BIRTH PREPAREDNESS AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINIC AT TAMALE TEACHING HOSPITAL

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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Item Type: Ghanaian Project Material  |  Attribute: 146 pages  |  Chapters: 1-5
Format: MS Word  |  Price: GH110 ($20)  |  Delivery: Within 30Mins.
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