|Year : 2017 | Volume
| Issue : 1 | Page : 70-74
Birth preparedness and complication readiness among rural pregnant women: A cross-sectional study in Udupi, Southern India
Jayata Gurung1, Varalakshmi Chandrasekaran2, Sameer Phadnis1, VS Binu3
1 Department of Public Health, Manipal University, Manipal, Karnataka, India
2 Department of Community Medicine, MMMC Manipal University, Manipal, Karnataka, India
3 Department of Biostatistics, Manipal University, Manipal, Karnataka, India
|Date of Web Publication||25-Jul-2017|
Department of Community Medicine, MMMC Manipal University, Manipal, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: As per the WHO estimates in 2013, about 289,000 women died of complications related to pregnancy or childbirth. The present study aimed at assessing the status of birth preparedness (BP) and complication readiness (CR) among rural pregnant women and its correlates in coastal Karnataka in Southern India. Methods: This cross-sectional study was conducted in Udupi taluk. In all, 305 pregnant women in the second and third trimesters of pregnancy were interviewed. Two-stage cluster sampling was used to select 320 women. To achieve this sample size, of 16 clusters using simple random sampling, 20 pregnant women in the second and third trimesters were selected from each village with the help of lay health workers in the community. Results: Among 305 pregnant women, 157 pregnant women (51.47%) were prepared to face birth. The factors associated with preparedness were awareness about expected date of delivery (odds ratio [OR] = 2.48, 95% confidence interval [CI]: 1.15–5.35) and at least one danger sign during delivery (OR = 2.88, 95% CI: 1.28–6.51). The identification of skilled birth attendant and arrangement for transportation were high at 99% and 100%. However, only about 42.3% of the respondents had identified a health facility for an emergency. Conclusion: The low preparedness level may be due to inadequate maternal knowledge on BP/CR practices as a result of inadequate information being provided to pregnant women. This study places emphasis on the need to plan and implement training programs for the health-care providers (ASHA, auxiliary nurse midwife's, staff nurse) on the components of BP/CR.
Keywords: Antenatal, birth preparedness and complication readiness, skilled birth attendants
|How to cite this article:|
Gurung J, Chandrasekaran V, Phadnis S, Binu V S. Birth preparedness and complication readiness among rural pregnant women: A cross-sectional study in Udupi, Southern India. J Datta Meghe Inst Med Sci Univ 2017;12:70-4
|How to cite this URL:|
Gurung J, Chandrasekaran V, Phadnis S, Binu V S. Birth preparedness and complication readiness among rural pregnant women: A cross-sectional study in Udupi, Southern India. J Datta Meghe Inst Med Sci Univ [serial online] 2017 [cited 2019 Oct 18];12:70-4. Available from: http://www.journaldmims.com/text.asp?2017/12/1/70/211579
| Introduction|| |
Improving maternal health has gained focus mostly in the resource-poor countries. According to the WHO estimates in 2013, about 289,000 women died of complications related to pregnancy or childbirth. The maternal mortality ratio (MMR) in 2013 in developing countries was higher compared to developed countries at 230 per 100,000 live births versus 16/100,000 live births. Thaddeus and Maine (1994) have provided the explanatory model known as Three Delays Model to explain delays in seeking effective maternal healthcare which includes delays in seeking, reaching, and obtaining care leading to maternal death. Birth preparedness and complication readiness (BP/CR) is a strategy that promotes safe delivery by emphasizing on the timely use of the neonatal and maternal services, enabling the mother to be ready to face the complications and reducing the delays in seeking care. Promotion of BP/CR increases the care-seeking behavior among the mothers, increases their knowledge on danger signs, and also improves the preventive behavior as evidenced by the studies conducted in Nepal, Burkina Faso and India.,, Although in India, the MMR has decreased from 254/100,000 live births in 2004–2006 to 178/100,000 live births in 2010–2012 the country is yet to achieve the Millennium Development Goal no. 5 target, i.e. 75% reduction in the MMR in 2015 as compared with the rate in the 1990s. However, in India, the rate of reduction in MMR is only 3.1% from 523 in 1990 to 212/100,000 live births in 2007–2009.
The percentage of women reporting any type of pregnancy complication was 46.7% in District Level Household and Facility Survey (DLHS-4) as compared to 47.9% in DLHS-3 which is insubstantial., A study conducted by PS R, et al. revealed that the maternal near-miss events were seen more among the women in the third trimester in Udupi when they are expected to be prepared for safe delivery during the last month of pregnancy. Hence, the present study aims to understand the status of BP/CR among the pregnant women in the rural areas in Udupi taluk and also to identify the factors associated with BP/CR. The findings of the study can provide valuable information in improving the maternal and neonatal health in the area.
| Methods|| |
The present study was designed as a cross-sectional study. It was conducted in villages of Udupi taluk in Karnataka, a Southern state in India, between January 2015 and April 2015. Pregnant women who were in the second and third trimesters were included while those women who were not currently pregnant, pregnant women who were mentally ill and unable to give consent were excluded from the study.
Ethics, consent, and permissions
Ethical approval was obtained from the Institutional Ethics Committee at Kasturba Medical College, Manipal, IEC-28/2015. Following written informed consent was obtained from all participants.
Sample size (n) was calculated based on prior 40% prevalence of BP/CR from prior studies which was available for mothers who had already delivered at around 47.8% with relative precision of 20%, confidence interval (CI) of 95%, design effect of 2 and nonresponse rate of 10%. The final sample size was 320.
Two-stage cluster sampling was used to select the study sample. List of villages with total number of households under Udupi taluk was obtained. As per the 2011 census, there were a total of 86 villages in Udupi taluk. An assumption was made that in a village with a minimum of 500 households about 20 pregnant women may be present in the second and third trimesters. Villages having lesser number of households were combined with the nearby village to increase the number of households. To achieve the sample size, 16 clusters were selected using simple random sampling. To achieve the sample size, 16 clusters were selected using simple random sampling and 20 pregnant women in second and third trimester were selected from each village with the help of Accredited Social Health Activists (ASHA) from the primary health centers and Anganwadi workers who are lay health workers in the community.
A pretested semi-structured interview questionnaire was used to collect the data from the pregnant women in their local language (Kannada). The pretested questionnaire elicited information about sociodemographic characteristics of the respondents, pregnancy characteristics including data on whether the pregnant women followed the five basic BP/CR practices with questions on having (i) identified a skilled birth attendant, (ii) identified a health facility in case of emergencies, (iii) identified a potential blood donor, (iv) arranged for transport, and (v) saved money for emergencies.
The data were analyzed using SPSS version 15 (SPSS Inc., Chicago, IL). The data were coded, entered, and checked for completeness. Descriptive frequencies were computed. Pregnant women who answered in the affirmative for least three out of five BP/CR steps were considered “prepared” and the remaining pregnant women were considered “not prepared.” Multiple logistic regression was done to glean factors associated with BP/CR.
| Results|| |
Of the 320 pregnant women sampled, 305 pregnant women consented to participate with a response rate of 95.3%. The mean age and standard deviation of the age of respondents was 26 ± 3.4 years. All women were currently married. The study sample predominantly consisted of Hindus (63.6%) and was mostly homemakers with respect to occupation (97.4%). Most women (62.3%) had attained the secondary level of education. The mean family size of the respondents was 6.8 with a standard deviation of ± 2.4. Total family income of the majority of respondents (59%) was between INR 13,000–19,000/month [Table 1].
|Table 1: Sociodemographic and obstetric characteristics among the pregnant women in Udupi taluk, Karnataka (n=305)|
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It was found that with respect to the pregnancy status, majority of the respondents were in the 3rd trimester (57%). More than half of the respondents (53.1%) had already given birth to two or more children. Only seven (2.3%) respondents reported a history of pregnancy complication. Almost all respondents had registered their current pregnancy at a health facility. About three-quarters of the respondents (74.4%) were aware of the expected date of delivery. Respondents had mostly (58.7%) visited the health facility more than five times for antenatal check-ups. The majority of the respondents (74.4%) had received two doses of TT injections and had largely (89.2%) received the iron and folic acid tablets (IFA) from the health facilities with 68% of the women having consumed IFA tablets for 100 days.
Of the total sample, most (89.2%) of the respondents had identified a person to accompany them to the health facility for delivery. Of the sampled women, most of them (79.3%) were aware regarding the Janani Suraksha Yojana, a Government of India initiative promoting institutional deliveries by providing financial incentives to pregnant women. It was reported by the respondents that the health information most frequently given by the health workers was about access to health services like antenatal care (65.2%) followed by delivery services (64.3%). About 54.4% of respondents received information about diet during pregnancy from the health workers whereas a miniscule proportion of respondents (0.7%) had received information about the need to make arrangements for transport in case of a health emergency arising either during pregnancy or to access the delivery services and also regarding the need to arrange funds for delivery.
Awareness of at least one danger sign during pregnancy, delivery, and newborn danger signs was present among 51.1%, 28%, and 32%, respectively [Table 1]. In this study, a large proportion (99%) of the respondents reported that they intended to give birth in a health facility and had identified a skilled birth attendant for delivery.
The study participants were assessed about the different elements of BP/CR, specifically 42.3% of them had identified the health facility for obstetric emergency. Most of respondents (65.11%) had identified private health providers for delivery followed by government health facilities (34.8%).
Although 64% of respondents felt that blood transfusion might be required during pregnancy or childbirth, their preparation was surprisingly very low as reflected by only 1% of the respondents having identified potential blood donor. Transportation was the only preparedness variable which all women had universally prepared for. In the present study, only about 80 (26.2%) women had put aside finances specifically to deal with emergencies or for the delivery itself.
It was found with respect to BP/CR that about half of the respondents (51.47%) were found to be prepared and 148 women (49%) were not prepared for birth and complications [Table 2].
|Table 2: Birth preparedness and complication readiness among the pregnant women in Udupi taluk (n=305)|
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The comparison between study participants with respect to BP/CR revealed that the prepared pregnant women were higher in age, had higher parity, had knowledge of danger signs during pregnancy, delivery and among newborns and were aware about government incentives for safe delivery. The multiple logistic regression model showed that statistical significance for being prepared were awareness about expected date of delivery (odds ratio [OR] = 2.4 95% CI; 1.15–5.35) and awareness about at least one danger signs during delivery (OR = 2.8 95% CI; 1.28–6.51) [Table 3].
|Table 3: Selected characteristics of pregnant women who were not prepared versus prepared (n=305)|
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| Discussion|| |
The present study found out that only about half of the respondents 157 (51.47%) seemed to be prepared for BP/CR in the study area. Awareness about expected date of delivery and awareness of at least one danger signs during delivery were the independent predictors for BP/CR in the present study. The prevalence of BP/CR in the present study is higher than that reported by Hailu and Berhe  in Southern Ethiopia, Kushwah et al. in India, Kabakyenga et al. in Uganda but lower than reported by Karkee et al. in Nepal. In this study, respondents made prior arrangements mostly for identification of skilled birth attendants and transportation while few made arrangements for identification of health facilities for any health emergency that pregnant women might face or blood donors.
The respondents who were aware of their expected of delivery were found to be more prepared than the ones who seemed to be unaware of their delivery date. It can be due to the fact that respondent's prior knowledge of their delivery date may lead them to be better prepared in advance to avoid any complications. The study also showed that the preparation for birth and CR was seen to be higher among the respondents who were aware of at least one danger sign during delivery. Prior knowledge about the danger signs is very useful as it can lead to desirable health seeking behavior among the pregnant women which will lead them to access treatment on time. Hence, IEC activities on the danger signs of pregnancy need to be strengthened in the rural areas through posters, videos, role play, etc., as the pregnant women in the rural areas are deprived of many facilities as compared to the urban areas.
About 99% of the respondents in the present study had identified the skilled birth attendant and plans to deliver in the health facility. Similarly, majority of the respondents have identified the skilled birth attendants during pregnancy in the previous studies.,
Knowledge about obstetric danger signs is very essential to prevent maternal deaths. Although about 51.1% of the respondents seemed to be aware of at least one danger signs during pregnancy less than half of the respondents were aware of at least one danger signs during childbirth and newborn danger signs, i.e., 28%, 32%, respectively. Severe bleeding from the vagina was the most common danger signs that the majority of the respondents were aware of. A similar response was obtained in the previous studies., In newborn danger signs, the awareness of difficulty in/fast breathing was highest (24.3%). A previous study conducted by Lliyasu et al., (2010) in Nigeria found difficulty/or fast breathing (49.7%) was identified as a key danger sign by the mothers.
Deliveries conducted by skilled birth attendants seemed to be high in the present study area. The present study also revealed that about 99% of the respondents had identified skilled birth attendant for childbirth. This is more than the findings of the study done in other parts of India such as Madhya Pradesh (69.6%). Identification of the health facility for obstetric emergencies was found to be low at 42.3% as compared to 63.8% in Rewa district of Madhya Pradesh. It can be due prior inexperience with complications leading to lack of interest in identifying the health facility for any obstetric emergencies. Hence, health education regarding the type of services being provided at each level of health care should be imparted to the pregnant women to save their lives during the emergencies. Arrangement for blood donor seemed to be very low in the study population (1%) although 64% of the respondents felt that blood transfusions might be needed during pregnancy or childbirth, their preparation level was low. This can be due to lack of sufficient knowledge regarding the complications of blood loss during pregnancy or delivery time and also because of their experience of pregnancy/delivery which did not require blood transfusion. The identification of potential blood donors was found to be low in the previous studies too., Preparedness for transportation was found to be 100%. This is higher than the findings reported by Agarwal et al. (29.5%) and Mazumdar et al. (70.4%). This could be due to the higher literacy rate in this population. In this study, only 26.2% of the respondents had saved money for delivery and emergency. This is less than the findings of Kushwah et al. Agarwal et al. and Karkee et al. 92.2%. The reason cited for not saving extra money was help obtained from parents, relatives during emergencies, free delivery services in the government hospitals and not feeling the need save money for pregnancy as it can be utilized for other purposes.
| Conclusion|| |
The low preparedness level may be due to inadequate maternal knowledge on BP/CR practices as a result of inadequate information being provided to pregnant women.
This study places emphasis on the need to plan and implement training programs for the health-care providers (ASHA, auxiliary nurse midwife's, staff nurse) on the components of BP/CR so that they can further impart knowledge to the pregnant women. IEC activities also need to be strengthened at the community level to create awareness regarding obstetric complications.
The authors declare that they have no competing interests.
The authors would like to acknowledge the support of the ASHA and Anganwadi workers, data collector, and study participants who participated in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Thaddeus S, Maine D. Too far to walk: Maternal mortality in context. Soc Sci Med 1994;38:1091-110.
Maternal and Neonatal Health Programme. Birth preparedness and complication readiness: A matrix of shared responsibilities. 1st
ed. Baltimore, MD: JHPIEGO; 2004. p. 1-6.
Moran AC, Sangli G, Dineen R, Rawlins B, Yaméogo M, Baya B. Birth-preparedness for maternal health: Findings from Koupéla district, Burkina Faso. J Health Popul Nutr 2006;24:489-97.
McPherson RA, Khadka N, Moore JM, Sharma M. Are birth-preparedness programmes effective? Results from a field trial in Siraha district, Nepal. J Health Popul Nutr 2006;24:479-88.
Fullerton JT, Killian R, Gass PM. Outcomes of a community- and home-based intervention for safe motherhood and newborn care. Health Care Women Int 2005;26:561-76.
Nath A. India's Progress Toward Achieving the Millennium Development Goals. Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive & Social Medicine. 2011;36:85-92.
Rai SK, Anand K, Misra P, Kant S, Upadhyay RP. Public health approach to address maternal mortality. Indian J Public Health 2012;56:196-203.
] [Full text]
International Institute for Population Sciences (IIPS), District Level Household and Facility Survey (DLHS-3), India. Mumbai: IIPS. 2010; 2007-08:.
International Institute for Population Sciences (IIPS), District Level Household and Facility Survey (DLHS-4), India: 2014. 2012-13.
Ps R, Verma S, Rai L, Kumar P, Pai MV, Shetty J. “Near miss” Obstetric events and maternal deaths in a tertiary care hospital: an audit. Journal of Pregnancy 2013;1-5.
Hailu D, Berhe H. Knowledge about obstetric danger signs and associated factors among mothers in Tsegedie district, Tigray region, Ethiopia 2013: Community based cross sectional study. PLos One 2014;9:1-8.
Kushwah SS, Dubey D, Singh G, Shivdasani JP, Adhish V, Nandan D. Status of birth preparedness and complication readiness in Rewa district of Madhya Pradesh. Indian J Public Health 2009;53:128-32.
Kabakyenga JK, Östergren PO, Turyakira E, Pettersson KO. Knowledge of obstetric danger signs and birth preparedness practices among women in rural Uganda. Reprod Health 2011;8:33.
Karkee R, Lee AH, Binns CW. Birth preparedness and skilled attendance at birth in Nepal: Implications for achieving millennium development goal 5. Midwifery 2013;29:1206-10.
Agarwal S, Sethi V, Srivastava K, Jha PK, Baqui AH. Birth Preparedness and Complication Readiness among Slum Women in Indore City, India. Journal of Health, Population, and Nutrition. 2010;28:383-91.
Lliyasu Z, Abubakar SI, Galadanci SH, Aliyu HM. Birth preparedness and complication readiness and fathers participation in maternity care in a northern Nigerian community. African Journal of Reproductive Health 2010;14:21-32.
Mazumdar R, Mukhopadhyay KD, Kole S, Malik D, Sinhababu A. Status of birth preparedness and complication readiness in a rural community: A study from West Bengal, India. Al Ameen J Med Sci 2014;7:52-7.
[Table 1], [Table 2], [Table 3]