Table of Contents
Title Page i
Approval Page ii
Table of Contents vi
List of Tables viii
CHAPTER ONE: Introduction
Background to the Study 1
Statement of the Problem 6
Purpose of the Study 7
Research Questions 7
Significance of the Study 9
Scope of the Study 11
CHAPTER TWO: Review of related literature
Conceptual Framework 12
• Pregnancy 13
• Factors associated with complication in pregnancy 25
• Childbearing mothers (CBMs) 27
Theoretical Framework 33
• Health belief model 34
• Self-efficacy theory 35
Empirical Studies 37
Summary of Literature Review 42
CHAPTER THREE: Methods
Research Design 44
Area of the Study 44
Population for Study 45
Sample and Sampling Technique 46
Instrument for Data Collection 46
• Validation of the instrument 47
• Reliability of the instrument 47
Method of Data Collection 48
Method of Data Analysis 48
CHAPTER FOUR: Results and Discussion
Results and Discussion 50
Summary of Major findings 65
Discussion of findings 66
• Factors associated with pregnancy complication 66
• Differences in the factors associated with pregnancy complications 67
CHAPTER FIVE: Summary, Conclusions and Recommendations
Suggestions for Further Studies 75
List of Tables
1. Responses on Age Associated With Pregnancy Complications
2. Responses on Educational Factors Associated With Pregnancy Complications
3. Responses on Parity Factors Associated With Pregnancy Complications
4. Responses on Nutritional Factors Associated With Pregnancy Complications
5. Responses on Medical Factors Associated With Pregnancy Complications
6. Data Testing the Significant Difference in the Factors Associated With Pregnancy Complication among Childbearing Mothers in Abuja Municipal Area Council According to Age
7. Data Testing the Significant Difference in the Factors Associated With Pregnancy Complication Among Childbearing Mothers in Abuja Municipal Area Council According to Educational Factors
8. Data Testing the Significant Difference in the Factors Associated With Pregnancy Complication Among Childbearing Mothers in Abuja Municipal Area Council According to Occupation.
The purpose of the study is to investigate the factors associated with pregnancy complications among child bearing mothers in Abuja Municipal Area Council. To achieve the purpose of the study, five specific objectives with corresponding research questions were posed, and three hypotheses postulated. Descriptive survey research design was used for the study. The population for the study. The population for the study comprised of 4080 childbearing mothers drawn from the eight selected Government and private hospitals in Abuja Municipal Area Council, while sample for the study consisted of 422. A 38 item of Factors Associated with Pregnancy Complications among childbearing Mothers Questionnaire (FAPCMQ). The researcher designed questionnaire comprising of five sections (A, B, C, D, and E) was the instrument used for data collection. The instrument was validated by five experts from the Department of Health and Physical Education and one from Department of Statistics all of the University of Nigeria Nsukka. Percentages and frequency were used for descriptive analysis of data; chi-square statistics was used for testing of the hull hypotheses at .05 level of significance. The result of the study showed that the following factors are associated with pregnancy complications: age (26-30 years (95%), 21-25 years (92.2%), 31-35years (86.6%), Educational levels that associated with pregnancy complications were inadequate knowledge of pregnancy related complication (51.5%), inadequate knowledge of need for antenatal registration (46.6%). Parity: (57.4%), lack of knowledge of the family planning (53.4%). Lack of the awareness of consequences of miscarriage to the mother’s health (52%). Nutritional factors: (lack of knowledge of the need for calcium in the diet (93.6%), lack of vitamins in the diet (91.7%), lack of protein in the diet (60%), inadequate intake of fruit and vegetables (55.9%). Medical factors: (ectopic pregnancy (92.2%), diabetes (75.5%), haemorrhage (62.3%), abortion (53.4%), Hypertension (51.5%). There was no significant different in age, parity and there were significant difference in some of the factors associated with pregnancy complications according to educational level, nutritional knowledge at the medical factors. It was therefore recommended that mothers of childbearing should be educated and examine during pregnancy early enough medically to avoid pregnancy complications. Pregnancy complications should be treated under health education in primary and secondary school curriculum to educate girl child and medical personnel and health educators.
Background to the Study
In the life of every mother she undergoes certain changes called pregnancy. It is a period when there are normal physical and physiological processes taking place in her body, which results in the continuation of the species. Pregnancy is the beginning of a new life, it starts with conception and continues through the development of the foetus and finally ends at birth (Isidro & Heminia, 2004).
Pregnancy as defined by Samuel (2010) is the state of having an implanted embryo in the uterus until such a time that it is terminated by spontaneous or elective abortion or delivery. Aguilar and Galbes (2004) opined that pregnancy is a normal physiological process which results in the continuation of the species. Pregnancy has a positive influence on the female organism both physically and psychologically. During gestation the mother reaches her full physiological and mental potential.
Pregnancy as conceived by lsidro and Heminia (2004) is the beginning of a new life. Benneth and Brown (1990) described pregnancy as a locus from conception to birth, which brings changes due to the effects of estrogen and progesterone. These changes enable the mother to nurture her foetus, prepare her body for labour, develop her breast and lay down stores of fat to provide calories for production of breast milk.
Pregnancy according to Roper (1999) is defined as carrying a baby from the last normal menstrual period to parturition, normally 40 weeks or 280 days. The concept of pregnancy is seen as a normal life event, to a mother, it appears discordant depending on her life experience (Myles, 1999). For instance globally, about 6,000,000 mothers die every year from pregnancy related complications. In Nigeria, maternal mortality ratio is estimated to be 800 per 100, 000 live births. WHO (2007) stated that mothers die as a result of the complications during childbirth. But experience and literature have shown that some mothers experience complications in pregnancy.
Mittendorf, Willian and Berher (1999) asserted that pregnancy is the carrying of one or more foetus in the body of a female mammal. The first trimester is from the first months, and to the third month, the second trimester is from the fourth to the sixth months, and the third trimester from the seventh to the ninth month. According to Benneth and Brown, (2001) pregnancy is normally forty weeks approximately for all mothers and mothers of childbearing age in Abuja Municipal Area Council inclusive. During pregnancy, because of the extra demand by the foetus on the mother and also due to hormonal influences, the mother is posed with many needs and problems (Agular & Galbes, 2004). Nevertheless, there are certain factors, which serve as ingredients for personal health. These factors are more pressing or are in greater demand at certain periods of human life, notably during pregnancy than at other periods. Therefore when those conditions or factors are absent or deficient, health needs and (health problems) complications arise because health of the mother is threatened (Adi, 1979).
The period of pregnancy according to Myles (2006) is the most demanding period in a mother’s life. The pregnant mother requires adequate attention to avoid malformation and problems which may be physical, emotional, social and economical in nature. According to Benneth and Brown (2001) the health needs of a pregnant women could be physical (needs concerned with the physical requirement such a good nutrition, medical care, personal hygiene, breast care, dental care, proper clothing, exercises, rest and sleep, sexual activity and traveling needs), psychological (emotional care that mothers need during pregnancy from their partner, other members of the family and the health workers), and social-economic (spouse support, accessibility of health facilities, availability of good roads and transportation, level of education, economic status, customs and beliefs, availability of qualified and skilled health workers and materials.
Pregnancy is the most nutrition demanding period in mother’s life because she needs enough nutrient everyday to support her health, demands from the growing foetus and many hormones induced developmental processes. the American Dietetic Association- ADA (2002) stated that a pregnant mother needs extra 300 calories daily, making it a total of 2500 to 2700 calories daily to improve the nutritional level of a mother thereby averting medical complications.
In the context of this study, pregnancy is defined as inception of the embryo in the uterus which continues through the development of the foetus and finally ends at birth.
Childbearing mother is a period including teenage age through young adult and middle age adult (U.S. Bureau of Census, 1995). National Opinion Research (1996) pointed out that it is a period characterized by increase in divorce, suicide and tumultuous personal struggle.
Complication is a situation that tends to compound the already existing complex situation. Complications in the context of this work is defined as when pregnancy, labour or delivery involves physical and mechanical difficulties or if there is a disproportion between the foetus and the mother’s pelvis or transverse position (Isidro and Herminia, 2004). As grouped by Nathalie (1996) the causes of pregnancy complications that were discussed in this work are haemorrhage, hypertension, infection, obstructed labour, unsafe abortion, ectopic pregnancy preeclampsia and diabetes. Haemorrhage is a complication that is common among the multiparty women. It is a complication during the third stage of labour, when there is disorder of the uterus and its functions. Labour is made up of three stages, cervical dilation, birth of the foetus and birth of the placenta. Isidro and Heminia (2004) opined that haemorrhage occurs when the blood lost rise above 520ml (half a litre) and when it occurs immediately after labour or within the first 24hours of delivery of the placenta.
Haemorrhage can occur at any point in pregnancy that is why a mother should be monitored at any given time and any haemorrhage should be addressed immediately, because it can occur during birth or after delivery. The treatment consist of verifying the emptiness of the uterus and working to make sure that it contract as it should. It also consists in giving blood transfusion to replace the blood which is being lost through the haemorrhage (Isidro & Heminia, 2004).
In haemorrhage the patient is apprehensive and restless, thirsty; the skin is cold, moist and pale. The pulse rates increases, the temperature falls and the respiration are rapid and deep. The patient is placed in shock position. Giving blood transfusion or blood products and determining the cause of haemorrhage are the initial therapeutic measure. An excessive stress and lack of rest can predispose a pregnant woman to this complication called haemorrhage.
Haemorrhage is classified as primary, intermediary and secondary. Primary haemorrhage occurs at the time of operation. Intermediary haemorrhage occurs during the first few hours after an operation when the rise of blood pressure to its normal level dislodged insecure clots from untied vessels. Secondary haemorrhage occurs some time after the operation when insecure tying, infection, or erosion of a vessel by drainage tube results in the slipping of a ligature (Smelrzer and Bare, 1992).
Hypertension can be defined as persistent elevations of blood pressure in which the systolic pressure is above140mm Hg and the diastolic pressure is above 90mmHg. It is the major cause of heart failure, stroke and liver failure. Essential hypertension usually begins as a liable (intermittent) process in a person late 30s to early 50s and gradually becomes fixed, Smeltzer and Bare (2001).
Essential hypertension is a medical condition that can complicate pregnancy. Myles (2001) opined that this is an elevation of blood pressure of over 190/140 monthly present on two or more occasion prior to the 20th week of pregnancy, which is due to any apparent pathological condition. Derek (2001) and Myles (2001) maintained that the disease is hereditary origin and is influenced by emotional and environmental factors. Essential hypertension is common among child bearing mothers and can cause an increase in maternal mortality. Ojo and Briggs (1992) pointed out that when the blood pressure is very high like 160/100 monthly or more, the mother may develop albuminuria and preeclampsia may set in. They further explained that in some cases every high level of blood pressure causes cerebral haemorrhage, concealed abruption, and acute heart fracture. The effect of essential hypertension on the foetus may be serious, leading to incidence of abortion, intrauterine death, and premature onset of labour and superimposed preeclampsia.
Preeclampsia is an outstanding complication that occurs during pregnancy and labour. It occurs more frequently in young primigravidae, (first pregnancies mothers) and mothers over 35years of age. It is usually diagnosed when there is a marked rise in the systolic and diastolic pressure, when proteinuria is present in the absence of urinary tract infection and when there is evidence of generalized oedema. Severe preeclampsia is diagnosed, when the blood pressure exceeds 170/110 mmhg (Myles, 1985).
The factors associated with pregnancy complication among childbearing mothers were age, parity, educational level, nutritional status and medical conditions. The rising of complications in pregnancy was found to be aggravated by these factors.
Akinsola (1993) posited that some of these mothers that were young were not keen about complications and do not report any experience or case to medical personnel. He pointed out that pregnancy complications such as essential hypertension were cases which vary from hour, day by day and show a slow but steady upward progression with increased age.