Utilization of preconception care and associated factors among reproductive age group women in Debre Birhan town, North Shewa, Ethiopia

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

Ukuhunyushwa

Background: Preconception care refers to things women can do before and between pregnancies to increase the chance of having a healthy baby and being a healthy mother. Unfortunately, millions of women in the world do not have access to pre-pregnancy, pregnancy health services and childbirth with suitable quality. Therefore, addressing this significant gap and coming up with the necessary information is helpful to improve maternal and child health in our country. So, this study was aimed to assess the utilization of preconception care and associated factors among reproductive age group women in Debre Birhan Town, North Shewa, Ethiopia. Methods: A mixed method of community based cross-sectional study was employed from March 1st to 30; 2017. Systematic sampling technique was used to select a total of 424 reproductive age women. The data were collected using pre-tested and structured questionnaire and eight in-depth interviews were done using an interview guide. The collected data were coded and entered into Epi data 3.5.1 and exported to SPSS version 21 for cleaning and analysis. Logistic regression was run to look for the association between dependent and explanatory variables; and using variables which have p-value ≤0.25 binary logistic regression was fitted. Association presented in Odds ratio with 95% confidence interval and significance determined at P-value less than 0.05. Result: A total of 410 subjects were participated with a response rate of 96.7%. The overall utilization of Preconception care was 13.4%. Woman’s age, marital status, knowledge and availability of unit for preconception care were significantly associated with utilization of preconception care with (AOR: 3.567; 95% CI: 1.082, 11.758), (AOR: 0.062; 95% CI: 0.007, 0.585), (AOR = 6.263; 95% CI: 2.855, 13.739) and AOR: 13.938; 95% CI: 3.516, 55.251) respectively. Conclusions: The finding of this study showed that women’s utilization of preconception care is relatively low. A woman’s age, marital status, educational status, knowledge about preconception care services and availability of unit for preconception care were factors affecting utilization of preconception care. Therefore, establishing preconception care strategies which can address all the components of the care will be essential when designing effective implementation strategies for improving the uptake of preconception care. A community based cross-sectional study design was conducted in Debre Birhan Town, North Shoa, Ethiopia; from March 1st to March 30, 2017. The town is located 130 km northeast of Addis Ababa. The town is divided into 9 kebeles that has a total area of 142.71 km with an average elevation of 2840 m above sea level. According to the information obtained from the district health office, in 2015/16, the total population size of the district is put as 92,887 out of which 54.78% (50,883) are women. From those women, 23.58% (21,903) are age between 15 and 49. There are one referral hospital, four health centers, one university and four colleges under the government and one private hospital and 17 private clinics in the town. All reproductive age women who lived in Debre Birhan town were the source and study population. All reproductive age group women who had a history of pregnancy and lived in Debre Birhan Town for 6 months and above were included under the study. A sample size of 424 was determined by using a single population proportion formula with the following assumptions: Since there is no local data for the value of p, the prevalence of 50% is taken. D is the expected margin of error (5%), Z, the standard score corresponding to a 95% confidence interval and α, the risk of rejecting the null hypothesis (0.05) and 10% non-response rate. The entire nine kebeles of Debre Birhan town was taken. A total number of households in each kebeles were taken from the 2017 work plan of the district health office. The sample size for each kebeles was determined proportionally to the number of households within each kebeles. To reach the study unit systematic sampling technique was used in the kebeles. The sampling interval of the households in each kebeles was determined by dividing the total number of households in the specific Kebele to the allocated sample size (N/n) th which is forty- two. The first house was selected randomly in one place and every 42nd house for all kebeles was asked. When there was no eligible woman in the selected house, a nearby house was asked. In case of more than one eligible woman were encountered in the selected household, a lottery method was used to determine which woman would be interviewed. In the qualitative study, eight key informants seven from health institution and one from Woreda health office were selected for in-depth interview using purposive sampling technique. The purpose was health professionals that were working on maternal, sexual and reproductive health services and relating issues. The dependent variable is the utilization of preconception care and the independent variables were Socio-demographic characteristics, obstetric and gynecologic history, Knowledge of preconception care and health service related factors. Preconception care: Any interventions either advice or treatment, and lifestyle modification women received regarding components of preconception care before being pregnant [26].(Preconception care components in this study is HIV testing and counseling, STI screening and treatment, Infertility/sub-fertility treatment, Nutrition, Ferrous supplementation, Immunization, Advice on cessation of alcohol, Advice on cessation of cigarette smoking). Unit for preconception care: is a unit or room where women’s received preconception care before being pregnant. Preconception care utilization: If women received any interventions either advice or treatment, and lifestyle modification regarding components of preconception care at least once before being pregnant. Good knowledge: Those who have scored above or equal to 50% of correct responses to preconception care knowledge questions [26]. Poor knowledge: Those who have scored less than 50% of correct responses to preconception care knowledge questions [26]. Data was collected using a pre-tested structured questionnaire through face to face interview. The study questionnaire consists of different parts for data collection up on the tool adapted from previous literature in different parts of the world and modified according to the local context. Six (6) Diploma Nurse and three Bsc Midwife supervisors who were familiar with the study area and experienced in data collection were hired to collect the data after attending 1 day training on the aim of the study, content, objective, data collection and interviewing technique and issue on confidentiality. During the data collection, regular supportive supervision and discussion with data collectors and supervisors were done. Every day, the supervisors have checked all the filled questionnaires for completion and clarity. A semi-structured in-depth interview guide was used to collect the qualitative data. The principal investigator has collected the data through the assistance of one Msc degree who are experienced in qualitative data collection. The collected data were first checked manually for completeness, missed values, unlikely responses and then coded, entered using Epi data version 3.5.1. Then cleaned and analyzed using SPSS version 20. Descriptive statistics were computed to determine frequencies and summary statistics (mean, standard deviation, and percentage) to describe the study population in relation to socio-demographic and other relevant variables. Data were presented using tables, graphs, and figures. Variables with a P value < 0.25 in bivariate analysis were transferred to multivariate analysis. Multiple logistic regressions were done to test the presence of an association between predictors and dependent variables. P value ≤0.05, at 95% confidence interval was considered as a cut point to declare the presence of statistically significant association. The odds ratio was used to determine the direction and strength of the association. For the qualitative part, thematic analyses were employed to extract meanings out of the texts manually. First, the data was transcribed and coded. Then categorized and thematized in line with Pre-determined thematic areas. Factors affecting utilization of preconception care as explained by the participants were thematically categorized to knowledge and health facility related factors. Then finally results were presented by supporting with the quantitative data. The data collection tool was translated into local language, Amharic by experts in both languages and was translated back to English by another person to ensure consistency and accuracy. Training was given to both the data collectors and supervisors for 1 day on the purpose of the study, data collection tools, and procedure, how to interview, handling ethical issues and maintaining confidentiality and privacy. Each supervisor and Principal investigator was supervised data collectors and checked all the filled questionnaires for completion, clarity, and consistency on daily bases. The questionnaire was pre-tested on 5% of the calculated sample size to familiarize enumerators with the administration of the interview process and for ensuring consistency. The pre-test study covered 22 eligible reproductive age group women who are living in Shewarobit town, which become out of the main study town 2 weeks before the commencement of the main data collection. Debriefing sessions were held with the pre-test field staff and the questionnaires were modified based on lessons drawn from the pre-test. The validity of the tool was also approved by experts. Ethical clearance and approval letter to conduct the study were obtained from Jimma University institutional review board and a letter of cooperation was taken from Jimma University institute of health to Debre Birhan town health bureau. Written consent was obtained from the study participants after explaining the study objectives and procedures. The right to refuse not to participate in the study any time they want was assured and Confidentiality of the information was ensured by coding. The interview was undertaken privately in a separate area. Only authorized person was getting access to the raw data collected from the field.

I-AI Digest

Study Justification:

– Preconception care is important for improving maternal and child health outcomes.
– Many women worldwide lack access to pre-pregnancy health services.
– Addressing this gap and obtaining necessary information can help improve maternal and child health in Ethiopia.

Study Highlights:

– A community-based cross-sectional study was conducted in Debre Birhan Town, North Shewa, Ethiopia.
– The study aimed to assess the utilization of preconception care and associated factors among reproductive age group women.
– A total of 410 subjects participated, with an overall utilization rate of preconception care at 13.4%.
– Factors such as age, marital status, knowledge, and availability of preconception care units were significantly associated with utilization.

Study Recommendations:

– Establish preconception care strategies that address all components of care to improve uptake.
– Increase awareness and knowledge about preconception care services among reproductive age women.
– Improve availability and accessibility of preconception care units in the community.

Key Role Players:

– Health professionals (nurses, midwives) for providing preconception care services.
– District health office for planning and coordination.
– Woreda health office for policy implementation and monitoring.

Cost Items for Planning Recommendations:

– Training for health professionals on preconception care services.
– Development and dissemination of educational materials on preconception care.
– Infrastructure and equipment for preconception care units.
– Monitoring and evaluation activities to assess the impact of interventions.
Please note that the cost items provided are general suggestions and may vary based on the specific context and resources available in Debre Birhan Town.

Amandla Obufakazi

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is relatively strong, but there are some areas for improvement. The study design is clearly described as a community-based cross-sectional study, which provides a good basis for assessing the utilization of preconception care. The sample size is also mentioned, which adds to the strength of the evidence. However, the abstract lacks information on the specific methods used for data collection and analysis, such as the types of questions asked in the questionnaire and the statistical tests used. Including these details would enhance the transparency and replicability of the study. Additionally, the abstract could benefit from providing more context on the generalizability of the findings, such as the demographic characteristics of the study population and how representative it is of the broader population. Overall, the evidence is fairly strong, but providing more methodological details and contextual information would improve its quality.

Abstract

A community based cross-sectional study design was conducted in Debre Birhan Town, North Shoa, Ethiopia; from March 1st to March 30, 2017. The town is located 130 km northeast of Addis Ababa. The town is divided into 9 kebeles that has a total area of 142.71 km with an average elevation of 2840 m above sea level. According to the information obtained from the district health office, in 2015/16, the total population size of the district is put as 92,887 out of which 54.78% (50,883) are women. From those women, 23.58% (21,903) are age between 15 and 49. There are one referral hospital, four health centers, one university and four colleges under the government and one private hospital and 17 private clinics in the town. All reproductive age women who lived in Debre Birhan town were the source and study population. All reproductive age group women who had a history of pregnancy and lived in Debre Birhan Town for 6 months and above were included under the study. A sample size of 424 was determined by using a single population proportion formula with the following assumptions: Since there is no local data for the value of p, the prevalence of 50% is taken. D is the expected margin of error (5%), Z, the standard score corresponding to a 95% confidence interval and α, the risk of rejecting the null hypothesis (0.05) and 10% non-response rate. The entire nine kebeles of Debre Birhan town was taken. A total number of households in each kebeles were taken from the 2017 work plan of the district health office. The sample size for each kebeles was determined proportionally to the number of households within each kebeles. To reach the study unit systematic sampling technique was used in the kebeles. The sampling interval of the households in each kebeles was determined by dividing the total number of households in the specific Kebele to the allocated sample size (N/n) th which is forty- two. The first house was selected randomly in one place and every 42nd house for all kebeles was asked. When there was no eligible woman in the selected house, a nearby house was asked. In case of more than one eligible woman were encountered in the selected household, a lottery method was used to determine which woman would be interviewed. In the qualitative study, eight key informants seven from health institution and one from Woreda health office were selected for in-depth interview using purposive sampling technique. The purpose was health professionals that were working on maternal, sexual and reproductive health services and relating issues. The dependent variable is the utilization of preconception care and the independent variables were Socio-demographic characteristics, obstetric and gynecologic history, Knowledge of preconception care and health service related factors. Preconception care: Any interventions either advice or treatment, and lifestyle modification women received regarding components of preconception care before being pregnant [26].(Preconception care components in this study is HIV testing and counseling, STI screening and treatment, Infertility/sub-fertility treatment, Nutrition, Ferrous supplementation, Immunization, Advice on cessation of alcohol, Advice on cessation of cigarette smoking). Unit for preconception care: is a unit or room where women’s received preconception care before being pregnant. Preconception care utilization: If women received any interventions either advice or treatment, and lifestyle modification regarding components of preconception care at least once before being pregnant. Good knowledge: Those who have scored above or equal to 50% of correct responses to preconception care knowledge questions [26]. Poor knowledge: Those who have scored less than 50% of correct responses to preconception care knowledge questions [26]. Data was collected using a pre-tested structured questionnaire through face to face interview. The study questionnaire consists of different parts for data collection up on the tool adapted from previous literature in different parts of the world and modified according to the local context. Six (6) Diploma Nurse and three Bsc Midwife supervisors who were familiar with the study area and experienced in data collection were hired to collect the data after attending 1 day training on the aim of the study, content, objective, data collection and interviewing technique and issue on confidentiality. During the data collection, regular supportive supervision and discussion with data collectors and supervisors were done. Every day, the supervisors have checked all the filled questionnaires for completion and clarity. A semi-structured in-depth interview guide was used to collect the qualitative data. The principal investigator has collected the data through the assistance of one Msc degree who are experienced in qualitative data collection. The collected data were first checked manually for completeness, missed values, unlikely responses and then coded, entered using Epi data version 3.5.1. Then cleaned and analyzed using SPSS version 20. Descriptive statistics were computed to determine frequencies and summary statistics (mean, standard deviation, and percentage) to describe the study population in relation to socio-demographic and other relevant variables. Data were presented using tables, graphs, and figures. Variables with a P value < 0.25 in bivariate analysis were transferred to multivariate analysis. Multiple logistic regressions were done to test the presence of an association between predictors and dependent variables. P value ≤0.05, at 95% confidence interval was considered as a cut point to declare the presence of statistically significant association. The odds ratio was used to determine the direction and strength of the association. For the qualitative part, thematic analyses were employed to extract meanings out of the texts manually. First, the data was transcribed and coded. Then categorized and thematized in line with Pre-determined thematic areas. Factors affecting utilization of preconception care as explained by the participants were thematically categorized to knowledge and health facility related factors. Then finally results were presented by supporting with the quantitative data. The data collection tool was translated into local language, Amharic by experts in both languages and was translated back to English by another person to ensure consistency and accuracy. Training was given to both the data collectors and supervisors for 1 day on the purpose of the study, data collection tools, and procedure, how to interview, handling ethical issues and maintaining confidentiality and privacy. Each supervisor and Principal investigator was supervised data collectors and checked all the filled questionnaires for completion, clarity, and consistency on daily bases. The questionnaire was pre-tested on 5% of the calculated sample size to familiarize enumerators with the administration of the interview process and for ensuring consistency. The pre-test study covered 22 eligible reproductive age group women who are living in Shewarobit town, which become out of the main study town 2 weeks before the commencement of the main data collection. Debriefing sessions were held with the pre-test field staff and the questionnaires were modified based on lessons drawn from the pre-test. The validity of the tool was also approved by experts. Ethical clearance and approval letter to conduct the study were obtained from Jimma University institutional review board and a letter of cooperation was taken from Jimma University institute of health to Debre Birhan town health bureau. Written consent was obtained from the study participants after explaining the study objectives and procedures. The right to refuse not to participate in the study any time they want was assured and Confidentiality of the information was ensured by coding. The interview was undertaken privately in a separate area. Only authorized person was getting access to the raw data collected from the field.

Izinto zokwakha

N/A

Emisha

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 resources on preconception care, pregnancy health services, and childbirth. These apps can be easily accessible to women in remote areas, providing them with essential knowledge and guidance.

2. Telemedicine: Establish telemedicine services that allow women to consult with healthcare professionals remotely. This can help overcome geographical barriers and provide access to prenatal care, advice, and support.

3. Community Health Workers: Train and deploy community health workers who can provide education, counseling, and basic healthcare services to women in their communities. These workers can play a crucial role in promoting preconception care and connecting women to appropriate healthcare facilities.

4. Public Awareness Campaigns: Launch targeted public awareness campaigns to educate women and their families about the importance of preconception care and the available services. These campaigns can use various media channels, including radio, television, and social media, to reach a wide audience.

5. Strengthening Healthcare Infrastructure: Invest in improving healthcare infrastructure, particularly in rural areas, by establishing well-equipped health centers and maternity clinics. This will ensure that women have access to quality maternal healthcare services closer to their homes.

6. Collaboration and Partnerships: Foster collaboration between government agencies, non-profit organizations, and private sector entities to pool resources and expertise in addressing the gaps in maternal health access. This can lead to more comprehensive and sustainable solutions.

7. Financial Support: Implement financial support programs, such as health insurance schemes or subsidies, to reduce the financial burden of accessing maternal healthcare services. This can make these services more affordable and accessible to a larger population.

8. Continuous Education and Training: Provide ongoing education and training to healthcare professionals on preconception care and best practices in maternal health. This will ensure that healthcare providers are equipped with the necessary knowledge and skills to deliver quality care.

9. Integration of Services: Integrate preconception care services with existing maternal health programs, such as antenatal care and family planning services. This will ensure a continuum of care and improve overall maternal health outcomes.

10. Research and Data Collection: Conduct further research and data collection to better understand the barriers and challenges in accessing maternal health services. This will help inform evidence-based interventions and policies to improve access and utilization of preconception care.

AI Innovations Description

Based on the study titled “Utilization of preconception care and associated factors among reproductive age group women in Debre Birhan town, North Shewa, Ethiopia,” the following recommendation can be developed into an innovation to improve access to maternal health:

1. Establishing Preconception Care Units: The study found that the availability of a unit for preconception care was significantly associated with the utilization of preconception care. Therefore, it is recommended to establish dedicated units or rooms within healthcare facilities where women can receive preconception care services. These units can provide comprehensive preconception care interventions, including advice, treatment, and lifestyle modifications, to women before they become pregnant.

2. Increasing Knowledge about Preconception Care: The study identified knowledge about preconception care as a significant factor affecting its utilization. To improve access to maternal health, it is important to increase awareness and knowledge among reproductive age women about the importance of preconception care. This can be achieved through targeted health education campaigns, community outreach programs, and the integration of preconception care information into existing maternal health programs.

3. Addressing Socio-Demographic Factors: The study found that factors such as age, marital status, and educational status were associated with the utilization of preconception care. To improve access to maternal health, it is crucial to address these socio-demographic factors. This can be done through targeted interventions that specifically cater to the needs and circumstances of different groups of women, such as adolescent girls, unmarried women, and women with low educational attainment.

4. Strengthening Health Service Delivery: The study highlighted the need for improved access to pre-pregnancy health services and childbirth with suitable quality. To address this gap, it is important to strengthen the overall health service delivery system. This can be achieved through capacity building of healthcare providers, ensuring the availability of essential equipment and supplies, improving the quality of care, and promoting a client-centered approach in maternal health services.

By implementing these recommendations, it is possible to develop an innovation that improves access to maternal health by increasing the utilization of preconception care services among reproductive age women. This, in turn, can contribute to better maternal and child health outcomes in the community.

AI Innovations Methodology

Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Increase awareness and education: Implement community-based education programs to raise awareness about the importance of preconception care and its benefits for both mothers and babies. This can be done through health campaigns, workshops, and outreach programs.

2. Strengthen healthcare infrastructure: Improve the availability and accessibility of preconception care services by establishing dedicated units or rooms within healthcare facilities. This will ensure that women have a designated space to receive preconception care services.

3. Enhance healthcare provider training: Provide comprehensive training to healthcare providers on preconception care, including the components of care, counseling techniques, and best practices. This will enable healthcare providers to deliver high-quality care and effectively communicate with women seeking preconception care.

4. Integrate preconception care into existing healthcare services: Integrate preconception care into routine healthcare services, such as antenatal care and family planning clinics. This will ensure that women receive preconception care as part of their overall reproductive healthcare.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define the indicators: Identify specific indicators that can measure the impact of the recommendations on access to maternal health. For example, the percentage of women receiving preconception care, the number of healthcare facilities with dedicated preconception care units, and the knowledge level of healthcare providers on preconception care.

2. Collect baseline data: Gather baseline data on the identified indicators before implementing the recommendations. This can be done through surveys, interviews, and data analysis of existing health records.

3. Implement the recommendations: Roll out the recommended interventions, such as awareness campaigns, infrastructure improvements, and healthcare provider training.

4. Monitor and evaluate: Continuously monitor the progress and impact of the implemented recommendations. Collect data on the indicators at regular intervals to assess any changes in access to maternal health.

5. Analyze the data: Analyze the collected data to determine the impact of the recommendations on access to maternal health. Compare the baseline data with the post-implementation data to identify any improvements or changes.

6. Draw conclusions and make adjustments: Based on the analysis, draw conclusions about the effectiveness of the recommendations in improving access to maternal health. If necessary, make adjustments to the interventions to further enhance their impact.

7. Repeat the process: Continuously repeat the monitoring, evaluation, and adjustment process to ensure ongoing improvement in access to maternal health.

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

Ababhali & Co-Ababhali

Statistics:

Citations: 26

Authors: 6

Identifiers:

DOI: 10.1186/s12978-019-0758-x

Research Areas:

Community Interventions, Food Security, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Substance Abuse

Study Countries:

Ethiopia

Study Design:

Case-Control Study, Cross Sectional Study, Grounded Theory

Study Approach:

Mixed-methods, Qualitative, Quantitative

Participants Gender:

Female

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