Discuss factors influencing birth preparedness and complication readiness among couples

Discuss factors influencing birth preparedness and complication readiness among couples

Birth Preparedness And Complication Readiness Among Couples Essay

This study was carried out to assess knowledge, practice and factors influencing birth preparedness and complication readiness among couples in selected rural communities in Oji River. The objectives of the study were to determine knowledge of birth preparedness and complication readiness among couples in the communities studied, couple’s practice of birth preparedness and complication readiness, identify factors that hinder couples practices of birth preparedness and complication readiness and establish the relationship between couple’s socio-economic status and their practice of birth preparedness and complication readiness. A cross-sectional descriptive survey research design was used for the study in selected seven communities of Oji River L.G.A. Snowball non probability sampling technique was used to select subjects for the study. A sample of 470 was determined using the formula by Surish & Chandrashekera. Descriptive and inferential statistics were used to analyze data at 0.05 level of significance. Birth Preparedness And Complication Readiness Among Couples Essay Results were presented in tables, frequencies, means and standard deviations. Findings revealed that majority of the couples 120 (78.7%) were knowledgeable on birth preparedness and complication readiness, knowledge did not translate to practice as less than 20% actually practiced the acceptable level of birth preparedness. Financial constraint was the significant factor that hindered couples practice of birth preparedness and complication readiness. All the socio-economic variable examined were associated with couple’s practice of birth preparedness and complication readiness. There was significant difference (P < 0.05) in the average monthly income and educational qualification of the couples and their practice of birth preparedness and complication readiness. In conclusion, although most of the couple had good knowledge of birth preparedness and complication readiness, knowledge still did not translate to practice as few of them actually practiced the acceptable level of birth preparedness and complication readiness. Based on the findings, the recommendations that there is a need for slight shift in focus of maternal and child care projects of governments and need to improve transportation facilities suitable for pregnant women at rural communities which will improve outcomes in emergencies were made.Birth Preparedness And Complication Readiness Among Couples Essay ORDER HERE A PLAGIARISM-FREE PAPER HERE CHAPTER ONE INTRODUCTION Background to the Study It is true that birth of baby precedes celebration but it equally poses source of concern as pregnancy and childbirth is sometimes a perilous journey especially in the developing countries, where the risk of a woman dying from pregnancy and related complications is almost 40 times greater than that of her counterparts in developed countries (Benson & Yinger, 2002). Maternal mortality remains a public health challenge world wide, and the global maternal mortality ratio of 525 per 100,000 live births annually is still unacceptably high (Hogan, 2010). A disproportionately high burden of these maternal deaths is borne by developing countries including Nigeria, with a maternal mortality ratio of 500– 1,000 per 100,000 live births (World Bank, 2013). These deaths arise from pregnancy, childbirth or postpartum complications. According to WHO (2009), maternal deaths are thought to occur in developing countries due to delay in deciding to seek appropriate care, delay in reaching an appropriate health facility, and delay in receiving adequate emergency care once at a facility. These delays may be reduced if pregnant women and their families are prepared for birth and its complications. Birth preparedness and complication readiness strategy is therefore, very relevant in this regard.This strategy can reduce the number of women dying from complications due to such delays by making a birth plan that constitutes birth-preparedness and complication-readiness measures for pregnant women, their spouses and their families (McPherson, Khadka, Moore & Sharma, 2006).Birth Preparedness And Complication Readiness Among Couples Essay Despite global progress, 303,000 women continue to die each year worldwide due to causes related to pregnancy and childbirth. Ninety-nine percent of these deaths, nearly all preventable, occur in low- and middle-income countries [1]. Between 1990 and 2015 the global maternal mortality ratio (MMR) decreased by 45%, well below the three-quarters reduction which was targeted by the Millennium Development Goal (MDG) 5 [2]. Over this same period, child mortality decreased by 53% [3]. However, among the under-5 age group, neonatal mortality rate (NMR) proved to be the most resistant to reduction, and in every region of the world neonatal mortality now accounts for a larger proportion of under-5 mortality than it did in 1990 [3]. While Bangladesh has made remarkable strides in reducing maternal and neonatal death over the past two decades, the progress was not sufficient for the country to achieve MDG-5 target [3] and MMR still stands at 176 per 100,000 live births[1]. With an estimated NMR of 23 per 1,000 live births in 2015, newborn mortality now accounts for 61% of all under-5 deaths in Bangladesh [3].Birth Preparedness And Complication Readiness Among Couples Essay In the new era of the Sustainable Development Goals (SDGs), maternal and newborn health (MNH) has been retained as a priority. The 2030 UN Agenda aims to achieve a MMR of ≤70 deaths per 100,000 live births, and NMR of ≤12 per 1,000 live births for every country. Most countries, including Bangladesh, have declared their commitment to achieve these targets, which will require countries to maximize their efforts to ensure access to and utilization of MNH care [4]. In addition to continued investment in increasing availability, readiness and quality of MNH services, birth preparedness and complication readiness (BPCR) can play a significant role in overcoming the barriers related to access to and utilization of skilled MNH care [5–11]. Recognized globally as a key approach for promoting the use of skilled MNH care for women and newborns, BPCR is the process through which women and families plan actions in anticipation of birth and possible obstetric and neonatal emergencies [12]. It has long been considered instrumental in improving the health of women and newborns, and was included by the World Health Organization (WHO) as an integral component of antenatal care (ANC) by the early 2000s [13]. The importance of BPCR has recently been reiterated by WHO as a recommended priority health promotion intervention for MNH [14]. Even in low- and middle-income countries with poorly functioning health systems, increased preparedness for birth and complications allows women and their families to anticipate potential delays, and ensure skilled care for birth and timely use of appropriate facility for complications [14].Birth Preparedness And Complication Readiness Among Couples Essay While BPCR is recommended as an integrated element of ANC contacts which are generally one-to-one interactions between women and health services providers, the benefits of BPCR practice are likely to be optimized when it is undertaken as a joint process between women and household decision-makers, and particularly male partners [15–18]. Indeed, WHO recommends involving male partners in MNH as a strategy for increasing women’s access to skilled care during pregnancy, around the time of birth and in the case of complications [14]. As men are critical gate-keepers in many societies, it is assumed that their involvement in BPCR can help to ensure that women are able to follow through with the plan which has been prepared in advance; however, little evidence exists regarding the benefit of male involvement in BPCR.Birth Preparedness And Complication Readiness Among Couples Essay In Bangladesh, utilization of MNH care remains low: less than half (42%) of births are attended by a skilled birth attendant [19]. The recently revised Maternal Health Strategy of Bangladesh 2017 envisions achieving very high national coverage of skilled birth attendance, i.e. 93% by 2030 [20]. BPCR has been prioritized as a key approach to achieve this target and is included by the Bangladesh Maternal Health Strategy as an essential intervention to be promoted during the antenatal period. The current Maternal Health Strategy of Bangladesh emphasizes promotion of the following five core components of BPCR: identifying the place of birth, identifying a birth attendant, arranging transport, saving money for emergencies and identifying a potential blood donor. The maternal health strategy recommends that all facility based health service providers should counsel pregnant women on these BPCR practices during routine ANC contacts. Community-based health workers are also instructed to promote BPCR practices during their routine domiciliary visits. The new strategy also recommends increasing the quality and effectiveness of BPCR through innovative and multi-sectoral approaches.Birth Preparedness And Complication Readiness Among Couples Essay To date, some evidence exists regarding the status of BPCR practice in Bangladesh [5], however there is no evidence correlating how these practices contribute to the use of skilled MNH care or the value of male involvement in BPCR in this context. Our study aims to explore the status of BPCR in a hard-to-reach area of rural Bangladesh and to demonstrate how practices related to BPCR among women and among couples contribute to ensuring birth in the presence of a skilled birth attendant. Finally, we assess the added value of couples’ joint BPCR planning over women’s planning.Birth Preparedness And Complication Readiness Among Couples Essay Materials and methods Study design and settings A community-based, cross-sectional household survey was conducted in hard-to-reach two sub-districts, Barhatta and Kalmakanda, of Netrokona district in Bangladesh in 2014. Netrokona is located approximately 200 kilometres north of Dhaka, the capital of Bangladesh. It is one of the 14 lowest performing districts of Bangladesh in terms of newborn and child mortality rates [21]. Netrokona’s landscape is dominated by four major rivers and abundant wetlands known as haors. Agriculture and fishing are the primary sources of income. The sub-district of Kalmakanda has a land area of 377 square kilometres and a total population of around 272,000. Barhatta covers 220 square kilometres of land with a total population of approximately 180,000.Birth Preparedness And Complication Readiness Among Couples Essay Kalmakanda was included in the study as it had been selected as the implementation site of a programme focusing on health promotion and community engagement actions to improve MNH. This programme was implemented by ‘PARI Development Trust’, a local non-governmental organization (NGO), in collaboration with the Directorate General of Health Services (DGHS) and the Directorate General of Family Planning (DGFP)- branches of the Ministry of Health and Family Welfare (MOHFW). Enfants du Monde (EdM), a Geneva-based NGO provided technical support to the programme and icddr,b (an international health research institute based in Bangladesh) conducted evaluation independently. One of the key planned interventions was the promotion of BPCR, which was initiated following the baseline study. Barhatta, an adjacent sub-district to Kalmadanda, was selected as the control site. Study population Eligible women who gave birth within the 12-month period preceding the survey and their husbands/partners were included in the study.Birth Preparedness And Complication Readiness Among Couples Essay Sample size The sample size was calculated for evaluating the effectiveness of the health promotion and community engagement intervention package on giving birth in the presence of a skilled birth attendant. As planned, the intervention package was delivered in one of the above mentioned sub-districts (Kalmakanda) and study adopted a quasi-experimental design with a comparison sub-district (Barhatta). As baseline assumption for sample size calculation, we considered the estimates from the BMMS 2010 report (the national survey reporting district-specific estimates in Bangladesh) where the coverage of birth with a skilled birth attendant in Netrokona was reported to be 15.6%. We assumed a minimum of a 10-percentage point (absolute) increase in coverage of skilled birth attendance between baseline and endline. We also wanted to ensure a higher sample from the intervention site (intervention: comparison = 1.5:1). The unadjusted sample size was 404 from the intervention site and 269 from the comparison site at 80% power and 5% error probabilities. The sample size was then adjusted for design effect/cluster effect (1.25) and non-response/loss to follow up (5%). The final sample size was 425 from the intervention site and 283 from the comparison site at baseline and at endline. We present here the findings from the baseline survey. At baseline (conducted in 2014), we interviewed 725 women with a recent birth history at baseline (444 from the intervention site and 281 from the comparison site). We approached all husbands of the women and conducted 317 interviews successfully. Information from 317 wife-husband dyads is presented in this paper.Birth Preparedness And Complication Readiness Among Couples Essay ORDER NOW Sampling This study used a multistage cluster sampling to select eligible respondents. In the first stage, four unions (the smallest administrative unit of Bangladesh with an average population of 30,000) were randomly selected from each of the selected sub-districts. In the second stage, four clusters (average population of approximately 1,000) were selected from each union using the probability proportional to size (PPS) sampling technique. All eligible respondents were included from the selected clusters.Birth Preparedness And Complication Readiness Among Couples Essay Data collection In the first stage of sampling, a sketch map was drawn for each of the selected clusters representing boundaries, landmarks and bari (extended household) locations. All households and women who had a birth outcome in the 12 months preceding the survey were enumerated and listed. In the second stage, separate structured questionnaires were used for interviewing all eligible women and their husbands (S1 Table). The questions were adopted from the Bangladesh Demographic and Health Survey (BDHS) 2011, Bangladesh Maternal Mortality Survey (BMMS) 2010 and other relevant studies [19, 22]. Women and their husbands were interviewed separately by different groups of data collectors. The questionnaire started with questions regarding personal and socioeconomic information such as age, education level, marital status and employment status followed by questions related to utilization of routine and emergency obstetric care. Data related to BPCR including identifying a birth place, identifying a birth attendant, saving money for emergencies, arranging transportation to reach the health facility, and arranging a potential blood donor were collected. Information on the extent and roles of spouses’ involvement in BPCR were also collected. For quality assurance, data collection instruments were pre-tested in non-selected clusters of the selected unions. Interviewers were locally recruited to facilitate the data collection processes as they would be familiar with the local context, culture and dialect. Experienced facilitators, trainers and field supervisors trained the data collectors.Birth Preparedness And Complication Readiness Among Couples Essay Data analysis Data was analysed using Stata 14.0 (StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: Stata Corp LP). Women’s education, husbands’ education and women’s age were converted to categorical variables from continuous variables. Religion was re-categorised to Muslim and “other”, as all other religions had smaller frequencies. The household asset score was generated using the principal component analysis [23, 24]. Then the asset scores were used to generate wealth quintiles (five categories). BPCR practices among women and couples were considered as the main explanatory factors. Birth in presence of a skilled birth attendant was considered to be the primary outcome of interest. Regarding BPCR practices, the following five components were included in the analysis as per the Bangladesh Maternal Health Strategy: identifying the place of birth, identifying a birth attendant, arranging transport, saving money for emergencies and identifying a potential blood donor. Couple preparedness for individual components of BPCR was considered when both the women and her husband/partner reporting to be prepared for that component. Complete BPCR was defined as having planned for 3–5 components of BPCR. We have also presented the completeness for 4–5 components and for all 5 components. Good BPCR practices were defined as the following: planning to give birth in a health facility or at home with a skilled birth attendant, discussing BPCR components with a health care provider and discussing BPCR components with the spouse. Regarding the primary outcome of interest, birth was considered to be in the presence of a skilled birth attendant if it occurred in a health facility or if a skilled birth attendant was present during a home birth (which is recognized as a legitimate option by the Ministry of Health and Family Welfare (MOHFW).Birth Preparedness And Complication Readiness Among Couples Essay We used descriptive statistics (both univariate and bivariate) to describe BPCR practices among women and couples. Proportion test (z test) was conducted to see the statistically significant difference of BPCR practice between women and couples. The associations between individual components of BPCR practice and birth in the presence of a skilled birth attendant were assessed using multiple logistic regressions after adjusting for known confounders (women age, women’s educations, husband’s education, religion, wealth quintile) when they have showed significant associations in bivariate analysis (S2 Table). Any significant association is reported at p-value<0.05.Birth Preparedness And Complication Readiness Among Couples Essay Ethical approval and consent to participate Ethical approval to conduct the study was obtained from the Institutional Review Board of icddr,b (Protocol Number: PR 14024). All participants interviewed in our survey were married and had a birth outcome in twelve months preceding the survey. As per the IRB recommendations, any married woman with a child can give consent for interviews in the Bangladeshi context (irrespective of age). Moreover, in the Bangladeshi context women move to their husbands’ residents (home) after marriage. Parents are not considered as the guardian of women after marriage irrespective of their age. In addition, husbands were informed regarding the interviews. Prior to interviews, participants were informed of the voluntary nature of their participation and their right to withdraw at any time during the study. They were also informed that refusal to participate in the study would not involve any penalty. Written and informed consent was obtained from each participant once they were fully informed. Privacy, anonymity and confidentiality of the participants were strictly maintained during data collection and analysis.Birth Preparedness And Complication Readiness Among Couples Essay Every pregnancy faces risks and every minute of every day, somewhere in the world, a woman dies as a result of complications arising during pregnancy and childbirth. The majority of these deaths are avoidable by accessing quality maternal health service [1, 2]. Globally, in year 2010, an estimated 287 000 maternal deaths occurred. Sub-Saharan Africa and Southern Asia accounted for 85% of the global burden (245,000 maternal deaths). Maternal mortality in developing regions was 15 times higher than in developed regions. Most of them died because they had no access to skilled routine and emergency care [3].Birth Preparedness And Complication Readiness Among Couples Essay Ethiopia as a sub-Saharan African country is characterized by very high maternal mortality, 676 maternal deaths per 100,000 live births, low coverage of ANC (34%), and low coverage of skilled delivery and immediate postpartum care (10% and 7%, resp.) [4]. About fifteen percent of pregnant women in Ethiopia are estimated to develop obstetric complications which are potentially life-threatening. An estimated 2.6 million births occur each year. Direct complication accounts for 85% of the deaths as well as many acute and chronic illnesses [5]. Maternal deaths in Ethiopia account for 30 percent of all deaths in women age 15–49 [4].Birth Preparedness And Complication Readiness Among Couples Essay Reduction of maternal mortality is a global priority and it is one of the millennium development goals [6]. The key to reducing maternal mortality ratio and improving maternal health is increasing attendance by skilled health personnel throughout pregnancy and delivery [7]. Birth preparedness and complication readiness is one of keys for safe motherhood strategy whose objective is to promote the timely use of skilled maternal and neonatal care during childbirth by making a birth plan and promoting active preparation and decision making for delivery of pregnant women and their families [8–11].Birth Preparedness And Complication Readiness Among Couples Essay In Ethiopia little has been documented on BPCR practice and most studies done on safe motherhood focus on service uptake, quality, and utilization. Therefore, this paper is designed to evaluate BPCR practice and associated factors among pregnant women with second and third trimester in South Wollo of Northwest Ethiopia. This study will contribute to provide evidence based knowledge on the current status of BPCR among pregnant women and provide basic data for service providers, policy makers, development partners, and programmers to design effective BPCR program intervention in an attempt to reduce highly maternal and neonatal mortality rate in Ethiopia.Birth Preparedness And Complication Readiness Among Couples Essay 2. Methods 2.1. Ethical Considerations Ethical clearance was obtained from Bahir Dar University and GAMBY College of Medical Sciences. A formal letter for permission and support was taken from the Amhara Regional Health Bureau to South Wollo Zone Health Department and District Health Offices. Pregnant women were informed about the objective of the study and verbal informed consent was obtained before conducting the interview. Client’s privacy and confidentiality of the information was assured during the interview process. After data collected from each client, counseling and education on BPCR and key danger signs are provided for women and their families. Mothers who did not attend or discontinued the ANC services were referred to the nearby health center/hospital using a referral tool for ANC service. 2.2. Study Design and Period A community-based cross-sectional study was conducted among pregnant women of second and third trimester of pregnancy in South Wollo Zone, Northwest Ethiopia, from March 1 to April 30, 2014. South Wollo Zone is one of the ten zones of Amhara National Regional State located 480 KM away from the Regional Capital, Bahir Dar.Birth Preparedness And Complication Readiness Among Couples Essay 2.3. Sample Size Determination The sample size was determined using single population proportion formula. The following assumptions were considered: a level of confidence 95%, a 5% margin of error, and 50% proportion of pregnant mothers prepared for birth. Additional 10% allowance for none response rate and correction for multistage sampling design effect 2 were considered. The final sample size becomes 845 pregnant mothers. Then, the calculated sample size was proportionally allocated to districts of urban and rural Kebele (the smallest administrative unit in Ethiopia) based on the expected number of pregnant women. Each Kebele was selected using simple random sampling method and finally pregnant women were selected by systematic sampling using the updated list of pregnant women from each selected Kebele.Birth Preparedness And Complication Readiness Among Couples Essay 2.4. Inclusion Criteria Those women with at least 3 months of current pregnancy, permanent resident of the study area, and who gave oral consent to participate were interviewed. 2.5. Exclusion Criteria Women who were severely ill and incapable of being interviewed and those who were not able to give the oral consents to participate in the study were excluded. 2.6. Data Collection and Analysis Structured questionnaires were adapted from a survey tool developed by JHPIEGO Maternal, Neonatal Health Program and translated into local Amharic language. Training was given for data collectors and supervisors on how to maintain a face-to-face interview, keeping the quality of data and ethical issues. The collected data were checked, cleaned, coded, entered, and analyzed using a computer program of SPSS version 20.00. Bivariate and multivariate logistic regression analyses were done. Crude and adjusted odds ratio (OR) with a corresponding 95% CI (confidence interval) was calculated to determine relationships between predictor variables and practice of birth preparedness and complication readiness. Birth Preparedness And Complication Readiness Among Couples Essay Why we are the best 100% non-plagiarized papers Dedicated nursing and healthcare writers 24/7 /365 Service Affordable Prices Money-back and Privacy guarantee Unlimited revisions on request Satisfaction guarantee

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