DETERMINANTS OF SEVERE MATERNAL OUTCOMES AMONG CHILDBEARING WOMEN IN IKOM LOCAL GOVERNMENT AREA, CROSS RIVER STATE

Abstract

This quantitative survey research sought to examine the socio-demographic, obstetric, and healthcare-related factors linked to severe maternal outcomes among childbearing women in Ikom Local Government Area. A structured questionnaire was used to gather data from a sample of 120 respondents. The study employed a one-sample t-test to evaluate the hypotheses regarding the relationship between these factors and severe maternal outcomes, with an assumed mean of 0. The results indicated significant associations between socio-demographic characteristics, obstetric factors, and healthcare-related factors with severe maternal outcomes. In particular, socio-demographic characteristics such as age and education level, obstetric factors like previous cesarean sections and prolonged labor duration, and healthcare-related factors such as access to skilled birth attendants and prenatal care services were found to significantly influence severe maternal outcomes. Based on these findings, the study concluded that these factors play vital roles in determining the likelihood of severe maternal outcomes among childbearing women in Ikom Local Government Area. Consequently, recommendations were proposed for targeted interventions to enhance access to quality maternal healthcare services, strengthen prenatal care, and implement maternal health education programs. Such measures are vital for alleviating the burden of severe maternal outcomes and promoting the overall well-being of women in the study area.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Maternal health continues to serve as a vital indicator of a country's development and overall well-being (Graham, Brass, & Snow, 2021). Although notable advancements have been made in lowering maternal mortality worldwide, numerous regions especially in low- and middle-income countries still encounter substantial obstacles in achieving safe motherhood (McCarthy & Maine, 2020). Nigeria, similar to many other nations, struggles with severe maternal outcomes (SMOs), which encompass maternal mortality and severe morbidity, thereby presenting considerable dangers to women of childbearing age (Ononokpono & Odimegwu, 2020). Ikom Local Government Area in Cross River State, Nigeria, exemplifies these difficulties, as maternal health inequalities endure and the underlying determinants of severe maternal outcomes are not yet fully comprehended (Adebayo et al., 2019).

Gaining insight into the determinants of severe maternal outcomes is fundamental to tackling maternal health disparities and enhancing maternal health results (Eboreime et al., 2021). Socio-demographic, obstetric, and healthcare-related factors exert considerable influence on maternal health outcomes (Babalola & Oyenubi, 2018). Elements such as poverty, inadequate access to high-quality healthcare, and limited women's empowerment contribute to elevated rates of maternal mortality and severe morbidity across various contexts (Lanre-Abass, 2018). In Ikom Local Government Area, these elements are expected to interact, intensifying the difficulties experienced by childbearing women in obtaining and making use of maternal healthcare services (Adamu et al., 2023).

Pinpointing the precise determinants of severe maternal outcomes in Ikom Local Government Area is essential for creating focused interventions to overcome these issues (McDermott & Cowden, 2023). Research conducted at the community level can yield important perspectives on the distinctive socio-cultural and contextual elements affecting maternal health outcomes in the area (Doctor et al., 2022). Engaging local communities in the planning and implementation of maternal health services allows interventions to be customized to the particular needs and preferences of women in Ikom Local Government Area (Galadanci et al., 2020). This participatory method is critical for guaranteeing the applicability and success of maternal health programs and policies within the region (Kusuma et al., 2022).

Enhancing access to quality maternal healthcare services is of utmost importance for decreasing maternal mortality and severe morbidity in Ikom Local Government Area (Wall, 2020). Investments in healthcare infrastructure, skilled birth attendance, and emergency obstetric care are required to guarantee that women receive prompt life-saving interventions throughout pregnancy and childbirth (Fawole et al., 2022). Furthermore, initiatives to tackle social determinants of health, including poverty and gender inequality, are necessary for advancing maternal health outcomes in the region (Akinlo et al., 2020). By confronting these fundamental determinants, policymakers and healthcare providers can achieve considerable progress in lowering maternal mortality and severe morbidity in Ikom Local Government Area (Khan et al., 2020).

Therefore, comprehending the determinants of severe maternal outcomes is indispensable for resolving maternal health disparities and improving maternal health results in Ikom Local Government Area, Cross River State, Nigeria. By recognizing the particular factors that lead to negative maternal outcomes, policymakers, healthcare providers, and other stakeholders can formulate focused interventions to tackle these issues effectively (Ariyo et al., 2017). Through investments in healthcare infrastructure, community-based research, and actions addressing social determinants of health, substantial advancements can be realized in reducing maternal mortality and severe morbidity in the region (Merdad et al., 2021).

1.2 Statement of Problem

The ongoing elevated rates of severe maternal outcomes (SMOs), which include maternal mortality and severe morbidity, in Ikom Local Government Area, Cross River State, Nigeria, underscore major deficiencies in our knowledge of the determinants driving these unfavorable results (Babalola & Oyenubi, 2018). Even with multiple global interventions designed to enhance maternal health outcomes, inequalities remain, particularly in low- and middle-income countries such as Nigeria (Ononokpono & Odimegwu, 2020). In Ikom Local Government Area, these inequalities are worsened by socio-economic difficulties, restricted access to quality healthcare services, and cultural obstacles to the use of maternal healthcare (Doctor et al., 2022).

A primary gap in understanding severe maternal outcomes in Ikom Local Government Area is the inadequate awareness of the specific socio-demographic factors that contribute to adverse maternal outcomes (Adamu et al., 2023). Although previous research has pointed to poverty, low education levels, and limited healthcare access as possible risk factors for maternal mortality and severe morbidity, the degree to which these factors affect maternal health outcomes in Ikom Local Government Area is still not well established (Eboreime et al., 2021). Moreover, there is insufficient research examining the intersectionality of these socio-demographic factors and their combined effect on maternal health outcomes in the area (McDermott & Cowden, 2023).

In addition, research on the obstetric factors linked to severe maternal outcomes in Ikom Local Government Area is limited (Galadanci et al., 2020). While pregnancy and childbirth complications are recognized contributors to maternal mortality and severe morbidity, the particular kinds of obstetric complications common in the region and their related risk factors need more thorough examination (Kusuma et al., 2022). Grasping these factors is crucial for carrying out targeted interventions to prevent and handle obstetric complications and lower rates of maternal mortality and morbidity (Akinlo et al., 2020).

Furthermore, there is a shortage of studies on the healthcare-related factors affecting severe maternal outcomes in Ikom Local Government Area (Adebayo et al., 2019). Restricted access to quality maternal healthcare services, insufficient infrastructure, and substandard healthcare delivery result in delays in obtaining essential maternal healthcare, causing poor outcomes for women in the region (Wall, 2020). Nevertheless, the specific barriers and enablers to healthcare access and utilization in Ikom Local Government Area demand additional exploration (McCarthy & Maine, 2020). Filling these knowledge gaps is essential for creating evidence-based interventions and policies intended to improve maternal health outcomes and decrease severe maternal outcomes in the region (Merdad et al., 2021).

1.3 Objectives of the Study

This study aimed to investigate the determinants of severe maternal outcomes among childbearing women in Ikom Local Government Area, Cross River State. The specific objectives were:

1. To assess the socio-demographic factors associated with severe maternal outcomes among childbearing women in Ikom Local Government Area.
2. To examine the obstetric factors contributing to severe maternal outcomes in the study area.
3. To explore the healthcare-related factors influencing severe maternal outcomes among childbearing women in Ikom Local Government Area.

1.4 Research Questions

To achieve the stated objectives, the study addressed the following research questions:

1. What socio-demographic characteristics are associated with severe maternal outcomes among childbearing women in Ikom Local Government Area?
2. What obstetric factors contribute to severe maternal outcomes in the study area?
3. How do healthcare-related factors influence severe maternal outcomes among childbearing women in Ikom Local Government Area?

1.5 Research Hypotheses

The study tested the following hypotheses:

1. There is no significant association between socio-demographic characteristics and severe maternal outcomes among childbearing women in Ikom Local Government Area.
2. Obstetric factors do not significantly contribute to severe maternal outcomes in the study area.
3. Healthcare-related factors have no significant influence on severe maternal outcomes among childbearing women in Ikom Local Government Area.

1.6 Significance of the Study

The importance of understanding the determinants of severe maternal outcomes in Ikom Local Government Area, Cross River State, is substantial. This study carries deep implications for multiple stakeholders, such as policymakers, healthcare providers, researchers, and the wider community. The following provides a thorough examination of its significance:

First and foremost, this study tackles a pressing public health concern. Maternal health is a central measure of a community's overall well-being, and severe maternal outcomes including maternal mortality and severe morbidity present major challenges. By exploring the determinants behind these adverse outcomes, the study illuminates the root causes of maternal health disparities in Ikom Local Government Area. This knowledge is essential for crafting targeted interventions and policies to reduce maternal mortality and morbidity rates.

Moreover, the study's results have immediate relevance for policy development and execution. Policymakers depend on evidence-based research to create effective strategies for better maternal health outcomes. By highlighting specific socio-demographic, obstetric, and healthcare-related factors connected to severe maternal outcomes, the study equips policymakers with critical insights for directing resources and interventions. This focused strategy improves the efficiency and impact of maternal health programs, ultimately resulting in better health outcomes for women in the region.

Furthermore, healthcare providers will gain considerably from the study's findings. Knowledge of the determinants of severe maternal outcomes allows providers to recognize high-risk women early during antenatal care and deliver focused interventions to reduce adverse outcomes. This could involve more intensive monitoring during pregnancy, prompt referrals for specialized care, or measures addressing social determinants of health that lead to poor maternal outcomes. By adopting evidence-based practices derived from this research, healthcare providers can improve the standard of maternal healthcare delivery and ultimately save lives.

Additionally, this study adds to the existing knowledge base on maternal health in Nigeria, with particular emphasis on Ikom Local Government Area. By expanding the current literature on severe maternal outcomes, it deepens our comprehension of the intricate interactions among factors affecting maternal health in the region. This information not only guides future research but also acts as a useful tool for advocacy to secure resources and build support for maternal health efforts.

Finally, the significance of this study reaches the broader community. Better maternal health outcomes produce positive effects that go beyond individual women to influence their families, communities, and society overall. By decreasing maternal mortality and morbidity rates, the study supports the general well-being and development of the community, enabling women to realize their reproductive potential and contribute effectively to society.

1.7 Scope of the Study

This study concentrated on examining the determinants of severe maternal outcomes among childbearing women in Ikom Local Government Area, Cross River State. It took into account socio-demographic, obstetric, and healthcare-related factors as possible determinants of severe maternal outcomes. The study utilized a cross-sectional design and gathered data from selected healthcare facilities and communities within Ikom Local Government Area.

1.8 Operational Definition of Terms

Severe Maternal Outcomes (SMOs): Refers to adverse maternal health events, including maternal mortality and severe morbidity, occurring during pregnancy, childbirth, or within the postpartum period.

Socio-demographic Factors: Includes variables such as age, education, marital status, occupation, and socio-economic status, which characterize the demographic and social attributes of individuals.

Obstetric Factors: Refers to factors related to pregnancy and childbirth, including parity, gestational age, mode of delivery, and complications during pregnancy or childbirth.

Healthcare-related Factors: Encompasses factors associated with healthcare access, utilization, and quality, including antenatal care attendance, skilled birth attendance, availability of emergency obstetric care, and healthcare infrastructure.

Cross-sectional Design: A research design that collects data at a single point in time to provide a snapshot of a population or phenomenon.

Maternal Mortality: The death of a woman during pregnancy, childbirth, or within 42 days of the termination of pregnancy, irrespective of the duration and site of pregnancy, from any cause related to or aggravated by the pregnancy or its management.

Maternal Morbidity: Refers to any health condition attributed to and/or aggravated by pregnancy and childbirth that has a negative impact on a woman's well-being.

Healthcare Facilities: Refers to institutions providing healthcare services, including hospitals, clinics, maternity centers, and primary healthcare facilities, where maternal health services are offered.