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ORIGINAL ARTICLE
Year : 2018  |  Volume : 11  |  Issue : 3  |  Page : 254-259

A cross-sectional study on knowledge and practices regarding birth preparedness and complication readiness among pregnant women attending antenatal clinic at KLE'S Dr. Prabhakar Kore Hospital and Medical Research Center, Belagavi


1 Department of Hospital Administration, J. N. Medical College, KLE Academy of Higher Education and Research (Deemed to be University), Belagavi, Karnataka, India
2 Department of Community Medicine, J. N. Medical College, KLE Academy of Higher Education and Research (Deemed to be University), Belagavi, Karnataka, India

Date of Web Publication25-Sep-2018

Correspondence Address:
M S Shivaswamy
Department of Community Medicine, J. N. Medical College, KLE Academy of Higher Education and Research (Deemed to be University), Belagavi - 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_49_18

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  Abstract 


OBJECTIVE: The objective is to assess the level of knowledge and practices regarding birth preparedness and complication readiness (BP and CR) among pregnant women.
MATERIALS AND METHODS: The study was carried out in 2400-bedded tertiary care teaching hospital, Belagavi, over a period of 3 months from September to November 2017. A total of 384 pregnant women attending the antenatal clinic at the tertiary care teaching hospital were included in the study by purposive sampling. A descriptive approach was adopted, including collection of information from the pregnant women through a pretested and structured interview questionnaire and the data were analyzed using descriptive and inferential statistics.
RESULTS: In this study among 384 pregnant women, there were 233 (60.7%) of respondents primigravida, nearly half of the pregnant women, i.e., 191 (49.7%) were between the age of 15 and 20 years, the majority of the women, i.e., 272 (70.8%) had visited the antenatal clinic around 5–10 times. Two hundred and forty-five (63.8%) of the respondents had their secondary education, the majority of women 278 (72.4%) belonged to rural area. In the level of knowledge about BP and CR, majority of the respondents, i.e., 296 (77.1%) had moderate level of knowledge and 66 (17.2%) women had poor level of knowledge and only 22 of the women (5.7%) had good level of knowledge. In the level of practice about BP and CR, there were 291 (75.8%) had a thorough awareness about the practices and <25%, i.e., 93 of the respondents (24.2%) had moderate level of knowledge regarding the practice.
CONCLUSION: The present study concluded that three-fourth pregnant women attending antenatal clinic in a tertiary care teaching hospital had average knowledge regarding BP and CR was found to be average (77.1%), whereas in practice, three-fourth of them had good practice (75.8%). Hence, there is a need to retrain health-care workers about BP and CR to educate women in early pregnancy.

Keywords: Antenatal clinic, birth preparedness and complication readiness, knowledge and practice, pregnant women


How to cite this article:
Padaguggari IF, Shivaswamy M S, Chougule SB. A cross-sectional study on knowledge and practices regarding birth preparedness and complication readiness among pregnant women attending antenatal clinic at KLE'S Dr. Prabhakar Kore Hospital and Medical Research Center, Belagavi. Indian J Health Sci Biomed Res 2018;11:254-9

How to cite this URL:
Padaguggari IF, Shivaswamy M S, Chougule SB. A cross-sectional study on knowledge and practices regarding birth preparedness and complication readiness among pregnant women attending antenatal clinic at KLE'S Dr. Prabhakar Kore Hospital and Medical Research Center, Belagavi. Indian J Health Sci Biomed Res [serial online] 2018 [cited 2018 Dec 15];11:254-9. Available from: http://www.ijournalhs.org/text.asp?2018/11/3/254/242050




  Introduction Top


Pregnancy is the vital event of the life of a woman. It needs special attention from the time of conception to the postnatal stage. Pregnancy is a normal process that results in a series of both physiological and psychological changes in expectant mothers. Pregnancy is a natural, but it does not mean that it is nestle-free.[1]

Every pregnancy faces risks every minute of the day; a woman may die as a result of complications arising during pregnancy and childbirth.[2]

Pregnancy in women is a very sensitive period during which unexpected life-threatening complications may arise at any stage and many women die as a result of complication. Maximum maternal deaths occur during labor, delivery, or within 24 h of childbirth.[3] The World Health Organization estimates that 300 million women in the developing world suffer from short-term or long-term morbidities brought about by pregnancy and childbirth. The current maternal mortality ratio in India is 167/100,000 live births (2011–2013), whereas the country's millennium development goal in this respect is 109/100,000 live births by 2015. High levels of infant mortality (50/1000 births), neonatal mortality (29/1000 live births), and maternal mortality (167/100,000 live births), and lower levels of deliveries with skilled assistance (45%-NFHS-3) remain major public-health challenges in India.[3] The presence of skilled attendants at births and availability of emergency obstetric care have been shown to greatly reduce maternal deaths due to obstetric complications.[4]

Birth preparedness and complication readiness (BP and CR) is a strategy to promote the timely use of skilled maternal and neonatal care, especially during childbirth.[5] In a skilled care approach, BP includes identifying a skilled provider and making the necessary plans to receive skilled care for all births. CR (emergency funds, transport facility, identify blood donor, and designated decision-maker) receive greater emphasis in emergency obstetric care programs. BP 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 before 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 members will waste a great time in recognizing the problem, getting organized, getting money, finding transport, and reaching the appropriate referral facility.[6] BP and CR is the process of planning for normal birth and anticipating the action needed in the case of emergency. It is also a strategy to promote the utilization of skilled maternal and neonatal care timely, based on the assumption that preparing for childbirth and being ready for complications reduces delay in obtaining care. BP includes selecting birthplace, identifying skilled provider, and making the necessary plan to receive skilled care for normal birth and preparing for rapid action in the event of an obstetric emergency. An emergency plan should include identifying the nearest 24-h emergency obstetric care facility, means of transportation in emergency, suitable blood donors, source of emergency funds, designation of person to make decision on the women's behalf, and a person to care for her family while she is away.[7] BP and CR is a safe motherhood strategy which addresses delays that could increase the risk of dying in pregnancy, childbirth, and the immediate postpartum period.[8] Hence, the present study aims to assess the level of knowledge and practice BP and CR among pregnant women attending the antenatal clinic at Dr. Prabhakar Kore Hospital and Medical Research Center, Belagavi.

Objectives of the study

The objective of this study is to assess the level of knowledge and practices regarding BP and CR among pregnant women.


  Materials and Methods Top


A facility-based cross-sectional study approach was adopted this study, conducted in KLES Dr. Prabhakar Kore Hospital and Medical Research Center, Belagavi, which is a 2400-bedded super specialty teaching hospital. Data were collected for 3 months, i.e., from September 1, 2017 to November 31, 2017. A total of 384 pregnant women participated in the study. The purposive sample size was taken using formula n = z2 pq/d2 with precision = 5% and confidence = 95% z = 1.96 as P = 48.33, q = 100-p, and d = 5%. This calculation was taken from the previous study done in Ambala, Haryana.[5]

The knowledge questionnaire prepared by John Hopkins University's JHPIEGO/Maternal and Neonatal Health Program Monitoring was used. For the knowledge assessment pretested structured questions, a score of zero was given for incorrect answers and a score of one was given for correct answers. A knowledge score was calculated for each participant out of a potential score 10.[9]

For the practice of BP and CR assessment, pretested structured questionnaire was used, and for the score assessment, a score of 1 was given for correct practice and score of 0 was given for wrong practice. A practice was calculated for each participant out of a potential total score.[9]

The level of knowledge score was grouped into poor level (0–4), moderate level (5–6), and good level (≥7), and the level of practice score was grouped into poor level (0–5), moderate level (5–8), and good level (≥9) for all the study participants.

The study participants included all the pregnant women – 384 attending antenatal clinic as outpatients at KLE'S Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, during the study period. The study was approved by the Institutional Ethics Committee on human subjects Research of the medical college and written informed consent was obtained from all the study participants.

Statistical analysis

The collected data were entered into MS Excel sheet, the master sheet was prepared and data were analyzed using SPSS version 20.0 (IBM SPSS South Asia Pvt. Ltd., Bengaluru, Karnataka, India), frequency, percentage, mean, median, standard deviation and range were calculated.


  Results Top


In this study, among 384 pregnant women, 233 (60.7%) of respondents were primigravida. Nearly half of the pregnant women, i.e., 191 (49.7%) were between the age of 15 and 20 years, and the majority of the women, i.e., 272 (70.8%) had visited the antenatal clinic around 5–10 times. Two hundred and forty-five (63.8%) of the respondents had their secondary education, the majority of women, i.e., 278 (72.4%) belonged to rural area [Table 1].
Table 1: Distribution of the study participants according to sociodemographic variables (n=384)

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[Table No -2]: In this knowledge study most of the pregnant women had knowledge about basic care for newborn immediate after birth i.e. 262 (68.2%) and gestational diabetes pregnant women hospital is suitable for delivery i.e. 230 (59.9%), transportation provided through JSSK i.e. 223 (57.9%) and some of the participants had poor knowledge about Danger sign during pregnancy i.e. 285 (74.2%), unforeseen health problems occur during pregnancy endanger life of women i.e. 278 (72.4%) and term of birth preparedness i.e. 233 (60.7%), and Financial assistance through JSY 209 (54.4%).
Table 2: Percentage of correct response of pregnant women related to the item pertaining to knowledge on birth preparedness and complication readiness

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The present study shows that majority of the respondents, i.e., 296 (77.1%) had moderate level of knowledge and 66 (17.2%) women had poor level of knowledge and only 22 of the women (5.7%) had good knowledge regarding BP and CR [Table 3].
Table 3: Distribution of pregnant women according to their levels of knowledge on birth preparedness and complication readiness (maximum score=10)

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[Table no 4]: In the level of practice questions, majority of pregnant womens had good knowledge of practice regarding receive antenatal visits i.e 384 (100%), more number of participants had received injection TT i.e. 379 (98.4%), and most of pregnant women i.e. 378 (98.2%) had received folic acid and iron tablets regularly, most of 289 (75.1%) of pregnant womens had identified the birth place before delivery. Similarly Some of study participants had poor practice of prepared essential items for childbirth before delivery i.e. 230 (59.9%), identified blood donor before delivery i.e. 236 (61.5%).
Table 4: Percentage of correct responses of pregnant mothers related to the item pertaining to practice on birth preparedness and complication readiness (n=384)

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In the present study, 291 (75.8%) respondents had good score of practice and <25%, i.e., 93 of the respondents (24.2%) had moderate score of practices regarding BP and CR [Table 5].
Table 5: Frequency and percentage distribution of pregnant women level of practice regarding birth preparedness and complication readiness (maximum score=12)

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  Discussion Top


Findings related to sociodemographic variables of pregnant women [Table 1]

In this study, there were 233 (60.7%) of respondents primigravida, nearly half of the pregnant women, i.e., 191 (49.7%) were between the age of 15 and 20 years, the majority of the women, i.e., 272 (70.8%) had visited the antenatal clinic around 5–10 times. Two hundred and forty-five (63.8%) of respondents had secondary education, the majority of women, i.e., 278 (72.4%) belonged to rural areas.

The finding is similar to the study done by Mired Hiluf1 and Magana Fanta Hun on BP and CR in Ethiopia in 2006. Five hundred and thirty-four women were included in the study, yielding a response rate 99.3%. About 49% of the respondents were between the ages of 25 and 34 years with median age of 26 years. Majority (89.9%) of the women were married. Most (75.1%) of the respondents were homemakers. About 70% of the respondents had attended formal education.[6]

Findings related to correct response of pregnant women related to the item pertaining to knowledge on Birth preparedness and complication readiness

In this study, most of the pregnant women had knowledge about basic care for newborn immediate after birth i.e. 262 (68.2%) and gestational diabetes pregnant women hospital is suitable for delivery i.e. 230 (59.9%), transportation provided through Janani Shishu Suraksha Karyakrama i.e. 223 (57.9%), but some of the participants had poor knowledge about danger signs during pregnancy i.e. 285 (74.2%), unforeseen health problems occur during pregnancy endanger life of women i.e. 278 (72.4%) and term of birth preparedness i.e. 233 (60.7%), and financial assistance through JSY 209 (54.4%).

This study finding is supported by Rajib Saha, Aditya Prasad Sarkar, Indranil Saha, Raghunath Misra, Samir Dasgupta and Supantha Chatterjee conducted in rural area of West Bengal, India in 2013. Among 200 pregnant women, more than half of mothers i.e. 64.8% had heard about the Janani Surakha Yojana and 84.6% mothers had knowledge about the available financial assistance under the scheme. Only 24.8% mothers knew about the available transport facilities under Nischay Yan Yojana (financial assistance for transport during delivery or complication management).[10]

Findings related to knowledge among pregnant women regarding birth preparedness and complication readiness [Table 3]

In the present study, majority of the respondents, i.e., 296 (77.1%) had moderate level of knowledge (5–6) and 66 (17.2%) women had poor level of knowledge (0–4) and only 22 of the women (5.7%) had good level of knowledge (>7) regarding BP and CR. The reason could be that more than half of respondents visited the antenatal clinic for approximately 6–10 times. The mean knowledge score among 384 pregnant women was 4, median was 4, and mode was 4, range was 2–8, and standard deviation was 1.18, out of 10 questions. The reason could be that more than half of respondents visited antenatal clinic for approximately 6–10 times.

The finding is similar to a study done by Chetna Mehta and Poonam Sheoran, conducted in Civil Hospital Ambala, Haryana in 2014. More than half of the primigravida mothers (52%) had below average knowledge and majority of the primigravida mothers (99%) had good level of expressed practices [Table 3].[5]

Findings related to the items pertaining to practice on birth preparedness and complication readiness: [Table No-4]

In the level of practice questions, majority of pregnant womens had good knowledge of practice regarding receiving antenatal visit i.e. 384 (100%), more number of participants had received injection TT i.e. 379 (98.4%) and most of pregnant women i.e. 378 (98.2%) had received folic acid and iron tablets regularly, most of 289 (75.1%) of pregnant womens had identified the birth place before delivery. Similarly some of the study participants had poor practice of prepared essential items for childbirth before delivery i.e 230 (59.9%), identified blood donor before delivery i.e. 236 (61.5%).

This study finding is supported by Anukiranjit Kaur, Manpreet Kaur, and Rajwant Kaur, carried out among antenatal mothers residing in Amritsar, Punjab in 2014. Among 100 pregnant women, most of pregnant women i.e. 69% had made arranged for delivery and 88% of them registered the pregnancy. Though 90% of antenatal mothers had identified the place of delivery and 83% identified the skilled birth attendant, only 69% arranged for transportation and 73% had planned to have someone to look after her health during & after childbirth. Very few had arranged money for delivery (35%) and blood donor (10%) for obstetric emergencies.[1]

Findings related to practice among pregnant women regarding birth preparedness and complications readiness [Table No-5]

In the present study, 291 (75.8%) had a thorough aware about the practices and < 25%, i.e., 93 of the respondents (24.2%) had moderate level of knowledge regarding the practices, this is because large number of respondents paid around 6–10 times visits the antenatal clinic.

This study supported by Anaam Ebrahim El-Nagar and Manal Hassan Ahmed's study conducted at four antenatal clinics (MCH centers) in Tanta City, Egypt in 2012–2013, presented the distribution of the pregnant women according to their practices regarding danger signs of obstetric complications. Regarding practices performed by the women toward danger signs during current pregnancy, the majority of the women (95.7%) contacted with a doctor, while anticipated practices to overcome any aroused danger signs during labor and delivery and postpartum period will consult a doctor and went to hospital was mentioned by nearly half and more than one-third (42.3% and 36.2%) of the women, respectively [Table 5].[11]


  Conclusion Top


The current study found out that the overall level of knowledge of pregnant women attending the antenatal clinic of the tertiary care teaching hospital was moderate, with good level of practice about BP and CR. Hence, it is better if local health offices arrange community-based education and empowering women by expanding educational opportunities. Antenatal care clinics should give due importance to preparation for birth and its complication and provide information and education to all pregnant women.

Recommendations

For research

  1. Similar longitudinal study with larger sample size can be replicated for broader generalization
  2. Further studies are needed in this field to assess the effect of health education program on women's knowledge and practices regarding obstetric danger signs during pregnancy, labor, and postpartum period
  3. Qualitative study may be done using focus group discussions and in-depth interviews about the knowledge and practice of BP and CR in pregnant women.


Improving pregnant women's knowledge and practices regarding birth preparedness and complication readiness through administrative measures

  1. ASHA workers/Anganwadi Workers/Auxiliary Nurse Midwives should be trained to give awareness about BP and CR at home visits, anganwadi/PHC, CHC visits, and the pregnant women should be given health education starting at the time of registration of pregnancy in the first trimester
  2. Develop and disseminate correct information about BP\CR with regard to pregnant women, using pamphlets/handbills/posters, etc
  3. Regular orientation sessions should be planned for pregnant women at antenatal clinics in all the major referral hospitals.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kaur A, Kaur M, Kaur R. Birth Preparedness among Antenatal Mothers. Amritsar. Nursing and Midwifery Research Journal 2015;11:153-162. Available from: http://medind.nic.in/nad/t15/i4/nadt15i4p153.pdf. [Last accessed on 2017 Jan 03].  Back to cited text no. 1
    
2.
Bitew Yw, Awoke W, Chekol S. Birth Preparedness and Complication Readiness Practice and Associated Factors among Pregnant Women, Northwest Ethiopia: Hindawi Publishing Corporation International Scholarly Research Notices2016. p.1-8. Available from: https://www.hindawi.com/journals/isrn/2016/8727365/cta/ Article ID 8727365, http://dx.doi.org/10.1155/2016/8727365.pdf. [Last accessed on 2017 Jan 03].  Back to cited text no. 2
    
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Monika S. Patil, Vinod L. Vedpathak, Nandkeshav R. Aswar, Deepali S. Deo, Prashant L. Dahire. Birth preparedness and complication readiness among primigravida women attending tertiary care hospital in a rural area, International Journal of Community Medicine and Public Health, 2016;3:2297-2304. Available from: www.ijcmpj.com/index.php/ijcmph/article/download/456/421. [Last accessed on 2017 Jan 31]. (DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20162587).  Back to cited text no. 3
    
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Kabakyenga JK, Östergren PO, Turyakira E and Pettersson KO, Knowledge of obstetric danger signs and birth preparedness practices among women in rural Uganda, https://reproductive-healthjournal.biomedcentral.com/articles/10.1186/1742-4755-8-33. [Last accessed on 2017 Feb 06].  Back to cited text no. 4
    
5.
Mehta C. and Sheoran P. Assessment of birth preparedness in terms of knowledge and practices among primigravida mothers in selected hospitals of Ambala, Haryana. Int. J Health Sci. Res. 2016;6. Available from: http://www.ijhsr.org/IJHSR_Vol.6_Issue.4_April2016/41.pdf. [Last accessed on 2017 Feb 21].  Back to cited text no. 5
    
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Hiluf M, Fantahun M. Birth Preparedness and Complication Readiness among women in Adigrat town, north Ethiopia. Ethiop. J. Health Dev 2008;22:1-7. Available from: https://www.ajol.info/index.php/ejhd/article/view/10057. [Last accessed on 2017 Apr 24].  Back to cited text no. 6
    
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Henok A. Knowledge towards Birth Preparedness and Complication Readiness among mothers who attend Antenatal Care at Mizan Aman General Hospital, South West Ethiopia. Journal of Health, Medicine and Nursing, https://iiste.org/Journals/index.php/JHMN/article/view/24452. [Last accessed on 2017 Oct 04].  Back to cited text no. 7
    
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Kuteyi EA, Kuku JO, Lateef IC, Ogundipe JA, Mogbeyteren T, and Banjo MA. Journal of Community Medicine and Primary Health Care 2011;23:41-54. Available from: https://www.ajol.info/index.php/jcmphc/article/view/84664. [Last accessed on 2017 Oct 04].  Back to cited text no. 8
    
9.
JHPIEGO/Maternal and Neonatal Health Program. Monitoring Birth Preparedness and Complication Readiness: Tools and Indicators for Maternal and New Born Health. Baltimore: JHPIEGO; 2004. p. 1 338. Available from: http://www.jhpiego. org/files/BPCRtoolkit.pdf. [Last accessed on 2017 Jan 02].  Back to cited text no. 9
    
10.
Rajib Saha, Aditya Prasad Sarkar, Indranil Saha, Raghunath Misra, Samir Dasgupta, and Supantha Chatterjee, The status of birth preparedness and complication readiness among rural Indian mothers. International Journal of Public Health Research 2014;4:510-8. https://www.researchgate.net/publication/273060626_The_Status_of_Birth_Preparedness_and_Complication_Readiness_among_Rural_Indian_Mothers. [Last accessed on 2017 Nov 26].   Back to cited text no. 10
    
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El-Nagar AE, AhmedMH, El-Salam Belal GA. Knowledge and Practices of Pregnant Women regarding Danger Signs of Obstetric Complications. IOSR Journal of Nursing and Health Science 2017;6:Ver. VI. 30-41. http://www.iosrjournals.org/iosr-jnhs/papers/vol6-issue4/Version-2/F0604023740.pdf. [Last accessed on 2017 Oct 20].  Back to cited text no. 11
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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