ASSESSING THE ROLE OF COMMUNITY HEALTH EXTENSION WORKERS (CHEWS) IN ENHANCING SKILLED BIRTH ATTENDANCE AND POSTNATAL CARE IN IKOT EKPENE LGA.

TOPIC IS SUITABLE FOR:
1-Department of  Nursing Science
2-Department of Community Health
3-Department of Public Health
4-Department of Health Education

TOPIC: ASSESSING THE ROLE OF COMMUNITY HEALTH EXTENSION WORKERS (CHEWS) IN ENHANCING SKILLED BIRTH ATTENDANCE AND POSTNATAL CARE IN IKOT EKPENE LGA.

TABLE OF CONTENT
Abstract
CHAPTER ONE: INTRODUCTION
1.1 Background of the Study
1.2 Statement of the Problem
1.3 Objectives of the Study
1.4 Research Questions
1.5 Significance of the Study
1.6 Scope of the Study
1.7 Definition of Terms
CHAPTER TWO: LITERATURE REVIEW
2.1 Conceptual Framework
2.2 Theoretical Framework
2.3 Empirical Review
2.4 Summary of Literature Review
CHAPTER THREE: RESEARCH METHODOLOGY
3.1 Research Design
3.2 Area of the Study
3.3 Population of the Study
3.4 Sample and Sampling Techniques
3.5 Research Instrument
3.6 Method of Data Collection
3.7 Method of Data Analysis
3.8 Validity of the Study
CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS
4.1 Presentation of Data
4.2 Analysis of Research Questions
4.3 Summary of Key Findings
CHAPTER FIVE: SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
5.1 Discussion of Findings
5.2 Summary
5.3 Conclusion
5.4 Implications for the Profession
5.5 Recommendations
5.6 Limitations of the Study
5.7 Suggestions for Further Studies
References
Appendix

ABSTRACT
This research work assessed the role of community health extension workers (CHEWs) in enhancing skilled birth attendance and postnatal care in Ikot Ekpene Local Government Area (LGA). The aims of the study were to determine the level of engagement of CHEWs in the promotion of skilled birth attendance, the role of the CHEW in improving postnatal care services, their effectiveness in improving maternal and newborn health outcomes and to identify the challenges in the performance of these roles. The research design used in this study was a descriptive survey research design. The population consisted of 232 Community Health Extension Workers (CHEWs) who worked in the public primary health facilities in Ikot Ekpene LGA. The sample size was calculated by Taro Yamane formula, from which 147 questionnaires were distributed, 141 were retrieved via a validated questionnaire, which was equivalent to a response rate of 96%. Questionnaire: The questionnaire was designed on a five-point Likert scale from Strongly Agree, Agree, Undecided, Disagree and Strongly Disagree and collected the data. Frequency distribution was used to provide the method of data analysis. The results showed that CHEWs are important in facilitating skilled birth attendance as 128 respondents acknowledged that they are actively involved in promoting maternal health and antenatal services. Similarly, 130 respondents also agreed that their postnatal visits have significantly increased the access to the new mother's care, and 126 respondents also confirmed that their health education activities had improved maternal and neonatal outcome. However, challenges were identified by 125 respondents including poor logistics, lack of training and bad incentives. Based on these findings, the study suggested that government and health agencies should equip CHEWs with good logistics, regular training and better welfare packages to enhance their capacity and effectiveness in the delivery of maternal and postnatal healthcare. The paper concludes that it is necessary to empower CHWs in order to ensure sustainable progress in maternal and child health care in Nigeria.

CHAPTER ONE
INTRODUCTION (Preview)
1.1 Background of the Study
Mothers and babies have remained a key theme of public health discourse throughout the world, particularly in low and middle-income countries where maternal mortality and morbidity rates remain relatively high. The World Health Organisation has said that skilled birth attendance and postnatal care (PNC) are crucial strategies in preventing preventable maternal and neonatal deaths. According to Shikuku et al. (2020), community-based maternal healthcare has been successful in establishing a link between the home and the healthcare centre because it is especially successful in resource-constrained environments. Similarly, Yaya and Bishwajit (2020) imply that CHWs have an important role in maternal health by education and promoting the use of skilled birth services through the frequent contact with women of reproductive age. In confirmation, Fulcher et al. (2020) state that utilising community-level interventions is a great way to raise the rate of delivery at facilities by increasing awareness and confidence in formal health care systems.
The contribution of community health workers to maternal health care is now widely accepted as a game changing approach to achieve universal health coverage and improve the maternal health. Gebretsadik et al. (2020) stated that the community-based maternal and neonatal care programmes have been expanded to increase early detection of pregnancy-related complications and increase birth preparedness in rural communities. Tesfau et al. (2020) further argue that home visits by trained community health personnel in the postnatal period has substantial effect on the use of maternal and newborn health services by the critical 48-hour period after delivery. In support of this, Burnett-Zieman et al. (2021) claim that community health interventions ensure quality postnatal care to prevent neonatal deaths because mothers and their newborns get timely follow-up services. Altogether, these results add to the global agreement on the critical role of CHWs in improving maternal and child health indicators.
In sub-Saharan Africa, there has been a lot of attention paid to the role of community health extension workers (CHEWs) in facilitating provision of skilled birth attendance and postnatal care. Tougri et al. (2023) stress that CHEWs are important linkers between the health system and rural populations, guaranteeing the continuity of care from pregnancy to postnatal. Furthermore, according to Tantu and Hadaro (2022), the participation of HEWs in PNC enables maternal awareness of health, health-seeking behaviour, and also enhances community trust in the formal health institutions. According to Moyo et al. (2024), organised postnatal care schemes conducted by CHEWs are critical in enhancing the experience of women in postpartum period hence promote adherence to health services. Taken together, these data suggest the need to build upon the community-level health systems in order to support effective maternal and neonatal care practises.
When linked to maternal health outcomes, Oyedele et al. (2023) say that part of the solution to improving the continuum of maternity care from the antenatal to the postnatal lies in the availability and quality of community-based services. Olajubu et al." (2022) confirm this assertion and state that the formal training of health workers has a positive impact on the health workers competence relating to the provision of standardised postnatal services. Furthermore, Esan et al. (2023) show that the more trained community workers are engaged in postpartum education of mothers, complications such as postpartum haemorrhage which is one of the major causes of maternal mortality are reduced. Further, Ogbuabor and Nwankwor (2021) state that person-centred maternity care, which is mostly provided by CHEWs, promotes satisfaction and the continuity of skilled care use during the reproductive cycle. Therefore the combination of skilled birth attendance and postnatal follow-up services is part of a wider approach to the provision of sustainable maternal health.
At the national level in Nigeria, the country is currently building up to strengthen the primary healthcare system by introducing CHEWs to provide maternal and newborn service at the frontline. Nyqvist et al. (2022) concluded that community health educators have an important role in behavioural change and safer childbirth practises especially in the rural communities. Similarly, Eze et al (2020) point out that neighbourhood based maternal interventions promote collective responsibility and improves women's preparedness for delivery and postnatal care. Fasawe et al. (2020) also argued that client-focused approach which is commonly operationalized by CHEWs, improves maternal satisfaction and continuity of care in the network of care. Similarly, Adefala et al. (2024) postulate that the availability of trained health extension workers in rural and semi-urban areas has increased the possibility of women giving birth under skilled attendance, which is in line with the general objective of Nigeria to reduce maternal mortality.
Focusing on Akwa Ibom State, specifically, Ikot Ekpene Local Government Area (LGA) is where the role of CHEWs have become very important in bridging the gaps in maternal healthcare. According to David et al (2024), community health practitioners in South- South Nigeria have demonstrated a great deal of knowledge and commitment to promote safe delivery practises. Furthermore, Osuchukwu et al. (2024) argues that the frequent contact that takes place between mothers and trained health personnel leads to more utilisation of postnatal services leading to better maternal and neonatal health. Similarly, Ononokpono et al (2020) point out the geographical disparities in the use of postnatal care in Nigeria and the importance of local interventions that tap into community health structures. Therefore, the evaluation of CHEWs in providing good quality skilled birth attendance and postnatal care in Ikot Ekpene LGA gives a relevant context through which to better understand and strengthen the effectiveness of community-based interventions in maternal health care in Nigeria.

1.2 Statement of the Problem
Despite various reforms in the health system, maternal and neonatal health in Nigeria are still below the standard provided by the world and the unnecessary loss of lives continues. According to a 2023 research conducted by Oyedele et al, the number of women in Nigeria who are able to complete the continuum of maternal care (from antenatal visits to skilled delivery to postnatal follow up) is very few, and as a result, opportunities of early detection and management of complications have been missed. The World Health Organisation recommendation to ensure that all births are attended by skilled health personnel and that postnatal care is delivered within 48 hours of delivery is not being optimally realised in many low resource settings (Hailemariam et al., 2024). In Nigeria, Bolarinwa et al. (2021) found several factors including socioeconomic inequalities, cultural preferences and proximity to health facility as hindrances to the provision of a skilled care to women. Ideally, every woman should have access to quality, continuous and community-friendly services related to maternal health but according to Tunde (2023) in rural and semi-urban communities such as that of southern Nigeria, the access and continuity of health care is intermittent and preventable maternal and neonatal complications occur.
But more is needed to know just how effective Community Health Extension Workers (CHEWs) are on the ground in increasing skilled birth attendance and utilisation of postnatal care. Although several studies by Tougri et al (2023) and Tesfau et al (2020), have shown that health extension programmes have been associated with a significant improvement in health of mothers and newborns in other African settings, local evidence from specific Nigerian settings are lacking. In particular, Ovaioza (2025) posits that shortfalls in the provision of postnatal services is in the disparity of capabilities and engagement of community health personnel across the local government areas. While the CHEWs have been in place in Ikot Ekpene LGA based on the primary health care philosophy, their level of participation and effectiveness in promoting skilled delivery and postnatal care have not been empirically ascertained. This, therefore, is a research that is aimed at addressing this gap by objectively appraising the community health extension workers in enhancing skilled birth attendance and postnatal care in Ikot Ekpene LGA, with a view to contribute to evidence-based interventions for enhancing maternal and new-born health outcomes in Nigeria.
1.3 Objectives of the Study
The general objective of this study is to assess the role of Community Health Extension Workers (CHEWs) in enhancing skilled birth attendance and postnatal care in Ikot Ekpene Local Government Area (LGA).
The specific objectives are to:
1.Assess the level of involvement of Community Health Extension Workers (CHEWs) in promoting skilled birth attendance in Ikot Ekpene LGA.
2.Examine the contribution of CHEWs to improving access to postnatal care services among women in Ikot Ekpene LGA.
3.Evaluate the effectiveness of Community Health Extension Workers in improving maternal and newborn health outcomes in Ikot Ekpene LGA.
4.Identify and evaluate the challenges faced by CHEWs in enhancing skilled birth attendance and postnatal care services in Ikot Ekpene LGA.
OTHER PARTS OF CHAPTER ONE INCLUDE:
1.4 Research Questions
1.5 Significance of the Study
1.6 Scope of the Study
1.7 Definition of Terms

CHAPTER TWO
LITERATURE REVIEW (Preview)
This chapter critically examines relevant literature that would assist in explaining the research problem and, furthermore, recognizes the efforts of scholars who had previously contributed immensely to similar research. The chapter intends to deepen the understanding of the study and close the perceived gaps. This chapter, therefore, focuses on the concept of community health extension workers (CHEWs), the concept of skilled birth attendance, postnatal care, roles of CHEWs in skilled birth attendance, roles of CHEWs in postnatal care, challenges affecting the effectiveness of CHEWs, etc. The chapter covers the following subheadings:

2.1 Conceptual Framework
2.2 Theoretical Framework
2.3 Empirical Review
2.4 Summary of Literature Review

CHAPTER THREE
RESEARCH METHODOLOGY (Preview)
Research Design: The study adopted a descriptive survey research design.
Population of the Study: The population of the study comprises all Community Health Extension Workers (CHEWs) working in public primary healthcare facilities in Ikot Ekpene Local Government Area.
Sample Size Determination: The study adopted the Taro Yamane formula to determine a sample size of 147 participants.
Sampling Technique: The study employed a simple random sampling technique to select the individual respondents.
Research Instrument: The study utilized a structured questionnaire as the instrument for data collection.
Methods of Data Analysis: The collected data were analyzed using frequencies and percentages to summarize and present the demographic characteristics of the respondents and their responses.

CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS
MAJOR FINDINGS (Preview)
The analysis results were presented in tables. Based on the results obtained from the analysis, the following findings are made:
i. The study found that Community Health Extension Workers (CHEWs) are highly involved in promoting skilled birth attendance in Ikot Ekpene LGA, as evidenced by the high number of respondents who agreed to their involvement in health education, antenatal care activities, community mobilization, collaboration with traditional birth attendants, and follow-up visits to expectant mothers.

ii. The study found that Community Health Extension Workers (CHEWs) make significant contributions to improving access to postnatal care services among women in Ikot Ekpene LGA, as evidenced by the high level of agreement on their involvement in postnatal home visits, exclusive breastfeeding education, immunization and postnatal check-ups, identification and referral of complications, and community outreach programmes.

iii. The study found that Community Health Extension Workers (CHEWs) are effective in improving maternal and newborn health outcomes in Ikot Ekpene LGA, as evidenced by the high level of agreement that their interventions reduce maternal complications, improve early detection of newborn health problems, enhance women's knowledge of maternal care practices, strengthen collaboration with health professionals, and increase community trust in maternal and newborn health services.

iv. The study found that Community Health Extension Workers (CHEWs) face several challenges in enhancing skilled birth attendance and postnatal care services in Ikot Ekpene LGA, as evidenced by the high level of agreement that inadequate logistics and medical supplies, lack of regular training and supervision, high workload and insufficient staffing, cultural beliefs and practices, and inadequate incentives and poor working conditions hinder effective service delivery.

CHAPTER FIVE: SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
This chapter covers the following outline:
5.1 Discussion of Findings
5.2 Summary
5.3 Conclusion
5.4 Implications for the Profession
5.5 Recommendations
5.6 Limitations of the Study
5.7 Suggestions for Further Studies
References
Appendix

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