ABSTRACT
Background:Birth preparedness and complication readiness (BP/CR) is a strategy to promote
the timely use of skilled maternal and neonatal care, especially during childbirth, based on the
theory that preparing for childbirth and being ready for complications reduces delays in
obtaining this care.
Objective: To assess knowledge and practice of birth preparedness and complication readiness
among women in Enugu Metropolis.
Method:A cross- sectional study was conducted to determine knowledge and practice of birth
preparedness and complication readiness among women bringing their babies for routine
immunization in ten selected health care facilities in Enugu metropolis by using a pretested
modified questionnaire in Enugu metropolis. Consecutive recruitment of consented mothers
was used and the sample size was 385.
Result: Data were obtained from 385 women, yielding a response rate of 100%.The proportion
of respondents considered knowledgeable on birth preparedness is 65.5% and those considered
to have practiced is 81.8%.When considering knowledge of the respondents using regression
model, secondary/tertiary education were a determinant of the respondents’ knowledge of birth
preparedness and complication readiness. (95%CI 3.546, 34.73). Also, respondents’ with 1 – 3
children were also a determinant of the knowledge of birth preparedness and complication
readiness (95%CI 1.142, 6.265).When considering practice of the respondents using regression
model, secondary/tertiary education were a determinant of the respondents’ practice of birth
preparedness and complication readiness (95%CI 2.505, 22.933). Also, women’s income were
a determinant of their practice of birth preparedness and complication readiness.Women
earning 31,000& above (95%CI 1.325, 349.044) were more likely to practice birth
preparedness and complication readiness than women with no income and those earning 30,000
and below.
Conclusion and recommendation: The study identified 65.5% knowledge and 81.8% practice
of birth preparedness and complication readiness in this study area.More community education
about birth preparation and its complication and also empowerment of women through
expansion of educational opportunities and skill acquisition are recommended for better
improvement on birth preparedness and consequently the effects of pregnancy related
complications.
CHAPTER ONE
INTRODUCTION
1.1 Background
Maternal mortality is a substantial burden in developing countries. World Health Organization
(WHO) estimated that 529,000 women die annually from maternal causes. Ninety-nine percent
of these deaths occur in the developing countries. The situation is most horrible for women in
Sub-Saharan Africa, where one in every 16 women dies of pregnancy related causes during her
lifetime, compared with only 1 in 2,800women in developed country.
Nigeria accounts for about 10% of all the maternal deaths globally, and has the second highest
mortality rate in the world, after India. It is also reported that, for every woman that dies from
pregnancy-related causes, 20-30 more will develop short and long term damage to their
reproductive organs resulting in disabilities such as obstetric fistula, pelvic inflammatory
disease, a ruptured uterus etc2. This high morbidity and mortality rates makes maternal health a
huge public health problem in the developing countries of the world, including Nigeria. For
example, the percentage of birth attended by skilled professionals range from high of 81.8% in
the South-east to a low of 9.8% in the North-west. Similarly, 90.1% of women in the North-
West are more likely to give birth at home compared to 22.5% in the South-west. Also, 22% of
the births are being attended by traditional birth attendants.
Also the most recent Nigerian National Demographic and Health survey (NDHS)3reported
maternal mortality ratio to be 545 / 100,000 live births. The data showed wide regional
disparity in maternal mortality ratios between the different geopolitical zones of the country.
The report showed that average maternal mortality ratio in northern Nigeria was 2420
(range:1060 – 4477) per 100,000 live births4,5,6,7, while similar data in the southern parts of the
country were considerably lower – between 454 and 772/100,000 live births8,9. There is
increasing evidence that this difference in maternal mortality between the northern and
southern parts of the country may be due to disparity in the accessibility and utilization of
health services, especially differences in the availability of skilled birth attendants between the
regions.Every pregnant woman faces the risk of sudden, unpredictable complications that could
end in death or injury to herself or to her infant. Pregnancy related complications cannot be
reliably predicted, hence, it is necessary to employ strategies to overcome such problems as
they arise.
Maternal mortality and morbidity are complex problems that require interventions10. Improving
maternal mortality has received recognition at a global level as evidenced by the inclusion of
reducing maternal mortality in the Millennium Development Goals. Since it is not possible to
predict which women will experience life -threatening obstetric complications that lead to
maternal mortality, receiving care from a skilled provider (doctor, nurse or midwife) during
childbirth has been identified as the single most important intervention in safe motherhood.
Birth preparedness and complication readiness (BP/CR) is a strategy to promote the timely use
of skilled maternal and neonatal care, especially during childbirth, based on the theory that
preparing for childbirth and being ready for complications reduces delays in obtaining this care.
Lack of advance planning for use of a skilled birth attendant for normal births, and particularly
inadequate preparation for rapid action in the event of obstetric complications, are well
documented factors contributing to delay in receiving skilled obstetric care. In a skilled care
approach, birth preparedness includes identifying a skilled provider and making the necessary
plans to receive skilled care for all births. Complication readiness (emergency funds, transport,
blood donor and designated decision-maker) receive greater emphasis in emergency obstetric
care programs. Birth preparedness has been globally endorsed as an essential component of
safe motherhood programs to reduce delays for care.
In many societies in the world, cultural beliefs and lack of awareness inhibit preparation in
advance for delivery and expected baby. Since no action is taken prior to the delivery, the
family tries to act only when labor begins. The majority of pregnant women and their families
do not know how to recognize the danger signs of complications. When complications occur,
the unprepared family will waste a great deal of time in recognizing the problem, getting
organized, getting money, finding transport and reaching the appropriate referral facility these
delays can cause maternal death.
For Some complications including; severe hemorrhage, a few hours matter to save life, while
for others hours or even days may be tolerable but with the prognosis getting worse as time
elapses.
Complication readiness is vital to survival. Complications need quick action. The interval from
onset to death for ante-partum and postpartum hemorrhage can be approximately 12 hours and
2 hours respectively. The hours required for making arrangements which should have been
made prior to the emergency, may define the line between survival and mortality10, 12. If the
woman and her family are well prepared for normal child birth as well as any possible maternal
or new born complications, the woman or baby are more likely to receive the skilled and timely
care needed to preserve health and ensure survival. Although most of the time focuses on what
the skilled provider, the woman, and her family can do to prepare for birth and possible
complications, birth preparedness or complication readiness is actually a community-wide
issue.
1.2Rationale and Justification of the Study
Maternal and infant mortality rates are unacceptably high in most developing countries.
Material mortality rate in Nigeria is 545/100.000 live births 3. Despite global efforts to reduce
maternal mortality ratio by 75% by the year 2015 (Millennium Development Goal-5, MDG-5),
it is worrisome that the maternal mortality rate remains high in Enugu State, southeast Nigeria.
Enugu state has a maternal mortality rate ranging from 772 and 998 per 100,000 women which
is high.Therefore, there is need to assess birth preparedness and complication readiness
among women in this study area.
1.3 General and Specific Objectives
General Objective
The study is to assess knowledge and practice of birth preparedness and complication readiness
among women in Enugu Metropolis.
Specific Objective
1. To assess the knowledge of the concept of birth preparedness and complication
readiness among women in Enugu metropolis.
2. To assess the practice of birth preparedness and complication readiness among the
women.
3. To identify factors associated with their knowledge and practice of birth preparedness
and complication readiness.
1.4 Research Questions.
· What is the knowledge of birth preparedness and complication readiness in this area?
· What plans are made for delivery?
· What factors affect the knowledge and practice of birth preparedness?