CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Maternal mortality is defined as the death of woman while pregnant or

within 42 days of pregnancy termination irrespective of the duration or

site of the pregnancy or its management but not from accidental or

incidental causes (WHO 1997). More than 600,000 women die due to the

child birth or pregnancy related complications around the world annually,

Nigeria solely responsible for close to 10% of that figure. Maternal

mortality is much higher in the North Eastern region of Nigeria

accounting for 75% of the country, maternal death compared to the South

East and South West region (WHO 2013).

The United States Agency for Internal Development (USAID) indicates

that, most of the victims of maternal death are women between the ages

of 15 to 45. After India, Nigeria has the second highest maternal death

rate in the World. 52,000 Nigerian women die every year, Unsafe

practices of child birth cause an average death of 144 Nigerian women,

this mean that every 10 minutes one Nigerian women dies due to the

child birth and pregnancy related causes (WHO 2013). Women die from

wide range of complications in pregnancy, child birth or the post-partum

period. Most of this complication develops because of their pregnancy

status and some is because of pregnancy aggravated existing disease.

1
The four major causes of maternal mortality are severe bleeding 25%

(mostly postpartum bleeding), infection 15% (mostly soon after delivery),

hypertensive disorders in pregnancy 12% (eclampsia) and obstructed

labour 8% complications after Unsafe abortion causes 13% of maternal

deaths (WHO 2018). Globally about 80% of maternal deaths are due to

this cause. Among the direct causes (20%) of maternal deaths are caused

by the diseases that has a complication during pregnancy or are

aggravated by pregnancy, such as malaria, Anaemia and HIV (Human

Immune deficiency virus), 8% women also die because of poor health at

conception and lack of adequate care needed for the healthy outcome of

the pregnancy for themselves and their babies (WHO 2017).

Dr. Amina Nasidi has noted that the increase in maternal mortality rate

may be attributed to an in adequate health care system. She stated that

lack of experienced health personnel’s, inadequate medication and

medical equipment in Nigerian health centres is part of the reason for the

country in escalating maternal mortality rate. This committee focuses on

controlling HIV and AIDs, tuberculosis, malaria as well as other

pregnancy and child birth related diseases all in order to reduce the rate of

maternal mortality. Establishment of many more health care centres and

training of health care personnel across the country would be an

investment not only to women as mothers, but ultimately also in their

families, societies, communities and wellbeing of every citizen.

2
The national primary health care development agency (NPHCDA),

recently in (2019) organized a training workshop on life saving skills for

midwives after 2,8, 9 midwives were deployed to 652 primary health care

facilities in all 36 state of Nigeria, including the Federal capital of Nigeria

(Abuja). The midwives were trained on life saving skills, integrated

management of child hood illness (IMCI) as well as educating the

mothers on how to use the "mama" kits, and each of the health centres

there is special book for the documentation of their health information.

The distributions of trained midwives across all the region of Nigeria,

urban and rural areas drastically reduce the rate of maternal and infant

mortality.

1.2 Statement of the Problem

More than 600,000 women die due to the child birth or pregnancy related

complications worldwide with Africa having the highest number in which

Nigeria has about 10% of that figure and the second highest in the world.

Even in Nigeria maternal mortality is higher in the Northern region in

which Katsina State is inclusive. The commonest predisposing factors to

these problems are poor awareness on the causes, ignorance, staff

attitudes and cultural factors. Due to this fact the study seeks to find out

the community awareness on the causes of maternal mortality in Kankia

Local Government Area, Katsina State.

3
1.3 Objectives of the Study

1. To assess the level of community awareness on the causes of

maternal mortality in Kankia Local Government Area

2. To identify the possible factors responsible for maternal mortality in

Kankia Local Government Area.

3. To encourage mothers’ utilization of maternal and child health care

services in Kankia Local Government Area.

4. To ensure that pregnant mothers and their unborn children attain their

maximum potential for health and wellbeing.

5. To ensure that postnatal care is also crucial in achieving the stated

aims and objectives.

1.4 Significance of the Study

The study will assess the community awareness on the causes of maternal

mortality in Kankia Local Government Area, Katsina State. When

concluded the study will be of immense benefit to:

1. The society by helping the pregnant mothers to seeks help in health

centres during deliveries.

2. The State and Local Government to plan ways that would help to

reduce maternal mortality in the community.

3. The health workers by acquiring more knowledge on the causes and

prevention of maternal mortality in their areas of work.

4
4. The students who wish to carry out a research on the same field to

serve as a document for reference.

1.5 Research Questions

1. What is the level of community awareness on the causes of maternal

mortality in Kankia Local Government Area?

2. What are the possible factors responsible for maternal mortality in

Kankia Local Government Area?

3. What are the ways to encourage mothers’ utilization of maternal and

child health care services in Kankia Local Government Area?

4. What are the ways to ensure that pregnant mothers and their unborn

children attain their maximum potential for health and wellbeing?

5. Is postnatal care crucial in achieving the stated aims and objectives?

1.6 Research Hypothesis

1. There is community awareness on the causes of maternal mortality in

Kankia Local Government Area.

2. There are factors responsible for maternal mortality in Kankia Local

Government Area.

3. There are possible ways to encourage mothers’ utilization of maternal

and child health care services in Kankia Local Government Area.

4. There are ways to ensure that pregnant mothers and their unborn

children attain maximum potential for health and wellbeing.

5
5. Yes, postnatal care is crucial in achieving the stated aims and

objectives.

1.7 Scope of the Study

The study seeks to find out the community awareness on the causes of

maternal mortality, specifically it is restricted to the awareness,

prevention of maternal mortality and utilization of maternal and child

health clinic in Kankia Local Government Area, Katsina state.

1.8 Definition of Terms

 Anaemia: Lack of blood due to decreased of haemoglobin (oxygen

carrying pigment).

 Antenatal Care: This refers to a series of health services giving to a

pregnant mother before delivery in the relevant health situation, with

the aim of improving health status of the mother and the child in the

womb.

 Awareness: Is the knowledge and understanding that something is

happening or exists. Awareness in this study is a level of knowledge

and understanding on the causes of maternal mortality among the

community.

 Causes: In this study causes refer to factor that leads to maternal

mortality.

6
 Health effects: Are changes in health resulting from exposure to a

source. It this study health effect refers to negative health implications

of maternal mortality.

 Hypertension: Is defined as blood pressure above 140/ 90 mmHg,

and is considered severe if the pressure is above 180/ 120 mmHg.

 Immunization: Protection of immunity by artificial means, passing

by anti-sera and activity by vaccination.

 Incidence: Number of cases recorded during a particular period of

time e.g. Year.

 Labour: The pains or contraction of the uterus of childbirth leading to

expulsion of the body (foetus).

 Maternal Health: Is the general health care services giving to a

woman especially in relation to pregnancy, labour and other

management of complications associated with childbirth or her

general health status.

 Maternal Mortality: Death of women due to infection and

complications associated with pregnancy of child birth.

 Maternal: Is relating to a mother, especially during pregnancy or

shortly after child birth.

 Midwives: Are professionals that has a knowledge and skills on

assisting women in child birth/delivery.

7
 Mortality: Refers to a death rate, is a measure of the number of

deaths in a particular population, scaled to the size of that population,

per unit of time.

 Placenta: An organ that develops in the womb during pregnancy and

supplies the foetus with nourishment.

 Post-Partum Period: Is a period that begins immediately after the

birth of a child as the mother's body, including hormone levels and

uterus size, returns to a non-pregnant state.

 Pregnancy: Is a state of developing embryo by women which

manifest her ability to give birth.

 Puerperium: Is a period of about six weeks after child birth during

which the mother's reproductive organs return to their original non

pregnant condition.

 TBAs (Traditional Birth Attendants): Front line workers, usually

older women attending to childbirth in the homes.

 Vaccine: Is a special preparation of antigenic materials that can be

used to stimulate the development of antibodies.

8
 CHAPTER TWO

REVIEW OF RELATED LITERATURE

2.0 Introduction

This chapter reviewed literatures related to the topic and it consists of the

concept of maternal mortality, related studies on community awareness

on the causes of maternal mortality, prevention of maternal mortality,

utilization of maternal and child health clinics as well as the summary of

related literature reviewed.

2.1 The concept of maternal mortality

The problem of maternal mortality worldwide can be pictured by imaging

a jumbo jet with 274 women aboard crashing in to the sea every four

hours, day in day out 365 days of the year (Pott, 1986). Maternal

mortality refers to the death of women while pregnant or within 42 days

of termination of pregnancy (WHO 1996). Maternal deaths often occur in

women and never become recorded by the health care system (WHO

1996). 600,000 women die every year as a direct result of child bearing,

and most of these death are preventable (WHO 2016), the loss of these

women is a great tragedy. The fact that the majority of maternal deaths

are preventable, when low to moderate technology and education are

available, add to the strategy. Yet maternal deaths even when one

considers are a small portion of the problem that the pregnant women
9
face. One study estimates that for every maternal death, there are 16 cases

of maternal illness (WHO 2018).

The impact of maternal death and illness on a nation economic

productivity, the heath of the family and loss of personal fulfillment of

the individual women is difficult to calculate. The difficulty of measuring

maternal mortality has long been a barrier to progress in alerting health

planners and others to the magnitude and causes of this problem and thus

to the development of effective interventions (WHO 2018). The major

causes of maternal mortality in Nigeria are haemorrhage, obstructed

labour, anaemia and malaria. Most of maternal deaths are preventable

through quality obstetric care including a functioning referral hospital.

Acceptance of referral by mother and family members, rapidly and safe

blood services, family planning (particularly child spacing), access to safe

abortion, improve nutrition, good transportation and communication,

improve female education as well as improvement of the general health

status of a woman within the culture are important to the quest of safe

motherhood (Training manual on life saving skills for Nurses/Midwives).

A. Causes of maternal mortality

More than 70% of maternal mortality in Nigeria are due to five major

complications e.g. haemorrhage, infection, unsafe abortion, hypertension

diseases in pregnant women and obstructed labour. Also poor access to and

quality utilization of reproductive health services contribute to increase

10
the level in Nigeria (WHO 2019). The major causes of maternal death are

bacterial infection, variant of gestational hypertension in clouding pre-

eclampsia, obstetrical haemorrhage, ectopic pregnancy, puerperal sepsis,

amniotic fluid embolism, uterine rapture and complications of unsafe or

unsanitary abortion. Lesser known causes of maternal death include renal

failure, cardiac failure, and hyperemesis gravidarum, also poor access to

quality and utilization of reproductive health services contribute

significantly to the high level of maternal mortality in Nigeria.

According to the 2017 Nigerian demographic survey, 30 percent of the

Nigerian women cited the problem of getting money for treatment, while

24 percent cited the problem of accessibility to health facilities and

transportation. Also 17 percent reported the problem of not getting a

female provider in the hospital, while 14 percent reported the problem of

not waiting to go alone. Again, 14 percent reported the problem of

ignorance of where to go for receiving a medical treatment, while one in

ten women complained of the bottle necks in getting permission to visit

hospital (WHO 2010). Majority of birth in Nigeria (66 percent) occur at

home and only one third of live births during the five years presiding the

most recent demographic health survey occurred in a health facility. A

smaller proportion of women received postnatal care, which is crucial for

monitoring and treating complications in the first two days after delivery,

only 23 percent of women who gave birth outside the health facility
11
received postnatal care within two days of birth of their last child. More

than seven in ten women who delivered outside the health facility

received no postnatal care at all (Demographic and health survey, 2010).

Evidence exist on the relationship between the density of health workers

and maternal mortality rate in Nigeria, slightly more than one third of

birth in Nigeria are attended by the doctors, trained nurses and midwives.

This is in spite of the fact that the level of assistance a woman receives

during delivery can reduce maternal deaths and related complications.

The attitude of many nurses and midwives toward pregnant women in

labour is poor in the causes of their professional duties as nurses and

midwives, they act in appropriate to the women in labour some times, one

wonders if any knowledge of the lateral meaning of their profession or

even what their profession entails (Akintola and Mashel 2013). Maternal

mortality statistic in Nigeria drive many from urban-based hospital data

and rural areas of the country where available medical facilities, trained

medical personnel are in adequate, the incidence and major causes of

maternal death may differ. The maternal mortality was 2,659/100,000,

maternities 789/100,000 for booked and 8,235/100,000 for un booked

women, ruptured uterus accounted for 31.9% of deaths, haemorrhage,

obstructed labour, sepsis and eclampsia accounted for 29, 2, 13, 9, 12, 5

and 8.3% of the deaths respectively.

12
A patient died from each complication of abortion, anesthesia, ruptured

uterus and obstructed labour where responsible for over half of the

maternal deaths. High maternal mortality ratio (MMR) reflect paucity of

maternal and public health services in the rural areas (Unwosu Dijohn

2018). In 2015, analysis show that, the major causes of maternal mortality

in Nigeria are prolonged labour, ruptured uterus, postpartum

haemorrhage, puerperal sepsis, abortion and lack of appropriate health

facilities for conducting successful deliveries mostly in the rural areas

(WHO 2017).

B. Objectives of maternal and child health services

The objectives of maternal and child health services, it's concern

generally for the solving health problems of all individual mothers and

their children, family members, societies, communities, and the nation at

large. The objectives of maternal and child health services, also concern

the health problems by which pregnant mothers faced before delivery and

discuss on the possible ways that are used to prevent the problems. The

programmes are conducted in order to ensure that, every pregnant women

and nursing mothers learn strategies that are used to maintain good health

of their babies, also secure in a healthy environment, well-nourished with

adequate medical attention and socialization both of the mothers and their

children (WHO 2017).

13
C. Factors influencing the health of mother and the child

1. Age of mothers: Women who marry too young often stand the risk of

having complications during pregnancy, labour and delivery.

2. Educational level of mothers: Illiterate mothers, lack the knowledge to

take care of themselves during pregnancy and after pregnancy as well

as the child.

3. Child spacing: The mothers should space pregnancies, which promote

the health of mother and the child both physically and psychologically

fit.

4. Climate: The children and the mothers in tropical climate stand the

risk of infection and poor health due to the poor environmental

condition.

5. Family size: The large size of the family, the more likely, the health of

the mother and the child will be poor due to poverty and in adequate

nutrition.

6. Barrier to maternal and child health care services. The government

failure to allocate adequate resources and to ensure accountability for

resources that are allocated has translated in to financial,

infrastructures and institutional barriers to maternal and child health

care services influencing the high number of maternal death in the

country. In 2010 concluding and observation on Nigeria, the

14
 committee on the right of the child recommended that the '' very

mortality rates" among mothers should be addressed through

improving ante and postnatal care. Also in 2010 concluding

observation on Nigeria, the non-government organizations (NGOs)

committee asked the government to improve the country's health

infrastructures particularly at the primary health care level, and to

integrate agenda perspective in to all health sector reforms. It also

urged the state party to improve women access to quality health care

and health related services at affordable and available to all

individuals, families, societies, communities and the nation at large

(WHO 2010).

7. Lack of availability of family planning services and information. The

lack of adequate information and counseling on family planning and

the resulting non-use of contraceptives is another major factor that

contributes to the high rate of maternal mortality in Nigeria. Access to

family planning and contraceptives is an important strategy in

reducing maternal mortality. In the absence of contraceptive services,

women may experience unwanted pregnancies, possibly resulting in

death or illness due to the lack of adequate health care, or they may

seek unsafe illegal abortion that can result in complications or death.

8. Unsafe abortion: The Nigerian government has admitted in its six

periodic report to the non-government organizations (NGOs)

15
 committee of the main causes of maternal mortality, unsafe abortion

remains frequent occupancies, killing over 34,000 Nigerian women

annually. Despite this affirmation, Nigerian abortion law remain very

restrictive, one study indicated that, majority of the abortions that are

performed in Nigeria are unsafe, partly because of the nation

restrictive legal context. For example, it has been estimated that,

456,000 unsafe abortions take place annually in Nigeria. The

restrictive abortion law in Nigeria has not only contributed to the high

number of unsafe abortion in the country, it has also had a

discriminatory impact. Poor and low income women are

disproportionately represented in the number of women who resort to

- and die from - unsafe abortion in the country. The government has

acknowledged in its six periodic report that "low income women and

girls" who cannot effort the high cost of abortion or who are ignorant

of the dangers of unsafe procedures utilized by the unqualified

individuals, stand very high risks of losing their lives.

D. Prevention of maternal mortality

There are different ways of preventing maternal mortality but, the best

strategy is family planning. At the international conference on

populations and development (ICPD) held in Cairo on 1994, 179

countries agreed that, reproductive rights are human rights and that sexual

health is a component of reproductive health, they collectively called for

16
universal access to reproductive health services, such as family planning

by 2015, the envisaged quality between men and women in respect to

reproductive decision making, there by promoting voluntary choice in the

determination of number and timing of children and they enclosed

freedom from sexual violence coercion, discrimination and other harmful

practices. According to Werner Harung in 1995, Director of technical

division at the united nation of population (UNP). Family planning is the

best documented practices to reduce maternal mortality rate, he further

commented that, maternal mortality rate may be decreased by 40%, if

men and women had access to the latest contraceptives (UNP, 1995).

Janet Museveni first lady of Uganda in 1999, consider family planning is

an effective, existing and low cost prevention strategy. Family planning

involved educating and assisting couples in planning for their next child

and the mother re-cooperate from their prior child birth and pregnancy.

Generally, in health, two important key fact that follows each and every

diseases condition after knowing what is it, its nature, causes and risk

factors; prevention and treatment. Maternal mortality is preventable and

for this to be achieved, so many faces has to be considered regarding its

causes and risk factors (Chendlar 2013).

2.2 Related studies on the community awareness on the causes of

maternal mortality

17
The neglected tragedy of maternal mortality has been described as the

health scandal of our time for women of reproductive age, complications

of pregnancy and child birth are the leading causes of maternal mortality,

diseases and disability, accounting for at least 18% of the global burden

of diseases in this age group. World Health Organization (WHO) and the

United Nations Children Education Fund (UNICEF) estimate that, there

are well over 600,000 maternal deaths worldwide annually, with 99% of

these maternal deaths occurring in the developing countries. Globally one

woman dies every minute from complication related to child birth, for

every maternal death 15-20 other women suffer severe disabilities that

significantly jeopardize their reproductive health and socio economic

status. Estimates as high as 1000-2000 per 100,000 live births are

commonly reported in Nigeria.

It is estimated that, 75% of maternal deaths are direct obstetric death due

to obstetric complications such as haemorrhage, sepsis, hypertensive

disorder, unsafe abortion and obstructed labour. Other non-obstetric

causes include; anaemia, sickle cell diseases and cardiac diseases, non-

medical factors include; socio economic factors (illiteracy, poverty,

ignorance, poor nutrition and poor use of available maternal services),

cultural factors, religious factors, poor transport and telecommunication

and biological factors (age and parity differential). These, apart from lack

of provision of emergency obstetric care, also play important roles have

18
been highlighted as significant contributor to maternal mortality in Africa

(Okolocha 2018). Concluded that, for a further understanding of maternal

mortality and morbidity, it is important to consider factors outside the

hospital and formal medical practice.

A study in Konduga, Borno State of Nigeria showed that, their

community members had a good understanding of obstetric complications

leading to maternal death. Another study among the Annang in

Southeastern Nigeria showed that, most of the participants felt hospitals

generally can note sickness and were places reserved for sick people only.

The most common causes of maternal death highlighted by the

participants were spiritual attack from enemies and the punishment by the

gods for infidelity.

Awareness among the community members on the causes of maternal

death will influences their decision to seek help in the face of an

emergency. Pregnancy and delivery are regarded as a natural process, and

complication may not be sufficient reason for concern. Nigerian women

recognition of the correct causes of maternal mortality will greatly

improve their health seeking behavior and therefore could reduce our

present alarming rate of maternal mortality. The issues of maternal deaths

emerged as a world health concern through the United Nations call for

"safe motherhood" education in the 1980's. Through "safe motherhood"

education and advocacy on improving maternal health and reducing

19
maternal deaths are to be the priority for government health care policy.

Despite such advocacy, it appears that there has been little improvement

in maternal and child health care delivery. Maternal mortality rate in

many countries have remained essential unchanged for 20 years,

countries in Africa may have actually lost ground. The world maternal

mortality ratio (The number of maternal deaths per 100,000 live births) is

declining too slowly to meet Millennium Development Goals (MDGs)

five target which aimed to reduce the number of women who die in

pregnancy and child birth by three quarters of 5.5 percent in maternal

mortality (MDGs for WHO 2017).

The previous study showed that, most of the women in this community

have a high degree of perception on the causes of maternal mortality, as

96.3% of the subject opined that pregnancy - related complications lead

to death. This may not be unrelated to the fact that, 61.4% of the subjects

had tertiary and secondary education. Similar observations have been

noted in previous studies. Surprisingly, this high level of perception even

among some section of the populace does not translate to reduce maternal

mortality rates, as Nigeria still has one of the worst statistic in the world

with regard to maternal mortality. Obstetric haemorrhage was the

commonest cause of maternal mortality mentioned by subjects (85.4%);

and out of the 69.1% that were aware of a maternal death in their

families, obstetric haemorrhage (79.7%) was the most frequent reason

20
given for death. The recognition that, obstetric haemorrhage is the

commonest cause of maternal mortality at the community level, mirrors

the popular research finding that in Nigeria and worldwide, obstetric

haemorrhage is the commonest cause of maternal mortality (Okolocha

2017), found that women in southern Nigeria had fairly good knowledge

of obstetric haemorrhage as a cause of maternal mortality, but yet their

attitudes, practices and situations kept them away from, or delayed the

decision to seek, modern obstetric care. Causes such as infidelity, witch

craft/evil forces and disobedience surprisingly constituted 8.3% of the

causes of death mentioned by the subjects. This may be due to the fact

that majority of the study population were educated.

2.3 Related studies on the prevention of maternal mortality

Maternal health is not a "women issue" It is about the integrity of the

communities, societies and the nation, as well as the well-being of all

men, women, boys and the girls whose own prospects in life depend upon

healthy women and mothers. Maternal health is not only needed as a

basis for social harmony economic productivity; it also reduces cost and

burdens to families, communities, service providers and the treasury-

smart investments in maternal health strengthen health system overall,

and increase cost- effectiveness of resources allocated to the health

sector. We believe that, investing in maternal health makes compelling

political and economic sense. Failure to invest in maternal health is not

21
only irresponsible and immoral; it is also deeply counterproductive, under

mining national growth and development. This report recommended what

can and must be done if Africa is to end the unnecessary death of millions

African women. It is simply unacceptable that so many women are dying.

Nearly 50 percent of all maternal death in the world happen in Africa,

which has only 15 percent of the world's population. Pregnancy and child

birth are all too often a cruel and harsh lived experience for Africa's

women, particularly the poor and women who die in child birth would be

alive if they had access to the interventions for preventing and child birth

complication. This policy brief is intended to complement the efforts of

maternal health advocates in government, civil society and the

developmental community by making the case for why urgent action to

reduce maternal mortality must be a top priority for African leaders,

including ministers of finance and the private sectors. It recommends

policy interventions and considers mechanisms to help with financing of

maternal health initiatives success in reducing maternal mortality is

dependent on and can accelerate progress on wider issues such as

nutrition, education, sexual and reproductive rights, including access to

comprehensive voluntary family planning. This brief recognizes that

maternal health requires taking a holistic view by addressing women's

sexual and reproductive health needs throughout their lives, including

adolescence, and articulating the responsibility of women and boys in

22
reducing gender in equalities. This can be achieved by educating the girl

child, providing employment for women and implementation of Nigeria's

gender policy. In addition, maternal mortality in Nigeria can be prevented

through, provision of adequate antenatal and postnatal clinics both in the

urban and rural areas and provision of skillful health workers e.g.

Midwives, Community health workers (CHEWs), Nurses, as well as

provision of adequate materials/instruments by which these group of

health personnel can be used to conduct successful deliveries. This might

help to reduce the occurrence of maternal mortality in Nigeria. (WHO for

MDGs 2017).

2.4 Related studies on the mothers’ utilization of maternal and child

health clinics

Poor maternal health delivery in developing countries results in more than

half a million maternal deaths during pregnancy, child birth or within a

few weeks of delivery. This is partly due to unavailability and low

utilization of maternal and child health care services in limited resources

setting. Improve maternal health is an important pre-requisite for

women's advancement, yet due to the low of access and utilization of

maternal and child health clinics, Women, especially those in rural

communities remain vulnerable and underserved. It is evident that the

past decade has observed dramatic improvements in the health of

mothers, owing to improved maternal and child health care, nutritional

23
practices and increased availability of low-cost and high impact public

health measures such as, oral rehydration therapy (ORT) and vaccine for

mothers/children.

According to the world health organization (WHO), specific interventions

such as iron or folic supplementation for pregnant and post-partum

women, vitamin A, supplementation for children and post-partum

women, malaria prophylaxis interventions such as, insecticide-treated net

(ITNs), as well as intermittent preventive treatment in pregnancy or

lactating mothers, have helped improve maternal and child health care. In

spite of these developments, more than half a million women die during

pregnancy or child birth or within a few weeks of delivery which most of

them living in developing countries. These have been partly attributed to

the low utilization of maternal and child health care services, and are also

influenced by social, economic and cultural factors as well as health care

availability and accessibility. In limited-resources settings, pregnant

women do not receive the full benefits of maternal and child health care

services, with benefits waning towards the rural and deprived

communities.

We defined maternal and child health care for the purpose of this

manuscript to include antenatal care (ANC), skilled birth attendance and

postnatal care (PNC), focused ANC has been found to offer the

opportunity for early detection and timely treatment of diseases, leading

24
to improve maternal and child health outcomes. The detection and

treatment of high blood pressure for example, help to prevent eclampsia

and greatly reduce maternal mortality. Similarly, improved through the

detection and treatment of anaemia. The attendance of ANC is known to

help augment health care during pregnancy through the provision of

preventive health services, such as prophylactic treatment of malaria, the

immunization against neonatal tetanus and screening for sexually

transmitted diseases such as, HIV infection and hepatitis. The assistance

by a skilled birth attendant at delivery is also an important aspect of

maternal and child health care services.

Several babies or mothers are lost due to critical issues such as the in

ability to recognize delivery complications and ensuring quick referrals.

Skilled delivery encompasses the presence of professionals (midwives,

doctors, nurses and others) during delivery. It also includes an enabling

environment where the equipment, drugs and other supplies required for

the effective and efficient management of obstetric complications are

available. The presence of skilled birth attendants (SBAs) in the

community may help to reduce maternal mortality, and this is regarded

as, probably one of the most critical interventions for reducing

pregnancy-related deaths and disabilities in developing countries. The

report from the world health organization (WHO), shows a 50%

reduction of maternal mortality in Nigeria through the doubling of the

25
proportion of births assisted by skilled professionals. However, the

provision of skilled attendance during delivery is only possible in the

presence of functioning health systems, which include adequately trained

and motivated workers, well equipped facilities, transportation and rapid

referral systems. These factors are under developed, in adequate or

nonresistant in most developing countries health systems.

The post-partum period, which is usually 42 days after child birth, is

equally important for mothers. More than 60% of maternal deaths are

known to occur during this period, the death of a mother further exposes

her new born child to risks of morbidity and mortality. In developing

countries, the most common causes of maternal deaths during the post-

partum period are haemorrhage, infections and hypertensive disorders.

These conditions and any other life-threatening or debilitating conditions

that may require urgent medical attention could be identified during PNC.

Other services and information such as, maternal and child nutrition,

immunization, hygiene and sanitation can all be provided during PNC. It

is however, reported that less than 30% of women in developing countries

receive PNC. Nigeria has seen an improvement in the utilization of

maternal and child health services over the years. There has been an

increase of the deliveries in health facilities from 57% in 2013 to 73% in

2018 with an increasing number of ANC visits. These improvements are

however, minimal in regions with more rural communities. Moreover,

26
there is a paucity of evidence on the specific factors that explain access

and utilization of maternal and child health care services in deprived and

rural communities in Nigeria.

2.5 Summary of related studies reviewed

Based on the various studies reviews in relation to awareness on maternal

mortality, prevention of maternal mortality and mothers’ utilization of

maternal and child health clinics. There is indication that, many people

are aware of maternal mortality, but there is low information on the

process to prevent the problem at the community level as well as low

utilization of maternal and child health clinics more especially in the rural

areas.

27
 CHAPTER THREE
RESEARCH METHODOLOGY
3.0 Introduction
This chapter deals with the design of the study, area of the study,

population of the study, sample and sampling techniques, instrument for

data collection, validation of the instrument, reliability of the instrument,

method of data collection, method of data analysis as well as decision

rule.

3.1 Study Design

The study adopted descriptive survey research design to ascertain the

level of community awareness on the causes of maternal mortality in

Kankia Local Government Area, Katsina State. This design is considered

suitable and appropriate because (Singhdu, 2008) defined the design that,

it involve clear definition of the problem, collection of relevant and

adequate data, careful analyses, interpretation of the data collected and

skilful professional reporting ofs the findings.

3.2 Area of the Study

Kankia is an old settlement, the beginning of which dates back to the

period of Trans-Saharan trade in the West African Sub-region south of

the Sahara. Kankia political history dated back to some centuries

happening about Kankia Local Government from 1975 to date. Following

28
the Local Government reform in 1975 of Murtala/Obasanjo

Administration Kankia happened to be one of the local governments

created. Kankia has a population of 151,435 people (2006 census).

Recent local government reforms have granted demarcation of Kankia

from other district mention above through the headquarters remained in

Kankia another districts were formed Kankia, Kusada and Rimaye.

During the Late General Sani Abacha Local Government reform have

created Kusada Local Government. Kankia town was built by nomadic

Fulani, the first to settle in the area mainly for hunting and subsistence

farming.

The precise location of Kankia on the Nigerian land mass is latitude 12 o

33 North and Longitude 7o 48” East. With and area of about 2,816km2

(square kilometers), Kankia has 10 wards. Political wards are Galadima

A, Galadima B, Gachi, Rimayye, Fakuwa/Kafin-Dangi, Kafin-Soli,

Kunduru/Gyaza, Tafashiya/Nasarawa, Tsa-Magam and Sukuntuni ward

respectively.

3.3 Population of the Study

The population of the study consist of all the people within 15-64years

living in Kankia Local Government Area i.e. seventy-four thousand two

hundred and seventy-eight (74,278) people (City Population 2006).

3.5 Sample and Sampling Techniques

29
For this study simple random sampling technique was used to select 100

respondents out of the study population.

3.6 Instrument for Data Collection

The instrument for data collection was a structured self-completion

questionnaire, containing 15 items designed in Likert rating scale of 4, 3,

2 and 1 developed from the research questions formulated in chapter one.

3.7 Validation of the Instrument for Data Collection

A draft copy of the instrument was subjected to face validation by the

project supervisor. Based on observations and comments from the

validator, correction and improvement were made before the final draft of

the instrument was produced.

3.8 Reliability of the Instrument

For the instrument to be reliable, pilot study was conducted within the

respondent of the target population after which the questionnaire was

reformed to ensure its reliability in providing the required information.

3.9 Method of Data Collection

Data for this study, were collected personally by the research, the

questionnaire were administered to the respondents on the spot while

those that could not be immediately collected were given 3 days for

collecting out of the 100 copies of the questionnaire administered.

3.10 Method of Data Analysis

30
A frequency and percentage were used in analyzing data for research

questions 1, 2 and 3.

3.11 Decision Rule

The decision was 2.5, as any item that scored a mean of 2.5 and above

was considered agreed and any item that scored a mean of less than 2.5

was considered disagreed.

= 4+3+2+1/4 = 10/4 =2.5

31
 CHAPTER FOUR

PRESENTATION AND ANALYSIS OF DATA

4.1 Data Analysis

This chapter deals with the presentation and analysis of data collected

from the various respondents, 100 questionnaires were distributed and all

the 100 questionnaires were answered and returned to the researcher. The

data collected was analyzed and presented in the tables according to the

research questions that guided the study.

Table 1: Gender Distribution of the Respondents

GENDER FREQUENCY PERCENTAGE

Males 45 45%
Females 55 55%
Total 100 100%

The table above shows the gender distribution of the respondents, where

by females has the highest number of respondents with about 55

respondents representing 55% of the total responses, while male

respondents are 45 with 45% respectively.

Table 2: Age Distribution of the Respondents

AGE FREQUENCY PERCENTAGE

15 - 23 25 25%
24- 32 35 35%
32
33 – 41 20 20%
42 – 50 15 15%
Above 50 5 5%
Total 100 100%

The table above indicate the age distribution of the respondents, where

15-23years have 25 respondents with 25%, followed by 24-32years which

have 35 respondents with 35% and they are the majority, followed by 33-

41years which have 20 respondents with 20% then followed by 42-

50years which have 15 respondents with 15% of the total responses,

lastly, above 50 occupied 5 responses with 5% respectively.

Table 3: Marital Status of the Respondents

MARITAL STATUS FREQUENCY PERCENTAGE

Married 70 70%
Single 20 20%
Separated 10 10%
Total 100 100%

The table above shows the marital status of the respondents, where

married respondents have the highest number of respondents with about

70 (70%), followed by single with 20 respondents and 20%, while 10

respondents representing 10% of the responses were separated.

Table 4: Occupational Distribution of the Respondents

OCCUPATION FREQUENCY PERCENTAGE

Civil servant 35 35%
Businesses man/woman 30 30%
Self-employed 20 20%
Not-employed 5 5%
33
Student 10 10%
Total 100 100%

The table above indicate the occupational distribution of the respondents,

35 respondents representing 35% of the responses are civil servants and

they have the highest number, 30 respondents representing 30% of the

total responses are business men/women, 20 respondents representing

20% of the total responses are self-employed, while 5 respondents that

represents 5% of the total responses are not-employed and lastly, 10

respondents that represent 10% of the total responses are students.

34
Research Question One: What is the level of community awareness on

the causes of maternal mortality in Kankia Local Government Area?

Table 5: Frequency and Mean Analysis on the Level of Community

Awareness on the Causes of Maternal Mortality in Kankia Local
Government Area.
S/NO ITEMS SA A D SD MeanDecision

1. Maternal mortality is the death of 49 42 6 3 3.37 A

woman due to pregnancy
complications
2. Antenatal care helps in reducing 41 40 13 6 3.16 A
maternal mortality
3. Postnatal care helps in reducing 39 46 9 6 3.18 A
maternal mortality
4. Maternal mortality is related to 41 37 13 9 3.10 A
unsafe abortion
5. Antepartum and postpartum 42 46 7 5 3.25 A
haemorrhage play role in maternal
mortality
6. Anaemia is one of the factors to 41 40 13 6 3.16 A
maternal mortality
7. Eclampsia is one of the factors to 39 42 11 8 3.12 A
maternal mortality
8. Malnutrition is a risk factor to 41 37 13 9 3.10 A
maternal mortality
9. Poor health services contribute to 33 43 15 9 3.00 A
maternal mortality
10. Poor utilization of maternal and 41 37 13 9 3.10 A
child health clinic predispose
mothers to maternal mortality
Grand Mean 3.15 A
Source: Field Work (2023)

35
Table 5 shows the mean responses of the respondents on the level of

community awareness on the causes of maternal mortality in Kankia

Local Government Area with corresponding Frequencies and Means.

From the table as presented, the respondents agreed to all the items (Items

1-10) with Mean values ranging from 3.00 - 3.37 which are above the

benchmark of 2.50 and this also shows that there is homogeneity of the

responses of the respondents. The table further revealed a cluster Mean of

3.15. With this cluster mean (3.15) which is above the benchmark of

2.50, it means that, there is community awareness on the causes of

maternal mortality in Kankia Local Government Area.

36
Research Question Two:

What are the possible factors responsible for maternal mortality in Kankia

Local Government Area?

Table 6: Frequency and Mean Analysis on the Possible Factors

Responsible for Maternal Mortality in Kankia Local Government
Area.
S/NO ITEMS SA A D SD MeanDecision
1. Lack of adequate nutrition 52 39 6 3 3.40 A
2. Irregular ANC Visit 62 29 5 4 3.49 A
3. Harmful practices during 34 47 10 4 3.01 A
pregnancy by pregnant women
4. State of anaemia 45 43 9 3 3.30 A
5. Age 46 39 9 6 3.22 A
6. Delivery method 52 39 6 3 3.40
7. Late referral 34 47 10 4 3.01
8. Pregnancy complications 44 39 11 5 3.20 A
Grand Mean 3.25 A
Source: Field Work (2023)

Table 6 shows the mean responses of the respondents on the possible

factors responsible for maternal mortality in Kankia Local Government

Area with corresponding percentages. From the table as presented, the

respondents agreed to all the items (Items 1-8) with Mean values ranging

from 3.01 - 3.49 which are above the benchmark of 2.50 and this also

shows that there is homogeneity of the responses from the respondents.

The table further revealed a Cluster Mean of 3.25. With this Cluster Mean

(3.25) which is above the benchmark of 2.50, it means that, there are
37
possible factors responsible for maternal mortality in Kankia Local

Government Area.

Research Question Three:

What are the ways to encourage mothers’ utilization of maternal and

child health care services in Kankia Local Government Area?

Table 7: Frequency and Mean Analysis on the Ways to Encourage

Mothers’ Utilization of Maternal and Child Health Care Services in
Kankia Local Government Area.
S/NO ITEMS SA A D SD MeanDecision
1. Increase access to healthcare 41 40 13 6 3.16 A
services
2. Empower women 44 39 11 5 3.20 A
3. Addressing inequalities that affect 41 37 13 9 3.10 A
health outcomes
4. Health educating women on the 41 39 13 7 3.26 A
importance of ANC services
5. Recruitment of skilled and 45 43 9 3 3.30 A
competent health workers
6. Modifying social determinants of 46 39 9 6 3.22 A
health
7. Boosting breastfeeding support 44 37 13 7 3.20 A
8. Addressing specific complications 39 46 9 6 3.18
9. Providing transport to specialty 34 47 10 4 3.01 A
care
Grand Mean 3.54 A
Source: Field Work (2023)

Table 7 shows the mean responses of the respondents on the ways to

encourage mothers’ utilization of maternal and child health care services

in Kankia Local Government Area with corresponding percentages. From

the table as presented, the respondents agreed to all the items (Items 1-9)

38
with Mean values ranging from 3.01 - 3.30 which are above the

benchmark of 2.50 and this also shows that there is homogeneity of the

responses of the respondents. The table further revealed a Cluster Mean

of 3.54. With this Cluster Mean (3.54) which is above the benchmark of

2.50, it means that, there are ways to encourage mothers’ utilization of

maternal and child health care services in Kankia Local Government

Area.

Research Question Four:

What are the ways to ensure that pregnant mothers and their unborn

children attain their maximum potential for health and wellbeing?

Table 8: Frequency and Mean Analysis on the Ways to Ensure that

Pregnant Mothers and their Unborn Children attain Their
Maximum Potential for Health and Wellbeing.
S/NO OPTIONS SA A D SD MeanDecision
1. Eating healthy and balanced diet 44 42 8 6 3.24 A
2. Take daily prenatal vitamins 43 42 8 5 3.19 A
(supplements)
3. Regular prenatal care checkups 45 43 9 3 3.30 A
4. Daily exercise 44 39 11 5 3.20 A
5. Reducing stress 46 39 9 6 3.22 A
6. Stay hydrated 39 46 9 6 3.18 A
7. Avoid exposure to toxic 34 47 10 4 3.01
substances
8. Maintain healthy weight 34 47 10 4 3.01
9. Avoid certain foods like raw 44 39 11 5 3.20
meat, raw eggs etc.
10. Maintain adequate sleeping 34 36 19 11 2.93 A
Grand Mean 3.18 A
Source: Field Work (2023)

39
Table 8 shows the mean responses of the respondents on the ways to

ensure that pregnant mothers and their unborn children attain their

maximum potential for health and wellbeing with corresponding

percentages. From the table as presented, the respondents agreed to all the

items (Items 1-10) with Mean values ranging from 2.93 - 3.30 which are

above the benchmark of 2.50 and this also shows that there is

homogeneity of the responses of the respondents. The table further

revealed a Cluster Mean of 3.18. With this cluster mean (3.18) which is

above the benchmark of 2.50, it means that, there are ways to ensure that

pregnant mothers and their unborn children attain their maximum

potential for health and wellbeing.

4.2 Discussion of Findings

Based on the findings derived from the results of the study, the following

were discussed. From the findings on table 5, the respondents agreed that,

maternal mortality is the death of woman due to pregnancy

complications, Antenatal care helps in reducing maternal mortality,

postnatal care helps in reducing maternal mortality, maternal mortality is

related to unsafe abortion, antepartum and postpartum haemorrhage play

role in maternal mortality, anaemia is one of the factors in maternal

mortality, eclampsia is one of the factors in maternal mortality,

malnutrition is a risk factor to maternal mortality, poor health services

contribute to maternal mortality and poor utilization of maternal and child

40
health services predispose mothers to maternal mortality are all level of

community awareness on the causes of maternal mortality in Kankia

Local Government Area. Moreover, the findings of the study as shown on

table 6 revealed that, lack of adequate nutrition, irregular ANC Visit,

harmful practices during pregnancy by pregnant women, State of

anaemia, age, delivery method, late referral and pregnancy complications

are the possible factors responsible for maternal mortality in Kankia

Local Government Area. Also, the findings of the study as shown on

table 7 revealed that, increase access to healthcare services, empower

women, addressing inequalities that affect health outcomes, health

educating women on the importance of ANC services, recruitment of

skilled and competent health workers, modifying social determinants of

health, boosting breastfeeding support, addressing specific complications

and providing transport to specialty care are ways to encourage mothers’

utilization of maternal and child health care services in Kankia Local

Government Area. Lastly, the findings of the study as shown on table 8

revealed that, eating healthy and balanced diet, take daily prenatal

vitamins (supplements), regular prenatal care checkups, daily exercise,

reducing stress, stay hydrated, avoid exposure to toxic substances,

maintain healthy weight, avoid certain foods like raw meat, raw eggs etc.

and maintain adequate sleeping are ways to ensure that pregnant mothers

41
and their unborn children attain their maximum potential for health and

wellbeing.

CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATIONS

5.0 Introduction

This chapter deals with the summary, conclusion, recommendation,

suggestions for further study as well as references.

5.1 Summary

This research is carried out in order to assess the community awareness

on the causes of maternal mortality in Kankia Local Government Area of

Katsina State.

The research is conducted following approved sequence and presented in

five distinct chapters otherwise known as the main body of the research

report comprising the introductory chapter, the reviewed literature,

methodology of the research where the research design was mentioned

and the population and sample was determined by random sampling

method and data collected using questionnaire, the results were presented

and discussed in chapter four (4) using 4 points Likert scale, the data was

analyzed using Frequency and Mean whereby every Mean over the

42
benchmark of 2.50 is considered agreed. Chapter five closed the research

with this summary, conclusion, some recommendations and some

suggestions for further studies.

5.2 Conclusion

The study is conducted in Kankia Local Government Area of Katsina

State on community awareness on the causes of maternal mortality. The

result that has been obtained in this study clear revealed that, most of the

community members are aware about maternal mortality and it's causes,

know the possible prevention measures of maternal mortality and had a

proper knowledge on the utilization of maternal and child health clinics.

This study corresponds with another study in Konduga, Borno State of

Nigeria where it also showed that, their community members had

awareness on the causes of maternal mortality, know the possible ways of

preventing maternal mortality as well as full understanding on the

utilization of maternal and child health clinics.

5.3 Recommendations

Based on the finding of this study, the following recommendations are

made:

43
1. There is need for more information, education, communication and

enlightenment of the community members to actively involve in the

prevention of maternal death.

2. Religious and traditional leaders must be included in health education

in order to increase the public awareness.

3. Dialogue among the policy makers, communities and health care

personnel are essential to identify ways of overcoming barriers to

women seeking medical care which is often over looked.

4. Encourage proper utilization of maternal and child health clinics.

5. The ministry of health and Local Government should collaborate and

undertake the training of community members as community health

motivators for maternal and child health services. Their duties include,

health education, information of village development for emergency

transport and the health facility of referrals for women with obstetric

complications.

5.4 Suggestions for Further Studies

The problem of maternal mortality worldwide can be pictured by imaging

a jumbo jet with 274 women a board crashing in to the sea every four

hours, day - in day out of the 365 days of the year (Pott 1986). Maternal

deaths often occur in women and never become recorded by the health

care system. 600,000 women die every year as a direct result of child

bearing and most of these deaths are preventable (WHO 1996). The loss
44
of these women is a great tragedy, the fact that the majority of maternal

deaths are preventable when low to moderate technology and education

are available add to the tragedy. Yet maternal deaths even when one

considers are a small portion of the problem that the pregnant women

face. One study estimates that, for every maternal death there are 16 cases

of maternal illness (WHO 1998).

The research suggested that, if the governments, health care providers and

the community members will actively involve in health education and

encouragement to the pregnant mothers for regular ANC Visits and

proper utilization of maternal and child health clinics, it will help in

reducing maternal mortality worldwide.

45
 REFERENCES

Akinsola, A.O. (2001) A Test Book on Community Health Practitioners.

3rd Edition.

Department of International Development for Reducing Maternal Deaths

Evidence and Action (2013).

Family Care International: Millennium Development Goals, Sexual and

Reproductive Health Briefing Cards New York Family Care

International (2019).

International Conference on Population and Development (ICPD) Held in

Cairo (1994).

Lifesaving Skills for Midwifery and Nurses from Wikipedia (2015)

Update.

National population Commission of Nigeria and Demographic Health

Survey (2017).

Nigerian Politics and Safe Motherhood: International Journal of

Obstetrics and Gynaecology (2007).

Segun Orisajo (2019) Maternal Mortality the Travails of Nigerian Health

Correspondents.
46
Submission of the centre for Reproductive Right Regarding to Maternal

Mortality in Nigeria (August, 2019).

United Nation International Children Emergency Fund (2012) Guidance

for Potential Users (Free Full Text Book).

Victoria Ajayi (2001) A Text Book of Midwifery 3rd Edition. Edited by

G.E Chamber.

Werner Harung (1995) Director of Technical Division at the United

Nation Population Fund (UNPF).

World Health Organization (WHO) Maternal Mortality from Wikipedia

the free (2019) Encyclopedia Date.

World Health Organization Progress in Reproductive Health Research No

67 Geneva Switzerland 2018.

47
 ENVIRONMENTAL HEALTH SCIENCES DEPARTMENT,
KANKIYA IRO SCHOOL OF HEALTH TECHNOLOGY,
KANKIA, KATSINA STATE

QUESTIONNAIRE ON COMMUNITY AWARENESS ON THE

CAUSES OF MATERNAL MORTALITY IN KANKIA LOCAL
GOVERNMENT AREA, KATSINA STATE

Dear Respondent,

The researcher’s carrying out a study whose main objective is to

investigate the community awareness on the causes of maternal mortality
in Kankia Local Government Area, Katsina state. You have been selected
as one of the respondents for the study and the information you give will
be treated with utmost confidentiality. Please note that this research is for
academic purpose and is meant to cause no harm to the community.
Please do not write your name or the name of your institution on this
paper.

SECTION “A” (BACKGROUND INFORMATION)

1) Gender: 1. Male ( ) 2. Female ( )

2) Age: 1. 15-23 years ( ) 2. 24-32 years ( ) 3. 33-41 years ( ) 4.
42-50years 5. 51 and Above years ( )
3) Marital Status: 1. Married ( ) 2. Single ( ) 3. Separated ( )
4) Education Level: 1. Tertiary ( ) 2. Secondary ( ) 3. Primary ( ) 4.
No Formal Education ( )
5) Employment Status: 1. Civil Servant ( ) 2. Business man/woman
( ) 3. Self-employed ( ) 4. Not-employed ( ) 5. Student ( )
48
 SECTION “B”
Key:
4 - Strongly Agree (SA)
3 - Agree (A)
2 - Disagree (D)
1 - Strongly Disagree (SD)

Research Question One:

What is the level of community awareness on the causes of maternal
mortality in Kankia Local Government Area?
S/N ITEMS SA A D SD
1. Maternal mortality is the death of woman due
to pregnancy complications
2. Antenatal care helps in reducing maternal
mortality
3. Postnatal care helps in reducing maternal
mortality
4. Maternal mortality is related to unsafe
abortion
5. Antepartum and postpartum haemorrhage
play role in maternal mortality
6. Anaemia is one of the factors to maternal
mortality
7. Eclampsia is one of the factors to maternal
mortality
8. Malnutrition is a risk factor to maternal
mortality
9. Poor health services contribute to maternal
mortality
10. Poor utilization of maternal and child health
clinic predispose mothers to maternal
mortality

Research Question Two:

What are the possible factors responsible for maternal mortality in Kankia
Local Government Area?
S/N ITEMS SA A D SD
1. Lack of adequate nutrition
2. Irregular ANC Visit
49
3. Harmful practices during pregnancy by
pregnant women
4. State of anaemia
5. Age
6. Delivery method
7. Late referral
8. Pregnancy complications

Research Question Three:

What are the ways to encourage mothers’ utilization of maternal and
child health care services in Kankia Local Government Area?
S/N ITEMS SA A D SA
1. Increase access to healthcare services
2. Empower women
3. Addressing inequalities that affect health
outcomes
4. Health educating women on the importance
of ANC services
5. Recruitment of skilled and competent health
workers
6. Modifying social determinants of health
7. Boosting breastfeeding support
8. Addressing specific complications
9. Providing transport to specialty care

Research Question Four:

What are the ways to ensure that pregnant mothers and their unborn
children attain their maximum potential for health and wellbeing?
S/N ITEMS SA A D SA
1. Eating healthy and balanced diet
2. Take daily prenatal vitamins (supplements)
3. Regular prenatal care checkups
4. Daily exercise
5. Reducing stress
6. Stay hydrated
7. Avoid exposure to toxic substances
8. Maintain healthy weight
9. Avoid certain foods like raw meat, raw eggs
etc.
10. Maintain adequate sleeping

50
51