A Survey Of Psychological Reaction And Perception Of Pregnant Women, To Prenatal Ultrasonography In Lagos University Teaching Hospital, Idi-Araba, Lagos
F Eniyandunni, K Soyebi, N Irurhe, O Olowoyeye, A Adeyomoye, K Ketiku, R Arogundade
Keywords
fetus, perception, pregnancy, prenatal, psychology, ultrasonography
Citation
F Eniyandunni, K Soyebi, N Irurhe, O Olowoyeye, A Adeyomoye, K Ketiku, R Arogundade. A Survey Of Psychological Reaction And Perception Of Pregnant Women, To Prenatal Ultrasonography In Lagos University Teaching Hospital, Idi-Araba, Lagos. The Internet Journal of Health. 2010 Volume 13 Number 1.
Abstract
Introduction
The psychological reactions and perceptions towards obstetric interventions are becoming important areas of concern noted by some group of scientist in the early 80’s 1,2 .
The reaction varied from little or no knowledge of the investigative modalities, its usefulness, harmfulness if any, to some even suspecting it could harm their unborn baby, cause cancer, while others leave all concerns to the referring Obstetrician and Radiologist “who must know what they are doing”. Discussion between patients however have been reported to indicate rather than be docile, several of these patient convey some information to their fellow patients sometimes alleviating fear and at other times instilling fears in the patients3.
Awareness of the investigative modality needs to be improved, so also communication between health care providers and the recipients are imperative.
This realization has resulted in several studies carried out in the western world to determine how patients in general and in particular antenatal care patients perceive and react to Ultrasonography. Some interesting findings include the women’s dissatisfaction of non-communication with by the person carrying out the study. Other documentations like Tautz’s are of women’s over expectation of what Ultrasonography is able to do, leaving them frustrated when these expectations are not met. Meanwhile, it is the desire of healthcare providers to attend to patients in such a way that their burdens are significantly alleviated before leaving the hospital4.
This study aims at assessing the perception and psychological effects of Ultrasonography on pregnant women using modality of investigation during the antenatal period and also to know how the level of literacy affects patients psychologically thereby adding to literature in Nigeria.
Methodology
Study Design
The study was conducted using a descriptive cross sectional study carried out with structured interview by self administered questionnaire.
Sampling Technique
Two hundred pregnant women who presented at the ultrasound unit of the Radiodiagnosis department for obstetric scan were considered for this study. These women were considered for the study through convenience sampling (simple random sampling) that is, all pregnant women were recruited into the study as they present for ultrasonography. There were no special criteria for selecting the target population.
Data Collection Tool
The study materials were self administered questionnaire to two hundred women referred to the Radiodiagnosis department for ultrasonography
Ethical Consideration
Permission was obtained from the Head of Department of Radiodiagnosis and Research and Ethic Committee of Lagos University Teaching Hospital to carry out the study.
The research was described to the patient, and the patient’s consent obtained. Ethical approval was also obtained from the teaching hospital.
Confidentiality was assured through use of number codes for anonymity. The research participants then completed administered questionnaire while waiting to be scanned in the department.
The data collected included bio-data of the research participants, obstetric history, knowledge of reactions to ultrasonography and its application/technique.
Results
Two hundred respondents were recruited with age range of 20 to 49years and their mean age was 31.1 4.6 years. The respondents were predominated by Yoruba ethnic group137 (68.5%), followed by the Igbo 37(18.5%), Hausa 18(9.0%) and other ethnic groups such as Edo, Calabar among others 6(3.0%). 166(83.0%) were Christians and 34(17.0%) were Muslims. 9(4.5%) of the women had no formal education, 2(1.0%) had attained primary level education, 14(7.0%) had secondary education and 175(87.5%) had tertiary education. 11(5.5%) were unskilled, 82(41.0%) were semiskilled and 101(50.5%) were skilled.
Table1: Shows the socio-demographic characteristics of pregnant women in Lagos University Teaching Hospital, Idi Araba, Lagos. The distribution of pregnant women by age, religion, marital status, education and tribe are shown in the tables and figures 1-3 below
Table 2 below shows the knowledge of research participants about ultrasonography. A vast majority (92.5%) of respondents had heard about ultrasonography and 45.5% believed that ultrasonography was beneficial in pregnancy. 191(95.5%) of respondents had previously undergone ultrasonography at one time or the other, Only 10(5%) believed prenatal ultrasonography was unsafe, while a larger percentage184 (92%) believed that it was safe
Table 3 shows the distribution of respondents’ source of information about ultrasonography. A larger percentage of pregnant women have heard about ultrasonography and the highest source being through friends 186(93.0%) and 91(45.5%) believe that it is beneficial in pregnancy.
Table 4 below shows the various importances of respondents for ultrasonography. 34(17.5%) believe that ultrasonography helps to determine abnormalities in the early stage of pregnancy, 23(11.5%) to know the sex, position and condition of the baby, 15(7.5%) to get prepared for time of delivery, 8(4.0%) to prevent complication, 7(3.5%) for confirmation of pregnancy and to determine if the baby is twins 3(1.5%).
Table 5 below shows the distribution of frequency of respondents’ reasons for ultrasonography. A larger percentage go for ultrasonography on doctors’ prescription, 75% colleagues advice and 59.5% due to personal reasons like checking fetal gender
Table 6 below shows the distribution of the necessary time to go for ultrasonography by respondents. A vast majority (87.9%) through doctors prescription, 67% when pain and 61% when pregnant
Table 7 below shows the different respondents’ psychological reactions towards ultrasonography. 188(94.0%) respondent said their doctor communicate with them during scan, majority of the respondent 194(97.0%) said they need their result immediately after an examination. 176(88.0%) believe that ultrasonography cannot cause cancer and 18(9.0%) believe that it can cause cancer. A vast majority 168 (84.0%) also agreed that ultrasonography is not dangerous to their baby and 26(13.0%) believe that it is dangerous to their baby when done frequently.
The result in table 8 below shows the test of awareness of respondents’ knowledge to prenatal ultrasonography and their socio-demographic variables.
There is a significant association between the knowledge of the respondent towards prenatal ultrasonography and the socio-demographic variables; age (p=0.000), highest educational level(p=0.00), number of pregnancy(p=0.000), number of pregnancies to term(p=0.000),and number of children living(p=0.000)
Figure 8
The result in table 9 shows the association between respondents’ knowledge to prenatal ultrasonography and their socio-demographic variables.
There was no significant association between the knowledge of the respondent towards ultrasonography and their age (p=0.576), highest educational level (p=0.953), number of pregnancy(p=0.552), number of pregnancies to term(p=0.745)and number of children living(p=0.753)
Figure 9
The result in table 10 shows the association between the psychological reactions of respondents’ to prenatal ultrasonography and their socio-demographic variables as regards to causing of cancer. There is a significant association between the psychological reactions of the respondents towards ultrasonography and their age (p=0.000), number of pregnancies to term (p=0.000) and there is no significant association in the number of children living (p=0.45)
Figure 10
The results in table 11 shows psychological reactions of respondents’ to prenatal ultrasonography with regards to socio-demographic variables on dangerous effect on fetus. There is a significant association between the knowledge of the respondent towards ultrasonography and their age(p=0.002), highest educational level(p=0.000), number of pregnancy(p=0.004), number of pregnancies to term(p=0.001),and finally there is no significant association in the number of children living(p=0.124)
Discussion
Two hundred questionnaires were administered by the Researcher to pregnant women aged between 20 and 49years (mean age = 31.14.6 years) at the Radiodiagnosis Department of Lagos University Teaching Hospital Nigeria. 166(83.0%) were Christians and 34(17.0%) were Muslims. The respondents were predominated by Yoruba ethnic group 137(68.5%), followed by the Igbo 37(18.5%), Hausa 18(9.0%) and other ethnic groups such as Edo, Calabar among others 6(3.0%) (Table: 1). the reason for this is most probably because Lagos is located in Western region which is predominantly occupied by the Yoruba’s. 9(4.5%) of the women had no formal education, 2(1.0%) had primary level education, 14(7.0%) secondary and 175(87.5%) had tertiary education. 11(5.5%) were unskilled, 82(41.0%) were semiskilled and 101(50.5%) were skilled. This is different from values of some other authors especially in some other parts of Nigeria where the percentage of tertiary education is lower, unskilled and primary education is higher5. The reason may be due to the cosmopolitan nature of Lagos where the study was carried out.
In this study, all women reported having some knowledge about ultrasonography no matter the level of education or occupation. However, knowledge level varied depending on the level of education. 34(17.5%) respondents believed that ultrasonography helped to determine abnormalities in early stage of pregnancy while 3(1.5%) said it helped to determine if it were twin pregnancy. The source of knowledge of ultrasonography in the respondents varied, the basic factors influencing the knowledge include radio, television programmes, newspapers in women with higher educational status and friends with peer group influence is higher in women with lower educational status (Table:3 ). This is similar to the results of other authors with the findings obtained in Naguru Health Center in Uganda about source of pregnant women knowledge on prenatal ultrasonography3.
Majority 190(95.0%) of the respondents did ultrasonography based on their doctor’s request, 150(75.0%) did one recommendation by colleagues, while 119(59.5%) did it during pregnancy on their personal conviction (Table: 5).
The compliance of pregnant women to do ultrasonography may be explained by the perceived benefits the women expect to get from the examination, like fetal sex, expected date of delivery among others. A larger proportion 102(51.0%) were aged between 25 to 35years (Figure: 1) falling in the range of primigravidae who are curious and women with two or three children are more likely to duly opt for ultrasonography to determine the sex of the fetus. This may be due to excitement of mothers at the first time for primigravidae while having a desire for a particular sex of child they have not had before in other to prepare for the baby in advance in multigravidae. This finding is similar to what Adewuya et al6 reported in their study that multigravidae women were more likely opt for ultrasonography simply to know the sex of their fetus as oppose to primigravidae women.
Further more, larger proportion of pregnant women reported a positive psychological reaction to prenatal ultrasonography. Most of the respondent’s value (94.0%) indicated that their doctors communicated with them during ultrasonography which differs from the study done by Bashour et al7 where patients complain of lack of communication with the doctors. Value 97.0% wished they received results immediately after an investigation (Table: 7).
This study also uniquely brings out an important issue; some respondents 9.0% believe ultrasonography can cause cancer and 13.0% believe that ultrasonography is dangerous to their fetus. These psychological reactions run across from the illiterate to the literate ones which are similar to the work of Gonzaga et al3. This psychological reaction of the respondents needs to be urgently addressed in Lagos University Teaching Hospital, Lagos, Nigeria and probably globally. However, the findings herein are useful to all health workers and policy makers as well as opening a way for further research in this area.
Conclusion
Prenatal ultrasonography has been embraced as being a vital part of prenatal care. A large percentage of respondents have heard about prenatal ultrasonography and duly opt for it. However their interpretation on what ultrasonography entails varied greatly with a lot of them having little or no knowledge about ultrasonography. The perception of 9% or 13% of pregnant women who believe ultrasonography could lead to cancer or dangerous need to be addressed so that healthcare provider and pregnant women appreciate the value and harmless/ safety of the prenatal ultrasonography.
Recommendations
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Considering the psychological reaction and perceptions of pregnant women, to prenatal ultrasonography. The following recommendations are suggested:
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Results of ultrasound examination conducted should be made ready for prompt collection by the patient immediately after examination.
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Advocacy by the health workers and hospital authorities for the inclusion of health education programmes on prenatal ultrasonography.
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Use of flayers and postal’s in different local languages
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Increased utilization of mass media by the government and nongovernmental organizations