CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Having a body is of vital importance to many people. It affects the family,

the community and the nation at large. Each pregnancy whether it is the first

of the presents a different experience. Yet having a body is always a

basically normal process and not only the mother and the child who need to

remain in a good state of health. However, having a pregnancy may present

risk that may leads to the baby as well.

In Nigeria, many women die during the process of child birth and it is

mainly occur due to ignorance on the services provided by the health

practitioner’s at the health centers especially the Maternal and Child Health

Center’s (MCHC) to the pregnant women and lack of good adequate

obstetric care other cause may include on satisfactory methods and lack of

adequate health facilities; traditional beliefs and taboos, superstation and

religious beliefs (Udoh M. A. 2005). Also have a great influence on pregnant

mothers.

As Nigeria is still passing through various stages of development, many

women still deliver at home without attending antenatal clinics.

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Child bearing is a natural process but it has specific risk particularly in less

developed countries of the world were mortality rate can be extremely high

from such potentially preventable conditions as infections of the birth

canal, leading to puerperal sepsis and tetanus post partum haemorrhage

ante partum haemorrhage often is back ground of anaemia and ruptured

uterus during delivery including dystocis in some cases severe to anaemia

of pregnancy . In developed nations such preventable conditions been very

greatly reduced by improved standard of living and good antenatal care

(ANC) and supervision as well as by the availability of good delivery

services. (Chado M. A., 1991)

Kankia Local Government being part of Nigeria also have many cases of

obstetric labour due to in adequate and sufficient antenatal care, Adebayo,

(2000) “there are lots of risk attached with pregnancy however, such risk are

having to become threat if the pregnant women does not appreciate or

recognizes the relevance of antenatal care to their health status as pregnant

women. These risks include anaemia, cardiac failure, premature sepsis,

eclampsia, infections, and premature onset of labour and cerebral malaria.

The above stated that health problems are normally affecting pregnant

women when there is low periodic pregnancy examination conducted at

2
ANC centers in order to ensure healthy condition of the women and her

child.

Aminu, (2003), pointed out that “some of the factor’s leading to the obstetric

labour that leads to the maternal mortality and the child mortality is the

illiteracy and lack of awareness among the mothers on the importance of

antenatal care (PNC) because of poor health education from the health

personnel’s; and due to low income or poverty among family member’s of

the pregnant women. He also noted that “the non-chalet attitude of some

health care personnel towards offering antenatal care services required by

the pregnant mothers leads discouraging the pregnant women from

patronizing the whole ANC and eventually the mother’s and the child may

due to complications during labour.

Antenatal care is one of the four pillars of the safe motherhood strategy

developed over the past 20yrs and implemented in most of the developing

countries to reduce maternal mortality. However, just because something is

advocated by WHO that it is very much relevant.

ANC particularly, is an umbrella term used to describe the medical

procedures and care that are carried out during pregnancy it is the care a

women receives throughout her pregnancy and is important in helping to

3
ensure a healthy pregnancy state and safe child birth. The objectives

therefore; of antenatal care are to assure that every pregnancy results in the

delivery of a healthy baby without impairing the mother’s health among

many others.

WHO, (2008) observes that Nigeria is among the developing nations that in

every 1o minutes children and pregnant women or may contact infections

that will lead to the loss of life; over 5,206 women die as a result of

pregnancy complications in 2yrs in Nigeria, and so of this number is mostly

affecting women in the North-western part of the country.

Poor nutrition during pregnancy apart from the pointed out pregnancy

complications, is among the factor leading to this death. This research

however “intends to find various factors leading to maternal death and

reasons why pregnant women in the case study area of this research work

who are not willingly attending antenatal care (ANC).

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1.2 Statement of the Problem

In line with the ongoing research studies concerning the relevance of

antenatal care towards improving maternal health, a lots of problems were

conspired together to leads to the in effective maternal health care services;

especially the antenatal care services to the pregnant women in Kankia Local

Government.

1.3 Objectives of the Study

1. To educate the general public about the importance of ANC services

to the pregnant women.

2. To find out the relevant disease and complications leading to the

maternal mortality.

3. To find out the level of government and NGOs commitment towards

improving maternal health and towards meeting millennium

development goals.

1.4 Research Questions

1. Do you believe that tradition and customs of people affects maternal

health care delivery?

2. Does training of more health personnel especially the midwives and

community health workers can help in improving maternal health?

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 3. Does poor nutrition and infection of various disease leads to maternal

death.

4. Do effective ANC services to the pregnant women can help in

reducing the rate of obstetric labour and maternal mortality?

1.5 Research Hypothesis

1. Tradition and customs of people can affect maternal health care

delivery.

2. Training of more health personnel especially the midwives and

community health workers can help in improving maternal health.

3. Poor nutrition and infection of various diseases can lead to maternal

death.

4. Effective ANC services to the pregnant women can help in reducing

the rate of obstetric labour and maternal mortality.

1.6 Significance of the Study

In conducting any research work on any expect of human endeavour, it must

be meaningful and significant before it is considered to make any sense.

Therefore, this research work “The Relevance of Antenatal Care (ANC) in

Improving Maternal Health in Kankia Local Government Area; if

6
successfully completed will be of utmost significant, especially on the

following pact:

1. The research if successfully completed will exposes the various

information needed by the general public on the importance of

antenatal care.

2. The project findings will be useful to any goat; ministries and extra-

ministerial dept.

3. Handing issues relating to maternal health with the information that

can be useful in educating the TBA (Traditional Birth Attendance)

towards ensuring proper handling of pregnant mothers’ right from

conception up to the delivery period.

The project will also assist the pregnant women on the simple

measures that should be taking in preventing maternal death finally.

4. The project will makes data available, to who ever intended to

undertake any research work that is bounded to this one.

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1.7 Definition of Terms

1. Antenatal: This is a term applied to conditions occurring before; and

it takes consideration in to the mother and child.

2. Antepartum Heamor: Bleeding from the placenta side due to

premature separation of the placenta after the 28 of pregnancy.

3. Birth Canal: This is a term applied to an open among where the baby

is been born.

4. Complication: A disease concurrent with another disease.

5. Cerebral Malaria: Malaria that attacks the cerebrum (the brain).

6. Dystocia: Difficult parturition e.g. feta dystocia i.e. due to

malformation or abnormal position of size of fetus.

7. Eclampsia: Convulsive attack of peripheral origin especially a

toxaemia of pregnancy, marked by high blood pressure.

8. Haemorrhage: Meaning bleeding of blood, it can be external

internal.

9. Labour: The function of female organism by the product of

conception is expected through the vagina to the outside world.

10.Puerperal Sepsis: A morbid conditions resulting from the pressure of

pathogenic bacteria and their product.

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 CHAPTER TWO

REVIEW OF RELATED LITERATURE

2.1 Introduction

This chapter deals with the reviewing of the work of other people within the

topic under discussion; so as to developed standard research work than will

proposed viable solution to the problem under discussion or study.

During the period of labour and delivery hospital and health care centers

assumed that in normal circumstances pregnancy last nine months, while

labour and delivery last for 24hrs. this period s however by far the most

critical time; the physiological stresses on both individual are high risk, this

risk for both the mother at time include: haemorrhage, complication of

infection agent into her uterus because of such risk there has been a trend in

the united states over the past years toward more and delivery to be hospital

and health centers. Dariye, (2000) in his statement continuous to point out

pauperism in a period of important, physiological readjustment for the

mother because of shortage of hospital bed and the important of early

ambulance most mothers are now discharge from the hospital within three

days of delivery or less. Subsequent checks up a physician in hospital are at

most important.

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According to Otalike (2009) maternal health care focuses on health of the

mother and her child, they are among the “vulnerable” or at “risk” group in

the community hence requiring special attention. It is obvious that the health

of the mother influence that of her children, family and entire society.

This concept, though not new, has attracted increased attention from the

people and the government such that there are increased concerns and

programmes and new approaches is put in place to secure good health of

mother and the child.

2.2 Prenatal (Antenatal Care) Care

According to john (2000) antenatal care implies maternal health care

consisting of care of the woman in pregnancy till the delivery period, while

maternal health incorporated the complete physical and maternal status of

room and her child in a good condition of health. The maternal health care

services are designed in order to improve and uplift the health status of

woman especially during pregnancy and delivery period. It is cumed at

promoting good health (physical and psychological) of mothers throughout

pregnancy, labour and puerperium, to promote a normal delivery of a

healthy baby, to educate mothers on the art of motherhood, provision of

10
healthy environment intake of a well balanced diet and to seek adequate

medical attention when necessary.

Adewale, (2000) observes that no maternal health objectives can be

effectively achieved or meet without effect competent, well trained and

highly sufficient and intellectual health personnel in all health facilities

across the society. He added that “the antenatal care services provided now

are so weak, ineffective and unreliable, because most of the health personnel

handling or manning health facilities in most of the societies in Nigeria are

not adherence to the relevant professional ethics due o low skills and

training. As such most of the people prepare to follow their traditional

beliefs sand customs towards managing pregnancy complications which of

course now is the major factor leading to the maternal mortality.

Adamo, (2006) highlight some aims and objectives which antenatal care are

out to achieve. According to him some of such aims are not likely to be

achieving in Nigeria due to so many factors.

2.3 Aims of Antenatal Care

To promote good general health (mental and physical) and to reduce

infant/maternal morbidity and mortality through the following:

1. To promote and maintain the health of pregnant women;

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 2. It educate parent on parenthood, its expectations and challenges;

3. Ensuring the delivery of a healthy baby as term;

4. Educating mother on preparation for labour and lactation;

5. Encouraging pregnant women to overcome the anxiety and fears

associated with pregnancy especially the primigravids);

6. Promote adequate nutrition by encouraging mothers on the

preparation and intake of balanced diet;

7. Caring out care of the preschool (under five (5) children, given

immunization on other assessments;

8. Giving health education to mothers on personal hygiene and

environmental sanitation;

9. Identify “high risk” pregnant mothers and manage as appropriate;

10.Promotion of appropriate utilization of health activities in the health

center for mothers and child care;

11.Detecting complication of pregnancy early and effect preventing

measures including referral if necessitated.

The above stated aims of antenatal care can only be achieved if there are

availability of well equipped health facilities with enough well trained health

personnel; range from midwives, nurses and community health extension

12
worker’s. Furthermore, effective health education services are highly needed

in order to achieve any of the aims of antenatal care.

According to Kuti, (1998) education is a process transmission of new ideas,

methodology, techniques and ways of improving health status of individual,

family and society at large by way of exposes issue relating to any

threatening issue to the health of an individual such as diseases or infections.

2.4 Stages of Pregnancy

A pregnancy consists of some stages of development. A woman is expected

to be aware and acquainted with the various age of development in

pregnancy which is normally called stages. These stages are:

1. 1st trimester – fertilization to 12th weeks which is equal to period

ranging from one to three months (1-3 months) of gestation;

2. 2nd trimester – 13th – 24th weeks this consist of the period after

gestation i.e. (6 months) and finally;

3. 3rd trimester – 25 – 38 weeks (6-9 months).

2.5 Antenatal Clinic Activities

According to Jonson (2006) here are some of the activities that take place in

the clinic mainly for the pregnant women. These activities include:

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1. Health Education

This service expect mothers on maintenance of good health during

pregnancy, preparation and adequate balance diet, use of flat shoes and non-

tight clothing expectations and signs of complications; the need to attend

clinic regular exercise, rest, hygiene and immunization, secondly,

2. History Taking

This is an activity saddled on every health personnel charged with the

responsibilities of providing antenatal care services in health facilities to

ensure it takes relevant history of the pregnant women on issues concerning

the following aspects:

a. Personal Data of the Pregnant Women: Name, Age, Occupation,

Address, Personal PHC Number.

b. Post Medical/Surgical History: This history comprises the heart

disease, blood transfusion, surgery etc.

c. Family History: Under this information on diseases such as diabetes,

heart diseases, TB, hypertension and multiple pregnancies in the

family are collected from the pregnant women.

Other includes;

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 d. History of Previous Pregnancies: Number of children with their age

of birth sex, weight, number alive or death, including still births,

abortions and bleeding.

e. History of Present Pregnancy: LMP vaginal discharge, bleeding,

however there are also the need at this activities to incorporates

calculation of expected date of delivery by adding 7 days to 9 months

from the first day of the last menstrual period, e.g. if LMP (last

menstrual period) = 30/10/2009, then EDD (expected date of delivery)

= 6/8/2010; and if LMP is given as 20/10/2010, EDD will be

27/10/2011.

To end this all of this information if they are not been provided by the

pregnant women during antenatal care or the ANC is not even attended, then

the information or activities cannot take place and as such any complication

there on can be fish out; furthermore, others include

3. Examination:

This consists of the following:

a. Physical examination: this is what is called head to toe for general

condition of health, abnormalities, cleanliness, parlor, swelling breast,

abnormalities, edema, vasicose veins.

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 b. Abdominal Examination: This examination consists of inspection

for size, shape, linear nigra, stregravidarom, old scar.

c. Palpation for fetal height (if larger polyhydraminous, big baby or

multiple pregnancy is suspected, if smaller small for data) fetal part,

position and presenting part. Abdominal UAS is also recommended.

Auscultation to assess the fetal heart beat.

d. Measurements: Blood pressure, height, weight.

4. Investigation:

This is another aspect of ANC activities in clinic to be pregnant women that

has to do with.

a. Blood PCV/HB, blood group, Rhesus factor, genotype, HIV, Wasser

Mannis Test.

b. Urine – for albuminorea, glucosuria, ketone bodres.

5. Others:

a. Patient at risk cases and others with signs of complications are

referred to the obstetrician.

All privigravidas are to be seen by the obstetrician who world also

perform pelvic assessment when they reach the 36 weeks of gestation.

According Arebashola, (2004) given routine drugs – fersolate, folic

acid, paludrine/daraprin immunization with tetanus taxoid as follows:

16
 i. TT1 – at 12 weeks gestation (1st contact, if not immunization

earlier).

ii. TT2 – at least 4 weeks after TT1

iii. TT3 – at least 6 weeks after TT2

iv. TT4 – at least one year after TT3

v. TT5 – at least one year after TT4 (given for protection for life).

However, it should be noted that this should continued and

completed even in subsequent pregnancies and then lastly.

Given appointed for subsequent visit as follows:

- 4 weeks interval from 1st contact to 28 weeks of gestation.

- 2 weeks interval from 28 – 36 weeks and weekly interval from 36 weeks

till birth. Antennal visits, based on focused ANC should be reduced to

only about 4 times it emphasizes clients need and clinic visits to be

according to the individuals needs.

The clients are given appointments in relation to their condition, and

advised to visit the hospital any times as the need arise. To this end, there

is no thought ending to all activities show cases or planned to be

executed at antenatal care activities in various health centres as such the

relevant for pregnancy woman to patronized and availated themselves to

the ANC services during any pregnancy cannot be over expressed

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 especially when considering the facts; that all complications and risk that

may lead to the danger of maternal death are planned to be take care of

16.

2.6 Pregnancies at Risk’s

According to Birsztal (2002) “some pregnancies may be exposes to so many

risk, that if they are not been attended they may eventually leads to maternal

death. These are:

1. Short stature (below 14cm) premigravida back and help deformity;

2. Elderly (30 years and above) premigravida;

3. Anaemia (HB below)

4. Mal-presentation

5. Bleeding (habitual abortion or ante partum haemorrhage);

6. Multi-parity (below 4 deliveries)

7. Multiple pregnancy;

8. Previous caesarian section (CS) difficult labour or instrumental

delivery.

9. Polyhydramnious;

10.Post maturity (over 2 weeks after the expected date of delivery EDD)

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 11.Medical condition with pregnancy e.g. heart diseases, tuberculosis,

diabetes, sickle cell anemia, urinary tract infection, essential

hypertension;

12.Warning signs e.g. severe headache, severe lower abdominal pain,

edema, blurring vision, cessation of fetal movements.

13.Below 16 years and above 35 years age.

2.7 Natal (Partureint) Care

According to Otalike, (2009) this is the care given to the pregnant women

during the later weeks of pregnancy until delivery. It is aimed at ensuring

safety by maintaining antiseptic techniques minimizing injuries to mother

and body readiness for emergency, resuscitation (cleaning of air ways) and

adequate care of the umbilical cord, eyes and others.

The delivery can take place at home by the community health officer (using

the standing orders) domiciliary midwife of TBAs if complications are not

anticipated. It could be at the health facilities if close to the client, or a high

risk or an emergency arises for home deliveries, visit the client at home to

plan and arrange the room expectation in labour preparation for the baby and

other requirements are expected to be discussed with the women.

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2.8 Care of the Client in Labour

There is the need for effective care to the pregnant women during labour.

These cares should be given at all the three stages of labour, so as to enhance

for facilities safe delivery. These cares at all labour stage are:

1. 1st stage – onset of labour (regular uterine contractions) to full dilation

of the cervical OS. This stage lasts between 12 – 18 hours in a

primigravida and 6-12hrs in multigravida, then the second stage:

2. 2nd stage – this is from full dilation of the cervix to the delivery of the

fetus. It lasts between 1 – 2 hours in a primigravida and 40 minutes to

1 hour in a multigravida.

3. 3rd stage –from the delivery of the foetus to the separation and

complete expulsion of the placenta and its membrane and the control

of bleeding it last between 30 minutes to 1 hour.

2.9 Management of the 3 Stages of Labour

Otalike, (2009) in Ayankabo, (1984) “observes that the 3 stages of labour

demand professional attention for effective management so as to enhance

safe delivery. These stages can be manages as follows.

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1. 1st stage:

The first stage can be managed by ensuring that:

a. Monitor the frequency and strength of contraction.

b. Monitor vital signs – temperature 4 hourly, pulse, respiration and

blood pressure (hourly but BP more frequently, if raised).

c. Monitor foetal heart beat ¼ hourly if not on monitor.

d. Maintain fluid balance chart.

e. Observe the colour of liquor amni when the membrane ruptures.

f. Encourage patient to empty the bladder regularly.

g. Administer analgesic if indicated.

h. Virginal examination to assess cervical dilation and monitor the

progress of labour while in managing stage two i.e. second stage the

following measures has to be observed.

2. 2nd stage:

The 2nd stage labour is marked by a more frequent and strong contractions

bulging of the perineum/anal gapping urge to bear down full dilation of the

cervix on virginal examination.

a. Monitor maternal pulse more frequently.

b. Monitor foetal heart beat ¼ hourly or after each contraction.

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 c. Monitor frequency and strength of contraction.

d. Check for descent of the presenting part.

e. Encourage the women to bear down with each contraction to avoid

laceration.

f. Guard the perineum to avoid laceration.

g. Give injection i.e. ergometrine 0.5mg in following the delivery of the

head, clean the round the neck, if present clamp with two forceps and

cut with scissors. Allow for rotation and deliver baby in a down wards

– upwards movement for the anterior shoulder to escape first.

h. Wrap the baby in a warm clean cloth and put to breast as soon as

mother is fit.

3. 3rd stage of labour:

a. Observe the foetal height (smaller and harder), lengthening of the

umbilical cord and slightest of blood.

b. With contraction hold the cord with one hand and with the other on

the abdomen gently push the uterus upward and gradually pull out the

placenta.

c. Check the perineum for laceration. If any suture or refer if deep.

d. Check the women and take her comfortable.

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 e. Check the placenta for completeness. However, the above state

processes, are those to be taken in order to effective manage the

labour at all the three (3) prevailing stages. So as to ensure that the

woman does not face the great challenges of complication that may

leads to her death.

According to Otalike (2009) there are some issues confronting management

of pregnancy at all the stage of its development. These are widely known as

delay in labour stages.

2.10 Causes of Delay in the 3 Stages of Labour

1. First stage:

a. Mal-presentation e.g. occipito – posterior position.

b. Cephalo – pelvic disproportion e.g. contracted pelvic, large baby.

c. In efficient uterine action cervical dystocia.

2. Second Stage:

a. Ineffective uterine contraction or uterine inertia;

b. Large baby, mal-presentation/ malformation position;

c. Deep transverse arrest due to occipito posterior position;

d. Android pelvic.

3. Three Stage:

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 a. Poor uterine action

b. Mismanagement of the 1st and 2nd stages of labour;

c. Full bladder;

d. Retained product of conception. The need for effective attention and

care in managing the three (3) stage of labour in the health facility by

an aspect i.e. well trained health personal cannot be over emphasized

due to the facts that the traditional birth attendance (TBA) that most of

the people in most of the secretes believed in due to long lasting

traditional believes, costumes and poverty and illiteracy which

restricted them i.e. the family members of the pregnant women to

brought her to the health centers. Even though it is widely believe that

in effective management of various stages of labour especially

obstetric labour may lead to undesirable complication. That may

demand the attention of medical doctor’s or professional obstristician

to attend to the case; if there are look able to address the problem on

time, the mother or the child may lost her or his life or even both.

2.11 Post Natal Care

According to Wilson, (2000) this is the health are given to the woman during

the first 6 – 8 weeks following her delivery. This is the period during which

24
the reproductive organs return to their pre-gravida state and the

establishment of the secretion of breast milk.

Postnatal care is aimed at ensuring or prevent complication such as bleeding,

infection ensuring establishment of breastfeeding, educating the mother and

family on balanced diet, hygiene and infant feeding the woman is

encouraged to observe and practice all aspects of mother-craft taught at the

antenatal clinic and report immediately to the hospital in case of any

abnormality like fever, haemorrhage, severe pain on discharge, she is given

six (6) weeks to return to the clinic for postnatal assessment, family planning

advise is also given to her at this activity.

In addition to that, there are some possible complications expected during

the postnatal period, such as:

a. Vaginal bleeding (post partum haemorrhage)

b. Pre-eclampsia/eclampsia

c. Puerperal pyrexis, mastilia, infection of the leg veins,

(phlebothrombosis and thrombophile ortis0

d. Puerperal psychosis (mental illness)

e. Vesico-vaginal/recto-vaginal fistula (especially in early teenagers,

prolonged labour or instruments deliveries) and

25
 f. Urinary tract infection “Wilson (2000)”

2.12 Condition Involve in Contributing to the High

Mortality of Child Bearing Mothers

Ojo and Biggs (1976) stated that path physiological condition that causes

maternal mortality if there is low level of AND service, could be primary or

secondary direct and true causes include the obstructed labour. This occur in

cephalapelic disproportion due to general pelvic condition on which might

have occurred due to impaired growth resulting from ruptured uterus with

several shock gross sepses. The infections are usually got from unhygienic

condition of skilled traditional birth attendant (TBA) nature midwife

secondly;

Anaemia: This is one of the commonest causes of maternal death especially

in the un-booked client there is deficiency of blood in quantity and quality

and could easily be complicated with heart failure which result in maternal

death. Ajayi (2002) stated that “anaemia after result from various courses

like malnutrition particularly in respects of iron and folic acid which be

made worse by haemolysis due to malaria, hemoglobin nopathics worms and

grand multi-parity, the malnutrition offer result from ignorant of balanced

diet in protein essential for blood formation.

26
Haemorrhage according to Lawson, (1999) interpreting and postpartum

hemorrhage result to maternal death because of pre-existing anaemia that

even minor blood loss may provide fetal patient often come under medical

care later either because they like far away from the hospital, and have no

means of transport or they are delayed by unskilled attendant. The

multigravida patient are often victim of this haemorrhage particularly the

postpartum due to repeated child birth which have made the uterine muscles

so relax that they cannot contract efficiently to arrest bleeding

(haemorrhage) in the 3rd stage at labour the result from retain placement and

trans to upper birth canal.

Other complication include, diabetes, cardise disease, urinary tract infection,

pulmonary, TB, essential hypertension, bleeding, placenta praevia, abruption

placenta, hydramnios, pre-eclampsia toxaemia, eclampsia, hyperemesis,

gravidarum and cephalo-pelvic disproportion.

27
 CHAPTER THREE

RESEARCH METHODOLOGY

3.1 Research Design

The research was investigation the awareness and participation of Kankia

people on the modern contraceptive techniques. Questionnaires were used to

gather the data. The questionnaire was deign with both open and closed

ended questions and distributed to ended questions and distributed to people

data will be analyzed and present in a tabular frequencies and graphical

presentation.

3.2 Population of the Study

The research constitutes almost everybody in the area of Kankia Local

Government Katsina state. Therefore, the subjects were randomly sample

after taking into consideration of the various industries in the area; the

population of workers, their ages, sexes and educational qualifications.

3.3 Sample and Sampling Techniques

Random sampling technique was used by the researcher in order to find out

the accurate information and relevant data. Therefore, the researcher selected

100 people using standard table for sampling from the entire population.

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3.4 Data Collection Instrument

The researcher personally issued the questionnaire by himself and week after

which he went back again to collect the filled questionnaires from the

sampling group of people selected in Kankia quarters of Kankia Local

Government, comprising Galadima ‘A’ ward, Galadima B ward and some

part of Gachi ward, as the local government sampling and sampling

techniques, the research adopted simple random sampling method, the place

selected are:

1- General hospital Kankia

2- Reproductive mothers within Galadima ‘A’ and ‘B’.

3- Natural demographic data from health centre in Galadima ‘A’ and

‘B’.

4- Gachi Galadima ‘B’.

3.5 Data Collection Procedure

The research as stated earlier prepare one hundred questionnaires and it

distributed across the section of respondent by direct hand to hand

distribution and mass in distribution in public place like hospital, clinics,

vital registration areas women of reproductive age (mother’s) within the

research area.

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3.6 Data Analysis

Mathematical tools such as percentage and traction as well as probability

tool were used in analyzing all primary data collection.

30
 CHAPTER FOUR

DATA ANALYSIS AND PRESENTATION

4.1 Data Presentation and Analysis

This chapter deals with the presentation and analysis of data collected from

primary sources. It shows the magnitude of responses of respondents on

issues relating to the topic under discussion as manifested on the

questionnaire of the research work.

Table 4.1

Sex Distribution of the Respondents

Sex No of Responses Percentage

Male 70 40%
Female 30 60%
Total 100 100%

The above table is discussing or showing the sex distribution of the

respondents of the questionnaire prepared and distributed by the research

were 20 respondents representing 40% of the total responses made

responded on male while greater 30 respondents representing 60% of the

total responses made responded on female.

Table 4.2

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Marital Status of the Respondents

Marital Status No of Responses Percentage

Married 98 96%
Single 2 4%
Total 100 100%

The above table is showing the marital status of respondents were 98

respondents representing 96% of the total responses made responded on

married while only 2 respondents representing only 4% responded on single.

Table 4.3

Age of the Respondents

Age No of Responses Percentage

18-25 50 29%
26-31 30 31%
32 and above 20 40%
Total 100 100%

The above table is manifesting age distribution of the respondents 29% of

the total responses made responded on 18-25 years, 30 respondents

representing 31% of responses made responded on 26-31 years and finally

20 respondents representing 40% of the total responses made responded on

32 and above years.

Table 4.4

Did you know anything about antenatal care?

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 Responses No of Responses Percentage
Yes 75 70%
No 25 30%
Total 100 100%

The above table is showing the responses of respondents on the question

asked, whether or not if they know anything about ANC were 75

respondents representing 70% of the total responses made responded on yes

while 25 respondents representing 30% responded on No.

Table 4.5

If yes, what did you know about among following?

Responses No of Responses Percentage

It is health service of pregnant 50 40%
women
Periodic check up pregnancy 20 30%
It is maintenance of pregnancy 20 20%
All of the above 5 10%
Total 100 100%

The above table is showing the responses of the respondents on the

information they know about ANC were 50 respondents representing 40% of

the total responses made, responded on a health services, responded on

periodic check up of pregnancy while 20 respondents representing 20% of

the total respondents on pregnancy examination health education.

Table 4.6

33
Is there any need for ANC to pregnant women?

Responses No of Responses Percentage

Yes 98 96%
No 2 4%
Total 100 100%

The above table is discussing on the question asked which what to find out

whether or not if there is any need for ANC serving to the pregnant women.

Were 98 respondents representing 96% of the total responses made,

responded on Yes while only 2 respondents made said No.

Table 4.7

Do you ever attend or allowed your wife to attend ANC?

Responses No of Responses Percentage

Yes 85 70%
No 15 30%
Total 100 100%

The above table is showing the responses of respondents on the question

asked, whether they are attending ANC services or allowing their wives to

attend antenatal care. Were 85 respondents representing 70% of the total

responses made, responded on Yes while only 15 respondents representing

30% of the total responses made, responded on No.

Table 4.8

Does maternal health status affects socially health status?

34
 Responses No of Responses Percentage
Yes 86 72%
No 14 28%
Total 100 100%

The above table is discussing on the question that said whether or not if

maternal health status has any effects to society’s health status 86

respondents representing 72% of the total responses were made, responded

on Yes; which only 14 respondents representing 28% of the total responses

responded on No.

Table 4.9

Do you think there is the need for neglecting bad tradition practices
towards pregnancy management?

Responses No of Responses Percentage

Yes 88 76%
No 12 24%
Total 100 100%

The above table is discussing on the question that asked the respondents,

whether or not if they think or not if there is the need for neglecting all bad

traditional practices towards pregnancy management provided by the family

or TBA. Were 88 respondents made, responded on yes which only 12

respondents representing 24% of the total responses made, said No.

35
Table 4.10

Did you subscribe the need for health education during antenatal care?

Responses No of Responses Percentage

Yes 100 100%
No 0 0%
Total 100 100%

The above table is showing responses of respondents on the need for health

education during ANC services or not was total responded at Yes, without

different opinion.

Table 4.11

Do people in your locality recognize the health services given to the

pregnant women either at pre-delivery during labour or after delivery?

Responses No of Responses Percentage

Yes 75 70%
No 25 30%
Total 100 100%

The above table is manifesting the opinion of respondents on the question

asked, that said do people in the case study area i.e. Kankia Local

Government do recognizes health services provided to the pregnant women

either at pre-delivery, during labour or after delivery were 75 respondents

representing 70% of the total responses responded on Yes and similarly, the

remain 25 responded on No.

36
Table 4.12

How can you describe the expertise of health personal attending to

pregnancy complication and providing ANC services among the
following?

Responses No of Responses Percentage

Excellent 25 10%
Good 30 20%
Average 25 30%
Fair 20 40%
Total 100 100%

The above table is showing opinion of respondents on the expertise and the

extent of services provided by health personnel to the pregnant women.

Were 25 respondents responded excellent, 20% responded on good, 15

respondent responded on average and finally 20 respondent representing

40% of the total responses made, responded on fair.

Table 4.13

Do you believe that lack of attending ANC services by pregnant women

can lead to maternal death?

Responses No of Responses Percentage

Yes 96 92%
No 4 8%
Total 100 100%

37
The above table is showing the opinion of respondents on the question that

said do you believe on that lack of attending to ANC services by pregnant

woman may lead them to the risk of mortality. Were 96 respondents

representing 92% of the total responses made, responded on Yes while only

4 respondents representing 8% of the total responses made, respond on No.

Table 4.14

Do ANC services have any relevancy to improvement of overall

maternal health?

Responses No of Responses Percentage

Yes 85 70%
No 15 30%
Total 100 100%

The above table is showing the responses of respondents on the question

asked, whether ANC services have any relevancy to improvement of overall

maternal health. Were 85 respondents representing 70% of the total

responses made, responded on Yes while only 15 respondents representing

30% of the total responses made, responded on No.

38
 CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATIONS

5.1 Summary

The research is designed in order to find out the relevant of antenatal care

(ANC) towards improving maternal health in Kankia Local Government

Area of Katsina. There are a lot of comments within the nation and outside

the nation pertaining rate of maternal mortality in Nigeria and sub-Saharan

African countries. This issues leads to the doughtily on whether or not if

Nigeria is likely to meat up the Millennium Development Goals (MDGs)

especially on the MDGs the reducing maternal mortality and improve

maternal health with the emphasis in Northern part of the countries where

Kankia Local Government and the sate i.e. Katsina is located.

39
5.2 Conclusion

From the previous research, we have indicated the causes of antenatal care

(ANC) and also went further to indicate the associated health problems with

regard to antenatal care and it indicate measures that will be taken to

improve ANC condition generally.

This research work is to enable the researcher to discover that there is

interconnectedness between maternal health improvements to the

patronization of ANC services or activities offered by health facilities such

as MCHC, general hospital and comprehensive health centres towards

reducing the danger of mortality of pregnant women and her child. However,

over receive by most of the pregnant women on the tradition believes and

other customs any practice towards managing pregnant women is one of the

major factors leading to maternal death due to low awareness and illiteracy.

Family members does not know the important of antenatal care (ANC) and
postnatal care (PNC) because of poor health education from the pregnant
mother does not visit the clinics as such some time the delivery comes with
problem e.g. mal-presentation and this may leads to the death of the mother
and the child.

Another factor which causes these problems is the attitude of the local

government towards running of primary health care is transferred to local

40
government. It is not doing much in terms of training qualified personnel

such as midwives and community health workers, through this research, the

research discovered that Kankia Local Government. (PHC) and family

support clinics have only five qualified midwives.

All other dispensaries, comprehensive health centres and MCHC they did

not have sufficient midwives that can render the antenatal Care together with

the health education so as the pregnant women can willingly come to the

hospital seeing for (ANC) services.

5.3 Recommendation

Base on the result and data collected from this research, particularly in the
area of study. The following recommendations are made to be put in place
by the relevant authority concerned in order to increase the rate at which
pregnant woman may patronize an antenatal care (ANC) so as the overall
maternal health can be improved:

To the Government

1. Proper and adequate equipping hospital and health centres with qualified
health personnel should be provided at least to every community with
population of not more than 200.
2. Government should appreciate proper training of the existing health

personnel so as to uplift the level of qualities at which ANC service are

given to the pregnant women.

41
3. Government should engage on daily campaigns on media so as to educate

people about the services provided in the hospital, especially to the

pregnant women during pregnancy, during labour and after delivery.

To the General Public

1. House holders should willingly be ready to allow their wives to attend for

antenatal care services, so as to uplift her health status.

2. House holders/ their wives should have a small guarding, where they will

plant some ingredients like tomatoes, green leaves etc. So as to be used

for improving the nutritional status of the entire family, pregnant women

in particular.

3. House holder should maintain balance diet to the pregnant women with

little emphasis on proteineous class food.

To the NGOs

1. Non-governmental organization and youth clubs should assist or

complement the effort of government in constructions of road in the rural

area which will be used for conveying the pregnant women for ANC or

PNC services.

2. NGOs should complement the effort of government in organizing health

education service through campaign so as to enlighten the general public

42
 on the need to patronize hospitals and health centres as the only place

designed mainly for attending to pregnancy complication rather than

TBAs house or marabou, house or craft with.

3. Private pharmaceuticals that are operating the localities should assist

pregnant women with modern ANC service drugs, the sway of

recommending such drugs to the family members of the pregnant

women.

References

Adebayo, A. O. (2000): Maternal Health in Tropical Areas: Ibadan Nigeria.

Adamu, H. Y. (2006): Malaria in Pregnancy: A Major Tool to Maternal

Mortality, A Paper Presented at the Malaria Conference Day.

Adewale, O. O. (2000): Practical Approach to Maternal Death, Gani Press:

Lagos Nigeria.

Arebashola, S. W. (2004): Health Education for Health Student, University

of Ilorin Press.

Ajoryin, B. A. (2003): MDGs in Nigeria: A Key to Success, A Paper

Presented at the 3rd Conference of the School: of Education F.C.E,
Zaria – Kaduna State.

Anyankaho, O. S. (1984): Primary Health Care in Developed Nations:

Bristol Press, New York U.S.A.

43
Dariye, B. V. (2000): Primary Health Care System in Nigeria. FMOH,
Abuja Nigeria.

Kuti, R. E. (1998); Implementation of PHC System in Nigeria in an

Economic Crises. An Article Public in this Day Newspaper vol. 20 No
3 Oct, 1993.

John, A. D. (2009): ANC and PNC A Major Key to Maternal Health

Improvement.

Ojalike, B. S. (2009): Primary Health Care Internet Made Easy. UDUS Press
Sokoto.

APPENDIX

QUESTIONNAIRE SAMPLE

My name is --------------- a student of Health Education and Promotion,

Kankia Iro School of Health Technology Kankia, Katsina State conducting a

research titled “An Analysis of Impact of Antenatal Care (ANC) in

Reducing Maternal Mortality Rate in Kankia Local Government Area”.

Your cooperation is highly appreciated in providing the answers to the

questions below:

Instruction: Kindly tick the (√) option that best satisfy your opinion.

SECTION A: PERSONAL INFORMATION

1. Sex: Male [ ] Female [ ]

2. Marital status: Single [ ] Married [ ]

44
3. Age: 18-25 [ ] 26-31 [ ] 32 and above [ ]

SECTION B: RESEARCH QUESTIONS

4. Did you know anything about antenatal care?

a. Yes [ ] b. No [ ]

5. If yes, what did you know about among following?

a. Periodic check up pregnancy [ ]

b. It is maintenance of pregnancy [ ]

c. All of the above [ ]

6. Is there any need for ANC to pregnant women?

a. Yes [ ] b. No [ ]

7. Do you ever attend or allowed your wife to attend ANC?

a. Yes [ ] b. No [ ]

8. Does maternal health status affects socially health status?

a. Yes [ ] b. No [ ]

9. Do you think there is the need for neglecting bad tradition practices

towards pregnancy management?

a. Yes [ ] b. No [ ]

10.Did you subscribe the need for health education during antenatal care?

a. Yes [ ] b. No [ ]

45
11.Do people in your locality recognize the health services given to the
pregnant women either at pre-delivery during labour or after delivery?
a. Yes [ ] b. No [ ]
12.How can you describe the expertise of health personal attending to
pregnancy complication and providing ANC services among the
following?
a. Excellent [ ] b. Good [ ] c. Average [ ] d. Fair [ ]
13.Do you believe that lack of attending ANC services by pregnant women
can lead to maternal death?
a. Yes [ ] b. No [ ]
14.Do ANC services have any relevancy to improvement of overall
maternal health?
a. Yes [ ] b. No [ ]

46