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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