ABSTRACT
Evidence indicates that promoting birth preparedness and
pregnancy complications readiness have important roles in combating maternal
mortality. The purpose of the study was to assess birth preparedness and
determinants influencing facility-based deliveries among expectant mothers in
the Tamale Teaching Hospital, Ghana. The systematic random sampling technique
was then used to select pregnant women for the study using structured
questionnaires. Data quality was ensured via crosschecks and double entry of
information into the Statistical Package for Social Sciences (SPSS) software
version 20.01 for analysis. At the 95% confidence interval, a p-value less than
0.05 was deemed statistically significant. Out of the 345 respondents, 150
respondents were well prepared
for birth representing 43.7%. The χ2 analysis revealed that age
(p < 0.05), religion (p < 0.05), educational status (p < 0.01), level of
knowledge on obstetric risks (p < 0.01), number of antenatal visits
(p < 0.01), marital status (p < 0.05), income level of participants
(p < 0.01) and cost of services (p < 0.01) determined birth preparedness and
the choice of facility delivery among the study women. Strong determinants of
women’s choice of facility for delivery included: higher education (AOR=1.9,
95% C.I. 1.16-3.04, p=0.01), women with four plus (4+) ANC visits (AOR=5.4, 95%
C.I. 2.54-11.29, p < 0.01), women who disagreed to ‘home birthing tradition’
(AOR=2.4, 95% C.I. 1.18-4.85, p = 0.02). Proportion of women who were well
prepared for birth and ready for complications was still found to be low.
Education of expectant mothers on issues of antenatal care on birth preparedness
must be stepped up.
CHAPTER ONE
INTRODUCTION
Birth preparedness has been considered as a comprehensive
strategy aimed at promoting the timely utilization of skilled maternal health
careespecially during childbirth. It is based on the theory that preparing for
childbirth reduces delays in obtaining emergency obstetric care(Kaso &
Addisse, 2014b). Birth preparedness and complication readiness (BP/CR) is the
process of planning for normal birth and anticipating the actions needed in
case of an emergency(Agbodohu, 2013; Solnes et al., 2013). However, BP/CR
status and affecting factors have not been well studied. Thus, this study aimed
to fill the gaps by conducting a study among pregnant women. This introductory
chapter is organized to include: background to the study, thesis statement, and
purpose of the study, objectives, and research questions. It also highlights
the national significance of the study, and particularises the operational
definition of terms and abbreviations specific to this study.
Background to the Study
Adequate health care provision and utilisation for women
during pregnancy is essential to ensure the normal, healthy evolution of the
pregnancy and to prevent, detect, or predict potential complications during
pregnancy and/or delivery(Berrin., Okka., Yasemin.,&Durduran, 2016). Good
quality care must be provided by skilled health personnel who are well trained
and equipped to detect potential complications and provide the necessary
attention or referral(Karkee., Lee., & Binns, 2013). Unfortunately, many
women in developing countries of the world, including Ghana, face
increased risk of morbidity and mortality from pregnancy and other pregnancy
related issues(Moran et al., 2006). Worldwide, 800 women die every day due to
pregnancy or child birth related complications. Almost all maternal deaths
(99%) occur in developing countries and more than half of these deaths occur in
Sub- Saharan Africa (Sunnyvale, City, Musa, & Amano, 2016). In developing
countries, specifically Sub-Saharan countries, skilled care providers are not
always readily available. This is considered as one of the major factors
accountable for the current trends of maternal and child
mortality(Byford-Richardson et al., 2013; Moran et al., 2006).
In Ghana, 52% of childbirths were assisted by skilled
personnel in 2012(Adu-Gyamfi, 2012). This means that a significant number of
women give birth alone or are assisted by unskilled birth attendants such as
Traditional Birth Attendance (TBAs) and mother-in-laws. Ghana is one of the
countries with a very high maternal mortality rate, (319 per 100,000 live
births) and is striving hard to reducethe numbers in maternal mortality(World
Bank Report, 2015). For instance, The United Nations (UN) as well as the
international community has resolved through the 5th Millennium Development
Goal (MDG) to reduce the high maternal mortality ratio by three quarters by
2015; however, this goal was largely unachieved(WHO, 2015a). Cultural beliefs,
lack of awareness of availability of maternal health care utilities, and
crippling poverty inhibit preparation for safe delivery and the post-delivery
health guarantees of the mother and baby in advance(Byford-Richardson et al.,
2013). 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 wastes a great deal of time in recognizing the problem,
getting organized, getting money, finding transport, and reaching the
appropriate referral facility (Ekabua et al., 2011). This often results in
avoidable delays in obtaining life-saving emergency services that could prevent
maternaldeaths.
Birth preparedness is a comprehensive strategy to improve the
use of skilled providers at birth and the key interventions to decrease
maternal mortality(Tura, Afework, & Yalew, 2014). Birth preparedness and
complication readiness (BP/CR) strategies encourage women to be informed of the
danger signs of obstetric complications and emergencies, choose a preferred
birth place and attendant at birth, make advance arrangement with the attendant
at birth, arrange for transport to skilled care site in case of emergency, save
or arrange alternative funds for costs of skilled and emergency care, finda
companion to be with the woman at birth or to accompany her to emergency care,
and identify blood donors in order to facilitate swift decision-making and
reduce delays in reaching a care facility when a problem arises(Nawal &
Goli, 2013). Responsibilities for BP/CR mustbe shared among all safe motherhood
stakeholders, since coordinated effort is needed to reduce the delays that
contribute to maternal and newborn deaths.
According to Kaso and Addisse, (2014b) the major causes of
maternal deaths include postpartum haemorrhaging, hypertension, anaemia, unsafe
abortions, infections and obstructed labour. Although these are the easily and
most identifiable causes of maternal deaths, there are several other
determinants associated with maternal deaths. For
example, access to health care is oftenimpeded by delays: delays in deciding to
seek care, delays in reaching care, and delays in receiving care(Solneset al.,
2013). These delays also have many causes, including: logistic and finances,
unsupportive policies and gaps in services, as well as inadequate community and
family awareness and knowledge about obstetric complication issues.
Statement of Problem
Avoidable maternal morbidity and mortality remains a
formidable challenge in many developing countries like Ghana. Sub-Saharan
Africa (SSA) has been the region with the highest maternal death ratio
(Soubeiga et al., 2014). For example, in 2008, 358,000 maternal deaths occurred
worldwide. Ninety-nine percent of these deaths were in countries of the
developing world, of which 57% were in the SSA including Ghana(Otoo., Habib.,
& Ankomah, 2015). Current statistics on maternal mortality rates in Ghana reveal
that, 319 deaths occurred per 100,000 live births(World Bank Report, 2015). The
situation is even worse in the deprived regions of Ghana where women give birth
at home due to unforeseen militating factors which compel pregnant women to
depend on TBA, village midwives, members of the families or neighbours who
provide unskilled support (Agarwal, Sethi, Srivastava, Jha, & Baqui, 2010).
Ironically, performance review of Ghana Health Service annual reports for 2009,
2010 and 2011 indicated that Ghana’s antenatal coverage often exceeded 90%
(WHO, 2015a). Analysis on maternal health also indicated higher coverage in the
Northern Region, where maternal mortality rate has been increasing consistently
for the past three years (Galaa, 2010). Whereas antenatal coverage was as high
as 97.1% in the Region, skilled deliveries were low (31.2%) during the same
period (Adu-Gyamfi, 2012). It is therefore, apparent that there is a huge
disparity between attendance for antenatal services by expectant mothers and
patronage of skilled care during childbirth. It is difficult to tell why the
recorded high coverage antenatal care does not commensurate with patronage of
skilled professionals for childbirth. Evidence from developing countries like
Ethiopia, Bangladesh, and Burkina Faso showed that counselling given during
BP/CR is helpful in improving institutional deliver utilizations (Tura et al.,
2014). Similar studies conducted in Nepal, Burkina Faso and India also showed
that the BP/CR plan improves preventive behaviours and knowledge of mothers
about danger signs, and leads to improvement in care-seeking during obstetric
emergency (Tura et al., 2014; Agarwal et al., 2010 and WHO, 2015b).
Despite the fact that BP/CR is essential for further
improvement of maternal and child health little is known about the current
magnitude of BP/CR strategies and associated factors in Ghana especially in
Tamale. This study, therefore, aimed at filling this gap by assessing the
current status and factors associated with birth preparedness and complication
readiness among pregnant women attending antenatal clinic at the Tamale
Teaching Hospital.
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