|Year : 2016 | Volume
| Issue : 2 | Page : 149-152
Awareness and perception of preconception care among health workers in Ahmadu Bello University Teaching University, Zaria
O Adeoye Tokunbo1, O Kolawole Abimbola1, I Onwuhuafua Polite1, O Adeoye Gbemiga2
1 Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
2 Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
|Date of Web Publication||13-Oct-2016|
O Kolawole Abimbola
Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Zaria
Source of Support: None, Conflict of Interest: None
Background: Preconception care (PCC) has been found to improve fetomaternal outcome but it is not widely practiced in Nigeria.
Objective: To obtain information concerning the level of awareness, perception and practice of PCC among health workers with the view of providing recommendation for a framework for its implementation in Ahmadu Bello University Teaching Hospital.
Materials and Methods: A descriptive cross-sectional study was conducted among 280 health workers (doctors and nurses) using pretested self-administered, semi-structured questionnaires between November 2013 and January 2014. Analysis was done using the Statistical Package for the Social Sciences version 16.0. Chi-square test was used to determine relationships between variables.
Results: The response rate was 85.0% with 130 (54.2%) doctors and 109 (45.8%) nurses. Most (83.3%) of the respondents had heard of PCC, and 91.6% defined it correctly. Only 55 (23%) knew more than 75% of the components of PCC. The difference in knowledge of PCC between doctors and nurses and based on years of experience was statistically significant (c2 = 0.014). Only 114 (47.7%) had ever offered some form of PCC. The most common intervention was preconception folic acid administration in 33% of the respondents. The perceived obstacles to assessing PCC were poor information (88.3%), poor health seeking behaviour (68.6%) and unplanned pregnancies (60.7%). Majority 182 (76.2%) felt obstetricians should handle PCC followed by family physicians. Opportunistic delivery was cited as the best mode of delivery.
Conclusion: The level of awareness of PCC is high among health workers, especially doctors. It can be offered opportunistically until full integration into the health care system. Training of health workers will improve its implementation.
Keywords: Awareness; care; health worker; perception; preconception.
|How to cite this article:|
Tokunbo O A, Abimbola O K, Polite I O, Gbemiga O A. Awareness and perception of preconception care among health workers in Ahmadu Bello University Teaching University, Zaria. Trop J Obstet Gynaecol 2016;33:149-52
|How to cite this URL:|
Tokunbo O A, Abimbola O K, Polite I O, Gbemiga O A. Awareness and perception of preconception care among health workers in Ahmadu Bello University Teaching University, Zaria. Trop J Obstet Gynaecol [serial online] 2016 [cited 2019 May 21];33:149-52. Available from: http://www.tjogonline.com/text.asp?2016/33/2/149/192215
| Introduction|| |
Preconception care (PCC) is still novel and not widely practiced in the health care system in Nigeria. It is imperative that this form of patient care be tailored according to the available human financial and institutional resources of individual settings within the context of sociocultural beliefs in order to ensure optimal utilization of PCC services.
PCC, which is a component of comprehensive obstetric care, can be described as a specialized form of care for women of reproductive age before the onset of pregnancy to detect, treat, or counsel them about the pre-existing medical and social conditions that may militate against safe motherhood and delivery of a healthy offspring. 
PCC has been implemented in some high income countries such as Italy, Netherlands, United States United Kingdom, Canada, Spain and Australia, as well as some middle income countries such as Bangladesh, Philippines and Sri Lanka. , A study in London among health workers and women showed that 86% of the doctors and 95% of the nurses believed that PCC was beneficial in reducing maternal and neonatal morbidity and mortality. Opportunistic delivery of this service was widely considered to be the most effective mode of delivery. 
This form of care is still evolving in Nigeria and is virtually nonexistent in North-west Nigeria where maternal and perinatal morbidity and mortality is very high due to unplanned and frequent pregnancies, high parity, suboptimal health care seeking behaviour and low level of maternal health care. ,
Challenges that may arise are that most pregnancies are unplanned, ,,, lack of information, ,,, poor attitude of the female population for whom the programme was designed ,,, and inherent aversion to unfamiliar terrain of PCC by reproductive health care providers. ,, Therefore, it is essential to ascertain the awareness of PCC and how it is perceived among health workers who will be involved in delivery of this form of care to ensure optimal provision of PCC services.
The objective of the research was to obtain information concerning the level of awareness, perception and practice of PCC among health workers, with the view of providing recommendation for a framework for its implementation in Ahmadu Bello University Teaching Hospital (ABUTH).
| Materials and Methods|| |
The present study was a descriptive, cross-sectional study conducted among 280 health workers (doctors and nurses) in ABUTH, Zaria located in Kaduna State, North-western Nigeria. ABUTH is the only tertiary health centre located in Zaria, and it receives referrals from Zaria and its neighbouring regions.
The sample size was derived from the formula  n = z2 pq/d 2
where n represents the desired sample size, z is standard normal deviate at 95% confidence interval at 1.96 corresponding to 95% confidence interval, P = 0.86 is the prevalence of the target population quoted from previous literature,  q = (1 − P) = 0.14 and d is precision limit of 0.05.
The sample size was calculated to be 185, and using an attrition rate of 10%, 19 respondents were included making a calculated minimum sample size of 204. A total of 280 questionnaires were, therefore, administered. Pretested, self-administered, semi-structured questionnaires were used to collect data between November, 2013 and January, 2014. Analysis was done using the SPSS Inc. Released 2007, SPSS for Windows, Version 16.0. Chicago, SPSS Inc. Chi-square test was used to determine relationships between variables.
| Results|| |
Two hundred and thirty-nine questionnaires were returned and analysed giving a response rate of 85.0%. One hundred and thirty (54.2%) respondents were doctors and 109 (45.8%) were nurses. The age range of respondents was 20-59 years. Most respondents 107 (44.8%) were within the age range of 30-39 years, with the mean being 36.64, mode 30 years and median 36 years. The standard deviation was 7.885 and variance 62.178.
There were 90 male respondents (37.7%) and 149 female respondents (62.3%); 150 (64.1%) were Christians and 85 (35.9%) were Muslims. Thirty-six (15.1%) respondents were Hausa, 32 (13.4%) Igbo and 71 (29.7%) Yoruba. Other tribes constituted 96 (40.2%) of the respondents. Majority of respondents were married 176 (73.6%) or single 49 (20.5%); 8 (3.3%) were separated and 4 (1.7%) were widowed [Table 1].
A total of 199 respondents (83.3%) had heard of PCC. Majority of the respondents (91.6%) defined PCC correctly. Only 55 (23%) of respondents knew more than 75% of the components of PCC, 71 (29.7%) knew 51-75%, 65 (26-50%) and 48 (20.1%) knew less than 25% of the components, as shown in [Figure 1].
[Table 2] shows the cross-tabulation of knowledge of components of PCC with occupation. The difference in knowledge of the components of preconception care among the doctors and nurses was statistically significant. (c2 = 0.000). The difference in knowledge based on years of experience was significant (c2 = 0.014), as shown in [Table 3]. The respondents who had fewer years of work experience had a better knowledge of PCC, as reflected in the higher percentage of knowledge of components of PCC.
|Table 2: Cross-tabulation of knowledge of components of preconception care with occupation |
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|Table 3: Cross-tabulation of knowledge of components of preconception care with years of work experience |
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Better pregnancy outcome (83.7%), better state of health (66.5%), health education (50.2%), counselling (42.7%) and decreased maternal and neonatal mortality (83.3%) were identified to be benefits. The major barrier perceived by respondents for patients to assess PCC was poor information in 88.3%, poor health seeking behaviour in 68.6% and unplanned pregnancies in 60.7%.
One hundred and fourteen (47.7%) respondents had offered some form of PCC. The most common intervention was preconception folic acid administration in 33% of the respondents followed by counselling in 23% and screening for diseases in 12%.
Majority of respondents, 115 (48.1%), felt any available contact with the patient to be best way to offer PCC. Majority of the respondents, 182 (76.2%), felt that obstetricians should handle PCC followed by family physicians 128 (53.6%), nurses 108 (45.2%), physicians 64 (26.8%) and midwives 50 (20.9%).
[Figure 2] shows that 199 (83.3%) of the respondents had never been trained on PCC. Two hundred and twenty-nine respondents (95.8%) felt training will improve their practice. Majority, 218 (91.2%), of the respondents were willing to offer PCC whereas 217 (90.8%) were willing to utilize the service if available.
| Discussion|| |
The level of awareness of PCC was high in this study as 83.3% of health workers had heard of PCC. Most respondents, 71 (29.7%), knew 51-75% of the various components of PCC; this is slightly lower than 77% in a study in UK.  This is, however, not surprising as most respondents (83.3%) had not been trained on PCC. The difference in knowledge based on years of work experience was highly significant as younger health personnel appeared to have more knowledge of PCC. This knowledge gap may be due to the fact that it is a new initiative that is yet to be fully incorporated into the health system. Older health personnel are not likely to have been exposed to PCC during their in-service training.
The difference in knowledge of the components of PCC among the doctors and nurses was also significant as a greater proportion of doctors (72%) had more than 50% knowledge compared to only 29% of nurses. This difference signifies the urgent need to increase training programs in PCC to health care providers.
Better pregnancy outcome (83.7%) and decreased maternal and neonatal mortality (83.3%) were the perceived benefits of PCC. This is similar to a previous study where 86% of the doctors and 95% of the nurses believed that PCC was beneficial in reducing maternal and neonatal morbidity and mortality. 
Opportunistic delivery such as any contact with patient was considered to be the best mode of service delivery similar to a previous study.  Less than half (47.7%) of the respondents had offered some form of PCC to patients opportunistically as there is no clinic for that purpose. This is slightly higher than what was observed in a survey where 1 in 6 (16.6%) health care providers (Obstetricians/General practitioners) offered PCC.  Majority of health workers, 182 (76.2%), were in favour of the obstetricians providing PCC followed by family physicians 128 (53.6%). This is quite pragmatic as a study done by Ezegwui showed that most women in the study presented to an obstetrician for PCC.  This is in contrast to another study where the patients preference for preconceptional health was the general practitioner (51.3%) followed by the obstetrician (44%).  In another study in Netherlands among general practitioners, 52% felt that the preconception consultation should be provided by the general practitioner. 
| Conclusion|| |
Preconception health care is yet to be fully explored in Nigeria. This service may be offered at every opportunity when women access health care until it becomes fully incorporated into a comprehensive obstetric package within the health care system. At present, training of health workers on PCC is very low, and hence, introducing it into in-service training as well continuous professional education and re-training will ultimately improve the knowledge and awareness of this service.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Omigbodun AO. Preconception care in Nigeria, Prospects and constraints. Arch Ibadan Med 2002;1:3-5.
Boulet SL, Parker C, Atrash H. Preconception Care in International Settings. Matern Child Health J 2006;10:S29-35.
World Health Organization. Meeting to develop a global consensus on preconception care to reduce maternal and childhood mortality and morbidity: Meeting Report 6-7; February 2012.
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.
Preconception and prenatal care for women: Maternal and child health online course Module 4. 2001 Available From: http://www.uniteforsight.org/women-children-
course/preconception- prenatal women/copyright 2000-2011. [Last accessed on 2016 Sep 15].
Fawole AO, Shah A, Tongo O, Dara K, El-Ladan AM, Umezulike AC, et al
. Determinants of perinatal mortality in Nigeria. Int J Gynaecol Obstet 2011;114:37-42.
Grunebaum A. Periconception care, Progress in Obstetrics and gynaecology No 17. In: Studd J, Tan SL, Chervenak FA, editors. Elsevier 2006;17:31-47
Mbuagbaw LC, Okwen PM, Enyama D, Mayouego JK. Preconception Care In Cameroon: Where Are We? Internet J Gynaecol Obstet 2007;8:2.
Omigbodun AO. Preconception and antenatal care. In: Kwawukume EY, Emuveyan EE, editors. Comprehensive Obstetrics in the tropics. Asante & Hittscher Printing Press, Limited; 2002. p. 7-13.
Delvoye P, Guillaume C, Collard S, Nardella T, Hannecart V, Mauroy MC. Preconception health promotion: Analysis of means and constraints. Eur J Contracept Reprod Health Care 2009;14:307-11.
ACOG. The importance of Preconception care in the continuum of the women′s health care. 2005 September; Number 313.
Preconception and health research strategies: Best Start Ontario′s Maternal, Newborn and Early child development resource centre; 2001.
Ezegwui HU, Dim C, Dim N, Ikeme AC. Preconception care in South Eastern Nigeria. J Obstet Gynaecol 2008;28:765-76.
Ebrahim SH, Lo SS, Zhuo J, Han J, Delvoye P, Zhu L. Models of Preconception Care Implementation in Selected Countries. Matern Child Health J 2006;10:S37-42.
Mazza D, Chapman A. Improving the uptake of preconception care and periconceptional folate supplementation: What do women think? BMC Public Health 2010;10:786.
Araoye OB. Research Methodology with statistics for health and social sciences. In: Araoye OB, editor. 1 st
ed. Ilorin: Nathadex Publishers Sawmill; 2003.
Lu MC. Recommendation for preconception care. Am Fam Physician 2007;76:397-400.
Frey KA, Files JA. Preconception Healthcare: What Women Know and Believe. Maternal Child Health J 2006;10(Suppl 1):73-7.
Poppelaars FA, Cornel MC, Ten Kate LP. Current practice and future interest of GPs and prospective parents in pre-conception care in The Netherlands. Fam Pract 2004;21:307-9.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]