1
|
Alizadeh-Dibazari Z, Abbasalizadeh F, Mohammad-Alizadeh-Charandabi S, Jahanfar S, Mirghafourvand M. Childbirth preparation and its facilitating and inhibiting factors from the perspectives of pregnant and postpartum women in Tabriz-Iran: a qualitative study. Reprod Health 2024; 21:106. [PMID: 38997718 PMCID: PMC11241919 DOI: 10.1186/s12978-024-01844-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND The World Health Organization recognizes childbirth preparation as an essential component of antenatal care, as it plays a crucial role in reducing maternal mortality and improving women's childbirth experience. Countries worldwide have implemented various interventions to assist women in preparing for childbirth, based on their own resources. This study was conducted with the aim of exploring the perspectives of pregnant and postpartum women on childbirth preparation and the facilitating and inhibiting factors, in Tabriz, Iran. METHODS This qualitative study was conducted with 25 participants, selected purposively among pregnant women in weeks 37 to 40 of gestation and postpartum women within 10 days to 6 weeks after childbirth. Data collection was done through semi-structured, in-depth individual interviews using an interview guide. The data was analyzed using content analysis method with conventional approach. RESULTS The perspectives of pregnant and postpartum women regarding childbirth preparation revealed that factors such as maternal health during pregnancy, having an antenatal care plan, improving health literacy, and developing a birth plan were identified as crucial elements for effective childbirth preparation. Additionally, mental and emotional preparation, support, financial planning, participation in preparation classes, and awareness of childbirth methods were recognized as facilitators. On the other hand, insufficient mental and emotional preparedness, inadequate support, weak antenatal care, information deficiencies, insufficient physical activity, and a lack of a birth plan were identified as barriers. CONCLUSION The findings highlight the multifaceted nature of childbirth preparedness, necessitating the involvement of families, the healthcare system, and the entire community. Utilizing the study results in strategic planning for pre-pregnancy, during pregnancy, and inter-pregnancy care can enhance childbirth preparedness and contribute to achieving Iran's population rejuvenation policy goals.
Collapse
Affiliation(s)
- Zohreh Alizadeh-Dibazari
- Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Abbasalizadeh
- Women Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Shayesteh Jahanfar
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| |
Collapse
|
2
|
Adetona A, Elegbede OE, Odu OO, Durowade KA, Ipinnimo TM, Ekpo DS, Sanni TA. Comparative assessment of birth preparedness and complication readiness among couples in rural and urban communities of Ekiti State, Southwestern Nigeria. Ghana Med J 2024; 58:34-43. [PMID: 38957284 PMCID: PMC11215245 DOI: 10.4314/gmj.v58i1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
Objectives To assess and compare the level of Birth Preparedness and Complications Readiness (BPCR) and determine the predicting effect of socio-demographic factors on it among couples in rural and urban communities of Ekiti State. Design A community-based comparative cross-sectional study. Setting The study was conducted in twelve rural and twelve urban communities in Ekiti State. Participants Couples from rural and urban communities. Female partners were women of reproductive age group (15-49 years) who gave birth within twelve months before the survey. Main outcome measures Proportion of couples that were well prepared for birth and obstetric emergencies, and its socio-demographic determinants. Results The proportion of couples that were well prepared for birth and its complications was significantly higher in urban (60.5%) than rural (48.4%) communities. The study also revealed that living above poverty line (95% CI=1.01-3.79), parity and spousal age difference less than five years (95% CI=1.09 - 2.40) were positive predictors of BPCR among respondents. Conclusions Urban residents were better prepared than their rural counterparts. Living above poverty line, parity, and spousal age difference less than five years were positive predictors of BPCR. There is a need to emphasize on educating couples on the importance of identifying blood donors as a vital component of BPCR. Funding None declared.
Collapse
Affiliation(s)
- Ademuyiwa Adetona
- Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Olusegun E Elegbede
- Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Olusola O Odu
- Department of Community Medicine, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
| | - Kabir A Durowade
- Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Tope M Ipinnimo
- Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria
| | - David S Ekpo
- Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria
| | - Taofeek A Sanni
- Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
| |
Collapse
|
3
|
Shibeshi K, Lemu Y, Gebretsadik L, Gebretsadik A, Morankar S. Understanding Gender-Based Perception During Pregnancy: A Qualitative Study. Int J Womens Health 2023; 15:1523-1535. [PMID: 37849848 PMCID: PMC10577245 DOI: 10.2147/ijwh.s418653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023] Open
Abstract
Purpose Gender-based perceptions about maternal health care during pregnancy draw attention to the existence of gender inequity in maternal health care. This study aimed to understand the gender-based perception of gender roles and norms, gender relations, social support, and psychosocial variation in maternal health care during pregnancy. Methods A qualitative study was conducted in three rural districts of Jimma, Ethiopia. Participants were purposefully chosen from the community groups, including male and female health development armies, religious leaders, health extension workers, midwifery nurses, and primary health care unit directors. The data was gathered through in-depth interviews and focus group discussions. The actual data was collected by men and women qualitative study experts. Atlas ti Ver 9 was used for the analysis. The data was initially coded then changed to a sub-category and at last converted to a category. Results Four categories emerged: Gender-based roles and norms, psychosocial variation, social support, and gender relations. The informants described men's and women's independent and shared roles improve maternal health care service usage during pregnancy. Once the women became pregnant, men undertook a variety of demanding duties to enhance maternity service consumption. Gender relations and shared decision-making were essential in facilitating maternal healthcare utilization during pregnancy and beyond. Conclusion This study revealed that maternal health care should not be limited to women alone. Men's and women's prior maternal health experiences, in addition to their knowledge and beliefs, have significantly impacted the utilization of maternal healthcare services during pregnancy. Policymakers and academics should consider men's essential contribution to maternal health care during pregnancy. However, in order to increase their intention to use maternal health care services, it is necessary to clearly identify the interests of women in which men should be involved.
Collapse
Affiliation(s)
- Ketema Shibeshi
- Dire Dawa University Department of Public Health, Dire Dawa, Ethiopia
| | - Yohannes Lemu
- Jimma University Department of Health, Behavior and Society, Jimma, Ethiopia
| | - Lakew Gebretsadik
- Jimma University Department of Health, Behavior and Society, Jimma, Ethiopia
| | - Abebe Gebretsadik
- Jimma University Department of Health, Behavior and Society, Jimma, Ethiopia
| | - Sudhakar Morankar
- Jimma University Department of Health, Behavior and Society, Jimma, Ethiopia
| |
Collapse
|
4
|
Said A, Malqvist M, Massawe S, Hanson C, Pembe AB. Community perceptions and experiences on the events leading to facility maternal death; a verbal autopsy qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 36:100851. [PMID: 37126964 DOI: 10.1016/j.srhc.2023.100851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/24/2023] [Accepted: 04/17/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Tanzania Maternal Death Surveillance and Response (MDSR) system introduced in 2015 emphasizes review of facility maternal deaths with little community involvement. Involving the community in deaths enquiry can help to make better strategies to prevent future deaths. We aimed to explore family members (caregivers) perceptions and experiences on the events leading to facility maternal deaths to inform future community involvement in MDSR. METHODS Narrative interviews were conducted with 20 caregivers who cared for women who died in childbirth to investigate into delays and health care seeking experience. The unstructured questions on perceptions and experiences of events leading to death were administered together with standard verbal autopsy questionnaire. Two regions, Lindi and Mtwara of Southern Tanzania were selected for the study in 2018. Narrative thematic analysis was used for data analysis. RESULTS Three main themes evolved: 'Prepared for birth but not ready for complications', 'Disconnect between caregivers and providers' and 'The bitter impact of maternal deaths. Caregivers made efforts to prepare for birth but their preparation were severely inadequate when complications that necessitated referral occurred. Decision to seek care was made jointly between the pregnant woman, husband and other family members. Caregivers tried with little success in communicating with heathcare providers regarding their admitted patients. They also experienced emotions of grief such as denial, anger, depression, bargaining and acceptance once maternal deaths occurred. Caregivers (mostly old women) were left with the burden of caring for the newborns and other children left by the deceased mother. CONCLUSION Caregivers' perceptions and experiences of maternal deaths events provide valuable information for community interventions on birth preparedness, decision making, communication and providers' accountability. Maternal deaths bring far reaching mental, social and economic consequences to the family and society.
Collapse
Affiliation(s)
- Ali Said
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, P.O. BOX 65001, Dar es Salaam, Tanzania; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Mats Malqvist
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Siriel Massawe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, P.O. BOX 65001, Dar es Salaam, Tanzania
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Department of Disease Control, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Andrea B Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, P.O. BOX 65001, Dar es Salaam, Tanzania
| |
Collapse
|
5
|
Sufian S, Kure MA, Dheresa M, Debella A, Balis B, Roba KT. Husbands' Plan to Participate in Birth Preparedness and Complication Readiness in Haramaya Health and Demographic Surveillance System Site, Eastern Ethiopia: A Community-Based Cross-Sectional Study. Front Public Health 2022; 10:856809. [PMID: 35509506 PMCID: PMC9058083 DOI: 10.3389/fpubh.2022.856809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/21/2022] [Indexed: 12/02/2022] Open
Abstract
Background Partner involvement in maternal health services utilization remains a major public challenge in the developing world. Strategies of involving men in maternal health services are a critical and proven intervention for reducing maternal and neonatal mortality by ensuring safe delivery and reducing complications during childbirth. Moreover, the husbands' involvement during pregnancy helps their spouses to make timely decisions and avoid maternal delays, especially first and second delays. Although birth and complication readiness have been studied in developing countries such as Ethiopia, almost all previous researchers were focused primarily on women participants. Therefore, we aimed to investigate factors associated with husband involvement in birth preparedness and complication readiness plan in Haramaya Health and Demographic Surveillance site, Eastern Ethiopia. Methods A community-based cross-sectional study was conducted from March 1 to 30, 2020 among men whose wives were pregnant in Haramaya Health and Demographic Surveillance (HDSS) site in Eastern Ethiopia. The calculated sample size was 653, however while contacting 653 husbands only 630 had given the full interview, hence 630 respondents were remained in the analysis. Participants were approached through a systematic sampling technique. Data were collected using a pre-tested structured questionnaire through a face-to-face interview, and entered into Epidata version 3.1 and analyzed using SPSS version 22 (IBM SPSS Statistics, 2013). The prevalence was reported using proportion with 95% Confidence Interval (CI) and summary measures. Predictors were assessed using a multivariable logistic regression analysis model and reported using an adjusted odds ratio (AOR) with 95%CI. Statistical significance was declared at p < 0.05. Results Overall, the prevalence of the husband's plan to participate in birth preparedness and complication readiness was 59.6% (95%CI:56-64%). In the final model of multivariable analysis, predictors like husband's knowledge of birth preparedness and complication readiness [AOR = 4.18, 95%CI:2.05, 8.51], having a discussion with spouse on the place of delivery [AOR = 6.84, 95% CI: 4.17, 11.22], husband's knowledge of danger signs during labor and delivery [AOR = 3.19, 95 % CI: 1.52, 6.71], and making a postpartum plan[AOR = 2.30, 95 % CI: 1.38, 3.85] were factors statistically associated with husband's plan to participate in birth preparedness. Conclusions This study pointed out that two in every five husbands failed to plan birth preparedness and complication readiness. As a result, all stakeholders should emphasize male partners' education in terms of birth preparedness and complication readiness, as well as knowledge of danger signs during labor and delivery. They should also encourage male partners to discuss a place of delivery and have a postpartum plan in place to reduce potential complications related to labor and delivery.
Collapse
Affiliation(s)
- Seada Sufian
- Department of Nursing, Harar Health Science College, Harar, Ethiopia
| | - Mohammed Abdurke Kure
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bikila Balis
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kedir Teji Roba
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| |
Collapse
|
6
|
Barriers to Maternal and Child Health Care Service Uptake in Assosa Zone, Benishangul Gumuz Region, Ethiopia: A Qualitative Study. Int J Reprod Med 2022; 2021:5154303. [PMID: 35097104 PMCID: PMC8794678 DOI: 10.1155/2021/5154303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background Ethiopia has reduced maternal mortality from 871 to 412 per 100,000 live births between 2000 and 2016. In 2019, under-5 mortality rates in Ethiopia were 55 deaths per 1,000 live births. Benishangul Gumuz was the second-largest region in the under-5 mortality rate (98/1,000 live births) in the country. Maternal and child health care service uptake is an important indicator of health outcomes. This study is aimed at exploring major barriers to maternal and child health care uptake in Assosa Zone. Methods This study was conducted in the Bambasi, Menge, and Sherkole districts of the Assosa Zone from July 17 to August 31/2019. The study explored the life experience of study participants about MCH services. The sampling technique was purposive, and data collection methods were focus group discussions, key informant interviews, and in-depth interviews. Data were analyzed thematically. Result The main barriers to child health care services were financial problems, lack of knowledge, preference of traditional medicines for a sick child, women having no time to care for their sick child, poor roads. poor health facility readiness, the poor economy of families, lack of ambulance, cultural and traditional beliefs, providers being male, and unprofessional behaviors which were the major barriers hindering the uptake of maternal health service utilization. Conclusion Poor health facility readiness, indirect costs, inaccessibility to health facilities, and cultural and traditional practices were among the major barriers to service uptake identified by this research in the study area.
Collapse
|
7
|
Wastnedge E, Waters D, Murray SR, McGowan B, Chipeta E, Nyondo-Mipando AL, Gadama L, Gadama G, Masamba M, Malata M, Taulo F, Dube Q, Kawaza K, Khomani PM, Whyte S, Crampin M, Freyne B, Norman JE, Reynolds RM. Interventions to reduce preterm birth and stillbirth, and improve outcomes for babies born preterm in low- and middle-income countries: A systematic review. J Glob Health 2021; 11:04050. [PMID: 35003711 PMCID: PMC8709903 DOI: 10.7189/jogh.11.04050] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Reducing preterm birth and stillbirth and improving outcomes for babies born too soon is essential to reduce under-5 mortality globally. In the context of a rapidly evolving evidence base and problems with extrapolating efficacy data from high- to low-income settings, an assessment of the evidence for maternal and newborn interventions specific to low- and middle-income countries (LMICs) is required. METHODS A systematic review of the literature was done. We included all studies performed in LMICs since the Every Newborn Action Plan, between 2013 - 2018, which reported on interventions where the outcome assessed was reduction in preterm birth or stillbirth incidence and/or a reduction in preterm infant neonatal mortality. Evidence was categorised according to maternal or neonatal intervention groups and a narrative synthesis conducted. RESULTS 179 studies (147 primary evidence studies and 32 systematic reviews) were identified in 82 LMICs. 81 studies reported on maternal interventions and 98 reported on neonatal interventions. Interventions in pregnant mothers which resulted in significant reductions in preterm birth and stillbirth were (i) multiple micronutrient supplementation and (ii) enhanced quality of antenatal care. Routine antenatal ultrasound in LMICs increased identification of fetal antenatal conditions but did not reduce stillbirth or preterm birth due to the absence of services to manage these diagnoses. Interventions in pre-term neonates which improved their survival included (i) feeding support including probiotics and (ii) thermal regulation. Improved provision of neonatal resuscitation did not improve pre-term mortality rates, highlighting the importance of post-resuscitation care. Community mobilisation, for example through community education packages, was found to be an effective way of delivering interventions. CONCLUSIONS Evidence supports the implementation of several low-cost interventions with the potential to deliver reductions in preterm birth and stillbirth and improve outcomes for preterm babies in LMICs. These, however, must be complemented by overall health systems strengthening to be effective. Quality improvement methodology and learning health systems approaches can provide important means of understanding and tackling implementation challenges within local contexts. Further pragmatic efficacy trials of interventions in LMICs are essential, particularly for interventions not previously tested in these contexts.
Collapse
Affiliation(s)
- Elizabeth Wastnedge
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Donald Waters
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Sarah R Murray
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Brian McGowan
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Effie Chipeta
- Centre for Reproductive Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Alinane Linda Nyondo-Mipando
- Department of Health Systems & Policy, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Luis Gadama
- Department of Obstetrics & Gynaecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Gladys Gadama
- Department of Obstetrics & Gynaecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Martha Masamba
- Department of Obstetrics & Gynaecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Monica Malata
- Centre for Reproductive Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Frank Taulo
- Department of Obstetrics & Gynaecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Queen Dube
- Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Kondwani Kawaza
- Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Sonia Whyte
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Mia Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Bridget Freyne
- Malawi-Liverpool Wellcome Trust Research Program, Blantyre, Malawi
- Institute of Infection & Global Health, University of Liverpool, Liverpool, UK
| | - Jane E Norman
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Rebecca M Reynolds
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
- Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| |
Collapse
|
8
|
Shimpuku Y, Mwilike B, Ito K, Mwakawanga D, Hirose N, Kubota K. Birth preparedness and related factors: a cross-sectional study in Tanzania City area. BMC Health Serv Res 2021; 21:818. [PMID: 34391421 PMCID: PMC8364692 DOI: 10.1186/s12913-021-06853-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 08/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background Birth preparedness could be the key factor that influences the choice of birthplace with skilled birth attendants. To reduce the high maternal mortality of Tanzania, a large study was planned to develop a smartphone app to promote birth preparedness in a city area of Tanzania. This study aimed to identify factors that influence birth preparedness in the city area of Tanzania. Methods Pregnant women were asked to complete the Birth Preparedness Questionnaire during antenatal visits using tablets. Multiple linear regression analyses were performed to determine the sociodemographic and obstetric characteristics that influenced the factors. Results A total of 211 participants were included in the analysis. Distance from the nearest health facility negatively influenced the total score of the Birth Preparedness Assessment (β= 0.7, p = 0.02). Education higher than college positively influenced the total score (β = 4.76, p = 0.01). Decision-making of birthplace by other people (not women) negatively influenced Family Support (β=1.18, p = 0.03). Having jobs negatively influenced Preparation of Money and Food (β=-1.02, p < 0.01) and positively influenced the knowledge (β = 0.75, p = 0.03). Being single positively influenced Preparation of Money and Food (β = 0.35, p = 0.19) and Preference of Skilled Birth Attendants (β = 0.42, p = 0.04). Experience of losing a baby negatively influenced the knowledge (β=0.80, p < 0.01) and Preference of Skilled Birth Attendants (β=0.38, p = 0.02). Conclusions The findings showed an updated information on pregnant Tanzanian women living in an urban area where rapid environmental development was observed. Birth preparedness was negatively affected when women reside far from the health facilities, the birthplace decision-making was taken by others beside the women, women have jobs, and when women have experienced the loss of a baby. We hope to use the information from this study as content in our future study, in which we will be applying a smartphone app intervention for healthy pregnancy and birth preparedness. This information will also help in guiding the analysis of this future study. Although generalization of the study needs careful consideration, it is important to reconsider issues surrounding birth preparedness as women’s roles both in the family and society, are more, especially in urban settings.
Collapse
Affiliation(s)
- Yoko Shimpuku
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 730-0045, Hiroshima, Japan.
| | - Beatrice Mwilike
- School of Nursing, Muhimbili University of Health and Allied Sciences, P. O. Box 65001, Dar es Salaam, Tanzania
| | - Keiko Ito
- Kyoto University Hospital, 53 Shogoin-kawaharacho, Sakyo-ku, 606-8507, Kyoto, Japan
| | - Dorkasi Mwakawanga
- School of Nursing, Muhimbili University of Health and Allied Sciences, P. O. Box 65001, Dar es Salaam, Tanzania
| | - Naoki Hirose
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 730-0045, Hiroshima, Japan
| | - Kazumi Kubota
- Department of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan
| |
Collapse
|
9
|
Mudonhi N, Nunu WN. Traditional medicine utilisation and maternal complications during antenatal care among women in Bulilima, Plumtree, Zimbabwe. Matern Health Neonatol Perinatol 2021; 7:9. [PMID: 33563339 PMCID: PMC7871636 DOI: 10.1186/s40748-021-00130-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 02/01/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND As part of the expectation enshrined in the Sustainable Development Goals, countries are expected to ensure maternal health outcomes are improved. It follows that under ideal circumstances, pregnant women should deliver safely without complications, neonatal, and maternal mortality. This paper analyses the relationship between traditional medicine utilisation and maternal complications during antenatal care among women in Bulilima, Plumtree, Zimbabwe. METHODS A quantitative cross-sectional survey was conducted on 185 randomly selected women who responded to a pre-tested semi-structured questionnaire. The Fisher's Exact Test and the Test of Proportions were used to probe the relationship between traditional medicine utilisation and the prevalence of maternal complications using STATA SE Version 13. RESULTS Complications were reported by (51) 29% of the women who were under study. The proportion of women who developed complications was higher in those that did not use traditional medicine as compared to those that used traditional medicine (30 and 26% respectively). In a generalised assessment, women who did not use traditional medicine contributed a significantly higher proportion of complications as compared to those that utilised traditional medicine. CONCLUSION This study found a significant relationship between the utilisation of traditional medicines and lesser chances of experiencing maternal complications. Significantly higher prevalence of maternal complications was observed in women who did not use traditional medicine compared to those that did. There is, therefore, a need to investigate further the constituents or active ingredients in this traditional medicine. This study provides a window of opportunity for fully recognising and integrating traditional medicine into Modern Health Systems. It can be argued that traditional medicine utilisation could be a viable alternative to modern medicine, particularly in resource-poor settings where access to modern medicine is seriously constrained.
Collapse
Affiliation(s)
- Nicholas Mudonhi
- Department of Environmental Science and Health, Faculty of Applied Sciences, National University of Science and Technology, Corner Gwanda Road and Cecil Avenue, Ascot, P O Box AC 939, Bulawayo, Zimbabwe
| | - Wilfred Njabulo Nunu
- Department of Environmental Science and Health, Faculty of Applied Sciences, National University of Science and Technology, Corner Gwanda Road and Cecil Avenue, Ascot, P O Box AC 939, Bulawayo, Zimbabwe. .,Scientific Agriculture and Environment Development Institute, Bulawayo, Zimbabwe.
| |
Collapse
|
10
|
Mutowo J, Yazbek M, van der Wath A, Maree C. Barriers to using antenatal care services in a rural district in Zimbabwe. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
11
|
Apolot RR, Tetui M, Nyachwo EB, Waldman L, Morgan R, Aanyu C, Mutebi A, Kiwanuka SN, Ekirapa E. Maternal health challenges experienced by adolescents; could community score cards address them? A case study of Kibuku District- Uganda. Int J Equity Health 2020; 19:191. [PMID: 33131497 PMCID: PMC7604956 DOI: 10.1186/s12939-020-01267-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 01/15/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Approximately 34.8% of the Ugandan population is adolescents. The national teenage pregnancy rate is 25% and in Kibuku district, 17.6% of adolescents aged 12-19 years have begun child bearing. Adolescents mothers are vulnerable to many maternal health challenges including; stigma, unfriendly services and early marriages. The community score card (CSC) is a social accountability tool that can be used to point out challenges faced by the community in service delivery and utilization and ultimately address them. In this paper we aimed to document the challenges faced by adolescents during pregnancy, delivery and postnatal period and the extent to which the community score card could address these challenges. METHODS This qualitative study utilized in-depth interviews conducted in August 2018 among 15 purposively selected adolescent women who had given birth 2 years prior to the study and had attended CSC meetings. The study was conducted in six sub counties of Kibuku district where the CSC intervention was implemented. Research assistants transcribed the audio-recorded interviews verbatim, and data was analyzed manually using the framework analysis approach. FINDINGS This study found five major maternal health challenges faced by adolescents during pregnancy namely; psychosocial challenges, physical abuse, denial of basic human rights, unfriendly adolescent services, lack of legal and cultural protection, and lack of birth preparedness. The CSC addressed general maternal and new born health issues of the community as a whole rather than specific adolescent health related maternal health challenges. CONCLUSION The maternal health challenges faced by adolescents in Kibuku have a cultural, legal, social and health service dimension. There is therefore need to look at a multi-faceted approach to holistically address them. CSCs that are targeted at the entire community are unlikely to address specific needs of vulnerable groups such as adolescents. To address the maternal health challenges of adolescents, there is need to have separate meetings with adolescents, targeted mobilization for adolescents to attend meetings and deliberate inclusion of their maternal health challenges into the CSC.
Collapse
Affiliation(s)
- Rebecca R. Apolot
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Moses Tetui
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
- Department of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
| | - Evelyne B. Nyachwo
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Linda Waldman
- Institute of Development Studies, Library Road, Brighton, BN1 9RE UK
| | - Rosemary Morgan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Christine Aanyu
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Aloysius Mutebi
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Suzanne N. Kiwanuka
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Elizabeth Ekirapa
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| |
Collapse
|
12
|
Orwa J, Gatimu SM, Mantel M, Luchters S, Mugerwa MA, Brownie S, Subi L, Mrema S, Nyaga L, Edwards G, Mwasha L, Isangula K, Selestine E, Jadavji S, Pell R, Mbekenga C, Temmerman M. Birth preparedness and complication readiness among women of reproductive age in Kenya and Tanzania: a community-based cross-sectional survey. BMC Pregnancy Childbirth 2020; 20:636. [PMID: 33076869 PMCID: PMC7574438 DOI: 10.1186/s12884-020-03329-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/09/2020] [Indexed: 12/28/2022] Open
Abstract
Background Delayed health-seeking continues to contribute to preventable maternal and neonatal deaths in low resource countries. Some of the strategies to avoid the delay include early preparation for the birth and detection of danger signs. We aimed to assess the level of practice and factors associated with birth preparedness and complication readiness (BPCR) in Kenya and Tanzania. Methods We conducted community-based multi-stage cross-sectional surveys in Kilifi and Kisii counties in Kenya and Mwanza region in Tanzania and included women who delivered two years preceding the survey (2016–2017). A woman who mentioned at least three out of five BPCR components was considered well-prepared. Bivariate and multivariable proportional odds model were used to determine the factors associated with the BPCR. The STROBE guidelines for cross-sectional studies informed the design and reporting of this study. Results Only 11.4% (59/519) and 7.6% (31/409) of women were well-prepared for birth and its complications in Kenya and Tanzania, respectively, while 39.7 and 30.6% were unprepared, respectively. Level of education (primary: adjusted odds ratio (aOR): 1.59, 95% CI: 1.14–2.20, secondary: aOR: 2.24, 95% CI: 1.39–3.59), delivery within health facility (aOR: 1.63, 95% CI: 1.15–2.29), good knowledge of danger signs during pregnancy (aOR: 1.28, 95% CI: 0.80–2.04), labour and childbirth (aOR: 1.57, 95% CI: 0.93–2.67), postpartum (aOR: 2.69, 95% CI: 1.24–5.79), and antenatal care were associated with BPCR (aOR: 1.42, 95% CI: 1.13–1.78). Conclusion Overall, most pregnant women were not prepared for birth and its complications in Kilifi, Kisii and Mwanza region. Improving level of education, creating awareness on danger signs during preconception, pregnancy, childbirth, and postpartum period, and encouraging antenatal care and skilled birth care among women and their male partners/families are recommended strategies to promote BPCR practices and contribute to improved pregnancy outcomes in women and newborns.
Collapse
Affiliation(s)
- James Orwa
- Centre of Excellence Women and Child Health/MERL, Aga Khan University, P. O. Box 30270-00010, Nairobi, Kenya. .,Department of Population Health, Aga Khan University, Nairobi, Kenya.
| | | | - Michaela Mantel
- Centre of Excellence Women and Child Health/MERL, Aga Khan University, P. O. Box 30270-00010, Nairobi, Kenya.,Department of Population Health, Aga Khan University, Nairobi, Kenya.,Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya
| | - Stanley Luchters
- Department of Population Health, Aga Khan University, Nairobi, Kenya.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | | | - Sharon Brownie
- Centre for Health & Social Practice, Waikato Institute of Technology (Wintec), Hamilton, New Zealand.,School of Medicine, Griffith University, Brisbane, QLD, Australia.,Green Templeton College, Oxford University, Oxford, UK
| | - Leonard Subi
- Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Secilia Mrema
- Regional Reproductive and Child Health Office, Region, Mwanza, Tanzania
| | - Lucy Nyaga
- Centre of Excellence Women and Child Health/MERL, Aga Khan University, P. O. Box 30270-00010, Nairobi, Kenya
| | - Grace Edwards
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| | - Loveluck Mwasha
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania
| | - Kahabi Isangula
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania
| | | | | | | | - Columba Mbekenga
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania
| | - Marleen Temmerman
- Centre of Excellence Women and Child Health/MERL, Aga Khan University, P. O. Box 30270-00010, Nairobi, Kenya.,Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| |
Collapse
|
13
|
Factors Influencing Birth Preparedness in Rapti Municipality of Chitwan, Nepal. Int J Pediatr 2020; 2020:7402163. [PMID: 32373182 PMCID: PMC7196150 DOI: 10.1155/2020/7402163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/03/2020] [Accepted: 04/07/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction Birth preparedness is crucial for health quality of mother and newborn and acts as a strong contributor in mitigating maternal and newborn mortalities. Different factors are predicted to have an influence upon birth preparedness practice. This paper aims at exploring relationship between various factors and birth preparedness practice. Methods A cross-sectional study design was used to find out the relationship between various factors and birth preparedness practice. One hundred sixty-five women residing at ward number 1 of Rapti Municipality, Chitwan who delivered in the last twelve months were selected consecutively and interviewed using a semistructured questionnaire. The collected data were analyzed using descriptive and bivariate techniques. Results Three quarters (75.2%) of the respondents had better birth preparedness, institutional delivery was 63.0%, antenatal care (ANC) visit as per protocol was about 62.0%, and about 90% of the respondents had received counseling during ANC. Age, religion, family types, education, age at marriage, parity, number of children, knowledge on birth preparedness, knowledge on danger sign, place for ANC and delivery, and decision-makers were found to be statistically significant (P value < 0.05) with birth preparedness practice. Conclusion Better knowledge on birth preparedness led to a better preparedness status. Age, religion, family type, education of women and partners, parity, and number of children were the factors that influence birth preparedness. Counseling during ANC played a significant role in birth preparedness.
Collapse
|
14
|
Ketema DB, Leshargie CT, Kibret GD, Assemie MA, Petrucka P, Alebel A. Effects of maternal education on birth preparedness and complication readiness among Ethiopian pregnant women: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2020; 20:149. [PMID: 32143581 PMCID: PMC7060625 DOI: 10.1186/s12884-020-2812-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 02/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Birth preparedness and complication readiness are broadly endorsed by governments and international agencies to reduce maternal and neonatal health threats in low income countries. Maternal education is broadly positioned to positively affect the mother's and her children's health and nutrition in low income countries. Thus, this systematic review and meta-analysis aims to estimate the effect of maternal education on birth preparedness and complication readiness. METHODS This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. We conducted an electronic based search using data bases of PubMed /MEDLINE, Science direct and google scholar. STATA™ Version 14.1 was used to analyze the data, and forest plots were used to present the findings. I2 test statistics and Egger's test were used to assess heterogeneity and publication bias. Pooled prevalence and pooled odd ratios with 95% confidence intervals were computed. Finally, Duval and Tweedie's nonparametric trim and fill analysis using random-effects meta-analysis was conducted to account for publication bias. RESULTS In this meta-analysis, 20 studies involving 13,744 pregnant women meeting the inclusion criteria were included, of which 15 studies reported effects of maternal education on birth preparedness and complication readiness. Overall estimated level of birth preparedness and complication readiness was 25.2% (95% CI 20.0, 30.6%). This meta-analysis found that maternal education and level of birth preparedness and complication readiness were positively associated. Pregnant mothers whose level of education was primary and above were more likely to prepare for birth and obstetric emergencies (OR = 2.4, 95% CI: 1.9, 3.1) than non-educated mothers. CONCLUSION In Ethiopia, the proportion of women prepared for birth and related complications remained low. Maternal education has a positive effect on the level of birth preparedness and complication readiness. Therefore, it is imperative to launch programs at national and regional levels to uplift women's educational status to enhance the likelihood of maternal health services utilization.
Collapse
Affiliation(s)
- Daniel Bekele Ketema
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Cheru Tesema Leshargie
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia.,Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Getiye Dejenu Kibret
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia.,Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Moges Agazhe Assemie
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, Canada.,School of Life Sciences and Bioengineering, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
| | - Animut Alebel
- Department of Nursing, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia. .,Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.
| |
Collapse
|
15
|
Mgbekem MA, Nsemo AD, Daufa CF, Ojong IN, Nwakwue N, Andrew-Bassey P. Nurses’ Role in Birth Preparedness and Complication Readiness among Pregnant Women in University of Calabar Teaching Hospital, Calabar. Health (London) 2020. [DOI: 10.4236/health.2020.122006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
16
|
Sharma V, Leight J, Giroux N, AbdulAziz F, Nyqvist MB. "That's a woman's problem": a qualitative analysis to understand male involvement in maternal and newborn health in Jigawa state, northern Nigeria. Reprod Health 2019; 16:143. [PMID: 31533839 PMCID: PMC6751687 DOI: 10.1186/s12978-019-0808-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/06/2019] [Indexed: 11/14/2022] Open
Abstract
Background Maternal and newborn mortality continue to be major challenges in Nigeria. While greater participation of men in maternal and newborn health has been associated with positive outcomes in many settings, male involvement remains low. The objective of this analysis was to investigate male involvement in maternal and newborn health in Jigawa state, northern Nigeria. Methods This qualitative study included 40 event narratives conducted with families who had experienced a maternal or newborn complication or death, in-depth interviews with 10 husbands and four community leaders, and four focus group discussions with community health workers. The interviews focused on understanding illness recognition and care seeking as well as the role of husbands at each stage on the continuum of maternal and newborn health. Data were transcribed, translated to English, and coded and analyzed using Dedoose software and a codebook developed a priori. Results This paper reports low levels of knowledge of obstetric and newborn complications among men and limited male involvement during pregnancy, childbirth and the post-partum period in Jigawa state. Men are key decision-makers around the location of the delivery and other decisions linked to maternal and newborn health, and they provide crucial resources including nutritious foods and transportation. However, they generally do not accompany their wives to antenatal visits, are rarely present for deliveries, and do not make decisions about complications arising during delivery and the immediate post-partum period. These gendered roles are deeply ingrained, and men are often ridiculed for stepping outside of them. Additional barriers for male involvement include minimal engagement with health programs and challenges at health facilities including a poor attitude of health providers towards men and accompanying family members. Conclusion These findings suggest that male involvement is limited by low knowledge and barriers related to social norms and within health systems. Interventions engaging men in maternal and newborn health must take into account these obstacles while protecting women’s autonomy and avoiding reinforcement of gender inequitable roles and behaviors.
Collapse
Affiliation(s)
- Vandana Sharma
- Abdul Latif Jameel Poverty Action Lab, Massachusetts Institute of Technology, 400 Main Street E19-201, Cambridge, MA, 02142, USA. .,Present Address: Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Jessica Leight
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | | | | | | |
Collapse
|
17
|
Shimpuku Y, Madeni FE, Horiuchi S, Kubota K, Leshabari SC. A family-oriented antenatal education program to improve birth preparedness and maternal-infant birth outcomes: A cross sectional evaluation study. Reprod Health 2019; 16:107. [PMID: 31311563 PMCID: PMC6636146 DOI: 10.1186/s12978-019-0776-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 07/10/2019] [Indexed: 11/12/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Yoko Shimpuku
- Graduate School of Medicine, Kyoto University, 53 Shogoin-kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Frida E Madeni
- Magunga District Hospital, P. O. Box 430, Old-Korogwe, Tanga, Tanzania
| | - Shigeko Horiuchi
- Graduate School of Nursing Science, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
| | - Kazumi Kubota
- Department of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Sebalda C Leshabari
- School of Nursing, Muhimbili University of Health and Allied Sciences, P. O. Box 65169, Dar es Salaam, Tanzania
| |
Collapse
|
18
|
Intended Pregnancy as a Predictor of Good Knowledge on Birth Preparedness and Complication Readiness: the Case of Northern Ethiopia Pregnant Mothers. Int J Reprod Med 2019; 2019:9653526. [PMID: 30805355 PMCID: PMC6360605 DOI: 10.1155/2019/9653526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 12/12/2018] [Accepted: 01/10/2019] [Indexed: 11/24/2022] Open
Abstract
Background Maternal mortality remains unacceptably high in developing countries. One key strategy to reduce such mortality is utilization of birth preparedness and complication readiness (BP/CR) and creating awareness of BP/CR is an important step for pregnant women, their families, and the community. However, there was limited to no evidence regarding the community's awareness on BP/CR in the study area. Therefore, this study aimed to assess knowledge on BP/CR and associated factors among pregnant women in Debremarkos town, Northwest Ethiopia, 2017. Methods A Community based cross-sectional study was conducted from July 1 to 30/2017. A total of 441 pregnant women were included in the study. Structured and pretested questionnaire was administered through face to face interview to collect the data. Simple random sampling technique was used to select the study participants. The data were entered in to Epinfo version 7.0 and then exported to SPSS version 20.0 for analysis. Both bivariate and multivariable logistic regression model were fitted. Crude and adjusted odds ratio with 95 % confidence interval have been computed and variables with p-value < 0.05 were considered statistically significance. Results. The proportion of pregnant women having good knowledge on birth preparedness and complication readiness was found to be 45.2 with 95%CI (40.4, 50.0). In the multivariable analysis, having history of childbirth (AOR=2.17;95%CI:1.18,4.00), having intended pregnancy (AOR=2.13;95%CI: 1.16, 3.90), being governmental employee ( AOR=6.50; 95%CI: 2.50, 16.87), and having Antenatal care visits (AOR=5.50; 95%CI:2.2,13.70) were factors which were independently and significantly associated with good knowledge on birth preparedness and complication readiness. Conclusion Proportion of pregnant women having good knowledge on birth preparedness and complication readiness was low. Putting emphasis on intended pregnancy and antenatal care visit was recommended.
Collapse
|
19
|
Pervin J, Nu UT, Rahman AMQ, Rahman M, Uddin B, Razzaque A, Johnson S, Kuhn R, Rahman A. Level and determinants of birth preparedness and complication readiness among pregnant women: A cross sectional study in a rural area in Bangladesh. PLoS One 2018; 13:e0209076. [PMID: 30557336 PMCID: PMC6296737 DOI: 10.1371/journal.pone.0209076] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 11/21/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Increasing the level of birth preparedness and complication readiness (BP/CR) is one of the key interventions to promote optimal utilization of skilled maternal health services. It is therefore essential to determine the women's ability to recognize the danger signs and the level of BP/CR. This information can be used to design more effective health interventions. OBJECTIVES This study was conducted to determine the knowledge in recognition of maternal complications, and the level and factors associated with BP/CR in rural Matlab, Bangladesh. METHODS A community-based cross-sectional survey was conducted from June- October 2015 on a randomly selected 2262 women who delivered live or stillbirth during the year 2014. A pretested and structured questionnaire was used for data collection. Descriptive and analytical statistical methods were used. RESULTS The proportion of study participants with "good knowledge", measured by the ability to recognise three or more danger signs, in pregnancy and delivery were 26% and 23%, respectively. Out of four BP/CR components, about 15% women saved money, 12% women identified facility for delivery, 9.6% women planned to deliver by skilled birth attendant and 5.3% of women arranged transport. About 12% of women were "well prepared", measured by planning of at least two components, for skilled childbirth and emergency obstetric complications. In the multivariable logistic regression analysis, asset index, antenatal care (ANC) visits and knowledge of danger signs during pregnancy and delivery were associated with BP/CR. The adjusted odds ratio (OR) of "well prepared" was 4.09 (95% confidence interval [CI]: 2.45-6.82) among women with an asset index of five (richest), compared with women in the asset index of one (poorest). The odds of "well prepared" was six times (OR 5.98, 95% CI: 3.85-9.28) higher for women with four or more ANC visits, compared to women with none or one ANC visit. In comparison to women with "poor knowledge" on maternal danger signs during pregnancy and delivery, the odds ratio of "well prepared" among women with good knowledge during pregnancy and in delivery were 1.95 (95% CI: 1.44-2.63) and 1.74 (95% CI: 1.28-2.36), respectively. CONCLUSION The study revealed a low level of maternal knowledge of danger signs and BP/CR among pregnant women. Further, low socioeconomic status, fewer ANC visits and poor knowledge in recognition of dangers signs on maternal health were associated with low BP/CR. More emphasis should be placed on the quality of information offered to the pregnant women during the prenatal contact and women from low socio-economic gradient should be prioritized to optimize the impact of future BP/CR interventions.
Collapse
Affiliation(s)
- Jesmin Pervin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); Mohakhali, Dhaka, Bangladesh
| | - U. Tin Nu
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); Mohakhali, Dhaka, Bangladesh
| | - A. M. Q. Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); Mohakhali, Dhaka, Bangladesh
| | - Mahabubur Rahman
- Upazilla Health and Family Planning, Ministry of Health and Family Welfare, Chandpur, Bangladesh
| | - Borhan Uddin
- Upazilla Health and Family Planning, Ministry of Health and Family Welfare, Chandpur, Bangladesh
| | - Abdur Razzaque
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); Mohakhali, Dhaka, Bangladesh
| | - Sandy Johnson
- University of Denver, Josef Korbel School of International Studies, Denver, United States of America
| | - Randall Kuhn
- University of California–Los Angeles, Jonathan and Karin Fielding School of Public Health, Department of Community Health Sciences, California, United States of America
| | - Anisur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); Mohakhali, Dhaka, Bangladesh
| |
Collapse
|
20
|
Muhumuza Kananura R, Tetui M, Bua J, Ekirapa-Kiracho E, Mutebi A, Namazzi G, Namusoke Kiwanuka S, Waiswa P. Effect of a participatory multisectoral maternal and newborn intervention on birth preparedness and knowledge of maternal and newborn danger signs among women in Eastern Uganda: a quasi-experiment study. Glob Health Action 2018; 10:1362826. [PMID: 28849729 PMCID: PMC5645681 DOI: 10.1080/16549716.2017.1362826] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Knowledge of obstetric danger signs and adequate birth preparedness (BP) are critical for improving maternal services utilization. Objectives: This study assessed the effect of a participatory multi-sectoral maternal and newborn intervention on BP and knowledge of obstetric danger signs among women in Eastern Uganda. Methods: The Maternal and Neonatal Implementation for Equitable Systems (MANIFEST) study was implemented in three districts from 2013 to 2015 using a quasi-experimental pre–post comparison design. Data were collected from women who delivered in the last 12 months. Difference-in-differences (DiD) and generalized linear modelling analysis were used to assess the effect of the intervention on BP practices and knowledge of obstetric danger signs. Results: The overall BP practices increased after the intervention (DiD = 5, p < 0.05). The increase was significant in both intervention and comparison areas (7–39% vs. 7–36%, respectively), with a slightly higher increase in the intervention area. Individual savings, group savings, and identification of a transporter increased in both intervention and comparison area (7–69% vs. 10–64%, 0–11% vs. 0–5%, and 9–14% vs. 9–13%, respectively). The intervention significantly increased the knowledge of at least three obstetric danger signs (DiD = 31%) and knowledge of at least two newborn danger signs (DiD = 21%). Having knowledge of at least three BP components and attending community dialogue meetings increased the odds of BP practices and obstetric danger signs’ knowledge, respectively. Village health teams’ home visits, intervention area residence, and being in the 25+ age group increased the odds of both BP practices and obstetric danger signs’ knowledge. Conclusions: The intervention resulted in a modest increase in BP practices and knowledge of obstetric danger signs. Multiple strategies targeting women, in particular the adolescent group, are needed to promote behavior change for improved BP and knowledge of obstetric danger signs.
Collapse
Affiliation(s)
- Rornald Muhumuza Kananura
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda.,c Makerere University Centre of Excellence for Maternal and Newborn Health Research , Kampala , Uganda
| | - Moses Tetui
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda.,b Unit of Epidemiology and Global Health , Department of Public Health and Clinical Medicine Umeå University , Umeå , Sweden
| | - John Bua
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| | - Elizabeth Ekirapa-Kiracho
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| | - Aloysius Mutebi
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| | - Gertrude Namazzi
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda.,c Makerere University Centre of Excellence for Maternal and Newborn Health Research , Kampala , Uganda
| | - Suzanne Namusoke Kiwanuka
- b Unit of Epidemiology and Global Health , Department of Public Health and Clinical Medicine Umeå University , Umeå , Sweden
| | - Peter Waiswa
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda.,c Makerere University Centre of Excellence for Maternal and Newborn Health Research , Kampala , Uganda.,d Global Health Division, Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
| |
Collapse
|
21
|
Kalisa R, Smeele P, van Elteren M, van den Akker T, van Roosmalen J. Facilitators and barriers to birth preparedness and complication readiness in rural Rwanda among community health workers and community members: a qualitative study. Matern Health Neonatol Perinatol 2018; 4:11. [PMID: 29992035 PMCID: PMC5989363 DOI: 10.1186/s40748-018-0080-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/26/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Birth preparedness and complication readiness (BP/CR) comprise a strategy to make women plan for birth and encourage them to seek professional care in order to reduce poor pregnancy outcome. We aimed to understand the facilitators and barriers to BP/CR among community health workers (CHWs) and community members in rural Rwanda. METHODS Eight focus group discussions were conducted with 88 participants comprising of CHWs, elderly women aged 45-68 and men aged 18-59, as well as two key informant interviews in Musanze district, Rwanda, between November and December 2015. Qualitative data were digitally recorded, transcribed verbatim and analysed using content analysis. RESULTS Participants perceived the importance of family assistance, medical insurance and attending antenatal care (ANC) to facilitate BP/CR and enhance professional care at birth. CHWs reinforced BP/CR messages by SMS alerts and during community gatherings. 'Ubudehe (collective action to combat poverty)' was known as a tool to identify the poorest families in need of government aid to pay for medical care. Disrespect and abuse of women during labor by health workers were perceived as important barriers to access professional care, as well as conflicting health policies such as user fees for ANC and family planning services, and imposing fines on women giving birth outside health facilities. CONCLUSION CHWs, ANC and medical insurance are perceived to be important facilitators of BP/CR. Respectful care is paramount for improved maternal health. There is a need for addressing inconsistent health policies hindering the intention to access professional care.
Collapse
Affiliation(s)
- Richard Kalisa
- Department of Obstetrics and Gynecology, Ruhengeri Hospital, Musanze, Rwanda
- Athena Institute, VU University, Amsterdam, The Netherlands
| | - Patrick Smeele
- Department of Medical Humanities, VU University Medical Center, Amsterdam, The Netherlands
| | - Marianne van Elteren
- Department of Medical Humanities, VU University Medical Center, Amsterdam, The Netherlands
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos van Roosmalen
- Athena Institute, VU University, Amsterdam, The Netherlands
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
22
|
Moinuddin M, Christou A, Hoque DME, Tahsina T, Salam SS, Billah SM, Kuppens L, Matin MZ, Arifeen SE. Birth preparedness and complication readiness (BPCR) among pregnant women in hard-to-reach areas in Bangladesh. PLoS One 2017; 12:e0189365. [PMID: 29228050 PMCID: PMC5724858 DOI: 10.1371/journal.pone.0189365] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 11/25/2017] [Indexed: 11/25/2022] Open
Abstract
Background Birth preparedness and complication readiness aims to reduce delays in care seeking, promote skilled birth attendance, and facility deliveries. Little is known about birth preparedness practices among populations living in hard-to-reach areas in Bangladesh. Objectives To describe levels of birth preparedness and complication readiness among recently delivered women, identify determinants of being better prepared for birth, and assess the impact of greater birth preparedness on maternal and neonatal health practices. Methods A cross-sectional survey with 2,897 recently delivered women was undertaken in 2012 as part of an evaluation trial done in five hard-to-reach districts in rural Bangladesh. Mothers were considered well prepared for birth if they adopted two or more of the four birth preparedness components. Descriptive statistics and multivariable logistic regression were used for analysis. Results Less than a quarter (24.5%) of women were considered well prepared for birth. Predictors of being well-prepared included: husband’s education (OR = 1.3; CI: 1.1–1.7), district of residence, exposure to media in the form of reading a newspaper (OR = 2.2; CI: 1.2–3.9), receiving home visit by a health worker during pregnancy (OR = 1.5; CI: 1.2–1.8), and receiving at least 3 antenatal care visits from a qualified provider (OR = 1.4; CI: 1.0–1.9). Well-prepared women were more likely to deliver at a health facility (OR = 2.4; CI: 1.9–3.1), use a skilled birth attendant (OR = 2.4, CI: 1.9–3.1), practice clean cord care (OR = 1.3, CI: 1.0–1.5), receive post-natal care from a trained provider within two days of birth for themselves (OR = 2.6, CI: 2.0–3.2) or their newborn (OR = 2.6, CI: 2.1–3.3), and seek care for delivery complications (OR = 1.8, CI: 1.3–2.6). Conclusion Greater emphasis on BPCR interventions tailored for hard to reach areas is needed to improve skilled birth attendance, care seeking for complications and essential newborn care and facilitate reductions in maternal and neonatal mortality in low performing districts in Bangladesh.
Collapse
Affiliation(s)
- Md Moinuddin
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
- * E-mail:
| | - Aliki Christou
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | | | - Tazeen Tahsina
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | | | - Sk Masum Billah
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | | | | | | |
Collapse
|
23
|
Osorio-Castaño JH, Carvajal-Carrascal G, Rodríguez-Gázquez M. Preparation for Motherhood during Pregnancy: a Concept Analysis. INVESTIGACION Y EDUCACION EN ENFERMERIA 2017; 35:295-305. [PMID: 29767910 DOI: 10.17533/udea.iee.v35n3a06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 08/11/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES This work sought to identify the attributes of the concept of preparation for motherhood during pregnancy. METHODS Concept analysis with the method by Walker and Avant, which conducted a literature review in databases and other sources. Inclusion criteria were defined and a database was created with the articles included for the analysis. The information was integrated, responding to the eight steps proposed in the method. RESULTS The concept of preparation for motherhood during pregnancy is defined as an intermediate process of active and conscious participation defined by the cultural, social, and historical contexts, which favor lifestyle changes to optimize health and whose attributes are classified into physical and psychological preparation. CONCLUSIONS The attributes identified contribute to understanding the preparation for motherhood during gestation as a multidimensional concept. These results could be used to design care actions to evaluate pregnant women and prescribe nursing care beyond purely biomedical issues.
Collapse
|
24
|
Akshaya KM, Shivalli S. Birth preparedness and complication readiness among the women beneficiaries of selected rural primary health centers of Dakshina Kannada district, Karnataka, India. PLoS One 2017; 12:e0183739. [PMID: 28837683 PMCID: PMC5570276 DOI: 10.1371/journal.pone.0183739] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/09/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Birth preparedness and complication readiness (BPCR) is a strategy to promote timely use of skilled maternal and neonatal care during childbirth. According to World Health Organization, BPCR should be a key component of focused antenatal care. Dakshina Kannada, a coastal district of Karnataka state, is categorized as a high-performing district (institutional delivery rate >25%) under the National Rural Health Mission. However, a substantial proportion of women in the district experience complications during pregnancy (58.3%), childbirth (45.7%), and postnatal (17.4%) period. There is a paucity of data on BPCR practice and the factors associated with it in the district. Exploring this would be of great use in the evidence-based fine-tuning of ongoing maternal and child health interventions. OBJECTIVE To assess BPCR practice and the factors associated with it among the beneficiaries of two rural Primary Health Centers (PHCs) of Dakshina Kannada district, Karnataka, India. METHODS A facility-based cross-sectional study was conducted among 217 pregnant (>28 weeks of gestation) and recently delivered (in the last 6 months) women in two randomly selected PHCs from June -September 2013. Exit interviews were conducted using a pre-designed semi-structured interview schedule. Information regarding socio-demographic profile, obstetric variables, and knowledge of key danger signs was collected. BPCR included information on five key components: identified the place of delivery, saved money to pay for expenses, mode of transport identified, identified a birth companion, and arranged a blood donor if the need arises. In this study, a woman who recalled at least two key danger signs in each of the three phases, i.e., pregnancy, childbirth, and postpartum (total six) was considered as knowledgeable on key danger signs. Optimal BPCR practice was defined as following at least three out of five key components of BPCR. OUTCOME MEASURES Proportion, Odds ratio, and adjusted Odds ratio (adj OR) for optimal BPCR practice. RESULTS A total of 184 women completed the exit interview (mean age: 26.9±3.9 years). Optimal BPCR practice was observed in 79.3% (95% CI: 73.5-85.2%) of the women. Multivariate logistic regression revealed that age >26 years (adj OR = 2.97; 95%CI: 1.15-7.7), economic status of above poverty line (adj OR = 4.3; 95%CI: 1.12-16.5), awareness of minimum two key danger signs in each of the three phases, i.e., pregnancy, childbirth, and postpartum (adj OR = 3.98; 95%CI: 1.4-11.1), preference to private health sector for antenatal care/delivery (adj OR = 2.9; 95%CI: 1.1-8.01), and woman's discussion about the BPCR with her family members (adj OR = 3.4; 95%CI: 1.1-10.4) as the significant factors associated with optimal BPCR practice. CONCLUSION In this study population, BPCR practice was better than other studies reported from India. Healthcare workers at the grassroots should be encouraged to involve women's family members while explaining BPCR and key danger signs with a special emphasis on young (<26 years) and economically poor women. Ensuring a reinforcing discussion between woman and her family members may further enhance the BPCR practice.
Collapse
Affiliation(s)
| | - Siddharudha Shivalli
- Department of Public Health, Yenepoya Medical College, Yenepoya University, Mangaluru, Karnataka, India.,Non-Communicable Diseases Regional Technical Advisor, Southeast Asia Regional Office (SEARO), TEPHINET, A Program of the Task Force for Global Health, Inc., Decatur, Georgia, United States of America
| |
Collapse
|
25
|
Fujita W, Leshabari S, Mlay ED, Ohashi K. Tanzanian women’s coping and understanding of labour: A qualitative study at the Amtulabhai Antenatal Clinic. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2017. [DOI: 10.1016/j.ijans.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
26
|
August F, Pembe AB, Mpembeni R, Axemo P, Darj E. Effectiveness of the Home Based Life Saving Skills training by community health workers on knowledge of danger signs, birth preparedness, complication readiness and facility delivery, among women in Rural Tanzania. BMC Pregnancy Childbirth 2016; 16:129. [PMID: 27251052 PMCID: PMC4890507 DOI: 10.1186/s12884-016-0916-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 05/25/2016] [Indexed: 11/28/2022] Open
Abstract
Background In spite of government efforts, maternal mortality in Tanzania is currently at more than 400 per 100,000 live births. Community-based interventions that encourage safe motherhood and improved health-seeking behaviour through acquiring knowledge on the danger signs and improving birth preparedness, and, ultimately, reduce maternal mortality, have been initiated in different parts of low-income countries. Our aim was to evaluate if the Home Based Life Saving Skills education by community health workers would improve knowledge of danger signs, birth preparedness and complication readiness and facility-based deliveries in a rural community in Tanzania. Methods A quasi-experimental study design was used to evaluate the effectiveness of Home Based Life Saving Skills education to pregnant women and their families through a community intervention. An intervention district received training with routine care. A comparison district continued to receive routine antenatal care. A structured household questionnaire was used in order to gather information from women who had delivered a child within the last two years before the intervention. This questionnaire was used in both the intervention and comparison districts before and after the intervention. The net intervention effect was estimated using the difference between the differences in the intervention and control districts at baseline and endline. Results A total of 1,584 and 1,486 women were interviewed at pre-intervention and post intervention, respectively. We observed significant improvement of knowledge of three or more danger signs during pregnancy (15.2 % vs. 48.1 %) with a net intervention effect of 29.0 % (95 % CI: 12.8–36.2; p < .0001) compared to the comparison district. There was significant effect on the knowledge of three or more danger signs during childbirth (15.3 % vs. 43.1 %) with a net intervention effect of 18.3 % (95 % CI: 11.4–25.2; p < .0001) and postpartum for those mentioning three or more of the signs (8.8 % vs. 19.8 %) with net effect of 9.4 % (95 % CI: 6.4–15.7; p < .0001). Birth preparedness practice improved for those who made more than three actions (20.8 vs. 35.3 %) with a net intervention effect of 10.3 % (95 % CI: 10.3–20.3; p < .0001) between the intervention and control district at pre-intervention and post intervention. Utilisation of antenatal care with four visits improved significantly (43.4 vs. 67.8 %) with net effect of 25.3 % (95 % CI: 16.9–33.2; p < .0001), use of facility delivery improved in the intervention area (75.6 vs. 90.2 %; p = 0.0002) but there was no significant net effect 11.5 % (95 % CI: -5.1–39.6; p = 0.123) compared to comparison district. Conclusion This study shows that a community-based intervention employing community health workers as teachers in delivering Home Based Life Saving Skills program to pregnant women and their families improved their knowledge of danger signs during pregnancy, childbirth and postpartum, preparedness for childbirth and increased deliveries at health facilities which employ skilled health workers in this rural community. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-0916-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Furaha August
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. .,Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden.
| | - Andrea B Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Rose Mpembeni
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Pia Axemo
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Elisabeth Darj
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden.,Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
27
|
August F, Pembe AB, Mpembeni R, Axemo P, Darj E. Community health workers can improve male involvement in maternal health: evidence from rural Tanzania. Glob Health Action 2016; 9:30064. [PMID: 26790461 PMCID: PMC4720685 DOI: 10.3402/gha.v9.30064] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 12/31/2015] [Accepted: 01/12/2016] [Indexed: 11/24/2022] Open
Abstract
Background Male involvement in maternal health is recommended as one of the interventions to improve maternal and newborn health. There have been challenges in realising this action, partly due to the position of men in society and partly due to health system challenges in accommodating men. The aim of this study was therefore to evaluate the effect of Home Based Life Saving Skills training by community health workers on improving male involvement in maternal health in terms of knowledge of danger signs, joint decision-making, birth preparedness, and escorting wives to antenatal and delivery care in a rural community in Tanzania. Design A community-based intervention consisting of educating the community in Home Based Life Saving Skills by community health workers was implemented using one district as the intervention district and another as comparison district. A pre-/post-intervention using quasi-experimental design was used to evaluate the effect of Home Based Life Saving Skills training on male involvement and place of delivery for their partners. The effect of the intervention was determined using difference in differences analysis between the intervention and comparison data at baseline and end line. Results The results show there was improvement in male involvement (39.2% vs. 80.9%) with a net intervention effect of 41.1% (confidence interval [CI]: 28.5–53.8; p <0.0001). There was improvement in the knowledge of danger signs during pregnancy, childbirth, and postpartum periods. The proportion of men accompanying their wives to antenatal and delivery also improved. Shared decision-making for place of delivery improved markedly (46.8% vs. 86.7%), showing a net effect of 38.5% (CI: 28.0–49.1; p <0.0001). Although facility delivery for spouses of the participants improved in the intervention district, this did not show statistical significance when compared to the comparison district with a net intervention effect of 12.2% (95% CI: −2.8–27.1: p=0.103). Conclusion This community-based intervention employing community health workers to educate the community in the Home Based Life Saving Skills programme is both feasible and effective in improving male involvement in maternal healthcare.
Collapse
Affiliation(s)
- Furaha August
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; .,Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Andrea B Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Rose Mpembeni
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Pia Axemo
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Elisabeth Darj
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden.,Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|