Journal of Patient Care

(Bad) Attitudes and Behaviors of Some Health Workers: An Important Contributory Factor to High Maternal Mortality in Nigeria

Joseph Oladimeji Olasupo^1*, Yusuf Olatunji Tijani², Aminat Ayomide Akinoso², Rosemary Komolafe², Victor Chisom Makata³, Abdulazeez Abdulazeez⁴, Abdulhammed Opeyemi Babatunde^5,6 and Soyemi Toluwalashe^{7 1}Department of Faculty of Pharmacy, University of Ibadan, Nigeria
²Department of Medicine and Surgery, Faculty of Clinical Sciences, University of Ilorin, Nigeria
³Department of Medical Laboratory Science, University of Nigeria, Enugu 4Department of Faculty of Pharmacy, University of Ibadan, Nigeria
⁴Department of Medical Laboratory Science, College of Health Technology, Moro, Osun State, Nigeria
⁵Department of Medicine and Surgery, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Nigeria
⁶Department of Healthy Africans Platform, Ibadan, Nigeria
⁷Department of Medicine and Surgery, Faculty of Clinical Sciences, Lagos State University College of Medicine, Nigeria
^*Correspondence: Joseph Oladimeji Olasupo, Department of Faculty of Pharmacy, University of Ibadan, Nigeria, Email:

Received: 03-Feb-2021 Published: 17-Nov-2021, DOI: 10.35248/2573-4598.21.7.176

Introduction

commitment Each day the world loses about 810 women to death due to pregnancy and childbirth complications1 and in Nigeria 145 die every day during childbirth.2 As defined by World Health Organization, Maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.3 Maternal mortality (MM) which is preventable has remained a global concern though not uniformly distributed throughout the world as low and middleincome countries(LMIC) account for 94% of all maternal deaths globally.1 Sub-Saharan Africa (SSA) as a region is mostly affected due to its poor living conditions, high rate of infections, and bad health system, having the worst maternal mortality ratio of 640 deaths per 100000 successful delivery.4 Nigeria is reported to have one of the highest occurrences of MM as she was listed as one of the 15 "high alert" countries in SSA according to fragile state index1. However, there is no prevention of any negative outcome without a proper assessment of the causes associated with it. In Nigeria, more than 70% of maternal deaths are due to the following reasons;5 hemorrhage, unsafe abortion, infections, hypertensive crisis, and obstructed labor. Other documented causes include anemia, malaria, heart disease, and eclampsia.6 While all these causes are merely an indication of a complication, it was disclosed that more than a third of all cases can be traced to poor quality of care in health care facilities.7 Nigeria health services often fall short of the principle of showing care; Beneficence (Do good) and non-maleficence (Do no harm) which is evident in the uncaring attitude of many maternal health care providers(MHCP).8 Several factors hinder access to health care services which is vital to prevent maternal mortality, these factors include cultural norms, lack of knowledge, poverty and behavioral attitude of health workers.9 This study aims to highlight the contributory role of negative attitude and behavior of health workers to high maternal mortality in Nigeria.

Effects of Poor Attitudes of Health Workers on Maternal Health

The quality of health care is a factor of clinical effectiveness, safety, and a good experience for individual patients.9 All these are factors that can be affected by the attitudes of health workers. Maternal health care providers' (MHCP) attitude and behaviors are important elements that influence the quality of care either positively or negatively the perception of patients towards health care services.9 Promptness and friendliness of MHCP are the positive attitude that influences healthcare utilization on the other hand hostile and uncompassionate attitude of MHCP creates a barrier to the patronage of health facility by pregnant women. This encourages them to seek medical care from quacks and untrained personnel and deliver at home, religious centres, and local delivery houses rather than standard hospitals and clinics.10

From the studies done on maternal health care seeking behavior, several factors have been identified to influence the patients seeking behavior for reproductive and maternal health services. These include; cost, distance, maternal education, cultural beliefs, and lack of autonomy of women. But it is noteworthy that most studies also identify poor attitudes and behaviour of MHCPs and perceptions of this as a significant impediment. This was mostly seen in studies from sub-Saharan African countries but was also identified in studies of health care seeking behaviour from other parts of the globe.11 Studies from Nigeria have shown women low satisfaction with maternal health care due to physical abuse and rude behaviour from MHCPs.12 Long waiting queues, health care providers' behaviours and unavailability of healthcare providers, bad interpersonal relationships as factors influencing pregnant women in choosing where they would access maternal and child health services.12,13 In another study, 'promptness of care' and 'friendliness of staff' were significant factors affecting the use of maternity services.10

Most of the studies available on how the attitudes and behavior of maternal health care providers in Sub-Saharan African have led to complications and death from maternal and child health conditions are not from Nigeria. One of such studies can be seen in a study of maternal death audits with verbal autopsies in the Gambia, Cham et al found that poor health care provider attitude and fear of abuse by health care providers based on previous experiences leads to delay in seeking help even during an emergency. 14

An exploratory qualitative study carried out in a rural district hospital in KwaZulu-Natal in South Africa highlighted the nurses' perspective on factors affecting patients' care where it was revealed that being understaffed with a high load of patients affects the quality of care and interpersonal communication maternal health care providers deliver to their patients.15 A study carried out in Ethiopia on the knowledge and attitude of nurses towards patient safety and its associated factors showed that about 52% of nurses in Ethiopia had poor and inadequate knowledge about patients' safety and as such are encouraged to promote their educational status and level of awareness on patients' safety.16 In many studies, poor working conditions and environments have accounted for negative attitudes from health care providers. These poor working conditions have led to fatigue and a lack of motivation which translates to poor health care delivered.12

Recommendations

Improving the quality of care given to women plays an important role in improving patient outcomes. According to a study carried out by Graham et al, it is important to listen to the patients. Making health care more patients focused by getting feedback and opinions from patients would help begin the process of delivering quality care.17 Appraisal forms should be given to patients to ascertain their feedback and satisfaction on care received. Based on feedback gotten, queries or positive reinforcements can be handed out as deemed fit by supervisors.

Proper training for health care workers would help to build proper interpersonal and communication skills and teach them to show empathy and compassion. An example of a resource that can help achieve this is the World Health Organization manual titled 'Counselling for maternal and newborn health care: a handbook for building skills.18 Similar training carried out on HIV/AIDS has been shown to improve behaviours.19 After training, proper supervision is necessary to ensure accountability adherence and application of skills learned. Positive reinforcement and incentives such as monetary bonuses, 'staff of the month' awards can serve as motivation for staff. Besides, there is a need for improved working conditions and welfare of healthcare workers in the country which may translate into improved attitudes towards their patients.20

Conclusion

The attitude of healthcare workers towards pregnant women and nursing mothers is an important but often overlooked factor contributing to the high maternal mortality in Nigeria. Hence, this article was written to draw the attention of government and stakeholders in Nigeria and other African countries to prioritize improving attitudes of healthcare workers in a bid to reduce maternal mortality and other mortalities.

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