Karuma cynthia

2020-b241-12158

MATERNAL HEALTH CARE SERVICES AND CHILDWELLBEING

(0-5YRS) AMONG REFUGEE MOTHERS IN ADJUMANI DISTRICT.

A CASE OF PAGIRINYA REFUGEE SETTLEMENT

CHAPTER ONE: INTRODUCTION

1.1 Introduction

In Pagirinya Refugee Settlement, Adjumani District, Uganda, this study will investigate the

effects of maternal healthcare services on children's well-being among refugee mothers. The

context of the study, the problem statement, the study's purpose, its objectives, its research

questions, its hypotheses, its conceptual framework, its importance, its scope, and its operational

definitions are all presented in this chapter.

1.2 Background of the Study

Globally, maternal and child health (MCH) has been a great concern in the field of public health

in the recent past, in the sense that 800 women are dying each day from complications in

pregnancy and childbirth (WHO, 2005). And for every woman who dies, approximately 20
others suffer serious injuries, infections or disabilities (UNICEF, 2019). According to a report of

the meeting of national maternal, neonatal and child health Programme managers addressing the

main causes of maternal, neonatal and child mortality in the World Health Organization (WHO)

Eastern Mediterranean Region held in Amman, Jordan, revealed that, every day around 1080

neonatal deaths occur in the Region (WHO, 2019). The report further revealed that neonatal

deaths constituted 47% of deaths in children under-five. However, the neonatal mortality rate

was reduced by 35% during 1990–2013 (Ibid). The major causes of neonatal death in the Region

were cited as: prematurity 34%, intrapartum complications 24%, sepsis 17% and congenital

disorders (Ibid)

In Africa, maternal mortality rate is still high even when it is preventable, it has continued to

increase in many nations in the African countries of the Sub-Saharan regions (Gyimaha et al.

2006). It is estimated that 99% of all maternal-related deaths occur in low- and middle-income

countries, of which most (66%) are located in Sub-Saharan Africa (SSA) (Tawiah, 2011). It is

estimated by (WHO) 2020. that more than 500,000 women die every year in the world due to

complications related to pregnancy or childbirth; half of them live in Sub-Saharan Africa. It

remains one of the regions with modest health outcomes; and evidenced by high maternal

mortality ratios and under-5 mortality rates. There are complications that occur during and

following pregnancy and childbirth that can contribute to maternal deaths; most of which are

preventable or treatable. According to a 2019 national report of Ethiopia under the umbrella of

Universal Health Coverage (UHC), only 62% of pregnant women made at least one antenatal

care visit. Examining changes since 1990 provides an opportunity to understand the existing gaps

and possible interventions to implement in order to improve maternal and health outcomes in

sub-Saharan Africa by 2030.

In East Africa, Kenya is one of the countries at the fore front in introducing free maternal

healthcare financing policies in an attempt to address the pressing complications and challenges

associated with maternal healthcare delivery in order to achieve the Millennium Development

Goal five (MDG 5) (Ansu-Mensah, 2021).

In Uganda, many births in rural areas take place with the help of traditional birth attendants

(TBAs) as a result of inaccessibility of formal health services (UBOS, 2018). For instance, rural

localities such as Karamoja, Westnile, Teso, and Bukedi regions have 50 to 60% gap in

midwifery staffing which presents significant implications for utilization of assisted delivery

services (UNFPA 2017). This means that in rural areas where availability of antenatal care and

skilled delivery service is low, mothers are more likely to miss these services during pregnancy

compared to their counterparts in urban localities. Studies have shown that this is due to poor

perception on the quality of ANC factored in by the mentality and behaviors of the midwives

who treat women in rather crude way, making women to rest on their own strength and try to

deliver from home. This is one of the causal theories which have been highlighted in most of the

studies among rural women in Uganda. The findings undermine the WHO recommendations

which highlights the importance of early initiation and optimal frequency of antenatal visits in

ensuring a safe motherhood and childhood (Bbaale, 2011). It also shows that early initiation of

an antenatal care visit enables early screening for complications, referral, and treatment of

complications identified during ANC.

Uganda is one of the largest refugee-hosting nations in the world, with over 1,529,904 refugees

as of 28 February 2022. It’s a home to more than 634,550 refugees from South Sudan living in

48 refugee settlements in four (4) West Nile districts (UNHCR, 2021). Adjumani (23,766
refugees) and Arua (183,438 refugees) districts both have 17 refugee settlements each, Koboko

(5,562) has eight, while Yumbe (233,959) has six settlements as of Janaury 2021.

In the northwest of Uganda, Mothers are unable to access this care if the facility is not within

walking distance, according to the Ministry of Health's 2021 Annual Maternal and Perinatal

Death Surveillance and Response (MPDSR) Report. The West Nile region reported one of the

highest delays in providing care for maternal health services. Education also increases a woman's

propensity to delay having children, which lowers her risk of developing potentially fatal

maternal health conditions. Young, single girls who conceal their pregnancies and may lack

partner support struggle to arrange safe deliveries. Campbell and S. Gabrysch (2009).

According to the Global Compact for refugees (GCR), Pagirinya refugee settlement, as of

October 2016 was one of the newest of Uganda's refugee settlements, launched in June 2016

after the Maaji Refugee Settlements reached its full capacity and could not accommodate the

great number of the refugee. Pagirinya settlement hosts 213,580 refugees (UN-HABITAT et al.,

2019).When it comes to their health, refugees are a group that is particularly weak. Intense

poverty, a breakdown in social support, loss of livelihood, an increase in sexual violence,

disruptions to health services, and an inability to meet basic nutritional needs have all resulted

from violent conflicts forcing them to flee their homes and enter neighboring countries, which

has made it more difficult to provide for mothers' needs and the wellbeing of children (WHO,

2007). According to the Amnesty Report (2012), nursing mothers and children are frequently

denied access to basic and life-saving services like child welfare services or maternity healthcare

for expectant moms. This has an effect on the maternal health care services and the wellbeing of

the children.
1.2 Statement of the Problem

According to estimates from the World Health Organization (WHO), over 150 million women in

developing countries fall pregnant each year, and over 500,000 of them die from pregnancy-

related problems. More than seven million pregnancies that end in stillbirths or infant deaths

within the first week of life are caused by maternal health problems. In addition, mothers who

are of childbearing age lack sufficient access to maternity healthcare services severely, devastate

their families' financial and social standing. Considering that the nearest medical facility is more

than 5 kilometers away, at least 38% of pregnant women in the Pagirinya refugee settlement do

not have access to maternity care, according to UBOS (2020). Receiving ANC treatments in the

settlement is hampered by this structural barrier. Women in this area are more likely to have poor

ANC attendance because of this factor and the rural setting of the area, which leads to higher

rates of perinatal problems.

The national health care system in Uganda has been developed by the government. Despite

government initiatives to promote maternal health care services, there is a knowledge gap on

child wellbeing and maternal health care services in refugee settlements that has to be filled. The

researcher advises, in this respect, looking at how mothers of refugees residing in the Pagirinya

Refugee Settlement in Adjumani District are affected by the availability of maternal health

services with relation to the wellness of children.The government of Uganda has set up public

healthcare programs. Despite government initiatives to improve maternal health care services,

there remains a knowledge vacuum about the availability of such services and how they affect

children's wellbeing in refugee camps. This study intends to close that gap. In this line, the

researcher seeks looking at how the provision of maternal health care services affect wellbeing of
children among refugee mothers residing in the Pagirinya Refugee Settlement in Adjumani

District.

1.4 General Objective

To investigate the effect of maternal healthcare services and child wellbeing (0-5 years) among

refugee mothers in Pagirinya refugee settlement in Adjumani district.

1.4.1 Specific Objective

i. To ascertain how frequently pregnant women in the Pagirinya refugee camp use antenatal

care.

ii. To identify the barriers preventing pregnant women in the Pagirinya refugee camp from

receiving high-quality antenatal care services.

iii. To determine how maternal healthcare affects the wellbeing of children in Pagirinya

refugee settlement

1.5 Research Questions

i. How frequently pregnant women in the Pagirinya refugee camp use antenatal care?

ii. What barriers are preventing pregnant women in the Pagirinya refugee camp from

receiving high-quality antenatal care services?

iii. How does maternal healthcare affect the wellbeing of children in Pagirinya refugee

settlement?
1.6 Scope of the Study

1.6.1 Geographical Scope

One of the districts of Uganda's northwestern area is called Adjumani. Moyo District to the

West, South Sudan to the North, Yumbe and Arua to the West with the River Nile in the middle,

and Amuru District to the South East form its borders. The district has a total area of 3128 square

kilometers, 1,455 square kilometers of which are arable land, and 225,251 people (UBOS, 2014),

including 213,580 refugees (UN-HABITAT et al., 2019). It is located at 3°30′00′′ latitude and

31°45′00′′ longitude. Many refugee communities, including Baratuku, Nyumanzi, Boroli, Ayilo

1 & 2, and Maaji, have been established in the Adjumani district to accommodate successive

waves of South Sudanese refugees. In the district, there are more than 236,000 refugees as of

2018.

In the eastern Adjumani District lies a camp for refugees called Pagirinya Refugee Settlement.

Since its debut in July 2016, it has taken in more over 32,000 South Sudanese refugees (UNHCR

2018). The settlement is physically constructed with a layout that makes it easy to reach

resources like schools and health clinics. Many areas, including water, health, sanitation, and

nutrition, are still insufficient for the people. Several ethnic groups, including the Nuer, Dinka,

Lolubo, Lotuko, Madi, Acholi, and Didinga, are represented among the refugees. These can be

found in the settlement's six blocks, A, B, C, D, E, and F. To cover their basic necessities,

refugees typically rely on aid organizations and remittances from their family. Some refugees

work in the economy, such as in retail,

1.6.2 Time Scope

The study will cover a period between 2020 and 2023, such a period is long enough for the

research to obtain current and up to date information that is sufficient for the researcher to

establish the effect of internal controls on the financial performance of banks.

1.7 Significance of the Study

The results of this study will provide researchers with information on mother health and the

wellbeing of children.

Inadequacies in the provision of maternal healthcare in the settlement are likely to be addressed

by the administration and administrators of the Pagirinya refugee settlement with the aid of this

study.

The study may be helpful to the Ministry of Health, which may decide to develop a strategy on

maternity healthcare that explicitly addresses inadequacies in the Pagirinya refugee settlement.

The results of this study will also add to the body of information and literature on child welfare

and maternal care.

This study will pique the curiosity of other scholars and the researcher and readers to do a more

empirical investigation on other similar topics in the area of maternity healthcare services and

child welfare among refugees in Uganda.

1.8 Justification of the Study

The majority of women in Uganda record their ANC attendance after the necessary four visits,

which is averagely at 5.5 months (second trimester) of pregnancy. High rates of maternal and

newborn mortality in Uganda continue in large part due to insufficient use of maternal healthcare

services (Kawungezi et al., 2015). The study will therefore focus on how frequently women use

ANC and barriers to accessing high-quality healthcare among refugee women, with its impacts to

the wellbeing of childern. The researcher’s findings will be able to educate decision-makers and

the general public on how to develop and evaluate effective strategies

1.9 Conceptual Framework

INDEPENDENT VARIABLE DEPENDENT VARIABLE

Child wellbeing
Maternal healthcare services
 Parent’s love, care and
 Prenatal care services
affection
 Delivery care services
 Social environment
 Postnatal care services
 Cognitive health

INTERVENING VARIABLE

 Culture
 Educational background
 NGOS
 Health policies
The conceptual framework identifies various factors that influence the development and well-

being of children, especially during the prenatal, delivery, and postnatal stages. The dependent

variables in this framework are the quality of prenatal care, delivery, and postnatal care services

received by the child. These variables can impact the child's health, growth, and development in

the short and long term.

The next dependent variable is the quality of love, care, and affection provided by the child's

parents, as well as the social environment that surrounds them. Such variables can shape the

developing cognitive and emotional abilities of the child and influence their social, behavioral,

and psychological development.

The intervening variables that operate in this conceptual framework are culture, educational

background, and non-governmental organizations (NGOs). The cultural beliefs, values, and

practices of parents and their communities can impact the child's care and development,

especially with respect to issues such as access to prenatal care, delivery, and postnatal care

services.

Educational background is another intervening variable that influences the parents' behavior,

knowledge, and attitudes towards their child's care and development. Parents with higher levels

of education are better equipped to provide optimal care and support their child's growth in an

effective way.
Finally, NGOs can play an essential role in providing additional support and resources to parents

and families, especially in marginalized communities where access to quality healthcare and

education may be limited. NGOs can help enhance the quality of care provided to children and

support parents in their efforts to promote their child's growth and development.

Thus, the conceptual framework highlights the importance of various factors that operate at

different levels to influence the child's development and well-being. It emphasizes the need for

holistic, multi-faceted, and culturally sensitive approaches to promote optimal child

development, which involves the collaboration of healthcare providers, parents, social services,

and NGO stakeholders.

1.10 Operational Definitions

Prenatal care services

According to Prenatal care services refer to the medical and supportive interventions provided to

pregnant individuals to ensure the health and well-being of both the mother and the developing

fetus. These services include regular medical check-ups, screenings, tests, and educational

support to monitor and manage the pregnancy, detect any potential complications, and promote a

healthy pregnancy outcome.

Delivery care services

According to World Health Organization. (2018), Delivery care services refer to the medical

care and support provided to pregnant individuals during the process of childbirth. These

services encompass a range of interventions aimed at ensuring a safe and healthy delivery for
both the mother and the newborn. Delivery care services typically include monitoring the

progress of labor, managing pain, addressing complications, and facilitating the actual delivery

of the baby.

Postnatal care services

According to World Health Organization. (2018), Postnatal care services, also known as

postpartum care services, refer to the medical and supportive interventions provided to mothers

and their newborns after childbirth. These services are designed to ensure the well-being of both

the mother and the baby during the period immediately following delivery. Postnatal care

includes monitoring the physical and emotional recovery of the mother, assessing the health of

the newborn, and providing guidance on breastfeeding, infant care, and maternal self-care.

Culture

Hofstede, G. (2021). Defines culture as the shared set of beliefs, values, norms, behaviors,

practices, symbols, and artifacts that characterize a particular group of people. It encompasses

the way of life, traditions, language, social interactions, and worldviews that are transmitted from

one generation to the next. Culture shapes individuals' identities, influences their perceptions and

behaviors, and provides a framework for understanding the world around them.

Health policies

Health policies refer to a set of guidelines, regulations, and strategies developed by governmental

bodies, healthcare organizations, or other stakeholders to address health-related issues, improve

healthcare delivery, and enhance overall population well-being. These policies encompass a wide
range of topics, including healthcare access, quality of care, disease prevention, public health

interventions, funding allocation, and more. They serve as a framework for decision-making and

action in the healthcare sector. According to World Health Organization. (2021).

Cognitive health

According to M. J., & Sachdev, P. (2007), Cognitive health refers to the state of an individual's

cognitive abilities, including memory, attention, problem-solving, reasoning, and overall mental

functioning. It encompasses the ability to think, learn, remember, and make decisions.

Maintaining good cognitive health is essential for a person's overall well-being, quality of life,

and daily functioning.

1.11 Conclusion

The chapter introduced the topic, gave the background of the study & case study, problem

statement, objectives of the study, research questions, scope of the study, significance of the

study, justification of the study, conceptual framework and definition of terms.

 CHAPTER TWO.

LITERATURE REVIEW

2.0 Introduction

This chapter elaborated the literature related to the effect of maternal healthcare services and

child wellbeing (0-5 years) among refugee mothers in Pagirinya refugee settlement in Adjumani

district. There were scholars who wrote about this topic and it was very important to credit them

for that by reviewing their literature. This discourse of literature review is offered along with

research objectives and the research gap.

2.1 Theoretical Review