Awareness, Attitudes and Perception of Antenatal Patients to Caesarean Section: The Jos, Nigeria Experience
Keywords:Attitude, Caesarean section, Knowledge, Perception
Background: Caesarean section (CS) rates have been increasing steadily globally. Although caesarean section is becoming increasingly safe, women still have aversion for caesarean section in our environment.
Objective: To determine the perception, knowledge and attitude of antenatal clinic (ANC) attendants in Jos University Teaching Hospital towards caesarean section as a mode of delivery.
Method: This was a descriptive cross-sectional study. A pre-tested structured questionnaire was administered to pregnant women who receive care at the antenatal clinic of the Jos University Teaching Hospital between 1st December 2013 to 31st January 2014.
Results: The average age of the respondents was 29.06±6.00 years, while the average income per month was 6786 ± 1053.92 naira. Fifty-five (24.2%) of the respondents did not know any indication for caesarean section while one hundred and seventy-two knew at least one correct indication out of which four (1.8%) knew three correct indications for caesarean section. Caesarean section was considered to be dangerous by 55.1%. The commonest reason given was that the mother could die (47.37%). Vaginal delivery was preferred by 88.5%, 6.20% had no preference while 5.30% preferred caesarean section. The commonest reason given for preference for vaginal delivery was that it is safer (32.34%). Eleven out of 12 respondents that preferred caesarean section preferred it because the stress of labour is eliminated. The commonest reasons for aversion to caesarean section was fear of operation (48.98%), lack of finance (30.61%) and fear of being stigmatized (26.53%). There was statistical significant relationship between income, religion and willingness to undergo caesarean section.
Conclusion: There is a high level of awareness of caesarean delivery among ANC attendants at the Jos University Teaching Hospital. Client education is necessary to address some concerns on safety of the operation, indications for the operation, and stigmatisation.
Obstetrics Appleton and Lange, Connecticut, 1997.
2. Shiono PIT, Fielden JG, Mc Nellis D, et al. Recent trends in caesarean birth and trial of labour rates in the United
States J. Amer Med Assoc 1987; 257(4): 494-7.
3. Unnikrishnan B. Trends and indications for caesarean section in a tertiary care obstetric hospital in coastal
South India. Australasian Medical Journal 2010; 3: 821-5.
4. Rohra S, Bacchus MJ. A review of caesarean sections performed at the George Town Hospital, Guyana. West
Indian Med J 1983; 32(2): 91-6.
5. Onwudiegwu U. The effects of a depressed economy on the utilization of maternal health services. The Nigerian experience II. Journal of Obstetrics and Gynaecology 1997; 17: 43-148.
6. Geidam AD, Audu BM, Kawuwa BM, et al. Rising trend and indications of caesarean section at the university
of Maiduguri teaching hospital, Nigeria. Ann Afr Med 2009; 8: 127-32.
7. Nkwo PO, Onah HE. Feasibility of reducing the caesarean section rate in the university of Nigeria
teaching hospital, Enugu. Trop J Obstet Gynaecol 2002; 19: 86-9.
8. Centers for Disease Control and Prevention (CDC). Rates of cesarean delivery--United States, 1991. MMWR
Morb Mortal Wkly Rep 1993; 42(15): 285-9.
9. Jaiyesimi AK, Ojo OE. Caesarean section in contemporary obstetrics and gynaecology for developing countries.
(eds): Okonofua F and Odunsi K. Women’s Health and Action Research Centre, Benin City 2003: 592.
10. Buekens P, Curtis S, Alayon S. Demographic and health surveys: caesarean section rates in sub-Saharan Africa. BMJ 2003; 326(7381): 136.
11. Dumont A, de Bernis L, Bonvier-colle MH, et al. Caesarean section rate for maternal indication for
sub-Saharan Africa: a systematic review. Lancet 2001; 358: 1328-33.
12. Oye-Adeniran BA, Umoh AV, Odum CU, et al. Recent trends in caesarean sections at the University of Lagos
Teaching Hospital, Nigeria. Nigerian Quarterly Journal of Hospital Medicine 1988; 8: 111-4.
13. Kwawukume EY. Caesarean section. In: Kwawukume EY, Emuveyan E, editors. Comprehensive obstetrics in
the tropic. Asante and Hittcher Printing Press Limited 2000: 321-9.
14. Igberase GO. High caesarean section rate: a ten-year experience in a tertiary hospital in the Niger Delta,
Nigeria. Niger J Clin Pract 2009; 12 (3): 294-7.
15. Ibekwe PC. Rising Trends in casearean section rates: an issue of major concern in Nigeria. Niger J Med 2004;
13 (2): 180-1.
16. Oladapo OT, Sotunsa JO, Sule-Odu AO. A rise in caesarean birth rate in Sagamu, Nigeria: A reflection
of changes in obstetric practice. J Obstet Gynecol 2004; 24 (4): 377-81.
17. Aisien AO, Lawson JO, Adebayo AA. A five-year appraisal of caesarean section in a Northern Nigeria University
Teaching Hospital. Niger Postgrad Med J 2002; 9: 146-50.
18. Awoyinka BS, Ayinde OA, Omigbodun AO. Acceptability of caesarean delivery to antenatal patients in a tertiary health facility in South West Nigeria. J Obstet Gynaecol 2006; 26(3): 208-10.
19. Aziken M, Omo-Aghoja L, Okonofua F. Perceptions and attitudes of pregnant women towards caesarean
section in urban Nigeria. Acta Obstet Gynecol Scand 2007; 86(1): 42-7.
20. Adageba RK, Danso KA, Adusu-donkor A, et al. Awareness and perceptions of and attitudes towards caesarean delivery among antenatal. Ghana MedicalJournal 2008; 42(4): 137-40.
21. Ezechi OC, Fasubaa OB, Dare FO. Socio economic barrier to safe motherhood among booked patients
in rural Nigerian communities. Journal of Obstetrics and Gynaecology 2000: 20(1): 32-4.
22. Ezechi OC, Nwokoro CA, Kalu BKE, et al. Caesarean Morbidity and mortality in a private hospital in Lagos
Nigeria. Trop J Obstet Gynaecol 2002; 19(2): 97-100.
23. Angeja AC, Washington AE, Vargas JE, et al. Chilean women’s preferences regarding mode of delivery:
which do they prefer and why? Br J Gynaecol 2006; 113(11): 1253-8.
24. Gamble JA, Creedy DK. Women’s preference for a caesarean section. Incidence and associated factors.
Birth 2001; 28(2): 101-10.
25. Adeleye JA. Primary elective caesarean section in Ibadan Nigeria. International Surgery 1977; 62: 97-9.
26. Lawson JB. Caesarean section. In: Obstetrics and Gynaecology in the Tropics edited by Lawson JB and
Stewart DB London. 1967: 184-185.
27. Olusanya O, Okpere E, Ezimokhai M. The importance of social class in voluntary fertility control in a developing country. W Afr Med 1985; 4(4): 205-12.
28. Fasubaa OB, Ogunniyi SO, Dare FO, et al. Uncomplicated caesarean section. Is prolonged hospital stay necessary? East Afr Med J 2000; 77(8): 448-51.
29. Oliver CE, Olusola BF, Bruno EKK, et al. Caesarean Delivery Why the aversion? Trop J Obstet Gynaecol
2004; 21: 164-7.
30. Thomas J, Callwood A, Brocklehurst P, et al. The National Sentinel Caesarean Section Audit. BJOG 2000;
31. Onwudiegwu U, Makinde ON, Ezechi OC, et al. Decision - caesarean delivery interval in a Nigerian University
hospital: implications for maternal morbidity and mortality. Journal of Obstetrics and Gynaecology 1999;
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