Thesis Abstract

Abstract
Antenatal care (ANC) is a crucial component of maternal healthcare services aimed at ensuring the well-being of pregnant women and their unborn babies. However, in riverine communities of the South West Senatorial District of Rivers State, the utilization of ANC services remains suboptimal, leading to increased maternal and neonatal health risks. This study aims to investigate the determinants influencing the utilization of ANC by women in these communities. A mixed-methods approach will be employed to gather data from both quantitative surveys and qualitative interviews. The quantitative aspect will involve a cross-sectional survey of pregnant women and new mothers in selected riverine communities within the study area. The sample size will be determined using a formula for estimating proportions, ensuring a representative sample. Data will be collected using structured questionnaires focusing on demographic characteristics, ANC attendance patterns, reasons for ANC utilization or non-utilization, and perceived barriers to accessing ANC services. In parallel, qualitative data will be collected through in-depth interviews with key stakeholders such as healthcare providers, community leaders, and traditional birth attendants. These interviews will provide insights into the contextual factors influencing ANC utilization in riverine communities, including cultural beliefs, geographical challenges, and healthcare service availability and quality. Data analysis will involve descriptive statistics to characterize the study population and ANC attendance patterns. Logistic regression analysis will be used to identify the determinants significantly associated with ANC utilization, controlling for potential confounders. Qualitative data will be thematically analyzed to extract key themes and patterns related to ANC utilization in riverine communities. The findings of this study are expected to provide valuable insights into the factors influencing the utilization of ANC services by women in riverine communities of the South West Senatorial District of Rivers State. By identifying these determinants, targeted interventions can be developed to improve ANC uptake and ultimately enhance maternal and neonatal health outcomes in these underserved areas. The study also aims to contribute to the existing literature on maternal healthcare utilization in rural and remote settings, with implications for policy and practice in similar contexts.

Thesis Overview

INTRODUCTION

Background of the Study

In Nigeria, as in most developing countries, women of reproductive age (WRA) constitute more than one-fifth of the total population (WHO 1978). According to WHO (2006), WRA are exposed repeatedly to the risk of pregnancy, continuous child-bearing and the attendant morbidity and mortality. They opined that the bad condition is exacerbated under existing socio-economic conditions and the inadequacy of medical and health facilities.

WRA often face serious health risks during pregnancy either for themselves or their children. In Africa, especially the sub-Saharan region, pregnancy related health risks caused about a quarter of the burden of disease in 1990 for women in the age group of 15 to 44 years (Murray & Lopez, 1996). Despite a steady decline over the past decade, maternal mortality is still high in Africa, with an estimated life time death risk of 1 to 16 and a maternal mortality ratio of about 1000 deaths per 100,000 live birth (WHO, 2001). Within Africa, Nigeria ranks quite high with a maternal mortality ratio of 585 per 100,000 (WHO, 2005). However, Alakija (2000) indicated that the situation had improved in the past decade. It was 11 over 1000 live births a decade ago. The author opined that even with such level, it is still high when compared to such other African countries as Sudan and Ghana with 3 to 5 deaths per 1000 live birth as at 2002; not to mention, the less than 21 death per 100,000 life birth for the developed countries.

UNICEF (2008) indicated that a woman’s chance of dying from pregnancy and child birth in Nigeria is 1 in 13; and that 145 women of child bearing age die every single day due to pregnancy related causes. This makes the country the second largest contributor to maternal mortality rate in the world and the worst in Africa (United State Agency for International Development (USAID), 2008).

Complications of unsafe abortion, pregnancy and child birth, (such as hemorrhage, obstructed labour or infection) are major causes of death for women of reproductive age in Nigeria (Alakija, 2000). In addition, these complications can cause severe pain or disabilities if not treated properly. WHO (2008) confirmed that in 2005 an estimated 538,000 women died from complications of pregnancy, child birth and unsafe abortion in developing countries, with Africa contributing 261,000 of such women. WHO and UNICEF (1996) had earlier stated that on the average, in developing countries, a pregnancy is 18 times more likely to end in the women’s death than in developed countries. The death of a woman who in most developing countries, plays the principal role in rearing of children and the management of family affairs, is a significant social and personal tragedy.

Antenatal care is that health care given to a pregnant woman and to the developing foetus until the time of delivery. Simoes, Kunz, Minnich and Schmatil (2006) stated that the health of a pregnant woman has been found to be significantly influenced by the utilization of antenatal care. This is because antenatal care can help to identify those women who are at risk of complications during pregnancy and delivery, and thus, ensure that they obtain special attention in suitably equipped facilities. It also provides an invaluable opportunity to increase the awareness of women, their families, and communities of the risk of pregnancy and how this can be overcome. The extent of utilization of modern antenatal clinics and the increase in proportion of mothers who visit trained personnel for antenatal check up, therefore indicates the success being made in improving maternal health.

Expectant mothers who obtain sufficient antenatal care generally have better pregnancy outcomes than those who lack such care, both in terms of their own health condition and that of their babies (Overbosch, Nsowal – Nuamch, Vander, Boom & Damnyag, 2005). Antenatal care whose sole aim is the care of the expectant mother from time of conception to delivery and six weeks post partum is taken very seriously in the developed world. This is to enhance the chances of healthy babies being delivered to healthy uninjured mothers. WHO (2004) stated that in most parts of the developing world like Nigeria and most Sub-Saharan Africa the provision of antenatal care services is yet to gain full acceptance, most especially in the rural communities.

Utilization of antenatal services enables general medical supervision of the expectant mother under the care or supervision of a medical personnel. From the earliest stages, it enables the physician or midwife to start treatment on time if anything is wrong. Besides, the expectant mothers are offered helpful guidance, re-assurance and instructions by the attendant physician or