CHAPTER ONE

1. INTRODUCTION
   1. BACKGROUND OF STUDY

        Antenatal care (ANC) coverage is a success story in Africa, since over two-thirds of pregnant women (69 percent) have at least one ANC contact. However, to achieve the full life-saving potential that ANC promises for women and babies, four visits providing essential evidence based interventions, a package often called focused antenatal care is required (World Health Organization, 2005).

         Antenatal services comprise complete health supervision of the pregnant women in order to maintain, protect and promote health and well being of the mother and the fetus (Ojo, 2004). These services, according to him are rendered to a pregnant woman at monthly intervals, to 28 weeks of gestation, then fortnightly until 36 weeks and finally weekly visit until the birth of the baby. Similarly, Adesokan (2010) describes antenatal services as the attention, education, supervision and treatment given to the pregnant women from the time  conception is confirmed until the beginning of labour, in order to ensure safe pregnancy, labour and puerperium.

         Qualitative antenatal services are care given to pregnant women by a skilled or trained health provider to promote the health and survival of mother and child (Adesokan, 2010). The focused antenatal services refer to minimum number of four antenatal clinic visits, each of which has specific items of client assessment, education and care to ensure early detection and prompt management of complication (Ekabua, Ekabua & Njoku, 2011) Focused antenatal care, which is evidence based, client-centered, goal directed care, provided by skilled health providers with emphasis on quality rather than frequency of visits, is an approach to be adopted globally. The approach accepts the view that every pregnant woman is at risk of complication and that all women should therefore; receive the same basic care and monitoring for complications (World Health Organization, 2005).

        Obionu (2006) postulates some justification for focused antenatal services. These include that all pregnant women are at risk of developing complication, that more attention are given to individuals in the high risk group but the risk approach to antenatal services increase the like hood that a skilled healthcare provider will present at birth. Essential interventions in ANC include identification and management of obstetric complications such as preeclampsia, tetanus toxoid immunization, intermittent preventive treatment for malaria during pregnancy (IPTp), and identification and management of infections including HIV, syphilis and other sexually transmitted infections (STIs). ANC is also an opportunity to promote the use of skilled attendance at birth and healthy behaviours such as breastfeeding, early postnatal care, and planning for optimal pregnancy spacing.

        Knowledge has been variously defined. Hornby (2006) describes knowledge as information, understanding and skills that one gains through education or experience. Knowledge is critical to man’s quality of life because everything that is done depends on knowledge.

        Knowledge is the sum of conceptions, views and propositions which have been established and tested. In the context of this study, knowledge refers to the act of having adequate information and understanding of the concept of focused antenatal care services. This knowledge can be obtained through health education, electronic media, prints and health education programmes.It could be in realization of the above assertion that Magadu, Maduse & Rodignes (2006) maintained that knowledge of pregnant mothers is a major factor in determining the extent of utilization of antenatal services.

        According to them, the educational status of pregnant mothers is an influencing determinant in the effective utilization of maternal and child health (MCH) services. Igbokwe (2008) indicated that urban and rural locations have great impact on the utilization of antenatal services. Expectant mothers in the urban area utilize antenatal services better than their counterparts in the rural area who have the problems of accessibility to MCH services; some pregnant mothers in the rural area may have basic knowledge of the importance of antenatal services but due to problems of accessibility to health facilities will hinder them from such services (Igbokwe, 2008). Also inadequate knowledge concerning health related matters usually lead to negative attitude towards the health issue. Attitude is the person’s affective feelings of like and dislike.

         Attitude emerges out of personal experience and can be positive or negative. It is positive when a person develops a strong attraction of likeness for the situation, objectives or other persons or groups while it is negative when the person develops dislike for such situations, objectives, group or any other identifiable aspects of our environment (Igbokwe, 2012). An attitude can be defined as a positive or negative evaluation of people, objects, events, activities, ideas, or  just about anything in your environment. An attitude is an expression of favour or disfavour towards a person, place, thing, or event (Whitley, 2010).

1. STATEMENT OF THE PROBLEM

        Antenatal care is one of the means to reduce maternal mortality and morbidity with interventions and information that promote the health, wellbeing and survival of mothers and their babies (UN 2012:32).The researcher observed that pregnant women in Ado-Ekiti  failed to reach health care facilities before severe forms of complications arose in which both mother and baby became at risk of dying from  complications. This could be due to a lack of awareness of the danger signs. Awareness of the danger and  complications is the essential first step in accepting appropriate and timely referral to  hospital.

         Most maternal mortality and morbidity can be avoided through timely access to basic maternity care supported by adequate emergency obstetric care, for which early recognition of the problem at the family level is crucial. It is therefore of vital importance that pregnant women and their families are aware of the danger signs and complications to enable them to respond appropriately to complications that may arise. This is because an informed individual is better placed to make reasonable decisions. An antenatal care services contact point should be the ideal opportunity to provide pregnant women with adequate information birth preparedness, and a complication readiness plan.

         Finally several research has been carried out on  knowledge and utilisation of antenatal care services by pregnant women at a clinic in Ekurhuleni. But not even a single research has been carried out on  knowledge, altitude and practice related to exercise and nutrition among pregnant women attending antenatal clinic in Ado-Ekiti.

1. AIMS AND OBJECTIVES OF STUDY

        The main aim of the study is to determine knowledge, altitude and practice related to exercise and nutrition among pregnant women attending antenatal clinic in Ado-Ekiti. Other specific objectives of the study includes;

1. to determine the relationship between knowledge, altitude and practice related to exercise and nutrition among pregnant women attending antenatal clinic in Ado-Ekiti.
2. to determine the effect of knowledge, altitude and practice related to exercise and nutrition among pregnant women attending antenatal clinic in Ado-Ekiti.
3. to determine the factors affecting knowledge, altitude and practice related to exercise and nutrition among pregnant women attending antenatal clinic in Ado-Ekiti.
4. to determine the extent to which knowledge, altitude and practice related to exercise and nutrition has affected  pregnant women attending antenatal clinic in Ado-Ekiti.
5. to proffer possible solutions to problems.

1. RESEARCH QUESTIONS

1. What is the relationship between knowledge, altitude and practice related to exercise and nutrition among pregnant women attending antenatal clinic in Ado-Ekiti?
2. What is the effect of knowledge, altitude and practice related to exercise and nutrition among pregnant women attending antenatal clinic in Ado-Ekiti?
3. What are the factors affecting knowledge, altitude and practice related to exercise and nutrition among pregnant women attending antenatal clinic in Ado-Ekiti?
4. What is the extent to which knowledge, altitude and practice related to exercise and nutrition has affected  pregnant women attending antenatal clinic in Ado-Ekiti?
5.  What are the possible solutions to problems.

1.5   STATEMENT OF RESEARCH HYPOTHESIS

1. SIGNIFICANCE OF STUDY

The study on knowledge, attitude and practices relatedto exercise and nutrition among pregnant women attending antenatal clinic will be of immense benefit to the people of Ado-Ekiti. In the sense that, it will enlighten the entire  people  of  Ado-Ekiti especially  the pregnant women on the need   towards  attending antenatal   clinic should be encourage among them.

    It will also help the government to develop and implement new policies towards encouraging proper utilization of antenatal care services, which will help to reduce maternal and neonatal morbidity and mortality rates. Finallythe study will contribute to the body of existing literature to this field of study and basis for further research.

1. SCOPE OF STUDY

        The study on knowledge, altitude and practice related to exercise and nutrition among pregnant women attending antenatal clinic  is limited to Ado-Ekiti.

Financial constraint- Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

Time constraint- The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.

1. DEFINITION OF TERMS

Knowledge

         Is a familiarity, awareness, or understanding of someone or something.

      Practice

         Is a technique or method that, through experience and. research, has proven reliably to lead to the desired result.

Is any bodily activity that enhances or maintains physical fitness.

 Is also known as gestation, is the time during which one or more offspring develops .

Antenatal clinic

 Is the routine health control of presumed healthy pregnant women without symptoms (screeening), in order to diagnose diseases or complicating obstetric conditions without symptoms, and to provide information about lifestyle, pregnancy and delivery.