ABSTRACT

The term preconception care is widely used for activities intended to address and prevent specific problems before conception. It has a positive impact on maternal and child health outcomes.

The research topic ‘‘Knowledge, Attitude and Practice of Preconception care among women of the Reproductive age group in the Buea Health District’’ is aimed at assessing the knowledge, attitude and practice of PCC and constraint faced by women of the reproductive age in the Buea Health District.

It was a descriptive cross sectional study using a sample size of 178 participants in three selected communities of the Buea Health District. The communities were selected using a simple random technique.

Data collection tool was a structured questionnaire with both closed and open ended questions based on research objectives. Data analyses was done using SPSS version 21.0. Regarding knowledge of preconception care, 40% (68) of women had good knowledge of preconception care and 60 % (103) had poor knowledge of PCC.

The study revealed that 27.5 % (47) of the participants practiced PCC while 72.5% (124) did not practice PCC before conception. Despite the poor knowledge and low practice level of PCC among women of the reproductive age, they had a high positive attitude regarding PCC.

Key word: Knowledge, Attitude, Practice, Preconception care

                                                        CHAPTER ONE

                                                   INTRODUCTION

1.1 Background to study

The term preconception care is widely used for activities intended to address and prevent specific problems before conception.

Preconception care is defined as the set of interventions and or programs provided to women and couples of childbearing age before conception that aim to identify and enable informed decision-making to modify biomedical, behavioral and (psycho-) social risks to parental health and the health of their future child, through counseling, prevention and management [1].

It has the potential to assist women and couples by reducing risk, maternal and child mortality, promoting healthy lifestyle and improving readiness for pregnancy as well as minimizing birth defects in infants such as neural tube defects, low birth weight babies and preterm babies [2].

Preconception care aims to promote health prior to conception and to improve pregnancy related outcomes. Pregnancy is common among women in the reproductive age. However, many of these women are unaware they are pregnant till they miss their menstrual cycle, which can occur approximately six weeks into their pregnancy [3].

The first trimester is a crucial period for the development of important organs.

Thus, many poor outcomes could have been determined prior to this women’s first antenatal visit. Counseling and prevention efforts implemented after the organogenesis period therefore do not improve outcomes related to congenital malformations.

Studies recommend that pre-pregnancy care should start before conception for better pregnancy outcome [3].

In 2012, The World Health Organization organized a meeting to develop a global consensus on preconception care to reduce maternal and childhood mortality and morbidity.

According to the review, lists of programs included in preconception care are tobacco use prevention and cessation, nutrition, vaccine, fertility and infertility, female genital mutilation, HIV testing, STIs screening and counseling, substance use, intimate partner and sexual violence, genetic counseling, adolescent-friendly services and occupational health [4].

Even if the maternal health has significantly improved in the twenty-first century, many women continue to die or suffer from pregnancy related complications every year [5].

This risk of maternal and infant mortality and pregnancy-related complications can be reduced by increasing access to quality preconception care (before pregnancy) and interconception care (between pregnancies) [6].

Despite the presence of PCC as a new standard of care within the maternal health services, maternal and new born mortality remains a major public health challenge in the developing countries [7].

Sustainable Development Goal (SDG) number three puts a target to reduce the global maternal mortality ratio to less than 70 per 100,000 live births and newborn mortality at least as low as 12 per 1000 live births by the year 2030[8]. Preconception care has a positive impact on reduction in mortality and decrease the risk of adverse health effects for the woman, fetus, and neonate by optimizing the woman’s health and knowledge before planning and conceiving a pregnancy [9].

The 2011 Sub-Saharan Africa report on maternal health shows that there is poor preconception care practice in SSA due to low economic, lack of health care providers being properly aware about maternal health including preconception care [10]. Studies have shown that less than 1/3of women of reproductive age visited the health institutions and speak with a health care provider prior to pregnancy about their health status and it potential impact on pregnancy outcome [11].

Furthermore, in low income countries preconception care has not been widely implemented because its aims and objectives are not widely understood and accepted (Demisse.T. 2019) [11].

Studies conducted in Nigeria, Ethiopia and Sudan showed that women’s level of knowledge regarding PCC is 20.61% [12], 13.4% [13] and 9% [14]respectively.

While in countries like China and Malaysia, women’s level of knowledge regarding PCC is higher; 40% [15] and 54% [16] respectively.

Moreover, preconception care in Cameroon is low and urgently have to be implemented, many pregnancies are unplanned and frequently end up unfavorable [17].

1.2Problem statement

According to Cameroon’s MDG Report, quoting results from the Cameroon Maternal Mortality Survey of 2015, the country’s maternal mortality rate stands at 596 death per 100,000 live births [18]. This is high and challenges Cameroon capacity to achieve its MDG of reducing maternal mortality to 185 per 100,000 live births. Identifying and addressing the critical issues affecting maternal health is essential in solving the problem. One such issue is the practice of PCC among women of the reproductive age.

Anecdotal evidence shows that preconception care has not become part of routine practice in Buea health District. Preconception care as a strategy for improving maternal and child health has not been fully embraced and incorporated in national and local strategies for improving maternal health in Cameroon and more particularly in Buea health District. Although antenatal care is set in the maternal, newborn, and child health continuum, it neglects the most critical time of embryonic development which occurs before the first antenatal care contact. Therefore introducing PCC services will be ideal both for women of child bearing age and their families.

1.3Research question

The research questions for investigation in this study include the following:

1. Do women in Buea know what preconception care is all about?
2. Do women in Buea practice preconception care?
3. What are the constraints to the practice of preconception care?
4. What are the women’s attitudes in Buea toward preconception care?

1.4  Objectives of the study

1.4.1 General objectives

This research seeks to assess the knowledge, attitude and practice of PCC and its barriers among women of the reproductive age in the Buea Health District.           

1.4.2Specific objectives

1. To assess women knowledge on PCC.
2. To investigate if women in the Buea Health District practice preconception care.
3. To assess women attitude toward PCC.
4. To find out constraints faced by women and factors associated to the practice of PCC.