|ORIGINAL RESEARCH REPORT
|Year : 2019 | Volume
| Issue : 3 | Page : 87-92
Preconception care: Assessing the level of awareness, knowledge and practice amongst pregnant women in a tertiary facility
Opeyemi Rebecca Akinajo, Gbemi Eniola Osanyin, Osemen Ehidiamen Okojie
Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
|Date of Web Publication||3-Jul-2019|
Dr. Opeyemi Rebecca Akinajo
Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos
Source of Support: None, Conflict of Interest: None
Background: One of the components of health care for every woman of reproductive age is preconception care (PCC). The adoption of this care will assist the healthcare system to shift from the delivery of procedure-based acute care to the provision of counseling-based preventive care. Aims: The aim of this study is to determine the level of awareness, knowledge, and the practice of our women on PCC. Settings and Design: A descriptive cross-sectional study was carried out on 50 consenting pregnant women at the antenatal outpatient clinic. Subjects and Methods: All pregnant women who booked for antenatal care during the period of data collection were consecutively recruited through convenient sampling technique. Data were collected using pretested, semi-structured questionnaires to provide answers to the objectives of the study. Statistical Analysis Used: Data obtained were analyzed using SPSS software version 22 and expressed as frequency and percentages. The Chi-square was used to test for association with a value of P < 0.05 indicating statistical significance. Results: The mean age was 31.5 ± 3.8 years and majority (80%) had tertiary education. There is high level of awareness of PCC (76%); however, awareness of its practice in Nigeria is very low (34.2%). Only 34.2% had received PCC before index pregnancy. There is, therefore, a huge disconnection between their level of awareness and practice. Conclusions: There is the need to arm our women with detailed and accurate information on PCC, establish functional clinics with availability of evidence-based guidelines to improve uptake and pregnancy outcome.
Keywords: Awareness, knowledge, practice, preconception care, pregnant women
|How to cite this article:|
Akinajo OR, Osanyin GE, Okojie OE. Preconception care: Assessing the level of awareness, knowledge and practice amongst pregnant women in a tertiary facility. J Clin Sci 2019;16:87-92
|How to cite this URL:|
Akinajo OR, Osanyin GE, Okojie OE. Preconception care: Assessing the level of awareness, knowledge and practice amongst pregnant women in a tertiary facility. J Clin Sci [serial online] 2019 [cited 2020 Sep 23];16:87-92. Available from: http://www.jcsjournal.org/text.asp?2019/16/3/87/262070
| Introduction|| |
Preconception care (PCC) is one of the most important components of health care for every woman of reproductive age. These groups of women are candidates for PCC regardless of whether they are planning to conceive or not. Care received at this vital period is essential and critical as it lays the foundation for the future health of the mother, her baby, and her family.
PCC is a form of care that provides series of interventions before conception with the aim of identifying and modifying biomedical, behavioral, and psychosocial risks to women's health or pregnancy outcome through prevention and management. It is yet to be a routine healthcare practice globally. Studies have shown that there are no well-established registered programs for its implementation which is critical to reducing perinatal/maternal morbidity and mortality rates. Its practice is almost nonexistent in developing countries., In Nigeria, this form of care is still evolving.
According to the estimate made in 2013 by the National Demographic Health Survey, maternal deaths account for 32% of all deaths among women between the age group of 15–49 years. The lifetime risk of which indicates that 1 in 30 women in Nigeria will die as a result of pregnancy or childbirth. Most of these complications predated pregnancy and get worsened during pregnancy, thereby causing a lot of pregnancy-related morbidities/mortality. The overall contraceptive prevalence among women in Nigeria is 16%. No wonder 4 out of every 10 women have been reported to have unplanned pregnancy, therefore making it difficult to address any premorbid condition or lifestyle that can affect the outcome of that pregnancy.,,
Previous studies on major congenital abnormalities in Nigeria have been reported to range between 2.8% and 4.0%., This form of care is, therefore, essential in reducing several risk behaviors and exposures that can affect fetal development and subsequent outcomes.
PCC is a neglected but a vital component of maternal and child healthcare services, and it serves as a form of primary prevention for the baby and secondary prevention for prospective mothers. Hence, many factors have been attributed to the cause of this which includes poor awareness of this care by our women and most healthcare personnel, low-economic status/poverty, ignorance, lack of healthcare providers, illiteracy, and poor health-seeking behavior among others.
With all these challenges in the developing countries where most pregnancies are unplanned, and the practice of PCC is still evolving, one wonders what these women know, how they feel and how they access this very important form of care if at all they are aware of it. This study was undertaken to determine the level of awareness, knowledge, and practice of PCC and to identify factors influencing the uptake and utilization of this care among our women.
| Subjects and Methods|| |
This was a descriptive cross-sectional study that was conducted at the antenatal outpatient clinic, Lagos University Teaching Hospital, Idi-Araba, Lagos, a tertiary level of care facility. This study was commenced after obtaining clearance from the hospital's Health Research Ethics committee (Approval number: ADM/DCST/HREC/APP/2060). The inclusion criteria were pregnant women attending the antenatal clinic who gave informed consent following adequate information and counseling.
The sample size was calculated using the formula for cross-sectional studies with qualitative variable
N = Z1−α/22 P (1 − P)/d2
Where Z1−α/2 = standard normal variate (at 5% type 1 error [P < 0.05] is 1.96).
P = expected proportion in population based on previous study or pilot study = 2.5%.
d = absolute error or precision = 5%, N = 1.962 × 0.025 (1–0.025)/0.052 = 37.5.
Applying a nonresponse rate of 10% gave an approximated minimum sample size of 41.2 and this was approximated to 50.
Consecutive sampling technique was utilized, in which pregnant women presenting at the antenatal clinics were consecutively recruited until the desired sample size was achieved.
All pregnant women who booked for antenatal care at the antenatal outpatient clinic during this study period were recruited. Women who gave their consents after being adequately informed of the processes involved in the study were recruited. The content validity and the reliability of the instrument were established before the final administration of the questionnaire. Once consent was obtained from the eligible participants, pretested semi-structured questionnaires were administered to collect information on their bio-demographic data, awareness, and knowledge of PCC, perception and practice of PCC, factors influencing the uptake and utilization of PCC among these women, etc.
These questionnaires were self-administered to all participants who can read and understands English language and interviewer-administered to all participants with no formal education. The participants were assured of strict confidentiality of information volunteered and kept a copy of the consent form. The primary outcome is to determine the level of awareness, knowledge, and practice of women on PCC. In comparing the respondent's response to the definition of PCC, the standard definition used in this study was stated as specialized care provided to women of reproductive age group before the onset of pregnancy to detect, treat, or counsel on preexisting medical or social conditions that may cause unfavorable pregnancy outcome.
The data were collected, cleaned, and manually entered into the statistical package for social sciences version 22 (IBM Corp., Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY, USA). Categorical variables were expressed as frequency and percentages, and continuous variables expressed as means and standard deviation. Test of the association was done using the Chi-square test, with the level of significance set at P < 0.05.
| Results|| |
A total of 50 women were invited to participate in this study with a response rate of 100%. The demographic profile of the study population is shown in [Table 1]. Majority of the respondents falls within the age group of 28–30 and 31–33 years and these were 17 (34%) and 16 (32%), respectively, with a mean age of 31.5 ± 3.8 years. Almost all of the respondents 48 (96%) were married, and 22 (44%) were primigravida. Christianity accounted for 45 (90%) of respondents religion and majority were Yoruba 24 (48%). Forty (80%) had tertiary education, whereas 16 (32%) of respondents were civil servants and 8 (16%) were health workers.
Awareness of respondents on the existence of preconception care
Among these participants, thirty eight (76%) were aware of PCC. Their major source of information were social media and health workers 16 (34.8%). Twenty-five of these women (65.8%), however, were not aware that PCC is practiced in Nigeria. Participants 13 (34.2%) who knew this care is practiced in Nigeria, stated General hospitals (38.5%), Tertiary hospitals (30.8%), Private Hospitals (23.1%), and Fertility Centers (7.7%) as their perceived place where PCC is offered. The study revealed no significant association between sociodemographic characteristics and the level of awareness [Table 2].
|Table 2: Association between awareness of preconception care and sociodemographic characteristics|
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Knowledge of respondents
Regarding their knowledge on PCC, 27 (71.1%) women understood PCC to be specialized care given to women planning for pregnancy, while 1 (2.6) understood it to be specialized care given to elderly women [Table 3]. Twenty-six (52%) of respondents felt that they would be able to define PCC however, none of them could define PCC satisfactorily. Further analysis revealed statistically significant associations between the awareness of PCC and the knowledge of the definition of PCC (P < 0.001) [Table 4], the knowledge of PCC and the definition of PCC (P < 0.001) [Table 5].
|Table 4: Association between awareness of preconception care and knowledge of definition of preconception care|
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|Table 5: Association between knowledge of definition and definition of preconception care|
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Thirty-five (22.6%) of the study populace felt that only women in the reproductive age group should benefit from PCC and 28 (18.1%) perceived that women trying to conceive only should benefit from this form of care. Other perceived benefits include women with established medical disorders only (13.5%), women with previous poor pregnancy outcome only (15.5%), women with poor obstetric history only (14.2%). All of the above-stated options were selected by 22 (14.2%) of our participants [Table 6]. In accessing their perception of changes that should be made before conception, 45 (14%) of respondents perceived that women should eat well/have good nutrition/vitamins, whereas 36 (11.2%) perceived that women should consult a physician before taking drugs and women should take folic acid before pregnancy, respectively. Twenty-five (7.8%) perceived that environmental pollution such as air/soil impacts on pregnancy.
|Table 6: Respondents assessment of who will benefit from preconception care (n=50)|
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As regards the timing of PCC, majority 35 (92.1%) felt that it should be offered before pregnancy, 16 (42.1%) felt it should be at any time, 15 (39.5%) at any opportunistic visit and 7 (18.4%) felt that it should be after delivery. Congenital disabilities such as spinal bifida and anencephaly were chosen by half of the respondents 25 (65.8%) as the effect of not seeking PCC, while 21 (55.3%) chose infertility/difficult conception and worsening medical disorders, respectively. Low birthweight was chosen by 15 (39.5%) of respondents only. Thirty (27.02%) of respondents felt that PCC will help in controlling medical conditions before pregnancy, while 29 (26.65%) felt that PCC will improve the positive outcome of pregnancy. A total of 19 (17.12) felt that PCC is for modification of any habitual lifestyle that can affect pregnancy.
Practice of respondents
As regards their practice, 33 (86.8%) of respondents with awareness of PCC had sought PCC in the past. Out of these group of women, (82.4%) received their care at the hospital, 2 (11.8%) from chemist shops and 1 (5.9%) had hers in her home. Thirteen (61.9%) women had their care provided by doctors, while 3 (14.3%) by nurses and pharmacists, respectively. However, 1 (4.7%) respondent had her PCC provided by friends and counselors. Majority of these respondents 16 (26.7%) received folic acid supplementation as PCC, while 13 (21.7%) commenced healthy food choices. Maintaining healthy weight and adequate exercise was the PCC received by 7 (11.7%) of respondents, while 2 (3.3%) received modification/adjustment of medication. Six (10%) had lifestyle modification such as smoking and alcohol/genetic counseling and screening, respectively, 3 (5%) had counseling and treatment of sexually transmitted infections (STIs) with counseling on contraception, respectively. There is a significant association between awareness of PCC and respondents seeking PCC (P < 0.04) [Table 7].
|Table 7: Association between awareness of preconception care and respondents seeking preconception care|
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The rate of unwanted pregnancy in this study is 5 (10%) with failed family planning method as the reason for this. Half of the respondents 25 (65.8%) did not access PCC before this index pregnancy making the uptake of PCC to be 13 (34.2%) [Table 8].
|Table 8: Response on whether preconception care was accessed before index pregnancy|
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Barriers to the utilization of preconception care
Lack of knowledge of PCC was chosen by majority of respondents 40 (25.2%) as barriers to the utilization of PCC, while lack of awareness of PCC amongst women was chosen by 39 (24.5%). Poverty and ignorance were selected by 30 (18.9%) of respondents, while 22 (13.8%) of respondents selected poor attitude to health behavior among the populace. Lack of access to the service was chosen by 26 (16.4%) women.
| Discussion|| |
The ultimate aim of PCC is basically prevention which is the most effective form of care in medicine. Therefore, it is of utmost importance that health care should shift from the delivery of procedure-based acute care to the provision of counseling-based preventive care.
Awareness of preconception care
The results of this study demonstrate a high rate of awareness among the participants which is higher than the rate (63%) recorded from a study done by Olowokere et al. in Ile-Ife. A low rate of 4% was revealed in a study done in the Northern part of this country  and 43.1% in a study done in the Southern part of Nigeria. Even though the rate of awareness of PCC is high in this study, 65.8% had no idea it is being practiced in Nigeria indicating poor awareness of its practice in Nigeria. Those (34.2%) who are, however, aware of this practice in Nigeria are not specifically clear about where to access it. This implies that many of these respondents even though are aware of PCC, they lack the necessary information needed as to where to access this form of care. The media (internet) and health care personnel were their major sources of information. A survey done in Ontario revealed health care personnel as effective sources of PCC due to the major role they play in informing, counseling, screening, identifying and referring patients appropriately. It is, therefore, imperative for the health care personnel to be highly trained and exposed to evidenced-based information/practices that will assist in the dissemination of adequate information to the women of reproductive age group. There may also be a need to develop national guidelines/protocols with the aim of providing uniformity of services and precision on this form of care to ensure and maintain quality assurance of this care across the nation. One may assume that since 80% of the respondents have tertiary education, this would reflect significantly on the level of awareness, this, however, did not show any significant association with the level of awareness.
Knowledge of preconception care
Even though more than half of the participants understood PCC to be specialized care given to women planning for pregnancy, none of them could satisfactorily define it. Their knowledge on the specifics of different PCC components is relatively low. This study demonstrates that the study population exhibited gaps in knowledge about specific preconception health care topics which is in keeping with previous studies., Coonrod et al. and Olowokere et al. however, reported a higher knowledge rate., This contrasting view may be due to lack of detailed information available on PCC, its components and importance/benefits to both mother and baby. Findings from this study pointed out the need to continue efforts at sensitizing the populace with emphasis on the specifics of health topics, the timing, and importance of PCC amongst others.
Practice of preconception care
The index study revealed that 86.8% of the women with awareness of PCC had sought for PCC in the past with the hospital (82.4%) as the major site where care was received and doctors (61.9%) as the major care provider followed by nurses (14.3%). This was in variance with another study done in Nigeria where a lower proportion of participants (34.1%) had PCC in the past. However, the uptake of PCC before the index pregnancy was 34.2%. This indicates dissociation in the level of awareness versus the level of practice before this index pregnancy. This rate though higher than the rates recorded from previous studies ,, it is still lower than the rate from studies conducted in Malaysia by Kasim et al. and other high-income countries where the majority of women were well informed about PCC., The major barriers established in this study were lack of knowledge of PCC and lack of awareness of PCC. Others factors are poverty and ignorance, poor attitude to health behavior among the populace and lack of access to the service. These factors were in keeping with the findings from Olowokere et al.
Ninety percent of the participants planned their current pregnancy disputing the fact that most pregnancies are unplanned in developing countries.,,
The strength of the current study was the high response rate which allowed data to be collected first hand. However, its limitation was that it's a facility-based study with small sample size. A larger sample size study preferably multicenter randomized controlled study is recommended for future research to address the factors affecting PCC in our environment and provide possible intervention with concrete resolutions made from such interventions.
| Conclusions|| |
Even though there is a high level of awareness of PCC among the study populace, there is low rate of awareness of its practice in Nigeria which as seen in this study is one of the barriers to the uptake of PCC. There is relatively low level of knowledge and uptake of PCC before the index pregnancy even though health care personnel and social media were their major sources of information. Medical practitioners are the key players in promoting maternal and child health, and as such they should intensify their efforts in encouraging women to receive this care, and to constantly emphasize the importance and benefits of PCC during routine hospital visits. PCC clinics should be easily accessible to the populace with evidence-based protocols/guidelines for the health workers as achievement to Target 3 of the sustainable development goals depend on this.
The findings from this study have helped to identify the barriers to PCC. It will also help in the promotion of PCC among women of the reproductive age group. This will help to boost maternal health care services, reduce complications that can occur during pregnancy, at delivery, and during postnatal care and may contribute to the reduction of maternal and infant morbidity and mortality rates.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: A life-course perspective. Matern Child Health J 2003;7:13-30.
Lu MC, Geffen D. Recommendations for preconception care. Am Fam Physician 2007;76:397-400.
Mitchell EW, Levis DM, Prue CE. Preconception health: Awareness, planning, and communication among a sample of US men and women. Matern Child Health J 2012;16:31-9.
Moos MK. From concept to practice: Reflections on the preconception health agenda. J Womens Health (Larchmt) 2010;19:561-7.
Frey KA, Files JA. Preconception healthcare: What women know and believe. Matern Child Health J 2006;10:S73-7.
Moos MK. Preconception health: Where to from here? Womens Health Issues 2006;16:156-8.
Boulet SL, Parker C, Atrash H. Preconception care in international settings. Matern Child Health J 2006;10:S29-35.
Ezegwui HU, Dim C, Dim N, Ikeme AC. Preconception care in south eastern Nigeria. J Obstet Gynaecol 2008;28:765-8.
Tokunbo OA, Abimbola OK, Polite IO, Gbemiga OA. Awareness and perception of preconception care; 33 among health workers in Ahmadu Bello University teaching university, Zaria. Trop J Obstet Gynaecol 2016:149-52. [Full text]
National Population Commission (NPC) [Nigeria] and ICF International. Nigeria Demographic and Health Survey 2013. Abuja, Nigeria, and Rockville, Maryland, USA: National Population Commission and ICF International; 2014.
Center WM. Maternal mortality 2012. Available from: URL: http://www.who.int/ mediacentre/factsheets/fs348/en/index.html. [Last accessed on 2019 May 07].
Singh S, Sedgh G, Hussain R. Unintended pregnancy: Worldwide levels, trends, and outcomes. Stud Fam Plann 2010;41:241-50.
Agida TE, Akaba GO, Ekele BA, Adebayo F. Unintended pregnancy among antenatal women in a tertiary hospital in North central Nigeria. Niger Med J 2016;57:334-8.
] [Full text]
Lamina MA. Prevalence and determinants of unintended pregnancy among women in south-western Nigeria. Ghana Med J 2015;49:187-94.
Sedgh G, Bankole A, Oye-Adeniran B, Adewole IF, Singh S, Hussain R, et al.
Unwanted pregnancy and associated factors among Nigerian women. Int Fam Plan Perspect 2006;32:175-84.
Obu HA, Chinawa JM, Uleanya ND, Adimora GN, Obi IE. Congenital malformations among newborns admitted in the neonatal unit of a tertiary hospital in Enugu, South-East Nigeria – A retrospective study. BMC Res Notes 2012;5:177.
Bakare TI, Sowande OA, Adejuyigbe OO, Chinda JY, Usang UE. Epidemiology of external birth defects in neonates in Southwestern Nigeria. Afr J Paediatr Surg 2009;6:28-30.
] [Full text]
Ayalew Y, Mulat A, Dile M, Simegn A. Women's knowledge and associated factors in preconception care in Adet, West Gojjam, Northwest Ethiopia: A community based cross sectional study. Reprod Health 2017;14:15.
Bialystok L, Poole N, Greaves L. Preconception care: Call for national guidelines. Can Fam Physician 2013;59:1037-9, e435-7.
Mason E, Chandra-Mouli V, Baltag V, Christiansen C, Lassi ZS, Bhutta ZA, et al.
Preconception care: Advancing from 'important to do and can be done' to'is being done and is making a difference'. Reprod Health 2014;11 Suppl 3:S8.
Lawal TA, Adeleye AO. Determinants of folic acid intake during preconception and in early pregnancy by mothers in Ibadan, Nigeria. Pan Afr Med J 2014;19:113.
Atrash H, Jack BW, Johnson K, Coonrod DV, Moos MK, Stubblefield PG, et al.
Where is the “W”oman in MCH? Am J Obstet Gynecol 2008;199:S259-65.
Olowokere AE, Komolafe A, Owofadeju C. Awareness, knowledge and uptake of preconception care among women in Ife central local government area of Osun state, Nigeria. J Community Med Prim Health Care 2015;27:83-92.
Idris SH, Sambo MN, Ibrahim MS. Barriers to utilisation of maternal health services in a semi-urban community in Northern Nigeria: The clients' perspective. Niger Med J 2013;54:27-32.
] [Full text]
Best Start Resource Centre. Preconception Health: Physician Practices in Ontario, Toronto, Canada: Best Start Resource Centre; 2009.
Kasim R, Draman N, Abdul Kadir A, Muhamad R. Knowledge, attitudes and practice of preconception care among women attending maternal health clinic in Kelantan. Educ Med J 2016;8:57-68.
Coonrod DV, Bruce NC, Malcolm TD, Drachman D, Frey KA. Knowledge and attitudes regarding preconception care in a predominantly low-income Mexican American population. Am J Obstet Gynecol 2009;200:686.e1-7.
Patabendige M, Goonewardene IM. Preconception care received by women attending antenatal clinics at a Teaching Hospital in Southern Sri Lanka. Sri Lanka J Obstet Gynaecol 2013;35:3-9.
Ekem NN, Lawani LO, Onoh RC, Iyoke CA, Ajah LO, Onwe EO, et al.
Utilisation of preconception care services and determinants of poor uptake among a cohort of women in Abakaliki Southeast Nigeria. J Obstet Gynaecol 2018;38:739-44.
Wallace M, Hurwitz B. Preconception care: Who needs it, who wants it, and how should it be provided? Br J Gen Pract 1998;48:963-6.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]