HEALTH PROBLEMS AND PROVISIONS FOR PREGNANT WOMEN ATTENDING GOVERNMENT HOSPITALS IN MAIDUGURI METROPOLIS, BORNO STATE

Table of Contents
Title Page i
Approval Page ii
Certification iii
Dedication iv
Acknowledgement v
Table of Contents vi
List of figures ix
List of Tables x
Abstract xii
CHAPTER ONE: Introduction
Background to the Study 1
Statement of the Study 11
Purpose of the Study 12
Research Questions 13
Hypotheses 13
Significance of the Study 13
Scope of the Study 15
CHAPTER TWO: Review of Related Literature
1. Conceptual Framework 17
• Health and health problems 17
• Health problems of pregnant women 21
• Health care provisions for pregnant women 29
• Demographic Factors Associated with Health Problems and health
care provisions 42
2. Theoretical Framework. 47
• Agent-Host-Environment (AHE) 47
• Gateway provider model (GPM) 48
3. Empirical Studies on Health Problems and Health care Provisions 50
4. Summary of Literature Review 59 CHAPTER THREE: Methods
Research Design 61
Area of Study 61
Population for the Study 62
Sample and Sampling Technique 62
Instrument for Data Collection 62
• Validity of the instrument 63
• Reliability of the instrument 63
Method of Data Collection 64
Method of Data Analysis 64
CHAPTER FOUR: Results and Discussion
Results 65
Summary of Major Findings 100
Discussion of findings 106
• Health problems of pregnant women 106
• Health care provisions for pregnant women 107
• Factors Associated with health care provisions 108
• Socio-demographic factors associated with health problems 109
CHAPTER FIVE: Summary, Conclusion and Recommendations
Summary 115
Conclusion 120
Recommendations 124
Suggestions for Further studies 124
Limitations of the Study 125
References 126
Appendices
Appendix A: Health Problems and Health care Provisions Questionnaire
(Two set of Questionnaire) (HPQ and HCPQ) 138
Appendix B: Official Introductory Letter of Investigator 142
Appendix C: List of Hospitals 143
Appendix D: Introductory Letter to Respondents 144

List of Figures
1. Diagrammatic Representation of Health Problems and Health care Provisions for
Pregnant women. 46
2. Diagrammatic Representation of Theoretical Framework 49

List of Tables
Tables Page
1. Physical Health Problems of Pregnant Women 65
2. Emotional Health Problems of Pregnant Women 66
3. Social Health Problem of Pregnant Women 67
4. Antenatal care Provided for Pregnant Women 68
5. Delivery care Provided for Pregnant Women 69
6. Postnatal care Provided for Pregnant Women 70
7. Factors Associated with Health care Provisions 71
8. Physical health Problems Associated with Age 72
9. Emotional health Problems Associated with Age 74
10. Social health Problems Associated with Age 75
11. Physical Health Problems Associated with Parity 77
12. Emotional Health Problems Associated with Parity 79
13. Social Health Problems Associated with Parity 80
14. Physical Health Problems Associated with Level of Education 82
15. Emotional Health Problems Associated with Level of Education 84
16. Social Health Problems Associated with Level of Education 85
17. Result of Chi-Square Analysis Verifying physical Health Problems of
Pregnant Women According to Age 86
18. Result of Chi-Square Analysis Testing Emotional Health
Problems of Pregnant Women According to Age 88
19. Result of Chi-Square Analysis Testing Social Health
Problems of Pregnant Women According to Age 89
20. Result of Chi-Square Analysis Testing physical Health Problems of
Pregnant Women According to Parity 91
21. Result of Chi-Square Analysis Testing emotional Health Problems of
Pregnant Women According to Parity 93
22. Result of Chi-Square Analysis Testing social Health Problems of
Pregnant Women According to Parity 94
23. Result of Chi-Square Analysis Testing physical Health Problems of
Pregnant Women According to Level of Education 96
24. Result of Chi-Square Analysis Testing emotional Health Problems of
Pregnant Women According to Level of Education 98
25. Result of Chi-Square Analysis Testing social Health Problems of
Pregnant Women According to Level of Education 99

Abstract

The Study was conducted to ascertain the health problems and provisions for Pregnant Women attending Government Hospitals in Maiduguri Metropolis, Borno State. The cross-sectional survey research design was used for the study. Ten specific objectives were formulated with ten corresponding research questions and three null hypotheses were also postulated to guide the study.. The population for the study was three hundred and twenty eight pregnant women and eighty seven health personnel while the sample for the study consisted of 328 pregnant women and 87 health personnel. Two set of researcher designed questionnaire was the instrument used for data collection. The instrument was validated by five experts. The instrument has reliability index of .87. Percentages was used to answer research questions while chi-square statistics was used in testing the null hypotheses at .05 level of significance (p-value=.05). The results the study showed that physical health problem experienced among pregnant women were malaria (93.6%) anaemia (91.2%), headache (85.4%), backpain (81.1%), urinary tract infections (76.2%), pre-eclampsia (74..4%), haemorrhage (64.9%), constipation (64.9%), vaginal bleeding (60.4%) heartburn (56.1%), placenta previa (53.4%), diarrhea(52.4%), heamorrhoids (51.2%). While lower proportion of pregnant had dental problem (45.7%), and rhesus factor (35.1%).Majority of health personnel indicated that the antenatal services of booking at first time of attendance (100%), health education (100%), administration of routine drug and malaria (100%), administration of tetanus toxoid vaccine (100%) and treatment of ailment and history taking(100%) were adequately provided. (37.9%) indicated that general assessment of mothers were provided, (25.3%) indicated that diagnose and treat complication are provided and medical examination (5.7%). Majority of the respondents indicated that the factors associated with health care provisions were lack of equipment (98.9%) inadequate funding (97.7%), inadequate number of staff (86.2%) and poor quality of staff (74.7%),cultural interference (20.7%) and lack of awareness of health facility/services (25.3%).There was no significant difference in such emotional health problem of pregnant women: alcoholism (χ²cal = 3.066, p-value = 216). while there was significant difference in the following emotional health problems moodiness and moodswing (χ²cal = 9.874, p-value = .007); ‘’anxiety’’(χ²cal = 44.769, p-value = .000), ‘’restlessness (χ²cal = 45.251, p-value = .000), ‘tension (χ²cal = 27.208, p-value = .00), ‘’aggression’’ (χ²cal = 16.169, p-value = .000), ‘depression’ (χ²cal = 16.345, p-value = .000) according to parity. The following Recommendation were made: Health workers, Government and non-governmental organization should organize health programme on safe motherhood, antenatal and postnatal programme for women especially those age 25-34 years. Federal Government should improve budgetary allocation to health as this will to a large extent, cater for new schemes such as proper welfare package for health personnel.

CHAPTER ONE
Introduction
Background to the Study
The health of a pregnant woman determines to a large extent the health of the family. A healthy pregnant woman brings forth a healthy baby with better chance of survival. These have made us to know that health of pregnant women deserve special attention because during pregnancy, the extra demand made by the foetus on the mother and also due to hormonal influence, the mother is posed with many health problems, for one to understand health problems require that the concept of health be clarified (Park, 2009).
Health as a concept means different things to different people. The world health organization, (1948) defined health as the state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. This embraces all aspect of human health namely physical, social, mental or emotional and it involves more than being ill in bed or being disabled. This is applicable to everyone including pregnant women at Maiduguri metropolis. By this wholistic definition of health, it means that one can indeed be free from disease or infirmity and yet experience health problem in any of the three dimension of health covered in the definition. Onuzulike (2008) viewed health as a multifaceted concept, consisting of six dimensions, namely: Physical health, mental health, social health, emotional health, spiritual health and occupational health. Park (2009) stated that health is a state of relative equilibrium of the body from function which results from its successful dynamic adjustment to forces tending to disturb it. It is that thing that makes you feel that now is the best and things that make you feel that now is the best time of the year, throwing up his hand in the morning and declare, “I feel great”. In this study, health is defined as a state of physical, emotional and social wellbeing of pregnant women which enables them to be fit during pregnancy. This is because WHO definition in 1948 used to be the mostly widely accepted and quoted definition in health. Therefore inability to adjust to changes within and outside the body, disequilibrium of the body to maintain normal function will then suggest the existence of health problem.
Health problem is seen as a state of disequilibrium, disease conditions and as a factor that predispose one to disease condition. According to Prothero (1994) health problem is a state of disequilibrium in which disease flourishes and health is impaired. He further stated that humankind and environment are closely linked in a complex relationship which frequently presents conditions of equilibrium between disease and health. Impairment of health according to him may manifest as a disease or infection. Meads (1994) posited that health problems represent something physical or emotionally and socially distressing for which relief is sought. In this definition health problems are categorized into three dimensions, such as physical, mental or emotional and social problems. Myles (2006) defined health problem as conditions which prevent individuals from mobilizing their physical, social and mental resources for optimal living. Thus any health condition which prevents pregnant women from attaining maximum working efficiency in daily tasks would constitute a health problem because it would not permit them to mobilize their physical, social and mental resources for optimal living. During the pregnancy period dozens of biochemical, physiological and anatomical changes occurs in woman’s body for such changes are beyond their control and are regarded as first changes that leaves women vulnerable physically and mentally (Weller, 2005).
Worldwide health problem during pregnancy is an important issue. An estimated 500,000 women die each year throughout the world from complications of health problems regarding pregnancy and childbirth. Over 99 per cent of those deaths occur in developing countries such as Ghana. Maternal deaths only tell part of the story because for every woman or girl who dies as a result of pregnancy-related causes, between 20 and 30 more may develop short and long term health problems, such as malaria, anaemia, and pelvic inflammatory disease. The deaths and complications that arise from pregnancy are related to several crude practices of pregnancy handling and management including abortion by women (WHO, 2007). They added that Nigeria has the second highest maternal deaths in the world, one in every eight pregnant women die while giving birth; most of these deaths are avoidable as compared to the United State where 1 in 4,800 maternal mortality that are recorded. However, one of the millennium development goals is to improve maternal health care which was adopted by the international community at the United Nations Millennium Summit in the year 2000, by achieving 75 per cent drop from the level of maternal mortality in the year 2015. Coming to think of it, would this be really possible in Nigeria, where women die from wide range of complications in pregnancy, childbirth or postpartum, which in most cases are caused by poor health at the conception and lack of adequate care needed for healthy outcome of the pregnancy and their babies (Muhammed, 2011). Ozumba (2008) stated that in Nigeria 40 per cent of pregnant women experience pregnancy related health problems during or after pregnancy and childbirth. He further stated that maternal death has implication for the family, the community and the society in general. Its impact is most immediate and especially severe on young children. He added that one million children worldwide are left motherless every year, primarily because their mother had no access to or could not afford quality health care. Egwuatu (2003) stated that pregnant women face considerable barriers in assessing hospital services throughout the country. These barriers are largely due to poverty at household level. WHO (2007) observed that physical existence of health facility does not mean that they function. WHO further stated that most of them are poorly equipped and lack essential supplies of equipment and qualified staff. Madunagu and Olaniran (2005) stated that available data have shown that the availability and attending to quality health care service in Nigeria is poor. Agular and Galbes (2004) pregnancy now goes on with physical, social and emotional health problems which if not well managed, the consequences could lead to morbidity or mortality of mother and infant. This cannot be less true about the pregnant women in Maiduguri metropolis in Borno state. Within the context of this study, health problems mean the physical, emotional or mental and social conditions which a pregnant woman encounters whether at the onset of pregnancy or as the pregnancy advances that give discomfort which lead to complication or even death. In this present study, physical, mental or emotional and social health problems were considered because WHO in 1948 used to be the most widely accepted and quoted definition of health.
Physical health problems according to Park, (2009) defined it as the notion of imperfect functioning of the body, that is a state in which every cell and every organ is not functioning at optimum capacity and not in perfect harmony with the rest of the body. Physical health problems of pregnant women are those health conditions relating to the body rather than to the mind, the soul, or the feelings of a pregnant woman (Encarta, 2009). Physical health problems of pregnant woman are those conditions when the cell and every organ is not functioning well with the rest of body. Meeds (1994) gave examples of physical health problems as skin disease, headache, vaginal discharge, ulcers, diarrhea, constipation, malaria, anaemia, pre-eclampsia, rhesus factor and bleeding. Myles, (2006) posited that physical health problems of a pregnant woman may include heartburn, nausea and vomiting, constipation, hemorrhoids, virginal discharge, placenta previa, high blood pressure or pre-eclampsia, bleeding, intrauterine growth retardation, urinary tract infection, indigestion, dental problem, pedal oedema and pica. In the present study Physical health problems of pregnant woman are those health conditions relating to the body. In this physical health problems malaria, anaemia, vaginal discharge, rhesus factor, constipation, pre-eclampsia and haemorrhage were discussed because they are serious public health problems in Africa, if allowed to continue, it will lead to complications and even death during pregnancy.
Okafor and Okafor (1998) viewed mental health problem as the culmination of unsuccessful reactions to life problems and long time failure to adjust to life situation. They further stated that the causes could be functional (psychological), and structural (organic), that mental health problems afflict almost all Nigerians, either themselves or their families, or among the neighbours and friends. Okafor (2011) explained mental health problem as when one is not able to cope with life’s circumstances and not develop to fullest potential. Almost all pregnant women are prone to emotional ups and downs. Pregnancy is replete with changes, physical as well as emotional. In fact the hormonal changes in pregnancy can subject the pregnant woman to experience a roller-coaster ride of emotions (Target Women, 2011). In this work mental or emotional problem is the inability to express comfortably and appropriately. Mental or emotional health problems include stress, anxiety disorder and alcoholism. Myles (2006) stated that mental or emotional problem include anxiety, fear, tension, mood swings and aggression. This is unacceptable health problem for women during pregnancy. This can lead to social health problem.

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