in maternal and child health care service utilization in both localities. Women in the rural communities were less likely to have access to quality MCH services, because they are less educated. Therefore, measures to improve maternal and child health service utilization should not only address the issue of access to care, but also improvement in quality of care and women empowerment. 7 CONTENTS PAGE DECLARATION i DEDICATION ii CERTIFICATION iii ACKNOWLEDGEMENT iv ABSTRACT v-vi TABLE OF CONTENTS vii-viii LIST OF TABLES ix LIST OF FIGURES x LIST OF ACRONYMS xi-xii CHAPTER ONE: INTRODUCTION 1.1 Background of maternal and child health 1-4 1.2 Statement of problem 4-6 1.3 Scope of study 6 1.4 Justification of the study 6-7 1.5 Relevance of the study 8 1.6 Aims and objectives 9 1.6.1 General objective 9 1.6.2 Specific objectives 9 TWO: LITERATURE REVIEW 2.1 Maternal and child health, Primary Health Care and Millennium Development Goals 11-12 2.2 Components and indicators of MCH services 13-14 2.3 Pattern and level of MCH service utilization 14-18 2.4 Factors influencing utilization of MCH services 18-30 8 2.5 Urban-Rural differences 30-33 THREE: MATERIALS AND METHOD 3.1 Study areas 34 3.1.1 Nnewi North LGA 34-36 3.1.2 Dunukofia LGA 36 3.2 Study population 37 3.3 Study design 37 3.4 Sample size estimation 38 3.5 Inclusion criteria 39 3.6 Sampling Technique 39-40 3.7 Data collection 40-41 3.8 Data analysis 42 3.9 Pretest 43 3.10 Study schedule 44 3.11 Ethical consideration 45 3.12 Limitations 45 3.13 Definition of key variables 46 FOUR: RESULTS 4.1 Tables 1–19 47-71 4.2 Figure 1 72 4.3 Figure 2 73 4.4 Table 20 74 FIVE: DISCUSSION 5.1 Discussion 75-84 5.2 Conclusion 85 5.3 Recommendations 86-87 REFERENCES 88-94 APPENDICES 95-111 9 LIST OF TABLES TABLE PAGE 1: Sociodemographic characteristics of respondents 47-49 2: Comparison of mean values of urban and rural dwellers 50 3: Household decision maker on health issues 51 4: Distance of nearest health facility from place of residence 52 5: Socioeconomic status and ownership of personal household items 53 6: Knowledge of mothers in utilization of MCH services 54 7: Perception of mothers in utilization of MCH services 55 8a: Utilization of MCH services regarding ANC 56 8b: Mean number of ANC visits before delivery 57 9: Reasons for non-attendance of ANC during last pregnancy 58 10: Utilization of maternity services among the respondents 59-60 11: Mothers reasons for not delivering in a health facility 61 12: Utilization of MCH services regarding postnatal care 62-63 13: Utilization of MCH services regarding immunization 64 14: Children’s completion of immunization 65 15: Mothers/caregivers reasons for non-completion of child’s immunization 66 16: Utilization of maternal health services in public health facilities 67-68 17: Proportion of deliveries and PNC visit in the public health facilities 69 18: Percentage DPT3 immunization coverage by wards in both communities 70 19: Percentage measles immunization coverage by wards in both communities 71 20: Dropout rate of immunization in the public health facilities for 2007-2008 74 10 LIST OF FIGURES FIGURE PAGE 1: Graph showing percent DPT3 immunization coverage in urban and rural areas 72 2: Graph showing percent measles immunization coverage in urban and rural areas 73 11 LIST OF ACRONYMS ANC Antenatal care ARI Acute respiratory infection BCG Bacillus calmette Guerin BI Bamako initiative CSM Cerebrospinal meningitis DALY Disability adjusted life year DHS Demographic health survey DPT Diphtheria, pertussis, tetanus HBV Hepatitis B virus IMCI Integrated management of childhood illnesses LGA Local government area MCH Maternal and child health MDG Millennium development goal NDHS National demographic and health surveys NFHS National family health survey NID National immunization day NICS National immunization coverage survey NPC National population commission NPI National programme on immunization NW North west 12 OPV Oral polio vaccine PHC Primary health care PNC Postnatal care PTF Petroleum trust fund RI Routine immunization SMOH State ministry of health SSA SubSaharan Africa SPSS Statistical package for social sciences TB Tuberculosis TBA Traditional birth attendant UN United Nations UNFPA United Nations Fund for Population Activities UNICEF United Nations Children’s Fund USAID United States Agency for International Development VPD Vaccine preventable disease WHO World Health Organization 13 CHAPTER ONE INTRODUCTION 1.1 Background of Maternal and Child Health (MCH) The National Health Policy places a major emphasis on primary health care (PHC) as the strategy for attaining health for all.
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