A model of community engagement in the prevention of maternal health complications in rural communities of Cross River State, Nigeria

Pregnancy-related poor maternal health and maternal death remain major problems in most Nigerian states including Cross River State. The acute impact of these problems is borne more heavily by rural communities where the majority of births take place at home unassisted or assisted by unskilled persons. These problems are due to a mixture of problem recognition and decision-making during obstetric emergencies leading to delayed actions. Every pregnancy faces risk, and prenatal screening cannot detect which pregnancy will develop complications. If the goal of reducing maternal morbidity/mortality is to be achieved, increasing the number of women receiving care from a skilled provider (doctor/nurse/midwife) during pregnancy, delivery, and post-delivery and prompt adequate care for obstetric complications has been identified as the single most important intervention. One of the strategies identified in many countries is engaging and working with individuals, families, and communities as partners to improve the quality of maternal healthcare. This strategy is thought to remove the barriers that dissuade women from using the services that are available, empowering the community members to increase their influence and control of maternal health, promote ownership and sustenance, as well as increase access to skilled care. The aim of the study: The overall aim of this PhD study was to develop a model of community engagement to facilitate the prevention of maternal health complications in the rural areas of Cross River State, Nigeria. To develop this model, the study specifically sought to: 1. Understand the current situation in Cross River State by exploring the knowledge gap of women of child-bearing age (pregnant and new mothers) regarding obstetric danger signs, birth preparedness and complication readiness, delivery practices of women, the action of family/community members, and the role of community-based maternal health initiatives, if any, in emergencies, as well as explore participants’ opinions on actions to be taken by the community to promote the utilisation of orthodox healthcare facilities by rural women of Cross River State (Phase 1). 2. Engage community members through a participatory approach (Photovoice) to highlight problems regarding pregnancy and birth practices, identify possible solutions, and make recommendations on communities’ roles in the prevention of maternal health complications (Phase 2). The older women of the study communities were also engaged to verify and validate the findings from phases 1 & 2 analyses. 3. Develop a model of community engagement to improve maternal health literacy by increasing knowledge on early detection of obstetric complications, birth preparedness, complication readiness, and improved access to skilled birth attendance (Phase 3). Methods: The study was conducted using a qualitative descriptive research approach that combined qualitative semi-structured interviews and focus group discussions within the Photovoice participatory approach. Purposive sampling was employed…