CHAPTER ONE

INTRODUCTION

1.1 Background

Maternal mortality is a substantial burden in developing countries. World Health Organization

(WHO) estimated that 529,000 women die annually from maternal causes. Ninety-nine percent of these deaths occur in the developing countries. The situation is most horrible for women in

Sub-Saharan Africa, where one in every 16 women dies of pregnancy related causes during her lifetime, compared with only 1 in 2,800women in developed country1.

Nigeria accounts for about 10% of all the maternal deaths globally, and has the second highest mortality rate in the world, after India. It is also reported that, for every woman that dies from pregnancy-related causes, 20-30 more will develop short and long term damage to their reproductive organs resulting in disabilities such as obstetric fistula, pelvic inflammatory disease, a ruptured uterus etc2. This high morbidity and mortality rates makes maternal health a huge public health problem in the developing countries of the world, including Nigeria. For example, the percentage of birth attended by skilled professionals range from high of 81.8% in the South-east to a low of 9.8% in the North-west. Similarly, 90.1% of women in the North-West are more likely to give birth at home compared to 22.5% in the South-west. Also, 22% of the births are being attended by traditional birth attendants2.

Also the most recent Nigerian National Demographic and Health survey (NDHS)3reported maternal mortality ratio to be 545 / 100,000 live births. The data showed wide regional disparity in maternal mortality ratios between the different geopolitical zones of the country3. The report showed that average maternal mortality ratio in northern Nigeria was 2420 (range:1060 - 4477) per 100,000 live births4,5,6,7, while similar data in the southern parts of the

country were considerably lower - between 454 and 772/100,000 live births8,9. There is increasing evidence that this difference in maternal mortality between the northern and southern parts of the country may be due to disparity in the accessibility and utilization of health services, especially differences in the availability of skilled birth attendants between the regions.Every pregnant woman faces the risk of sudden, unpredictable complications that could end in death or injury to herself or to her infant. Pregnancy related complications cannot be reliably predicted, hence, it is necessary to employ strategies to overcome such problems as they arise.

Maternal mortality and morbidity are complex problems that require interventions10. Improving maternal mortality has received recognition at a global level as evidenced by the inclusion of reducing maternal mortality in the Millennium Development Goals. Since it is not possible to predict which women will experience life -threatening obstetric complications that lead to maternal mortality, receiving care from a skilled provider (doctor, nurse or midwife) during childbirth has been identified as the single most important intervention in safe motherhood11.

Birth preparedness and complication readiness (BP/CR) is a strategy to promote the timely use of skilled maternal and neonatal care, especially during childbirth, based on the theory that preparing for childbirth and being ready for complications reduces delays in obtaining this care.

Lack of advance planning for use of a skilled birth attendant for normal births, and particularly inadequate preparation for rapid action in the event of obstetric complications, are well documented factors contributing to delay in receiving skilled obstetric care. In a skilled care approach, birth preparedness includes identifying a skilled provider and making the necessary plans to receive skilled care for all births. Complication readiness (emergency funds, transport, blood donor and designated decision-maker) receive greater emphasis in emergency obstetric

care programs. Birth preparedness has been globally endorsed as an essential component of safe motherhood programs to reduce delays for care10, 11.

In many societies in the world, cultural beliefs and lack of awareness inhibit preparation in advance for delivery and expected baby. Since no action is taken prior to the delivery, the family tries to act only when labor begins. The majority of pregnant women and their families do not know how to recognize the danger signs of complications. When complications occur, the unprepared family will waste a great deal of time in recognizing the problem, getting organized, getting money, finding transport and reaching the appropriate referral facility these delays can cause maternal death12.

For Some complications including; severe hemorrhage, a few hours matter to save life, while for others hours or even days may be tolerable but with the prognosis getting worse as time elapses.

Complication readiness is vital to survival. Complications need quick action. The interval from onset to death for ante-partum and postpartum hemorrhage can be approximately 12 hours and 2 hours respectively. The hours required for making arrangements which should have been made prior to the emergency, may define the line between survival and mortality10, 12. If the woman and her family are well prepared for normal child birth as well as any possible maternal or new born complications, the woman or baby are more likely to receive the skilled and timely care needed to preserve health and ensure survival. Although most of the time focuses on what the skilled provider, the woman, and her family can do to prepare for birth and possible complications, birth preparedness or complication readiness is actually a community-wide issue12.

1.2Rationale and Justification of the Study

Maternal and infant mortality rates are unacceptably high in most developing countries. Material mortality rate in Nigeria is 545/100.000 live births 3. Despite global efforts to reduce maternal mortality ratio by 75% by the year 2015 (Millennium Development Goal-5, MDG-5), it is worrisome that the maternal mortality rate remains high in Enugu State, southeast Nigeria. Enugu state has a maternal mortality rate ranging from 772 and 998 per 100,000 women which is high13.Therefore, there is need to assess birth preparedness and complication readiness among women in this study area.

1.3 General and Specific Objectives

General Objective

The study is to assess knowledge and practice of birth preparedness and complication readiness among women in Enugu Metropolis.

Specific Objective