Objectives: Every pregnancy can face risk. One of the World Health Organization recommendations for health promotion interventions for maternal and newborn health was to increase birth preparedness and complication readiness. The main objective of this recommendation was to increase the use of skilled care at birth and to increase the timely use of facility care for obstetric and newborn complications. However, to the best of our knowledge, there is a dearth of documented evidence on the magnitude of birth preparedness and complication readiness and factors associated with it in our study area. Thus, the aim of this study was to identify factors affecting the practice of birth preparedness and complication readiness. Methods: A community-based cross-sectional study was carried out from 15 February to 15 March 2020. A total of 698 pregnant women were randomly selected and interviewed using a pretested semi-structured questionnaire. A multivariate generalized linear regression with Poisson link was carried out to see the effect of each independent variable on the dependent variable. Result: Of the sampled 710 participants, 698 participated, which made a response rate of 98.3%. The mean score of practice of birth preparedness and complication readiness was 3.3 (standard deviation = 1.8). Mothers who used pre-pregnancy contraception methods (adjusted odds ratio = 1.22 (95% confidence interval = 1.09, 1.37)), used bare feet as a mode of transportation (adjusted odds ratio = 1.11 (95% confidence interval = 1.01, 1.21)), used more antenatal care content (adjusted odds ratio = 1.09 (95% confidence interval = 1.06, 1.13)), and whose husbands were educated at the primary level of education (adjusted odds ratio = 1.19 (95% confidence interval = 1.03, 1.37)) were predictors in multivariable general. Conclusion: The mean score and overall practice of birth preparedness and complication readiness were low. This study revealed a low level of birth preparedness and complication readiness. In order to improve access to lifesaving care for women and neonates, there is a pressing need for implementation of existing strategies to increase practice of birth preparedness and complication readiness.
The study was conducted in Sodo Zuria Woreda which is one of 16 Woredas and 6 town administrations of Wolaita Zone. Wolaita Sodo is a capital city of the Woreda (Woreda: an administrative unit corresponding to district in other parts of the world and Kebele: the smallest administrative unit in the current Ethiopian government structure under Woreda), which is 327 km away from Addis Ababa through Butajira, and 160 km from Hawassa, the capital city of southern nation, nationalities and peoples region. The Woreda has 20 Kebeles and 5 town administrations. According to Central Statistical Agency report, projected total population of Woreda is 117,884. Expected pregnancy of the district was 4078 (3.6% from a total population of the district). A community-based cross-sectional study was conducted from 15 February 2020 to 15 March 2020. The source population for this study was all pregnant women attending antenatal care (ANC) clinic during study period. To measure the practice of BPCR accurately, women who had late gestational age (women whose gestational age >28 weeks (n = 710) were considered and included in the study. All women who were critically ill and who reside less than 6 months in the study area during data collection period were excluded from this study. The sample size for this study was calculated using stat-calc menu of Epi-info software version 7 initially using the assumptions for single population proportion with estimated prevalence of 30% of practice of BPCR, 9 confidence level of 95% and 5% degree of precision which gives 323. With a consideration of design effect of 2 and 10% non-response rate, the final sample size was 710. Multistage (two stages) sampling was used to select the study participants. Fifteen Kebeles were taken out of 25 using simple random sampling methods (lottery methods). Lists of all pregnant women whose gestational age >28 weeks were obtained from health post. The total sample size was allocated proportionally to the size of the selected Kebeles. Finally, systematic sampling was employed to select the study participants in each Kebele until the desired numbers of sample were obtained. The first household was selected by simple random sampling lottery method. The sampling interval of the households in each Kebele was determined by dividing the total number of eligible households to the allocated sample size. In a case when the study participants were not able to be interviewed for some reason, the next coded house was interviewed. Six data collectors with prior data collection experience were hired, and the data gathering was overseen by three public health professionals from several district health facilities. Both data collectors and supervisors received comprehensive training on data gathering methods and instruments over the course of a day. The data were collected from women using semi-structured interviewer-administered questionnaires for 1-month duration. Data on the practice of BPCR were obtained through face-to-face interview. A pretested, semi-structured, interviewer-administered questionnaire which includes socio-demographic characteristics of the respondents like age, education status, religion, occupation, women’s decision-making power and obstetric characteristics like parity, obstetric complication, antenatal care (ANC) visit, and danger signs of pregnancy was used. The questionnaire was adapted from EDHS 3 and other published literatures.10–13 The data collection team received extensive training from the investigators, with a special focus on the questionnaire’s contents. The data collection tool was written in English, then translated into the local language by a native speaker, and then back translated by another native speaker into English to check its consistency with the original meaning. Another expert on English to check its consistency with the original meaning. Finally, data were collected using a standardized questionnaire written in the local language. Pre-testing was done on 5% of the sample size (36 women) from outside the study region who had similar characteristics to the study population and was not from the sampled clusters in the study area before data collection began. Data were entered in to Epi-data software version 3.1 and then exported to SPSS version 23 statistical package for analysis. 14 Findings have been summarized in tables and graphs using frequencies, percentages, and standard deviations. Bivariate statistical analysis was conducted using analysis of variance (ANOVA) and independent t-test was used to check statistical significance. Multivariate statistical analyses using generalized linear model (GLM) approach were carried out to identify the determinants of BPCR. Poisson’s regression analysis was performed between dependent and independent variables. Since our response variables is count variable, Poisson’s regression was used. When checking assumption for Poisson’s regression model, it fulfills assumption of equi-dispersion. 15 Because of that Poisson’s regression was used in this study. Finally, the odd ratios and the corresponding 95% confidence interval were calculated for each independent variable. The statistical software packages SPSS 23 is used for all statistical analyses. It includes the practice of BPCR. BPCR which was measured as count variables with a maximum of 8 and a minimum of 0 scores The components of BPCR considered in this study were identified place for birth, identified birth attendants, saved money, identified emergency transportation, identified labor and birth companion, identified nearby health facility, identified blood donors if needed, and identified care giver to children’s at home when the mother was away.9,16,17 Ethics clearance was obtained from Ethical Review Committee of Wolkite University, Department of Public Health (ethical code of IRB/175/12). Respondents were informed about the purpose and procedure of the study and written informed consent was obtained from the educated subjects before the study. Verbal informed consent was obtained from the illiterate subjects before the study and this method of obtaining consent was approved by the ethics committee. Privacy and confidentiality of information were assured in advance of data collection. The questionnaire used during the data collection was anonymous by assigning unique ID numbers to each study participant. With regard to confidentiality, respondents were given information that guaranteed them that the information they provided during the study would be used for the research purpose and would not be disclosed to anybody outside the research team. A formal letter of permission was obtained from Wolaita Zone Health Department and Sodo Zuria Woreda Health Office.
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