Factors Associated with Birth Preparedness and Complication Readiness Among Pregnant Women in Bench Maji Zone, Southwest Ethiopia: A Community-Based Cross-Sectional Study (2024)

Abstract

Keywords: Birth preparedness, complication readiness, pregnancy, women, Ethiopia

Introduction

Birth Preparedness and Complication Readiness (BP/CR) is considered as preparation for normal birth and readiness to take emergency actions when needed which is important for safety and healthiness of mothers and newborns during pregnancy, labor and child birth, and post-partum. Any pregnant woman is at risk to develop pregnancy complications which are not predictable, and that can cause morbidity or mortality of both mothers and her newborns (1,2).

The policies support that all pregnant women must get maternal and neonatal health care. The health care system also guarantees that all health care providers who give service for pregnant women and their families must have the abilities to support woman in birth preparedness and complication readiness (3).

More than 40% of pregnant women may develop acute obstetric complication, globally. The WHO estimates that 300 million women in low income countries suffer from short-term or long-term complications related to pregnancy and childbirth (3). In 2008, 52% of maternal deaths out of 342,900 occurred in sub-Saharan Africa. Inadequacy or lack of birth preparedness and complication readiness is among the main reasons of maternal deaths, which is an important component of globally accepted programs of safe maternal health. Birth preparedness and emergency readiness helps the women to be attended by professionals when labour begins and decreases delays that occur when mothers develop obstetric complications (4).

Apart from medical causes, there are many interrelated socio-cultural factors which delay careseeking and contribute to maternal deaths, because of non-preparation. Thus BP and CR is one of the interventions that address these delays by encouraging pregnant women, their families and communities to effectively plan for births and deal with emergencies, if they occur(5).

The approach of BP/CR has been encouraged in many African countries at the level of mother, family and community to prvent home delivery and potential complications. This approach includes identifying a health facility for emergency, trained birth attendant for delivery, attainment of sterile/clean materials (blade, soap, cord ties, clean linen), saving money for delivery, arranging transportation to a facility, and planning for referral if needed and also ensure women to be informed of danger signs.

However most of pregnant mothers and their families are not aware about how to recognize the danger signs of complications. The unprepared family will waste time in getting organized, getting money, recognizing the complications, reaching the appropriate referral facility and finding transport (2,6,7).

Generally, BP/CR significantly reduces maternal mortality and morbidity. Ethiopia is among the low income countries, in which maternal mortality ratio is 412 deaths per 100,000 live births (8), it is important to have up-to-date information about birth preparedness and complication readiness and its associated factors for policy makers and program implications at different levels. However, studies on this issue are not sufficient in Ethiopia, especially in the study area (Bench Maji Zone), this study was planned to fill this gap.

Methods

Study area and period: This study was conducted in Bench Maji Zone from December 01 -30/2016. Bench Maji is one of the zones found in the Ethiopian Southern Nations, Nationalities and Peoples Region (SNNPR), 565km away from the Addis Abeba. The zone consists of one administration town and ten woredas. According to the Zonal Health Department report of 2015, the zone had estimated population of 829,493; of them 181,974 were women of childbearing age, and there were about 28,700 expected pregnant women (9).

Study design: A community-based cross-sectional study design with quantitative methods of data collection was used.

Source and study population: All pregnant women in Bench Maji zone were source of population. All sampled pregnant women in the selected woredas were study population.

Inclusion and exclusion criteria: All pregnant women in selected kebeles with gestational age of ≥ 16 weeks and those who lived in the kebeles for six or more months were included in the study. Pregnant women who were critically ill and mentally incapable to communicate were excluded from the study.

Sample size determination and sampling technique: Sample size (605) was determined using single population proportion formula with the following assumptions: d = margin of error of 5% with 95% confidence interval, p = proportion of expected prevalence of BP/CR being 23.3%.The multistage sampling was used to select woredas and kebeles. The five woredas were selected by simple random sampling (SRS) technique. Based on source population, the sample size of each woreda was proportionally allocated. From the selected woredas again, the kebeles were selected by lottery method. Then, the sample size was proportionally allocated to each kebeles. Then, systematic sampling technique was used to select eligible pregnant women. The list of pregnant women was taken from health posts of each kebele.

Results

Socio-demographic characteristics of the study participants: Among the total study participants, 258(43.8 %) were age between 25–29 years. Regarding their religion, 261(44.35%) were protestant. Around 576(97.8%) were married by their marital status. More than half, 358(60.8%), of the study participants were rural residents.

Regarding educational level, 236(40.1%) of the respondents were not able to read and write. The majority, 400(67.9%) of the respondents were housewives and more than half 371(63%) respondents had less than four family size (Table 1).

Variables related to obstetrics: Regarding the gravida of the mother, more than half 346(58.7%) were 2–4, and the majority 451(76.6%) of them were multiparous. Concerning the status of current pregnancy, 526(89.3%) were wanted, and almost half 308(52.3%) of them were on the third trimester during interview. Among the respondents, 22(3.7%) had history of stillbirth, and 36(6.1%) had history of abortion (Table 2).

Knowledge of respondents about birth preparedness and its complication readiness: In this study, the majority, 572 (97.1) of the respondents had information about birth preparedness and complication readiness. The primary source of information about birth preparedness and complication readiness, 494(85.8%) were health extension workers followed by health professionals 278(48.3%).

Regarding the knowledge of respondents about birth preparedness and its complication readiness, 502(85.2%), 403(68.4%), 273(46.3) and 44(7.5%) knew identification of place of delivery, identification of skilled birth attendant, saving money and arranging blood donor respectively. From the total score of knowledge, 285(48.4%) of the respondents were identified as knowledgeable about BP/CR (Table 3).

Knowledge of key danger signs during pregnancy, labour and child birth, and postpartum: Severe vagin*l bleeding, swollen hands/face, blurred vision, high fever, severe abdominal pain and severe headache were the six main danger signs during pregnancy that were spontaneously mentioned by 529(89.8%), 285(4948.4%), 238 (40.4%), 260 (44.1 %), 205(34.8 %) and 270(45.8%) respectively. However, all the six key danger signs during pregnancy were spontaneously mentioned only by 86(14.6 %) respondents.

The four key danger signs during labor and delivery (severe vagin*l bleeding, prolonged labor (>12hrs), convulsions and retained placenta) were spontaneously mentioned by 486 (82.5%), 206 (35.0%), 177(30.1%) and 265(45.0%) respectively. Few of the respondents, 47(8.0%), were able to answere all the four key danger signs during labour and delivery spontaneously. The three key danger signs during postnatal period (severe vagin*l bleeding, foul smelling vagin*l discharge and high fever) were spontaneously mentioned by 539(91.5%), 189(32.1) and 227(38.5%) respectively. However 132(22.4%) women were able to mention all the three crucial danger signs during post-partum spontaneous.

The overall knowledge on danger signs, 329(55.9%), 145(24.6%), and 257(43.6%) of the respondents were found to be knowledgeable on obstetric danger signs during pregnancy, labor and childbirth and postpartum respectively (Table 4).

Antenatal care experience and history of previous delivery: Almost all, 575(98.0%) of the respondents attended antenatal care (ANC) at least once in their current pregnancy. Among those pregnant women who attended ANC, the majority 498(86.6%) had 1–3 visits while 77(13.4%) had more than three visits.

Among pregnant women who attended ANC, most of them 567(98.6%) received advice from care providers on the components of birth preparedness and complication readiness. Accordingly,502(87.8%) of them adviced where to deliver, 406(71.0%) identifying skilled birth attendants, 294(51.4%) on saving money for delivery and emergency, 133(23.3%) on mode of transportation, 94(16.4%) on the identifying decision maker and support person, 373(65.2%) on danger signs, 321(56.1%) on the preparation of items for delivery and 37(6.5%) on arranging blood donor in case of emergency.

Among the study participants, 452(76.7%) gave birth previously. Among those who had delivery in the past, more than have, 289(63.8%), of the respondents gave recent birth in health facility, and 164(36.2%) gave recent birth at home. Among the respondents who had delivery in the past, the recent birth were attended by 286(63.3%) skilled birth attendants, 33(7.3%) trained traditional birth attendants, 33(7.3%) untrained traditional birth attendants and 100 (22.1%) family member/neighbor/self. Among those who had at least one delivery in the past, during their recent pregnancy, 391(86.5%) had at least one ANC visit, and more than half of the respondents, 250(63.6%), had 1–3 visits and 143(36.4%) had more than three visits.

Practices of birth preparedness and complication readiness: Majority 563(95.6%) of the respondents reported that they made at least one arrangement for birth and ready for complication. Among the eight elements of BP and CR practice, 493(83.7%) of respondents were identified place of delivery, 397(67.4%) planned to be attended by skilled attendant for their current pregnancy, 266(45.2%) were started saving money and 335(56.9) were started preparation of essential items for child birth. Birth preparedness and complication readiness score was computed from components of BP/CR. Then categorized as well prepared if the woman scored four or more out of the eight BP/CR elements. Accordingly, out of the total, 249(42.3%) of the pregnant women in this study were considered as well prepared for birth and complications (Table 5).

Factors affecting birth preparedness and complication readiness: The binary logistic regression analysis was done to see the association between the dependent and the independent variables and to identify the candidate variables for multivariable logistic regression. Among the candidate variables for multivariable logistic regression, which were analyzed with bivariate logistic regression; Residence, Educational status of mother, Occupational status of mother, Family size, Gravida, Parity, Trimester during interview, Having Information, Knowledge of BP/CR, Danger sign during Pregnancy, During Labour and Delivery, During Post Natal and Previous delivery.

In multivariable logistic regression analysis, factors associated with BP/CR were identified. Accordingly, Residence, Occupational status of mother, Knowledge of BP/CR and Knowledge of danger sign During Pregnancy were statistically associated with BP and CR practice. Women from urban residence (OR = 2.0; 95%CI: 1.2–3.2) were more likely to be prepared for birth and its complications. Women who were employed (Gov't, NGO) (OR=3.2; 95%CI: 1.2–8.1) were more likely to be prepared as compared to women who were housewives.

Women who knew at least four components of BP/CR (OR=12.6; 95%CI: 7.5–21.4) were more likely prepared for BP/CR as compared to the women who were not knowledgeable. Similarly, women who were knowledgeable about key danger signs during pregnancy (OR=1.9; 95%CI: 1.1–3.3) were more likely prepared as compared to those not knowledgeable (Table 6).

Discussion

The practice of birth preparedness and complication reediness in this study was 42.3%, which shows low proportion of the respondents' preparedness for birth and its complications. This points out that high proportion of the pregnant women did not receive the crucial strategy that highly reduces maternal and infant mortality and morbidity by enhancing preparedness for birth and its complication.

The finding of this study is lower than the study done in India which was 47.8% (5) and Dire Dawa at Dilchora Referral Hospital that was 54.7% (13). The difference of this finding with the study in India might be due to the deference in facility, access to information and life style of the people among the countries. The difference with the study in Dire Dawa is due to the fact that the former study was done at hospital in which most of the respondents might have been from the urban and inhabitants near to the town. Therefore, it is known that the respondents from the town and around the town get information about the BP/CR to seek for healthcare.

On the other hand, the finding of this study was higher than the study conducted in Ethiopia; Gurage zone Abeshige district, which was 37.2% (14), Goba woreda which was 29.9%(10) and Jimma Zone 29.4% (11). The difference might be due to the time, the former studies were conducted before years. Therefore, it is obvious that the current quality of healthcare and availability of information about the BP/CR is not the same as the previous years.

In this study, the most commonly practiced elements of BP/CR were identification of place of delivery (83.7%), identifying skilled birth attendants (67.4%). And also 56.9% of respondents identified and prepared needed items for birth, 56.9% were ready by identifying danger signs and 45.2% saved money. It is nearly similar to the study conducted in India which indicated that 69.6% of the mothers identified a trained birth attendant for delivery, 63.8% of the mothers identified a health facility, 76.9% saved some money (5). A study in Ethiopia, Gurage Zone, showed that 95.1% of women made decision on place of delivery, 65.9% saved money, 50.1% identified skilled birth attendants (14). In Dire Dawa, 98.0% respondents reported having identified their place of delivery, 75.7% identified their skilled birth attendant, 63.9%) saved money (15). However, 17% planned to identify mode of transport, 13.4% decision maker and support person, and 5.6% planned to prepare blood donor which was still very low. These low levels of preparations were also stated in other previous studies in the country. The study conducted in Arsi Zone, Robe Woreda showed that 28.5% identified a mode of transportation (16), and in Ahmara Reginal State in Basoliben District, 7% arranged blood donors (17). In this study, being urban resident increases the likelihood of birth preparation and its complication readiness practice by two times. This finding is similar with previous studies in Ethiopia (10,11).

This might be justified by the fact that women in urban areas had access to health information through different media, contact with health professionals working in health centers and hospitals. Relatively low barriers to health information due to distance and lack of transportations as compared to the rural women.

The women who are employed in the governmental organization and none government organization were increased the likelihood of preparation for birth and its complication by three times as compared to house wife women. Even though there is no literature support our findings. The reasons could be, that mothers employed in the governmental and none government organization were educated mothers, and also in most cases, live in the urban area. Being educated and living in urban areas increase the understanding of obstetric complications and chance access health information regarding BP/CR, which enables them to be prepared for birth and its complications.

In this study, having knowledge of BP/CR and knowledge of danger signs during pregnancy were more likely practice BP and CR by 13 and 2 times respectively. This findings are consistent with previous studies in the country (11–17). The implication of this finding could be when women become knowledgeable about birth preparedness and its complications, and danger sign during pregnancy, they are likely to practice the components of birth preparedness and also they can be ready to act upon it when any pregnancy, labour and child birth complications occur. However in this study, knowledge of danger signs during labour and child birth, and post-partum did not have statistically significant associations with BP/CR.

As strength, this study was conducted in the community as a zone with sufficient sample size. On the other hand, this study may have its own limitation because of its cross-sectional nature to ascertain temporal relationship. In addition, dichotomizing BP/CR component and dander sign components may have its own limitations in identifying cut-off points. Possible efforts were made to use standard and as many variables as possible to make them objective.

The finding of this study revealed that the level of knowledge of key danger signs and the status of birth preparedness and complication readiness were still found to be low. Place of residence, occupation (governmental and nongovernmental organization), having knowledge about BP and CR and having knowledge about danger sign during pregnancy were the factors associated with birth preparedness and complication readiness.

Acknowledgments

We would like to express our deepest gratitude to our data collectors, supervisors, zonal health department, woreda health office and study participants for their valuable contribution in the realization of this study. And also we would like to thank Mizan-Tepi University for your budget grant.

References