ASSESSESSMENT ON THE KNOWLEDGE, ATTITUDE AND PRACTICE OF ANTENATAL EXERCISES AMONG PREGNANT MOTHERS ATTENDING IFITE IGBOUKWU PRIMARY HEALTH CARE

CHAPTER ONE

INTRODUCTION

Background of the Study 

Antenatal exercises offer numerous health benefits to expectant mothers and their developing foetuses. Specific exercises and postures can assist the pregnant woman in adapting to the physical changes in her body during childbearing, as noted by Adewoye et al. (2018). The latest occurred 9 years ago. According to these guidelines, pregnant women are advised to engage in at least 30 minutes of moderate exercise on most, if not all, days of the week, provided there are no medical or obstetric complications. However, moderate-intensity exercise was not defined. Furthermore, the precise weekly energy expenditure of physical activity was not indicated. Recent research has determined that, in comparison to less vigorous activities, exercising with an intensity that reaches at least 60% of the heart rate reserve during pregnancy, while gradually increasing physical-activity energy expenditure, can decrease the risk of gestational diabetes. To achieve the minimum expenditure of metabolic equivalent task-hours per week, as stated by Ye, Harun-Or-Rashid, and Junichi Sakamoto in their 2020 study, one could engage in walking at a speed of 2 miles per hour for a duration of 6.4 hours per week. This level of activity corresponds to a light intensity, with a metabolic equivalent task value of 2.5. Avoiding many pregnancy-related complications, such as gestational diabetes mellitus (GDM), bladder and bowel problems, back pain, fatigue, weakness of the abdominal muscles, obesity, and varicose veins, can contribute to the overall health of both the mother and the baby (Ojo, 2016). Additionally, it has been found that these benefits can also lead to shorter labour and a reduction in difficulties associated with delivery. Furthermore, it has been demonstrated that expectant mothers can derive additional advantages by engaging in exercises that target the strengthening of their back muscles, abdominal muscles, and pelvic floor muscles. Strengthening abdominal muscles can be beneficial in mitigating the impact of strain experienced during pregnancy. Strengthening pelvic floor muscles allows the vagina to widen more easily during childbirth. Furthermore, it aids in the prevention of urinary incontinence both during and after pregnancy. Strengthening the back muscles and improving the postures can help minimise the strain on the lower back during pregnancy. Foot and leg exercises should be recommended to improve circulation and prevent further complications (Effendi, Isaranurug & Chompikul, 2018), as suggested in the most recent study conducted 9 years ago. According to these guidelines, pregnant women are advised to engage in 30 minutes or more of moderate exercise on most, if not all, days of the week, provided there are no medical or obstetric complications. However, moderate-intensity exercise was not defined. Furthermore, the precise weekly energy expenditure of physical activity was not indicated. Recent research has determined that, compared with less vigorous activities, exercise intensity that reaches at least 60% of the heart rate reserve during pregnancy while gradually increasing physical-activity energy expenditure reduces the risk of gestational diabetes. To achieve the minimum expenditure of 16 metabolic equivalent task-hours per week, one could engage in walking at a speed of (Regassa, 2021) miles per hour for a duration of 6.4 hours per week. This activity corresponds to 2.5 metabolic equivalent task-hours and is considered to be of light intensity. 

Although most women who are in good health can safely engage in physical exercises and other forms of physical activities during their pregnancy, it is strongly advised that women adhere to medical recommendations when performing such exercises (Ye, Harun-Or-Rashid & Junichi Sakamoto, 2020). 

Accurate and appropriate knowledge and favourable attitudes regarding antenatal exercises among pregnant mothers have been shown to be vital in promoting the practice of exercises (Regassa, 2021). An understanding of the existing knowledge about antenatal exercises among pregnant mothers, as well as insight into their attitudes regarding antenatal exercises in the context of their socio-cultural, educational, and economic backgrounds, is imperative in designing any educational intervention to promote antenatal exercises. 

1.2 Statement of the Problem 

From the time the women are pregnant, it appears that the attention of everyone and everything is directed towards the baby rather than the pregnant women. Within our conscious mind, women experience physical and physiological changes in order to adapt to the demands of pregnancy. The woman's body shape will change, the centre of gravity will be altered, and the mobility and balance will be affected (Berman, Snyder, Kozier & Erb, 2018). Moreover, it should be noted that pregnancy can also have an impact on the emotions, career, and sexual life of expectant mothers (Berman et al., 2018). 

Maternal health is of utmost importance, as women play a pivotal role as the primary carers, first educators, and nurturers of the next generation (Sharma, 2017). Pregnancy and childbirth are significant milestones in a woman's life and for her family. Exercise has significant health benefits for women of all ages and is widely acknowledged for improving the well-being of pregnant women worldwide. However, there are fewer individuals engaging in it during pregnancy. In Malaysia, more women were classified as having a sedentary Physical Activity Level (PAL) in comparison to their male counterparts (Pok, Safiah, Tahir, et al., 2020). It can be concluded that Malaysian adults are generally sedentary. The antenatal exercise is an exercise that should be practiced by pregnant women; the importance of antenatal exercise should be further promoted in order to improve their knowledge, attitude, and practice regarding antenatal exercise during pregnancy.In Nigeria, a cross sectional study conducted by Rosediani, Nik Rosmawati, Juliawati, and Norwati (2022) examined the knowledge, attitude, and practice towards pelvic floor muscle exercise (PFME) among antenatal women in Alimosho, Lagos state. The findings revealed that approximately 51.8% of the antenatal women had good knowledge, while 96.4% exhibited a positive attitude towards PFME. However, only 10.7% of the participants reported practicing PFME. Despite the good attitude, the overall knowledge and practice on ANC exercise were still poor among pregnant women (Rosediani et al., 2022). Thus, it can be stated that the prevalence of exercise among pregnant women in Alimosho LGA is relatively low. 

However, it is important to note that the lack of antenatal exercise is not limited to just Alimosho LGA, Nigeria. This issue is prevalent in various other regions of the country as well. According to Ribeiro and Milanez (2021), the prevalence of physical activity among pregnant women in Igboukwu Aguata local government area of Anambra state is low, specifically at 12.9%. The knowledge and attitude of pregnant women are favourable, but few are actually practicing antenatal exercise, as stated by Ribeiro and Milanez (2021). Although physical activity is not threatening for pregnant women and it is recommended by current guidelines, the attitude of the population does not seem to change. Although the majority of research suggests the significance and advantages of engaging in antenatal exercise during pregnancy, and it is recommended that pregnant mothers participate in antenatal exercise programmes, there is a limited amount of studies that have examined the knowledge, attitudes, and practices regarding antenatal exercises among pregnant women (Ribeiro & Milanez, 2021). 

Despite the importance of knowledge regarding antenatal exercise in influencing the attitude of pregnant women towards practicing it, it has been observed that the majority of pregnant women, particularly in the Igboukwu Aguata local government area of Anambra state, do not adhere to the recommended physical activity guidelines (Evenson, Savitz & Huston, 2016). According to Ribeiro and Milanez (2021), the barrier to not practicing antenatal exercise is fatigue, lack of time, discomfort, lack of information, and fear that antenatal exercise may be harmful. 

To this end this study tends to examine the knowledge, attitude and practice of antenatal exercises among pregnant mothers attending Ifite Igboukwu primary health care in Igboukwu Aguata local government area of Anambra state.

1.3 General Objective of the Study

The main objective of this study is to assess the knowledge, attitude and practice of antenatal exercises among pregnant mothers attending Ifite Igboukwu primary health care in Igboukwu Aguata local government area of Anambra state. Specifically the study will: 

Assess the level of knowledge regarding antenatal exercises among pregnant mothers attending Ifite Igboukwu Primary Health Care in Igboukwu Aguata Local Government Area of Anambra State.

Determine the attitudes of pregnant mothers towards antenatal exercises at Ifite Igboukwu Primary Health Care in Igboukwu Aguata Local Government Area of Anambra State.

Determine the perceived benefits of antenatal exercises among pregnant mothers at Ifite Igboukwu Primary Health Care in Igboukwu Aguata Local Government Area of Anambra State

Identify the factors influencing the knowledge, attitude, and practice of antenatal exercises among pregnant mothers attending Ifite Igboukwu Primary Health Care in Igboukwu Aguata Local Government Area of Anambra State

1.4 Research Questions

The following research questions will be answered in this study:

What is the level of knowledge regarding antenatal exercises among pregnant mothers attending Ifite Igboukwu Primary Health Care in Igboukwu Aguata Local Government Area of Anambra State.

What is the attitudes of pregnant mothers towards antenatal exercises at Ifite Igboukwu Primary Health Care in Igboukwu Aguata Local Government Area of Anambra State?

What are the perceived benefits of antenatal exercises among pregnant mothers at Ifite Igboukwu Primary Health Care in Igboukwu Aguata Local Government Area of Anambra State?

What are the factors influencing the knowledge, attitude, and practice of antenatal exercises among pregnant mothers attending Ifite Igboukwu Primary Health Care in Igboukwu Aguata Local Government Area of Anambra State?

1.5 Research Hypothesis

Ho: There are no factors influencing the knowledge, attitude, and practice of antenatal exercises among pregnant mothers attending Ifite Igboukwu Primary Health Care in Igboukwu Aguata Local Government Area of Anambra State.

Ha: There are factors influencing the knowledge, attitude, and practice of antenatal exercises among pregnant mothers attending Ifite Igboukwu Primary Health Care in Igboukwu Aguata Local Government Area of Anambra State.

1.6 Significance of the Study 

This study is significant and worthy of investigation to provide corresponding research into the impact of knowledge, attitude and practice of antenatal exercises among pregnant. 

The significance of this study will be helpful to pregnant women in various endeavors in an integrated and enthusiastic approach in carrying out recommended guildline for physical exercise during pregnancy However, it will contribute to academic knowledge in availing researchers to have a broad insight into the benefits of having sound antenatal exercise. However, the significance of this research study will also be a source of empirical framework for future researchers into this concept. This study is intended to extract the knowledge and attitude of pregnant women on the benefits of antenatal exercises. The findings of this study will serve as a reference for giving intervention accordingly by the health care providers and others who are concerned; for conducting further researches; the findings of this study will have special importance for health care providers because it will serve as a baseline for filling gaps of the actual practices on antenatal exercises. The findings with relevant recommendations will be also submitted to the health care centers involved in the study for the implementation of the researchers’ recommendation.

1.7 Scope Of The Study

This study is focused on the knowledge, attitude and practice of antenatal exercises among pregnant mothers attending Ifite Igboukwu primary health care in Igboukwu Aguata local government area of Anambra state. Geographically, the study will be delimited to Ifite Igboukwu primary health care in Igboukwu Aguata local government area of Anambra state.

1.8 Limitations of the Study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. However, the researcher was able to manage these just to ensure the success of this study.

Moreover, the case study method utilized in the study posed some challenges to the investigator including the possibility of biases and poor judgment of issues. However, the investigator relied on respect for the general principles of procedures, justice, fairness, objectivity in observation and recording, and weighing of evidence to overcome the challenges.

1.9 Definition of Terms

Pregnancy: Pregnancy refers to the condition in which a woman carries one or more offspring (embryo or fetus) in her uterus, typically lasting around 40 weeks from the last menstrual period to childbirth.

Antenatal Care: Antenatal care is the care you get from health professionals during your pregnancy. It's sometimes called pregnancy care or maternity care.

Antenatal Exercise: Exercise during pregnancy is also called as antenatal exercise  The antenatal exercise in this study includes water aerobics, walking, swimming, stationary cycling, yoga, Pilates and so on.