Introduction:
Globally over the decades, there has been an exponential rise in home birth[1]. This is far becoming common in developing countries. Unfortunately, due to poor status of healthcare facilities, pregnant are faced with the decision to deliver their unborn babies at home[2]. Documentation of home deliveries exist[3], even suggesting that about half of the pregnant women give birth at home[4]. Apart from the poor state of healthcare facilities, other factors that contribute to home deliveries have also been identified[5-7]. Whereas the healthcare facilities have the equipment and trained personnel to handle all conditions that may arise from deliveries, home delivery has been documented to have its shortfalls which in most conditions is not handled by trained professionals[2]. Serious consequences such as postpartum haemorrhage, retained placenta, sepsis [8,9], ruptured uterus[10], and maternal death[11] are known to occur. Yet programs like ‘Safe Motherhood’ are geared towards reducing maternal mortality exists[12]. In facilities where there is an adequate number of midwives, maternal mortality is low [13, 14]. Along with the poor utilization of health facilities by pregnant women, especially in rural areas, the consequences of home delivery remain high in home deliveries in rural areas[15-17]. Hence this study seeks to explore the perceived consequences of home deliveries on mothers and babies' health in Anantigha Community, Calabar South Local Government Area, Cross River State. Four (4) specific objectives and one hypothesis were developed for the study and they are:
- Determine the incidence of home deliveries among mothers in Anantigha, Calabar South Local Government Area between March 2019 and March 2020.
- Identify the factors associated with home deliveries among mothers in Anantigha Community, Calabar South Local Government.
- Ascertain the perceived consequences of home deliveries on mothers’ health in Anantigha, Calabar South.
- Assess the perceived consequences of home deliveries on babies’ health in Anantigha Calabar South Local Government.
Our hypothesis was that - H0: There is no significant relationship between the incidence of home deliveries and the perceived consequences of home deliveries on mothers’ health in Anantigha, Calabar South.
Methodology
Research Design: The study adopted a cross-sectional research design.
Research Setting: This research was conducted in Anantigha, Calabar South Local Government Area. Anantigha has an area of about 14.8 square kilometers with an estimated population of about 191,550 of which 84,527 are females[18].
Target Population: The primary population that was used for this study were women who had given birth at least once between March 2019 and March 2020 in addition to women who were pregnant at the time of data collection and those who may have observed or attended to home deliveries. The number of women who were pregnant within the period was 1005.
Sample and Sampling Technique
The convenience sample technique was employed to select the pregnant/nursing mothers for the study. For instance, communities and streets were purposively selected depending on their distance from the two health centres mentioned in the foregoing. Thus, a total of five settings in Anantigha were selected: two streets were selected close to the Ekpo Abasi and Anantigha Health Centers while two more streets were selected a mid-distance from, and far away from, these health centres respectively.
Sample Size/ Accessible Population: A total of 1005 pregnant/nursing mothers were recorded within the period. The sample size was determined using
Select Statistics Services [19] and 279 women were selected for the study.
The instrument for Data Collection: A structured questionnaire was used to collect data in this study.
Validity: Correction and for face and content validity were all ensured before instrument distribution.
Reliability: A Pilot study was done which allowed the researchers to test the reliability of the instrument and also to familiarize them with the administration of the instrument. A correlation coefficient was then calculated using Pearson’s formula for Correlation and found to be 0.85.
Ethical Consideration: Ethical approval was obtained from the Cross River State Ethics Committee. Verbal consent was obtained from respondents. Participants in this investigation were allowed the freedom to participate. They were also informed of the study and the necessary rapport was created before the commencement of data collection. Confidentiality and anonymity were ensured in the study.
Method of Data Collection: Structured questionnaires were administered to participants with the help of three (3) research assistants. After
the consent was obtained from eligible mothers, questionnaires were administered and collected immediately after filling. Data collection lasted for three weeks.
Method of Data Analysis: Data was analyzed by descriptive statistics including frequencies and percentages. Also, descriptive and inferential statistics were used to make a statistically valid population inferences from sample data. Chi-Square Statistical Analysis was also performed to compare the variables when testing the hypothesis. Statistical difference was considered significant as the p-value was less than 0.05 at 95% confidence level.
Results
| Table 1: Socio-demographic data (n= 279) |
| Variables |
Category |
Frequency (N) |
Percentage (%) |
Age |
18-25years |
31 |
11.1 |
26-30years |
45 |
16.1 |
31-35years |
94 |
33.7 |
36-40years |
75 |
26.9 |
41-45years |
27 |
9.7 |
46-50years |
7 |
2.5 |
Total |
279 |
100 |
Marital Status |
Single |
96 |
34.4 |
Married |
120 |
43.0 |
Divorced |
10 |
3.6 |
Separated |
53 |
19.0 |
Total |
279 |
100 |
Religion |
Christianity |
242 |
86.7 |
African traditional |
37 |
13.3 |
Total |
279 |
100 |
Educational Level |
No formal |
65 |
23.3 |
Primary |
81 |
29.0 |
Secondary |
98 |
35.1 |
Tertiary |
35 |
12.5 |
Total |
279 |
100 |
Employment Status |
Employed |
226 |
81.0 |
Unemployed |
53 |
19.0 |
Total |
279 |
100 |
Research question 1: What is the incidence of home deliveries among mothers in Anantigha, Calabar South Local Government between March 2019 and March 2020?
To answer this question, items 6-9 in Section A of the questionnaire were analyzed as shown in Table 2 below.
| Table 2: Incidence of home deliveries among mothers in Anantigha (n = 279) |
|
Variables |
Response |
Yes |
No |
Total |
No. |
% |
No. |
% |
No. |
% |
Number of pregnancies |
|
|
|
|
|
|
One (1) |
62 |
22.2 |
217 |
77.8 |
279 |
100 |
Two (2) |
81 |
29.0 |
198 |
71.0 |
279 |
100 |
Three (3) |
96 |
34.4 |
183 |
65.6 |
279 |
100 |
More than three |
40 |
14.3 |
239 |
85.7 |
279 |
100 |
Number of births |
|
|
|
|
|
|
One (1) |
45 |
16.1 |
234 |
83.9 |
279 |
100 |
Two (2) |
67 |
24.0 |
212 |
76.0 |
279 |
100 |
Three (3) |
73 |
26.2 |
206 |
73.8 |
279 |
100 |
More than three |
36 |
12.9 |
243 |
87.1 |
279 |
100 |
Place of last birth |
|
At home |
115 |
41.2 |
164 |
58.8 |
279 |
100 |
In a health centre |
129 |
46.2 |
150 |
53.8 |
279 |
100 |
In a hospital |
35 |
12.6 |
244 |
87.4 |
279 |
100 |
The distance of home from the birthplace |
|
|
|
|
|
|
1-3km |
103 |
26.9 |
176 |
63.1 |
279 |
100 |
4-6km |
91 |
32.6 |
188 |
67.4 |
279 |
100 |
7-10km |
85 |
30.5 |
194 |
69.5 |
279 |
100 |
The results on the incidence of home deliveries among mothers in Anantigha, Calabar South Local Government between March 2019 and March 2020 are displayed in Table 2. When asked about their place of birth, 115 (41.2%) respondents stated “home”, 129 (46.2%) stated “in a health centre” and 35(12.6%) stated, "in a hospital”. When asked about the number of times they were pregnant, 62 (22.2%) of the 279 respondents indicated one (1) time, 81 (29.0%) indicated two (2) times, 96 (34.4%) indicated three (3) times and 40 (14.3%) indicated more than three times. With regards to the number of births, 45 (16.1%) indicated one (1), 67 (24.0%) indicated two (2), 73 (26.2%) indicated three (3) and 36 (12.9%) indicated more than three. The majority of the 279 respondents, 103 (26.9%) had their homes 1-3 km away from birthplace, 91 (32.6%) had their homes 4-6km away from birthplace and 85 (30.5%) had their home 7-10km away from the birthplace.
Research question 2: What are the factors associated with home deliveries in Anantigha Calabar South Local Government Area?
To answer this question, item 10-17 on Section B of the questionnaire was used. See Table 3 below.
| Table 3: Factors associated with home deliveries in Anantigha Calabar (n = 279) |
|
Variables |
Response |
SA |
A |
D |
SD |
Total |
No. |
% |
No. |
% |
No. |
% |
No. |
% |
No. |
% |
Family and maternal income can influence home deliveries. |
57 |
20.4 |
141 |
50.5 |
49 |
17.6 |
32 |
11.5 |
279 |
100 |
The distance of the health center from the mother’s home can lead to home deliveries. |
110 |
39.4 |
73 |
26.2 |
51 |
18.3 |
45 |
16.1 |
279 |
100 |
The cost of hospital care can influence home deliveries. |
71 |
25.5 |
197 |
70.6 |
4 |
1.4 |
7 |
2.5 |
279 |
100 |
Quality of hospital care can influence home. |
99 |
35.5 |
64 |
22.9 |
70 |
25.1 |
46 |
16.5 |
279 |
100 |
The attitude of healthcare workers can influence home deliveries |
69 |
24.7 |
75 |
26.9 |
79 |
28.3 |
56 |
20.1 |
279 |
100 |
Participation in antenatal care can influence home deliveries. |
54 |
19.4 |
12 |
4.3 |
137 |
49.1 |
76 |
27.2 |
279 |
100 |
Transportation costs can influence home delivery. |
67 |
24.0 |
91 |
32.6 |
77 |
27.6 |
44 |
15.8 |
279 |
100 |
Culture and traditional norms can result in home deliveries. |
85 |
30.5 |
95 |
34.1 |
52 |
18.6 |
47 |
16.8 |
279 |
100 |
Table 3 above shows 57(20.4%) respondents strongly agreed that family and maternal income can influence home deliveries, 141 (50.5%) agreed to it, 49 (17.6%) disagreed with it and 32 (11.5%) strongly disagreed to it. Majority of the respondents, 110 (39.4%) strongly agreed distance of the health center from mother’s home can lead to home deliveries; 197 (70.6%) agreed that cost of hospital care can influence home deliveries; 99 (35.5%) strongly agreed that quality of hospital care can influence home deliveries; 79 (28.3%) disagreed that attitude of healthcare workers can influence home deliveries; 137 (49.1%) disagreed that participation in antenatal care can influence home deliveries; 91 (32.6%) agreed that transportation costs can influence home delivery and 95 (34.1%) agreed that culture and traditional norms can result in home deliveries.
Research question 3: What are the perceived health consequences of home deliveries on mothers in Anantigha, Calabar South Local Government?
To answer this question, item 18-21 on Section C of the questionnaire was used and results present in the bar chart below (Figure 1).
 |
Fig. 1: Perceived health consequences of home deliveries on mothers in Anantigha (n = 279) |
 |
Fig. 2: Perceived consequences of home deliveries on the health of babies in Anantigha (n = 279) |
Results in Fig. 1 revealed the perceived health consequences of home deliveries on mothers in Anantigha, Calabar South LGA. Among the 279 respondents, 79 (28.3%) perceive excessive bleeding or blood loss to be a consequence of home deliveries, 96 (34.4%) perceive maternal death to be a consequence, 58 (20.8%) perceive maternal birth injuries (like fistulas) to be a consequence while 46 (16.5%) perceive the loss of consciousness and shock to be a consequence of home deliveries on mothers.
Research question 4: What are the perceived consequences of home deliveries on the health of babies in Anantigha, Calabar South Local Government Area?
To answer this question, item 23-30 on Section D of the questionnaire was used, and results present in the bar chart below (Figure 2).
Results in Fig. 2 revealed the perceived consequences of home deliveries on the health of babies in Anantigha, Calabar South LGA. Out of the 279 respondents, 94 (33.7%) identified stillbirths (babies born dead) as a consequence of home deliveries on the hearth of the baby, 111 (39.8%) identified neonatal death as a consequence, 46 (16.5%) identified poor immunization and infections as a consequence and 28 (10.0%) identified child abnormalities as a consequence of home deliveries on the health of the babies.
Hypotheses testing
We hypothesized that there is no significant relationship between the incidence of home deliveries and the perceived consequences of home deliveries on mothers’ health in Anantigha, Calabar South LGA. To test this hypothesis Pearson product-moment correlation statistics were used and Table 4 below was obtained.
| Table 4: Analysis of the relationship between the incidence of home deliveries and the perceived consequences of home deliveries on mothers’ health (n = 70) |
| Variable |
N |
Mean |
Standard deviation |
r calculated |
r critical |
p-value |
Incidence of home deliveries |
115 |
69.2 |
51.8 |
0.2533* |
0.1793 |
0.05 |
Perceived consequences of home deliveries |
279 |
83.1 |
74.4 |
|
|
|
Excessive bleeding or blood loss |
79 |
49.7 |
43.9 |
0.5119* |
0.2199 |
0.05 |
Maternal death |
96 |
53.6 |
47.3 |
0.5570* |
0.1966 |
|
Maternal birth injuries (like fistulas) |
58 |
47.1 |
39.6 |
0.4398* |
0.2542 |
|
Loss of consciousness and shock |
46 |
44.7 |
41.5 |
0.3857* |
0.2907 |
|
| *Result significant at P < 0.05 r-cal = 0.25, r-critical = 0.18 |
Decision rule:
If rcal > rcrit, reject H0, Otherwise, accept H0
Since the r-calculated value (0.25) is greater than the r-critical value (0.18), the null hypothesis stated that there is no significant relationship between the incidence of home deliveries and the perceived consequences of home deliveries on mothers’ health in Anantigha, Calabar South LGA is rejected. This implies that the incidence of home deliveries has a very strong positive and significant relationship with the perceived consequences of home deliveries on mothers’ health in Anantigha, Calabar South LGA. This is also proven by the p>0.05 as well as the individual results (rcal > rcrit) for each perceived consequences of home deliveries.
Discussion
Child delivery is best with the presence of specialists. Findings from this study revealed that 115 (41.2%) mothers had given birth to their babies at home. These findings support the findings of Kasaye HK et al (20) who after studying 502 women revealed that a small number of women (127; 25.3%) had home childbirths. Also, the findings agree with Mwewa D et al (21) who reported a home delivery prevalence of 43% in a landmark study of two countries. However, the results of this study are in contrast with those of Ogolla JO (22) who reported after a study of 600 mothers that majority (400; 66.7%) delivered at home. Results of this study are also in contrast with those of Kucho B et al (23) who revealed after a study of 447 women studied, 302 (67.6%) gave birth at home for their last pregnancy.
So many factors influence home delivery. The current study explored factors responsible for home delivery. Findings revealed that the home deliveries were cheaper than the cost of hospital care (96.1%), and family and maternal income (70.9%), the distance of the health center from mother’s home (65.6%), culture and traditional norms (64.6%), quality of hospital care (58.4%) and attitude of healthcare workers (51.6%) played their roles. This is in agreement with Kaul S et al (24) who reported that income was a major factor associated with home deliveries among women. This is in line with the study by Kimani M (11) who discovered that two factors associated with home deliveries among women living in developing countries were the distance from home to health facilities and maintenance of traditional customs and beliefs. Besides, the study is at par with that of Gabrysch S et al (25) who reported that socioeconomic status, community health infrastructure, region, rural/urban residence, available health facilities, and distance to health facilities were the community factors associated with home deliveries among women.
The findings of this study revealed that the perceived health consequences of home deliveries on mothers were maternal death (34.4%), excessive bleeding/blood loss (28.3%), maternal birth injuries like fistulas (20.8%), and loss of consciousness and shock (16.5%). The findings of this study are in line with that of Kucho B (23) who reported that mothers die before, during, or after delivery and if they happen to survive, they end up with missing babies and/or severe disabilities. Another study found that more than 95% of uterine ruptures occur in-home deliveries(10). This finding is also in line with the finding of Baig SA et al (26) who reported that the perceived critical risks that accompany home deliveries include postpartum hemorrhage, retained placenta, sepsis and tetanus, diarrhea, preterm birth, unhygienic delivery, and infections.
The major focus of this study is to examine the perceived consequences of home delivery. Analysis of the data revealed that the perceived consequences of home deliveries on the health of babies included; stillbirths (33.7%), neonatal death (39.8%), poor immunization practices and infections (16.5%), and child abnormalities (10.0%). The findings of this study are in line with that of Darega B et al (27) who reported that neglect of colostrum provision and breastfeeding practices, immunizations, and nutrient supplementation for the child were the perceived consequences of home deliveries on the health of babies. The findings of this study agree with that of Agha S (8) who observed that the critical health consequences in children that accompany home births include tetanus, diarrhea, preterm birth, asphyxia, and infections. This finding is also in line with the report of the WHO, that the total number of neonatal deaths, nearly fifty percent occur among children delivered at home. (28)
The findings in this study showed the null hypothesis which stated that there is no significant relationship between the incidence of home deliveries and the perceived consequences of home deliveries on mothers’ health in Anantigha, Calabar South LGA was rejected. This implied that the incidence of home deliveries determined the level at which the perceived consequences of home deliveries on mothers’ health occurs. This finding is also in line with the finding of Baig SA et al (26) who reported that the perceived critical risks that accompany home deliveries include postpartum hemorrhage, retained placenta, sepsis and tetanus, diarrhea, preterm birth, unhygienic delivery, and infections. The findings of this particular study agree with that of Qudsia QA et al (10) who stated that more than 95% of uterine ruptures occur in home deliveries. Also, Simfukwe ME (3) reported that mothers die before, during, or after delivery, and if they happen to survive, they end up with missing babies and/or severe disabilities.
Conclusion
The researchers conclude that there was a significant level of home delivery among women in Anantigha. This was due to the cost of hospital care, low-socioeconomic status, distance of the health center from mother’s home, cultural norms, quality of hospital care, and attitude of healthcare workers. Also, the study concludes that the perceived health consequences of home deliveries on mothers and babies include stillbirths, neonatal death, poor immunization practices and infections and birth abnormalities and maternal death, excessive bleeding/blood loss, maternal birth injuries like fistulas and loss of consciousness and shock. The researcher suggests a more enlightenment campaign on the benefits of institutional delivery, provision of good transport facilities to and from the health institutions.
Disclosure of commercial interests: None
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