Community education to encourage use of emergency obstetric services, Kebbi State, Nigeria

Abstract

Focus group discussions and a mini-survey in Kebbi State, Nigeria, revealed poor knowledge of obstetric complications, lack of confidence in health services, and cultural barriers to seeking care. After upgrading services in emergency obstetric facilities, the team began community education to encourage utilization. Messages focused on recognition and need for prompt treatment of complications, and addressed men's role as decision-makers. Beginning in 1992, messages were disseminated through weekly meetings with community opinion leaders, video shows, posters and handbills. A post-intervention mini-survey showed knowledge gains of over 30% among women and men. The increase was greatest (59% increase among women and 55% among men) on the need for prompt care for women with obstetric complications. However, utilization of emergency obstetric services did not increase. At Maiyama Maternity Center, referrals declined from 18 in 1992 to four in 1995. At Jega Health Center, referrals remained relatively stable at 20-30/year, but the number of women with major obstetric complications treated declined from 234 in 1992 to 136 in 1995. At Birnin Kebbi Specialist Hospital, the referral center, the number of women with complications treated declined from 200 in 1990 to 152 in 1995. The cost of community education was approximately US $9500, of which 15% was contributed by the community. Increased awareness of the signs of obstetric complications and the need for prompt treatment among community women and men did not result in greater utilization of emergency obstetric services at the facilities studied.