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ORIGINAL ARTICLE
Year : 2014  |  Volume : 8  |  Issue : 2  |  Page : 76-81

Assessment of birth preparedness and complication readiness among pregnant women attending Primary Health Care Centres in Edo State, Nigeria


1 Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
2 Department of Community Health, University of Benin, Benin City, Edo State, Nigeria

Date of Web Publication16-Mar-2015

Correspondence Address:
Ekaete A Tobin
Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0331-3131.153358

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   Abstract 

Background: The principle and practice of birth preparedness and complication readiness (BP/CR) in resource-poor settings have the potential of reducing maternal, and neonatal morbidity and mortality rates.
Aim: The aim was to assess BP/CR among pregnant women attending Antenatal care in Primary Health Care Centres in Oredo Local Government Area (LGA) in Benin City, Edo State.
Materials and Methods: A descriptive cross-sectional study carried out among pregnant women attending antenatal clinic in Primary Health Centres in Oredo LGA. Data were collected using structured questionnaires, and analyzed using the Statistical Package for Social sciences (SPSS) Version 16.0. Descriptive data were presented in frequency tables. Statistical testing using Chi-square was carried out with level of significance set as P < 0.05.
Results: One hundred and fourteen pregnant women (49.6%) were aware of at least one danger sign associated with pregnancy, labor, and postpartum, while 201 women (87.4%) had identified a skilled birth attendant. Twenty-six (11.3%) had saved money for obstetric care, and 143 (62.2%) had purchased or made plans to purchase birth supplies. Two hundred and one (87.4%) respondents were found to be well-prepared for the birth. Having a tertiary education and being married were factors found to be significantly associated with BP.
Conclusion: Majority of the women had BP/CR in place. However, emphasis should be placed on identifying target groups and practice gaps, for intensified health education.

Keywords: Birth preparedness, complication readiness, pregnancy, Primary Health Centre, Nigeria


How to cite this article:
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;8:76-81

How to cite this URL:
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 [serial online] 2014 [cited 2020 Mar 28];8:76-81. Available from: http://www.anmjournal.com/text.asp?2014/8/2/76/153358


   Introduction Top


High maternal mortality is an important public health concern in developing countries. [1] The World Health Organization (WHO) estimates that about 800 women die daily from pregnancy and childbirth-related complications each year, mainly in developing countries. [2] The situation is most dire for women in Sub-Saharan Africa, where one out of every 16 women dies of pregnancy-related causes during her lifetime. [2] For every woman who dies, 30-50 more women suffer childbirth-related injuries, infections, or diseases. [3] Beyond the emotional loss caused by her death, her children are also negatively impacted, with increased risk of dying before the teenage years, reduced nutritional status, mental health outcome, and lower educational attainment. [4],[5],[6]

Every pregnant woman faces the risk of sudden, unpredictable complications that could end in death or injury to herself or her infant. [7] Lack of advance planning for the utilization of the services of a skilled birth attendant for normal births; and inadequate preparation for rapid intervention in the event of obstetric complications, are well-documented factors contributing to delay in receiving skilled obstetric care. [8] Because there is no reliable way to predict which women will develop these complications, all pregnant women must have access to high quality obstetric monitoring throughout their pregnancies, during and immediately after childbirth, when most emergency complications do arise; creating the need to introduce women to birth preparedness. [9],[10] Birth preparedness and complication readiness (BP/CR) is a strategy to promote utilization of skilled maternal and neonatal care on the assumption that preparing for childbirth and being ready for complications reduces delays in obtaining care. [8],[9],[10]

The aim of this study was to assess the level of BP/CR among pregnant women in Oredo Local Government Area (LGA) in Benin City, Edo state.


   Materials and Methods Top


Study area

This cross-sectional study was carried out in Oredo LGA of Edo State, Nigeria. The LGA has an estimated population of 780,976, made up of 397,296 males and 383,680 females. There are 10 Primary Health Care Centres in the LGA.

The study population included all pregnant women attending antenatal clinic in the 10 primary health care centers of the study LGA. The inclusion criteria were women that had passed the first trimester of current pregnancy, and were permanent residents of the study area. Those who failed to give consent because they were morbidly ill or who were judged by the researchers to be mentally unstable were excluded.

Sample size was determined using the formula for finite population:

n = (Z 2 pq)/d 2[11]

with z, the standard normal deviate taken at 1.96, p as 84.4%, the prevalence of antenatal clinic attendance by pregnant women in a previous study, [12] and d as 5%. With a 10% nonresponse rate, sample size was calculated as 222 and rounded up to 230.

Sampling technique

Twenty-three consenting participants from each of the 10 primary health care centers in the LGA were recruited serially as they presented for antenatal clinic visits.

Data collection tools

Data for this study were obtained using a structured pretested English language interviewer-administered questionnaire divided into three sections, namely, information on biodata, utilization of antenatal care services, and level of BP and plans in case of emergencies.

Institutional ethical clearance was obtained, and assent granted by the chairman of the LGA and the matrons of the Primary Health Care Centres. Privacy of respondents was respected during the interview. Data were kept secure and made available only to the researchers.

Data analysis

Data were analyzed using the Statistical Package for Social Sciences (SPSS) Version 16.0 (SPSS Inc., Chicago, IL., USA). Awareness of danger signs in pregnancy was determined by identification, without prompting; of at least one danger sign each in pregnancy, childbirth, and the postpartum period. The danger signs during pregnancy include vaginal bleeding, swollen hands/face, and difficulty with sight. Danger signs during labour are vaginal bleeding, prolonged labor (>12 h), convulsions and retained placenta, and in the postpartum period, danger signs include vaginal bleeding, foul-smelling vaginal discharge, and high fever. [13],[14] A woman was classified as "well birth prepared" if she had taken any three of the following steps: had knowledge of danger signs of pregnancy, identified a skilled birth provider at birth, saved or had plans to save money for delivery, or had identified a means of transport to a place of childbirth, in the event of an obstetric emergency occurring during childbirth or ahead of childbirth, or had purchased delivery kit/materials. [15],[16] A respondent who achieved two or less of the three steps was classified as not well birth prepared. [17]

Results were presented as frequency tables, and test of association carried out using Chi-square, with level of significance set as P < 0.05.


   Results Top


The mean age of respondents was 28 ± 3.65 years, with 158 of the respondents (68.7%) being married. Most of the respondents were Christians 203 (88.3%), of Benin ethnic group 104 (45.2%), with 97 (42.2%) having secondary school level education. The socio-demographic characteristics of the respondents are summarized in [Table 1].
Table 1: Sociodemographic characteristics of respondents (n = 230)

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One hundred and fourteen (49.6%) respondents registered for antenatal care at >6 months of gestation. Other registration periods included 29 (12.6%) within the first 3 months and 87 (37.8%) between 4 and 5 months gestation. One hundred and sixty-nine (73.5%) knew their expected date of delivery, and 201 (87.4%) had identified a place for delivery. These included the Tertiary Hospital in the Capital City-142 (70.4%), with 30 respondents (14.8%) choosing the state-owned central hospital, 18 (19.1%) the primary health center, and 11 (5.7%) choosing private health facilities. One hundred and seventy-three (75.2%) respondents had received spousal agreement on the choice of the identified health facility for delivery.

Two hundred and one (87.4%) respondents had identified a skilled birth attendant. Two hundred and nineteen (95.2%) had identified a health facility for provision of emergency obstetric care if needed, with the tertiary hospital regarded as the first choice for 144 (65.8%) respondents, followed by the central hospital, 64 (29.2%), and the private clinics, 11 (5.0%). Eleven (4.8%) respondents were undecided as to where to seek care in case of an emergency. Birth supplies/delivery kit were being purchased or were available at home for the majority, 143 (62.2%) [Table 2].
Table 2: Self-reported practices of respondents on BP/CR
(n = 230)


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One hundred and fourteen (49.6%) knew of at least one obstetric danger sign during pregnancy, labour, and the postpartum period. Frequently mentioned signs during pregnancy were bleeding by 114 (49.6%) and severe abdominal pains, 96 (41.7%). Most common danger sign during labour was severe vaginal bleeding, 201 (87.4%), and in the postpartum, smelly vaginal discharge, 86 (37.4%). Knowledge of obstetric danger signs was significantly associated with maternal age, with respondents aged <24 years and >35 years having better knowledge, than respondents in other age groups (P < 0.001).

One hundred and twenty-five (54.3%) respondents had identified a means of transportation to the health facility in the event of an emergency. Ten (4.3%) respondents had identified a potential blood donor, and 26 (11.3%) respondents had money kept aside for payment for emergency service.

Majority listed their spouse as the most likely accompanying persons, 113 (49.1%). Others made arrangements with relatives-66 (28.6%), neighbors-30 (13.2%), and friends-21 (9.1%).

Two hundred and one (87.4%) respondents were graded as well birth prepared, while 29 (12.6%) did not have adequate preparations. BP was significantly associated with being married (P < 0.001) and with having attained an educational level above primary education (P < 0.001) [Table 3].
Table 3: Sociodemographic factors associated with birth preparedness

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   Discussion Top


Given the need for early identification of underlying problems to ensure efficacious treatment, the first ANC visit should be as early as possible in pregnancy, preferably the first trimester. [18],[19] The delayed timing for first registration observed among respondents corroborates with findings from other studies carried out among African women, which show that antenatal registration usually occurs around the second trimester. [20],[21],[24],[25] This delay in registration may stem out of an ignorance of the purpose of antenatal care, as was found in a study carried out among antenatal attendees in Warri, Nigeria. [26] In the traditional African society, cultural beliefs about pregnancy, such as that pregnancy should not be revealed in its early stages, because the fetus might be at risk of harm, and that the pregnancy is still in "liquid form" may also be responsible for delayed first registration. [26],[27],[28] On the contrary, booking in the first trimester was the practice by the majority of respondents in a West Bengal study. [29] Aggressive health education on the benefits of antenatal care and the need for booking in the first trimester is advocated during antenatal sessions. Engagement of community health workers has been shown to be beneficial as well. [30],[31]

The large number of respondents aware of their due dates for delivery, and this was similarly reported in Nairobi, Kenya. [32] This was not the case in a study carried out in Ife, where 45.5% of women interviewed knew their expected delivery dates. [33] The observed association with literacy may be because women who are literate are more likely to ask and be told the dates. Recognition of prolongation of the duration of pregnancy can only come when a woman is aware of her expected due date. Thus, all women regardless of age, status or literacy level need to be aware of their due dates.

Knowledge of obstetric danger signs is essential to motivating women to seek skilled attendance at birth and prompt referral when complications may arise. [34] Slightly less than half of the respondents were aware of at least one danger signs associated with pregnancy and childbirth. Almost similar figures were reported in two other studies, [13],[32] contrasting with the poorer knowledge reported in studies carried out in West Bengal, [29] and Mpwapwa. [23] Educational level, maternal age, and occupation have been linked to knowledge of danger signs, as was similarly observed in this study, but contrary to what was observed in West Bengal. [29]

Majority of the respondents had plans in place for critical components of BP, including arranged transportation during delivery, purchase of birth supplies, and identification of a skilled birth attendant. Such preparedness has also been reported in other studies. [15],[23] The preference for delivery in a tertiary health facility as opposed to the secondary and private health facilities may be a sign of the confidence respondents have in the services rendered by the former and the availability of a large pool of experts and infrastructure. A study carried out in Ethiopia showed the preference among pregnant women was for home birth. [35]

Majority of the respondents had plans in place for an emergency conveyance to a health facility in the event of an emergency. This plan is important as one of the factors leading to maternal death has been identified as delay in reaching the health facility. A similar figure was obtained in a study in Umahia. [13] Gaps in planning were however noted with regards to identifying potential blood donors as was also noted in other studies. [23],[29],[33] In rural settings where blood bank services are nonexistent or inadequate, the prior identification of a donor cannot be overemphasized. More so in a rural area where pregnant women suffer from anemia, the risk of bleeding, especially postpartum is higher than in the developed world. The practice of saving money for any obstetric emergency was low in this study, as was reported by some authors, [36] but also contrary to the findings of other studies. [17],[23],[37],[38] Consequently, health educators should ensure that the need for such is highlighted to pregnant women. In a study carried out in Burkina Faso, women who had made transportation plans and those who had saved money were more likely to deliver with a skilled birth attendant. [37] Another study found that pregnant women who took at least one BP step were more likely to have skilled care at birth. [39] This underscores the need to promote BP/CR.

Community resources were poorly known or recognized by the majority of women, which corroborates with earlier studies, [13] and contrary to what was reported in West Bengal, [29] probably because they were unavailable or because information about them was not made available to the mothers. The approach to tackling this problem is to involve and obtain the commitment of local government chairpersons, community, and opinion leaders, with the aim of strengthen existing service; so as to be able provide local transport, blood donors and emergency funds through community health funds. The local media, grass-root faith-based organizations, and nongovernmental agencies can be involved to carry out information dissemination as well.

The finding of a large number of respondents who were well-prepared for childbirth is contrary to findings from some studies, [17],[23],[29] and agrees with a study carried out in Uganda. [15] Previous studies have found maternal literacy, awareness of obstetric complications, and attendance at antenatal clinic to be determining factors for BP. [17],[23] Indeed, antenatal clinics, if well-attended, should give due emphasis to preparing pregnant women for birth and its complication, by providing adequate information and education. [23]


   Conclusion Top


The study showed that the level of BP was high in the study area, with gaps identified as the need for pregnant women and their families to make plans for blood donors, and save money for emergencies; as well as the need to encourage women to register early in pregnancy. Women with primary level of education and single mothers were identified as groups to be targeted in any intervention to improve BP.

 
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    Tables

  [Table 1], [Table 2], [Table 3]


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