Study aim
The overall aim of this study is to evaluate the effects of goal-oriented prenatal education on birth preparedness and complication readiness of pregnant women and institutional delivery in selected primary healthcare facilities in semi-urban areas of Ibadan, Nigeria.
Study design
A quasi-experimental two-group pre-post design was adopted for the study. Details of the study flow chart are as shown in figure 2.
Study setting
The two selected out of the six semi-urban (less city ) Local Government Areas are Oluyole and Akinyele local government areas (LGAs). They are classified as semi-urban (less city) LGAs of Ibadan the capital city of Oyo State, Nigeria. Oluyole LGA has 28 primary health care centers (PHCs). Adaramagbo and Odo-ona elewe PHCs are two PHCs with high client flow out of the 28 PHCs in Oluyole LGA. Similarly, Akinyele LGA has 13 Primary Health Care centers (PHCs). Ojoo and Moniya PHCs are two PHCs with the highest client flow out of the 13 PHCs in Akinyele LGA.
Sampling technique
A three-stage sampling technique was used for the study. The first stage involved simple random selection (through balloting) of two out of six semi-urban LGAs in Ibadan. Two selected LGAs were Oluyole and Akinyele LGAs. These two selected LGAs were randomized to intervention and control groups also through balloting. The second stage included drawing a list of all the primary healthcare centers (PHCs) in each local government, Ojoo and Moniya (out of 13) PHCs were purposively selected based on the high client flow from Akinyele LGA while Adaramagbo and Odo-ona elewe (out of 28) PHCs were randomly selected out of four PHCs with highest client flow from Oluyole LGA. At the third stage, all antenatal clinic attendees who met the inclusion criteria at each visit were purposively selected to participate in the study.
Sample size determination
The sample size was calculated according to the sample for proportions formula by Charan et al [12] with a 95% confidence level and 0.05 precision to yield a representative sample using the formula below:
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)
Where:
N – sample size
Zα – standard normal deviate corresponding to the null hypothesis = 1.96 (from Z table) at type 1 error of 5%
Zβ – standard normal deviate corresponding to the alternative hypothesis = 0.842 (from Z table) at 80% power
P1 – the proportion of practice of birth preparedness and complication readiness in previous study = 35% [14]
P2 - the proportion of practice of birth preparedness and complication readiness desired in current study = 50%
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oNizq/4kPke33IZANa75U99i/RP/MXn2b9yUWNP/fSKJ+9fcNsbs/iD1eOIx2j64xZ0R2m1dbo/czWiOOWD7P+9M2O8XXmW8ZHluNMvsrx3nXw/4iEI+wuaXzWsS6vjM+9N7rP8GXUd4lvvTH/2zX0eq+8lglIIEe22BnBqkmN7Myna+QTZ5JbF9ZcY5JstepDKxs9VXcrw/lMrsch13oco6vXh62MrVwzpudnKx/ZPfqjY2vMqD+Mwy76agzpyzFjkE3LtZzniF36qmz6jjjG/x5v7IVxrz9ja+y51uMXXb0+bGVs1ZcxK/Yju0d/bI7GROfMfh0bfTWGNm/08UI2LddyniO6W9n0tce9OmaxVd0zuV68uVa5RF/62DCutt7mkg/M3poY/dV2rsFn1MIOWVrGVD0ZO8oJhWD60Mf7UXEYXbFFPPGBjVUbW/TGv4yf5Sb6Wll09VorX2ViP0UKRzbJWy3+jWxmfPQjf0kL75Wxqz61uhh3iX8rXKvesGhzjT/R1eujP2Orvoxp4+nJR3aP/tjcGtPrx09sVn9zDb29hp74mf5c641pZTOmPY50jK4zfkX3ikx8mdkacd7SP+unj/Vmpc1869mYyffsIf/q62A4wuKSxk/7ZY3eGr91n+FL737a0runf/yJvEfLQDYTkECObLEzgpWk8qFefxxl9E1s5PF5r3ziTHJ7C+vK5is+9CZiT3fs1uNMLszqJiLXehyZ1PjEt6W91hu7x/4l+ns2q29b/WGcMZfmutUTfaMPjPTf+ph465yrNvbkg3HRd5b5sBJ/jfWR82HvnJrFdtQcyPxY3cDEj2wyGM9a2PvRrNH8uyQn8bPmNr5s3aOMjQxrX1sYRk97ZD1LnK3d6EN3bbMctvMhsq3u6Gvlc51jeOAfDR0rm5Ytm7GR+JC/pOH7KK5W36pPvXGX+Dfjmrjr53uutbnGn8yP0Y+89cbusX+J/p7Nym7Wn1xUrrf+XJ/FX/3MHMff2kbXkVnRHaY1x1V/fT+zNeK45cOsn766n6u+tO9nvvVszORb3fX8ldfBcITd3sZn4sqaHL2599r5nn58GfVF5trjoVVeJiCBHNlipweLD3/s15ssC0JvEc9mperaK0+sSW5vYcWX3qaE4jYTCPv43dto9XT3+M7kWAzRXzeCM47hwpheEZ4PjRrvHvuX6J/5C4+tfmLhVdslue7pQWdyiB/3aIm35qDa3ZMPxkVfvRei75J87bF/if6Zv/g9sz8a+6j5sHdOzWJLzrYYXLomUGT11gTWOPxqW9YK5hUvct1rt8rJSA82e/doXRPjF+swOel9ZkSmHUf8rPWMq3x6NtExy2E7HxIT13v8Wvn4mGN8wOfRF4SRzTE2uSdmLbp7uZ+NSx++o2Ol4T/ye20hv3cM/sy4Jtf1sz0sYNe2zCmeQPQanNsvMPbYv0T/zF98nPXDs83FrdfxWfyVYeZqO49G1xm7ojt/G2KUszqnZrZGHLd8mPXnsyp7yMqD93V9mvnWszGTn9mh71XXwXCE3Z7GfTv7nOnp2loH8aW9F3p6rrn27530NZo6Y7M5IZAjWyZ670OOpGC/3mDZzLQLNT6mr06AXFuVR09vYeWmQgf+8MFTv93iPf7ngyg2ka0bkaq7Lg49vvGBydm2LIp1IxKOo0mXD6deP30tn7329+rf8rfth21lCVtetYV7Gwsy6atzg+s9PVwffWBUe7d8n3jrB1rVvzcf0dfLN3r35muv/b36t/yN/fBhLuR+G41Nzu89H/bOqTa2mvf6PnKwbdsla0LmOHxgFZ6wZY2Da9uQQZ4YR3OLMbfOSZvDrLn4Uf3Ep3pefZl9yLf6GRfedd0Js9ioxx6TfIbRV1s2j72NLbK8ko86jvfYjEzuh1amPUdXxrR99TxF1areOjbFx2xeVPmwrJ+ltX/0Ht8u8S/x189NbJBf+tr7Kv4lx9WfxMq4tj99rY977EfHHv0zf/G97a9+4yu2Wp9vuY4n/sqx9x6/kMXf2kbXkVnRnfHItmsB523+kWvXhdG6s+LDzMfwR4b3maMc8avmJXG0fEY+tPKsBXVNq4zbeOmLb3XMaC61tqL7Pa2Dda0kntVGnto5lLGwqznMdY5hOVoHmRO9XFcd177/96fTtdrKeGBmc0IgoyDLkIvfZvJhh0Rgm8bmhondSw7XkOeDLzcdepDvFWl75LGf5LYf9HDAbu+Fv7XFJj4xifCPYzYRuR7/61je5wbGVhY+fMv11l6+3UBvTydjs1HAt3DOTd7mOHZW7e/Vv+VvPuCxjyw5ic91ztQFDm7hvjI3YJhcVj3YSZ5686nN1S3OExPce21vPrb47s3XXvt79W/5m3ma+6bem/GtfqEThveeD8kj86rOKe7JzLXcz/Exa22d4+mrx8SJnuiAc67vXRPwCZ7xqx7hNmqx164ZVT4y1+YEnVmPuafRCy9irdfDg2vEFBbwQZ5rvB81Ykc/+aPBBt/RV1tyhSxzFn9o6A5LZLjO2LqOcT3MuB555LjOK/rxh/eJo/rAe8Yg01vrW9mcR3edl+njWOcu+me86ri8zz266hd8t/IS3fUIkxGXKte+xy9e7WcD57xqvPXeGH0G4AP6iKHOm+i7xj5j9+hf8Tf5x786d7GV+YRMbTBBnjhX9g1Zb9v7vt4HuQeqnfp+tHbcQnd0EE/ub45t/vEnTOjbWneICZ28evFt9WMvnKMnx9a3xLDKuLIn77N7G5vYq/M5nGqORnPpDOtg5h8sRvd+ZcH75AS27St5Ha278J2tg/iBziPbIcVkBZnJnGMm2C2DygcYwEkcULEH4GwQevZYaJMk5JncvZs4Y1flE2s91riZELmRkKk3XmzlCEviQI4j/uUasdUPr4zJMXlgkm7Zq77mPePbhr3YRw7W6O9N8j32Y2dVf3ysx56/zAdkYBcfuanqON63Y1dy3dPDtcTd2kiMRx1zH7SxxF78etX5wNxKzjjm3mnzxHm9X+F3r/kQ/6pP5C25q9fjZ3st15P3eoyeW88B9K2uu/gDe+7JUVuJaSUn0c+9H7ZZR+njWrvucx7Z+MG1raILvfXzBB6sP5ln1Rdk0d1uNFjf04cPWbNG6yz9dW0nD9hDN+/beRwfOPL5wdg9Debo5ti2sGqPxLHVsnbtGUs+kCfOe7X4B7vkqZfn3GeRz7HnJ7HXHDKHRvuW6NmyX+2s6F/1l/mWuDN3R7mrPjAnsZGxo/mc+OqRce39SP9oXtWxeT/yca/uxMT8b2Np73NkV9edrfi2+uMXx5ZzuwaFST2ucEAPY4g761K1m/f0v+o6OJpncIPxqIVtzUn7Hqa9trIOomt0v/R0XnLtkGLyEkeuGZMEHg3rGh8fMZbJuzWJj/Tr0faPjO0Zdec+GC1aj87Ho+0/Y87u7ZM5uDfx57XH5oQ1Y29j3N4idK+NFXkKKoqSrSJ/RdeqTDZ4q/K3lnu0/VvHoz4JPJrAK6yDFpOLsyybaIvJfwN79Mbx0fb/TeP8Z7kP4N5rj87Ho+33mLzaNXPwahnvx8tawROESxpPJdiczJ5OXKJ37xj8Hz3B26trVf7Rxdyj7a9yUk4C74HAq6yDFpOLszGbaIvJfwN79Mbx0fb/TeP8Z7kP4N5rj87Ho+33mLzaNXPwahn/v3j5ETwKLwpA3vNtfO9HVVfpMBYdj2rEcs8fb02cjy7mHm0/HDxK4D0SeNV10GJycbZmg8Q3lff8kZdF9x4ixk2T38PgyPk926Pt3zPWZ7CVTYbH/h+3kotcnAPOAeeAc8A54Bx49TlwxJ713f/OZG9SUFy+cssTqpYN1+/RHm3/HjE+o40Z93YucO58eMYsHuPTbG4cY1Gtz0SAJ5L8fmHvj8Vc4yd67/l5yxPR2R/JuyaW2Vh+6qldQ+/5k1CPtj9jY58E3guBV1kH84CtrllHr1fvvph8L5NYPyUgAQlIQAISkIAEJCABCZyJgMXkmbJpLBKQgAQkIAEJSEACEpCABO5EwGLyTqA1IwEJSEACEpCABCQgAQlI4EwELCbPlE1jkYAEJCABCUhAAhKQgAQkcCcCFpN3Aq0ZCUhAAhKQgAQkIAEJSEACZyJgMXmmbBqLBCQgAQlIQAISkIAEJCCBOxGwmLwTaM1IQAISkIAE3hsB/mfw169ff/1bEf7UPP9ehPN7/+/i98ZNfyUgAQm8CgGLyVfJtHFKQAISkIAEdhCgYMz/p+T/lH369Omf/7f48eNHC8odLBWVgAQkcFYCFpNnzaxxSUACEpCABK4gwBNI/gF2fQr58+fPf55S0m+TgAQkIIHXJmAx+dr5N3oJSEACEpBAl8CoWPzjjz/+eULZHehFCUhAAhJ4GQIWky+TagOVgAQkIAEJ3IYAvz/JyyYBCUhAAq9NwE+C186/0UtAAhKQgAR2E6CQ5HcobRKQgAQk8NoELCZfO/9GLwEJSEACEthF4K+//vr1VJLfp7RJQAISkMBrE7CYfO38G70EJCABCUhgFwGKSP+a6y5kCktAAhI4LQGLydOm1sAkIAEJSEACtyWQfxfCX3W1SUACEpCABCwmnQMSkIAEJCABCSwR+PLly69/F7IkrJAEJCABCZyegMXk6VNsgBKQgAQkIIHrCXz//v1t9O9CrteuBglIQAISeI8ELCbfY9b0WQISkIAEJHBHAvxvSQvJOwLXlAQkIIF3QsBi8p0kSjclIAEJSEACjyBAIcmPt9okIAEJSEACLQGLyZaI5xKQgAQkIAEJ/CJAIcn/k+QP77SNaz6tbKl4LgEJSOC1CFhMvla+jVYCEpCABCSwRIBC8sOHD7+Kyc+fP7+1L/r4PUqbBCQgAQm8LgGLydfNvZFLQAISkIAEugR+/Pjxq5CkYJy9ek8suwq9KAEJSEACpyRgMXnKtBqUBCQgAQlIQAISkIAEJCCBYwlYTB7LV+0SkIAEJCABCUhAAhKQgAROScBi8pRpNSgJSEACEpCABCQgAQlIQALHErCYPJav2iUgAQlIQAISkIAEJCABCZySgMXkKdNqUBKQgAQkIAEJSEACEpCABI4lYDF5LF+1S0ACEpCABCQgAQlIQAISOCUBi8lTptWgJCABCUhAAhKQgAQkIAEJHEvAYvJYvmqXgAQkIAEJSEACEpCABCRwSgIWk6dMq0FJQAISkIAEJCABCUhAAhI4loDF5LF81S4BCUhAAhKQgAQkIAEJSOCUBCwmT5lWg5KABCQgAQlIQAISkIAEJHAsAYvJY/mqXQISkIAEJCABCUhAAhKQwCkJWEyeMq0GJQEJSEACEpCABCQgAQlI4FgCFpPH8lW7BCQgAQlIQAISkIAEJCCBUxKwmDxlWg1KAhKQgAQkIAEJSEACEpDAsQQsJo/lq3YJSEACEpCABCQgAQlIQAKnJGAxecq0GpQEJCABCUhAAhKQgAQkIIFjCVhMHstX7RKQgAQkIAEJSEACEpCABE5JwGLylGk1KAlIQAISkIAEJCABCUhAAscSsJg8lq/aJSABCUhAAhKQgAQkIAEJnJKAxeQp02pQEpCABCQgAQlIQAISkIAEjiVgMXksX7VLQAISkIAEJCABCUhAAhI4JQGLyVOm1aAkIAEJSEACEpCABCQgAQkcS8Bi8li+apeABCQgAQlIQAISkIAEJHBKAhaTp0yrQUlAAhKQgAQkIAEJSEACEjiWgMXksXzVLgEJSEACEpCABCQgAQlI4JQELCZPmVaDkoAEJCABCUhAAhKQgAQkcCwBi8lj+apdAhKQgAQkIAEJSEACEpDAKQlYTJ4yrQYlAQlIQAISkIAEJCABCUjgWAIWk8fyVbsEJCABCUhAAhKQgAQkIIFTErCYPGVaDUoCEpCABCQgAQlIQAISkMCxBCwmj+WrdglIQAISkIAEJCABCUhAAqckYDF5yrQalAQkIAEJSEACEpCABCQggWMJWEwey1ftEpCABCQgAQlIQAISkIAETknAYvKUaTUoCUhAAhKQgAQkIAEJSEACxxKwmDyWr9olIAEJSDzurZYAABWsSURBVEACEpCABCQgAQmckoDF5CnTalASkIAEJCABCUhAAhKQgASOJWAxeSxftUtAAhKQgAQkIAEJSEACEjglAYvJG6T177//fvv999/f/vrrrxtoU8UjCHz79u3tzz//fITpd2MTPszzV23c38wT7nebBCQgAQlIQAISkMDb282LyZ8/f759+PDhX68//vhjyJrNaSvP+b0bG+UvX77848vHjx+XNs6M+/z583CDmQ0oui9tMMIfuPz2229vX79+HdprbZAP5DP+lsXAjx8/3j59+vTLL/R///69Nb95Dh/8I64a32phDn/GjuKqPqIff7nWNgoE/JjNVcas6mv1b53fKo4tO/QTa3jDJK/ZHIULfEYt82yUh9G4revYxT/091q9N5AjBlhe0nprFzrrvGZecr9fauMSv7bGkE985B6ctdyryXd77I3PfZH5At/Ve3Pmi30SkIAEJCABCZyDwCFVGxsQNoHZgLBpmW2+kGeTgvxM7ijk2USymWKjyDEbrdkGG1+Rxf+2seFioxsG6L2ksQHklc00R3RyrWc3NsKUOLBNPm65CWTziu5stOPXrOCIbzniD7HUDSrXMhdW/M0GuVfEcA0fkYFBclH9ji8cYYYsrHptr76ejtG1W8YxspHriQMO9ZU5Frkc4TGav4zhaV309PIQPXuPmR/o7vmGT/RxzHvOyXNPfst+1ZF40NXeZ7nvH7FW1Rjwi/svcwefRw2WiWl0JI+1oZ/1Df2M5zxf/Dw69uqn7yUgAQlIQAISeByB8e7jBj7xFCcbFzZls+KAzR+buUe0XgGRYgn/e8VFNlq9vhpDGFwSWzb9LTds4tdIJ75lg5lir/o0ez/SWceQK+y3hWP87T35q+PzPhtT/K2N857+KsN7Nr/MK2TbIgZmMKhFBXqxiTyvlis62STT126WL9XX+tw7PyKOnh2uwWD0BUhvTHj0WFX5FJRtHqrM3vfkL/mteUQP90D9EoJryRH5I8Y9Df0rcz86ua/2cMy4I465X4h71MgPuUG2bXDrzXl4cL3mnvHkhNzYJCABCUhAAhKQwHj3cQM2bNDYcGVDyAakt5nB1N7N3A3c+6WCzfKo4Erh0dtkpgDY8iMbtZ6OrbFwG22Kud7bAMIXzvRtFbo9+4zbatlk9gouxo98bvWiZySLnhmz/LhpCti2iCGnrX+xH3btmPRjt90sX6MvenvHI+Po2SPmUdw9eTjMns5nTL7g2KM7Y3tH7i9emWttMUlfby3J/cb8acf07OQadvbIp6jCj2domdMjX0ZrHPL0tfchLGDYy33WxUvWl5F/XpeABCQgAQlI4H0S2K4croiLDQmbtDzdYHPCRqTXItvre9S1bKiIobZsWEexVFnebxVGrTznI9uRzYau3byz+cNeez3jto6MnbXEPpLLpnZUyFXdKRTaJ5ls1Gcx0I8dfCHOmWy1l/dbY9hco3N1s7ylL3bb49FxtPZq7pgnW/GlQNySw07m66XzrvqKrhTzmSNcW217xyROvrzhvlq1lXsNro9uifkSP2DdFsWj9QX94dUrNC+x7xgJSEACEpCABN4vgXnlcGVcbMrY5NCyAWGT3vuWvMpeafZmw/EJf9uNVoqHlU02zqAjHFadi+1sqttx8aHqzRg2xRQqlzR8nbXkceRXNrW9HLd6KSKxh7+VJZvUGlc7jr7Ih8OeIiZj2iI2dvLlx+pmeUtf9LbHo+No7aVAgHleFOXMm15LLleKpcy9PXno2UyBnS8j4sPIx56OjFm9B/IFSJhwRMdW3PnSYWWu9/y85bXEvFdnvmAI74wPk949klxz39okIAEJSEACEnhtAvPK4Uo2bDrY5KRRlGXD1m4OW9mMaY/ZyETPyrG11eocnadwasdTSGG3vT7Sg2zlMJKr12ucvU1xCpiqN8UCRRAb3PiZJy49PdUm7/F11np2q3w2tatFRXzGLu/xvS3eq370IpcWf1btMY7xWwU3/vBaYbaiL/7meK84Yi9H4mFuwRgGibMtGpBLX8bOjpmve/LQ08f8yRcF9Gc+rd5rjKEQqvdFz057jaIKBuQyccNnVlAm5tEXK7ERuehdOe6JFzvhFJurR9YJeLUtPvb8qPG04zyXgAQkIAEJSOC1CMwrhytZsOloN3XZ9LBRq9+G92SvNH/1cHztPZ3KRmul0MAJ5FsOK87l6UBvg55Nb/UvxQG2sglkM5yicmvTG19nvuHLLJ7kt/o100dfnvCgFx9HG3jmC/2Ve/zpMerZZSyctp4mhWU49nRxbVVfHX/POKrd9j2+J1/EW7kSd/LRjuudR341Dz0d5IR5XVv828pDxsSPurakb/XI2Nx72B815GDE69EtnPb6wf3U+/ImcfW4hzEy13De66vyEpCABCQgAQk8H4FDd0FsOtrNGBtWNjBsRGph0JN9JC78aTfY+FM3Uqv+EWvLYWUsT0qyqcvTGgotNuwpdrJ5rxvbdoOXggddKaKy+Yz+rWP8xx6yOW/jiN62KGjl6jmb2fqkjNh6MTBf2uvxJxyq3t575Ea+V/nEsaV3VV90Z/7fK47YnR1zP2ZuIEtcszy3+nJfbPFqx+UcHnU9yPXkAf0rDflLfaj6uc9yj7W5qnK5b1b9q2Nv+T6c9ugkRvzvxTeLK7lGZvTFzx4/lJWABCQgAQlI4P0SuHsxCSo2L9mo5QkWGxQ2RFutbmSy4dk6MmZPY8PPk4neuGp/VSf+rcTW04e9bPZhRpFWi8xsBLf8olhb8QOZWdsqMrKpXd3Qk/88GUmhhQ9tQYlcCurqX/xZsZd5h52tthLHHn2xd+84Ynd2zNypXwCE6+q8jY6VPLS+JO+Zy7U/eUD/VqMYXvV3Sxf9YdCbdxnPXOU18y9sIrtynOmL7XoMp3pt6z28ej/iyrj42POjxrNlw34JSEACEpCABM5NYF45XBk7m47R5q5uSNi0zWSvdGP38NGGH0XV71XFbMxGHFZ1VLlscqvOLb9SgNYxVWfe4+ussQGdxYN++utTrpG+xFGLuxQW1QZFBucrr1F80dsrWHr+JQ587LW9+tDxiDh6vveuUbwz79OSmxHPyOWY+TfiFX1tDrmeOdX29c5H+mHbe7IZ/y45Jl+zuRwfif+RLfN1jw/wyhc57bh82deLK7lGxiYBCUhAAhKQwGsTmFcOV7Jh0zHbjPKNfzZjbGpmsle6sjycpzOzJxHZSOH3akP2VrHNfvwuLHs/eha/t/zYiisb7NFGMptQ5LYasj1/KNTyO2voQBdyvVfkONLf2xyjj74Vn+Iz8rDoFS+X6HtUHIln6wi/WjSl+IPDSsv86vFiPPcUutoX10d9yGY+Ufhw3rs3Mz/Iyy3b7MdAYyf3HPE/ssFm696t/m3FxhcL6KtzIuNT/NcvH9LnUQISkIAEJCCB1yKwXhFdwIUNFpucWaN4y4ZsS3am5xZ9+NLbPLW642+vaGtlOUf+FrGxWc6PvPb8zAawt+HOk8neuOozvm61+NAWZ9mg0r/SZlxSzGzpidyoiAmz1tctvYmxLRIu1bdl76g4tuzST94o2up8TnFIkbnSIj/Kw4qOnkyKpDYPkSWv5OrWhST6uY9mcxmbWQviz6OO4bRqn3VgFlvWi17BmDUbGZsEJCABCUhAAq9NYLtyuIIPG8CVzWg2QrcouC51lw0Sr15jw1o3yaNCozc2BdYsNjal6J9tzlLEsHmtvlSb+El/jzmbQgqGrU0347faqHDAL8a3cYQfx9qS91rEpB9/e3GkP8fY7DEJs15xzXiut75GL3Hwqryu0Re9o+Mt4+jxxncKiBHr9ksG5MNg5HO9Dkvke3mocnvfZ470ikniZI608yo2uJ9r/sg1/tVr8CD2eo3xnM90I5P7YFaUxZejj/gK/9WGz23O27Gwb9cMuHDtGWJu/fVcAhKQgAQkIIH7E1jffVzgGz9yyAantxGs6tigsDmZFVxV/tbv80079tsXfhFD3bCyCePa1mYMPyOLfG8jj0wKCWTalsKADRyvUfGTcdnUZyMN2+jfygM6VnOAfvyJzmo3vuSITmJrdRNbNqbRE3+5XplHV3tMbBxry5xCT5tTztl809dr5Kn19xp9PRvttVvG0eMNX2LixX3JOTljfrfs4luedK/kIbLog9WtWmLJ/IjezB3y2MsvucWn2hJ/jTfckedexQ5H9K7ea1VftXev97BIbOR0q2V+j9ajjA/jrCXIwxpWK3MiejxKQAISkIAEJHBeAv+tXm4QazZo2eDkOFPN5qTd/M3kb9WXgjc+9o5skGvLZoxN1qjVzXvVyWasbcjONr+MYYO7uklnE5wiGNtwPWLzl003NrA32nwjhwzHtsEyhSkycOB8a6MbPZlr7Ya+xo/e3qv3+5XoTWFcN+bX6Iuvs+Mt4xjxJl74woJiaYtzj0MbQ/xu+bb5aMetnjP30V2LSeZG4mjt1vN2PnIfMK7q4p7iesaRZ3xfudfgx7jVuboa8x65+N0eZzqYB8S50ogtfHJvrrBZ0a2MBCQgAQlIQALvn8AhxeT7x7IdQTbm25JKvDcCbJ5XN9vvLba9/sIBHrb/EqC4Gn0h8V9pr0hAAhKQgAQkIIHzEbCYvDCnfDvP053e07YLVTrsCQjwJIanPEc8yX2C8Ha7AAd5/BcbT225/31K9182XpGABCQgAQlI4HUIWExekWs22mwoH/ljble479AOAZ7C1R9v7Yi83CV4+KT2f2mngISHXzj8j4nvJCABCUhAAhJ4TQIvX0y2v2vkef/3C+UiF+fAfA685keIUUtAAhKQgAQk8MoEXr6YvEXyeVLBH+3wCeUtaD5GB/nzSdOcPXxu9Yd15paes5f7e/WP8zxnBHolAQlIQAISkIAEbkvAYvK2PNUmAQlIQAISkIAEJCABCUjgJQhYTL5Emg1SAhKQgAQkIAEJSEACEpDAbQlYTN6Wp9okIAEJSEACEpCABCQgAQm8BAGLyZdIs0FKQAISkIAEJCABCUhAAhK4LQGLydvyVJsEJCABCUhAAhKQgAQkIIGXIGAx+RJpNsj3QKD+6w3/1+V7yJg+SkACEpCABCQggdcmYDH52vl/aPTfv39/+/nz50N9uIdxYtz6lxofP378xxVkKSwtKP9B4hsJSEACEpCABCQggSckYDH5hEk5u0v8X87Pnz93/68jhRSFFcXUb7/99vbt27c35GctxVd9ssf7S/9v5B59+Pb169dfvmLzy5cv3f83SkFJzL1Y6Gv/RykM0GuTgAQkIAEJSEACEpDAsxKwmHzWzJzUL4qpT58+dZ9IUmzxophrC7QRDvRRdLaFJHouaXv0IUvRRzwUg5zH714hy5NGZJHbavhvMblFyX4JSEACEpCABCQggUcSsJh8JP0XtM2Tu16RRKHV/lgnBVmKxPbJXdBRePK6Vdujj4IP/6pvKUYpGnuN+HltNXS3PLbG2C8BCUhAAhKQgAQkIIF7ErCYvCftF7f148ePX8VX76ld7xq4UrD1+vNkcOVJ3wr6Pfr40dT8WGurm2KZvl4xmHGwGDWKU+K2SUACEpCABCQgAQlI4JkJWEw+c3ZO5hs/EsprT+MJ3+gpX4o2dPK7lfUJ4R4bkd2jL7K9p6IUkaNCE1v8WO6MA4XktbEkJo8SkIAEJCABCUhAAhI4ioDF5FFk1fsvAnkiRxG22ijKKLx6TyUptijY2tfKH+zp2d+rj2IQ270njIkV33uNH3NlbC8uilPG2yQgAQlIQAISkIAEJPDsBCwmnz1DJ/GPIo8Cqvckrw2RIitP/vj3IbOGLEVnfhwWG6MnmTM96VvVhx1evcIvxST9vQYD+mBSG3Gs8KljfC8BCUhAAhKQgAQkIIFHEejvdh/ljXZPSyDFXu9JXg26FmIp2FafZuZJJuNuUZTN9MW3rWKy9/SRApnx9fcisdXGSQw9/ZWX7yUgAQlIQAISkIAEJPAoAhaTjyL/YnZnxVcPBUVnCtA9xSHjkB/9iGnP1uzaSN8snloQ9373sfZjO08qozPHWmzOfLRPAhKQgAQkIAEJSEACjyBgMfkI6i9oMwXS3idt+XHX2R+saXGmCO0Vcq3synlP3yyetlhsbWz1t/KeS0ACEpCABCQgAQlI4BkJWEw+Y1ZO6NOs+JqFm//byPjVlh8jrT9iGvvtcUVnTx9PPtHVK45TLI6ejqZ/T0wrfiojAQlIQAISkIAEJCCBexJY36Hf0yttnY5Airhe8bUVLE8GR4VZb2x+17H2oaP3qjKj9z19+YusvT8QlOITmV6zmOxR8ZoEJCABCUhAAhKQwHsjYDH53jL2Tv3Nj4pSmO1tjG3/OM1MB7LtX0qdyW/19fTldyl7BWN+NBeZXstY4rJJQAISkIAEJCABCUjgvRKwmHyvmXtnfu/51yA1NH5UlaeS9UdW6efpXq8wRY7fr+THY/e0S/RRDOJbtZUfy539e5L8wZ1bFrx7YlVWAhKQgAQkIAEJSEACtyBgMXkLiurYJECRx4+69p7kMZiijBeFVv5wDgUehWGvaMyTToo2+pGlOOO8LTw3nXt7++cvx+7Rhx185kkkRSR+p8Cc+ZAnl/hsk4AEJCABCUhAAhKQwHslYDH5XjP3Dv2mMBz9VVYKQQqz/G4lRR3XUli24VKsIRN5irhe0dmOG51fqg//8vuTtbAc2eH6jMNsnH0SkIAEJCABCUhAAhJ4JgIWk8+UjZP7kt8VnD21OzmCX09NKYBHv0959viNTwISkIAEJCABCUjgPAQsJs+Ty3cRCU/xRj/q+i4CuNJJfsT1leO/Ep/DJSABCUhAAhKQgASeiIDF5BMl4xVc4XcL+fHUV3wylx+lrX+w5xVybowSkIAEJCABCUhAAuckYDF5zrw+dVQUUzyde6UfdyVWfq/TQvKpp6bOSUACEpCABCQgAQnsIGAxuQOWorcl8P37919/hfW2Wp9PG3+1lVhtEpCABCQgAQlIQAISOBMBi8kzZdNYJCABCUhAAhKQgAQkIAEJ3ImAxeSdQGtGAhKQgAQkIAEJSEACEpDAmQhYTJ4pm8YiAQlIQAISkIAEJCABCUjgTgQsJu8EWjMSkIAEJCABCUhAAhKQgATORMBi8kzZNBYJSEACEpCABCQgAQlIQAJ3ImAxeSfQmpGABCQgAQlIQAISkIAEJHAmAhaTZ8qmsUhAAhKQgAQkIAEJSEACErgTAYvJO4HWjAQkIAEJSEACEpCABCQggTMRsJg8UzaNRQISkIAEJCABCUhAAhKQwJ0IWEzeCbRmJCABCUhAAhKQgAQkIAEJnImAxeSZsmksEpCABCQgAQlIQAISkIAE7kTAYvJOoDUjAQlIQAISkIAEJCABCUjgTAQsJs+UTWORgAQkIAEJSEACEpCABCRwJwIWk3cCrRkJSEACEpCABCQgAQlIQAJnIvD/AHhIAw/hKmurAAAAAElFTkSuQmCC)
Based on the calculated sample size, a minimum of 170 pregnant women were to be studied. Assuming an additional loss to follow-up and a non-response rate of 10%, the minimum number of pregnant women to be studied was calculated to be 187, which was rounded up to 200 in each control and intervention group.
Hence, 200 participants were recruited from Akinyele LGA and 200 from Oluyole LGA.
Characteristics of participants
Four hundred pregnant women were recruited across the selected health facilities to participate in the study following appropriate inclusion criteria which included; pregnant women who have signed up for antenatal care at one of the participating health facilities, and pregnant women with an estimated gestational age of 20 to 24 weeks.
Instrument Development.
The instrument for the study included a questionnaire, a checklist, and the intervention tools (BPCR flip chart and BPCR card). The study adopted a validated, semi-structured/structured questionnaire from 'Monitoring BPCR tools and indicators for maternal and newborn health' developed by Johns Hopkins Program for International Education in Gynaecology and Obstetrics [13]. The instrument was modified following a rigorous review of literature based on relevance to the cultural values of the study setting. An observational checklist was developed by the researcher after a thorough literature review. It consists of 11 items used to assess expected actions indicating BPCR practice. The reliability of the instrument was conducted to assess the psychometric properties and ensure the adaptability of the instrument to the study setting. Also, back-to-back translation of the instrument (English and Yoruba language) was done to ascertain its reliability of the instrument. The correlation coefficient of scores was obtained to evaluate the test for stability over time. The result of the reliability test was found to be 0.8. Hence, the instrument was considered to be reliable.
Two tools were developed by the researcher. These are BPCR cards and BPCR flip charts, both were developed in English and Yoruba (local dialect) language.
BPCR card: The BPCR card was designed to complement the usual antenatal card, a 6-page, and 3-fold card. The first page provided information on the research study objective and briefly introduced the researcher, including the researcher's contact. The second page is for documentation of the personal and obstetric data of the participants. Such as name, expected date of delivery, and appointment date. The third, fourth, and fifth pages are displayed in pictures and words, likely health problems during pregnancy that require a prompt report to the health facility. The last (sixth) page has a list of elements of BPCR. The BPCR card is handy to remind them of the information given during educational intervention.
BPCR flip chart: The BPCR flip chart is an 8-page chart. It was compiled and designed by the researcher. The 8-page chart contained information that was presented in simple pictures to capture the attention of the respondents and to facilitate learning among the educated, less educated, and uneducated participants. The content focuses on obstetric danger signs, elements of BPCR, and characteristics of skilled birth attendants. The participants were instructed to hang the chart in their various homes so that it can also provide information for their spouses at home and can also remind them of what they have been taught.
Data collection procedure
The study was done, starting from the pre-intervention, the intervention, and the post-intervention. The study was conducted in six phases (the intervention phase inclusive) while data collection and analysis were done in five phases (Baseline – P0, Immediate post-intervention – P1, six weeks post-intervention – P2, twelve weeks post-intervention – P3, and at delivery – P4).
At the pre-intervention stage/planning stage, the research assistants were trained, a pilot study was conducted and baseline data were collected.
Phase 1: Participants' recruitment and Baseline survey (P0)
The recruitment of the study participants spanned from March 2019 to January 2020. The participants were recruited in batches/cohorts at every antenatal clinic day. All pregnant women who met the inclusion criteria were recruited during the antenatal clinic, and scheduled for intervention at a pre-determined day and venue (intervention group), while the control group had routine prenatal education. Both groups were followed up for continued data collection till their delivery. This process of recruitment and follow-up continued until the researcher got the desired sample size of 200 participants in each of the intervention group sites and control group sites.
At recruitment, each participant was given a tally bearing the identification number of the participant, the study-validated questionnaire was administered and participants from the intervention group were scheduled for intervention on a given date written on their tallies. The questionnaire was retrieved immediately to ensure completion and sorting. The participants in the control group were not scheduled for intervention, however, baseline data were collected at recruitment and they were given dates for follow-up interviews. Also, the phone numbers of all participants were documented to remind them of the intervention date and/or follow-up interview date.
Phase 2: Intervention
The Intervention Process
The intervention group met in batches/cohorts as recruited at the various antenatal clinic venues on the scheduled and communicated date and time which was planned to be their usual antenatal clinic day. This group was exposed to BPCR prenatal education with the use of a BPCR flip chart and cards after the usual routine prenatal education provided by their healthcare workers. The content was taught by the researcher for 30 minutes and there was another interactive session of 60 minutes The BPCR flip charts provided information on how to recognize skilled birth attendants, signs of health problems in pregnancy, at childbirth, and immediately after childbirth that require urgent medical attention. It also provided information on institutions that can take care of emergencies, what pregnant women should do to prepare in advance for birth and any complication, the consequence of delay in seeking care, benefits of receiving prompt care in case of any emergency. The BPCR card given to the participants, provided information on; personal data of the participant, history of antenatal visits, recognition of skilled birth attendant (SBA), delivery with SBA, signs of problems that can occur in pregnancy, childbirth, and immediately after birth, what to do in emergencies, saving money for birth cost, identification of birth location, arrangement for a compatible blood donor, mode of transportation, items needed for birth.
The participants were allowed to ask questions for clarification. Participants were informed of the next post-intervention data collection, why it is important, and the date, time, and venue of collection.
Phase 3: Immediate post-intervention (P2)
Immediate post-intervention data collection was done two weeks after the intervention in the two groups using the questionnaire. Each batch/cohort of the participants reported back for data collection as scheduled. The date for the data collection was fixed to coincide with their antenatal clinic day.
Phase 4: Six weeks post-intervention follow up (P3)
This included data collection with the use of a questionnaire six weeks after the intervention. This was meant for a follow-up assessment to assess retained memory over some time after the intervention. Each batch/cohort of the participants reported back for data collection at the clinic site as scheduled. The date for the data collection was planned to coincide with their antenatal clinic day.
Phase 5: Twelve weeks follow up
This included data collection with the use of a checklist at twelve weeks after the intervention. This was meant to assess the necessary actions taken or not taken by pregnant women towards safe delivery at a time very close (four to six weeks) to their expected date of delivery. The participants reported back to the clinic for data collection as scheduled. The date for the data collection was planned to coincide with their antenatal clinic day.
Phase 6: Delivery monitoring
A structured weekly telephone call was put across to all participants from 36 weeks of estimated gestational age till delivery. The main purpose of the telephone call was to ask whether or not the participant had delivered, and where the participant delivered. Many of them also called the researcher to inform the researcher of their delivery and site of delivery. This was to document their site of birth which is a determinant of skilled birth attendance.
For ethical reasons, debriefing at the control sites was done after the completion of data collection for the study.
Ethical approval
Ethical approval number UI/EC/18/0629 was obtained from the University of Ibadan/University College Hospital institutional review committee before the commencement of data collection. The objectives of the study were explained to the study participants, and informed consent was obtained. They were assured of the confidentiality of information received and the right to opt out at any point of the study without any consequence.
Data analysis
Preliminary checking of the questionnaires was carried out for errors. The data were entered into IBM - SPSS version 22. Percentages were used to summarize categorical variables, while mean, median, and standard deviation were used to summarize continuous variables. The 50th percentile of the knowledge score was used in both the intervention and control groups for the categorization of variables. Bivariate analysis was done using a chi-square test between the control and intervention groups at baseline and post-intervention. The significance level was set at p< 0.05. Relevant tables and figures were used in presenting some of the results.