COMPARATIVE ASSESSMENT OF BIRTH PREPAREDNESS AND COMPLICATION READINESS AMONG WOMEN IN RURAL AND URBAN AREAS OF LAGOS STATE

Abstract

Background:
The maternal mortality rate in sub-Saharan Africa remains the highest globally and Nigeria with just about 2% of the global population accounts for over 10% of the global maternal mortality. Birth preparedness and complication readiness (BPCR) which is the process of planning for birth and anticipating the actions needed in case of an emergency is a key determinant in the survival of a pregnant woman and her unborn child. In Nigeria, disparities often exist between rural and urban areas, with more maternal deaths occurring in the rural areas. This study thus set out to assess and compare the knowledge, attitude, practice and factors associated with birth preparedness and complication readiness among women in rural and urban areas in Lagos State.

Methodology:

The study was a comparative cross sectional study among 500 women of reproductive age in Surulere and Epe Local Government Areas (LGA) of Lagos State. A multi-staged sampling technique was used to select respondents for the study. A structured interviewer administered questionnaire adapted from the safe motherhood John Hopkins Program for International Education in Gynaecology and Obstetrics prototype questionnaire was used to collect data. Focus group discussions (FGD) were also used to collect data among women of reproductive age and their spouses in both Surulere and Epe LGAs. IBM SPSS Statistics Software package version 20 was used to analyse the questionnaires and a thematic framework analysis was used to analyse the FGDs

Results:

Majority of the respondents were married, of Yoruba ethnicity and had secondary level of education. More of the respondents in the rural area (93.2%) had good knowledge of birth preparedness and complication readiness compared with urban respondents (83.6%). A
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higher proportion of respondents in the urban area (26.8%) had positive attitude to birth preparedness and complication readiness compared with their peers in the rural area (24.8%). A higher proportion of urban respondents (49.6%) had good practice of BPCR compared with their rural peers (41.6%). Factors associated with practice of BPCR in rural and urban areas were good knowledge of BPCR, educational level, maternal monthly income and previous still birth. (p<0.05) However, after adjusting for confounders, significant predictors for practice of BPCR in the rural and urban areas were good knowledge of BPCR (AOR= 3.04; 95% CI: 1.61-5.75) and educational level (AOR=2.33 95% CI; 1.39-17.54). Maternal monthly income (p=0.518) and history of still birth (p=0.578) were not significant predictors of good practice of BPCR in the rural and urban areas. (p>0.05)

Conclusion:

Both rural and urban respondents had good knowledge of BPCR however knowledge of BPCR was significantly higher in the rural areas. Attitude towards BPCR was negative among both rural and urban respondents however positive attitude toward BPCR was higher in the urban area. Practice of BPCR was poor among both rural and urban respondents particularly in the area of identifying a blood donor however good practice of BPCR was higher in the urban area than in the rural area.

Recommendations:

It is important that urban populations should not be neglected in carrying out maternal health education interventions. Health care workers should educate pregnant women and their families on the need to identify potential blood donors and skilled health providers and encouraged to do so early in pregnancy. The government should train health workers in the area of service provision and introduce flexible payment schemes and community based health insurance for pregnant women to reduce out of pocket spending.

CHAPTER ONE

INTRODUCTION

BACKGROUND

A mother’s death is a tragedy like no other because no one should die during child birth- a natural physiologic process of giving life to another; and also because of the devastating effect a maternal death has on the new-born and the entire family at large.¹ The current maternal mortality ratio in Nigeria of 576 deaths per 100,000 live births infers that Nigeria is making very slow progress to meet the millennium development goal as regards maternal health.² This unacceptably high maternal mortality ratio should be a source of concern to every Nigerian as maternal mortality reduction has been described as a key developmental goal (MDG 5) and as a basic human right. ^3,4

Inadequacy or lack of birth preparedness and complication readiness (BPCR) is one of several factors contributing to the high levels of maternal deaths in the developing world.⁵ Focused Antenatal Care exposes pregnant women to counselling and education about their health and also provides an opportunity for preparing a birth preparedness and complication readiness plan and reviewing such a plan with a skilled birth attendant.^5,6  Given the strong positive association that exists between the level of care obtained during pregnancy and the use of safe delivery care, birth preparedness and complication readiness stands to contribute a great deal to maternal mortality reduction.⁶

Adequate birth preparedness and complication readiness (BPCR) is a key determinant in the survival of a pregnant woman and her unborn child.⁷ It is the process of planning for normal birth and anticipating the actions needed in case of an emergency. Birth preparedness programmes generally address the  ‘three delays’ to seeking obstetric health care;  firstly delay in recognition of a life threatening problem and thus seeking care, secondly, delay in reaching care, and thirdly, delay in receiving care at the health facility. These delays represent barriers that often result in avoidable maternal deaths.^8,9 Delays in seeking care are often caused by failure to recognize signs of complications or perceive the severity of illness, considerations of cost, and previous adverse experiences with the healthcare system. Delays in reaching care may be caused by the long distances from a woman’s home to a health facility, poor condition of roads, and absence of or inability to afford emergency transportation. Delays in receiving care may result from negative attitudes of healthcare providers, shortages of supplies and basic equipment, a lack of healthcare personnel, and poor skills of healthcare providers.¹⁰

Birth preparedness and Complication readiness (BPCR) therefore is an integral component of focused antenatal care which involves planning with key stakeholders such as health providers, pregnant women, their relatives and the community at large.¹¹ The objective of the BPCR strategy is to promote active preparation and decision making for delivery by pregnant women and their families, as every pregnant woman faces risk of sudden and unpredictable life threatening complications. The BPCR strategy includes knowing what danger signs are, planning for a birth attendant and birth location, arranging transportation, identifying a blood donor, and saving money in case of an obstetric complication.¹⁰ Birth preparedness and Complication readiness helps women reach professional health care when labour begins and reduces delays that can invariably result in preventable maternal deaths. Also women are able to identify potential problems or childbirth complications which help to reduce significantly both the first and second delays¹² For some maternal complications like severe haemorrhage, a few minutes matter to save life, while for others hours or days may be tolerable. But prognosis may be worse as more time passes by.¹³ Adequate birth preparedness and complication readiness (BPCR) planning could determine the survival of a pregnant woman and her unborn child.⁷

COMPARATIVE ASSESSMENT OF BIRTH PREPAREDNESS AND COMPLICATION READINESS AMONG WOMEN IN RURAL AND URBAN AREAS OF LAGOS STATE. GET MORE PUBLIC HEALTH PROJECT TOPICS AND MATERIALS