Individual- and Community-Level Predictors of Birth Preparedness and Complication Readiness: Multilevel Evidence from Southern Ethiopia

BackgroundInadequate knowledge of birth preparedness and complication readiness (BPCR) among expecting couples delays timely access to maternal emergency services. The aim of this study was to assess knowledge on birth preparedness and complication readiness and how men and women differ" among expecting couples in a rural setting of Rukwa Region, Tanzania.MethodsA community-based cross-sectional study targeting pregnant women and their partners was performed from June 2017 to October 2017. A total of 546 couples were sampled using three-stage probability sampling techniques and then interviewed using a structured questionnaire. The mean score difference was sought using independent t-test. Multiple linear regressions were performed to determine the predictors of knowledge.ResultsThere was a significant difference in mean knowledge scores between pregnant women (M = 5.58, SD = 4.591) and male partners (M = 4.37, SD = 4.285); t (1085) = -4.525; p<0.001. Among women, BPCR levels were positively influenced by age (β = 0.236; p<0.01), having ever heard about birth preparedness (β = 0.176;p<0.001), being of Mambwe ethnicity (β = 0.187; p<0.001), living near a health center rather than a dispensary (β = 0.101;p<0.05) and having had a prior preterm delivery (β = 0.086;p<0.05). Access to media through radio ownership negatively influenced BPCR levels among both women (β-.119; p<0.01) and men (β = -0.168; p<0.0001). Among men, the BPCR knowledge was only positively influenced by having ever heard about birth preparedness (β = 0.169;p<0.001), age at marriage (β = -0.103; p<0.05), and having completed either primary (β = 0.157;p<0.001) or secondary education (β = 0.131;p<0.01).ConclusionSome important predictors of knowledge were revealed among women and men, but overall knowledge about birth preparedness and complication readiness was low. This study demonstrates inadequate knowledge and understanding at the community level about key elements of birth preparedness and complication readiness. In order to improve access to life-saving care for women and neonates, there is a pressing need for innovative community strategies to increase knowledge about birth preparedness and complication readiness. Such strategies are essential in order to reduce maternal and neonatal mortality in rural Tanzania.

INTRODUCTION:Globally, efforts are being made to reduce the menace of maternal death in order to achieve the sustainable development goal. Maternal death has been associated with inadequate Birth Preparedness and Complication Readiness (BPCR), especially in low- and middle-income countries. Therefore, this review assessed birth preparedness and complication readiness in Nigeria.METHODS:A systematic review and meta-analysis of published research articles on birth preparedness and complication readiness in Nigeria were done using PubMed, EMBASE, and MEDLINE databases. All published articles from inception to November 2018 were included in the review. A total of 8,913 published articles were identified from an electronic search, and a total of 4,440 studies were included in this review, while only 12 articles met the inclusion criteria and were included in the meta-analysis.RESULTS:The pooled prevalence of “good BPCR” for all studies yielded an estimate of 58.7% (95% CI 43.9%–72.7%). TheI 2statistic was 98%, indicating statistically significant heterogeneity among the studies. The percentage of women with good birth preparedness and complication readiness increases with the year of publication, such that women have tended to be more aware of good birth preparedness and complication readiness in recent years. More than half of the women had knowledge of obstetric danger signs (52.0%, 95% CI 39.5%–64.4%, 10 studies), arranged for transportation (59.5%, 95% CI 36.2%–80.7%, 11 studies), or saved money (63.4%, 95% CI 44.7%–80.2%, 11 studies) as part of the BPCR.PROSPERO REGISTRATION NUMBER:The study protocol was registered with PROSPERO number CRD42019123220.CONCLUSION:Women in Nigeria are better prepared for birth preparedness and complication readiness in recent years. Therefore, interventions to promote more adequate birth preparedness and complication readiness among women are recommended.

Background: Birth preparedness and complication readiness serve as valuable tactics for enhancing the provision of maternal and child care services, consequently reducing morbidity and mortality associated with childbirth. Anticipating childbirth and possessing prior awareness of potential complications enables women to access services promptly. Methods: In 2022, a community-based cross-sectional study was conducted involving a sample of 480 pregnant women. Data on Birth Preparedness and Complication Readiness (BPCR) were gathered using a pretested and standardized questionnaire. Data analysis was performed utilizing SPSS version 20. The questionnaire encompassed inquiries regarding birth preparedness, such as the selection of a health facility, designation of a birth attendant, arrangement for transportation, securing a blood donor, and whether the woman had saved money for delivery. Complication readiness was assessed through questions concerning complications during pregnancy, delivery, and the neonatal period. Results: Out of the 480 pregnant women included in the study, 30.8% were classified as belonging to the upper middle class. Additionally, 55% of the participants had experienced multiple pregnancies, while 74.2% were identified as being in their third trimester. Furthermore, 70% of the women had undergone their initial Antenatal Care (ANC) checkup before reaching 12 weeks of gestation. Despite these demographics, the study found a general lack of awareness regarding Birth Preparedness and Complication Readiness (BPCR) among the participants. Conclusion: The study indicates a low level of birth preparedness and complication readiness within Rural Tamilnadu. To address this issue effectively, targeted health education strategies should be directed towards young couples and adolescent girls, who represent the future mothers. Implementing both individual and community-level interventions focused on birth preparedness and complication readiness has the potential to enhance maternal service delivery and ultimately reduce both morbidity and mortality rates associated with childbirth.

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.

Introduction: Every pregnant woman faces risk of life-threatening obstetric complications. A birth-preparedness package promotes active preparation and assists in decision-making for healthcare seeking in case of such complications. The main objective of this study was to assess the determinant factors of male involvement on birth preparedness and complication readiness at Mekelle town. Methods: A community based cross-sectional study was conducted from July to October/2014 among 376 husbands/male whose wives was delivered within the last 12 months at Mekelle town northern part of Ethiopia. Multi stage stratified sampling technique with Probabilities proportional to size was used. Study subjects again were selected by systematic random sampling technique from 6 randomly selected kebelle’s in the town. Data was collected using structured interview questionnaire and entered, cleaned and analyzed using SPPS version 20.00. Bivariate and multivariate logistic regression analysis was used to avoid any confounding variables. Results: A total of 376 husbands were participated in the study with 95% response rate. About 60% of the husbands had participated in birth preparedness and complication readiness (BP/CR). The study revealed that husbands were more likely to participate in birth preparedness if they had better knowledge in postnatal danger signs (AOR= 4.29, 95% CI: 1.54-11.94) and with good (AOR=9.05, 95% CI=4.27-19.18) & better knowledge on birth preparedness (AOR=16.50, 95% CI=7.25-37.58). Conclusion & Recommendation: Male involvement in birth preparedness and complication readiness is still low in this study. But there is slightly better knowledge on postnatal danger signs and knowledge on birth preparedness and complication readiness. Thus, male awareness in postnatal danger signs and birth preparedness should be increased by local and other concerned bodies to make husbands to share in birth preparedness.

Introduction: Motherhood is a time of anticipation of joy for a woman, her family and her community. In spite of this fact, it is not as enjoyable as it should be because of numerous reasons. Insufficiency or lack of birth preparedness and complication readiness is the most common reason. Birth preparedness & complication readiness (BPACR) is a strategy that effectively plan birth and deals with emergencies. Objective: This study aimed to assess the Birth Preparedness and Complication Readiness (BPACR) status in antenatal mothers and its relationship with selected demographic variables and disseminate information booklet regarding BPACR. Materials and Methods: An exploratory cross-sectional study was carried out in selected PHCs of New Delhi in October-November 2017. A total of 200 women were randomly selected and interviewed using pretested structured interview schedule and the data was analysed using a computer program of SPSS version 25. Results: 50.4 percent of the respondents were found to have prepared for birth and its complications. In present study BPACR status of 156 antenatal mothers i.e. 78% was adequate and 22% (44) was found to be inadequate. Less than half of the respondents were aware on birth preparedness (44.6%) and complication readiness (43.4%). There is statistically significant relationship of BPACR with age of the mother (p=0.043), education status of the mother (p=0.037) and parity (p=0.027) at 0.05 level of significance. Conclusion: This study identified that poor knowledge, inadequate birth preparedness, and complication readiness were prevalent among mothers in the study area. Community participation and health care providers in the areas of maternal and child health should operate together to maximize birth preparedness and complication readiness practices.

BackgroundThe poor emphasis on the role of husbands in birth preparedness and complication readiness (BPCR) is a major factor that should be addressed in tackling maternal mortality.AimTo assess the level of husbands’ participation in BPCR and associated factors.SettingWolaita Sodo town, Southern Ethiopia.MethodsA community based cross-sectional study was conducted among 608 husbands of pregnant women and nursing mothers. Multivariate logistic regression model was used for the analysis.ResultsForty-five per cent of husbands studied had poor participation in BPCR. Out of the total husbands studied, 40% (235) did not identify transportation, 49% (291) did not accompany their wives to antenatal care (ANC) clinic, 59% (350) did not identify skilled birth attendant, 26% (155) did not identify health facility for delivery and 30% (179) did not save money for emergency. Only 42% (250) of husbands had awareness of emergency conditions, while 75% (444) did not make postpartum plan. Husbands who knew the place of birth of the baby [adjusted odds ratio (AOR) = 7.23; 95% confidence interval (CI): 2.98–17.54] and those who discussed with their wives about birth preparedness (AOR = 2.03; 95% CI: 1.37–3.02) were significantly more likely to participate in BPCR compared to those who did not.ConclusionParticipation of husbands in BPCR was poor in the study area. The level of participation in relation to selection of service provider and health facility, financial and transportation planning for delivery and identifying blood donor needs attention to achieve better husband participation in BPCR.

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

About 287,000 mothers lost their lives due to pregnancy and delivery in 2020 worldwide. Birth preparedness and complication readiness (BPCR) is an approach used to utilize the timely use of skilled maternal and neonatal services. Preparing mothers for childbirth and against its dangers has great importance in reducing maternal mortality. Little is known about BPCR and influencing factors in Hargeisa town, Somaliland. To assess the level of BPCR and its associated factors among recently delivered women in Hargeisa. A community-based cross-sectional study was carried out in September 2022 among 300 women who delivered in the one-year time interval before the study period. A census was done to identify the women, and then they were selected by simple random sampling. Face-to-face interviews were conducted using a pre-structured questionnaire. A woman was considered prepared for birth if she made preparations for at least three of the BPCR components. Data were cleaned, entered, and analyzed using SPSS V.25. Bivariate and multivariate logistic regression analyses were performed with a cut-point of 0.05 significance level. From a total of 300 women, 38.3% had good knowledge of BPCR, and only one-fourth (25%) were prepared for birth and its complications. Access and media usage (AOR = 9.64, CI 1.09-82.248), receiving health education about BPCR (AOR = 3.75, CI 1.01-13.87), giving birth at health institutions (AOR = 6.02, CI 1.39-25.95), and good knowledge of key danger signs of pregnancy (AOR = 0.017, CI 0.004-0.069) were factors significantly associated with BPCR practice. The study identified that the BPCR level was very low compared to many other studies. Such a low BPCR level may have a negative impact on maternal health and lives, hindering interventions conducted to reduce maternal mortality rates. All concerned bodies should consider the importance of awareness creation regarding BPCR in their core interventions.

Magnitude and factors associated with birth preparedness and complication readiness among pregnant women in Wolaita Zone, Ethiopia.

BackgroundMaternal mortality in Kenya remains unacceptably high. Mobile pastoralist communities, Pokot community included take the greatest burden of these maternal deaths. Knowledge of obstetric danger signs is important for the prevention of pregnancy and birth complications as it influences pregnant women to prepare for birth and complications. The aim of this study was to assess the level of knowledge of obstetrics danger signs and their effect on Birth Preparedness and complications Readiness among mobile Pokot nomadic pastoralist in Kenya.MethodsA descriptive cross-sectional study was conducted among 275 pregnant Pokot nomadic pastoralist women using a multistage sampling technique. Chi-square (X2) was used to test the association between categorical variables and a P-value of < 0.05 was considered significant.ResultsMajority of the women demonstrated a high level of knowledge regarding obstetric danger signs, with 80% (n = 220) recognizing these danger signs during pregnancy and 69.1% (n = 190) during labour. However, despite this awareness, the overall Birth Preparedness and Complication Readiness (BPCR) remained low, with only 28% (n = 77) adequately prepared and 77% (n = 212) were unprepared.ConclusionHigh awareness of obstetric danger signs among Pokot pastoralist women has not translated into adequate birth preparedness and complication readiness. To reduce maternal mortality especially in these pastoralists and unsettled communities where services are unpredictable and disrupted by frequent movements, government and other stakeholders must implement powerful, targeted actions that address their unique challenges such as robust mobile clinics and outreach services, community based birth preparedness programs, emergency transport networks, maternity waiting homes, improved referral systems, culturally sensitive health education and policy and infrastructural investments. These bold, community-centered interventions can significantly reduce maternal deaths and improve maternal health outcomes among Kenya’s pastoral populations.

Background: Birth preparedness and complication readiness (BPCR) is an evidence-based strategy to reduce maternal mortality. Husbands have an important role to play in birth preparedness. There is paucity of data regarding husband’s participation and the use of technology in BPCR. The objective is to assess awareness, attitudes and the use of mass media and technology in BPCR among husbands of women availing obstetric care at a rural maternity hospital.Methods: A cross-sectional study was conducted in a rural maternity hospital in Ramanagara district, Karnataka. Husbands of women of more than 28 weeks of gestation, or postnatal mothers up to 6 weeks after delivery were included in the study.Results: Of the 133 participants, only 37.6% of the husbands had adequate awareness of BPCR, 62.4% had adequate participation in BPCR. Husbands’ participation was highest in saving money for delivery (75.9%), and lowest for arranging a blood donor (27.8%). Commonest source of information regarding BPCR was mobile phone (30.8%). Husbands awareness of BPCR was associate with reading MCP card OR=5.36 (2.47-11.63), seeing BPCR- related posters in hospital OR=6.59 (1.32-33.13) and using mobile phone for accessing BPCR-related information OR=2.28 (1.07-4.85). Husbands participation in BPCR was associated with awareness of BPCR OR=3.72 (1.65-8.41) and accompanying wife for antenatal visits OR=2.84 (2.25-3.59). Only one third of husbands felt it necessary to accompany their wife for antenatal visits or delivery.Conclusions: The MCP card and mobile phone technology may be further tapped to improve husband’s awareness and participation in BPCR, besides encouraging men to accompany their wife for antenatal visits.

BackgroundMaternal and neonatal health outcomes remain a challenge in low- and middle-income countries (LMICs) despite priority given to involving male partners in birth preparedness and complication readiness (BPCR). Men in LMICs often determine women’s access to and affordability of health services. This systematic review and meta-analysis determined the pooled magnitude of male partner’s participation in birth preparedness and complication readiness in LMICs.MethodsLiterature published in English language from 2004 to 2019 was retrieved from Google Scholar, PubMed, CINAHL, Scopus, and EMBASE databases. The Joanna Briggs Institute’s critical appraisal tool for prevalence and incidence studies were used. A pooled statistical meta-analysis was conducted using STATA Version 14.0. The heterogeneity and publication bias were assessed using the I2 statistics and Egger’s test. Duval and Tweedie's nonparametric trim and fill analysis using the random-effect analysis was carried out to validate publication bias and heterogeneity. The random effect model was used to estimate the summary prevalence and the corresponding 95% confidence interval (CI) of birth preparedness and complication readiness. The review protocol has been registered in PROSPERO number CRD42019140752. The PRISMA flow chart was used to show the number of articles identified, included, and excluded with justifications described.ResultsThirty-seven studies with a total of 17, 148 participants were included. The pooled results showed that 42.4% of male partners participated in BPCR. Among the study participants, 54% reported having saved money for delivery, whereas 44% identified skilled birth attendants. 45.8% of male partners arranged transportation and 57.2% of study participants identified health facility as a place of birth. Only 16.1% of the male partners identified potential blood donors.ConclusionsA low proportion of male partners were identified to have participated in BPCR in LMICs. This calls countries in low- and middle-income setting for action to review their health care policies, to remove the barriers and promote facilitators to male partner’s involvement in BPCR. Health systems in LMICs must design and innovate scalable strategies to improve male partner’s arrangements for a potential blood donor and transportation for complications that could arise during delivery or postpartum haemorrhage.

Background Birth preparedness and complication readiness (BPACR), promotes utilization of skilled maternal and neonatal care. Preparing for childbirth reduces delays in seeking care. Brick-kiln workers constitute a vulnerable social group who contribute to city infrastructure by laboring at low wages. 37% of the sample were Scheduled Castes, 49% Scheduled Tribes. Methods 139 mothers of children &amp;lt; 2 years, residing temporarily in brick kilns of Indore were asked about preparedness for birth of youngest child. Birth preparedness was assessed by enquiring about saving money, arranging transport, identifying health facility for delivery, identified family member to accompany for labor/emergency. Findings 10% did &amp;gt;3 BPACR practices implying good level of preparedness; 50% did 1-2 BPACR practices; 40% did no birth preparedness. Access to maternity benefit scheme was twice as likely to result in reasonable birth preparedness as compared to no access. Those with primary to class XII were twice as likely to practice birth preparedness as compared to those with no formal education. &amp;gt;3 ANC was associated with 8 percentage points greater practice of reasonable BPACR as compared to &amp;lt; 2 or no ANC. Mothers with knowledge of one danger sign each of pregnancy and delivery were 3 times more likely to practice BPACR than those without this knowledge. FGDs revealed challenges in access to bank account, obtaining required documents to apply for and access state maternity benefit. Lack of family support led to low BPCAR and low institutional delivery. Conclusions Brick-kiln women face risk of low utilization of government healthcare services. The health systems should conduct outreach antenatal care sessions in brick-kilns on knowledge of key danger signs and BPACR during health education and ANC counselling can help promote BPACR and hospital delivery. Information on requisite steps to apply for maternity benefit schemes should be shared among brick-kiln workers. Key messages It is crucial to promote BPACR among urban vulnerable sections, through NUHM’s outreach sessions by ANMs/ASHAs in brick-kiln, construction workers and similar groups. Access to maternity benefit cash transfer scheme should be enhanced particularly among excluded temporary urban groups such as brick-kiln workers as it is a motivation to avail hospital care.

Birth preparedness and complication readiness (BPCR) is a comprehensive strategy, aimed at ensuring that expectant mothers and their families are for normal delivery and preparing for potential complications that may arise during pregnancy, labor, delivery, and the postpartum period without any delays. BPCR interventions are widely promoted by government and international agencies to reduce maternal and neonatal health risk in developing countries like Nepal. Studying BPCR also helps identify gaps in knowledge, access, and practices, guiding interventions to strengthen health system and community awareness, especially in low-resource settings. This study was conducted to assess birth preparedness and complication readiness knowledge, practices and its associated factors among recently delivered women in Bharatpur city, Chitwan, Nepal. A community based cross-sectional study was conducted in 2022, on a sample of 220 recently delivered women. Data were collected using pre-tested structured interview questionnaire. The collected data were analyzed by IBM SPSS 20 version software. Variables with p-value ≤0.05 on the bivariate analysis were included in multivariate analysis. Adjusted odds ratios (AOR) with the respective 95% Confidence Interval (CI) and a p-value <0.05 was used to set statistically significant variables in the multivariable analysis. Among 220 recently delivered women, majority (91.4%) of the women identified the place of delivery and saved money for childbirth (97.7%). Similarly, most of them arranged transportation (87.3%), identified a companion (85.9%), and arranged necessary materials (90%) for childbirth. Considerable (52.3%) women identified skilled birth attendants. Preparedness for blood donors (36.4%) found to be low as compared to other components. Overall, 46.8% of recently delivered women were well prepared. Family type, knowledge on components of BPCR, obstetric signs and symptoms and ANC visits were found to be statistically significant (p-value<0.05) with birth preparedness practice. Associated characteristics were further subjected to multivariate logistic regression where knowledge on components of BPCR (AOR = 5.34,95%CI: (2.728-10.478) was found significantly associated with BPCR practice. The overall 46.8% of women who prepared for birth and its complication readiness was found to be higher as compared to other reports. Encouraging women to utilize antenatal care, and such as sensitization of pregnant women, during ANC visit by the health workers, regarding components of BPCR, danger sign and symptoms during pregnancy, may enhance BPCR.