Predictors of Women’s awareness of common non-communicable diseases screening during preconception period in Manna District, Southwest Ethiopia: implication for wellness check-up

BMC Health Services Research, Volume 21, No. 1, Year 2021

Interpretation

Background: Non-communicable diseases (NCDs) are the dominant cause of global morbidity and mortality, especially in developing countries. Tackling NCDs is central to advancing women’s and child health, and future generations. Many NCDs can be prevented with appropriate approaches across the maternal and child health life-cycle, throughout the years of reproductive age especially before conception and continuing through pregnancy. However, women’s awareness of NCDs screening during the preconception period was not well known in many countries including Ethiopia. Therefore, this study aimed to assess women’s awareness of common NCDs screening during the preconception period and associated factors in Manna District, Jimma Zone, Oromia Region, Ethiopia, 2019. Methods: A community-based cross-sectional study was conducted from March 02 to April 10, 2019. The sample size was 636 pregnant women from eight randomly selected rural kebeles and a purposively taken urban kebele. The data were collected using a pre-tested structured questionnaire and entered into Epi data manager version 4.0.2 and exported to SPSS version 21. Descriptive, binary, and multivariable logistic regression analyses were carried out. Results: Of the total of 623 respondents, 459 (73.7%) of them had good awareness of common NCDs screening during the preconception period. Women who had formal education [AOR = 1.95, 95% CI: (1.31–2.89)], those who had planned pregnancy [AOR = 2.17, 95% CI: (1.47–3.19)], on ANC follow up [AOR = 1.79, 95% CI: (1.16–2.74], and those who had media (radio and/or television) in their house [AOR = 1.55, 95% CI: (1.05–2.29)] had good awareness on common NCDs screening during the preconception period compared to their counterparts. Conclusions: In this study, nearly three-quarters of respondents had a good awareness of common NCDs screening during the preconception period. Women’s educational status, pregnancy planning status, ANC visit, and having radio and/or television in the house were predictors of women’s good awareness of common NCDs screening during the preconception period. Therefore, all concerned bodies are recommended to work toward increasing women’s awareness using different approaches like awareness creation campaigns and counseling clients attending health facilities. A community-based cross-sectional study was conducted from March 02/2019 to April 10/2019 in the Manna district among pregnant women. The Manna district is one of the 21 districts found in Jimma zone, Oromia Region. It is located 368 km southwest far from Addis Ababa (the capital city of Ethiopia) and 22 km from Jimma town. According to the 2019 report obtained from the Manna District Health Office, the district has a total population of 197,911, of which 26,451 were urban and 171,460 were rural. Women of reproductive age groups of the district were 43,738, and pregnant women were 6868. The district has a total of 26 kebeles: 1 urban and 25 rural kebeles. It has 7 health centers, 26 health posts, 11 private clinics, and 3 private pharmacies. It has also 68 health extension workers and 121 health care providers of different professions. The source populations were all pregnant women found in the district during the study period, and the study populations were randomly selected pregnant women who fulfilled the inclusion criteria. All pregnant women (regardless of the gestational age) who lived in the district for at least 6 months prior to the study period were included in the study. Pregnant women who were critically ill and unable to communicate were excluded. In this study, pregnant women were recruited instead of women in preconception period due to issues related to feasibility, as list of pregnant women were easily obtained from the family folder of the community health information system. The sample size was determined by using a single population proportion formula, considering the following assumptions: 50% proportion of women’s awareness of NCDs screening during the preconception period since there was no prior study in Ethiopia specifically to address the study objectives, 95% level of confidence, 5% margin of tolerable sampling error, 10% non-response, and 1.5 design effects. Based on these, the final sample size of the study was 636. To select the study participants, first, the 26 kebeles were stratified into rural and urban. Then, the urban kebele was included in the study purposively for representation. Eight kebeles among the 25 rural kebeles were selected using a simple random sampling technique. Then, the sample size was proportionally allocated to the selected 9 kebeles. Accordingly, a total of 566 pregnant women (Haro = 89, Gudeta Bula = 42, Buxure = 54, Somodo = 83, Gube Muleta = 65, Bilida = 86, Kenteri = 72, and Sombo Manna = 75) were allocated to the eight selected rural kebeles. For the urban kebele (Yabbu town), 70 pregnant women were allocated. The lists of the total number of pregnant women found in the selected rural kebeles were obtained from the family folder of the community health information system, which is available at the health post. The rural health extension workers identify pregnant women, women on family planning and women who had under-five children and register them on the family folder. They update the family folder every month. For the urban kebele, since the family folder did not exist, a census was conducted by two urban health extension workers to construct the sampling frame. The two health extension workers conducted home to home visit and asked every woman of reproductive age whether they are on family planning or not, the absence of their menstrual period, its duration, early pregnancy symptoms and visits women’s abdomen to identify the pregnant women. The human chorionic gonadotropin (HCG) test was not done due to a lack of resources. Finally, computer-generated simple random sampling was used to identify the study participants. Their usual place of residence was identified in collaboration with kebele leaders. Data were collected using an interviewer-administered structured questionnaire developed after reviewing different relevant literatures. It was first prepared in English and then translated to Afan Oromo and Amharic by experts. Then, it was translated back to English by another person to ensure its consistency and accuracy. A pretest was conducted among 5% of pregnant women in the Saka district, which is located 20 km away from the study area. A total of 6 data collectors (4 clinical nurses and 2 BSc nurses) and 2 public health officers as supervisors were recruited based on their previous experience in data collection and fluency in the languages of the community. In addition, the authors also closely supervised the data collection processes. The data collectors and supervisors were trained for 1 day on the objective of the study, data collection tool, approach to the interviewees, details of interviewing techniques, respect and maintaining privacy and confidentiality of the respondents. Cronbach’s α coefficient was computed to test the internal consistency of the tool, which was 0.88. The data collectors asked pregnant women about their awareness of NCDs screening specifically before they became pregnant. Awareness of Common non-communicable diseases screening during the preconception period was the dependent variable. Socio-economic and demographic factors (age, residence, educational level, occupation, marital status, family size, and wealth of the household), gynecologic and obstetric factors (history of family planning use prior to conception, pregnancy planning status, parity, gravidity, and antenatal care visit), preexisting medical illnesses, health facility-related factor (distance from health facility), and media-related factors (access of radio and/or television in the household) were independent variables. Kebele: The lowest government administrative hierarchy that exists next to district. Common non-communicable diseases: In this study, the common non-communicable diseases are anemia, diabetes mellitus and hypertension. Good awareness of common non-communicable diseases screening during preconception period: defined as having ever “heard” or “read” about screening for at least one of the three common non-communicable diseases (anemia, diabetes mellitus and hypertension) for the sake of becoming pregnant. That means, in this study, women who answered “Yes” to at least one of the following three questions were considered as “women with good awareness of common non-communicable diseases screening during preconception period”. Questions: After checking the completeness of the data manually, the collected data were entered, cleaned, and checked using Epi data manager version 4.0.2. Then, the data were exported to SPSS version 21 for analyses. Bivariable and multivariable logistic regression analyses were carried out to identify an association between the predictors and outcome variables. Binary logistic regression analysis was performed to select variables for multivariable logistic regression analysis. Variables with a p-value < 0.25 in the binary logistic regression analysis were taken as candidates for multivariable logistic regression analysis. Finally, multivariable logistic regression analysis was performed to control for the possible confounding effects of the selected variables. Variables with a p-value < 0.05 were recognized as statistically significant associations with women’s good awareness of NCDs screening during the preconception period. Odds ratio with its 95% CI was used to show the degree of association between the outcome and independent variables. Descriptive analyses like frequencies and proportions were also conducted for different variables as necessary. A letter of ethical approval was received from the Institutional Review Board of Jimma University Institute of Health. The necessary permission was obtained from the Manna district health office and kebele administrative offices. All the study participants were informed about the purpose of the study, their right to refuse and assured about the confidentiality of the information they provided. Written informed consent was obtained from all the study participants. For participants under 18 years old, written consent was obtained from their parents.

AI Digest

Study Justification:

– Non-communicable diseases (NCDs) are a major cause of morbidity and mortality globally, particularly in developing countries.
– Addressing NCDs is crucial for women’s and child health, as well as future generations.
– Many NCDs can be prevented through appropriate approaches during the preconception period and throughout reproductive age.
– However, the level of awareness among women regarding NCDs screening during the preconception period is not well known, including in Ethiopia.

Study Highlights:

– A community-based cross-sectional study was conducted in the Manna District, Southwest Ethiopia, from March 02 to April 10, 2019.
– The study aimed to assess women’s awareness of common NCDs screening during the preconception period and associated factors.
– A total of 623 pregnant women participated in the study.
– Findings showed that 73.7% of respondents had good awareness of common NCDs screening during the preconception period.
– Factors associated with good awareness included formal education, planned pregnancy, ANC follow-up, and having media (radio and/or television) in the house.

Recommendations for Lay Reader and Policy Maker:

– Increase women’s awareness of common NCDs screening during the preconception period through awareness creation campaigns and counseling at health facilities.
– Promote education and literacy among women to improve awareness levels.
– Encourage planned pregnancies and ANC follow-up to enhance awareness and access to screening services.
– Ensure availability and accessibility of media (radio and/or television) to disseminate information on NCDs screening.

Key Role Players:

– Ministry of Health: Responsible for developing and implementing awareness campaigns and policies related to NCDs screening during the preconception period.
– Health Extension Workers: Involved in community-level education and counseling on NCDs screening.
– Health Care Providers: Responsible for providing accurate information and counseling to pregnant women during ANC visits.
– Media Organizations: Play a role in disseminating information through radio and television programs.

Cost Items for Planning Recommendations:

– Development and production of awareness materials (brochures, posters, etc.).
– Training programs for health extension workers and healthcare providers.
– Operational costs for awareness campaigns (transportation, logistics, etc.).
– Media production and broadcasting costs for radio and television programs.
– Monitoring and evaluation of awareness campaigns.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a community-based cross-sectional study with a sample size of 623 pregnant women. The study used a structured questionnaire and conducted descriptive, binary, and multivariable logistic regression analyses. The results showed that 73.7% of the respondents had good awareness of common NCDs screening during the preconception period. The study identified predictors of good awareness, including women’s educational status, pregnancy planning status, ANC visit, and having media (radio and/or television) in the house. The study provides valuable insights into the awareness of NCDs screening in a specific district in Ethiopia. However, the study design is cross-sectional, which limits the ability to establish causality. To improve the evidence, future research could consider a longitudinal design to examine the changes in awareness over time and explore the effectiveness of different approaches to increase awareness.

Abstract

A community-based cross-sectional study was conducted from March 02/2019 to April 10/2019 in the Manna district among pregnant women. The Manna district is one of the 21 districts found in Jimma zone, Oromia Region. It is located 368 km southwest far from Addis Ababa (the capital city of Ethiopia) and 22 km from Jimma town. According to the 2019 report obtained from the Manna District Health Office, the district has a total population of 197,911, of which 26,451 were urban and 171,460 were rural. Women of reproductive age groups of the district were 43,738, and pregnant women were 6868. The district has a total of 26 kebeles: 1 urban and 25 rural kebeles. It has 7 health centers, 26 health posts, 11 private clinics, and 3 private pharmacies. It has also 68 health extension workers and 121 health care providers of different professions. The source populations were all pregnant women found in the district during the study period, and the study populations were randomly selected pregnant women who fulfilled the inclusion criteria. All pregnant women (regardless of the gestational age) who lived in the district for at least 6 months prior to the study period were included in the study. Pregnant women who were critically ill and unable to communicate were excluded. In this study, pregnant women were recruited instead of women in preconception period due to issues related to feasibility, as list of pregnant women were easily obtained from the family folder of the community health information system. The sample size was determined by using a single population proportion formula, considering the following assumptions: 50% proportion of women’s awareness of NCDs screening during the preconception period since there was no prior study in Ethiopia specifically to address the study objectives, 95% level of confidence, 5% margin of tolerable sampling error, 10% non-response, and 1.5 design effects. Based on these, the final sample size of the study was 636. To select the study participants, first, the 26 kebeles were stratified into rural and urban. Then, the urban kebele was included in the study purposively for representation. Eight kebeles among the 25 rural kebeles were selected using a simple random sampling technique. Then, the sample size was proportionally allocated to the selected 9 kebeles. Accordingly, a total of 566 pregnant women (Haro = 89, Gudeta Bula = 42, Buxure = 54, Somodo = 83, Gube Muleta = 65, Bilida = 86, Kenteri = 72, and Sombo Manna = 75) were allocated to the eight selected rural kebeles. For the urban kebele (Yabbu town), 70 pregnant women were allocated. The lists of the total number of pregnant women found in the selected rural kebeles were obtained from the family folder of the community health information system, which is available at the health post. The rural health extension workers identify pregnant women, women on family planning and women who had under-five children and register them on the family folder. They update the family folder every month. For the urban kebele, since the family folder did not exist, a census was conducted by two urban health extension workers to construct the sampling frame. The two health extension workers conducted home to home visit and asked every woman of reproductive age whether they are on family planning or not, the absence of their menstrual period, its duration, early pregnancy symptoms and visits women’s abdomen to identify the pregnant women. The human chorionic gonadotropin (HCG) test was not done due to a lack of resources. Finally, computer-generated simple random sampling was used to identify the study participants. Their usual place of residence was identified in collaboration with kebele leaders. Data were collected using an interviewer-administered structured questionnaire developed after reviewing different relevant literatures. It was first prepared in English and then translated to Afan Oromo and Amharic by experts. Then, it was translated back to English by another person to ensure its consistency and accuracy. A pretest was conducted among 5% of pregnant women in the Saka district, which is located 20 km away from the study area. A total of 6 data collectors (4 clinical nurses and 2 BSc nurses) and 2 public health officers as supervisors were recruited based on their previous experience in data collection and fluency in the languages of the community. In addition, the authors also closely supervised the data collection processes. The data collectors and supervisors were trained for 1 day on the objective of the study, data collection tool, approach to the interviewees, details of interviewing techniques, respect and maintaining privacy and confidentiality of the respondents. Cronbach’s α coefficient was computed to test the internal consistency of the tool, which was 0.88. The data collectors asked pregnant women about their awareness of NCDs screening specifically before they became pregnant. Awareness of Common non-communicable diseases screening during the preconception period was the dependent variable. Socio-economic and demographic factors (age, residence, educational level, occupation, marital status, family size, and wealth of the household), gynecologic and obstetric factors (history of family planning use prior to conception, pregnancy planning status, parity, gravidity, and antenatal care visit), preexisting medical illnesses, health facility-related factor (distance from health facility), and media-related factors (access of radio and/or television in the household) were independent variables. Kebele: The lowest government administrative hierarchy that exists next to district. Common non-communicable diseases: In this study, the common non-communicable diseases are anemia, diabetes mellitus and hypertension. Good awareness of common non-communicable diseases screening during preconception period: defined as having ever “heard” or “read” about screening for at least one of the three common non-communicable diseases (anemia, diabetes mellitus and hypertension) for the sake of becoming pregnant. That means, in this study, women who answered “Yes” to at least one of the following three questions were considered as “women with good awareness of common non-communicable diseases screening during preconception period”. Questions: After checking the completeness of the data manually, the collected data were entered, cleaned, and checked using Epi data manager version 4.0.2. Then, the data were exported to SPSS version 21 for analyses. Bivariable and multivariable logistic regression analyses were carried out to identify an association between the predictors and outcome variables. Binary logistic regression analysis was performed to select variables for multivariable logistic regression analysis. Variables with a p-value < 0.25 in the binary logistic regression analysis were taken as candidates for multivariable logistic regression analysis. Finally, multivariable logistic regression analysis was performed to control for the possible confounding effects of the selected variables. Variables with a p-value < 0.05 were recognized as statistically significant associations with women’s good awareness of NCDs screening during the preconception period. Odds ratio with its 95% CI was used to show the degree of association between the outcome and independent variables. Descriptive analyses like frequencies and proportions were also conducted for different variables as necessary. A letter of ethical approval was received from the Institutional Review Board of Jimma University Institute of Health. The necessary permission was obtained from the Manna district health office and kebele administrative offices. All the study participants were informed about the purpose of the study, their right to refuse and assured about the confidentiality of the information they provided. Written informed consent was obtained from all the study participants. For participants under 18 years old, written consent was obtained from their parents.

Materials

N/A

Innovations

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

1. Mobile Health (mHealth) Applications: Develop and implement mobile applications that provide information and reminders about common non-communicable diseases (NCDs) screening during the preconception period. These apps can also offer personalized health advice and connect women to healthcare providers.

2. Community Health Workers: Train and deploy community health workers to educate women about the importance of NCDs screening during the preconception period. These workers can conduct home visits, organize community awareness campaigns, and provide counseling services.

3. Telemedicine Services: Establish telemedicine services that allow pregnant women in remote areas to consult with healthcare professionals and receive guidance on NCDs screening. This can help overcome geographical barriers and improve access to healthcare services.

4. Health Education Programs: Develop and implement comprehensive health education programs that target women of reproductive age. These programs should focus on raising awareness about NCDs, the importance of preconception care, and the benefits of early screening.

5. Collaboration with Media Outlets: Partner with radio and television stations to broadcast educational programs and advertisements that promote NCDs screening during the preconception period. This can reach a wide audience and increase awareness among women and their families.

6. Integration of Services: Integrate NCDs screening services with existing maternal health programs, such as antenatal care visits. This can ensure that women receive comprehensive care and screening for NCDs throughout their reproductive journey.

7. Strengthening Health Systems: Invest in improving healthcare infrastructure, staffing, and resources in order to provide quality NCDs screening services. This includes ensuring the availability of necessary equipment, medications, and trained healthcare professionals.

8. Public-Private Partnerships: Foster collaborations between public and private sectors to expand access to NCDs screening services. This can involve leveraging private healthcare facilities and resources to reach more women in need.

9. Financial Support: Provide financial assistance or subsidies to make NCDs screening services more affordable and accessible to women, especially those from low-income backgrounds.

10. Research and Data Collection: Conduct further research to better understand the barriers and facilitators to accessing NCDs screening during the preconception period. This can inform the development of targeted interventions and policies to improve access and outcomes.

It is important to note that these recommendations are based on the provided information and may need to be tailored to the specific context and resources available in Manna District, Southwest Ethiopia.

AI Innovations Description

Based on the description provided, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Awareness Creation Campaigns: Develop and implement awareness creation campaigns targeting women of reproductive age, especially those in the preconception period. These campaigns can include educational materials, such as brochures and posters, as well as community outreach programs to disseminate information about the importance of NCDs screening during the preconception period.

2. Counseling Services: Establish counseling services at health facilities to provide information and support to women regarding NCDs screening during the preconception period. Trained healthcare professionals can offer personalized guidance and address any concerns or misconceptions that women may have.

3. Integration of NCDs Screening: Integrate NCDs screening into existing maternal health services, such as antenatal care visits. This can ensure that women receive comprehensive care that includes screening for common NCDs before conception and throughout pregnancy.

4. Mobile Health (mHealth) Solutions: Develop mobile health applications or SMS-based platforms to deliver educational messages and reminders to women about the importance of NCDs screening during the preconception period. These technologies can reach a wide audience and provide timely information to women, even in remote areas.

5. Collaboration with Media Outlets: Collaborate with radio and television stations to broadcast educational programs and advertisements that raise awareness about NCDs screening during the preconception period. This can reach a larger audience and reinforce the importance of screening.

6. Training for Healthcare Providers: Provide training for healthcare providers on the importance of NCDs screening during the preconception period and how to effectively communicate this information to women. This can ensure that healthcare providers are knowledgeable and equipped to address women’s questions and concerns.

7. Community Engagement: Engage community leaders, local organizations, and community health workers to promote awareness and encourage women to seek NCDs screening during the preconception period. This can help create a supportive environment that values and prioritizes maternal health.

By implementing these recommendations, access to maternal health can be improved, and more women can be aware of the importance of NCDs screening during the preconception period. This can lead to better health outcomes for both women and their future children.

AI Innovations Methodology

Based on the provided description, here are some potential recommendations for improving access to maternal health:

1. Increase awareness campaigns: Conduct awareness campaigns to educate women about the importance of maternal health, including the screening for common non-communicable diseases during the preconception period. These campaigns can be conducted through various channels such as community meetings, radio broadcasts, and television programs.

2. Strengthen antenatal care services: Improve access to antenatal care services by ensuring that pregnant women have regular check-ups and receive appropriate screening for non-communicable diseases. This can be achieved by increasing the number of health facilities, trained healthcare providers, and necessary equipment in the study area.

3. Enhance education opportunities: Promote education among women, as the study found that women with formal education had higher awareness of NCDs screening during the preconception period. Providing educational opportunities can empower women to make informed decisions about their health and seek appropriate care.

4. Improve family planning services: Emphasize the importance of family planning and encourage women to plan their pregnancies. Women who had planned pregnancies were found to have higher awareness of NCDs screening. Strengthening family planning services can help women space their pregnancies and ensure they are in good health before conceiving.

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

1. Define the indicators: Identify specific indicators that can measure the impact of the recommendations, such as the percentage of women aware of NCDs screening during the preconception period, the number of antenatal care visits, and the rate of planned pregnancies.

2. Collect baseline data: Gather data on the current status of maternal health access and awareness in the study area. This can be done through surveys, interviews, and data from health facilities.

3. Implement the recommendations: Roll out the recommended interventions, such as awareness campaigns, strengthening antenatal care services, promoting education, and improving family planning services. Ensure that these interventions are implemented consistently and monitored closely.

4. Monitor and evaluate: Continuously monitor the progress of the interventions and collect data on the selected indicators. This can be done through regular surveys, interviews, and monitoring of health facility records.

5. Analyze the data: Use statistical analysis to assess the impact of the recommendations on the selected indicators. Compare the baseline data with the data collected after the implementation of the interventions to determine any changes or improvements.

6. Draw conclusions and make adjustments: Based on the analysis, draw conclusions about the effectiveness of the recommendations in improving access to maternal health. Identify any areas that may require adjustments or further interventions.

7. Share findings and recommendations: Communicate the findings of the impact assessment to relevant stakeholders, such as policymakers, healthcare providers, and community members. Provide recommendations for further actions to sustain and enhance the improvements in maternal health access.

By following this methodology, it is possible to simulate the impact of the recommendations on improving access to maternal health and make informed decisions for future interventions.

Authors & Co-Authors

Statistics:

Citations: 2

Authors: 3

Identifiers:

DOI: 10.1186/s12913-021-06067-2

Research Areas:

Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Noncommunicable Diseases, Sexual and Reproductive Health, Social Determinants

Study Countries:

Ethiopia

Study Design:

Case-Control Study, Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative

Participants Gender:

Female