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Birth preparedness and complication readiness (BPCR) have been shown to increase knowledge of danger signs and enhance access to skilled obstetric care. Previous studies have focused on intermediate outcomes of BPCR such as utilization of skilled care for pregnancy and delivery. Aims: This study aims to determine the maternal and perinatal outcomes associated with birth preparedness and complication readiness. Settings and Design: A cross-sectional study involving 827 recently delivered women, attending selected health facilities in Ikenne, southwestern Nigeria. Materials and Methods: BPCR was determined from a set of eight indicators that were developed by the John Hopkin’s Bloomberg School of Public Health. Statistical Analysis: The data were analyzed using SPSS version 21. Bivariate analysis was done using Chi-square test, and binary logistic regression model was used to assess factors related to BPCR practice among respondents. The level of statistical significance was set to P 2 years preceding this study, or who were critically ill, or are below 15 or above 49 years or failed to give consent for the study were excluded. Descriptive cross-sectional study. The minimum sample size was determined using the Leslie Kish formula for estimating single proportion.[16] The prevalence of 58.2% obtained for BPCR from a similar study done in Tanzania,[14] was applied to the formula, to calculate the sample size. A minimum sample size of 410 was obtained and multiplied by a design effect of 2 obtained from a previous similar study assessing BPCR among recently delivered women,[14] to remove cluster effect from the multistage sampling technique. Thus, a final sample size of n = 820 was calculated for the study. Data were obtained from women attending the ANC, postnatal clinic, infant welfare clinic, family planning, gynecology clinics, and the general outpatient department. A multi-stage sampling technique was employed. First, the health facilities in Ikenne were divided into two broad categories: providers of comprehensive EOC (6 in number) and the providers of basic EOC services (BEOC, 16 in numbers; 10 PHCs and 6 registered private clinics/maternity centers). A sampling frame of 1 in every 3 health facility was used to determine the representative health facilities that were included. Thus 2 Comprehensive providers and 6 BEOC providers (4 PHC and 2 private clinics) were selected giving a total of 8 health facilities within the Ikenne LGA. Simple random sampling was then done at the individual clinics of each selected facility, using the same sampling frame. Thus, 1 in every 3 women who met the selection criteria was recruited at the clinics for interview. Exit interviews were conducted for the participants with the aid of a modified, interviewer administered, semistructured questionnaire adapted from the safe motherhood questionnaire developed by the maternal and neonatal health program of JHPIEGO an affiliate of the Johns Hopkins University Baltimore, Maryland, USA.[7] This was adapted according to context and the objectives of this study. The questionnaire was translated into the Yoruba language and translated back into the English language to retain the original meaning of the questions. Five research assistants, who are fresh graduates of the school of public and allied health of the Babcock University, served as data collectors after training by the principal investigator. BPCR was calculated from a set of eight indicators that were developed by the John Hopkins Bloomberg School of Public Health, which applied to recently delivered mothers; these indicators were expressed as percentage of women having each specific characteristic.[7] The BPCR indicators are as follows: The mothers who fulfilled 3 of 5 selected BPCR practice indicators were considered as “Birth prepared and complication ready” (BPCR), the selected indicators were; “identified a mode of transportation to the place of delivery,” delivery attended by skilled provider, saved money for child birth, had at least 4 ANC visits with a skilled provider and ‘made arrangement for blood before delivery’. Similar sets of BPCR indicators have been reported in literature.[14,17,18] The key danger signs that were expected to be spontaneously known and supplied by the respondents include that designed by the JHPIEGO, MNH programme in the BPCR manual and they include:[7] MNM was defined as an acute obstetric complication that immediately threatened a woman’s survival but did not result in her death; either by chance or because of hospital care she received during pregnancy, labor or within 6 weeks after termination of pregnancy or delivery.[19] A participant was considered as having had institutional delivery if she delivered at a health facility and was attended by a skilled birth attendant (Physicians, Nurses, Midwives, or community health officers).[14] Perinatal mortality was considered as stillbirths or neonatal deaths that occurred within the first 7 days of life. A stillbirth was considered as the death of foetus occurring in the interval from 28 weeks gestational age to delivery. The data was edited on a daily basis before leaving the field and entered using excel spread sheet before converting into SPSS version 21 (Inc., Chicago, IL, USA) for computer analysis. Bivariate analysis was done using Chi-square test for categorical variables and binary logistic regression model was used to assess the factors related to BPCR practice in the respondents. The level of statistical significance was set to P < 0.05. Ethical approval for this study was obtained from the Babcock University Health Research and Ethics Committee and permissions from the Ikenne LGA, through the PHC department and the administrative heads of all facilities that were involved in the study, before commencing data collection. Written informed consent with signature or thumb print was obtained from the study participants before the start of the interview. Respondents that were assessed preliminarily and found not to have been birth prepared and complication ready were counseled regardless of the outcome of that pregnancy.
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