Birth preparedness, complication readiness and male partner involvement for obstetric emergencies in rural Rwanda

  • Pan African Medical Journal, Volume 25, Year 2016

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Study Justification:
– Birth preparedness and complication readiness (BP/CR) is crucial for ensuring timely access to skilled maternal and neonatal services and preventing adverse outcomes.
– This study aimed to assess the level of male partner involvement in birth plans and the attitudes of women towards maternal care in rural Rwanda.
– The findings of this study can provide valuable insights into the factors associated with BP/CR and help inform interventions to improve maternal and neonatal health outcomes.
Study Highlights:
– The study included 350 pregnant women admitted as referrals at Ruhengeri hospital in rural Rwanda.
– The mean age of the women was 27.7 years, and the mean age of their spouses was 31.3 years.
– Majority of the women (55.1%) and their spouses (59.4%) had completed primary education.
– Men’s role in maternal health care was mainly in the area of financial support.
– The level of men’s attendance at antenatal care was low (29.4%), and only 22.3% of women were accompanied to the labor ward.
– There was strong opposition to the physical presence of male partners in the labor room, citing cultural reasons.
– Factors associated with being well prepared included maternal education level of secondary or higher, formal occupation of the spouse, and being checked by a community health worker during antenatal care.
Recommendations for Lay Reader and Policy Maker:
– Increase male involvement in pregnancy and antenatal care to improve birth preparedness and complication readiness.
– Address cultural barriers that prevent male partners from being present in the labor room.
– Reframe care-givers and health facility policies to support family-centered delivery.
Key Role Players:
– Community health workers: They can play a crucial role in providing health education and promoting birth preparedness and complication readiness.
– Health facility staff: They need to be trained and sensitized to support male involvement in maternal health care and address cultural barriers.
– Policy makers: They can create policies and guidelines that promote male involvement and family-centered care.
Cost Items for Planning Recommendations:
– Training programs for community health workers and health facility staff on promoting male involvement and addressing cultural barriers.
– Sensitization campaigns to raise awareness among the community about the importance of male involvement in maternal health care.
– Development and implementation of policies and guidelines that support family-centered care.
– Monitoring and evaluation activities to assess the impact of interventions and make necessary adjustments.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is cross-sectional, which limits the ability to establish causality. However, the study includes a relatively large sample size of 350 pregnant women and provides detailed information on the socio-demographics, male partner involvement, and birth preparedness. To improve the strength of the evidence, future research could consider using a longitudinal design to establish causal relationships and include a control group for comparison. Additionally, conducting the study in multiple hospitals or regions could enhance the generalizability of the findings.

Introduction: Birth preparedness and complication readiness (BP/CR) promotes timely access to skilled maternal and neonatal services, active preparation and decision-making for seeking health care to prevent any adverse outcomes. The aim was to assess level of male partner (MP) involvement in the birth plan, the attitude of the women towards maternal care and factors associated with BP/CR among obstetric referrals in rural Rwanda. Methods: This was a cross-sectional study among 350 pregnant women who were admitted as referrals at Ruhengeri hospital, between July 2015 and November 2015. Data was collected on socio-demographics, level of MP’s participation in maternal health care and domestic activities, women’s attitude towards involvement of men in maternal care and BP/CR. Any woman who arranged to have a birth companion, made a plan of where to deliver from, received health education on pregnancy and childbirth complications, saved money in case of pregnancy complication and had attended antenatal care (ANC) at least 4 times, was deemed as having made a birth plan. Results: The mean age was 27.7 years, while mean age of the spouse was 31.3 years. Majority of the women (n=193; 55.1%) and their spouse (n=208; 59.4%) had completed primary education. Men’s role was found to be mainly in the area of financial support. The level of men ANC attendance was low (n=103; 29.4%), while 78 (22.3%) women were accompanied to the labor ward. However, there was a strong opposition to the physical presence of MP in the labor room (n=178; 50.9%). The main reason cited by women opposing MP presence is that it is against their culture for a man to witness the delivery of a baby. On multivariable analysis, maternal education level of secondary or higher adjusted odds ratio [AOR] 1.4 95% CI (1.8-2.6), formal occupation of spouse, AOR 2.4 95% CI (1.4-4.2) and personnel checked during ANC being community health worker AOR 2.2, 95% CI; (1.3-3.7) were associated with being well prepared. Conclusion: Male involvement in pregnancy and antenatal care is low. To increase men involvement in birth plan addressing cultural barriers and refraining care-givers and health facility policies towards family delivery is paramount.

This was a cross sectional study among pregnant women who were admitted as referrals at Ruhengeri hospital located in Musanze district, Rwanda, between July 2015 and November 2015. According to the Population census 2012, Musanze district had a population of 368 267 inhabitants with a total fertility rate of 4.6 births per woman [21]. Literacy rate is 88.6% and 79.7% for men and females respectively [21]. Health insurance coverage is 85.1% and 65.3% of women are delivered by skilled birth attendants [21]. Uptake of postnatal care by skilled personnel was at 4.5% [21]. Ruhengeri hospital acts as a provincial referral hospital for high-risk obstetric cases and referrals from health centers and other district hospitals in the northern province. Medical services offered are covered by community-based health insurance (“mutual d’sante”) at contribution of an annual fee of RWF 3,000 (US$4.5), with a 10% surcharge for each episode of illness. In case of shortages of drug supplies, patients are requested to procure missing items from private pharmacies. During the study period, medical staff consisted of one specialist obstetrician, four medical officers, two intern doctors and 18 midwives running the unit. The study included all pregnant women who presented as referrals at the maternity ward with willingness to consent and participate in this study. Participants were followed up to their discharge from hospital or death. Two trained research assistants identified participants while the principal investigator verified suitability for study inclusion. A pretested structured interview questionnaire was used for data collection, based on “Monitoring BP/CR: tools and indicators for maternal and newborn health” [3] and adapted according to local context and the objectives of the study. Data was collected using an interviewer-administered questionnaire on i) socio-demographic variables such as age, education level, marital status, employment status and personnel checked during ANC ii) Medical history on ANC, obstetric history, reasons for referral, mode of delivery and care received for obstetric complications were recorded; iii) Level of MP’s participation in maternal health care and domestic activities and women’s attitudes towards male partner involvement in BP/CR; iv) Data was also collected on BP/CR, based on the number of arrangements a woman had made, including arranged to have a birth companion or attendant during delivery, made a plan of where to deliver from, received health education on pregnancy and childbirth complications, saved money in case of pregnancy complication and attended antenatal care at least 4 times was deemed as having made a birth plan. Any woman who mentioned at least three of these four BP/CR steps was considered “well prepared”. The remaining women were considered “less prepared”. The collected data were entered, coded, cleaned and analyzed using SPSS for Windows Version 18.0. First, simple frequency distributions were calculated. Comparisons of the proportion of women who are birth prepared by each category of the independent variables were done and statistical significance assessed using the Chi-square test. To identify factors associated with BP/CR, bivariate logistic regression were used. These results were expressed as the Odds Ratio (OR) and with 95% Confidence Interval (CI). Factors that were found to have a p-value of less than 0.2 in the bivariate analysis were then entered into multivariable logistic regression analysis to identify factors associated with BP/CR. Ethical approval was obtained from the National Ethical Committee (N°582/RNEC/2013). Participants were recruited after getting informed consent, at a time when they had recovered from the acute obstetric complications that necessitated their admission.

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Based on the provided information, here are some potential innovations that can be used to improve access to maternal health:

1. Mobile health (mHealth) technology: Implementing mobile health applications or text messaging services to provide pregnant women with important information about pregnancy, childbirth, and postnatal care. This can help improve birth preparedness and complication readiness by ensuring women have access to timely and accurate information.

2. Community-based health education: Conducting community-based health education programs to raise awareness about the importance of birth preparedness and complication readiness. This can involve engaging community leaders, local health workers, and male partners to promote the involvement of men in maternal health care and encourage women to make birth plans.

3. Male partner involvement programs: Developing programs that specifically target male partners to increase their involvement in maternal health care. This can include providing education and support to men on the importance of accompanying their partners to antenatal care visits, participating in birth plans, and being present during labor and delivery.

4. Addressing cultural barriers: Working with communities to address cultural barriers that may prevent men from being involved in maternal health care. This can involve sensitization campaigns, community dialogues, and engaging local leaders to promote cultural acceptance of male involvement in childbirth.

5. Strengthening health systems: Improving the availability and quality of maternal health services, including antenatal care, skilled birth attendance, and emergency obstetric care. This can be achieved through training and capacity building for health workers, ensuring the availability of essential supplies and medications, and improving referral systems between health facilities.

These innovations can help improve access to maternal health by promoting birth preparedness, complication readiness, and male partner involvement, ultimately reducing maternal and neonatal morbidity and mortality.
AI Innovations Description
The recommendation from the study is to improve access to maternal health by promoting birth preparedness, complication readiness, and male partner involvement. This can be achieved by addressing cultural barriers and reframing caregiver and health facility policies towards family delivery.

Specific actions that can be taken to implement this recommendation include:
1. Educating and raising awareness among pregnant women and their male partners about the importance of birth preparedness and complication readiness.
2. Providing comprehensive antenatal care that includes health education on pregnancy and childbirth complications.
3. Encouraging men to actively participate in maternal health care, including attending antenatal care visits and accompanying their partners to the labor ward.
4. Training healthcare providers on how to involve and engage male partners in the maternal care process.
5. Addressing cultural norms and beliefs that may hinder male partner involvement, such as the opposition to men being present in the labor room.
6. Collaborating with community leaders and influencers to promote and support male partner involvement in maternal health.
7. Ensuring that health facilities have policies and guidelines in place that support and encourage family-centered care during childbirth.

By implementing these recommendations, access to maternal health can be improved, leading to better outcomes for both mothers and newborns.
AI Innovations Methodology
Based on the provided information, the study titled “Birth preparedness, complication readiness and male partner involvement for obstetric emergencies in rural Rwanda” aims to assess the level of male partner involvement in birth plans, women’s attitudes towards maternal care, and factors associated with birth preparedness and complication readiness (BP/CR) among obstetric referrals in rural Rwanda.

To improve access to maternal health, the following innovations and recommendations can be considered:

1. Male Partner Involvement: Encourage and promote active involvement of male partners in maternal health care. This can include providing education and awareness programs specifically targeting men, highlighting the importance of their role in supporting their partners during pregnancy, childbirth, and postpartum.

2. Cultural Sensitivity: Address cultural barriers that discourage male partners from being present in the labor room. Develop strategies to educate communities about the benefits of male involvement and challenge traditional beliefs that hinder their participation.

3. Health Facility Policies: Review and revise health facility policies to support family-centered care and allow male partners to be present during labor and delivery if desired by the woman. This can help create a supportive environment and enhance the overall birth experience.

4. Community Health Workers: Strengthen the role of community health workers in promoting birth preparedness and complication readiness. They can provide education, counseling, and support to pregnant women and their families, emphasizing the importance of making birth plans and seeking timely care.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Baseline Data Collection: Gather data on the current level of male partner involvement, women’s attitudes, and factors associated with birth preparedness and complication readiness among obstetric referrals in rural Rwanda. This can be done through surveys, interviews, and medical records review.

2. Intervention Implementation: Implement the recommended innovations, such as educational programs for male partners, cultural sensitivity training, policy changes in health facilities, and strengthening the role of community health workers. Ensure that these interventions are implemented consistently and monitored for fidelity.

3. Data Collection Post-Intervention: Collect data after the implementation of the interventions to assess any changes in male partner involvement, women’s attitudes, and birth preparedness and complication readiness. This can be done using the same methods as the baseline data collection.

4. Data Analysis: Analyze the collected data to determine the impact of the interventions on improving access to maternal health. Compare the pre- and post-intervention data to identify any significant changes and calculate the associated odds ratios and confidence intervals.

5. Interpretation and Recommendations: Interpret the findings of the data analysis and draw conclusions about the effectiveness of the interventions. Based on the results, provide recommendations for further improvements and potential scaling up of successful interventions.

6. Continuous Monitoring and Evaluation: Establish a system for ongoing monitoring and evaluation to ensure the sustainability and effectiveness of the implemented interventions. This can involve regular data collection, feedback from stakeholders, and adjustments to the interventions as needed.

By following this methodology, it is possible to simulate the impact of the recommended innovations on improving access to maternal health and make evidence-based decisions for future interventions.

Statistics:
Citations: 14
Authors: 2
Identifiers:
DOI: 10.11604/pamj.2016.25.91.9710
Research Areas:
Community Interventions, Disparities, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Workforce
Study Countries:
Rwanda
Study Design:
Case-Control Study, Cross Sectional Study, Grounded Theory
Study Approach:
Quantitative
Participants Gender:
Male & Female
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