Determinants of practice of preconception care among women of reproductive age group in southern Ethiopia, 2020: content analysis

Background: Preconception care (PCC) is a series of biomedical, mental, and psycho-social health services provided to women and a couple before pregnancy and throughout subsequent pregnancies for desired outcomes. Millions of women and new-borns have died in low-income countries due to impediments that arise before and exaggerate during pregnancies that are not deal with as part of pre-conception care. To the best of our knowledge, however, there is a lack of information about preconception care practice and its determinants in southern Ethiopia, including the study area. This study was therefore planned to assess the practice of preconception care and its determinants among mothers who recently gave birth in Wolkite town, southern Ethiopia, in 2020. Methods: A community-based cross-sectional study was conducted from February 1 to 30, 2020. A total of 600 mothers who have given birth in the last 12 months have been randomly selected. A two-stage sampling technique was employed. For data collection, a pre-tested, semi-structured questionnaire was used. The data was encoded and entered into Epi-Data version 3.1 and exported for analysis to SPSS version 23. Household wealth status was determined through the application of principal component analysis(PCA). The practice PCC was considered as a count variable and measured as a minimum score of 0 and a maximum of 10. A bivariable statistical analysis was performed through analysis of variance (ANOVA) and independent t-tests and variables with a p-value of < 0.05 were eligible for the generalized linear regression model. To see the weight of each explanatory variable on PCC utilization, generalized linear regression with a Poisson link was done. Results: Of the sampled 600 participants, 591 took part in the study, which yielded a response rate of 98.8%.The mean (± SD) score of the practice of PCC was 3.94 (± 1.98) with minimum and maximum scores of 0 and 10 respectively. Only 6.4% (95%CI: 4.6, 8.6) of mothers received all selected items of PCC services. Thecommonest item received by 67.2% of mothers was Folic acid supplementation, while 16.1% of mothers received the least item of optimizing psychological health. Education status of mother[AOR 0.74, 95%CI 0.63, 0.97], time spent to access nearby health facilities [AOR 0.69, 95%CI 0.58, 0.83], availability of PCC unit [AOR 1.46; 95%CI 1.17, 1.67], mother’s knowledge on PCC [AOR 1.34, 95%CI 1.13, 1.65], being a model household [AOR 1.31, 95%CI 1.18, 1.52] and women’s autonomy in decision making [AOR 0.75, 95%CI 0.64, 0.96] were identified as significant predictors of practice of PCC. Conclusion: The uptake of WHO-recommended PCC service elements in the current study area was found to be unsatisfactory. Stakeholders must therefore increase their efforts to align PCC units with existing MNCH service delivery points, improve women's decision-making autonomy, and focus on behavioral change communication to strengthen PCC practice. Plain language summary Preconception care (PCC) is a series of biomedical, mental, and psycho-social health services provided to women and a couple before pregnancy and throughout subsequent pregnancies for better endings. The main goal of the PCC is to improve maternal and child health outcomes, by-promoting wellness and providing preventive care. It can also be seen as an earlier chance for teenage girls, mothers, and children to live a better and longer-term healthy life. Pieces of PCC service packages suggested by the World Health Organization(WHO) are, micronutrient supplementation (Folate supplementation), infectious disease (STI/HIV) screening and testing, chronic disease screening and management, healthy diet therapy, vaccination, prevention of substance use (cessation of cigarette smoking and too much alcohol consumption), optimizing psychological health, counseling on the importance of exercise and reproductive health planning and implementation. Millions of women and new-borns have died in low-income countries due to impediments that arise before and exaggerate during pregnancies that are not deal with as part of pre-conception care. To the best of our knowledge, however, there is a lack of information about preconception care practice and its determinants in southern Ethiopia, including the study area. This study was therefore planned to evaluate the practice of preconception care and its determinants among mothers who recently gave birth in Wolkite town, southern Ethiopia, in 2020. Mothers who have given birth in the last 12 months have been randomly selected Household wealth status was determined through the application of principal component analysis(PCA). To see the weight of each explanatory variable on PCC, generalized linear regression with a Poisson type was done. Accordingly, the Education status of the mother, time spent to access nearby health facilities, availability of PCC unit, mother’s knowledge on PCC, being a model household, and women’s autonomy in decision making were identified as significant predictors of practice of PCC. Stakeholders must therefore increase their efforts to align PCC units with existing MNCH service delivery points, improve women's decision-making autonomy, and focus on behavioral change communication to strengthen PCC practice. The Community-based cross-sectional study was conducted from 1 to 30 February 2020 in Wolkite town, southern Ethiopia. The town is located 151km southeast of the capital city, Addis Ababa. Administratively, the town is divided into 13 kebeles (Kebele is the smallest administrative unit in Ethiopia). The projected total population of the town for the 2020 fiscal year was 102,948 (Male=55,858, Female=52,090), based on the 2007 CSA forecast. The total number of women in the reproductive age group (1549years) was 23,246, representing 22.6% of the population as a whole. In the town that was providing maternal and child health services, there are a total of 19 health facilities and further quantified as one teaching and referral hospital, two health centers, 10 health posts, and six medium clinics. The source populations for this study were all mothers in the town who had given birth in the preceding 12months. The study population is made up of women in seven randomly selected kebeles in the town who come across eligibility criteria. Women who had lived in the study area for less than 6 months and were critically ill at the time of data collection were excluded from the study. The sample size for the study was determined by applying the single population proportion formula. The parameters such as the reported prevalence of PCC practice, which is 38.2% from a study conducted in western Ethiopia [34], a 95% confidence level, 5% margins of error, 1.5% design effect, and 10% non-response rate was used. Consequently, the final sample size for the study was 600. To get study participants, a two-stage sampling technique was used. There are 13 Kebeles in the town, and seven of them were chosen randomly by lottery method. The total number of mothers who had given birth in the previous 12months in each kebele was taken from the delivery registration books located in health posts. The sample size for each kebele was distributed by proportional allocation and each study participant was accessed by using the lottery method. When more than one eligible woman was identified in the chosen household, a lottery method was applied. Six diploma nurses with previous data collection experience conducted face-to-face interviews under the supervision of three BSc Midwives, using a pre-tested, standardized questionnaire. Both data collectors and supervisors were given intense training that lasted one day. An intensive training that lasts one day was provided to both data collectors and supervisors. The data collection tool was developed after reviewing relevant literature in the field of interest [1, 8, 31, 33]. The questionnaire contains socio-demographic variables, obstetric variables, health system-related features, and respondents' knowledge of PCC. The wealth status of households was evaluated using a standardized questionnaire adapted from EDHS 2016 [14]. The pre-test was conducted prior to the actual data collection. Women were contacted with the guidance of local community health workers (CHWs) in each Kebele. The list of women selected for the interview in each kebele was provided in advance to the data collectors. The data were collected on a house-to-house basis. The questionnaire used to collect data was initially prepared in English, then translated into the local language by an expert in that language, and then re-translated into English to ensure consistency with the original meanings. One-day intensive training was provided to both data collectors and supervisors on the purpose of the study, the content of the questionnaire, and the method of data collection was. A pretest among 5% of the sample size (30 respondents) was conducted in Wolliso town, and possible adjustments were made for the better completion of the questionnaire. A day-to-day follow-up during the data collection period was carried out by the principal investigator and supervisors. Before entering the data, the supervisors checked it for completeness and consistency. Incomplete data were omitted from the analysis. To reduce social desirability bias, study participants were interviewed privately. The data was coded and entered into Epi Data Version 3.1 and exported to SPSS version 23 for analysis. Descriptive statistics such as frequencies, mean, and standard deviation were computed to describe the characteristics of the respondents. The wealth status of households was determined by applying principal component analysis (PCA). Initially, 27 items were used and grouped into six components, namely: household properties, livestock ownership, crop production in quintal, the average estimated monthly income, hectares of agricultural land, and housing conditions. Fulfillment of PCA assumptions such as; overall sampling adequacy (KMO0.6), sampling adequacy of individual variables (anti-image correlations>0.4), Bartlett Sphericity Test (p-value<0.05) were checked. In each step, these variables with communities less than 0.5 and complex structures (i.e. having correlations greater than 0.4 in more than one component) were removed before the criteria were met iteratively. Finally, three components were extracted from the PCA that clarified a total variance of 66.94% and used to rate the study participants' household wealth status in quintiles [14]. A bivariable analysis using analysis of variance (ANOVA) and independent t-tests had been used to test statistical significance, and variables with a p-value of 0.05 were eligible for a generalized linear regression model. Multivariable statistical analysis using the Generalized Linear Model (GLM) approach was used to classify the determinants of PCC practice. A Poisson regression model with a log link was used since our response variable was measured in terms of count variables [40]. The property of equidispersion, which states that the variance of a distribution of count-dependent variables is equal to its mean, is one of the basic assumptions of Poisson regression [40, 41], and the current study almost meets this criterion with mean and variance of 3.940 and 3.938, respectively. Finally, the odds ratios and 95% confidence intervals for each independent variable were calculated. The strength and direction of the association were determined using crude and adjusted odds ratios. Charts, graphs, and figures were used to display the information. Preconception care: the complete range of interventions to promote the well-being of the expectant mother and the baby [1]. The ten selected items of PCC services considered in this study were: Folic acid supplementation, vaccination, screening and management of infectious diseases (STI/HIV), screening and management of chronic diseases, balanced diet therapy, cessation of cigarette smoking, avoidance of excessive alcohol consumption, optimization of psychological wellbeing, provision of modern contraceptive/s [1, 8]. Information on these ten contents of PCC was derived from the response to the question Prior to your last pregnancy, did you received any of the following services at least once? Have you got any vaccination?, Have you got any contraceptive? Answer categories were developed for each practice assessment question as' YES=1' and' No=0. It is possible for a single mother may get a vaccination or modern contraceptive several times prior to pregnancy. However, as the mother was asked to report any service at least once, the response for any action was recorded as a single action. On the basis of responses, we have created a composite index of PCC content as our outcome variable which comprises a simple count of the number of elements of care received. The variable had a minimum value of zero indicating that the women did not receive any PCC services and a maximum value of ten indicating that the women received services for all the ten elements. Household wealth index: a composite measure of respondents' socio-economic status was computed using PCA based on data from sustainable household goods and equipment, livestock ownership, quintal crop production, the average projected monthly income, agricultural land in hectares, and residential housing characteristics. Finally, the first component which explained maximum factor scores were split into quintiles [14]. Women's Autonomy in household decision-making: A woman is said to be autonomous of decision-making power when she decides on at least one of the following three issues alone or jointly (with her husband): (1) the health of the woman (personal decision-making authority), (2) big transactions (economic decision-making authority), and (3) visits to friends or relatives (mobility decision-making authority)otherwise considered as non-autonomous when the husband alone or a third person decides on seeking MNCH services [14, 42, 43]. Knowledge on PCC:: If a woman correctly answered at least 50% of the correct answers to eight PCC knowledge assessment questions, she was classified as knowledgeable; otherwise, she was classified as not knowledgeable [31, 44]. Being a household model (MHH): a family that implements all health extension packages and has received certificates of appreciation from responsible bodies [45]. Perceived distance to the nearest health facility: This was determined by the respondents' answers to questions of how long they walked to the health facilities. If mothers reported walking for less than 30min to reach the nearest health facility, this was coded as 'closer;' otherwise, it was coded as 'far' [46]. Preconception care unit: This is a unit or space where preconception care for women was offered before becoming pregnant [31].