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Nigeria reported that the community was knowledgeable about hemorrhage in pregnancy and delivery, however because of the inability to recognize early warning signs they continued with traditional treatment even when clear evidence of danger existed (Chiwuzie et al 1995). Mothers have a tendency to believe that, the more they deliver the less the complications and hence the less need to deliver in health facility. The TDHS (1996) discovered that in overall 45% of births were delivered in a health unit, while about half of the births were delivered at home. The proportion of births delivered in a health unit decreases with the mothers parity. A similar study in Mongachi Malawi by Godfrey and Margaret (1996) reported that many deliveries which took place at home, were either primegravide or grand multiparous. Although the reasons given for not being attended or being attended by non- trained personnel during delivery appeared genuine, the risks taken by the grand multiparas remained disturbingly high. These women who take the trouble to attend antenatal clinics, among them, they were assumed to have been motivated to use the health facilities. The influence of distance cannot be underscored. WHO (1986), Studies done in Cuba, Egypt, Indonesia, Jamaica and Turkey on maternal mortality demonstrated that maternal complication rates are increased in areas where women are likely to arrive in the hospital, in a serious condition. This includes distance to the health facility and in adequate action by medical personnel. On the other hand Godfrey et al (1996) reported that among reasons given by mothers for not delivering in health units was distance to the health unit. Eighteen percent (18%) of the respondents in this study most of them primegravida and grand multiparas had their confinement at home. 7
Several other studies have been done on perception regarding the quality of obstetric care. According to Walker D et al (WHO 2002) in a study done in Kalimantan Indonesia where preference to home delivery among pregnant women was high was found due to poor quality of care which was an important contributor to excessive maternal mortality in many countries. Another study done in Conakry Guinea considering the short distance between the sub urban units and referral units being less than 10km usually covered by taxi, rates of maternal mortality related to uterine rupture were suprisingly high. Among other causes was inability to monitor deliveries adequately caused delays in transferring women with real obstetric complications (Thonneau et al 1994) Rizzuto and Stars (1997) pointed out that in Africa, staffs often lack clinical and interpersonal skills. Facilities are in poor repair drugs and medical supplies and equipment are not existent or expensive. Problem of inadequately trained staff and supplies also came up in focus group discussions, in Ekpoma[ Nigeria] it was noted that there was a negative perception of the quality of care available in which shortages of materials, adequately trained personnel and committed personnel in the modern health institutions serving the community Chiwuzie et al (WHF 1995). Brieger et al 1994 described other factors which keep women away from higher level health facilities are costs of hospital delivery, unfamiliar practices, in appropriate staff attitudes, restrictions with regard to the attendance of family members before seeking institutional care. Other factors included negative perceptions of the quality care provided, related to bureaucracy, lack of drugs and other supplies, none functioning equipments, absence of doctors especially at night and apparently unfriendly attitudes of staff towards patients, also referral from one level of care to another was not well organised. 8
Page 1 and 2: PRIMARY HEALTH CARE INSTITUTE - IRI
Page 3 and 4: DEDICATION I dedicate this work to
Page 5 and 6: TABLE OF CONTENTS SUBJECT PAGE Decl
Page 7 and 8: LIST OF TABLES Table 1: Distributio
Page 9 and 10: ABREVIATIONS ANC - Ante-Natal Care
Page 11 and 12: ABSTRACT Health unit delivery is a
Page 13 and 14: Globally Safe Mother Hood Initiativ
Page 15 and 16: and delivery in Health units for pr
Page 17: 2.0. LITRATURE REVIEW CHAPTER TWO S
Page 21 and 22: 3.0. RESEARCH METHODOLOGY 3.1. STUD
Page 23 and 24: 3.4. STUDY POPULATION The populatio
Page 25 and 26: The processed data was analyzed man
Page 27 and 28: 4.0. RESEARCH FINDINGS CHAPTER FOUR
Page 29 and 30: Table 5: Distribution of respondent
Page 31 and 32: Table 8: Distribution of Respondent
Page 33 and 34: The table above shows that women wh
Page 35 and 36: Table 14: Reasons given by mothers
Page 37 and 38: Introduction FOCUS GROUP DISCUSSION
Page 39 and 40: Focus group discussion with health
Page 41 and 42: Social Economic/Cultural factors ar
Page 43 and 44: HEALTH EDUCATION MODEL 5.3.THEORETI
Page 45 and 46: To reduce the complications that ap
Page 47 and 48: People will only perform a given be
Page 49 and 50: BIBLIOGRAPHY Ahmad Z. et al (1998).
Page 51 and 52: Ladfors L. et al (2001). A populati
Page 53 and 54: Walraven et al (2000) Maternal mort
Page 55 and 56: 8. How long does it take you to rea
Page 57 and 58: ANNEX 2 FOCUS GROUP DISCUSSION FOR
Page 59 and 60: ANNEX 2: QUESTIONS FOR FOCUS GROUP
Page 61: ANNEX 5: PERMISSION LETTER 47

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