Survey of Reproductive Health Information Seeking Behaviour among Pregnant Women in Some Selected Hospitals in Kano Metropolis, Nigeria

Health professionals and health workers target different
categories of people using sources of information including
the mass media of communication...


Introduction
Health professionals and health workers target different categories of people using sources of information including the mass media of communication. McQuail [1] describes mass media as the organized means for communicating openly and at a distance to many receivers within a short space of time. Radio as one of the mass media, is one of the cheapest medium, which is used to transfer information to target audiences especially in the developing nations, such as Nigeria. State owned-radio station presents news and information, using local language, which make it easier for the people in that locality to understand the message presented to them, that is why health professionals and health workers use radio as one of their media in which they enlighten the public especially women on its activities. These programs are mostly sponsored by organizations like World Health Organizations (WHO), United Nation International Children Emergency Fund (UNICEF) or non-governmental organizations like Maternal and Neonatal Child Health 2 (MNCH2), among others. These programs mostly target women and children due to the fact that they are more vulnerable when it comes to the issue of health, therefore information on reproductive health is provided to them.
Information is a major resource that is needed in every sphere of life endeavour especially in health matters. Information assist in reducing the degree of uncertainty and ignorance in the operating environment, therefore the quality of information a pregnant women receives enhances her rightful choice of health care on reproductive health. Pregnancy is a period of substantial physical and role change for women, which is also a time when health related behaviours are more salient because they affect DOI: 10.26717/BJSTR.2020. 30.005006 the pregnant mother as well as the developing fetus [2]. Getting information during pregnancy can improve the health knowledge of the expectant mother [3]. Substantial information can help pregnant women to communicate with health service providers, demonstrate preventive health care behaviours, and improve selfcare abilities. The information provides them with the opportunity to learn about their pregnancy, childbirth, parenting, and in case of any potential health problem, will be diagnosed and treated at early stage. For pregnant women to adequately live a healthy life and ensure the safe delivery of their babies, they need to search and acquire information necessary for healthy living.
The search for information, however, starts with the identification of a gap in knowledge for which the individual makes an effort to bridge. According to [4] information need occurs whenever an individual's knowledge fails. Saleh [5] states that the most paramount health information required is antenatal and postnatal care, how to safely deliver pregnancy and immunizations especially on the six childhood killer disease, which are polio, whooping cough, tetanus, diphtheria, measles, and tuberculosis.
Wilson [6] notes that in the course of seeking information, an individual may interact with manual information in the form of newspaper or a library or with computer based systems, such as web. Information can be derived from a variety of sources, including books, journals, the internet, family or relatives, and persons at the work place (Doctors or paramedical staff in antenatal clinics for pregnant women). UNICEF [7] observed that in the poorest parts of the world, the risk of a women dying as a result of pregnancy or childbirth during her lifetime is about one in six compared to about one in 30,000 in Northern Europe. India being a developing country contributes 26% of the global burden of maternal deaths with nearly 136,000 women dying annually due to causes related to pregnancy and childbirth. Udofia, et al. [8] observed that Africa accounts for the highest burden of mortality among women and children in the world. Oyedele [9] affirms that Nigeria ranks high among the list of countries with high maternal and infant mortality rates with a ratio of 545 per 100,000 live births on the maternal mortality index, therefore, such revelation makes it necessary to study the reproductive health information seeking behaviour among pregnant women as this will create more awareness of maternal health care issues.
Poor reproductive health is one of the barriers to development, affecting the health status of humans in the developing world, women are the most vulnerable groups to the consequences of poor reproductive health, and they face many reproductive health threats including pregnancy complication, sexually transmitted infection (STIs) and HIV/AIDS. Reproductive Health encompasses a wide range of events and conditions, which take place throughout the life span. Globally, more than half a million women die of complications due to pregnancy, child birth and postpartum period annually. Kistiana [10] noted that about 99 percent (533,000) of these deaths occur in developing regions, with sub-Saharan Africa and Southern Asia accounting for 86 percent of maternal deaths.
In sub-Saharan Africa, it is estimated that 30 women die from complications of pregnancy and childbirth every hour of each day [11] . In other words, about 270,000 maternal deaths occur every year. Furthermore, the lifetime risk of maternal mortality in Africa is 1 in 26 [12]. About 125,000 women and 870,000 newborn babies on the continent die annually in the first week after delivery [13], and more than two thirds of maternal deaths occur after delivery.
Warren, et al. [13] found that 30 to 50 maternal morbidities occur for each maternal death.
The World Bank's estimate of 630 per 100,000 maternal mortality ratio suggests that the maternal health situation for women in Nigeria is quite poor [14]. With an estimated 59,000 maternal deaths annually, Nigeria contributes 10 percent of the world's maternal deaths [15]. Metiboba [16] [17]. The situation is even more critical in Northern Nigeria, where strong cultural and religious beliefs and practices involving childbirth contribute significantly to maternal morbidity and mortality. Scholars like [10,18] have linked the high maternal mortality ratios to the inaccessibility of health services, lack of functional and effective health care systems, and more importantly, the non-use of modern maternal health care services, such as antenatal care, delivery care and postnatal care, that is why reproductive health information should be provided to pregnant women in order to reduce the number of deaths to occur, therefore, within this context, the study is conducted in order to survey the reproductive health information seeking behaviour among pregnant women going for antenatal in some selected hospitals in Kano Metropolis.
Infertility on the other hand is found both in men and women but it is a particular burden in women. Such pressure to reproduce is intense in agrarian societies, which have a high demand for labour.
Just as beliefs and practices regarding fertility and culturally patterned, birth itself is a cultural production as noted by [20].
Gazali, et al. [21] identified low self-esteem and socio-demographic factors as among the problems faced by women when seeking information.
They state that there are many challenges women face in order to access health and maternity information. The social and economic status is another contributing factor in this country where poverty levels have increased in previous years, also the physical access, cost and lack of ability to use information and illiteracy, has made it impossible for illiterate women especially having easy access to information relating to women's health and maternity issues. A study conducted by [22] revealed that the barriers to accessing information include the use of medical terminology by the information source, which the information seeker may not understand. Furthermore, [23] also affirm that low

The Basic Tools of Scientific Inquires
Based on the problem statement, the following research questions are set:

1.
What are the sources of reproductive health information used by pregnant women in Kano metropolis?

2.
How useful were the sources of maternal information to pregnant woman in Kano metropolis?

3.
How early do pregnant women attend antenatal clinics?

4.
What are the outcomes of antenatal information seeking behaviour among pregnant women in Kano metropolis?

Sources of Maternal Health Information Used by Women
Davies, et al. [24] conducted a study, which aimed at identifying the main maternity information sources used by Somali women living in the Northern city of United Kingdom (UK), the result showed that women sought and used information from several interpersonal sources, which included their mothers, grandmothers and friends, informal sources were perceived as being approachable and providing a means through which further information could be sought, while each information source was also evaluated according to specific criteria. The study was conducted using instructed exploratory focus group and semi structured interviews with Somali women, all the discussions and interviews were audio taped, translated and transcribed in their entirety and then analyzed using a variation of the theme analysis method. Sources of information emerged as sub-theme from the data. O'Keefe et al. [25] conducted a research on the sources of maternal information used by women, the findings of the research revealed that depending on the nature of information need, different sources are been used to get information. Information from the media are usually the most important ones, like the television, which plays an important role in providing health information.
However, other researches by [24] show that print media are the most important sources of getting health information; these include leaflets from health organization, magazine and newspapers for women, medical books and journals. An older research, which was also conducted on the sources of maternal information used by women was done by [26] the findings of the research was contrary to that of [25] because the result revealed that the major sources of health information was from health practitioners and not media sources. Although, the younger clients in the study suggested that the use of information provided by family members should be the major source of information, five hundred and twenty nine (529) women were targeted; questionnaires and telephone interviews were used to collect data. Akakandelwa [27] states that the format of information is changing as a result of the impact of technology, access to information can be through internet, computers and mobile phones; our environment is changing by an increasing rate due to information technology. This technology provides improved opportunities for accessing information. The integration of information communication technologies (ICT) in people's life has become today the fastest change in the society.

Accessibility of Maternal Health Information by Women
The factors that affected the accessibility to maternal health services are unavailability of health facilities in the slums, high cost of maternal health care, low income levels, long queues and waiting times at modern health facilities and the perception that traditional medicines are more healthy and protective for pregnant mother and babies. Also, [27] findings revealed that women had access to maternal information as a result of attending antenatal clinics, which is a maternity service. The maternal information provides women and their families with appropriate information for a healthy pregnancy, safe childbirth, and postnatal recovery, including care of new born baby, exclusive breastfeeding, and assistance with deciding on future pregnancies in order to improve pregnancy outcomes, therefore an effective ANC package depends on the health care providers in an excellent health system with adequate supplies and laboratory support.

Relevance of Maternal Health Information among
Women O'kereke et al. [28] findings revealed that knowledge of

Information-Seeking Behaviour of Women Attending
Antenatal Care (ANC) Kabir, et al. [29] results showed that the knowledge of antenatal care was better among those that utilized antenatal care than those that did not utilize it; also the result showed that health-seeking behaviour is highly distinctive among poor and rich people. 3,549 women were used as the sample size they were interviewed individually. The women that utilized antenatal care, their information-seeking behaviour was good and those that didn't utilize it their own were bad. Therefore informationseeking behaviour can be affected by psychological and personal factors, such as socio-demographic characteristics. Therefore, one can concludes that behaviour is expressed by the use of different information source. Aaronson, et al. [26] conducted a research which examines information-seeking behaviour among pregnant women in a rural region of New Delhi, India, information needs, perceived barriers, knowledge and direct experience were found to be significant predictors of pregnancy related informationseeking. A mixed method approach and a variant of the sequential mixed method was used to collect data, focus group discussion, interview with key informants, and questionnaire was also used, 165 pregnant women attending antenatal clinics were used as the sample size of the study, the need for increasing low-income, rural women's awareness through innovative means were also pointed out in the study. Also, the need for proper counseling, which is an integral component of antenatal, the findings indicate the high confidence level of women in terms of obtaining information, which may delay their information-seeking until complications arise.
Their information seeking was bad because it was not in line with the medical regulations of antenatal.

Health Information
Jiyane [19] observed that a number of factors create problems when accessing information by any community, but in particular the peri-urban community. Thus, most information access is from the media, such as radio, television, books, magazine, posters, health centers, community groups and clubs. Illiteracy, poverty, unemployment and poor infrastructure, hinder rural community to access information in the peri-urban communities. The findings also reveal that during antenatal care, some women value having access to modern technology. Just as beliefs and practices regarding fertility are culturally patterned, birth itself is a cultural production [20]. Gazali et al. [21] found many challenges women face in order to access health and maternity information. The social and economic status of the country is a contributing factor where poverty levels have increased in the last years. Also, the physical access, cost and lack of ability to use information, that is, illiteracy, which has made it impossible for illiterate women especially having easy access to information relating to women's health and maternity issues.
Glenton [22] found that the barriers to accessing information include the use of medical terminology by the information source, which the information seeker may not understand. Furthermore, Parker et al. [23] also affirm that low levels of literacy and the understanding of medical information constitute to the barriers of health information seeking.

Empirical Review of Previous Studies
Brettell, et al. [20] carried out a cross sectional study, between Bandura [30] identified information relating to baby feeding as an information need of pregnant women. This is particularly so as women often express concern over breast feeding and formula feeding. In a related study, [5] identified antenatal and post-natal care, immunizations especially on the six childhood killer diseases, prevention and management of vascular virginal fistula (VVF), and delivery options as the paramount health information required by rural women. In a research conducted by [26] revealed that major sources of information were health care providers and books.

They concluded that multiple channels of acquiring information
were used by pregnant women. Saleh, et al. [5] affirmed that health care providers were the highest source of information in their study. Rasheed, et al. [31] also identified family and friends, local herb hawkers, local drug sellers (hawkers) and traditional healers as the most utilized information sources.
Guiglani, et al. (1998) found that women sought information from many sources in the first stage of their research. Towards the later stages, specific information from mid-wives was sought.
The authors also outlined various factors influencing HISB, and classified them according to the stages of pregnancy. For example, women in the third trimester were influenced by questions of location, whereas women who had yet to conceive were influence by questions related to conception. Pregnancy, particularly first pregnancy, is a major transition in every woman's life. This is particularly so as a pregnant woman finds herself in a unique and relatively new context, in which she undergoes major physical, psychological, and social transformations. Uloma, et al. [32] state that although pregnancy is exciting, a woman may also experience doubts and uncertainties about her new identity as a potential mother and her life style, which may in turn trigger her to rethink and reconsider a lot of her behaviour, including her nutrition.
Since, high quality nutrition is of extra importance during this period, it becomes one of the few logical moments in a woman's life when it is necessary to rethink nutrition habits. Glanz, et al. [33] findings further affirm that women are more interested in nutrition information during pregnancy than before conception.
Rasheed, et al. [31] found that women had an information need for food in pregnancy, rest, exercise importance of antenatal care, antenatal visits, importance of blood examination and immunization in pregnancy among other things. The result showed that many women were well informed about certain aspects of pregnancy, such as dietary requirements, the need of adequate daily exercise and timing of the antenatal visits. The findings indicate that there is need to reactivate health education programs through the local primary health centers as well as the mass media.
Uloma, et al. [32] investigate health information needs of pregnant women by identifying the major health problems faced by pregnant women and to the extent to which their information needs are met; descriptive survey research design was used for the study. The population consisted of 50 women, the sampling was enumerative.
Structured questionnaire was used for data collection; the data was analyzed using frequency distribution and percentage counts. The result showed that the major problems faced by pregnant were vomiting, lack of appetite, headaches, fear of labour, miscarriages, complication, and hemorrhage. Within the area of channels of information, respondents identified their mothers and the antenatal care givers, followed by their friends as their primary sources of information.

Theoretical Framework
The study is anchored on Health Belief Model and Wilson Model. The health belief model was first developed in the 1950 by social psychologists Houcbaum, Rosenstock and Kegels working in the U.S Public Health Services. This model holds that the response and utilization of disease prevention programs will be predicted on an individual's knowledge of seriousness of the disease, severity of the disease, information benefit of services, and barriers to accessing such services. Glanz, et al. [33] argued that a wide variety of demographic, social, psychological, and structural might also impact people's perceptions and indirectly their health-related behaviours, these factors were later added to connect the various types of perceptions with the predicted health behaviour, it is also a psychological model that attempts to explain and predict health behaviours' by focusing on the attitudes and beliefs of individuals.
This model was used due to the fact that is one of the models of behaviour change typically used for studying and promoting the uptake of health services Becker [34]. Therefore Health Belief Model guides and informs health communication and programs as regards to individual response and utilization of health information [35]. Therefore this model was used on the survey of reproductive health information seeking behaviour among pregnant women in some selected hospitals in Kano metropolis.

Wilson Model. The Model was propounded by Wilson in
1997. This model is based on two main propositions. First, that information need is not a primarily need, but a secondary need that arises out of needs of a more basic kind (defined as physiological, cognitive, or affective); and second, that in the effort to discover information to satisfy a need, the enquirer is likely to meet with barriers of different kinds, these barriers are known as intervening variables according to Wilson. The Wilson Model was recently revised in order to direct attention to certain activating mechanism that may influence the decision to satisfy a need for information or search for it (Figure 1) [36]. Two new theoretical ideas were included in the model. These were: 1.
risk or reward theory, which explains which source of information may be used more than others and 2. social learning theory, which embodies the concept of selfefficacy. Self-efficacy refers to an individual's belief that he or she can successfully execute the behavior required to produce desired outcomes [30]. Thus, Wilson identifies the factors in his model from literature in other fields, including decision making, psychology, innovation, and health communication and consumer research [36].
Therefore, the health belief models is imperative to this study because of its response and utilization of disease prevention programs, which can be predicted on an individual's knowledge of the seriousness of the disease, severity of the disease, information benefit of services, and barriers to accessing such services.
Arguably, the theory provides a wide variety of demographic, social, psychological, and structural might, which impact on people's perceptions and indirectly their health-related behaviours, these factors can be added to connect the various types of perceptions with the predicted health behaviour, it also explains and predict health behaviours' by focusing on the attitudes and beliefs of individuals. Similarly, Wilson's Model is also important in activating mechanism that may influence the decision to satisfy, which information that is search for.

Research Method
This study adopts the positivist approach of data generation Primary Health Care Centers, and one private hospital [38]. This number was generated from the patients' daily attendance register of the following hospitals, which also served as a sampling frame for the study. The breakdown of the hospitals is shown in the table below (Table 1).     [32] found where they identified their mothers, antenatal clinics followed by their friends as their primary sources of information. Among these sources, media sources especially the broadcast media, which plays a significant role in providing reproductive health information. However, it differs from the study carried by [5] which stated that there are basically five sources through which pregnant women satisfy their information needs.
These are: government and its agents, elite groups, relatives and friends, market women and Non-Governmental Organization (NGO).   outcome about their antenatal information seeking behaviour.
The data indicate that 71.6% (n=154) of the respondents believed that their antenatal information seeking behaviour outcome was excellent, 24.7% (n=53) believed that their outcome was good while 3.7% (n=8) believed that their outcome was fair. A similar result was obtained in [20] where majority of the outcomes of antenatal information seeking behaviour among pregnant women were very good.

Conclusion
Reproductive health information seeking behaviour among pregnant women in Kano metropolis play an important role in helping pregnant women understand issues relating to their health and the babies. The findings of the study indicate that the respondents strongly agree that they are satisfied with the information they obtain from antenatal clinics. Apparently, some of the respondents admitted that the information provided to them is very useful and timely too. Therefore, the study articulated that reproductive health practitioners must encourage pregnant women to use other information sources that are readily available which mostly include; family, friends, medical doctors and mass media as well as the internet. Again, reproductive health practitioners should emphasize the importance of attending antenatal clinics on a monthly basis as soon as women become pregnant as this will expose them to a lot of information that will help them with issues pertaining to pregnancy and also avoid complications.
Conclusively, the reproductive health information obtained by the pregnant women is very useful and relevant and able to meet their information needs as pregnant women, the information they received made their pregnancy life easier and understandable to the changes occurring in their body. Recommendations Based on the findings, the following recommendations are made:

1.
Reproductive health practitioners must encourage pregnant women to use other information sources that are readily available, which mostly include family, friends, medical doctors and mass media as well as the internet.

2.
Reproductive health practitioners should emphasize the importance of attending antenatal clinics on a monthly basis as soon as women become pregnant as this will expose them to a lot of information that will help them with issues pertaining to pregnancy and also avoid complications.

3.
For further studies, a comparative study on reproductive health information attitude between rural and urban pregnant women should be conducted.