Birth Preparedness and Complication Readiness among Pregnant Women in Southern Ethiopia

Institute for Clinical Effectiveness and Health Policy (IECS), Argentina
PLoS ONE (Impact Factor: 3.23). 06/2011; 6(6):e21432. DOI: 10.1371/journal.pone.0021432
Source: PubMed


Birth preparedness and complication preparedness (BPACR) is a key component of globally accepted safe motherhood programs, which helps ensure women to reach professional delivery care when labor begins and to reduce delays that occur when mothers in labor experience obstetric complications.
This study was conducted to assess practice and factors associated with BPACR among pregnant women in Aleta Wondo district in Sidama Zone, South Ethiopia.
A community based cross sectional study was conducted in 2007, on a sample of 812 pregnant women. Data were collected using pre-tested and structured questionnaire. The collected data were analyzed by SPSS for windows version 12.0.1. The women were asked whether they followed the desired five steps while pregnant: identified a trained birth attendant, identified a health facility, arranged for transport, identified blood donor and saved money for emergency. Taking at least two steps was considered being well-prepared.
Among 743 pregnant women only a quarter (20.5%) of pregnant women identified skilled provider. Only 8.1% identified health facility for delivery and/or for obstetric emergencies. Preparedness for transportation was found to be very low (7.7%). Considerable (34.5%) number of families saved money for incurred costs of delivery and emergency if needed. Only few (2.3%) identified potential blood donor in case of emergency. Majority (87.9%) of the respondents reported that they intended to deliver at home, and only 60(8%) planned to deliver at health facilities. Overall only 17% of pregnant women were well prepared. The adjusted multivariate model showed that significant predictors for being well-prepared were maternal availing of antenatal services (OR = 1.91 95% CI; 1.21-3.01) and being pregnant for the first time (OR = 6.82, 95% CI; 1.27-36.55).
BPACR practice in the study area was found to be low. Effort to increase BPACR should focus on availing antenatal care services.

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    • "This referral system is seen as the key to reducing the delays that currently contribute to maternal and neonatal mortality (Thaddeus and Maine 1994;Jackson 2010Jackson , 2013). While some studies show that the HEP has been well received and that the use of family planning and ANC by women has increased, the impact on the program on other maternal health indicators such as skilled assistance at birth has been limited (Hadley et al. 2011;Karim et al. 2013;Medhanyie et al. 2012a;Medhanyie et al. 2012b;Admassie et al. 2009;Grépin and Klugman 2013;Koblinsky et al. 2010;Hailu et al. 2010;Hailu et al. 2011;Shiferaw et al. 2013). For reasons why women prefer to give birth at home see (Medhanyie et al. 2012a;Medhanyie et al. 2012b;Gebrehiwot et al. 2012;McCord et al. 2012;Mengesha et al. 2013;Busza and Baschieri 2011;Jackson 2010Jackson , 2013Bedford et al. 2013;Worku et al. 2013aWorku et al. , 2013bTeferra et al. 2012). "
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    ABSTRACT: The health sector is a key priority sector for addressing women’s needs and priorities in Ethiopia. Under the Health Sector Development Program (HSDP), the Health Extension Program (HEP) aims to improve equitable access to essential health services through neighborhood (kebele) based services with a strong focus on sustained preventive health actions and increased health awareness. The HEP includes 16 health intervention packages that are delivered by two government-salaried Health Extension Workers (HEWs) who are assigned to each rural kebele of around 5,000 people. HEWs spend much of their time on community outreach programs to households, especially to mothers and children. Women are selected for the HEW role because of their key role in improving the health of mothers and newborns at the community level. Within this document, the authors wanted to understand gender dimensions of the HEWs’ role and experiences of serving in that role in the HEP; issues of HEWs’ performance and satisfaction; and to identify possible gaps and come up with recommendations for improvement. They specifically wanted to give voice to the HEWs; to critique some of the assumptions underlying the gender aspects of the HEP; and, to make recommendations for considering gender issues/mainstreaming gender and HEWs empowerment in the HEP. Job opportunity and desire to help the community were the main reasons for HEWs joining the HEP. The things that make them HEWs happy are helping mothers and children, ensuring they are vaccinated and that women attend Antenatal Care (ANC) and are referred to health centers for skilled attendance during delivery—things that coincide with the goals of the HEP. However, a recurring theme among HEWs’ responses is that they struggle with excessive workload including unpaid overtime in fulfilling their responsibilities. This is exacerbated by their gendered household duties, which have not diminished with their taking up of paid work in the HEW role. Other constraints in their duties include trying to manage day-to-day with a shortage of medical and other equipment and lack of transport. Many HEWs spoke of feeling unhappy with the lack of career path or opportunities to move into positions with more or different responsibilities and better conditions. While there are some limited opportunities to upgrade training, few HEWs believe there is much opportunity for them to better themselves or move beyond the HEW role. For some, the lack of opportunity for advancement impacts on their enjoyment of being a HEW. The lack of opportunity to transfer was raised repeatedly by HEWs and appears to have been a source of considerable dissatisfaction and practical inconvenience, or worse, for many HEWs. Under HEP policy, HEWs have been unable to transfer from one location to another because they have been recruited from their own kebeles on the understanding that they will return to them after training and serve in their own community. The no-transfer policy means that some HEWs who have worked for many years in one place and have married and had children are unable to live with their husband and children. The authors examined the findings in the data through a ‘gender lens,’ using a number of established gender analysis conceptual frameworks. A key conclusion is that the health system, and the HEP specifically, are in some ways gender blind in that they fail to look at the gender of the health workers who are responsible for delivering the health services to women.
    Full-text · Technical Report · Nov 2015
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    • "In addition, antenatal care is the entry point to birth preparedness. This finding is supported by a study from southern Ethiopia, which found that the availability and use of antenatal services positively influenced birth preparedness (Hailu et al, 2011). Participants also indicated that a recent change that had been made to the antenatal care card affected the quality of birth preparedness advice by health professionals. "

    Full-text · Article · Oct 2015
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    • "For example, only 47.8% women who have already given birth in Indore city in India [9] and 35% of pregnant women in Uganda were prepared for birth and its complication [10]. Additionally, according to the research done in some part of Ethiopia, only 22% of pregnant women in Adigrat town [7] and 17% of pregnant women in Aleta Wondo of southern region [11] were prepared for birth and its complication. Even though there are some studies which were conducted on this similar issue in Ethiopia, they mainly encompass the urban area. "
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    ABSTRACT: Background Birth preparedness and complication readiness is the process of planning for normal birth and anticipating the actions needed in case of an emergency. It is also a strategy to promote the timely use of skilled maternal care, especially during childbirth, based on the theory that preparing for childbirth reduces delays in obtaining this care. Therefore, the aim of this study was to assess birth preparedness and complication readiness among women of child bearing age group in Goba woreda, Oromia region, Ethiopia. Methods A community based cross sectional study was conducted in Goba woreda, Oromia region, Ethiopia. Multistage sampling was employed. Descriptive, binary and multiple logistic regression analyses were conducted. Statistically significant tests were declared at a level of significance of P value < 0.05. Results Only 29.9% of the respondents were prepared for birth and its complications. And, only 82 (14.6%) study participants were knowledgeable about birth preparedness and complication readiness.Variables having statistically significant association with birth preparedness and complication readiness of women were attending up to primary education (AOR = 3.24, 95% CI = 1.75, 6.02), attending up to secondary and higher level of education (AOR = 2.88, 95% CI = 1.34, 6.15), the presence of antenatal care follow up (AOR = 8.07, 95% CI = 2.41,27.00), knowledge about key danger signs during pregnancy (AOR = 1.74, 95% CI = 1.06,2.88), and knowledge about key danger signs during the postpartum period (AOR = 2.08, 95% CI = 1.20,3.60). Conclusions Only a small number of respondents were prepared for birth and its complications. Furthermore, the vast majority of women were not knowledgeable about birth preparedness and complication readiness. Residence, educational status, ANC follow up, knowledge of key danger signs during pregnancy and the postpartum period were independent predictors of birth preparedness and complication readiness.
    Full-text · Article · Aug 2014 · BMC Pregnancy and Childbirth
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