Clinics in Mother and Child Health

Perceptions on the COVID-19 Pandemic by Pregnant Women in South Eastern Nigeria

Joseph Ifeanyi Brian^1,2*, Egeonu Richard Obinwanne¹, Nnedum Ugochukwu², Anthony¹, Adinma-Obiajulu Nneoma Dolores¹ and Edet Mark Matthew^{3 1}Department of Obstetrics and Gynecology, Nnamdi Azikiwe University and Teaching Hospital (NAUTH), Nnewi, Nigeria
²Department of psychology, Nnamdi Azikiwe University, Awka, Nigeria
³Centre for Health and Allied Legal and Demographical Development Research and Training (CHALADDRAT), Nnamdi Azikiwe University, Awka, Nigeria
^*Correspondence: Joseph Ifeanyi Brian, Department of Obstetrics and Gynecology, Nnamdi Azikiwe University and Teaching Hospital (NAUTH), Nnewi, Nigeria, Email:

Received: 08-Oct-2021 Published: 29-Oct-2021

Introduction

Since the report of the outbreak of COVID-19 in Wuhan City, China in December, 2019 and subsequent declaration of the disease as a pandemic by the WHO in January 30, 2020; the virus which causes SARS-Cov-2 has spread to almost all the countries of the world, Nigeria inclusive [1]. The infection has not only disrupted economic activities but also has caused significant morbidity and mortality across the globe. Presently, there is no cure for the virus, but frantic efforts are being made by scientists all over the world to get a vaccine for it. Consequently, WHO has recommended a series of preventive measures to reduce the spread of the infection such as social distancing, use of face mask, regular washing of hands, etc? As the disease is in its evolutional stage, the impact of COVID-19 on pregnant women is not clear yet. However, there are speculations that it may have some untoward effects on maternal and prenatal outcomes due to some immunologic changes that accompany pregnancy; and superimposed outpouring of cytokines that accompany the infection [2].

The disease is at community transition level since the compulsory lockdown of the countries air space and immigration. In effort to fight the spread of this disease, better understanding of the people’s perception of the disease especially among the pregnant women who are classified as vulnerable group cannot be overemphasized. This study aims to assess the perception of COVID-19 among pregnant women in south east Nigeria. The finding will help to modify policies and guidelines towards prevention of this current pandemic among obstetric population and indeed other members of the society [3].

Study area

This study was carried out in Anambra state, one of the five states of the southeastern geopolitical zone of Nigeria. The state has a population of approximately 5 million people of Igbo-speaking ethnic group.

Methodology

This is a cross-sectional questionnaire-based study conducted on 370 pregnant womens in Anambra state of southeastern Nigeria, during the one month period from 25th March 2020 to 22nd April 2020 (corresponding to the period of the lockdown measure in response to the containment of spread of the COVID-19 pandemic). The study facilities included Nnamdi Azikiwe University teaching Hospital, Nnewi (Anambra south senatorial district); Chukwuemeka Odumegwu Ojukwu University Teaching Hospital and Regina Caeli mission hospital (both in Awka)-Anambra Central senatorial district; and St. Patrick Hospital (private hospital) and Holy Rosary Maternity hospital (both in Onitsha), Anambra North senatorial district. The questionnaire was designed following a focus group discussion with some pregnant women from some of the facilities of study and was shared out to a few reproductive health practitioners to ascertain content validity. Ethical clearance was duly obtained from the study facilities.

The questionnaire were administered to the pregnant women following due explanation of the study. Only those who voluntarily consented were administered the questionnaire for completion, and those who could did not read nor write were assisted to complete the questionnaires by trained aids employing face-to- face interview. The study was conducted with due observation of the recommended safety precautionary measures under the COVID-19 protocol [4-7]. The questionnaire schedule contained information with respect to the biosocial characteristics of the patient: age, gestational age, parity and social class; general perception about COVID-19; perceptions on the symptoms and signs on COVID-19, seriousness of COVID-19, the likelihood of COVID-19 affecting pregnant women than non-pregnant, and whether or not it has any effect on pregnancy. The social class of the women was obtained from Olusanya’s classification making use of the educational status of the pregnant woman and her husband’s occupation. The completed questionnaires were screened, coded and subsequently entered into the system for analysis. Data obtained were analyzed in respect of the pregnant women and the variables related to their bio-data, and perceptions on the COVID-19 pandemic using SPSS IBM windows version 26.

Results

A total of 415 pregnant women participated in the study. However, only 370 questionnaires were fully completed and were therefore duly coded and analyzed. Table 1 shows the distribution by the biosocial characteristics of the pregnant women. Of the 370 pregnant womens studied, majority 182 (49.2%) were of 25- 29 years age range [8,9]. The predominant gestational age was <28 weeks, 162 (44.1%); while the predominant parity group was 1-4, 331(89.5%). Most of the women were of tertiary educational qualification 200 (54.1%). Table 2 shows the distribution by place of domicile and type of health facilities patronized by the women. Majority of the respondents were of urban residence 334 (80%) and patronage to private hospital accounted for 296 (90.3%) of all the respondents. The predominant social class of the women was social class 5 (108, 29.2%); followed by social class 4 (28.1%) and social class 3 (102, 27.6%). The distribution by the general perception about COVID-19 amongst pregnant women as shown in Table 3 indicates that 220 (59.5%) of the women perceived COVID-19 to be real, 100 (27.0%) that it’s a ploy to steal money; 88 (23.8%), that it is not for the children of God; 70 (18.9%), that it is a scam; 48 (13.0%), that it is for rich and politicians; while only 12 (3.2%) believed that it has come to stay. The distribution by women’s perception on symptoms and signs of COVID-19 is shown in Table 4. Most of the respondents (332, 89.7%) perceived cough and catarrh as symptoms of COVID-19. Other major symptoms identified by the respondents include fever, 289 (69.7%); headache 234 (63.2%); and sore throat (182, 49.2%).

Table 1: Distribution by biosocial characteristics of the respondents (N=370).

Table 2: Distribution by place of domicile of the respondents and type of health facilities studied.

The distribution by the perception on the seriousness of COVID-19 as a disease by the pregnant women is shown in Table 3. Majority 320(86.5%) of the women perceived the disease as serious, among the reasons given as to the seriousness of COVID-19 include it is lethal 213 (66.6%); no known vaccine 46 (14.4%); it is highly contagious, 43 (13.4%); it is a global pandemic 22 (6.9%). Fourteen (3.8%) of the women did not perceived COVID-19 as being a serious disease, citing the following as reasons COVID-19 not being real 4 (28.6%); not as serious as Malaria, death rate not much compared to other infections, haven't seen evidence, don't believe it exist 2 (14.3%), each; while 4 (28.6%) had no reason [10,11].

Table 3: Distribution by the general perception about COVID-19 amongst pregnant women (N =370).

Table 4: Distribution by women’s perception on symptoms and signs of COVID-19.

It shows the distribution by the women’s perception on the likelihood of COVID-19 affecting pregnant women than nonpregnant. A hundred and eight (29.2%) women believed that COVID-19 may affect pregnant women than none; while 113 (30.5%) did not believe such. Up to 149 (40.3%) of the women had no idea whether or not COVID-19 affect pregnant women. The distribution by the women’s perception on whether COVID-19 can affect pregnancy or not is shown. More than half of the women 218 (58.9%) thought that COVID-19 can affect pregnancy; 62 (16.8%) believed that it can’t, while up to 90 (24.3%) of them did not know whether it can harm pregnancy or not. Of the 218 (58.9%) women who accepted that COVID-19 can harm pregnancy, 138 (63.3%) attributed their reasons to COVID-19 killing the baby in the womb; 126 (57.8%), to baby delivered with COVID-19 [12-15].

The distribution by the perceptions on whether COVID-19 affects pregnancy and childbirth as shown, indicates that most 154 (41.6%) of the respondents believed that COVID-19 can affect pregnancy and childbirth. Their reasons for this were more frequent birth complications 82 (53.2%); less frequent ANC visits 78 (50.6%); reduction in visits for immunization 62 (40.3%); reduction in visits for postnatal care 58 (37.7%); and increased maternal mortality 24 (15.6%). Eighty-two (22.2%) women did not belief COVID-19 can affect pregnancy and childbirth, however, substantial number 134 (36.2%) did not know whether or not COVID-19 affects pregnancy and childbirth [16].

Up to 190 (51.4%) of the women maintained that lockdown is not necessary; while 180 (48.6%) of them believed it is necessary and their reasons included to prevent community spread 170 (94.4%), to enable families stay together 62 (34.4%), to enable people rest at home 38 (21.1%), and the reduction in expenses (school fees etc) 2 (1.1%); while only 4 (2.2%) gave no reason. On the other hand, the women’s reasons for lockdown not being necessary were-increase in hunger 158 (83.2%); paralyzing the economy 88 (46.3%); engendering vices in the community (example-stealing, raping) 84 (44.2%); unnecessary stress to the people 68 (35.8%); a waste of people’s time 54 (28.4%), increased violence at home 54 (28.4%); and a bridge of people's human right to freedom 36 (18.9%). Twelve women (6.3%) had no reason.

The distribution by the sources of information on COVID-19 amongst the pregnant women studied is shown. Electronic media (radio and television) accounted for the most common source of information, 306 (82.7%); followed by social media, 232 (62.7%); public talks in churches and town hall meetings 192 (51.9%); print media, newspaper, and bulletin, 176 (47.6%). None of the women 0 (0.0%) had obtained information on COVID-19 from their peers or friends.

Discussion

The perception of the reality of existence of COVID-19 among pregnant women in this study was 59.5%; and 66.6% of the participants believed that it is serious enough to cause death, and can be transmitted to the unborn child. This finding agrees with the report by Anikwe, et al. at Abakaliki that revealed adequate knowledge about COVID-19. It also corroborated reports by Zhong, et al. and Zhou, et al. both in china, as well as that by Ranjan, et al. in India. In the same vein, a study by Hossain, et al. in Karachi, Pakistan, which showed that 8 in 10 pregnant women perceived that if the mother has infection, it can similarly, is transmitted from her to her infant.

This perception that COVID-19 can affect pregnancy is accompanied with fear and anxiety as to the possibility of an untoward consequence on the pregnancy outcome. A systematic review and meta-analysis involving 17000 pregnant women reported a significant increase in preterm birth among women with anxiety disorder leading to low birth weight. It is also known to affect the fetal neurological development.

In spite of the high level of perception as to the reality of COVID-19 amongst the study group, an appreciable number of participants were still in doubt as to the truth about the existence of such infection, since as high as 27% of the women studied believed that it was a ploy to still money, while up to 18.9% actually perceived COVID-19 to be an outright scam. Put together, this perception is actually worse than the observation by Anikwe, et al. in Abakiliki who reported that 24% of the women studied perceived COVID-19 to be a scam. The negative perceptions displayed by these relatively high numbers of respondents are likely to have the effect of undermining the efforts of the government and other stakeholders towards curbing the spread of this virus. This situation calls for restrategization to improve the effectiveness of public enlightenment measures against the spread of COVID-19 so as to dispel their ignorance.

As high as 51.4% of the respondents in this study opined that the “lock-down” measure towards the containment of COVID-19 was not necessary, citing as major reasons that continued lockdown will affect the national economy and that the COVID-19 pandemic was a scam. This perception on face value may seem unreasonable considering the fact that most countries affected by COVID-19 introduced and enforced some form of lockdown in order to curtail the spread of the disease. Incidentally, some countries that enforced total lockdown recorded more cases and deaths than those that did not such as South Korea, Taiwan, etc. This apparent paradoxical relationship between “lock-down” and containment of COVID-19 virus has elicited a lot of debate as to the necessity or not of employing lock-down measures in the management of COVID-19. So far, the answer to this debate is not clear. It is however expected that in the near future and with unfolding facts in the management of the COVID-19 pandemic, the world over, a clearer and more universally acceptable management protocol may emerge.

The majority (82.7%) of the participants got the information about COVID-19 through the mass media. A similar finding was reported by Anikwe, et al. where 61% of pregnant women obtained information on COVID-19 from mass media. This emphasizes the importance of mass media in creating awareness towards the fight of the pandemic especially during the lockdown.

The participants in this study showed a fair knowledge of the signs and symptoms of COVID-19 recognizing symptoms such as cough and catarrh; fever; headache; sore throat; loss of apetite; loss of sensation; body ache; and diarrhea as the commonest signs and symptoms of COVID-19. Incidentally, only 4 (3.8%) identified shortness of breath to be a major symptom of COVID-19 infection. This is not surprising, considering the fact that rarely do ordinary people encounter COVID-19 patients manifesting with this symptom which occurs in the later part of the illness. In fact many patients known to have tested positive to COVID-19 are either symptomless or manifest mild symptoms recovering with or without treatment. This fair attempt in recognizing symptoms of the disease was similar to the finding in Abakaliki by Anikwe, et al.

Conclusion

The findings in this study suggest that a very good proportion of women have strong belief that COVID-19 is real, lethal and can affect pregnancy and its outcome. In as much as presently, there is paucity of evidence to support vertical transmission of the infection, it is obvious however, that the pandemic constitute a worry to pregnant women. Therefore, counselling of these pregnant women is advocated as well as increasing advocacy to help address their worries so as to reduce anxiety and optimize pregnancy outcomes.

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