EFFECT OF HOME DELIVERY ON MATERNAL AND CHILD HEALTH OUTCOME AMONG WOMEN OF CHILD BEARING AGE

1.1 Introduction

Home delivery refers to the widespread traditional belief that childbirth is a natural process that doesn't need medical attention and should be done by a family member who is well-known and trusted, readily available, and reasonably priced. In Nigeria, home deliveries by traditional birth attendants are customary. This holds true for both urban shantytowns and rural areas.

The majority of Nigerian women prefer to give birth at home, which can be attributed to this attitude as well as poverty, illiteracy, and ignorance of the complications involved in childbirth. George (2014) articulated that, most women of reproductive age in developing nations give birth at home, usually with the assistance of unskilled workers, though there may be national differences (George, 2014).

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitation of the study and Definition of terms.

1.2 Background of Study

An estimated 529,000 maternal deaths occur annually worldwide, nearly all of which occur in developing nations like Nigeria, Chad, etc. The percentage of deliveries assisted by a skilled attendant and the maternal mortality ratio in these nations are inversely correlated. According to WHO, immediate and effective professional care at the time of delivery can make the difference between life and death for both women and their new born. Furthermore, this care should be available close to where people live, but at the same time safe with a skilled professional able to act immediately when unpredictable complications occurs TBAs (whether trained or not) have not been included among the skilled birth attendants by the WHO.

Since their training has not shown any reduction in maternal mortality. However, it has been suggested that TBAs could perform the role of the skilled attendants where required with some training as they may be the only source of care for some women. In addition they may also serve to provide emotional support and health education to pregnant women at the local level.

According to the latest Nigeria Demographic and Health Survey (DNHs) 2007, the maternal mortality ratio of Nigeria is 276/100,000 live births and the three major killers are post partum hemorrhage, puerperal sepsis and eclampsia. This survey, the largest household survey ever conducted in Nigeria also showed that 65% of deliveries are conducted at home. Traditional birth attendants assisted almost 79% of home deliveries followed by relatives or friends in 11%. According to this survey, the most frequent reason (stated by 57% of women) for not delivering in a facility was the belief that it was not necessary. The next most common reason (stated by 38% of women) was that the cost is too much.

Maternal health is one of the biggest health concerns in the world. Although the government has taken steps to guarantee skilled attendants and an institutional delivery setting, over 80% of pregnant women still give birth at home, which means that it is unsanitary, unsupervised, and typically occurs after it is too late to provide necessary care (WHO, 2016). Talks about global health and development frequently touch on the unacceptablely high rates of maternal mortality. Despite some notable advancements, Sub-Saharan Africa continues to account for half of global maternal deaths, with little to no progress made in this region (Sychareun, 2013).

Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the Effect of Home Delivery on Maternal and Child Health Outcome among Women of Child Bearing Age.

1.3 Statement of Problems

Investigation revealed that home deliveries are extremely common in the study area. However, in the majority of these cases, complications arise during the delivery, such as a high risk of neonatal or hemorrhage and fatal mal-position, which can kill the mother or the child. Additionally, it occasionally occurs that a woman may have a serious issue with her child, in which case those close to her may not become aware of it unless they speak with medical professionals (doctors, nurses, midwives).

Therefore, this research tends to find out how home delivery affects Maternal and Child Health Outcome among Women of Child Bearing Age in Gwandu Local Government Area of Kebbi State.

1.4 Aim and Objectives of Study

The aim of the study is to investigate the Effect of Home Delivery on Maternal and Child Health Outcome among Women of Child Bearing Age. In achieving this aim, the following specific objectives were laid out as follows:

1. To find out the possible measures that will reduce home delivery among pregnant women in the study area;
2. To investigate the factors that make women deliver at home after attending antenatal care in the area under study;
3. To identify the reason and adverse outcomes of home deliveries in women of child bearing age;
4. To ascertain how home delivery affects the outcomes for maternal and child health among pregnant women;
5. To identify the causes of home delivery among women of child bearing age; and
6. To make recommendation according to findings of this research.

1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• Are there the factors that make women deliver at home after attending antenatal care in the area under study?
• Does home delivery affect the outcomes for maternal and child health among pregnant women?
• What is home delivery with reference to expectant women?
• What is the importance of delivering at the presence of medical personnel?
• What is the reason and adverse outcomes of home deliveries in women of child bearing age?
• What are the causes of home delivery among women of child bearing age?
• What are the possible measures that will reduce home delivery among pregnant women in the study area?

1.6 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

Hypothesis One

• H0: Home Delivery has no significant effect on Maternal and Child Health Outcome among Women of Child Bearing Age
• H1: Home Delivery has significant effect on Maternal and Child Health Outcome among Women of Child Bearing Age

Hypothesis Two

• H0: There are no significant factors that make women of child bearing age deliver at home after attending antenatal care in the area under study
• H1: There are significant factors that make women of child bearing age deliver at home after attending antenatal care in the area under study

1.7 Significance of Study

The research holds importance in raising awareness among expectant mothers, particularly those within the reproductive age range in Gwandu Local Government Area of Kebbi State.

Additionally, to raise awareness of the significance of delivery from a health care facility in order to avoid complications like postpartum hemorrhage and maternal mortality that may occur at home.

1.8 Scope of Study

The scope of the research is focused on the Effect of Home Delivery on Maternal and Child Health Outcome among Women of Child Bearing Age using Gwandu Local Government Area in Kebbi State as a case study.

1.9 Limitations of the Study

During the course of this study, there were some problems encountered which stood as limitations to the research work. Some of the limitations include:

1. Time Constraint:The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Research Material: availability of research material is a major setback to the scope of the study.
3. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
4. Initial Cooperation Delay from Respondents: A particular limitation of this work came as a result of the respondent refusal to offer their cooperation at the initial time they were contacted. This contributed in making the success of this research study difficult.

1.10 Definition of Terms

Home Delivery:

It refers to as non-skilled delivery in a non-clinical setting.

Distance to the Nearest Health Facility:

It refers to near if it takes less than 30 minutes on foot walking home and far if it takes more than 30 minutes in foot walking.

Maternal Mortality:

It is the death rate of women as a result of complication.

TBAs:

It is an acronym for Traditional Birth Attendants.

Post-Partum Haemorage:

It is the loss of more than 500ml – 1000ml of blood within the first 24hours following child birth.

Bleeding:

It is the loss of blood from the body as a result of injury.

Puerperal Sepsis:

It is a condition that occurs after child birth as a result of infection.