Male partners' involvement in birth preparedness and complication readiness plan in Dale district, Sidama regional state, Ethiopia, 2021.

BACKGROUND: Male partners' involvement in birth preparedness and complication readiness plans is a key strategy to improve maternal and child health. It assists an expectant mother to make timely decisions in receiving care where service is inaccessible. Despite its significance, information is scarce about male partner involvement in birth preparedness and complication readiness plan in the study setting. OBJECTIVE: To assess prevalence and factors associated with male partners' involvement in birth preparedness and complication readiness plan in Dale district Sidama, Ethiopia in 2021. METHODS: A community-based survey was done from November to December, in 2021. Data were collected using a structured, pre-tested and interview administered questionnaire. A multi-stage cluster sampling was applied to recruit 634 samples. Logistic regression analysis was performed to identify factors associated with male partner involvement in birth preparedness and complication readiness plan. Adjusted odds ratios (AORs) and 95% confidence intervals (95% CI) of associated factors were estimated by stepwise backward likelihood ratio method. RESULTS: 622 out of the 634 study participants completed the interview, yielding a 98.1% response rate. Prevalence of male partners' involvement in birth preparedness and complication readiness plan was 47.6% (95%CI: 44.9%, 48.9%). After adjusting the cofounding variables, factors like accompanying wives with their partners during their antenatal care visits (AOR = 2.3, 95%CI 1.5, 3.5), male partners whose wives had a history of caesarean birth (AOR = 2.1, 95%CI 1.1, 3.8), knowledge of male partners on birth preparedness and complication readiness plan (AOR = 3.5, 95%CI:3.1,6.6), presence of obstetric complications(AOR = 5.1,95%CI:4.3,11.2),primi-gravida (AOR = 2.7,95%CI:1.6,4.7), and male partners' knowledge of obstetrics complications (AOR = 3.5,95%CI,2.2,5.7) were significantly associated with male partners' involvement in birth preparedness and complication readiness plan. CONCLUSION: This study indicates that prevalence of male partners' involvement in birth preparedness and complication readiness was low. Therefore, awareness creation should be strengthened on male involvement on birth preparedness and complication readiness plan.

Examining birth preparedness and complication readiness: a systematic review and meta-analysis of pregnant and recently delivered women in India.

BACKGROUND: Birth preparedness and complication readiness (BPCR) is an essential component of safe motherhood programs. This study aims to systematically identify and synthesize available evidence on birth preparedness and complication readiness among pregnant and recently delivered women in India. METHODS: The study followed PRISMA guidelines and used databases such as PubMed, Cochrane Library, and ProQuest. Joanna Briggs Institute [JBI] Tool was used for critical appraisal of studies. The meta-analysis was conducted using Comprehensive Meta-Analysis [CMA] tool and R studio software. Statistical heterogeneity was evaluated using visual inspection of the forest plot, Cochran's Q test, and the I2 statistic results. Funnel plot and Egger's tests were applied to explore the possibility of the publication bias in the studies [PROSPERO: CRD42023396109]. RESULT: Thirty-five cross-sectional studies reported knowledge on one or more components of birth preparedness [BP], whilst knowledge on complication readiness [CR] or danger signs was reported in 34 included studies. Utilizing the random effect model, the pooled result showed that only about half of the women [49%; 95% CI: 44%, 53%] were aware on BPCR components. This result ranged between 15% [95% CI: 12%, 19%] to 79% [95% CI: 72%, 84%] in Maharashtra and Karnataka respectively [I2 = 94%, p = < 0.01]. High heterogeneity [> 90%] is observed across all components [p < 0.01]. The result of subgroup analysis indicated no significant difference in the proportion on BPCR among pregnant women [50%; 95% CI: 45%, 55%] and recently delivered women [54%; 95% CI: 46%, 62%]. However, the southern region of India indicates relatively better [56%; 95% CI: 45%, 67%] prevalence. CONCLUSION: Our study highlights the low prevalence of BPCR in India and the factors associated with it. Scaling up cost-effective interventions like BPCR that have a positive overall effect is necessary. Authors strongly suggests that birth preparedness and complication readiness should be given utmost importance to reduce maternal morbidity and mortality to achieve the Sustainable Development Goals. Consideration should be given to fortifying existing resources, such as frontline workers and primary healthcare, as a strategic approach to augmenting the effectiveness of awareness initiatives.

Birth preparedness and complications readiness among women in disadvantaged rural districts of Ghana.

INTRODUCTION: Essentially all women and babies irrespective of their economic and social status should reach their full potential for health and well-being. The study assessed the readiness of mothers and their preparedness for birth across three disadvantaged rural districts in Ghana. METHODS: A multi-centre quantitative survey from January to December 2018 using a multistage sampling approach was employed. Using a structured questionnaire data from mothers attending antenatal and postnatal clinics in three main ecological zones of Ghana were collected. Women who provided informed consent were consecutively recruited until the sample size was achieved. For categorical data, summary tables, proportions and percentage are presented. Multivariate logistic regression analysis determined the effect of selected characteristics on birth preparedness. Ethics approval was obtained from the Navrongo Health Research Centre. RESULTS: A total of 1058 mothers were enrolled: 33.6%, 33.4% and 33.0% respectively from the Ada west, Upper Denkyira west and Builsa south districts. About 94% of the women had prior knowledge of birth preparedness. Approximately 22.6% (95%CI 20.1, 25. 2) of the mothers were assessed to have poor birth preparedness: 8.0% in Builsa south, 27.8% in Ada west and 31.7% in Upper Denkyira west. Prenatal and postnatal data showed no statistically significant difference in poor preparedness (21.9% vs 23.3%; p-value > 0.05). Maternal age, employment status, religious affiliation and parity were not associated with birth preparedness (p-value > 0.05). Area of study (P < 0.001), educational level (P < 0.016), marital status (p < 0.001) and antenatal contacts (< 0.001) were significantly associated with birth preparedness. CONCLUSIONS: As an important safe motherhood strategy woman should plan their pregnancy and birth well to reduce maternal and neonatal mortality. Policy initiatives should take into consideration area of residence, education, marital status and antenatal contacts of women.

Effects of a community-level intervention on maternal health care utilization in a resource-poor setting of Northern Ghana.

BACKGROUND: This study aimed to assess the effects of health education and community-level participatory interventions at the community level and the use of community maternal health promoters on the utilization of maternal health care services in poor rural settings of northern Ghana. METHODS: A randomized controlled survey design was conducted from June 2019 to July 2020 in two rural districts of northern Ghana. A multistage cluster sampling technique was used to select the participants. Data were collected from a repeated cross-sectional household survey. Descriptive analysis, bivariate and covariates adjusted simple logistic regression analyses were performed using STATA version 16 statistical software. RESULTS: At post-intervention, the two groups differed significantly in terms of ANC (p = 0.001), skilled delivery (SD) (p = 0.003), and PNC (p < 0.0001). Women who received health education on obstetric danger signs had improved knowledge by 50% at the end of the study. Women who received the health education intervention (HEI) on practices related to ANC and skilled delivery had increased odds to utilize ANC (AOR = 4.18; 95% CI = 2.48-7.04) and SD (AOR = 3.90; 95% CI = 1.83-8.29) services. Institutional delivery and PNC attendance for at least four times significantly increased from 88.5 to 97.5% (p < 0.0001), and 77.3-96.7% (p < 0.0001) respectively at postintervention. Women who had received the HEI were significantly more likely to have good knowledge about obstetric danger signs (AOR = 10.17; 95% CI = 6.59-15.69), and BPCR (AOR = 2.10; 95% CI = 1.36-3.24). Women who had obtained tertiary education were significantly more likely to make at least four visits to ANC (AOR = 2.38; 95% CI = 0.09-1.67). CONCLUSIONS: This study suggests that the use of health education and participatory sessions led by community-based facilitators could be a potentially effective intervention to improve the knowledge of women about obstetric danger signs and encourage the uptake of maternity care services in resource-poor settings of Ghana.

Evaluation of a community-based intervention package to improve knowledge of obstetric danger signs, birth preparedness, and institutional delivery care utilization in Arba Minch Zuria District, Ethiopia: a cluster-randomized trial.

INTRODUCTION: Maternal healthcare utilization, particularly the institutional delivery, is disproportionately low in rural Ethiopia. This study aimed to evaluate the effectiveness of an integrated package of community-based interventions on the improved knowledge of obstetric danger signs, birth preparedness, and institutional delivery services utilization in rural areas of Gamo zone, southern Ethiopia. METHODS: We conducted cluster-randomized controlled trial (NCT05385380) from 2019 to 2021 at the Arba Minch Health and Demographic Surveillance System site. We randomly assigned the 10 kebele clusters to intervention and control arm. We used a package of interventions, which included providing information on safe motherhood via video and/or audio with a birth preparedness card for pregnant women, training for community volunteers and health extension workers, and improving maternity waiting home services. Women in the control arm received routine services only. We used generalized mixed-effects logistic regression models to evaluate the effectiveness of the intervention on the outcome variables. RESULTS: The study enrolled 727 pregnant women across the 10 clusters, with a 617 (84.9%) successful follow-up rate. The proportion of institutional delivery in the intervention arm was increased by 16.1% from 36.4% (174/478) at the baseline to 52.5% (224/427) at the endline (Adjusted odds ratio [AOR] for McNemar's Test = 1.5; 95% confidence interval [CI]: 1.1 to 2; p < 0.001). In the control arm, however, there was a 10.3% fall in the proportion of institutional delivery (from 164/249 to 105/190). Pregnant women who received the intervention were significantly more likely to give birth in a health institution than those who did not (AOR 2.8; 95% CI: 1.2, 6.4). CONCLUSION: The study demonstrates that an integrated community-based intervention package that included video-based storytelling and upgrading maternity waiting homes increased institutional delivery care utilization among rural women. We recommend that audio-visual storytelling, starting during pregnancy and continuing postpartum, be incorporated into routine maternal healthcare services to address access to care inequalities in rural settings. TRIAL REGISTRATION: The study protocol was registered in the clinicaltrials.gov with registry number NCT05385380.

Many women in developing nations, including Ethiopia, are dying due to problems related to pregnancy and childbirth. One of the interventions to prevent maternal illness and deaths is promoting and ensuring the timely use of maternal health care services. This study aimed to evaluate the effectiveness of an integrated package of community-based interventions on the improved institutional birth rate in rural Ethiopia. We conducted a trial at the Arba Minch HDSS site. The package provided information on safe motherhood via videos and audiocassettes for pregnant women, a birth preparedness card for women, community volunteers and extension workers training, and maternity waiting home services upgrading. In the control arm, women received routine services only. From the 10 Arba Minch HDSS kebele clusters, six kebele clusters were randomly assigned to the intervention and an additional four were assigned to the control. Different statistical techniques were used to evaluate the effectiveness of the intervention on the institutional birth rate. At the baseline, 727 pregnant women had enrolled across all 10 clusters, with a 617 (84.9%) successful follow-up rate. The intervention arm had a higher proportion of institutional birth (224/427 [52.5%]) at the endline than the baseline (174/478 [36.4%). Furthermore, the study showed a significant association between intervention status and institutional birth rate. Therefore, stimulating demand for existing services to ensure the timely use of care can improve maternal health service utilization, particularly the institutional birth rate.

Birth preparedness and complication readiness: Evaluating the "know-do" gap among women receiving antenatal care in Benin City, Nigeria.

Across several African countries, birth preparedness and complication readiness (BPACR) among pregnant women is poor. The practice of BPACR, though improving in recent years, is not commensurate with the knowledge available to pregnant women. Maternal health indices remain sub-optimal. This study evaluates the determinants of this "know-do' gap among women receiving antenatal care at a secondary health facility in Benin City, Nigeria. A cross-sectional study involving 427 pregnant women was conducted between October and December 2020 using a structured interviewer-administered questionnaire. The prevalence of knowledge and practice were described, and the determinants of BPACR practice evaluated using bivariable (chi-square) analysis and multivariable ordinal logistic regression with post-estimation predictive margins analysis. About 77% of respondents had good birth preparedness practice. Multivariable regression revealed that respondents with poor knowledge and moderate knowledge of components of BPACR had statistically significant lower odds (OR:0.05 (95% CI: 0.02-0.13) and 0.10 (95% CI: 0.03-0.30) times, respectively) for greater practice of BPACR when compared to those with good knowledge. Respondents with poor knowledge of danger signs had statistically significant lower odds (OR: 0.08 (95% CI: 0.03-0.26) for greater practice of BPACR when compared to those with good knowledge. But predictive margins analyses demonstrates that knowledge, though critical to practice, is insufficient to optimize practice. The optimum number of danger signs women need to know to improve practice may be between eight to ten. Beyond this number, practice may not change significantly. Other predictors of BPACR practice include income level, parity, gravidity, and residential settings. The number of antenatal clinic visits had no statistically significant correlation with BPACR practice. Interventions to facilitate practice at the community level may be helpful to improve outcomes and bridge the know-do gap with respect to BPACR within the study context.

Birth preparedness and complication readiness among husbands and its association with skilled birth attendance in southern Ethiopia.

INTRODUCTION: Birth preparedness and Complication Readiness (BPCR) promotes prompt use of skilled delivery and readiness for any complications to reduce delays in the provision of emergency care. Husband's involvement in preparation for childbirth is one way to mitigate life-threatening delays in providing care during childbirth. The current study assessed the association of the husband's involvement in birth preparedness and complication readiness with the use of skilled birth attendants. METHOD: A community-based cross-sectional study was conducted among 1,432 husbands. Study participants were selected from Arbaminch university health and demographic surveillance sites. Data were collected electronically using the Open Data Kit. The data were exported to STATA version 16 for analysis. Descriptive statistics were computed to describe the sociodemographic and reproductive variables of the study. The associations between birth preparedness and complication readiness practice and birth in the presence of a skilled birth attendant were assessed using multiple logistic regressions after adjusting for known confounders. Explanatory variables on bivariate logistic regression analysis were entered into multivariable logistic regression analysis, and a p-value of less than 0.05 was used to ascertain statistical significance. RESULTS: Mean age of respondents was 33.7 (SD ± 6.2) years. Of all the respondents, 140 (10.3%) had made at least three preparations according to birth preparedness and complication readiness. After controlling for confounders through multivariable logistic regression, giving birth in the presence of a skilled birth attendant consistently increased with husbands involved in birth preparedness and complication readiness (AOR = 4.1, 95% CI: 2.5-6.9). Husbands whose wives had complications during previous pregnancy were 33% less likely to have skilled birth attendants (AOR = 0.67, 95% CI: 0.49-0.917). Moreover, husbands whose houses were near the health facilities were more likely to have skilled birth attendants for their wives (AOR = 3.93, 95% CI: 2.57-6.02). CONCLUSION: Husband's involvement in birth preparedness and complication readiness is strongly associated with using skilled birth attendants in Ethiopia. It is imperative that when designing husband's involvement programs targeting birth preparedness and complication readiness, programs and strategies should focus on enhancing activities that are inclusive of husbands in birth preparedness and complication education.

Male partners' participation in birth preparedness and complication readiness in low- and middle-income countries: a systematic review and meta-analysis.

BACKGROUND: Maternal 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. METHODS: Literature 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. RESULTS: Thirty-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. CONCLUSIONS: A 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.

Association of identification of facility and transportation for childbirth with institutional delivery in high priority districts of Uttar Pradesh, India.

BACKGROUND: Timely and skilled care is key to reducing maternal and neonatal mortality. Birth preparedness involves preparation for safe childbirth during the antenatal period to reach the appropriate health facility for ensuring safe delivery. Hence, understanding the factors associated with birth preparedness and its significance for safe delivery is essential. This paper aims to assess the levels of birth preparedness, its determinants and association with institutional deliveries in High Priority Districts of Uttar Pradesh, India. METHODS: A community-based cross-sectional survey was conducted between June-October 2018 in the rural areas of 25 high priority districts of Uttar Pradesh, India. Simple random sampling was used to select 40 blocks among 294 blocks in 25 districts and 2646 primary sampling units within the selected blocks. The survey interviewed 9458 women who had a delivery 2 months prior to the survey. Descriptive statistics were included to characterize the study population. Multivariable logistic regression analyses were performed to identify the determinants of birth preparedness and to examine the association of birth preparedness with institutional delivery. RESULTS: Among the 9458 respondents, 61.8% had birth preparedness (both facility and transportation identified) and 79.1% delivered in a health facility. Women in other caste category (aOR = 1.24, CI 1.06-1.45) and those with 10 or more years of education (aOR = 1.68, CI 1.46-1.92) were more likely to have birth preparedness. Antenatal care (ANC) service uptake related factors like early registration for ANC (aOR = 1.14, CI 1.04-1.25) and three or more front line worker contacts (aOR = 1.61, CI 1.46-1.79) were also found to be significantly associated with birth preparedness. The adjusted multivariate model showed that those who identified both facility and transport were seven times more likely to undergo delivery in a health facility (aOR = 7.00, CI 6.07-8.08). CONCLUSION: The results indicate the need for focussing on marginalized groups for improving birth preparedness. Increasing ANC registration in the first trimester of pregnancy, improving frontline worker contact, and optimum utilization of antenatal care check-ups for effective counselling on birth preparedness along with system level improvements could improve birth preparedness and consequently institutional delivery rates in Uttar Pradesh, India.

Effects of health education on spousal knowledge and participation in birth preparedness in Farafenni Regional Hospital, The Gambia: a randomized trial.

BACKGROUND: The Gambia is a male-dominant society in which the cultural norms empower husbands to decide when and where their wives seek care, yet they are not always involved in maternal health care services. Therefore, the purpose of this study was to design and measure the effects of antenatal health education on spousal participation in birth preparedness in Farafenni and satellite villages. METHODS: The study used a quasi-experimental design, and the participants were 300 spouses of pregnant women attending their antenatal care booking at Farafenni Hospital. A multistage sampling method was used to select the study participants who were then equally distributed to the intervention and comparison groups. Pre-test data were collected from both groups. Thereafter, the intervention group was exposed to two health education sessions on obstetric danger signs and birth preparedness. The post-test data were collected immediately before discharge of the participants' wives after institutional delivery or within 2 weeks post-delivery for those who did not accompany their wives to the health care institution, or whose wives delivered at home. IBM SPSS version 21 software was used to analyze the data. RESULTS: The differences between the demographic characteristics of participants in the intervention and comparison groups were not statistically significant except for the highest level of education achieved. After controlling for the demographic variables, the health education administered to the intervention group effectively increased knowledge on birth preparedness among them (F (1, 255) = 376.108, p < .001). Every unit increase in the intervention led to a unit increase in the spouses' knowledge on birth preparedness (ß = 0.789, p <  0.001). Furthermore, the participants in the intervention group had higher mean score (M = 4.4; SD = 0.8) on participation in birth preparedness than those in the comparison group (M = 0.9; SD = 0.8). The spouses in the intervention group were four times more likely to be prepared for the delivery of their wives after being exposed to the health education than those in the comparison group (F (1, 255) = 522.414, p < .001). CONCLUSION: The study provides evidence that educating men on maternal health care can improve their level of participation in birth preparedness. TRIAL REGISTRATION: Name of Registry: Pan African Clinical Trial Registry ( www.pactr.org ). Registry Number: PACTR202004752273171 . Date of Registration: 19th April 2020. Retrospectively Registered.

Male partner involvement in birth preparedness, complication readiness and obstetric emergencies in Sub-Saharan Africa: a scoping review.

BACKGROUND: Maternal mortality remains a pressing concern across Sub-Sahara Africa. The 'Three Delays Model' suggests that maternal deaths are a consequence of delays in: seeking care, reaching medical care and receiving care. Birth Preparedness and Complication Readiness (BPCR) refers to a plan organised during pregnancy in preparation for a normal birth and in case of complications. Male partners in many Sub-Saharan African communities could play a pivotal role in a woman's ability to prepare for birth and respond to obstetric complications. This review aimed identify: the extent and quality of research performed on the topic of male partner involvement in BPCR in Sub-Saharan Africa; the degree to which populations and geographic areas are represented; how male partner involvement has been conceptualized; how male partners response to obstetric complications has been conceptualised; how the variation in male partners involvement has been measured and if any interventions have been performed. METHODS: In this scoping review, articles were identified through a systematic search of databases MEDLINE, EMBASE and Maternity and Infant Care and a manual scan of relevant papers, journals and websites. All authors contributed to the screening process and a quality assessment using the Kmet checklist. The PRISMA checking list for Scoping Reviews was used to guide the search, data charting and reporting of the review The protocol was registered with PROSPERO (ID: CRD42019126263). RESULTS: Thirty-five articles met inclusion criteria, reporting: 13 qualitative, 13 cross-sectional, 5 mixed method and 4 intervention studies. Data were contributed by approximately 14,550 participants (numbers were not always reported for focus groups) including: women who were pregnant or who had experienced pregnancy or childbirth within the previous 3 years, their male partners and key informants such as health workers and community leaders. CONCLUSIONS: The diversity of study designs, aims and source countries in this body of literature reflects an emerging stage of research; as a result, the review yielded strong evidence in some areas and gaps in others. Male partner's involvement in BPCR and responding to obstetric emergencies can be conceptualised as being centrally involved in responding to complications and having some role in preparing for birth through their position in the chain of decisions and provision of logistic support. However, their knowledge of pregnancy complications and level of preparation for birth is low, suggesting they are making decisions without being fully informed. There is limited evidence on interventions to improve their knowledge. Future research efforts should be focused on producing standardised, culturally appropriate, higher level evidence.

Birth preparedness and related factors: a cross-sectional study in Tanzania City area.

BACKGROUND: Birth preparedness could be the key factor that influences the choice of birthplace with skilled birth attendants. To reduce the high maternal mortality of Tanzania, a large study was planned to develop a smartphone app to promote birth preparedness in a city area of Tanzania. This study aimed to identify factors that influence birth preparedness in the city area of Tanzania. METHODS: Pregnant women were asked to complete the Birth Preparedness Questionnaire during antenatal visits using tablets. Multiple linear regression analyses were performed to determine the sociodemographic and obstetric characteristics that influenced the factors. RESULTS: A total of 211 participants were included in the analysis. Distance from the nearest health facility negatively influenced the total score of the Birth Preparedness Assessment (ß= 0.7, p = 0.02). Education higher than college positively influenced the total score (ß = 4.76, p = 0.01). Decision-making of birthplace by other people (not women) negatively influenced Family Support (ß=1.18, p = 0.03). Having jobs negatively influenced Preparation of Money and Food (ß=-1.02, p < 0.01) and positively influenced the knowledge (ß = 0.75, p = 0.03). Being single positively influenced Preparation of Money and Food (ß = 0.35, p = 0.19) and Preference of Skilled Birth Attendants (ß = 0.42, p = 0.04). Experience of losing a baby negatively influenced the knowledge (ß=0.80, p < 0.01) and Preference of Skilled Birth Attendants (ß=0.38, p = 0.02). CONCLUSIONS: The findings showed an updated information on pregnant Tanzanian women living in an urban area where rapid environmental development was observed. Birth preparedness was negatively affected when women reside far from the health facilities, the birthplace decision-making was taken by others beside the women, women have jobs, and when women have experienced the loss of a baby. We hope to use the information from this study as content in our future study, in which we will be applying a smartphone app intervention for healthy pregnancy and birth preparedness. This information will also help in guiding the analysis of this future study. Although generalization of the study needs careful consideration, it is important to reconsider issues surrounding birth preparedness as women's roles both in the family and society, are more, especially in urban settings.

Maternity waiting homes as component of birth preparedness and complication readiness for rural women in hard-to-reach areas in Ethiopia.

BACKGROUND: In rural areas of Ethiopia, 57% of births occur at home without the assistance of skilled birth attendants, geographical inaccessibility being one of the main factors that hinder skilled birth attendance. Establishment of maternity waiting homes (MWH) is part of a strategy to improve access to skilled care by bringing pregnant women physically close to health facilities. This study assessed barriers to MWHs in Arba Minch Zuria District, Southern Ethiopia. METHODS: A community-based cross-sectional study was undertaken from February 01 to 28, 2019. Study participants were selected by computer-generated random numbers from a list of women who gave birth from 2017 to 2018 in Arba Minch Health and Demographic Surveillance System site. Data were collected using a pre-tested and interviewer-administered questionnaire. Stata software version-15 was used for data management and analysis, and variables with p-values ≤ 0.2 in bivariate analysis were considered for multivariable logistic regression analysis. Level of statistical significance was declared at a p-value < 0.05. Qualitative data were analyzed manually based on thematic areas. RESULTS: MWH utilization was found to be 8.4%. Wealth index (lowest wealth quintile aOR 7.3; 95% CI 1.2, 42), decisions made jointly with male partners (husbands) for obstetric emergencies (aOR 3.6; 95% CI 1.0, 12), birth preparedness plan practice (aOR 6.5; 95% CI 2.3, 18.2), complications in previous childbirth (aOR 3; 95% 1.0, 9), history of previous institutional childbirth (aOR 12; 95% CI 3.8, 40), residence in areas within two hours walking distance to the nearest health facility (aOR 3.3; 95% CI: 1.4, 7.7), and ease of access to transport in obstetric emergencies (aOR 8.8; 95% CI: 3.9, 19) were factors that showed significant associations with MWH utilization. CONCLUSIONS: A low proportion of women has ever used MWHs in the study area. To increase MWH utilization, promoting birth preparedness practices, incorporating MWH as part of a personalized birth plan, improving access to health institutions for women living far away and upgrading existing MWHs are highly recommended.

Birth preparedness complication readiness and determinants among pregnant women: a community-based survey from Ethiopia.

BACKGROUND: Maternal death related to obstetric complications remains a great challenge in developing countries. Since these complications are not consistently predictable, it is important to plan different preventive approaches to overcome them when. As the information on birth preparedness, complication readiness, and predictors were limited in the study area, we conducted this study. METHODS: A Cross-sectional study involving 396 pregnant women was conducted from 1st April to 1st May 2018. Data were collected using a pre-tested structured questionnaire. Descriptive, binary and multiple logistic regression analyses were conducted in SPSS for windows version 20. P values < 0.05 were considered significant. RESULTS: Of 361 women interviewed (91% response rate), birth preparedness and complication readiness were present in 24.10% (87/361) of women. Maternal factors, age 18-19 (AOR = 0.18; 95% CI (0.04,0.94)), 20-34 (AOR = 0.40; 95% CI (0.20,0.78)), education, not able to read/write (AOR = 0.36;95% CI (0.15,0.85),read/write (AOR = 0.41;95% CI (0.19,0.89)), Muslim religion (AOR = 0.40; 95% CI (0.18,0.85)) income ETB, < 1000 (AOR = 0.21; 95% CI (0.07,0.67)),1000-2000, (AOR = 0.38; 95% CI (0.19,0.76)), and the mothers' knowledge on key danger signs of postpartum (AOR = 0.48; 95% CI (0.26,0.90)) were independent predictors of birth preparedness and complication readiness. CONCLUSIONS: Educational status, age, religion, family income, and knowledge of obstetric danger signs were significantly associated with birth preparedness and complication readiness. The Government and other health sector partners should work to improve women's education, income, and focus on young age groups on pregnancy danger signs.

Effects of maternal education on birth preparedness and complication readiness among Ethiopian pregnant women: a systematic review and meta-analysis.

BACKGROUND: Birth preparedness and complication readiness are broadly endorsed by governments and international agencies to reduce maternal and neonatal health threats in low income countries. Maternal education is broadly positioned to positively affect the mother's and her children's health and nutrition in low income countries. Thus, this systematic review and meta-analysis aims to estimate the effect of maternal education on birth preparedness and complication readiness. METHODS: This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. We conducted an electronic based search using data bases of PubMed /MEDLINE, Science direct and google scholar. STATA™ Version 14.1 was used to analyze the data, and forest plots were used to present the findings. I2 test statistics and Egger's test were used to assess heterogeneity and publication bias. Pooled prevalence and pooled odd ratios with 95% confidence intervals were computed. Finally, Duval and Tweedie's nonparametric trim and fill analysis using random-effects meta-analysis was conducted to account for publication bias. RESULTS: In this meta-analysis, 20 studies involving 13,744 pregnant women meeting the inclusion criteria were included, of which 15 studies reported effects of maternal education on birth preparedness and complication readiness. Overall estimated level of birth preparedness and complication readiness was 25.2% (95% CI 20.0, 30.6%). This meta-analysis found that maternal education and level of birth preparedness and complication readiness were positively associated. Pregnant mothers whose level of education was primary and above were more likely to prepare for birth and obstetric emergencies (OR = 2.4, 95% CI: 1.9, 3.1) than non-educated mothers. CONCLUSION: In Ethiopia, the proportion of women prepared for birth and related complications remained low. Maternal education has a positive effect on the level of birth preparedness and complication readiness. Therefore, it is imperative to launch programs at national and regional levels to uplift women's educational status to enhance the likelihood of maternal health services utilization.

Birth preparedness, complication readiness and associated factors among pregnant women in Agnuak zone, Southwest Ethiopia: a community based comparative cross-sectional study.

BACKGROUND: Birth Preparedness and Complication Readiness interventions have a significant role in the reduction of maternal and neonatal mortality risk. Inadequacy of birth and emergency preparedness were depicted as one of the major reasons for high maternal deaths in sub-Saharan Africa. The main objective of this study was to assess birth preparedness, complication readiness and associated factors among pregnant women. METHODS: A community based comparative cross-sectional study design was conducted among 411 urban and 209 rural respondents who were selected using multi-stage stratified random sampling technique. Quantitative data were collected by interviewer administered questionnaire while qualitative data were collected from purposely selected 54 members of the community by using guiding checklist and analyzed by thematic areas. Birth preparedness and complication readiness was measured using five birth preparedness and complication readiness items then women who scored at least three were considered as well prepared. Bivariate and multivariable logistic regressions were used to examine the association between independent variables and birth preparedness and complication readiness. The result were presented as Odds Ratio at 95% CI. P < 0.05 ware used to dictate statistical significance. RESULTS: A total response rate of the study was 97.3%. The prevalence of birth preparedness and complication readiness was significantly higher among urban respondents (P = 25.8%; p < 0.05). Factors such as history of obstetric complication, knowledge of key danger signs, having favourable attitude towards birth preparedness and complication readiness, starting antenatal care visit within 3 months age of pregnancy, completing at least four antenatal care visits, urban residence, having occupation of government employee or merchant and being in the higher wealth quintile were variables positively associated with birth preparedness and complication readiness. CONCLUSIONS: Prevalence of birth preparedness and complication readiness was low in this study, though significantly higher in urban area. Three-fourth of women planned to attend 4+ antenatal care visits indicating opportunity to counsel them on birth preparedness and complication readiness which increases its prevalence. Health workers should counsel every woman on birth preparedness and complication readiness components during her first antenatal care visit and subsequent visits.

Unlocking community capabilities for addressing social norms/practices: behavioural change intervention study to improve birth preparedness and complication readiness among pregnant women in rural Nigeria.

BACKGROUND: Maternal mortality is attributed to combination of contextual factors that cause delay in seeking care, leading to poor utilization of skilled health services. Community participation is one of the acknowledged strategies to improve health services utilization amongst the poor and rural communities. The study aimed at assessing the potentials of improving birth preparedness and complication readiness (BP/CR) using community-driven behavioural change intervention among pregnant women in rural Nigeria. METHODS: A pre-post intervention study was conducted from June 2018 to October 2019 on 158 pregnant women selected through multi-stage sampling technique from 10 villages. Data on knowledge and practices of birth preparedness and utilization of facility health services were collected through interviewer-administered pre-tested structured questionnaire. Behavioural change intervention comprising of stakeholders' engagement, health education, facilitation of emergency transport and fund saving system, and distribution of educational leaflets/posters were delivered by twenty trained volunteer community health workers. The intervention activities focused on sensitization on danger signs of pregnancy, birth preparedness and complication readiness practices and emergency response. Means, standard deviations, and percentages were calculated for descriptive statistics; and T-test and Chi square statistical tests were carried out to determine associations between variables. Statistical significance was set at p-value < 0.05. RESULTS: The result showed that after the intervention, mean knowledge score of danger signs of pregnancy increased by 0.37 from baseline value of 3.94 (p < 0.001), and BP/CR elements increased by 0.27 from baseline value of 4.00 (p < 0.001). Mean score for BP/CR practices increased significantly by 0.22 for saving money. The proportion that had antenatal care (76.6%) and had facility delivery (60.0%) increased significantly by 8.2 and 8.3% respectively. Participation in Community-related BP/CR activities increased by 11.6% (p = 0.012). CONCLUSION: With the improvements recorded in the community-participatory intervention, birth preparedness and complication readiness should be promoted through community, household and male-partner inclusive strategies. Further evaluation will be required to ascertain the sustainability and impact of the programme.

Maternal birth preparedness and complication readiness in the Greater Accra region of Ghana: a cross-sectional study of two urban health facilities.

BACKGROUND: High maternal mortality ratios remain a critical public health concern in Ghana. Birth preparedness and complication readiness (BP/CR), which is a component of focused antenatal care, is a safe motherhood strategy intended to promote skilled birth attendance by helping women and their families plan for pregnancy and childbirth, thereby reducing maternal mortality. The objective of this study was to determine the level of BP/CR and to assess factors associated with maternal BP/CR in the Greater Accra Region of Ghana. METHOD: A cross sectional descriptive quantitative study was carried out among 300 postnatal women attending the Adabraka Polyclinic and the Greater Accra Regional Hospital both within Accra, the capital city of Ghana. Data were collected with a structured questionnaire which assessed socio-demographic, health facility/provider and social support factors and their associations with BP/CR. Levels of BP/CR were assessed using validated tools. Data from 300 women were analyzed using STATA version 15.0. Logistic regression analysis was conducted to establish associations between BP/CR and socio-demographic, health facility/provider and social support factors. RESULTS: Approximately 234 (78%) of the women were birth prepared. Strong predictors of BP/CR included having ≥4 antenatal clinic visits (aOR 2.63; 95% CI 1.03-6.73), being employed (aOR 4.07; 95% CI 1.49-11.11) and belonging to maternal health promoting clubs or groups during the antenatal period (aOR 3.00; 95% CI 1.07-8.40) . CONCLUSION: BP/CR is generally high among the study population. Predictors of BP/CR are multifactorial and found to cut across all aspects assessed in the study. Therefore, the creation of a BP/CR tool is recommended to routinely monitor trends in maternal birth preparedness in antenatal clinics. This may help to sustain and improve current levels and indicators of BP/CR.

Birth preparedness and complication readiness among women of reproductive age in Kenya and Tanzania: a community-based cross-sectional survey.

BACKGROUND: Delayed health-seeking continues to contribute to preventable maternal and neonatal deaths in low resource countries. Some of the strategies to avoid the delay include early preparation for the birth and detection of danger signs. We aimed to assess the level of practice and factors associated with birth preparedness and complication readiness (BPCR) in Kenya and Tanzania. METHODS: We conducted community-based multi-stage cross-sectional surveys in Kilifi and Kisii counties in Kenya and Mwanza region in Tanzania and included women who delivered two years preceding the survey (2016-2017). A woman who mentioned at least three out of five BPCR components was considered well-prepared. Bivariate and multivariable proportional odds model were used to determine the factors associated with the BPCR. The STROBE guidelines for cross-sectional studies informed the design and reporting of this study. RESULTS: Only 11.4% (59/519) and 7.6% (31/409) of women were well-prepared for birth and its complications in Kenya and Tanzania, respectively, while 39.7 and 30.6% were unprepared, respectively. Level of education (primary: adjusted odds ratio (aOR): 1.59, 95% CI: 1.14-2.20, secondary: aOR: 2.24, 95% CI: 1.39-3.59), delivery within health facility (aOR: 1.63, 95% CI: 1.15-2.29), good knowledge of danger signs during pregnancy (aOR: 1.28, 95% CI: 0.80-2.04), labour and childbirth (aOR: 1.57, 95% CI: 0.93-2.67), postpartum (aOR: 2.69, 95% CI: 1.24-5.79), and antenatal care were associated with BPCR (aOR: 1.42, 95% CI: 1.13-1.78). CONCLUSION: Overall, most pregnant women were not prepared for birth and its complications in Kilifi, Kisii and Mwanza region. Improving level of education, creating awareness on danger signs during preconception, pregnancy, childbirth, and postpartum period, and encouraging antenatal care and skilled birth care among women and their male partners/families are recommended strategies to promote BPCR practices and contribute to improved pregnancy outcomes in women and newborns.

Do male engagement and couples' communication influence maternal health care-seeking? Findings from a household survey in Mozambique.

BACKGROUND: This study explored effects of couples' communication and male participation in birth preparedness and complication readiness (BPCR) on delivery in a health facility ("institutional delivery"). A cross-sectional, baseline household survey was conducted in November 2016 prior to an integrated maternal and child health project in Nampula and Sofala Provinces in Mozambique. METHODS: The study used the Knowledge, Practices and Coverage survey tool, a condensed version of the Demographic and Health Survey and other tools. The sample included 1422 women. Multivariable logit regression models tested the association of institutional delivery with couples' communication and four elements of BPCR both with and without male partners: 1) saving money, 2) arranging transport, 3) choosing a birth companion, and 4) choosing a delivery site; controlling for partners' attendance in antenatal care and social and demographic determinants (education, wealth, urban/rural location, and province). RESULTS: The odds that women would deliver in a health facility were 46% greater (adjusted odds ratio (aOR) = 1.46, 95% confidence interval (CI) = 1.02-2.10, p = 0.04) amongst women who discussed family planning with their partners than those who did not. Approximately half of this effect was mediated through BPCR. When a woman arranged transport on her own, there was no significant increase in institutional delivery, but with partner involvement, there was a larger, significant association (aOR = 4.31, 2.64-7.02). Similarly, when a woman chose a delivery site on her own, there was no significant association with institutional delivery (aOR 1.52,0.81-2.83), but with her partner, there was a larger and significant association (aOR 1.98, 1.16-3.36). Neither saving money nor choosing a birth companion showed a significant association with institutional delivery-with or without partner involvement. The odds of delivering in a facility were 28% less amongst poor women whose partners did not participate in BPCR than wealthy women, but when partners helped choose a place of delivery and arrange transport, this gap was nearly eliminated. CONCLUSIONS: Our findings add to growing global evidence that men play an important role in improving maternal and newborn health, particularly through BPCR, and that couples' communication is a key approach for promoting high-impact health behaviors.