FACTORS ASSOCIATED WITH USE OF MATERNITY SERVICES IN ENUGU

Abstract

Background Maternal mortality is still a major public health problem in sub-Saharan African, including Nigeria. On the other hand, maternal mortality has been reduced drastically through improved access to quality care during pregnancy and especially at delivery in the industrialized world.

Objectives This study was carried out 1. to identify the factors which influenced the choice of place of delivery by pregnant women in Enugu metropolis. 2. to determine the relative ranking of these factors and 3. To make recommendations on ways to improve women’s access to skilled health providers at delivery in the study community.

Methods This was a pretested interviewer administered questionnaire study of women who delivered within 3 months prior to date of data collection. In an increasing order of level of care, the outcome variables were categorized as 1. home deliveries 2. spiritual houses 3. traditional birth attendants 4. maternity homes/primary health centers 5. general/ private/mission/hospitals (without specialist obstetricians), 6. teaching hospital/state specialist hospital (with specialist obstetricians) and 7. private (obstetrician) hospitals. These were further sub-categorized into non-institutional deliveries (numbers 13) and institutional deliveries (numbers 4-7)
The predictor variables were socio-demographic factors, religion, rural/urban residence, and respondents’ perceived factors influencing their choice of place of delivery. Data analysis was by means of descriptive and inferential statistics including means, frequencies, chi-square tests, univariate and multivariate logistic regression at the 95% confidence level.

Results Out of a total of 1450 women to whom the questionnaires were administered, 1095 women responded giving a response rate of 75.5%. Five hundred and seventy nine (52.9%) of the respondents delivered outside health institutions while the remaining 516 (47.1%) delivered in health institutions. The major factors influencing there choice of place of delivery included promptness of care, competence of midwife /doctor, affordability of cost, health education 24-hour presence of doctors, team work among doctors and presence of specialist obstetricians. There were statistically significant associations between choice of institutional or non institutional and sociodemographic/economic factors such as place of residence (urban/rural), religion , educational status, tribe, marital status, occupational level, husband’s occupational and educational levels, age and parity (P < 0.05). When the significant bio-social and economic factors were subjected to multivariate logistic regression, ten factors remained significant. The five most important of these were availability of equipment, availability of ambulance services, friendliness of staff, 24-hour presence of doctors and urban compared with rural residence.
Conclusion
It is concluded that factors that will positively influence a
woman to deliver in a health institution are mainly her perception of
the quality of care offered in the health facility.

FACTORS ASSOCIATED WITH USE OF MATERNITY SERVICES IN ENUGU