A family-oriented antenatal education program to improve birth preparedness and maternal-infant birth outcomes: A cross sectional evaluation study

Reproductive Health, Volume 16, No. 1, Year 2019

Interpretação

Background: In Tanzania, the information on Birth Preparedness and Complication Readiness is insufficiently provided to pregnant women and their families. The aim of this study was to evaluate the maternal and infant outcomes of a family-oriented antenatal group education program that promotes Birth Preparedness and Complication Readiness in rural Tanzania. Methods: Pregnant women and families were enrolled in a program about nutrition and exercise, danger signs, and birth preparedness. The cross sectional survey was conducted one year later to evaluate if the participants of the program (intervention group) were different from those who did not participate (control group) with respect to birth-preparedness and maternal and infant outcomes. Results: A total of 194 participants (intervention group, 50; control group, 144) were analyzed. For Birth Preparedness and Complication Readiness, the intervention group participants knew a health facility in case of emergency (OR: 3.11, 95% CI: 1.39-6.97); arranged accompaniment to go to a health facility for birth (OR: 2.56, 95% CI: 1.17-5.60); decided the birthplace with or by the pregnant women (OR: 3.11, 95% CI: 1.44-6.70); and attended antenatal clinic more than four times (OR: 2.39, 95% CI: 1.20-4.78). For birth outcomes, the intervention group had less bleeding or seizure during labour and birth (OR: 0.28, 95%CI: 0.13-0.58); fewer Caesarean sections (OR: 0.16, 95% CI: 0.07-0.36); and less neonatal complications (OR: 0.28, 95% CI: 0.13-0.60). Conclusions: The four variables were significantly better in the intervention group, i.e., identifying a health facility for emergencies, family accompaniment for facility birth, antenatal visits, and involvement of women in decision-making, which may be key factors for improving birth outcome variables. Having identified these key factors, male involvement and healthy pregnant lives should be emphasized in antenatal education to reduce pregnancy and childbirth complications. Trial registration: No.2013-273-NA-2013-101. Registered 12 August 2013. This research was a cross sectional evaluation study to identify the effects of an antenatal education program on birth preparedness and maternal-infant outcomes (the second phase). All the participants were convenient samples of pregnant women and their families in villages. For the first phase, villagers were recruited to receive an antenatal education program. The details of the process were published elsewhere [13]. For the second phase, the participants in the first phase (the intervention group) were followed after one year. The research team visited the same villages of the first phase and requested the village leaders to announce the present research to both participants of the first phase and those who did not participate in the first phase of the study. The researchers explained the purpose, the content of the second phase, and the ethical considerations. The inclusion criteria were as follows: 16 years old or older, had experienced pregnancy and childbirth in their family including themselves, had no severe physical or psychological illness, and can read Kiswahili. The study was conducted in Korogwe district, which is one of the eight districts in the Tanga region, located in the North Eastern area of the country. Maternal healthcare in Korogwe is provided at one district hospital, three government health centers, one faith-based organization, six private dispensaries, and 41 government dispensaries. Three villages were purposefully selected as the research sites, which were located at least 5 km away from the closest health facility. The distance of villages from health facilities was important as this study focused on preparation of birth and those who live distant from health facilities needed to prepare for birth to be able to seek healthcare when necessary. Thus, if villages were sufficiently close to health facilities, they could access healthcare even if they were not well prepared. The purpose of this family-oriented antenatal group education program was to promote BPCR and family involvement in pregnancy and childbirth. A picture drama was developed by the research team to convey the story of two pregnant women. The material was first developed in English and then translated by a master-prepared bilingual Tanzanian midwife. The program lasts for approximately 45 min, including explanation of the research, pre-test/post-test, picture drama, and discussion among the participants. The result of the pre-test/post-test was published elsewhere [13]. The Tanzanian midwife led the entire program, reading picture drama and encouraging the participants to talk about the contents in the end. As the picture drama unfolds, the story shows one woman who had attended an antenatal clinic more than four times. During the antenatal clinic visit, a midwife provided information on appropriate nutrition and exercise, danger signs, and birth preparedness. This pregnant woman and her family had prepared transportation, money, and an accompanying person, and identified a health facility to give birth. When she started having contractions, her family was ready to support her timely trip to a health facility. With the support of a Skilled Birth Attendant (SBA), she gave birth a healthy baby. The other pregnant woman had a family who did not understand the importance of antenatal clinic visits and facility births. She did not visit an antenatal clinic and expected a home birth. When she started having contractions, a Traditional Birth Attendant (TBA) came to support her, but she was having an obstructed labour at that time. They waited for many hours before birth, and then observed that the baby was not breathing after birth. The mother started bleeding after giving birth, thus both the mother and the baby were brought to the hospital, but it was too late to save either one of them. The story illustrated the importance of BPCR and family support, as most household decisions including the birthplace in Tanzania are made by the family members, particularly the husband, and not by the woman [11, 14–16]. The primary outcome was whether the BPCR variables of pregnant women and their families were higher in the intervention group than in the control group. As the pre-test/post-test results of the education program was published elsewhere [13], the present report clarifies whether pregnant women had actually prepared for birth according to the BPCR variables, including a visit to an antenatal clinic four times or more. The questions were asked retrospectively in the second phase. The secondary outcomes were as follows: (1) birth in a health facility, (2) women’s complications at birth, and (3) infants’ complications and deaths. To evaluate the outcomes, the survey items were developed on the basis of the elements of BPCR [1] in English. The survey included demographic information, BPCR, and outcomes of the most recent childbirth in the family including their own childbirth. A Kiswahili-English bilingual translated the English items into Kiswahili. Another Tanzanian researcher who is a PhD holder and is also a Kiswahili-English bilingual conducted the back translation and confirmed the accuracy of the survey items. As for the primary outcome, the BPCR variables included the following elements: desired place of birth; preferred birth attendant; location of the closest facility for birth and in case of complications; funds for any expenses related to birth and in case of complications; supplies and materials necessary to bring to the facility; an identified labour and birth companion; an identified support to look after the home and other children while the woman was away; transport to a facility for birth or in the case of a complications; and identification of compatible blood donors in case of complications. The questions were answerable by yes/no (e.g., “Did you arrange for someone to accompany you or her to go to a health center or a hospital for birth or emergency?”). For the secondary outcome, the birth outcome variables included the following: did they give birth in a health facility, did an SBA assisted their birth, were there any complications, was the birth by Caesarean section, was it a live birth, did the baby have any complications, and did they want to give birth again at a health facility. The related questions were to be answered by yes or no (e.g., “Did you or she gave birth at a health center or a hospital?”, “Were there any problems like bleeding or seizure during the labour and birth?”). The sample size of this study was calculated on the basis of the basic formula with two groups, a two-sided alternative and normal distributions with the same variances. The sample size was calculated as 64 for each group to detect a difference (10 points) between groups at a 5% level of significance with 80% power. During the first phase of the study, the family-oriented antenatal group education program was provided to pregnant women and their families in the intervention group to promote BPCR and family involvement in the villages, as we intended to reach people who were neither attending an antenatal clinic nor planned to give birth at a health facility. At the second phase of the study, that is, one year later after providing the education program, we returned to the same three villages and contacted those who attended the education program and those in the control group who did not. Those who agreed to participate answered a survey about their BPCR before childbirth and their behaviors and childbirth outcomes for the most recent childbirth they experienced. For the first phase, the education program was provided in August 2013. For the second phase, the outcome survey was conducted in August 2014. Ethical clearance and permissions were obtained from the 1) Institutional Review Board at St. Luke’s International University, Tokyo, Japan (14–040); 2) Director of Korogwe District Council, 3) National Institute for Medical Research (NIMR), Tanzania (NIMR/HQ/R.8/Vol.IX/1604), and 4) Tanzania Commission for Science and Technology (COSTECH) (No.2013–273-NA-2013-101). For background data, the t-test was used for numerical control of the intervention and control groups (i.e., age and number of children). Pearson’s chi-square test was used for other nominal background data. Those who missed values were excluded from the final analysis, so there was no missing data. For BPCR and outcome variables, the odds ratios (ORs) and 95% confidence intervals (CIs) were also calculated with logistic analysis, comparing the intervention group with the control group. As the number of antenatal visits might affect facility delivery [17, 18], the variable of antenatal visit was used as cofounder in the analysis of outcome variables. Data were analyzed using SPSS ver. 24 (SPSS Inc., Chicago, IL, USA).

AI Digest

Study Justification:

– The study aimed to evaluate the effects of a family-oriented antenatal education program on birth preparedness and maternal-infant outcomes in rural Tanzania.
– The information on Birth Preparedness and Complication Readiness (BPCR) is insufficiently provided to pregnant women and their families in Tanzania.
– The study aimed to address this gap and determine the impact of the education program on improving birth outcomes.

Highlights:

– The intervention group participants showed significant improvements in several BPCR variables compared to the control group.
– The intervention group had better knowledge of a health facility in case of emergency, arranged accompaniment for facility birth, decided the birthplace with or by the pregnant women, and attended antenatal clinic more than four times.
– The intervention group also had fewer instances of bleeding or seizure during labor and birth, fewer Caesarean sections, and fewer neonatal complications.

Recommendations for Lay Reader:

– The study highlights the importance of antenatal education programs in improving birth preparedness and maternal-infant outcomes.
– Pregnant women and their families should be encouraged to attend antenatal clinics, identify a health facility for emergencies, and arrange for accompaniment to the facility for birth.
– Involvement of women in decision-making regarding birthplace is crucial for better birth outcomes.
– Male involvement and healthy pregnant lives should be emphasized in antenatal education to reduce pregnancy and childbirth complications.

Recommendations for Policy Maker:

– The study findings suggest the need for implementing family-oriented antenatal education programs in rural areas of Tanzania.
– Policies should be developed to ensure that pregnant women and their families have access to comprehensive information on BPCR.
– Efforts should be made to increase the number of antenatal clinic visits and promote male involvement in decision-making during pregnancy and childbirth.
– Resources should be allocated to train healthcare providers and community workers to deliver effective antenatal education programs.

Key Role Players:

– Healthcare providers: Midwives, nurses, and doctors who can deliver antenatal education programs and provide necessary healthcare services.
– Community workers: Individuals who can reach out to pregnant women and their families in rural areas and provide information on BPCR.
– Village leaders: They can help in disseminating information about the education program and encourage participation.
– Policy makers: Government officials and policymakers who can develop and implement policies to support antenatal education programs.

Cost Items for Planning Recommendations:

– Training programs: Budget for training healthcare providers and community workers in delivering effective antenatal education programs.
– Educational materials: Funds for developing and distributing educational materials, such as picture dramas, to pregnant women and their families.
– Outreach activities: Budget for community outreach activities to reach pregnant women and their families in rural areas.
– Monitoring and evaluation: Resources for monitoring and evaluating the implementation and impact of the antenatal education programs.
– Infrastructure and equipment: Funds for improving healthcare facilities and providing necessary equipment for safe childbirth.
Please note that the provided cost items are general suggestions and may vary based on the specific context and requirements of the implementation.

Força da prova

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is a cross-sectional evaluation study, which limits the ability to establish causality. However, the study includes a control group and reports odds ratios with 95% confidence intervals, which adds strength to the findings. To improve the strength of the evidence, the study could have used a randomized controlled trial design to better control for confounding variables and establish causality. Additionally, a larger sample size would increase the generalizability of the findings. Finally, conducting a follow-up study to assess the long-term effects of the antenatal education program would provide more robust evidence.

Resumo

This research was a cross sectional evaluation study to identify the effects of an antenatal education program on birth preparedness and maternal-infant outcomes (the second phase). All the participants were convenient samples of pregnant women and their families in villages. For the first phase, villagers were recruited to receive an antenatal education program. The details of the process were published elsewhere [13]. For the second phase, the participants in the first phase (the intervention group) were followed after one year. The research team visited the same villages of the first phase and requested the village leaders to announce the present research to both participants of the first phase and those who did not participate in the first phase of the study. The researchers explained the purpose, the content of the second phase, and the ethical considerations. The inclusion criteria were as follows: 16 years old or older, had experienced pregnancy and childbirth in their family including themselves, had no severe physical or psychological illness, and can read Kiswahili. The study was conducted in Korogwe district, which is one of the eight districts in the Tanga region, located in the North Eastern area of the country. Maternal healthcare in Korogwe is provided at one district hospital, three government health centers, one faith-based organization, six private dispensaries, and 41 government dispensaries. Three villages were purposefully selected as the research sites, which were located at least 5 km away from the closest health facility. The distance of villages from health facilities was important as this study focused on preparation of birth and those who live distant from health facilities needed to prepare for birth to be able to seek healthcare when necessary. Thus, if villages were sufficiently close to health facilities, they could access healthcare even if they were not well prepared. The purpose of this family-oriented antenatal group education program was to promote BPCR and family involvement in pregnancy and childbirth. A picture drama was developed by the research team to convey the story of two pregnant women. The material was first developed in English and then translated by a master-prepared bilingual Tanzanian midwife. The program lasts for approximately 45 min, including explanation of the research, pre-test/post-test, picture drama, and discussion among the participants. The result of the pre-test/post-test was published elsewhere [13]. The Tanzanian midwife led the entire program, reading picture drama and encouraging the participants to talk about the contents in the end. As the picture drama unfolds, the story shows one woman who had attended an antenatal clinic more than four times. During the antenatal clinic visit, a midwife provided information on appropriate nutrition and exercise, danger signs, and birth preparedness. This pregnant woman and her family had prepared transportation, money, and an accompanying person, and identified a health facility to give birth. When she started having contractions, her family was ready to support her timely trip to a health facility. With the support of a Skilled Birth Attendant (SBA), she gave birth a healthy baby. The other pregnant woman had a family who did not understand the importance of antenatal clinic visits and facility births. She did not visit an antenatal clinic and expected a home birth. When she started having contractions, a Traditional Birth Attendant (TBA) came to support her, but she was having an obstructed labour at that time. They waited for many hours before birth, and then observed that the baby was not breathing after birth. The mother started bleeding after giving birth, thus both the mother and the baby were brought to the hospital, but it was too late to save either one of them. The story illustrated the importance of BPCR and family support, as most household decisions including the birthplace in Tanzania are made by the family members, particularly the husband, and not by the woman [11, 14–16]. The primary outcome was whether the BPCR variables of pregnant women and their families were higher in the intervention group than in the control group. As the pre-test/post-test results of the education program was published elsewhere [13], the present report clarifies whether pregnant women had actually prepared for birth according to the BPCR variables, including a visit to an antenatal clinic four times or more. The questions were asked retrospectively in the second phase. The secondary outcomes were as follows: (1) birth in a health facility, (2) women’s complications at birth, and (3) infants’ complications and deaths. To evaluate the outcomes, the survey items were developed on the basis of the elements of BPCR [1] in English. The survey included demographic information, BPCR, and outcomes of the most recent childbirth in the family including their own childbirth. A Kiswahili-English bilingual translated the English items into Kiswahili. Another Tanzanian researcher who is a PhD holder and is also a Kiswahili-English bilingual conducted the back translation and confirmed the accuracy of the survey items. As for the primary outcome, the BPCR variables included the following elements: desired place of birth; preferred birth attendant; location of the closest facility for birth and in case of complications; funds for any expenses related to birth and in case of complications; supplies and materials necessary to bring to the facility; an identified labour and birth companion; an identified support to look after the home and other children while the woman was away; transport to a facility for birth or in the case of a complications; and identification of compatible blood donors in case of complications. The questions were answerable by yes/no (e.g., “Did you arrange for someone to accompany you or her to go to a health center or a hospital for birth or emergency?”). For the secondary outcome, the birth outcome variables included the following: did they give birth in a health facility, did an SBA assisted their birth, were there any complications, was the birth by Caesarean section, was it a live birth, did the baby have any complications, and did they want to give birth again at a health facility. The related questions were to be answered by yes or no (e.g., “Did you or she gave birth at a health center or a hospital?”, “Were there any problems like bleeding or seizure during the labour and birth?”). The sample size of this study was calculated on the basis of the basic formula with two groups, a two-sided alternative and normal distributions with the same variances. The sample size was calculated as 64 for each group to detect a difference (10 points) between groups at a 5% level of significance with 80% power. During the first phase of the study, the family-oriented antenatal group education program was provided to pregnant women and their families in the intervention group to promote BPCR and family involvement in the villages, as we intended to reach people who were neither attending an antenatal clinic nor planned to give birth at a health facility. At the second phase of the study, that is, one year later after providing the education program, we returned to the same three villages and contacted those who attended the education program and those in the control group who did not. Those who agreed to participate answered a survey about their BPCR before childbirth and their behaviors and childbirth outcomes for the most recent childbirth they experienced. For the first phase, the education program was provided in August 2013. For the second phase, the outcome survey was conducted in August 2014. Ethical clearance and permissions were obtained from the 1) Institutional Review Board at St. Luke’s International University, Tokyo, Japan (14–040); 2) Director of Korogwe District Council, 3) National Institute for Medical Research (NIMR), Tanzania (NIMR/HQ/R.8/Vol.IX/1604), and 4) Tanzania Commission for Science and Technology (COSTECH) (No.2013–273-NA-2013-101). For background data, the t-test was used for numerical control of the intervention and control groups (i.e., age and number of children). Pearson’s chi-square test was used for other nominal background data. Those who missed values were excluded from the final analysis, so there was no missing data. For BPCR and outcome variables, the odds ratios (ORs) and 95% confidence intervals (CIs) were also calculated with logistic analysis, comparing the intervention group with the control group. As the number of antenatal visits might affect facility delivery [17, 18], the variable of antenatal visit was used as cofounder in the analysis of outcome variables. Data were analyzed using SPSS ver. 24 (SPSS Inc., Chicago, IL, USA).

Materiais

N/A

Inovações

The recommendation from the research study is to implement a family-oriented antenatal education program in rural Tanzania to improve birth preparedness and maternal-infant outcomes. The program aims to promote Birth Preparedness and Complication Readiness (BPCR) by providing pregnant women and their families with information on nutrition and exercise, danger signs, and birth preparedness.

The program utilizes a picture drama to convey the importance of BPCR and family involvement in pregnancy and childbirth. It emphasizes the need for pregnant women and their families to identify a health facility for emergencies, arrange accompaniment for facility birth, decide the birthplace, and attend antenatal clinic more than four times.

The study found that participants in the intervention group who received the antenatal education program had better birth preparedness and maternal-infant outcomes compared to those in the control group. The intervention group showed higher knowledge of health facilities for emergencies, arranged accompaniment for facility birth, decided the birthplace, and attended antenatal clinic more frequently. They also had fewer instances of bleeding or seizure during labor and birth, fewer Caesarean sections, and fewer neonatal complications.

Based on these findings, the researchers recommend emphasizing male involvement and healthy pregnant lives in antenatal education programs to reduce pregnancy and childbirth complications. The program can be implemented in rural areas where access to maternal healthcare facilities is limited. By providing pregnant women and their families with the necessary knowledge and support, this program can improve birth preparedness and ultimately contribute to better maternal and infant outcomes.

The research study was published in the journal Reproductive Health in 2019.

AI Innovations Description

The recommendation from the research study is to implement a family-oriented antenatal education program to improve birth preparedness and maternal-infant outcomes in rural Tanzania. This program aims to promote Birth Preparedness and Complication Readiness (BPCR) by providing pregnant women and their families with information on nutrition and exercise, danger signs, and birth preparedness.

The program utilizes a picture drama to convey the importance of BPCR and family involvement in pregnancy and childbirth. It emphasizes the need for pregnant women and their families to identify a health facility for emergencies, arrange accompaniment to go to a health facility for birth, decide the birthplace with or by the pregnant women, and attend antenatal clinic more than four times.

The study found that participants in the intervention group who received the antenatal education program had better birth preparedness and maternal-infant outcomes compared to those in the control group. The intervention group showed higher knowledge of health facilities for emergencies, arranged accompaniment for facility birth, decided the birthplace, and attended antenatal clinic more frequently. They also had fewer instances of bleeding or seizure during labor and birth, fewer Caesarean sections, and fewer neonatal complications.

Based on these findings, the researchers recommend emphasizing male involvement and healthy pregnant lives in antenatal education programs to reduce pregnancy and childbirth complications. The program can be implemented in rural areas where access to maternal healthcare facilities is limited. By providing pregnant women and their families with the necessary knowledge and support, this program can improve birth preparedness and ultimately contribute to better maternal and infant outcomes.

The research study was published in the journal Reproductive Health in 2019.

AI Innovations Methodology

The methodology used in this research study involved a cross-sectional evaluation to assess the effects of a family-oriented antenatal education program on birth preparedness and maternal-infant outcomes in rural Tanzania. The study consisted of two phases.

In the first phase, pregnant women and their families in villages were recruited to participate in the antenatal education program. The program focused on promoting Birth Preparedness and Complication Readiness (BPCR) and included information on nutrition and exercise, danger signs, and birth preparedness. A picture drama was used to convey the importance of BPCR and family involvement in pregnancy and childbirth.

After one year, in the second phase, the participants in the intervention group were followed up to evaluate the outcomes of the program. The research team visited the same villages and informed both the participants of the first phase and those who did not participate about the second phase of the study. The inclusion criteria for participants were being 16 years old or older, having experienced pregnancy and childbirth in their family, having no severe physical or psychological illness, and being able to read Kiswahili.

The study was conducted in the Korogwe district of Tanzania, which has limited access to maternal healthcare facilities. Three villages were purposefully selected as research sites, located at least 5 km away from the closest health facility. This distance was important to focus on the preparation for birth in areas where access to healthcare is limited.

The primary outcome of the study was to compare the BPCR variables between the intervention group and the control group. The BPCR variables included elements such as desired place of birth, preferred birth attendant, location of the closest facility for birth and emergencies, funds for expenses, supplies and materials necessary for birth, and identified support and transportation.

The secondary outcomes included birth in a health facility, women’s complications at birth, and infants’ complications and deaths. The survey included questions about these outcomes, which were answered retrospectively by the participants.

Statistical analysis, including t-tests and chi-square tests, was conducted to compare the intervention group and the control group. Logistic analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) to assess the differences between the groups.

The study found that participants in the intervention group who received the antenatal education program had better birth preparedness and improved maternal-infant outcomes compared to those in the control group. The intervention group showed higher knowledge of health facilities for emergencies, arranged accompaniment for facility birth, decided the birthplace, and attended antenatal clinic more frequently. They also had fewer instances of bleeding or seizure during labor and birth, fewer Caesarean sections, and fewer neonatal complications.

Based on these findings, the researchers recommend emphasizing male involvement and healthy pregnant lives in antenatal education programs to reduce pregnancy and childbirth complications. The program can be implemented in rural areas where access to maternal healthcare facilities is limited, providing pregnant women and their families with the necessary knowledge and support to improve birth preparedness and maternal-infant outcomes.

The research study was published in the journal Reproductive Health in 2019.

Autor

Dima Health

Statistics:

Citations: 10

Identifiers:

DOI: 10.1186/s12978-019-0776-8

Research Areas:

Community Interventions, Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Sexual and Reproductive Health, Technology and Innovations

Study Countries:

Tanzania

Study Design:

Cross Sectional Study, randomised-control-trial

Study Approach:

Quantitative

Participants Gender:

Male & Female

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