Knowledge of pre-conception health and planned pregnancy among married women in Jinka town, southern Ethiopia and factors influencing knowledge

Background Optimizing women’s health and knowledge of preconception healthcare before conceiving a pregnancy decreases the risk of adverse pregnancy outcomes. However, preconception health care is one of the missing pillars in the continuum of maternal and child health care in Ethiopia. Therefore, this study aimed to assess knowledge of pre-conception health, its relation to planned pregnancy, parity, family planning use, and education among married women in Southern Ethiopia. Methods A community-based cross-sectional study was conducted with 337 married women recruited from March 25 to April 30, 2018 in Jinka town. A simple random sampling technique was employed and the data was collected using a structured questionnaire. Data analysis involved calculating frequencies, percentages, and logistic regression. Associations were assessed using odds ratios and 95% confidence intervals with statistical significance determined at a p-value < 0.05. Results The overall women’s preconception health care knowledge score in this study was 55.2%, which is a moderate score. In multivariable analyses, women’s secondary level of education [AOR = 2.3; 95% CI = 1.13–4.87], family planning use [AOR = 2.6, 95% CI = 1.37–4.87], planned pregnancy [AOR = 3.2, 95% CI = 1.35–7.44], Nullyparity [AOR = 21.2; 95% CI = 4.92–91.5], and market trade vendors [AOR = 2.5; 95%CI = 1.06–6.03], were significantly associated with knowledge of preconception health care. Conclusion The findings show that women’s knowledge of preconception health care is moderate. Women’s knowledge of preconception health care can be linked to their level of education, use of family planning methods, pregnancy planning, and Nullyparity. Therefore, the government and other key stakeholders need to develop a specific education package that improves women’s knowledge of preconception care and pregnancy planning, taking into account factors such as levels of education and literacy when designing implementation strategies. The study was a community-based cross-sectional study conducted from March to April 2018 among married women in the Jinka town administration within the territory of Jinka, 750 km south of Addis Ababa, at a latitude and longitude of 5°47’N 36°34’E/5.783°N 36.567°E. In 2018, the total population was estimated at 30,493, including 15,217 [49.9%] males and 15,276 [50.1%] females. Of the total women of reproductive age, roughly 3147 [44.3%] were reported to be married [23]. The public health infrastructure in the town consists of one general hospital, two health centers, and six health posts where health extension workers serve. Health extension workers are primarily trained to offer community health services in line with the primary health care package. They are responsible for identifying pregnant women within their catchment area, and delivering subsequent antenatal care services. They also keep vital statistics, such as gender, number of children, pregnancy, abortion, death, live births, etc., in the family folder register, including for married women. The study area was selected purposively as it was considered feasible and appropriate to address the study objectives in an urban setting. The study population consisted of all married women who lived in Jinka town for six months or more. Lastly, individual married women were the study units and self-reported married women who lived in Jinka town were included in this study. Women with hearing problems and critical illnesses were not eligible for the study. A sample size of 337 was estimated using a single population proportion formula [n = Z2 P [P-1]/d2] considering the proportion [P] of women’s level of knowledge of preconception health care to be 27.5% from a study conducted in West Gojjam, Ethiopia [22], Z2 [Standard score corresponding to a given confidence interval [CI] of 95%, and the tolerable risk of rejecting the null hypothesis [d = 5%], and a 10% non-response rate. All the kebeles [local administration units] of Jinka town were included. An updated list of households from the 2018 report of each Kebele’s family folder was taken as the sampling frame. A list of married women was identified from the family folder register. The sample size for each kebele was determined proportional to the number of married women per kebele. Using proportional to size allocation, the probability of women being selected is proportional to the size of the overall group of married women of the reproductive age in the kebele, giving a larger proportion of the total group of women participants came from the larger kebeles. A unique code was given to hide the identity and thus, a serial number based on the sequence of registration was taken and frame was formed and fed to the compute to pick the samples randomly. The first married woman’s house was approached by a health extension worker who acted as a guide during the data collection period. A lottery method was applied when more than one candidate was found per household. If an eligible woman in the chosen house was unavailable, the data collector addressed the situation with the individual who was available and set up an appointment with the study subject at a time when she was available. The data collector then returned the next day to see if the women were still at home. Three consecutive days were spent revisiting the woman until she was deemed a non-respondent. Re-visiting helped to reduce the number of non-responses when the interviewee was not present during the data collection day. All women who were approached for participation agreed to take part and were subsequently consented using a short form approved by the Institutional Ethical Review Board. The dependent variable was women’s knowledge of preconception health care and the independent variables were socio-demographic characteristics, obstetric, and behavioral history such as habit of alcohol intake, smoking, and substance use. Women’s knowledge of preconception health care was measured using twenty preconception health care questions that we developed for this study. Those who scored above the mean score in the preconception care knowledge questions were considered to have high knowledge. Those who scored less than or equal to the mean score in the preconception care knowledge questions were considered to have low knowledge. Therefore, the scale was dichotomized into high and low knowledge. A face-to-face interview was used to collect data using a pre-tested, structured questionnaire. It consisted of different parts adapted from previously published literature in developing nations [20, 22], and it was modified considering the context and objectives of the study. The questionnaire was divided into sections on socio-demographic characteristics, birth outcomes, chronic illness profiles, general awareness of preconception health care [such as women who have heard about preconception health, their source of information, information on the eligible population, and getting preconception healthcare], as well as questions about pregnancy. The reliability coefficient was computed using SPSS version 26 window-compatible software and it was 0.86. Each question had one correct response where those who score above the mean of knowledge measuring questions are labeled as women with “High knowledge]. Participants were recruited by five Diploma midwife data collectors and two BSc midwife supervisors who were fluent in the local language and experienced in data collection. They were provided with a two-day training on the objectives of the study, data collection techniques, and informed consent and confidentiality issues. During the data collection period, supportive supervision and panels with the data collectors and supervisors were conducted on a regular basis. Every day, before, during, and after the data collection period, the supervisors checked the questionnaire for clarity and completeness. Throughout the data collection period, the principal investigator was a frontline supervisor. Data was first checked for consistency and completeness, missing values, and discordant responses. Then, the data was coded and entered into Epi-info version 7.2 and exported to SPSS software [version 26] for further cleaning and analysis. Descriptive statistics were calculated to determine percentages and frequencies and summary statistics [median and inter quartile range] were used to describe the study population. Independent variables with a p-value of less than 0.25 in the binary logistic regression analysis were included in the multivariable analysis. The model was adjusted for age. The presence of an association between factors and dependent variables was tested using multiple logistic regression. For the multivariate analysis, a p-value of less than 0.05 was determined as the cut point of a statistically significant association with 95 percent confidence intervals along with the adjusted odds ratio. Primarily, the questionnaire was prepared in English and translated into Amharic using experts in both languages. For data analysis, the Amharic version was reverted to the English version to keep the data consistent and clear. Regular meetings were held between data collectors and supervisors to discuss lessons learned and to overcome challenges before the next data collection day. On a regular basis, the principal investigator met with each supervisor. The data collection instrument was pre-tested on 5% of the calculated sample to familiarize the tool for data collectors with the interviewing technique and to ensure consistency. However, neither the location where we conducted the pretesting nor the women on whom the questionnaire was pre-tested were included in the final sample. The Tool Piloting included 18 married women from Karat town and was administered two weeks before the actual data collection began. Data collectors and supervisors were debriefed on the lessons drawn from the pretest and modifications were made for logical order, ambiguity, leading questions, and the addition of details unrelated to the research question the study intended to answer. The instrument’s overall reliability coefficient was 0.86. In addition, content validity was assessed by three independent maternal and child health experts at Arba Minch University. Ethical clearance and a letter of approval to conduct this study were obtained from the institutional board of the College of Medicine and Health Sciences, Arba Minch University and an official letter of cooperation was obtained from Jinka town administration. Written informed consent was obtained from each study participants after explaining the purpose and procedures of the study. The right to withdraw from the study at any time the participants wished to leave was assured and information confidentiality was ensured with coding. Interviews were conducted in a separate area where privacy could be assured. Only the principal investigator had access to the raw data. Parents or guardians of study participants under the age of 18 also gave their written approval.