DOI: 10.3886/e123302v1-145202
title: Increasing Women's Access to Skilled Pregnancy Care in Rural Nigeria

description: Nigeria
is estimated to account for 19% of all estimated global maternal deaths with
approximately 58,000 in 2015. The high number is partly due to the
inadequate access of women to evidence-based skilled pregnancy care. The
Federal Ministry of Health (FMoH) and all major health policy agencies in
Nigeria have recognized the need for increased access to skilled obstetric
care, especially in rural areas, as critical to reducing the high rate of
maternal mortality. However, despite the fact that policymakers recognize that
primary health care should play a key role in improving rural women's access to
skilled pregnancy care, Primary Health Centres (PHCs) are often poorly utilized
throughout the country. This project is a 5-year (2015-2020) implementation
research conducted by the Women's Health and Action Research Centre (WHARC),
Benin City, Nigeria in collaboration with the University of Ottawa (UOttawa),
Canada and with funding from the International Development Research Centre
(IDRC), Global Affairs Canada (GAC) and the Canadian Institute for Health Research
(CIHR) under the Innovating for Maternal and Child Health in Africa (IMCHA)
Initiative. 

The project's specific objectives are: 

1) to identify the demand and supply
factors responsible for the use and non-use of PHCs for pregnancy care in Esan
South East and Etsako East LGAs of Edo State, Nigeria; 

2) based on Objective 1, to derive and
implement a set of multi-faceted community-led interventions to increase women's
access to skilled pregnancy care offered in PHCs in Esan South East and Etsako East Local Government Areas (LGA);
and

3) to evaluate the effectiveness of the
interventions using both indicators of access to services, as well as maternal
and fetal/newborn health outcomes in the intervention communities.

 

The study was conducted in Esan South East
and Etsako East Local Government Areas (LGAs) in Edo State in southern
Nigeria. Both LGAs are located in the
rural and riverine areas of the state, adjacent to River Niger, with Estako
East in the northern part of the Edo State part of the river, while Esan South
East is in the southern part. Edo State is one of Nigeria’s thirty-six states.
Each state consists of LGAs, and LGAs consist of political/health Wards. The
study was originally designed to be a randomized control trial (Yaya et al.,
2018) but was changed to a quasi-experiment separate sample pretest and
posttest design. The change was necessitated by the difficulty in achieving
reliable randomization in the study communities. The study was conducted in
three phases. At phase one, a baseline was conducted using a mixed-method
approach to address objective 1. Based on the results of the baseline research,
a set of intervention activities were designed and implemented simultaneously in
phase 2 for two years. Phase three was the endline
research which addressed the study objective 3.

 

Ethical approval for the study was
obtained from the National Health Research Ethics Committee (NHREC) of Nigeria
– protocol number NHREC/01/01/2007 – 10/04/2017; and written informed consent
was obtained from individual respondent/participant, except in the community
conversations where the consent was verbal. 

 

The data we are sharing contain baseline
and endline data. collected through a mixed-method approach to address the
study objectives. The baseline data were
collected between July 29 to August 16, 2017, using a mixed-method that
comprises a household survey, exit interview, PHC site assessment survey,
community conversation, focus group discussion, and key informant interview. The
endline data were collected between June 24 and July 6, 2020, using a household
survey. All the data collection instruments were pretested and the data were
collected by trained data collectors. 

<br><br><br><br><br>
description: Response Rates: The sample size for the baseline and end household survey was 1,318, to adjust for non-response, 10% was added to derive a total of 1,450. At baseline, 1408 responded, and at endline 1,411 responded. <br>Based on
replacement of non-response, the total number expected were covered during the
two surveys bringing the response rate to be 100%

<br><br><br><br>
description: Household survey: Multistage, systematic, random
sampling design;Exit Interview: All eligible women were interviewed;Site
Assessment survey: Random sampling;Qualitative data: Purposive and convenient sampling <br><br><br><br>
description: <br>Ever married women age 15-45 years old<br>Primary Health Centres<br>. Smallest Geographic Unit: Local Government Area
description: computer-assisted personal interview (CAPI); face-to-face interview;