ISSN 2360 -8935

JOURNAL OF GENDER &

WOMEN DEVELOPMENT
[JOGEWOOD]
A Publication of Patience Jonathan Centre
for Gender & Women Development Studies
(PJC-GWDS)

UNIVERSITY OF PORT HARCOURT, NIGERIA

VOL. 2, Nos. 1 & 2, November, 2014

JOURNAL OF GENDER & WOMEN DEVELOPMENT (JOGEWOD)

A Publication of Patience Jonathan Centre for Gender & Women Development
Studies (PJC-GWDS)

UNIVERSITY OF PORT HARCOURT, NIGERIA

IMPACT OF HEALTH EDUCATION INTERVENTION ON KNOWLEDGE OF SAFE MOTHERHOOD
AMONG WOMEN OF REPRODUCTIVE AGE IN ELEME, RIVERS STATE, NIGERIA
Ene P.J. & Inyang, M.P.
Abstract
The high rate of maternal morbidity and mortality mostly in developing countries
necessitated the institution of Safe Motherhood (SM) and the establishment of SM initiative
to address this public health tragedy globally. This study investigated the impact of health
education intervention using health talk, demonstration, role play, among others, on
knowledge of SM among women of reproductive age in Model Primary Health Centres
(MPHCs) in Eleme, Rivers State. Quasi experimental design, four research questions and
four hypotheses were utilized for the study. A total of 1082 women constituted the population
from where a sample size 400 was drawn using purposive, quota and simple random
sampling techniques. A 40-item self-designed questionnaire was the instrument for data
collection. Demographic data. were analyzed with simple percentage and frequency
distribution tables, research questions were addressed with mean and standard deviation, and
ANCOVA was used to test the hypotheses at 0.05 level of significance. Statistically, findings
revealed that health ta.lk, demonstration, role play, and the like, significantly impacted on
the women's knowledge of SM components of antenatal, family planning and PMTCT as the
intervention group had higher mean gain difference (MGD =
.2822, .7118 & .6168) than the' control group (MGD =
1985,.5082,&.4408) in the post test scores and calculated ANCOVA significant at p<0.05.
The study showed no significant difference on impact of health talk, demonstration, role
play, etc, women of reproductive age knowledge of SM, based on age, educational status
and parity with calculated ANCOVA insignificant at p>0.05. Government of Rivers State
should therefore, provide functional health education units in all the MPHCs in the LGAs of
the State for planned and consistent health education, covering all aspects of SM to mitigate
maternal morbidity and mortality arising from pregnancy, childbirth and related issues.

Introduction
Pregnancy is a physiological and not a pathological process or disease in normal conditions. It is a blessing; a
time of joy and no woman ought therefore, to lose her life from pregnancy or child-birth (Olise, 2007).
However, many women in developing countries face high risk of morbidity and mortality from pregnancy and
related issues. Complications arising from pregnancy, childbirth and related issues rank highest among the
leading causes of maternal morbidity and mortality in women aged 15-49 years in underdeveloped countries
(Mahler in Ravindran & Berer, 2000).

The term maternal death signifies the death of a woman who is pregnant or within 42 days of the end of
pregnancy, without minding the age or location of the pregnancy. Such death may be due to any cause related
to or worsened by the pregnancy or its management.
Journal of Gender & Women Development (JOGEWOD) ISSN 2360-8935

However, this does not include deaths from accidental or incidental causes (WHO, 1977).
Haemorrhage, sepsis, toxemias of pregnancy, ruptured uterus and abortion with its complications are
noted to be the main causes of maternal deaths. For each woman that dies, a corresponding 30 to 50
more are either injured, suffered infection or illness (Ravindan & Berer, 2000). The death of a woman
means her children would lose her love and nurturing; her community would be denied her paid and
unpaid services; and her economic and social contributions to development to her country and the
world at large would cease (Olise, 2007).

SM means that women are safe and healthy during pregnancy and delivery. It is made up of initiatives,
practices, protocols and service delivery guidelines so organized to provide high-quality obstetric and
gynaecological services to women and their babies throughout the duration of pregnancy and
afterwards. Such services include family planning, prenatal delivery and post partum care to ensure
that the highest level of health for the mother, fetus and infant in the ante partum, intra partum and
post partum periods are maintained (The Human Rights Matrix, 2013).

The Safe Motherhood Initiative (SMI) launched in 1989 in Nairobi, Kenya was to enlighten the world
of the mortality, encourage governments, nongovernmental, United Nations (UN) agencies, and other
stakeholders to strategize, synergize and seek ways to end this public health tragedy (FCI, 2007). The
SMI aimed at reducing the burden of maternal morbidity and mortality in third world countries, in
addition to providing a framework for activities and empirical studies on how to improve the health
of mothers in developing countries (Jowett, 2013).

Sweden's maternal mortality rate was similar to that of developing countries in the 19th Century and
there was strong advocacy within the country to combat it to less than 300 per 100,000 livebirths. The
Swedish government embarked on the strategy of training midwives to attend to all births; Norway,
Denmark, and the Netherlands later used this approach with similar successes (De Brouwere, Tonglet
& Van Lerberghe, 1998). Health education aims at teaching and motivating individuals to gain
appropriate knowledge and skills to enable them live and behave in ways that promote, maintain and
restore health. These capabilities are acquired through awareness-raising and skill-acquisition
educational methodologies. The most effective health education interventions have been shown
through research to be those most likely to be based on theory and are known as evidence-based
health education interventions (Rimer, Glanz & Rasband, 2001).

According to Bankole, Sedgh, Okonofua, Imarhiagbe, Hussain and Wulf (2009), Nigeria's maternal
mortality ratios of 1,100 maternal deaths for every 100,000 live-births is one of the highest in the
world. High risk births persist in Nigeria although patterns differ in various regions. Mother's age,
parity or spacing of births made two-thirds of all births high risk in both 1990 and 2003; the country
maybe facing the most serious maternal mortality crisis in the world with more maternal deaths in
childbirth than any country except India. Nigeria with only 2% of the world's population contributes
10% of the world's maternal deaths; also, as many as 60,000 Nigerian women die due to pregnancy-
related complications each year (Bankole et a1, 2009). It is only because India has a population eight
times higher than Nigeria that it has a larger number of maternal deaths globally (Shiffman &
Okonofua, 2007).

169
 3. Health talk, demonstration and role play do not significantly impact women
of reproductive age knowledge of safe motherhood based on educational
status.
4. Health talk, demonstration and role play do not significantly impact women
of reproductive age knowledge of safe motherhood based on parity.

Methodology
Pre-test post-test control group of quasi experimental design was adopted for the study. It was
considered appropriate for this study because the researcher sought to test the impact of health
talk, demonstration, role play and the likes, on women of reproductive age knowledge of safe
motherhood in Eleme, Rivers State that would result from the health- talk, demonstration, role-
play, and others, carried out in the course of the study, using a Quick Reference Teaching Guide
on SM components of antenatal care, family planning and PMTCT designed by the researcher. A
population of 1082 which comprised the average monthly attendance of all women of reproductive
age at three of the six government owned Model Primary health Centre. Among the eligibility
criteria for enrolment were women of reproductive age - healthy, pregnant or not; attendance of
the antenatal, family planning, and infant welfare clinics at Ebubu, Eteo and Onne Model Primary
Health Centres (MPHC). The exclusion criteria included women outside the reproductive age
group - unhealthy, pregnant or not; non-attendance of antenatal, family planning, and infant
welfare clinics at Ebubu, Eteo and Onne Model Primary Health Centres (MPHC). A total of 1082
and 400 women constituted the population and sample size respectively, drawn using purposive,
quota and simple random sampling techniques. A 40-item self-designed questionnaire was the
instrument for data collection. Demographic data were analyzed with simple percentage and
frequency distribution tables, while research questions were addressed with mean and standard
deviation, and ANCOVA was used to test the hypotheses at 0.05 level of significance.

Result and Findings

This section shows each research question and each hypothesis in the null form, with the variables
identified as well as the results of the statistical analysis carried out to answer the research
questions and test the hypotheses. The hypotheses were tested at 05 level of significance.

Research Question One

Does health talk, demonstration and role play have impact on women of reproductive age
knowledge of safe motherhood?
Table 1: Mean/Mean Gain Scores on Knowledge of Safe Motherhood among Women of
Reproductive Age Based on Group (Pre-Test and Post-Test).

Pre-test Post-test Mean

Group N Mean SD Mean SD Gain SD

Intervention group 200 51.5850 20.22643 83.6000 10.28928 14.0050 6.18516

Control group 200 71.3550 11.62604 81.5400 10.21126 12.9000 7.28115
Journal of Gender & Women Development (JOGEWOD) ISSN 2360-8935

The result of findings in Table 1 shows that the pre-test knowledge mean score of the respondents in the
intervention group was 51.59, with SD of 20.23, while that of their control counterparts was 71.36 with SD of l1.63.
The post-test mean score of the intervention group was 83.60 nnd SD of 10.29, while that of control group was
81.54 With SD of 10.211. The mean gain score of women in the intervention group was 14.00and SD of 6.19, while
that of their control counterparts was 12.90 and SD of 7.28. Hence, women who were taught using the health
education methods listed above had higher mean gain score post health education than the control group who
did not undergo any health education.

Research Question Two

Does health talk, demonstration and role play have impact on women of reproductive age knowledge of safe motherhood
based on age group?
Table 2: Gain Scores on the Influence of Age on the Impact of Health Education
Intervention on Knowledge of Safe Motherhood among Women of Reproductive Age

Knowledge

Group Age N Mean SD

Intervention group 15-24 yrs 41 29.6098 22.89201
25-34 yrs 87 29.5632 21.46479

35-44 yrs 67 36.2537 23.63827

45 yrs and above 5 37.6000 20.10721

Control group 15-24 yrs 51 9.4118 7.72833

25-34 yrs 87 10.0345 7.39964

35-44 yrs 53 10.9245 8.57736

45 yrs and above 9 11.6667 7.14143

Findings in Table 2 reveals that the intervention group had the highest mean gain in knowledge among women
in the age bracket of35-44 years (M=36.2537, SD=23.63827). That of the control group occurred among women
in the age bracket of 45 years and above (M=l 1.6667, SD=7.14143).

Research Question Three

Does health talk, demonstration and role play have impact on women of reproductive age knowledge of safe motherhood
based on educational status?
Table 3: Gain Scores on the Influence of Educational Status on the Impact of Health
Education Intervention on Knowledge of Safe Motherhood among Women of Reproductive
Age.
Knowledge
Journal of Gender & Women Development (JOGEWOD) ISSN 2360-8935
Group Edu. status N Mean SD

Intervention group No formal edu. 3 18.0000 25.35744

Primary edu 42 22.4048 18.21291
Sec. edu. 86 34.2093 25.14107
Tertiary edu. 69 35.7391 19.83361
No formal edu. 23 10.6087 6.90019
Primary edu. 54 11.5926 9.04187
Control group Sec. edu. 96 9.9375 7.39675
Tertiary edu. 27 7.8889 6.71584
Table 3 shows that the intervention group had the highest mean gain in knowledge among women
who had tertiary education (M=3 5.7391, SD^ 19.83361). That of the control group occurred
among women who had primary education (M= 11.5926, SD=9.04187).

Research Question Four

Does health talk, demonstration and role play have impact on women of reproductive age knowledge of safe
motherhood based on parity?

Table 4: Gain Scores on Influence of Parity on Impact of Health Education Intervention on

Knowledge of Safe Motherhood among Women of Reproductive Age

Knowledge
Group Parity N Mean SD
Intervention First 17 31.7059 20.56625
group Sec. 49 33.8776 23.32616
Third 82 35.6341 22.41225
fourth 34 28.0294 23.36338
fifth and above 18 18.2778 16.14932

Control group first 33 9.7576 8.35924

Sec. 39 10.0000 7.57767
Third 92 10.2283 7.55217
fourth 21 8.4762 7.32543
fifth and above 15 13.7333 8.74616

The result of findings in Table 4 shows that the intervention group had the highest mean gain in knowledge
among women who had tfre third pregnancy (M=35.6341, SD=22.41225). That of the control group occurred
among women who had the fifth and above pregnancies (M= 13.73 3 3, SD=8.74616).

Hypothesis One
Journal of Gender & Women Development (JOGEWOD) ISSN 2360-8935
Health talk, demonstration and role play do not significantly impact women of reproductive age knowledge of
safe motherhood.
Table 5: Summary of ANCOVA on Difference in Knowledge of Safe Motherhood among Women of
Reproductive Age
Source of Type III Sum of Mean Square F Sig.
variation Squares d
f
a
Corrected Model .445 2 .222 18.875
.00
0
Intercept 12.700 1 12.700 1077.677 .000

Pre-test .043 1 .043 3.643 .057

Intervention .244 1 .244 20.736

.00
0
Error 4.679 397 .012
Total 1340.222 400

Corrected Total 5.123 399

a. R Squared = .087 (Adjusted R Squared = .082)

The result of the analysis as presented in Table 5 indicates that health talk, demonstration, role play, etc, does
not significantly impact women of reproductive age knowledge of safe motherhood as calculated ANCOVA
(FI, 397=20.736, p=.000, p<.05) was significant. The null hypothesis one was rejected. Health talk,
demonstration, role play, etc, significantly impacted on women of reproductive age knowledge of safe
motherhood.

Hypothesis Two
Health talk, demonstration, role play, etc, does not significantly impact women of reproductive age knowledge of safe
motherhood based on age group.

Table 6
Summary of ANCOVAon Difference in Knowledge of Safe Motherhood among Women of a. R Squared = .090
(Adjusted R Squared = .078)
Reproductive Age based on Age Group _________
Source of variation Type III Sum of df Mean Square F Sig.
Squares
Corrected Model .46 la 5 .092 7.793 .000
Intercept 12.493 1 12.493 1055.710 .000
Pre-test .039 1 .039 3.323 .069
Journal of Gender & Women Development (JOGEWOD) ISSN 2360-8935
Intervention .237 1 .237 20.065 .000
Age .016 3 .005 .456 .713
Error 4.662 394 .012
Total 1340.222 400
Corrected Total 5.123 399

The result of the analysis as presented in Table 6 shows that there was no significant difference on impact of
health talk, demonstration, role play, etc, on women of reproductive age knowledge of safe motherhood based
on age group as calculated ANCOVA(F3,394=456, p=.713, p>.05) was insignificant. The null hypothesis two
was accepted. Health talk, demonstration, role play, etc, does not significantly impact women of reproductive
age knowledge of safe motherhood based on age group.

Hypothesis Three
Health talk, demonstration, role play, etc, does not significantly impact women of reproductive age knowledge of safe
motherhood based on educational status.
Table 7: Summary of ANCOVA on Difference in Knowledge of Safe Motherhood among Women of
Reproductive Age based on Educational Status
Source of variation Type III Sum of df Mean Square F sig.
Squares
Corrected Model ,515a 5 .103 8.814 .000
Intercept 12.434 1 12.434 1063.143 .000
Pre-test .044 1 .044 3.744 .054
Intervention .180 1 .180 15.372 .000
Educational .071 3 .024 2.011 .112
Status
Error 4.608 394 .012
Total 1340.222 400
Corrected Total 5.123 399

R Squared = .101 (Adjusted R Squared = .089

I

The result of the analysis as presented in Table 7 reveals that there was no significant difference
on impact of Health talk, demonstration, role play, etc, on women of reproductive age knowledge
of safe motherhood based on educational status as calculated ANCOVA (F3, 394=2.011, p=. 112,
p>.05) was iosignificant. The null hypothesis was accepted. Health talk, demonstration, role play,
etc, does not significantly impact women of reproductive age knowledge of safe motherhood based
on educational status.
Journal of Gender & Women Development (JOGEWOD) ISSN 2360-8935
Hypothesis Four
Health talk, demonstration and role play do not significantly impact women of reproductive age knowledge
of safe motherhood based on parity.

Table 8: Summary of ANCOVA on Difference in Knowledge of Safe Motherhood among

Women of Reproductive Age based on Parity
Source of Type III Sum df Mean Square F Sig.
variation of Squares

Corrected Model .494a 6 .082 6.986 .000

Intercept 12.411 1 12.41 1 1053.578 .000
Pre-test .044 1 .044 3.735 .054
Intervention .251 1 .251 21.343 .000

Parity .049 4 .012 1.038 .387

Error 4.630 393 .012
Total 1340.222 400
Corrected Total 5.123 399

a. R Squared = .096 (Adjusted R Squared = .083)

The result of the analysis as presented in Table 8 shows that there was no significant
difference on impact of health talk, demonstration and role play on women of
reproductive age knowledge of safe motherhood based on parity as calculated ANCOVA
(F4, 393= 1.038, p=.387, p>.05) was insignificant. The null hypothesis was accepted.
Health talk, demonstration and role play do not significantly impact women of
reproductive age knowledge of safe motherhood based on parity.

Discussion of Findings
The study showed from the overall SM pre-test mean scores that the participants in both the
intervention and control groups had knowledge of safe motherhood. The control group pre-test
mean score for knowledge was 1.66 while that of their counterparts in the intervention group was
1.51.This finding was not surprising to the researcher. This is because women of reproductive age
Journal of Gender & Women Development (JOGEWOD) ISSN 2360-8935
from the sampled model primary health centres are effectively and continuously taught safe
motherhood components of antenatal care, family planning and PMTCT by the nurses, mid-wives
and community health officers on every clinic day. This finding supports that of Igbokwe and
Adama (2011) who noted that childbearing mothers have higher knowledge of various components
of safe motherhood.

Age, parity and educational status do not have significant difference on impact of health talk,
demonstration and role play on women of reproductive age knowledge of safe motherhood in
Eleme, Rivers State. This is because regardless of age, parity and educational status, health
education's goal is to improve the health of the individual through appropriate teaching and
learning experiences in order to increase knowledge of related health issues and motivate the
acquisition of skills needed to behave in health promoting ways. It is basically made up of planned
opportunities for learning using communication designed to improve health literacy, including
enhancing knowledge, and imbibing life skills which are positive to individual and community's
health (World Health Organization, 1998). Its effectiveness is increased when people are taughtto
take personal actions to address discrete and immediate health or behavioural problem of
importance to them (Green & Rreuter, 1991), for example, in family planning in which people
want to space pregnancy through the use of birth control methods (Green, 1980 in WHO, 2012).
Journal of Gender & Women Development (JOGEWOD) ISSN 2360-8935

Conclusion
Health education interventions are planned learning experiences which use different forms of
communication to help individual adopt behaviours to improve, promote, maintain or restore
health, irrespective of the individuals' age, educational status and parity. The findings of this study
revealed that women of reproductive age had knowledge of safe motherhood. The intervention
group, who had a higher mean gain, performed better than their control group counterparts in their
knowledge of safe motherhood after the former had two hours of health talk, demonstration and
role play and the later maintained the usual clinic routine. Likewise, there was no significant
difference on impact of health talk, demonstration and role play on women of reproductive age
knowledge of safe motherhood based on age, educational status and parity among the women in
both the intervention and control groups.

Recommendation
Based on the findings of this research, it is recommended that:

1. Government of Rivers State should provide functional health education units in all the
MPHC in the LG As of the state to ensure planned health education activities in the health
centres as well as in the communities. The health education activities should cover all
aspects of safe motherhood to ensure decrease in maternal morbidity and mortality rates
in the State.

2. Government technocrats, administrators and health managers in R/State should be

properly oriented on WHO's policy guidelines on health education practice as presented
in the current National Policy on Health Promotion.

References
Bankole, A., Sedgh, G., Okonofua, F., Imarhiagbe, C., Hussain, R. & Wulf, D. (2009).