KNOWLEDGE OF POST-PARTUM HAEMORRHAGE AND FACTORS AFFECTING UTILISATION OF SECONDARY HEALTH CARE FACILITIES BY PREGNANT WOMEN IN SELECTED HOSPITALS IN IBADAN METROPOLIS, NIGERIA

Abstract

Post-partum haemorrhage (PPH) is a preventable obstetric complication which can be defined as blood loss of more than 500mL following vaginal delivery. In developing countries, mortality from PPH remains high. Adequate knowledge of obstetric complication during pregnancy has been shown to improve utilisation of health facilities but few studies have linked knowledge of pregnant women on PPH with utilisation of health facilities. This study was designed to examine the knowledge of PPH and factors affecting utilisation of secondary health care facilities by pregnant women in Ibadan metropolis, Oyo Slate, Nigeria. The study was cross-sectional using three-stage sampling technique. Two local government areas were randomly selected from five LGAs of lbadan metropolis. All the three secondary health facilities in the LGAs were used. Four hundred and fifty pregnant women were systematically selected from medical record. A combination of qualitative and quantitative methods was used to collect data. Six Focus Group Discussion (FGD) sessions were conducted. A semi-structured interviewer-administered questionnaire was used to obtain information. The questionnaire contained 17-point knowledge scale that covers definition, causes and risk factors for PPH graded poor (<5), fair (>5 ≤10) and good (>10). An 8-point attitudinal scale graded into negative (<4) and positive (≥4) was also used. Qualitative data were analysed using thematic approach while quantitative data were analysed using descriptive statistics, Chi-square and logistic regression tests at 5% level of significance. Focus group discussion (FGD) participants stated that PPH is severe bleeding from the vagina after delivery and could be prevented if pregnant women delivered at health facilities with skilled attendants. Age of respondents was 29.2±5.5 years. Almost all of the respondents (99.1%) attended school, 49.1% attended secondary school while 42.2% obtained higher education. Many of the respondents (71.1%) had been pregnant before and 81.8% have been pregnant 1-3 times while 15.8% had been pregnant 4-6 times. Knowledge score was 9.6±3.7% with 60.0% having good knowledge of PPH and 57.1% reported PPH was caused by poor uterine contraction. Other causes were episiotomy or tear (64.7%) and retained product of conception (77.8%). There was no association between respondents' level of education and knowledge about PPH. Reported risk factors for PPH were previous PPH (59.1%), grand-multiparity (50.9%), and adolescent pregnancy (49.1%). Most of the respondents (96.0%) had positive attitude toward PPH and 95.3% agreed that pregnant women must deliver under the supervision of skilled attendants in order to prevent PPH. Majority of the respondents (91.6%) had registered at health facilities. Factors that influenced pregnant women to utilise healthcare facilities were services rendered at the facility (94.7%) and perceived competence of health care providers (91.8%). Pregnant women who had had 1-3 pregnancies were more knowledgeable of PPH (OR=3.49, CI=1.22- 9.95) compared with those who had not been pregnant before. Pregnant women had good knowledge of post-partum heamorrhage. Service quality and competence of healthcare providers influenced health facility utilisation.