Improving skilled attendants at birth: Experience in a primary health care facility in Rivers State, South-South Nigeria.

Abstract

Background: Skilled attendance at birth has been identified as one of the most cost-effective methods of reducing maternal and neonatal mortality, but in spite of the efforts made to address the poor access in Nigeria, utilization in some communities is surprisingly poor. This study highlighted the experience of a primary health care (PHC) facility in south-south Nigeria, in encouraging the utilization of its maternity services.
Methods: The study is a review of the antenatal and delivery records of PHC Aluu, before and after an educational programme, to improve the utilization of its maternity services, especially by patients that had antenatal care (ANC) in the facility. An exit interview of the antenatal patients was also carried out to collect relevant information.
Results:  Antenatal registration increased by 15.04% after the programme, but there were no significant differences in the socio-demographic characteristics of the patients (p-value > 0.05). The ANC-Delivery ratio of the health center increased by 3.09% (p-value > 0.05); the patients that had their babies in the facility were mostly (60.71%) non-indigenes, with (61.16%) tertiary education, and several were nulliparous (41.52%), but there were no significant differences in the socio-demographic characteristics of the patients, before and after the programme (p-value >0.05). Most (51.84%) of the respondents of the exit interview registered at the health center, for the privileged access to the teaching hospital; several of them (56.33%) would prefer to give birth in the health center; but most (54.69%) believed that the difficulty in getting to the health center, might discourage several women from having their babies in the health center.
Conclusions: The efforts made by the PHC facility to improve the patronage of its maternity services only resulted in a small increase. Patronage can be improved if deliberate effort is made to out-compete the unorthodox birth attendants, and if there is a proper division of labour amongst the three tiers of the health system.

Keywords: Skilled Birth Attendant, Basic Obstetric Care,Traditional Birth Attendants, Maternal Mortality, Neonatal Mortality, Primary Health Care, Rivers State, Nigeria.