HEALTH NEEDS AND HEALTH PROBLEMS OF CHILD BEARING WOMEN IN AYAMELUM LGA OF ANAMBRA STATE

Abstract

The study was designed to determine the health needs and health problems of child bearing women in Ayamelum  LGA of Anembra State. The cross-sectional  survey research design was used for the study; and the instrument for data collection was the questionnaire. The population of the study consisted of child bearing women in Ayamulum LGA. A sample of 632 subjects was selected for the study. The major findings of the study were that: physical health needs with the grand mean of 2.53 are very much needed among the child bearing mothers in Ayamelum LGA; emotional health  needs of 2.53  are  very much  needed  among  the  child  bearing  mothers  in Ayamulum  LGA;  social  health  needs  with  grand  mean  2.17  are  slightly needed among he child bearing mothers in Ayamelum  LGA; economic health needs with grand  mean  of  2.54  are  very much  needed  among  the  child  bearing  mothers  in Ayamelum  LGA; physical health problems with grand mean of 2.21 is slightly a problem  among  the child bearing mothers in Ayamuelum  LGA;  emotional health problems  with  grand  mean  of 1.6  is  slightly  a problem  among  the child  bearing mothers in Ayamelum LGA; social health problems with grand mean of 2.0 is slightly a problem  among  the  child bearing  mothers in  Aymelum  LGA;  economic  health problems  with  grand  mean  of 2.54  is a severe  problem  among  the  child  bearing mothers  in  Ayamelum  LGA;  the  null  hypothesis  which  states  that  there  is  no significant difference in health needs of child bearing mothers in Ayamelum LGA according to Age was accepted (2  = 0.415 > 0.05), and the null hypothesis  which states  that  there  is  no  significant  difference  in  health  problems  of  child  bearing mothers in Ayamelum LGA according to parity was accepted  (2 = 0.753 > 0.05). On the basis of the findings and discussions, it was concluded among other things that the physical, emotional and economic health needs are very much  experienced among child bearing mothers in Ayamelum LGA and economic health problems are severely experienced among the child bearing mothers in Ayamelum LGA of Anambra State. Following from the findings and conclusions relevant recommendations were made.

Background to the Study

CHAPTER ONE Introduction

During pregnancy, because of the extra demand made by the foetus on the mother and also due to hormonal influences, the mother is posed with many needs and problems. These needs and problems could be physical, emotional, social or economic in nature (Agular & Galbes,  2004).  Nevertheless,  there are certain  factors,  which serve as ingredients for personal health. These factors must be available in appropriate quantity for health to be optimal. Some of these factors are more pressing or are in greater demand at certain periods of human life, notably during pregnancy than at other periods.  Therefore  when  these conditions  or factors are absent or deficient, health needs and health problems arise because health is threatened (Adi, 1979).

Levenstein (1975) affirmed that health needs refer to all the measures adopted to  safeguard  and  restore  health,  which  include  medical  care,  safety,  nutrition, emergency care, exercises, rest and sleep, cleanliness and keeping of health records. This definition is considered reasonable because it is comprehensive in terms of the objectives of health needs, which are to safeguard health, prevent ill-health and to restore health  when it has failed. Therefore availability of these health needs can counteract the health problems. Werner (1984) supported this claim when he stated that these health needs of people who could be pregnant women as in this present study describe optimal health requirement. Health needs as implied  in the present study  refers  to  all  the  measures  adopted  to  safeguard  and  restore  health.  These measures as enumerated by Akhtar (1994) to include medical and dental care, safety, proper nutrition, exercises, rest and sleep, health record keeping, cleanliness (personal and  environmental)  and  emergency  care.  He  stated  that  failure  to  provide  these measures  or health  requirements  in required  quantity could  threaten  or  constitute health problems. These health needs which exist along side the various dimensions of health namely physical, social, emotional and economic aspects can pre-empt a health problem  of corresponding  nature.  Health  need  therefore  defines  the  gap  between optimal health conditions or requirements and health impairment such that when the conditions for health are not satisfied, a health need is created which result in a health problem to a pregnant mother.

The time of pregnancy according  to Myles  (2006),  is the most demanding period in a woman’s life. The demands and needs of this pregnant woman require adequate  attention  to  avoid  malformation  or deformation,  or retardation  in  foetal growth and development. During pregnancy, because of organogenesis and hormonal influences, the woman is posed with many needs and problems which are physical, emotional, social and economical in nature. According to Bermete and Brown (2001) the health needs of a pregnant women could be physical (needs concerned with the physical requirement such as good nutrition, medical care, personal hygiene, breast care,  dental  care,  proper  clothing,  exercises,  rest  and  sleep,  sexual  activity  and traveling needs), psychological (emotional care that women need during pregnancy from their partner, other members of the family and the health workers), and socio- economic (spouse support, accessibility of health facilities, availability of good roads and   transportation,   level  of  education,   economic   status,   customs   and  beliefs, availability of qualified and skilled health workers and materials.

Explaining further on the physical needs they stated that pregnancy is the most nutrition  demanding period  of a mother’s  life  because  she needs  enough  nutrient everyday to support her health, demands from the growing foetus and many hormone induced developmental processes. Supporting this claim, the American Dietetic Association – ADA (2002) stated that a pregnant mother needs extra 300 calories daily; making it a total of 2500 to 2700 calories daily to improve the nutritional level of the women thereby averting medical problems.

The medical need also included in the physical health needs is treated under prenatal care services. Prenatal care being the series of test, examinations, diagnosis and treatment  a pregnant mother gets from the time of conception  as noted by a qualified medical personnel till the date of delivery. It is therefore imperative that all pregnant  women  should  attend  regular prenatal care,  for proper assessment,  early detection and prompt management of risk factors. It will also be a medium whereby the health care providers can help the mothers to identify their needs in pregnancy and be able to meet their according thus reducing the risks involved during pregnancy and delivery (Lerfer & Hatson, 2002). Activities involved during the prenatal care period include physical examination of the pregnant women, data collection and analysis, laboratory investigations and examinations; blood grouping, gerotype, haemoglobin

estimation, urine testing, weight and height estimation history taking, blood pressure estimation and height education. All these serve as monitor for proper assessment of maternal and foetal well-being.

Exercises as one of the physical health needs of a pregnant woman is essential because it is one of the factors that pave way to successful delivery. Agurlar and Galbes  (2004)  affirmed  that  a  woman  that  is  physically  fit  hardly  gets  any complication  because  complication  from  clinical  records  are usually an  aspect  of pregnancy  of  those  who  are  not  physically  fit.  Regular  exercise  improves  the muscular system and one of the basic needs of the pregnant mother since muscular contraction is an integral part of labour.

Although  the  pregnant  woman  needs  exercises  to  improve  the  muscular system, sleep and rest (as physical needs) are also very import during pregnancy. According to Myles (2006) a pregnant mother needs one or two hours of sleep in the afternoon and a total of nine hours sleep in the night for proper development of the foetus and maternal well-being.

Pregnant women need adequate clothing as part of the physical needs. The clothing of pregnant women should be clean, loose-fitting and attractive and should be worn according to weather (Fraser, Cooper and Nolte, 2006). They submitted that maternity gowns are preferred to tight flitting gowns. Tight-fitting belts, under wears and shirts should be avoided to prevent constriction of blood vessels. According to them pregnant women should wear comfortable shoes with broad base to avoid falls and ensure proper balancing.

Many pregnant mothers experience undue distress and anxiety because they are not aware of the normal psychological upheavals, emotional changes and adjustments that  are  integral  of  the  child  bearing  process.  Myles  (2006)  stated  that  during pregnancy,  woman  need  high  level of emotional  care, usually from her husband, members of her family and health personnel. She is encouraged  to stay mostly in places where there are joy inducing faculties like amusement parks, places that will divert her mind from worries and tension. In the case of first pregnancy (primips) she stated that so many factors are responsible for fear and anxiety because she is so afraid of what will befall her, what will be her faith during labour. Usually one sees signs of relief on their faces following antenatal classes when solutions and answers

are given to their numerous health care questions. Emotional care is therefore very important because anxiety and fear has been discovered to be responsible for high blood  pressure  in  pregnancy.  When  neglected,  it  leads  to  abortion  of the  foctus, excessive bleeding during child birth or bleeding during pregnancy.

During pregnancy, women require social and economic health needs. Where the social and economic health needs are deficient socio-economic health problems result.  According  to  Smith  (2006),  the  social  and  economic  needs  of  a pregnant woman  include  spouse support, accessible of health facilities,  availability of good roads and transportation, sound education, stable economy, availability of qualified and skilled health workers and materials.  Smith further pointed out that failure to provide these needs in required quantity will lead to corresponding health problems. Health need therefore defines the gap between optimal health conditions and health impairment such that when the conditions for health are not satisfied, a health need is created which results to a health problem.

Health problem has been defined severally. Some view health problem as a state of disequilibrium, others as disease conditions, and while others as factors that predispose one to disease condition. Health problem according to Prothero (1994), is a state of disequilibrium in which diseases flourish and health is impaired. Continuing, he  explained  that  man  and  the  environment  are  closely  linked  in  a  complex relationship, which frequently presents conditions of equilibrium between disease and health impairment. Impairment of health, according to him, may manifest as disease or  infection.   Meads  (1994)  posited   that  health  problems   represent  something physically or emotionally distressing for which relief is sought. In this definition, she categorized health problems into dimensions, such as physical, mental or emotional and social problems. She gave examples of physical problems as skin diseases, ulcers, diarrhoea and of mental or emotional problems as stress, anxiety disorder, alcoholism and psychotic disorders. Her examples of social problems include maladoptation and maladjustment. She explained further that such health problems are so distressing that the person  affected  usually seeks relief. Myles (1999) defined  health problems as conditions  which  prevent  individuals  from  mobilizing  their  physical,  social  and mental  resources  for  optimal  living.  Thus  any  health  condition  which  prevent pregnant women from attaining maximum working efficiency in daily tasks, would

constitute  a  health  problem  because  it  would  not  permit  them  to  mobilize  their physical, social and mental resources for optimal living. She also pointed out that in order  to  counteract  the  health  problems,  corresponding  health  needs  should  be provided.  As  implied  in  the  present  study,  health  problems  are  deficiencies  in conditions  of  a  pregnant  woman  necessary  for  attaining  or  promoting  health. Therefore  it  becomes  imperative  that  health  problems  of pregnant  women  in  the process of attaining or enjoying  motherhood  be averted by adequate provision  of health needs to ensure proper development of the foetus and maternal well being (Fraser, 2006).

Health  problems  are  the  conditions  which  a  pregnant  woman  encounters whether at the on set of the pregnancy or as the pregnancy advances that give discomfort and in some cases may lead to complications or even death. These health problems could be physical, emotional, social and economic in nature. According to Myles (2006) the physical problems include heart burn, nausea and vomiting, constipation, haemorrhoids, vaginal discharge, placenta previa, premature rupture of membranes,  pregnancy induced high  blood pressure  or pre-eclampsia,  intrauterine growth retardation, urinary tract infection, indigestion, dental problems, pedal oedema and pica. She also stated that emotional problems include anxiety, fear, tension, moodswings and aggression; and that poverty, neglect, illiteracy, inadequate provision of health  facilities  and basic facilities  like good  roads, transportation,  good water supply,  electricity  among  others  belong  to  socio-economic  problems.  Besides, problems pregnant women may develop a wide range of complications  or disease conditions such as hepatitis, congestive heart failure, high blood pressure and aneamia in pregnancy.

Pregnancy for extremes of age (that is too young and too old) and parity should not  be  neglected  while  addressing  the  issue  of  health  problems  of child  bearing women. Myles (1999) posited that women of less than eighteen years and over thirty five years, multparous women, previous obstetrical difficulty such as unexplained still births, premature deliveries and abortions pose a lot of health problems to the child bearing women. According to myles child birth at a very young age or old age, most of the time does not go  without complications  like vesico  vaginal fistula (VVF), cephalopelvic disproportion (CPD), premature delivery, pre-eclampsia, post partum

haemohage, abnormal babies and increased maternal mortality. Lock wood and Funai (1999) affirmed that problems of placenta praevia is more common in multiparous or multigravidae with an incidence rate of 1 in 90 deliveries. According to them placenta pravia rates rise in women with increasing age and increasing parity. These problems can be avoided as the health care solution to prevent or manage these complications are well known, especially for pregnant women in Ayamelum LGA.

Motherhood is one of the greatest aspirations of a woman, yet being pregnant demands so much from her in terms of fitness (Udoh & Amuse, 1982). They added that it requires a healthy woman to carry and bear a normal healthy baby, because she needs to be physically,  emotionally and socially stable to achieve this. Pregnancy according to Roper (1999) is being with a child, that is gestation from the last normal menstrual  period  to parturition,  normally 40  weeks  or 280  days.  The  concept  of pregnancy usually seen as a normal life event may, to a woman, appear discordant depending on her life experience. In a woman who has rarely been ill, the discomfort of heartburn, intestinal pains due to constipation  and constant desire to vomit can indeed be perceived as more akin to an illness than anything previously experienced (Myles, 1999). Mittendorf, Willian and Berher (1999) asserted that pregnancy is the carrying of one or more foetuses inside the body of a female mammal such as a woman. According to them pregnancy is usually divided into three trimesters as a means of simplifying reference to the different stages of prenatal development. The first trimester is from the first month to the third month, the second trimester is from the fourth to the sixth months, and the third trimester from the seventh to the ninth month. According to Benneth and Brown, (2001) pregnancy is normally forty weeks approximately for all women, women in Ayamelum LGA inclusive.

Ayamelum is a typical rural settlement in Anambra State, Nigeria. The LGA comprises  mainly the Igbo ethnic nationality.  The predominant  occupation  of the people  is  farming.  Most  of them  own  large  expanse  of land  for farming.  Public utilities such as good water supply, electricity supply, good roads and hospitals do not seem adequate. Hospitals like general hospitals where referral services can be made in case of emergency are still lacking. There are only few health centres and maternity homes,  managed  by nurses and  midwives  and  traditional birth  attendants  without resident doctors. This poor distribution of health system and qualified personnel may

constitute a very big problem for childbearing women in Ayamelum LGA, hence the topic health needs and problems of child bearing women in Ayamelum LGA.

Statement of the Problem

Pregnancy and childbirth are natural processes requiring the provision of health care supervision  and support because of expectant mother’s hope for a rewarding experience in pregnancy, labour and delivery. Apart from this, a pregnant mother has special  needs  and  lack of these needs  at  certain  stages  can  be dangerous.  World Health  Organization  (WHO)  identified  maternal  and  child  health  care  including family planning as one of the eight essential components of primary health care to be vigorously pursued, improved and implemented at all levels of care (Egwu, 1996). Although  majority of women  have normal pregnancies,  safe delivery and  healthy babies but some do develop complications during the course of pregnancy which may be minor, severe or even life threatening to the mother, baby or both. Many of these health  problems  and  deaths  encountered  by mothers  and  children  are preventable through maternal and child health care services. Way back to 1978 at the international conference on primary health care Alma Ata, maternal and child morbidity and mortality were  recognized  as  a major  public  health  problem  that  needed  priority action. The conference through  the Alma Ata declaration,  also affirmed access to basic health services as a fundamental human right (Owuole, 2004). Access to basic health services should be the right of every human being, pregnant women inclusive.

Moreover,  the health  for  all policy for  the  21st  century in  African  region (Agenda, 2020) calls for focus on making pregnancy safer. This addresses all levels of the health care delivery system; community, primary health care and referral levels. The  interventions  at  community level aim  at  empowering  pregnant  women,  their partners,  families and communities  to make appropriate decisions and take timely actions  in  the  face  of  pregnancy related  complications.  This  is because  pregnant women  and  children  represent  high  risk  groups  within  the  population.  Maternal services are to ensure as far as possible, that these women remain healthy throughout pregnancy and delivery and recover fully from the effects of pregnancy and delivery, by making provision for the basic needs of these women.

Despite the provision of all these meternal health services aimed at making pregnancy and childbirth  safe,  still a lot of childbearing  women  especially in the developing   countries   like   Nigeria,   Ayamelum    LGA   inclusive   do   develop complications and die from pregnancy related problems. This may be due to poor distribution of health facilities by the government.

Additionally, during pregnancy, because of extra demand made by the foetus on the mother and also due to hormonal influences, the mother is posed with many problems which are health related. Amidst these health problems, it is still doubtful whether the health management board has adequate provision for the needs of these pregnant women as to counteract these health problems. Could this condition in Ayamelum LGA be a difficult one or problem to pregnant women in the area? Hence the topic health needs and problems of childbearing women in Ayamelum LGA.

Purpose of the Study

The purpose of the study was to identify the health needs and problems of pregnant women in Ayamelum LGA of Anambra State. Specifically, the objective of the study is to identify the:

1.     physical health needs of pregnant women in Ayamelum LGA;

2.     emotional health needs of pregnant women in Ayamelum LGA;

3.     social health needs of pregnant women in Ayamelum LGA;

4.     economic health needs of pregnant women in Ayamelum LGA;

5.     physical health problems of pregnant women in Ayamelum LGA;

6.     emotional health problems of pregnant women in Ayamelum LGA;

7.     social health problems of pregnant women in Ayamelum LGA, and

8.     economic health problems of pregnant women in Ayamelum LGA.

Research Questions

The following research questions were posed for the study.

1.     What are the physical health needs of pregnant women in Ayamelum LGA?

2.     What are the emotional health needs of pregnant women in Ayamelum LGA?

3.     What are the social health needs of pregnant women in Ayamelum LGA?

4.     What are the economic health needs of pregnant women in Ayamelum LGA?

5.     What are the physical health problems of pregnant women in Ayamelum LGA?

6.     What are the emotional health problems of pregnant women in Ayamelum LGA?

7.     What are the social health problems of pregnant women in Ayamelum LGA?

8.     What are the economic health problems of pregnant women in Ayamelum LGA?

Hypotheses

The following hypotheses were formulated and tested in the course of this study at .05 level of significance.

1.     There is no statistical significant difference in health needs of women of child bearing in Ayamelum LGA according to age.

2.     There is no statistical significant  difference in health problems of women of

child bearing in Ayamelum LGA according to parity.

Significance of the Study

The present study provided information on the physical, emotional, social, and economic health needs of pregnant women in Ayamelum. It also provided information on the physical, emotional, social, economic health problems of pregnant women in Ayamelum LGA. The information obtained will be useful to the Government, researchers, social workers, doctors and midwives, health educators and pregnant women in Ayamelum LGA.

The information obtained on the physical health needs will increase the awareness of the doctors, nurses and midwives including the social health workers to the dire needs of pregnant women in the area, Ayamelum LGA.

Information obtained on the economic and social health needs will also provide data on the health services available in the LGA. This information will be of great interest to the ministry of health in finding out the level of health facilities needed in the area and help the health planning unit to develop strategies for addressing these health needs.

Information on the emotional needs will help midwives in health counseling and  care  during  antenatal  visits.  It  will  as  well  help  the  spouse  and  the  family members to support the women in this condition.

Information on physical health problems will be useful for  pregnant women to be careful and serious with their prenatal care to avoid complications. It will also be useful to the doctors and midwives because it will increase their awareness to the prevalent physical health problems of women in that area, Ayamelum LGA.

The information generated from the social and economic health problems will help the social health workers in planning to find solution to the prevalent health problems of the women  in that area. It will as well help the health planning unit towards finding lasting solution to the socio-economic health problems of the women in the area.

Information on the emotional health problems will also be of help to the midwives,  doctors  and  family  members  towards  counseling  and  supporting  the women till delivery.

The result of the study will be useful to researchers because it will add to the existing literature and will provide additional platform  for similar studies in other location as well.

Scope of the Study

This  study  covered  all  the  child  bearing  women  in  Ayamelum  LGA  of Anambra State. It included all the eight communities in Ayamelum, LGA. The study focused on the health needs of pregnant women which include physical health needs of pregnant women, emotional needs, socio needs and economic needs, while the health problems incorporated the physical health problems, emotional, social and economic health problems.

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