Effect of health education on birth preparedness and complication readiness on the use of maternal health services: A propensity score-matched analysis

Abstract

ObjectiveAt 789 maternal deaths per 100,000 live births, South Sudan has one of the worst maternal mortality indicators in the world. Utilization of maternal health services namely antenatal care (ANC), skilled birth attendance (SBA), and early postnatal care (EPNC) is critical in reducing these deaths. We evaluated whether health education on birth preparedness and complication readiness (BPCR) has an impact on the utilization of skilled birth attendance and early postnatal care in Mundri East County, South Sudan. DesignWe used observational data collected from antenatal clinics in South Sudan to perform a propensity score matched analysis. Treatment effects in both unmatched and matched cohorts were estimated using modified Poisson regression analysis with robust standard errors in prevalence risk ratios (PR) and 95% confidence intervals. Setting13 primary healthcare facilities. Participants385 postpartum mothers. InterventionsHealth education on BPCR. MeasurementsTwo outcomes were evaluated: (1) SBA measured as delivery in a health facility, and (2) EPNC use measured as use of postnatal care within 2–7 days of delivery. FindingsData on 243 (67.9%) mothers who attended antenatal care were analyzed. 92 participants who received BPCR health education were matched with 92 who had never. In unmatched adjusted analysis, health education on BPCR significantly increased SBA (Adjusted PR (APR), 1.99; 95% confidence interval (CI), 1.99–3.65) but not EPNC use (APR, 1.78; 95% CI, 0.73–4.35). In propensity score-matched analysis, SBA significantly improved (PR, 2.64; 95% CI, 1.91–3.66) while the increase in EPNC use was insignificant (PR, 1.14; 95% CI, 0.43–3.03). ConclusionsHealth education on BPCR improves SBA but not EPNC use among mothers in Mundri East County, South Sudan. Implication for practiceSouth Sudan's health systems should design new strategies to enhance EPNC use in order to significantly reduce maternal and newborn deaths in the earlier days of the postpartum period. In addition, a qualitative study is needed to identify barriers to EPNC use.