KNOWLEDGE OF POSTPARTUM HAEMORRHAGE AND ITS CAUSES AMONG  WOMEN OF CHILD BEARING AGE IN IHIALA COMMUNITY, IHIALA LOCAL GOVERNMENT AREA

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Maternal mortality, undoubtedly, stands as a paramount health and development predicament faced by developing nations, Nigeria being no exception. It is apparent that in the year 2015, Nigeria and India collectively represented more than a third of all maternal deaths globally. Nigeria reported an estimated 58,000 maternal deaths, accounting for 19% of the total, while India reported approximately 45,000 maternal deaths, representing 15% of the total (World Health Organisation (WHO), 2015). It can be inferred from the given data that a Nigerian woman succumbs to maternal mortality every ten minutes. 

Postpartum haemorrhage, commonly referred to as PPH, stands as the foremost cause of maternal mortality. It is important to note that women who continue their pregnancy beyond 20 weeks' gestation are susceptible to the occurrence of postpartum haemorrhage (PPH) and its subsequent complications, as mentioned by Smith in 2018. Whilst there has been a significant reduction in maternal mortality rates within the developed world, it is important to note that postpartum haemorrhage (PPH) continues to be a prominent contributing factor to maternal mortality in other regions. As the foremost aetiology of morbidity and mortality in the context of parturition, it manifests in roughly 1% to 6% of all instances of parturition (Wormer et al., 2018). 

The classification of postpartum haemorrhage encompasses two distinct categories: primary and secondary postpartum haemorrhage. Primary postpartum haemorrhage, also known as PPH, is characterised by excessive bleeding within the first 24 hours following delivery. On the other hand, secondary PPH refers to the occurrence of significant bleeding between 24 hours and 6 weeks after childbirth. It is worth noting that primary postpartum haemorrhage is responsible for a significant majority, specifically 99%, of most cases, as mentioned by Smith in 2018. One must consider several common causes of postpartum haemorrhage (PPH), including uterine atony, genital tract injuries, failure of the blood coagulation system, and trauma. It is worth noting that uterine atony is the primary cause of PPH, accounting for approximately 70% to 80% of haemorrhage cases (Wormer et al., 2018). Predisposing factors contributing to postpartum haemorrhage (PPH) encompass various elements. These include but are not limited to: a previous history of PPH, the occurrence of a multiple pregnancy, the presence of a large foetus (also known as a macrocosmic foetus), being a prime gravida (i.e., a woman who is pregnant for the first time), maternal age exceeding 35 years, pre-term births, genital tract injuries, labour induction, and intrauterine foetal death (Ngwenya et al., 2016). 

The American College of Obstetricians and Gynaecologists (ACOG, 2016) provides a definition for early postpartum haemorrhage. According to ACOG, this condition is characterised by a minimum total blood loss of 1,000 millilitres or the occurrence of blood loss accompanied by signs and symptoms of hypovolemia, which refers to a reduction in the volume of circulating blood. These criteria must be met within 24 hours following the delivery of the foetus or intrapartum loss. Postpartum haemorrhage (PPH) refers to the occurrence of excessive bleeding from the vagina and/or uterus following childbirth, surpassing the anticipated amount. Furthermore, it is important to note that the aforementioned condition may encompass a surplus of blood loss that occurs either during or subsequent to a Caesarean procedure. Postpartum haemorrhage, also known as PPH, is a condition that occurs subsequent to the delivery of the baby, occurring either prior to or subsequent to the expulsion of the placenta from the uterus. 

Within the context of Nigeria, it is worth noting that postpartum haemorrhage (PPH) plays a significant role in the occurrence of maternal fatalities. This can be attributed to a lack of sufficient understanding and awareness among women of childbearing age, which subsequently leads to delays in seeking prompt and suitable medical attention. It is of utmost importance to comprehend the various levels of knowledge and the underlying factors contributing to Postpartum Haemorrhage (PPH) among women of childbearing age residing in communities such as Ihiala. This understanding is essential in order to devise specific interventions aimed at mitigating the rates of maternal mortality. 

1.2 The Statement of the Problem 

From a global perspective, it is imperative to acknowledge that Postpartum haemorrhage holds the position of being the foremost cause of maternal mortality, contributing to a significant 25% of all maternal deaths. The global incidence of this condition is observed to impact approximately 5% of women undergoing childbirth, as reported by Dadelszen et al. in 2017. It is deemed highly inappropriate and morally reprehensible for a woman to succumb to an unpreventable medical condition. The ramifications of such a tragic event extend far beyond the individual and have profound implications for the family unit, the surrounding community, and even the governing bodies that oversee societal affairs (Ramanathan et al., 2018). 

Postpartum haemorrhage (PPH), a condition characterised by excessive bleeding following childbirth, remains a prominent contributor to maternal mortality on a global scale. This is especially true in regions with limited resources, such as the Ihiala Community located within the Ihiala Local Government Area of Nigeria. Notwithstanding endeavours to enhance maternal healthcare, insufficiency in understanding the aetiology of postpartum haemorrhage (PPH) among women of childbearing age persists as a noteworthy obstacle, resulting in delays in seeking suitable medical attention and contributing to unfavourable maternal health consequences. The aforementioned deficiency in comprehension among childbearing women residing in communities such as Ihiala highlights the imperative nature of implementing focused interventions aimed at rectifying knowledge deficiencies and enhancing maternal health outcomes.To this end, this study seek to assess the knowledge of postpartum haemorrhage and its causes among  women of child bearing age in Ihiala Community, Ihiala Local Government Area.

1.3 Objective Of The Study

The main objective of this study is to assess knowledge of postpartum haemorrhage and its causes among  women of child bearing age in Ihiala Community, Ihiala Local Government Area, the researcher intends to achieve the following objectives;

Determine the level of awareness towards the postpartum hemorrhage (PPH) among childbearing women in Ihiala Community, Ihiala Local Government Area.

Assess the knowledge on the causes of postpartum hemorrhage (PPH) among childbearing women in Ihiala Community, Ihiala Local Government Area.

Assess the knowledge on the measure require to manage and prevent postpartum hemorrhage (PPH) among childbearing women in Ihiala Community, Ihiala Local Government Area.

1.4 Research Question

The following questions will guide this study.

What is the level of awareness towards the postpartum hemorrhage (PPH) among childbearing women in Ihiala Community, Ihiala Local Government Area?

What are the causes of postpartum hemorrhage (PPH) among childbearing women in Ihiala Community, Ihiala Local Government Area? 

What are the measure require to manage and prevent postpartum hemorrhage (PPH) among childbearing women in Ihiala Community, Ihiala Local Government Area? 

1.5 Research Hypothesis

Ho: There is a low level of knowledge on the causes of postpartum hemorrhage (PPH) among childbearing women in Ihiala Community, Ihiala Local Government Area.

Ha: There is a high level of knowledge on the causes of postpartum hemorrhage (PPH) among childbearing women in Ihiala Community, Ihiala Local Government Area.

1.6 Significance of the Study

The significance of this study can not be over emphasized. The study will contribute significantly to maternal health outcomes in the region. Understanding the factors contributing to PPH is crucial for preventing and managing this potentially life-threatening condition, which remains a leading cause of maternal mortality globally. By identifying gaps in knowledge regarding the causes of PPH among childbearing women in Ihiala Community, healthcare providers can develop targeted educational interventions to improve awareness and promote early detection and appropriate management of PPH cases. Ultimately, enhancing knowledge about PPH among childbearing women can lead to better health-seeking behaviors, timely access to healthcare services, and improved maternal health outcomes in Ihiala Local Government.

1.7 Scope Of The Study

The study focuses on the assessment of thee knowledge and causes of post-partum haemorrhage among childbearing women. Hence the study will be delimited to Ihiala Community, Ihiala Local Government Area.

1.8 Limitation Of The Study

Like in every human endeavour, the researcher encountered slight constraints while carrying out the study. Insufficient funds tend to impede the efficiency of the researcher in sourcing for the relevant materials, literature, or information and in the process of data collection, which is why the researcher resorted to a limited choice of sample size. More so, the researcher simultaneously engaged in this study with other academic work. As a result, the amount of time spent on research will be reduced.

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 Definitions of Terms

Post-Partum Haemorrhage (PPH): 

Post-partum hemorrhage refers to excessive bleeding following childbirth, typically defined as blood loss exceeding 500 milliliters within 24 hours of delivery. PPH can occur due to various factors, including uterine atony, retained placental tissue, genital tract trauma, and coagulation disorders.

Childbearing Women: 

Childbearing women refer to females of reproductive age who are capable of conceiving, carrying, and delivering a child. In this study, childbearing women specifically pertain to those residing in Ihiala Community, Ihiala Local Government, who have experienced childbirth or are currently pregnant.

Knowledge: 

Knowledge in the context of this study refers to the understanding and awareness of the causes of post-partum hemorrhage among childbearing women in Ihiala Community. It encompasses familiarity with risk factors, signs, symptoms, and preventive measures related to PPH.