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BIRTH PREPAREDNESS AND COMPLICATION READINESS: A CROSS SECTIONAL SURVEY FROM EXPECTANT MOTHERS VISITING A RURAL HEALTH CENTER.

Byline: Saira Maroof, Naila Azam, Syed Fawad Mashhadi, Humaira Mahmood, Sumaira Masood and Huma Babar

Abstract

Objective: To assess level of awareness of expectant mothers about their birth preparedness and complication readiness (BPACR).

Study Design: Descriptive cross sectional study.

Place and Duration of Study: It was a descriptive cross sectional study conducted at a Rural Health Center, Mandra over period of six months, from Sep 2016 to Feb 2017.

Material and Methods: Three hundred and twenty pregnant women of rural area of residence in their third trimester (29-40 wks) were approached using non probability convenient sampling. They were interviewed by using a structured questionnaire after taking informed consent. SPSS version 20 was used for data entry and analysis. A p-value <0.05 was considered statistically significant.

Results: The mean age of the participants was 29.02 +- 6.403 years. All the 320 participants were from rural area of residence. The knowledge of elements of BPACR was highest (7 out of 8) in only 26 (8.1%) women followed by 6 elements in 47 (14.7%), 5 elements in 78 (24.4%), 4 elements in 83 (25.9%). There was significant number of females who had poor knowledge of only 3 elements 69 (21.6%). Overall 45% of pregnant women knew 5 or more elements were well prepared while 55% were less prepared regarding birth and related complications. Participants' education and husbands' monthly income was found to be significantly associated with birth preparedness and complication readiness knowledge (p-value<0.05).

Conclusion: The majority of expectant mothers were well prepared for the birth and were also aware of the danger signs of pregnancy. Antenatal visits were taken by majority of the participants. However arrangements for transportation, financial support and blood donor identification were not satisfactory.

Keywords: Antenatal, Awareness, Pregnancy complication.

INTRODUCTION

Maternal mortality has always remained a public health issue all over the world and is an important health burden in developing countries. The World Health Organization (WHO) has estimated that in developing countries 300 million women suffer from pregnancy and childbirth related short term or long term morbidities1. The burden due to maternal death is frightening; 289,000 maternal deaths occurred globally in 2013; Sub-Saharan Africa (SSA) 62%2 and Southern Asia 29% account for 85% of global burden of maternal deaths3. In Pakistan according to Pakistan Demographic and Health Survey 2012-13 (PDHS 2012-13), Maternal Mortality Ratio (MMR) was 260 per 100,000 live births4. This rate of maternal mortality is higher in rural areas (23%) of Pakistan than urban areas (14%) as rural women are less likely to have access to a hospital. Home births are extremely common in rural areas.

A total of 74%of women in rural areas give birth at home, compared to 43% of women in urban areas of Pakistan4.

The MMR is more than 15 times higher in developing countries than in the developed regions of the world5. The Sustainable Development Goal (SDG-3 Target-1) calls for Maternal Mortality Ratio (MMR) to be reduced to less than 70 per 100,000 live births by 2030. However, in Eastern Asia, Northern Africa and Southern Asia there has been observed two third decline in maternal mortality but maternal mortality ratio in developing countries is still fourteen times higher than developed regions6.

In addition to medical causes, there are many interlinked sociocultural factors which cause delay in care-seeking by the pregnant women and later contribute to maternal deaths. There are four types of recognized delays to care seeking. These are: (1) Delay in identifying the complication (2) Delay in decision making to seek care (3) Delay in identifying and then reaching the health facility (4) Delay in getting appropriate and adequate advice and treatment at the health facility7.

If an expectant mothers prepares herself for birth, makes advance plan of delivery by a trained birth attendant and prepares to take quick action in case of any obstetric emergency, then these four delays can be addressed amicably8.

Birth Preparedness and Complication Readiness (BPACR) is the process of planning for normal birth and precludes the actions that are required in any kind of emergency9. It makes use of different strategies that enable pregnant women to choose a health facility for her delivery, select a trained birth attendant, decide about someone to accompany her for delivery, had saved money for any kind of emergency and made arrangement of transport and a blood donor as well10. World Health Organization (WHO) in 2001 recognized the importance of BPACR in reducing maternal and neonatal deaths. Then WHO made BPACR intervention as a basic element of various antenatal programs2.

BPACR also involves family of pregnant women, community and health staff of that health facility in getting ready for birth plan and delivery. On first antenatal visit birth plan should be discussed with each and every pregnant women, reviewed on later visits and should be finalized by 32 weeks of gestational period8.

Among various studies conducted for BPACR, 48.6% of pregnant women were aware of their expected date of delivery and 34.1% had identified a transport for any emergency11, while 41.6% and 36.6% of pregnant women had identified a health facility and a skilled birth attendant respectively9,3 Blood donor for any obstetric emergency was arranged by 13.8% had arranged for a blood donor for any obstetric emergency12, 54.1% of females had saved money for delivery and any obstetric emergency13.

Only 14.8% of pregnant women were aware of danger signs during pregnancy10. In another study 62.2% and 87.4% of pregnant women had prepared birth supplies for delivery and identified an accompanying person during an emergency respectively14.

Pregnant females in rural areas have poor access to health facilities and they are at more risk of birth and birth related morbidities. This study focuses on birth preparedness and complication readiness in rural women and the social support system available at home. It will also help us in counseling on BPACR during antenatal care for better outcomes.

MATERIAL AND METHODS

It was a descriptive cross sectional study conducted at a Rural Health Center, Mandra over period of six months from Sep 2016 to Feb 2017. Using WHO sample size calculator with p=0.1412 sample size was computed to be 320 at 95% confidence interval and 5% permissible margin of error. Pregnant women in their third trimester (29-40 weeks) were interviewed using a structured questionnaire after informed consent. Pregnant women in labour and those whose husband are abroad were excluded from the study. The Questionnaire was developed after thorough literature search. Overall scoring of elements of BPACR enabled to categorize participants as well prepared regarding birth and complications with score [greater than or equal to]5 and less prepared with score <5. Non probability convenient sampling was used for data collection. The questionnaire was divided into three parts. In demographic part, participants' profile in aspects of education, occupation, family size, area of residence and family system was taken.

In the second part, questions regarding birth preparedness like identifying a skilled birth attendant; closest appropriate health care facility; funds for birth related and emergency expenses, identifying a transport to the health facility for the birth and obstetric emergency and identification of a compatible blood donor in case of emergency were asked. In the third part, knowledge regarding danger signs of pregnancy like headache, swelling of feet and ankles, pervaginal bleeding or leaking, decreased fetal movements, fits or convulsions was assessed.

Table-I: Demographic characteristics of participants (n=320).

Variable###Frequency (n)###Percentage (%)

###Nuclear###36###11.2

Family system

###Joint###284###88.8

###10000-15,000###185###57.8

Husbands' monthly

###16000-20,000###122###38.1

income

###21000###13###4.1

###Illiterate###155###48.4

###Primary Education###62###19.4

###Middle Level Education###61###19.1

Educational status of###Matriculation###31###9.7

the participants###Intermediate level

###8###2.5

###Education

###Bachelor's level

###3###0.9

###Education

Occupation of###Housewife###291###90.9

respondents###Working###29###9.1

###Primigravida###45###14.06

Parity###3 or less alive issues###244###76.25

###4 or more alive issues###31###9.68

Table-II: Knowledge of the participants regarding various danger signs.

###S No.###Danger signs###Frequency (n)###Percentage (%)

###PV bleeding/ PV leaking

###1###206###64.4

###Decreased fetal movements

###PV leaking/ PV bleeding

###2###Decreased fetal movements###56###17.5

###Ankle or feet swelling

###PV leaking/ PV bleeding

###3###Decreased fetal movements###41###12.8

###Fit sankle swelling

###4###Decreased fetal movements###10###3.1

###PV leaking/ PV bleeding

###Decreased fetal movements

###5###6###1.9

###Ankle or feet swelling

###Headache

###6###PV bleeding or PV leaking###1###0.3

Data were entered and analyzed using SPSS 20. Descriptive statistics in terms of frequency and percentages were used to describe qualitative variables like educational status, occupation and area of residence. Mean along with standard deviation was calculated for quantitative variables. Mean score of knowledge about eight key elements of BPACR was computed. The association of family characteristics, pregnancy characteristics, and maternal education with knowledge of BPACR was determined by using chi square test of significance. A p-value <0.05 was considered significant.

Table-III: Association of family characteristics and knowledge of BPACR.

Variables###BPACR Score###p-value

###BPACR <5###BPACR [greater than or equal to]5

###No formal

###137###80

Mothers###education

educational###middle###29###32###p=0.001

status###matriculate###8###23

###Intermediate or

###2###9

###higher

Husbands###10,000-15,000###125###60

Monthly income###16,000-20,000###44###78###p=0.001

(Rupees)###21,000-25,000###7###6

###One visit###56###18

No of antenatal###Two visits###94###67

###p=0.001

visits###Three visits###26###56

###Four visits###0###3

###Nuclear###5###21

Family system###p=0.088

###joint###161###123

###2 alive issues###164###125

Parity###p=0.055

###3 alive issues###12###19

RESULTS

The mean age of the participants was 29.02 +- 6.403 years. All the participants (320) were from rural area of residence. Table-I shows the demographic characteristics of the participants.

When the participants were inquired about number of antenatal checkups in present pregnancy, 161 (50.3%) had 2 antenatal visits, 85 (26.5%) had 3 antenatal visits while 74 (23.1%) had only one antenatal visit including this visit.

Out of total 29 working women, 17 (58.6%) were well prepared for their birth and had better knowledge regarding complications as compared to 127 (43.6%) housewives out of total 291 housewives.

On inquiring about elements of birth preparedness and complication readiness, majority 316 (98.8%) were aware of their expected date of delivery and 249 (77.8%) had even identified their place of delivery. When the participants were asked if they had identified a companion in case of emergency or for normal labour 243 (75.9%) said they had decided for it, 153 (47.8%) had even saved money for any kind of emergency (figure).

Mode of transportation at time of emergency or labour was identified by 87 (27.2%) of the participants while only 42 (13.1%) had arranged a bag containing items needed post delivery and items for newborn.

Blood donor for emergency needs was identified by few, 4 (1.25%) participants. Knowledge about danger signs of pregnancy was found in 318 (99.4%) participants. Detail about knowledge regarding danger signs is given in table-II.

The knowledge of elements of BPACR was highest (7 out of 8) in only 26 (8.1%) women followed by 6 elements in 47 (14.7%), 5 elements in 78 (24.4%), 4 elements in 83 (25.9%). There was significant number of females 69 (21.6%), who had poor knowledge of only 3 elements.

It was found that participants whose husband's have high income showed better BPACR with p-value=0.001. Participants with better education showed statistically significant results with p-value=0.001. Similarly no. of antenatal visits had a significant association with better BPACR scores with p=0.001. However family system and parity were not significantly associated to BPACR (p=0.088) and (p=0.05) respectively (table-III).

DISCUSSION

The current study showed that 45% of expectant mothers were well prepared for their birth and any kind of complications which is much higher than studies conducted in North West Ethiopia and Nigeria which reported only 24.1% and 24.3% pregnant females well prepared respectively15,16. This is because of Rural Health Centers are being equipped for better health coverage and provion of primary health care facilities.

In this study, 98.8% of the participants were aware of their expected date of delivery as compared to a study Nigeria in which only 45.5% were aware of it which is critical to their preparation for upcoming birth16. Again shows that even a single antenatal visit enables women to be aware of their expected date of delivery.

In this study 77.8% of respondents had identified a health facility for delivery which is much better to 4.3% in Nepali women which shows better preparedness and readiness regarding place of delivery. Mode of transportation in our study was identified by only 27.2% which is much less to 49.5% identified in Nepal17 which shows lack of preparation regarding this important element of BPACR.

An important element of birth preparedness was saving money to bear out expenses of delivery which was adequately done by 47.8% of our respondents as compared to 31.50% of study participants in Indian rural women18 Blood donor, as anticipation to any requirement or some previous history of transfusion requirement was identified by 1.2% of our respondents which was much less to 12.9%19 in Indian women and 7.8% in Ethiopian respondents20 which shows lack of preemptive approach in Pakistani women.

Knowledge about danger signs is instrumental in taking appropriate and timely decisions. In our study 99.4% of the respondents were aware of some kind of danger signs in pregnancy which is much better than 59% found in Ethiopia21 which again shows better antenatal coverage and counseling by the health staff.

Amongst these, knowledge of key danger signs like vaginal bleeding, PV leaking and decreased fetal movements were identified by 64.4% of the participants which is higher as compared to a study in Tanzania in which only 47% females could recognize these danger signs correctly10.

This study showed statistically significant association between education of pregnant ladies and husband monthly income which is similar to a study conducted in Tanzania10, Sudan22 and other countries of the world23.

CONCLUSION

The majority of the expectant mothers were well prepared for the birth and were also aware of the danger signs of pregnancy. Antenatal visits were taken by majority of the participants. However arrangements for transportation, financial support and blood donor identification were not satisfactory.

RECOMMENDATION

Antenatal coverage during pregnancy is the important hall mark to achieve healthy outcome. Antenatal visits should be taken as an opportunity by the health staff to empower women of their health, timely decisions, plan and practice of BPACR. Male partner should be involved during antenatal visits. They should take the responsibility and commit to fulfill the needs of their wives in pregnancy, arrangement of transport facility and financial support.

Female education, income generating activities and female empowerment has the potential to bring about the desired change in socio-economic of our females population.

CONFLICT OF INTEREST

This study has no conflict of interest to declare by any author.

REFERENCES

1. Acharya AS, Kaur R, Prasuna JG, Rasheed N. Making pregnancy safer-birth preparedness and complication readiness study among antenatal women attendees of a primary health center, Delhi. Indian J Community Med 2015; 40(2): 127-34.

2. Idowu A, Deji SA, Aremu OA, Bojuwoye OM, Ofakunrin AD. Birth Preparedness and Complication Readiness among Women Attending Antenatal Clinics in Ogbomoso, South West, Niger J Clin 2015; 4(1): 47-56.

3. Austin A, Langer A, Salam RA, Lassi ZS, Das JK, Bhutta ZA. Approaches to Improve Quality of Maternal and Newborn Health Care: An Overview of the Evidence. Reproductive Health Journal 2014.

4. The DHS Programme Pakistan: DHS 2012-13 Final Report 2013.

5. Debelew GT, Afework MF, Yalew AW. Factors affecting birth preparedness and complication readiness in Jimma Zone, Southwest Ethiopia: A multilevel analysis. Pan Afr Med J 2014; 19: 272.

6. UNO. The Sustainable Development Goals Report 2016.

7. Agarwal S, Sethi V, Srivastava K, Jha PK, Baqui AH. Birth preparedness and complication readiness among slum women in Indore city. J Health Popul Nutr 2010; 28(4): 383-91.

8. Mahar B, Bahalkani HA, Shafat S. Birth preparedness among the antenatal clients of public and private hospitals of Bahawalpur, Pakistan. A Public Health Nutritional Assessment of Elderly in Islamabad: A mixed method Study 2013; 3(4): 6-10.

9. Hailu M, Gebremariam A, Alemseged F, Deribe K. Birth preparedness and complication readiness among pregnant women in Southern Ethiopia. PLoS One 2011; 6(6): e21432.

10. Urassa DP, Pembe AB, Mganga F. Birth preparedness and complication readiness among women in Mpwapwa district, Tanzania. Tanzan J Health Res 2012; 14(1): 42-7.

11. Bintabara D, Mohamed MA, Mghamba J, Wasswa P,M pembeni RN. Birth preparedness and complication readiness among recently delivered women in chamwino district, central Tanzania: a cross sectional study Reprod Health 2015; 12(1): 44.

12. Karkee R, Lee AH, Binns CW. Birth preparedness and skilled attendance at birth in Nepal: implications for achieving millennium development goal 5. Midwifery 2013; 29(10): 1206-10.

13. Gebre M, Gebremariam A, Abebe TA. Birth Preparedness and Complication Readiness among Pregnant Women in Duguna Fango District, Wolayta Zone, Ethiopia. PloS One 2015; 10(9): e0137570.

14. Tobin EA, Ofili AN, Enebeli N, Enueze O. Assessment of birth preparedness and complication readiness among pregnant women attending Primary Health Care Centres in Edo State, Nigeria. Ann Nigerian Med 2014; 8(2): 76-81.

15. Bitew Y, Awoke W, Chekol S. Birth Preparedness and Complication Readiness Practice and Associated Factors among Pregnant Women, Int Sch Res Notices 2016; 2016: 8727365.

16. Kuteyi EA, Kuku J, Lateef I, Ogundipe J, Mogbeyteren T, Banjo M. Birth preparedness and complication readiness of pregnant women attending the three levels of health facilities in if e central local government, Nigeria. J Community Med Health 2011; 23(1-2): 61-68.

17. Dhakal P, Shrestha M. Knowledge on birth preparedness and complication readiness in Eastern Region of Nepal. Int J Nurs. Midwifery 2016; 8(10): 75-80.

18. Patil MS, Vedpathak VL, Aswar NR, Deo DS, Dahire PL. Birth preparedness and complication readiness among primigravida women attending tertiary care hospital in a rural area. J Community Med Health 2016; 3(8): 2297-304.

19. Mazumdar R, Mukhopadhyay DK, Kole S, Mallik D, Sinhababu A. Status of birth preparedness and complication readiness in a rural community: a study from West Bengal, India. Al Ameen J Med Sci 2014; 7(1): 52-7.

20. Zepre K, Kaba M. Birth preparedness and complication readiness among rural women of reproductive age in abeshige district, guraghe zone, snnPr, ethiopia. Int J Womens Health. 2017; 9: 11-21.

21. Hailu D, Berhe H. Knowledge about obstetric danger signs and associated factors among mothers in Tsegedie District, Tigray Region, Ethiopia 2013 community based cross-sectional study. Plos One 2014; 9(2): e83459.

22. Anastasi E, Borchert M, Campbell OM, Sondorp E, Kaducu F, Hill O, et al. Losing women along the path to safe motherhood: Why is there such a gap between women's use of antenatal care and skilled birth attendance? A mixed methods study in northern Uganda. BMC pregnancy and childbirth 2015; 15(1): 287.

23. Organization WH. Trends in maternal mortality 1990 to 2010: WHO, UNICEF, UNFPA and The World Bank estimates. Trends in maternal mortality 1990 to 2010: WHO, UNICEF, UNFPA and The World Bank estimates 2012.
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Publication:Pakistan Armed Forces Medical Journal
Geographic Code:9PAKI
Date:Dec 31, 2017
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