|Year : 2020 | Volume
| Issue : 2 | Page : 82-87
Factors affecting utilization of obstetric ultrasound: a study of semi-urban pregnant women in a developing nation
Bello O Usman1, Suleiman Hadeja Idris2, Umar Abdulaziz3, A Olorunkoba Abdulhakim2
1 Department of Radiology, Faculty of Clinical Science, College of Medicine, Ahmadu Bello University, Zaria, Kaduna, Nigeria
2 Department of Community Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
3 Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
|Date of Submission||20-Jan-2019|
|Date of Decision||20-Mar-2019|
|Date of Acceptance||23-Jun-2019|
|Date of Web Publication||10-Jul-2020|
Dr. Bello O Usman
Department of Radiology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna
Background: Ultrasound scanning presently forms an integral part of antenatal care around the globe. It is a common investigative tool in most public and private health facilities in developing countries. Routine obstetric ultrasound has been one of the most important advances in antenatal care worldwide. It is also useful in the early detection and monitoring of the conditions that give rise to fetal and maternal compromise and has become an indispensable adjunct to the management efforts of practitioners in this regard. Therefore, utilization of this innovation by pregnant mothers is paramount toward good outcome. Objective: The objective is to determine the factors affecting utilization of ultrasound by pregnant mothers attending antenatal care in Zaria Local Government, Kaduna State, Northern Nigeria. Materials and Methods: This cross-sectional descriptive was used to carry out the study among 200 pregnant mothers selected through multistage sampling technique. This study was conducted over a period of 6 months from November 6, 2017, to May 6, 2018, after approval was given by the ethical committee of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. A structured interviewer-administered, validated questionnaire was administered to each participant to ascertain the factors affecting utilization of obstetric ultrasound by pregnant women in Zaria Local Government, Kaduna State. Data were analyzed using IBM SPSS 22. Results: The data obtained from the questionnaire were scored for proper evaluation. Furthermore, all collected data were carefully tallied, various frequencies, ranges, and mean (standard deviation) were determined. Most (29.5%) of the respondents aged 20–24 years, majority (95.5%) were homemakers that are not gainfully employed. Majority of the respondents were Hausa (94.5) and Muslims (96.5%). The findings of this study have shown that educational status, husband occupation, and knowledge affect the utilization of ultrasound by respondents. Conclusion: The common factors that affect the utilization of obstetric scan in Zaria were knowledge, education background, and husband occupation. Attitude, age, and the occupation of the respondents do not affect the utilization of obstetrics scan in Zaria.
Keywords: Antenatal care, pregnant mothers, ultrasound, Zaria
|How to cite this article:|
Usman BO, Idris SH, Abdulaziz U, Abdulhakim A O. Factors affecting utilization of obstetric ultrasound: a study of semi-urban pregnant women in a developing nation. Sahel Med J 2020;23:82-7
|How to cite this URL:|
Usman BO, Idris SH, Abdulaziz U, Abdulhakim A O. Factors affecting utilization of obstetric ultrasound: a study of semi-urban pregnant women in a developing nation. Sahel Med J [serial online] 2020 [cited 2020 Sep 30];23:82-7. Available from: http://www.smjonline.org/text.asp?2020/23/2/82/289359
| Introduction|| |
Routine obstetric ultrasound has been one of the most important advances in antenatal care worldwide.,,, Ultrasound is a safe, nonionizing modality that meets the World Health Organization (WHO) standard for the use of technology (1994)., It is affordable, accessible, acceptable, and scientifically sound. However, it raises social, ethical, and economic dilemmas for both health workers and the recipients of its services. In Nigeria, its uses said to be on the rise. However, the utilization of ultrasound may be affected by women literacy level. Obstetric ultrasound imaging has a lot of benefits for screening and diagnosis. Psychological effects on initiates bonding, reduction of anxiety, depression, hostility, and somatic symptom after ultrasound scanning (USS) was also well established.
Poor utilization and knowledge of unexpected findings may have adverse effects on pregnant women and may provoke an emotional crisis. A lot is known about women's views on and experiences of this technology in the developed world. Paucity or reduce information on how technology is perceived by women in a developing African country like Nigeria.
Maternal mortality is important issues globally. The WHO revealed 536,000 women died in 2005 because of complications related to pregnancy. About 99% of deaths, occurred in the developing world, often due to preventable causes., The WHO reported 25% of maternal deaths were due to bleeding, and 8% were caused by obstructed labor. In Britain, utilization of obstetric scan to prevent complication among antenatal clinic (ANC) women are found only to be 59%. Utilization of obstetric scan to prevent complication among ANC women in studies from Rajasthan and Mumbai were found to be 52.4% and 34.3%., High percentage of maternal mortality in the developing world, particularly in Nigeria, may due to poor utilization of obstetric scan to prevent complications of pregnancy. This study provides bases for public health intervention to reduce maternal and perinatal morbidity and mortality. The paucity of literature in the Nigerian situation in exploring this issue warrants attention for broad understanding of the topic. This contributes immensely to safe motherhood that will significantly reduce maternal, neonatal, and prenatal mortality.
| Materials and Methods|| |
The study was a cross-sectional descriptive study of the factors affecting the utilization of ultrasound among pregnant woman attending ANC in Zaria local government.
The study population consists of pregnant women attending the ANC in Zaria Local government area (LGA). This study was conducted over a period of 6 months from November 6, 2017 to May 6, 2018, after approval was given by the ethical committee of Ahmadu Bello University Teaching Hospital Zaria, Nigeria. Informed written consents were obtained from the participants before the interview. Two hundred pregnant women attending ANC in the selected primary health center (PHC) through multistage sampling technique were recruited for this study.
- Pregnant women in their second or third trimester
- Pregnant women without bad obstetrics history of multiple fetal loss
- Multiparous women.
- Pregnant women from other LGAs of Kaduna state attending ANC in Zaria LGA PHC
- Pregnant women who are acutely and severely ill.
A multistage sampling technique was used for the study.
- First stage – Four wards out of 13 geographical wards of Zaria LGA were selected using simple random sampling
- Second stage –Two PHC per ward from the list of total PHC of the four wards were selected using simple random sampling
- The final stage allocating the minimum sample size in proportion to average monthly turnover of ANC attendees in each PHC.
Instrument (study instrument)
Interviewer-administered questionnaire was used. The questionnaire was adopted fromthe previous study. It was inthe Hausa language with accompanying translation and English language. Pretesting of the questionnaire was done in Samaru, a setting close to the area where the study was being conducted. The same questionnaire was administered among fifty pregnant women in Samaru. Areas of conflict were identified and addressed. Data were collected for 2 weeks, and there were ongoing collation and quality checks on the field and during daily evening debrief meetings.
Data collection method
Open Data Kit version nine electronic form on phone device (Techno L9+).
Measures of variable-Independent variables are age, marital status, parity, level of education, employment status, and religion. While dependent variable is obstetric USS during ANC by the pregnancy mothers. Factors affecting utilization of obstetric scan questions are in Section IV of the questionnaire.
Data were statistically analysed using the statistical package for social science (SPSS) software version 22 (SPSS, Inc Chicago, IL). Categorical variables were expressed as percentages and compared using Chi squared test. Descriptive analysis was done using tables, diagrams and graphs. A p-value<0.05 was considered significant.
Ethical clearance (NHREC/10/12/2015) was obtained from Ahmadu Bello University Teaching Hospital Health Research Ethical committee on 11THh April 2017. The guidelines of Geneva declaration 2013 were adhered to. Informed consent to participate in the study was obtained.
| Results|| |
Most (51.5%) of the respondents were 20–29 years old, predominantly Muslims (96.5%), and Hausa (94.5%) by tribe. Majority (58.5%) of respondents had Quranic education, 95.5% are not doing any occupation, and 96.5% are married [illustrated in [Table 1].
|Table 1: Sociodemographic characteristics of the respondents in Zaria, 2017|
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Most (70.5%) of the respondent's husbands were employee. Majority (35.5%) of respondent's husbands are civil servant followed by daily laborers (21.5%), others are engaged with different forms of occupation [illustrated in [Table 2].
|Table 2: Sociodemographic characteristic of the respondent's husband in Zaria, 2017|
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The relationship between utilization of obstetric ultrasound and various variables are shown in [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]. There is statistically significant relationship between utilization and educational status. There is no statistically significant relationship between utilization and occupation. There is no statistically significant relationship between utilization and respondent's age. There is statistically significant relationship between utilization and the knowledge of the respondent. There is no statistically significant relationship between utilization and attitude. There is statistically significant relationship between utilization and husband occupation. This is important because 95.5% of respondents are not employed, and their health care finance was from their husband. It was also found in this study that husband's occupation affects the utilization of ultrasound by respondents with P = 0.014, Fisher's = 14.637, and df = 6.
|Table 3: Relationship between utilization and educational status of respondents in Zaria, 2017|
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|Table 4: Relationship between utilization and occupation of respondents in Zaria, 2017|
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|Table 5: Relationship between utilization and age of respondents in Zaria, 2017|
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|Table 6: Relationship between utilization and knowledge category of respondents in Zaria, 2017|
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|Table 7: Relationship between utilization and attitude of respondents in Zaria, 2017|
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|Table 8: Relationship between utilization and husband occupation of respondents in Zaria, 2017|
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| Discussion|| |
The finding of this study has shown that educational status affects the utilization of ultrasound by respondents. It shows P = 0.024 with strong statistical significance between them [illustrated in [Table 3]. This finding is similar to findings from studies in Nigeria and in other countries. In Nigeria, a study by Oche et al. in Sokoto, Nigeria, showed that the level of education significantly influenced the decision for personal ultrasound requests (P = 0.001). The reason for this similarity may be due to common education background shared between the two study area. Another Nigeria study by Ikeako et al. in Southeast Nigeria found that the level of education significantly influenced the decision for personal ultrasound requests (P = 0.001). The reason for this similarity may be due to improved health service delivery systems and health-seeking behavior.
In addition, Gonzaga et al. observed that the level of education tends to influence the methods in which women obtain and analyze information about ultrasound. A study carried out in China by Huang et al. that in both counties, women with education were more likely to have more ultrasound scans. Other studies also indicate the level of education influenced the utilization of Obstetric scan. Education has severally been found to influence the opinion and experience of pregnant women on the reasons and benefits of obstetric ultrasound utilization. This is not surprising as the level of education determines one's occupation and also the awareness of reproductive health right.
This study has shown that knowledge affects the utilization of ultrasound by respondents. This finding is similar to findings from studies in Nigeria and in other countries. In Nigeria, a study by Oche et al. in Sokoto, Nigeria found that knowledge significantly influenced the utilization of prenatal scan, knowledge on the utilization of obstetric ultrasound scan was P = 0.006. The reason for this similarity may be due to common sociodemographic background shared between the two study area. This study compares favorably well with a study conducted in Southeastern Nigeria by Ugwu et al., where similar finding was reported.
The study in Uganda by Gonzaga et al. also showed that knowledge affects the utilization of ultrasound by respondents. All women reported in their study that having the knowledge that obstetric ultrasound can give details information on fetal sex, expected date of delivery, and fetal viability, is possibly the major reason as to why they readily go for it even when their doctor has not requested for it. It was also found in this study that husband's occupation affects the utilization of ultrasound by respondents. The possible explanation for husband's occupation affecting utilization is not far-fetched, as shown in this study, as 95.5% of respondents are doing nothing and majority of respondents husbands are civil servants, so the cost of ultrasound can majorly be afford by the husbands. This study compares favorably well with study conducted in Eastern China by Huang et al., where similar finding was reported that husband/family income was found to influence utilization. The public health significance is that, men should also be given proper health education on all the benefits of obstetric scan, to make it easier for them to give full support.
This study has shown that, respondent's occupation does not affect the utilization of ultrasound. It shows P = 0.462, with no statistical significance between them [Table 4]. This finding is different from other findings in studies done in Nigeria and in other countries. In Nigeria, a study by Ikeako et al. in Enugu, Nigeria, found that respondents' occupation significantly influenced the utilization of prenatal scan. In addition, a study carried out in China by Huang et al. found that respondents' occupation/income significantly affect utilization of ultrasound. It was shown in this study that age does not affect the utilization of ultrasound by respondents. It shows P = 0.435 with no statistically significant between them [Table 5]. In contrast, a study carried out in China by Huang et al. found that age significantly affects utilization of ultrasound. Younger and primiparous women are more likely to have more utilization antenatal ultrasound scans. It is possible because that young women in their first pregnancy experience stronger feelings and have more fear of childbirth than women with previous deliveries, bringing greater interest to see the baby and assure the baby's health by ultrasound scans.,
This study has shown that that respondent's attitude does not affect the utilization of ultrasound. It shows P = 0.427, with no statistical significance between them [illustrated in [Table 7]. In contrast, a study of pregnant Danish women by Gudex et al. found that the attitudinal factors significantly affect the utilization of prenatal ultrasound. Their reasons for wanting prenatal ultrasound may differ from those of another sample with different attitudes towards abortion. The public health implication of this finding is the impact it can cause towards decreasing prenatal and maternal mortality.
Limitation of the study
Willful misstatements from respondents were also a setback. However, this effect was reduced to the barest minimum by repeating the questions thrice.
| Conclusion|| |
The common factors that affect the utilization of obstetric scan in Zaria are knowledge, education background, and husband occupation. Attitude, age, and the occupation of the respondents do not affect the utilization of obstetrics scan in Zaria.
- Other researchers– to do more studies to ascertain why the attitude toward obstetric scan of respondents in Zaria LGA, does not affect its utilization
- Pregnant mothers should improve their knowledge on some gray areas on the negative effect of obstetric scan, to improve utilization of obstetric scan
- Kaduna State Ministry of health/LGA should organize health education/promotion on benefits of obstetric scan for men/husband, for full support.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]