Maternal Healthcare Services in Nigeria

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CHAPTER 3 RESEARCH DESIGN AND METHODS

INTRODUCTION

In Chapter one, this research was introduced as an empirical health facility-based cross-sectional survey to explore the socio-economic factors contributing to the exclusion of women from maternal health benefits in Abuja, Nigeria. This chapter includes the description of the research design and methodology. While the description of the research design focused on the blueprint of how the research was conducted, the methodology focuses on the processes, tools and procedure utilized in the research (Babbie and Mouton 2004:74-5; Mouton 2001:55).
The description in this chapter covers the research design; the method and procedure for data collection including the development of the data collection instrument; the study population and sampling method; and ethical considerations. This chapter also included measures to control for reliability and validity, as well as the data analysis procedure.

RESEARCH DESIGN

The research design is a plan or blueprint of how this research was conducted, detailing the plans that were followed during the study to answer the research questions (Babbie and Mouton 2002:72; Mouton 2001:55). The focus of the research design was on the logic of the research and aimed at the kind of evidence that was required to address the research questions (Mouton 2001:56).
Guided by Babbie and Mouton (2004:72), a clear articulation of (i) what the research is intended to explore detailed in chapter one of this report together with (ii) the outline of the process to answer the research questions as described below are the two major aspects of the research design.
In chapter one, the orientation to this study detailed the background to the study including the research problem, purpose and objectives. This research is a non-experimental, facility-based descriptive cross-sectional survey of the socio-economic factors that contribute to the exclusion of women from maternal health benefits in AMAC, Abuja Nigeria and a descriptive survey was selected as the best approach to explore the research questions. Further exploration of the research design is detailed below.

Descriptive study

Descriptive studies are aimed at observing, documenting and describing situation and event in a population (Araoye 2003:55; Babbie and Mouton 2004:180; Grimes and Schulz 2002:145). In the context of this research, descriptive study was utilized to observe and describe the socioeconomic factors that contribute to the exclusion of women from maternal health benefits in AMAC, Abuja Nigeria. The approach (descriptive studies) provide answers to questions relating to who, what, why, when and where and implicitly what within a population (Grimes and Schulz 2002:145) and describe the amount (frequency) and distribution (by person, place and time) of an event within a population (Araoye 2003:55). In Chapter four of this report, several measurements were used to describe the socioeconomic factors that contribute to the exclusion of women from maternal health benefits as such provide answers to the research questions.
According to Grimes and Schulz (2002:146), descriptive studies are broadly categorized into two groups. Studies that deal with (i) individuals like case reports, case series, cross sectional studies and surveillance and (ii) those that examine populations like ecological correlational studies. As this study examined pregnant women (individuals) within the population, a cross-sectional survey was adopted (Babbie and Mouton 2004:232).
Cross-sectional survey describes the characteristics of a representative sample of a larger population (Mouton 2001:152) and was noted as the best method available to social scientists interested in collecting original data (like in the case of this study) for describing a population too large to be observed directly (Babbie and Mouton 2004:232). In this study, the population of pregnant women in AMAC are too large to observe directly; as such a representative sample of the population was studied.
Where appropriate sampling approach was applied (like the case of this study), cross-sectional survey offers the opportunity to generalize findings in a sub-group (like pregnant women attending ANC clinics in the five district hospitals in AMAC) to the general population (of pregnant women in AMAC) as such inform appropriate policy and programme review (Araoye 2003:58; Babbie and Mouton 2004:263; Grimes and Schulz 2002:145; Mouton 2001:153). In addition, cross-sectional survey is most ideal for this research as cost required was small (Araoye 2003:56; Grimes and Schulz 2002:146), data collection was undertaken as a single observation and information were generated quickly (Araoye 2003:58; Grimes and Schulz 2002:145) to accommodate the limited timeframe for the completion of the research.
In line with the fact that descriptive studies provide information for planning and programme implementation, and make comparison between groups (Araoye 2003:55), recommendations were made in Chapter five of this report on how to improve coverage of maternal healthcare service utilization among women in AMAC, Abuja Nigeria based on the findings of this study. Consistent with the fact that descriptive studies serve as first foray into an area of enquiry (Grimes and Schulz 2002:145), the findings of this research have opened up additional enquiries (Chapter 5) into socio-economic factors that limit full benefits from investment in maternal healthcare in Nigeria.

RESEARCH METHOD

The research method focused on the process, tools and procedure utilized in the research process (Babbie and Mouton 2004:74-5; Mouton 2001:55). In this section, the sampling, data collection approach and ethical consideration in data collection were discussed. The discussion was followed by the description of the process for data processing, analysis and management.

Sampling

Sampling is the process of selecting observations (Babbie and Mouton 2004:164) within the study population in a study. The study population, sample size determination, sampling method and method of selecting research subjects for the study of the socioeconomic factors contributing to the exclusion of women from maternal health benefits in Abuja, Nigeria are discussed in this sub-section.

Study population

The study population comprised the group of individual units being investigated, i.e. the population from where the study sample would be drawn (Araoye 2003:115; Babbie and Mouton 2004:174). In this study, all pregnant women attending ANC clinic in the five district hospitals (study site) in AMAC, Abuja Nigeria constituted the study population. Inclusion criteria for the study were pregnant women irrespective of their age, religion and tribe (i) with past pregnancy history irrespective of pregnancy outcome as data collected were related to past pregnancy history and (ii) currently registered at the ANC clinic of the study sites. Exclusion criteria were women (i) attending ANC in other health facilities other than the five district hospitals and (ii) female relations accompanying pregnant women to the study sites irrespective of their pregnancy status (except if registered in the same facility). The demographic characteristics of Abuja, Nigeria are discussed below.
Demographic characteristics and political structure of Nigeria
The Federal Republic of Nigeria lies within latitude 4º16′ and 13º53′ north and longitude 2º40′ and 14º41′ east (NPC 2009:1), and bordered by Niger Republic in the north, Chad in the northeast, Cameroon in the east and Benin Republic in the west. The Gulf of Guinea in the Atlantic Ocean bounds the country to the south. The total population from the 2006 national household and population census was 134 million accounting for 2.04% of the global population (NPC 2010a:6). The country occupies 923,768 square kilometres (NPC 2009:1) and currently divided into 36 states and the Federal Capital Territory (FCT) – Abuja (See Figure 3.1). The 36 states are grouped into 6 geo-political zones (North-East; North-West and North-Central; and South-East, South-West and South-South) and are comprised of 774 Local Government Areas (LGA).
Demographic characteristics of Abuja, Nigeria
Abuja, the Federal Capital Territory (FCT) of Nigeria, occupies 7.75 square kilometres in the North-Central Zone of the country. Abuja is sub-divided into 6 Area Councils (See Figure 3.2), and has a total population of 1.4 Million – 52% males and 48% females (NPC 2010a:36). Table 3.1 presents the demographic distribution (by gender) of the population in Abuja, Nigeria.

Sample size determination

The sample size for this study was estimated a priori using the formula n = z²pq / d², where n= sample size, z= standard deviation set at 1.96 corresponding to 95% confidence interval, p= the proportion in the target population estimated to have a particular characteristics (utilized maternal healthcare services) estimated to be 50% or 0.50, d = degree of accuracy usually set at 0.05and and q= 1 – p (Araoye 2003:119).
Thence, sample size n= (1.96) ² (0.5) (0.5) / (0.05)² = 384.
Equal allocation of samples per health facility (384 samples / 5 health facilities) was done due to the lack of reliable planning data at the FCT department of health for district level population as well as lack of disaggregated data beyond the level of the area council in the report of the national census and household survey (NPC 2010a:36). As such 77 women of reproductive age defined as individuals between the ages of 15 – 49 years (NPC 2009:51) who met the inclusion criteria defined above (under study population) were identified in each facility and included in the study. This brings the total sample size to 385 respondents. The process of selecting samples is described below.

Subject selection

The selection of sample participants from each study site was undertaken by simple random sampling. Considering the fact that the district hospital operated multiple ANC clinic days per week (Table 3.2), proportionate allocation of samples to each clinic day was done in each district hospital. The ante-natal register of the facilities were used as the sampling frame. Specifically, the following steps were followed.

• All pregnant women registered in the ANC clinic and recorded in the ante-natal register of the facility during the week of data collection were clustered into two groups by parity i.e. first pregnancy and two or more pregnancy history.
• Based on the inclusion criteria defined under the study population, women with two or more pregnancy history were included in the study.
• The number of women interviewed per ANC clinic day was calculated using the formula (a /A) X N, where a = total number of registered women with pregnancy history of two or more per clinic day in a facility, A = total number of registered women with pregnancy history of two or more in a facility (district hospital) in the week of data collection (total for all clinic days), and N = allocated sample size per district hospital – already determined in the earlier section of this report as 77 women of reproductive age group.

Simple ballot during the respective clinic days was used to determine women to be interviewed in each facility. Where a selected woman in a clinic declined, another woman identified by simple ballot was interviewed till the allocation for the clinic day was met.

Dedication
Declaration
Acknowledgements
Abstract
CHAPTER 1  Orientation to the Study
1.1 Introduction
1.2 Background Information about the Research
1.3 Research Problem
1.4 Aim of the Study
1.5 Significance of the Study
1.6 Definitions of Key Terms
1.7 Foundation of the Study
1.8 Research Design and Method
1.9 Scope of the Study
1.10 Structure of the Report
1.11 Conclusions
CHAPTER 2 Literature Review
2.1 Introduction
2.2 Situation of Maternal Health
2.3 Determinants of Maternal Mortality
2.4 Maternal Healthcare Services in Nigeria
2.5.1 Predisposing Characteristics
2.6 Conclusion
CHAPTER 3 Research Design and Methods
3.1 Introduction
3.2 Research Design
3.3 Research Methodd in any Manner
3.4 Data Processing, Analysis and Management
3.5 Measures to Assure Reliability and Validity
3.6 Conclusion
CHAPTER 4 Analysis, Presentation and Description of the Research Findings
4.1 Introduction
4.2 Background Characteristics of Respondents
4.3 Description of Utilization of Maternal Healthcare Services among Respondents.
4.4 Determinants of Quality Maternal Healthcare Services Utilization among Respondents.
4.5 Measures of Inequality in Maternal Healthcare Services among Respondents
4.6 Effect of Socio-Economic Characteristics on Quality Maternal Healthcare Service Utilization among Respondents
4.7 Overview of Research Findings.
4.8 Conclusion
CHAPTER 5 Conclusions and Recommendations
5.1 Introduction
5.2 Research Design and Method
5.3 Conclusions
5.4 Recommendations
5.5 Contribution of the Study
5.6 Limitation of the Study
5.7 Conclusion
LIST OF REFERENCES
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SOCIO-ECONOMIC FACTORS CONTRIBUTING TO EXCLUSION OF WOMEN FROM MATERNAL HEALTH BENEFIT IN ABUJA, NIGERIA