CHAPTER ONE

1.0 Introduction

This chapter contains of the following:-

1.0 introduction

1.1 background of the study

1.2 statement of the problem

1.3 scope of the study

1.4 significance of the study

I.4.1 purpose of the study

1.4.2 Objectives of the stud

1.5 research questionnaire and research hypothesis

1.1 Background of the Study

Antenatal care is a branch of preventive medicine dealing with pre-symptomatic diagnosis of

general medical disorder, nutrition, immunology, health education and social medicine in

addition to the prevention and early detection of pregnancy disorders. The world Health

Organization (WHO). Geneva has issued a new series of recommendation to improve quality

of antenatal care services to reduce the risk of stillbirth and pregnancy complication, and give

a women a positive pregnancy experience, these new guideline seek to ensure not only a

healthy pregnancy for mother and a baby, but also an effective transition to positive labour

and childbirth and ultimately to a positive experience of motherhood.

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(WHO 2016) Bahamas 2011. Antenatal or pre-natal care is the special care given to pregnant

Women. It refers to the regular routine checkup recommended before and during pregnancy.

Midwives are trained professionals, qualified, to provide antenatal care for a woman with a

normal pregnancy and this care is sustained through up to delivery. If any complication

develop, then midwives refers women to a doctor, at the hospital, women they give birth in

the hospital delivery ward closely attended by the midwives and doctors (Bahamas 2011).

Recent estimates of global maternal mortality ratios (MMRs) suggest a substantial decline in

recent years, however current rates of decline will still fall well short of meeting millennium

development goals (MDGs), in reducing maternal mortality by 75% by 2015. Data from the

world health organization (WHO) indicate that in many low and middle income countries

(LMICs), especially in sub Saharan Africa, the rate of decline in MMR is less than 1% per

year, and in some countries (e. g south Africa, Nigeria, Mozambique, and Switzerland) rates

even appear to be increasing. This slow rate progress is starkly highlighted in the most recent

countdown to 201$*" report, which found that only nine of the countries with the highest

MMRs in the world were on target to archive MDGs. The world health organization (WHO)

report in 2015 about 830 women died every day from problems of pregnancy and childbirth,

and only five (5) of the women who died lived in high income countries, the rest of the

women live in low income countries (WHO 2015).

Pregnancy related deaths and diseases remain unacceptably high in 2015, and estimated

303000 women died from pregnancy related causes, 2.7 million babies died during the first

28 days of life and 2.6 million babies were stillborn, while substantial progress has been

made over the past two decades.

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1.2 Statement of the Problem

The health of the women is regard as the most important in the community; the

research is carried out to improved good Antenatal Care services programme effectively

particularly of Darazao Local Government, Bauchi State.

1.3 scope of the study

The researcher is limited to entire community of Daburai town of Darzao Local

Government, Buuchi State.

1.4 significance of the study

The research of this nature could be used by ministry of health, institutions, are

research institution and institution of higher learning, and individual who want to conduct

study.

1.4.1 Purpose of the Study

The main purpose of this study is to ascertain the factors affecting the utilization of

antenatal care services among mothers of childbearing age in the area of study.

1.4.2 Objectives of the Study

1. To determine the factors responsible for underutilization of antenatal care services.

2. To encourage mothers of childbearing age to utilize the available located facilities.

1.4.3 Research Question and Research Hypothesis

 RESEARCH QUESTION ONE

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Are there any factors responsible for utilization of antenatal care service?

 RESEARCH HYPOTHESIS

There are significance factors responsible for the underutilization of antenatal care services.

 RESEARCH QUESTION TWO

Are there any ways to encourage mothers of childbearing age to utilize the available located

health facilities?

 RESEARCHHYPOTHESIS TWO

There are various ways to encourage mothers of childbearing age to utilize the available

located health facilities.

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 CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction

This chapter was discussed under the following headings:-

2.1 Concept of Antenatal Care Services

2.2 Components of Antenatal Care Services

2.3 Important of Antenatal Care Services

2.4 Factors Affecting the Utilization of Antenatal Care Services

2.1 Concept of Antenatal Care Services

The world health organization (WHO) 2016 Geneva has issued a new series of

recommendation to improve quality of antenatal care services to reduce the risk of stillbirth

and pregnancy complications and give a women a positive pregnancy experience, by focusing

on a positive pregnancy experience, these new guideline seek to ensure not only a healthy

pregnancy for mother and baby, but also an effective transition to a positive labour,

childbirth and ultimately to a positive experience of motherhood (WHO 2016).

The world health organization (WHO) report that in 2015 about 830 women died every day

from problems of pregnancy and childbirth, only five (5) of the women who died lived in

high income countries, and the rest of the women live in low income countries (WH0) 2015.

5|Page
 Bahamas (2011) antenatal or prenatal care is the special care given to a pregnant

woman. It refers to the regular routine checkups recommended before and during pregnancy.

Midwives are trained professionals, qualified to provide care for women with a normal

pregnancy and this care is sustained through up to delivery. If any complications develop,

then the midwives refers women to a doctor, at the hospital women then give birth in the

hospital delivery ward closely attended by the midwives and doctors. (Bahamas 2011).

ANTENATAL CARE SERVICE

Dr. Sunil Shroff (2016) defined antenatal care as pregnancy, labour and birth of a child are

important milestones on a couples life, regular medical care, knowledge of your choices and

understanding the unknown event during pregnancy, can make childbirth an extremely

enriching and joyful event. (Dr. Sunil Shruff 20 1 6).

Tommy's (2014) antenatal care or "pregnancy care" is the health and support you have

while you are pregnant, it is very important to make sure you and your unborn baby, are both

looked after throughout your pregnancy (Tommy's 2014).

2.2 Component of Antenatal Care Services

a) ANTENATAL CLINIC

Chou. D (2010), antenatal care service is the care you receive from health care professionals

during your pregnancy. The purpose of antenatal care services is to monitor your health, and

your baby's health and support you to make plan's which are right for you (Chou. D 2010).

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b) POSTNATAL CLINIC

Jenine Knelbach 2015 defined postnatal clinic/postnatal period is the period that is

lasts six to eight (6-8) weeks beginning right after the baby is born. Post-natal care involved

getting proper rest, nutrition and virginal care (Jeninse) 2015.

c) FAMILY PLANNING CLINIC

The world health organization (WHO) 2012, definition of family planning state that it is a

way of thinking and living, that is adopted voluntarily upon the basis of knowledge, attitude

and responsible decisions, by an individual and couples in order to promote health and

welfare of the family, group and thus contribute effectively to the social development of the

country", (WHO, 2012).

d) HOME VISITING

Minnesota (2012) department of health, data book for at least 100years, home visiting has

been used as a service delivery strategy, to improve the health and wellbeing of families.

Home visiting has been shown to make a difference by increasing tax, revenue while

decreasing cost within the education, social service and criminal justice system (Minnesota)

2012.

e) EDUCATION OF THE PARENTS

MCHENZIE (2012), health education is a profession of educating people about health. Area

within this pro-encompasses environmental health, intellectual health spiritual health

(Mckenzie 2012).

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f) PREVENTION OF SEXUAL TRANSMITTED INFECTION

Murray (2013) also referred to as sexual transmitted disease (STD) and venereal diseases

(VD) an infection that are commonly spread by sex, especially virginal intercourse, oral sex

or anal sex.

SYMPTOMS INCLUDE:-

 Vaginal discharge

 Penile discharge

 Ulcer on or around the genitals

 Pelvic pain

 Poor outcome of the babies (Murray 2013)

PROVENTION OF (STI)

a. Vaccine: are available to protect against some viral STIs such as hepatitis A, hepatitis B,

and some types of HPV.

b. Condom: male and female condom only is provide protection when used properly as

barrier.

c. Nonoxynol 9: researcher had hoped that nonoxynol; a vaginal microbicide would help to

decrease STI risk.

d. Screening: sexually active women under the age of 25 and those over

25 with risk should be screened for Chlamydia and gonorrhea yearly.

(Abs-sexually transmitted diseases treatment guideline 2015).

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g). YOUNTH FRIENDLY SERVICE

Gina desic0.

lerio (2014) many of the barriers that youth face in accessing health care service are unique to

young people due to their stage in life and associated special needs, perceptions, and abilities

a youth friendly service that all adolescents are able to obtain and these services, should meet

adolescents expectation, needs and improve their health (Gino 2014)

h). HYGIENE IN PREGNANCY

CAWST (2013), hygiene is a set of practices performed for the prevention of health.

Also refers to condition and practices that help to maintain health and prevent the spread of

disease (CAWST 2013).

JULIE (2014), defined personal hygiene having a good personal hygiene practice means

taking care of yourself and leading a healthy lifestyle. Personal hygiene habits and techniques

should be installed by parents for their children at very young age, personal hygiene includes

cleaning all areas of young body on a daily or regular basis, to prevent odor and keeping up

with your appearance. Personal hygiene is more than just staying cleans. It can affect your

self-esteem and others view and approach you (Julie 2014).

DELIVERY CARE SERVICES

Me Cleery (2011) the primary goal of the present guideline is to improve the quality of

care and outcomes for pregnant women undergoing induction of labour in under resourced

setting. The target audience of this guideline includes obstetricians, health care managers and

public health policy makers. The guidance provide is evidence based, and covers selected

topics related to induction of labour that were regarded as critical priority questions by an
9|Page
international, multidisc plenary groups of health care workers, consumers and other

stakeholders (McCrery 2011).

2.3 Important Of Antenatal Care Services

Agus Y. (2012), every year nearly half of million women and girls needlessly die as a result

of complication during pregnancy childbirth or the six (6) weeks following delivery. Almost

all (99%) of these deaths occur in developing countries. The studied aim was to describe the

factors related to low visits for antenatal care (ANC) service among pregnant women in

Indonesia, and regular attending of antenatal care service, will help for the reduction of

maternal and child mortality, as well as morbidity (Agus [Link] 2012)

2.5 Factors Affecting the Utilization of Antenatal Health Care Services

The following are the major factors that affect the utilization of antenatal health care

services:-

1. Ignorance

2. Poverty

3. Culture

4. Poor quality of health workers

5. Lack of equipment

6. Lack of good management/ government.

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1. IGNORANCE:

WorldNet (2011) defined ignorance as the lack of knowledge the word ignorance is an

adjective describes a person in the state of being unaware and is often incorrectly used to

describe individual who deliberately ignore or disregard important information or fact (word

net, (2011).

2. POVERTY:

Merriam (2013) define poverty as a general scarcity or the state of one who lack a certain

amount of material possession or money. It is a multifaceted concept, which includes social,

economic and political elements. Absolutely poverty or destitution refers to the lack of means

necessary to meet basic needs such as food, clothing and shelter.

3. CUTURE:

James (2015) defined the word culture as a social domain that emphasize the practices,

discourses and material expressions, which over time, express the continuities and

discontinuities of social meaning of a life held in common (James, 2015).

4. LACK OF EQUIPMENT:

SHAUNA (2013) I ask anyone who has worked in a low recourse hospital and they will tell

you that the lack of medical equipment that is either available or working is heretical barrier

to their ability to deliver health services to patients (Shauna, 2013).

Live seen entire maternity wards that rely on a single blood pressure machine and weighting

scale: no oxygen, no fetal or maternal monitoring let alone point of care diagnostics (Shauna,

2013).

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Recently, I visited a hospital in central Zambia where a single oxygen concentration was

shared between the operating theatre and all the clinical wards, moved around by harried

nursing staff for the next emergency (Shauna,2013).

5. POOR QUALITY HEALTH WORKERS:

Chioma Obinha (2011) today impact of the negative attitude to work by health providers in

public and private hospital in Nigeria is particularly worrisome. Years of poor attitudinal

problem particular in the public sector has further endangered lived of patient, many already

in critical condition (Ehioma,2011).

6. LACK OF GOOD MANAGEMENT:

SHAUNA (2013). Adequate knowledge about the use of the equipment 'swill help for the

maintaining and managing the apparatus appropriately by the workers, and the government

should be supervise regularly and supply a newly and good equipment (Shauna 2013).

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 CHAPTER THREE

RESEARCH METHODOLOGY

Introduction
This chapter will be discuss under the following heading: - research design aims and

objectives of study, population, universe of injury, sample and sampling techniques,

instrument for data collection. Validation and reliability of the instrument, administration

of instrument and techniques for (data analysis.

Research Design

The research design in this condition intends to investigate the factors affecting the

utilization of antenatal service among mother of child bearing age.

Types of Study

The research work is survey research because, the survey research is the type of research

that focused of population, and data are collected from the sample group choose at

random from population that are study by using questionnaire, interview and observation

on the rule that random sampling techniques must be adhered by the researcher in order

to generalize the findings.

Population/Universe/Inquiry

A population is the number of all the organisms of the same group or species, which live
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in a particular geographical area, and have the capability of interbreeding. (Population

Biology Online Retrieved, 2012).

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Shackman (2011) defined population refers to a collection of human demography is a

social science which entails the statistical study of human population. (shackman, 2011).

Sample and Sampling Techniques

Deep an Algeria, Vikas Joshi, Venkatesan ChakaraVerthy, Ravi Kothari and L.V.

Subramaniam (2015). Sampling is concerned with the selection of a subset of individuals

from within a statistical population to estimate characteristics of the whole population.

Two advantage of sampling are that the cost is lower and data collection is faster than

measuring the entire population (Deepen Palguria, etal 2015).

The sampling process comprises several stages:-

1. Defining the population of concern.

2. Specifying a sampling frame, a set of items or events possible to measure.

3. Specifying a sampling method for selecting items or event from the frame.

4. Determining the sample size.

5. Implementing the sampling plan.

6. Sampling and data collecting (Deepanetal, 2015).

The researcher used random sampling techniques to select 30 female of 15 to 35 years of

age, and 20 female from 36 to 45 age to make the total sum of 50 randomly selected

sample was used to get the responses of the peoples.

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 Instrument for Data Collection

The questionnaire method was used to obtain the data with regard to the researcher topic

in the area of study.

The questionnaire were distributed to the small group of people out of the entire

population, choose at random within the area of study on the same number were filled

and returned for continuation for the project work

Validation and Reliability of the Instrument

The questionnaire is reliable for being framed and tested according to research topic and

state research hypothesis. They are also valid after being thoroughly supervised corrected

and clarified by the project supervisor and other experts.

Administration of Instrument

The questionnaires were distributed directly to relatively large number of peoples. In

each zone some were served officially while the other personally I the area of study.

After interval of one week from the filled questionnaire where collected back from

respondents for data analysis.

Techniques for Data Analysis

The data collected from the respondents were analyzed using chi-square dichotomous

methods. The statistical analysis of the data is made to prove the two hypotheses.

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 CHAPTER FOUR

Data Analysis and Presentation

o'neiletal, Cathy and schff Rachel (2014) analysis refers to breaking a whole in to it is

spread component for individual examination

Whole in to it is spread component for individual examination. (Data analysis" Wikipedia,

2017).

o'neiletal (2014) define data analysis is a process for obtaining raw data and

converting it in to information useful for decision making by users. Data 1s collected and

analyzed to answer questions, test hypothesis or disprove theories (0'neiletal 2014).

In the following analysis the test statistic employed was CHI - SQUARE (x2) dichotomous

in nature of information statistic in the research work.

Therefore contain need to be exercise when drawing conclusion on this test

hypothesis since the pairs of value are less or greater than.

Test of Hypothesis I

There are significant factors responsible for underutilization of antenatal care

services.

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 TABLE 4.1

GENDER RESPONSES TOTAL

MALE 18 2 20

FEMALE 26 4 30

TOTAL 44 6 K=50

GENDER RESPONSES TOTAL

MALE 18 2 20

FEMALE 26 4 30

TOTAL 44 6 K=50

SOURCES: QUESTIONNAIRE

From the appendix Bi since x2cal =0.12 which is less than (<) x2 tabulated at 0.05

=3.841 we therefore accept all hypothesis and conclude that there are significant factors

responsible for underutilization of antenatal care services.

Test of Hypothesis Two

There one various ways to encourage mother of childbearing age to utilize the

available health facilities.

TABLE 4.2
Gender Responses Total

AGREE DISAGREE

MALE 10 11 21

FEMALE 20 9 29

TOTAL 30 20 50

SOURCES: QUESTIONNAIRE
18 | P a g e
From the appendix C since X² calculated is equal to X'-2.315 which is less than (L) X

tabulated at 0.5 = 3.941 we therefore accept then will hypothesis and concluded that, there

various ways for encourage mothers of childbearing age to utilize the available located

health facilities that, were stated in the questionnaire in optional table two are trice.

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 APPENDIX B

TEST OF HYPOTHESIS

STEP I: - Formulate the hypothesis

HO: - there are significant factors responsible for underutilization of antenatal care

services.

HO: - the above statement is true.

HO = Ha

STEP II: - Select the level of significant let alpha (alpha) at degrees of Freedom (df) =

(r-1) (c-l) = (2-9)(2-9) - 1x1 =1

df-3.841 there 0.05 =3.841

STEP III: - state the test statistic

X2= (ad – be)2

KLmn

STEP IV:- State the decision rule

a. Accept null hypothesis (Ho) if x2<X2 tab.

b. Reject null hypothesis (Ho) if X2 tabulated.

STEP v:- compute the test statistic from the table

4.1 X2 = (ad - bc)2

KLmn
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Data:- a=18b=2c=26d=4where 1a (constant)= 50

X2 =(18 x4 -2x 26)2

20x30x44x6x50

X2 =(75-2x26)2 x50

158400

X2 =(20)2
158400 x 50

X2 = 400
158400

X2 = 0.0025x50

X2 = 0.125

STEP VI: Apply decision rule

X2=0.125 X2=0.05 df= 3.841 since X2=0.125 which is less than (9X tabulated at 0.05 =

3.841 level of significance alpha degree of freedom (d) we therefore, accepted null

hypothesis and conclude that "THERE ARE SIGNIFICANCE FOR UTILIZATION OF

ANTENATAL CARE SERVICE.

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 APPENDIX “C"

TEST OF HYPOTHESIS

STEP I :- Formulate the hypothesis

HO:- there are various ways to encourage mothers of child bearing age to utilize the

available located health facilities.

HO :- the above statement is true.

HO = Ha

STEP II:- Select the level of significant let (alpha) at degrees of Freedom (d) = (r-1)(c-1)

= (2-1)(2-1) = Ix1 =1

df= 3.841 then 0.05 =3.841

STEP III:- state the test statistic

X2= (ad - bc) K

KLmn

STEP IV:- State the decision rule

a. Accept null hypothesis (Ho) if table tabulated.

b. Reject null hypothesis from the table X2> tab.

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STEP V;- compute the test statistic from the table 4.2

X2= (ad- bc)2 K

KLmn

Data: a= 10, b= 11, c=20, d=a, m=30, n=20

Where la = 29, L=21 and la (constant) = 50

X2= (ad- bc) K

KLmn

X2=(10 x9-11 x 20) X 50

29 X 21X 30 X 20

X2= (90- 220)2X50

365400

X2 = 16900 X 50

365400

X2 = 0.0463 X 50

X2 =0.0025 X 50

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X2= 2.315

STEP VI: Apply decision rule:

X2 = 2.315 X2=0.05 = 3.841

SINCE X2 = 2.315 which is less than (<) tabulated at 0.05 = 3.841 alpha level of

significant degree of freedom we therefore accept the null hypothesis and state that

“THERE ARE VARIOUS WAYS TO ENCOURAGE MOTHERS OF CHILD

BEARING AGE TO UTILIZE THE AVAILABLE LOCATED HEALTH FACILITIES

TEST

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 CHAPTER FIVE

SUMMARY, RECOMMENDATION AND CONCLUSION

Introduction

This chapter consists of the following: - the summary of the study, recommendation and

conclusion.

Summary

The research was conducted in order to determine the factors affecting the utilization of

antenatal care service among the mother of child bearing age a case study of Daburai

Rural Community Darazo Local Government Area, Bauchi State of Nigeria.

An introduction stated from the chapter I and it is the chapter which precise chapter II

and it contain the following :- Introduction, background of the study, statement of the

problem, scope of the study, significance of the study, purpose of the study, objective of

the study, research question and research hypothesis are presented.

Chapter II review of related literature and it contain the following: An introduction,

concept of antenatal care services, component of the antenatal care services, importance

of antenatal care services, factors affecting the utilization of antenatal care services.

Chapter III:- research methodology which contains the following:- Introduction, research

design, types of study, population universe inquiry sample and sampling techniques,

instruments for data collection, validation and Liability of the instrument, administration

of the instruments, techniques for data analysis.

25 | P a g e
Chapter iv:- data analysis and presentation:- this chapter talk about the sources of data,

presentation of the data collected and testing of the hypothesis are presented.

Recommendation

For us to have lasting solution to the problem that arise the factors affecting the

utilization of antenatal care service among mothers of child bearing age in the community

and the consequences, the following recommendation were made by the research as

follows:-

1. Government should assist by providing survey of the factors affecting the

utilization of antenatal care services.

2. Government should provide adequate and qualitative qualified health workers that

can rendered the services effectively.

3. Government should organized workshops and seminars to improve the knowledge

of health personals on the important' of antenatal care services.

4. Both government and non-governmental organization should provide the available

health facilities with necessary facilities for effective utilization.

5. Health workers should provide regular health education to all women of child

bearing age about the consequences and the important of antenatal care services.

6. Health workers should provide advocacy, community mobilization, and

community diagnosis and situation analysis in order to know the community.

7. Community members should be always prepared and takes all the necessary things

in order to help themselves.

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 5.2 Conclusion

The research work was concluded with the following:- since there are significant

factors responsible for underutilization of ante-natal care services that can lead to partial

or total failure of attending antenatal care services, and also there are various ways to

encourage mothers of child bearing age to utilize the available located health facilities in

Daburai Rural Community of Darazo Local Government Area of Bauchi State.

27 | P a g e
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Bahamas (2011) official website of the government of Bahamas

a. ([Link]@[Link]).

WHO (2016) recommendation on antenatal cares for a positive

a. Pregnancy Experience new guideline.

Prenatal care"US national library of medicine 22 February 2012.

Tommy's antenatal care (1 April, 20 14). Review.

Dr. Sunil Shroff (2016). Mediridia/health information/pregnancy

And antenatal care overview

Jeninekelbach, RNC OB (2015) written by Robin medal. On

prenatal care, pregnancy, postnatal care and take away.

WHO (20120familyplanning fact sheet

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McKenzie, J Neiger, B, Thackeray, R, (2012) health education can

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Management experience, supporting professionals to provide programsand services to

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trainer guide center for affordable water and sanitation technology.

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^James, Paul, Magee, Liam, Scerri, Andy, Streger Manfred B (2015)

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Shackman, gene, xunwang and yalinliu (201 l). Brief review of word

Population friends. Available at htp://gsociology in

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 Questionnaire

QUESTIONNAIRE ON THE FACTORS AFFECTING THE UTILIZATION OF ANTE-

NATAL CARE SERVICES AMONG MOTHERS OF CHILD BEARING AGE AT

DABURAI RURAL COMMUNITY, DARAZO LOCAL GOVERNMENT AREA OF

BAUCHI STATE

The questionnaire is designed by the researcher to obtain the relevant information on the

above topic of research under listed test items, you are kindly requested to give the bearer

Musa Ali with Registration Number COM/072/2020 give him all the necessary support

he need from you.

SECTION “A” PERSONAL DATA

1. AGE

a. 15-25 years

b. 26-35 years

c. 36 years and above

2. SEX

a. Male

b. Female

3. MARITAL STATUS

a. Married

b. Single

c. Divorced

4. EDUCATIONAL QUALIFICATION

a. Primary

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 b. Secondary

c. Tertiary

5. OCCUPATION

a. Civil servant

b. Farmer

c. Student

d. Others

33 | P a g e
SECTION “B” GENERAL

INFORMATIONA RESEARCH

/HYPOTHESIS I

Factors responsible for underutilization of ante-natal care service are:

S/N ITEMS AGREED DISAGREED

1. Ignorance
2. Poverty
3. Culture
4. Poor health facilities
5. Lack of qualified workers
6. Poor governmental assisting
7. Nature of the community

RESEARCH HYPOTHESIS II
The following ways serves to encourage mothers of child bearing age utilize the

availablelocated health facilities are:-

S/N ITEMS AGREED DISAGREED

1. Health education
2. Provision of adequate Health facilities
3. By use of mass media
4. Implementation of progarmme on ante-
natal care services for mothers of child
bearing age.
5. Adequate assisting from government

34 | P a g e