Socio-demographic characteristics of respondents
Among the 253 women who participated in this study, 45.8% of the women were young women aged between 15 to 24 years. At least 38.3% of women had gone up to secondary school. About 63.3% of women had children with 34% of them having 5 or more children. Nearly one third of the women (31.6%) were still in School. Over half (54.2%) of the women had ever used family planning. 48.2% of the women were married while 36% were single and 11.9% were divorced (Table 1).
Table 1
Socio-demographic characteristics of women of reproductive age
Characteristics
|
Frequency
|
%
|
Age
|
|
|
15-24
|
116
|
45.8%
|
25-34
|
82
|
32.40%
|
35-49
|
55
|
21.70%
|
Education level
|
|
|
None
|
5
|
2.0%
|
primary
|
76
|
30.0%
|
secondary
|
97
|
38.3%
|
Tertiary
|
75
|
29.6%
|
Occupation
|
|
|
Student
|
80
|
31.6%
|
house wife
|
67
|
26.5%
|
Business
|
64
|
25.3%
|
Working class
|
41
|
16.2%
|
Marital Status
|
|
|
Single
|
91
|
36.0%
|
Married
|
122
|
48.2%
|
Divorced
|
30
|
11.9%
|
Widowed
|
10
|
4.0%
|
Number of children
|
|
|
None
|
93
|
36.8%
|
1 to 2
|
51
|
20.2%
|
3 to 4
|
23
|
9.1%
|
5 or more
|
86
|
34.0%
|
Family Planning history
|
|
|
Yes
|
116
|
45.8%
|
No
|
137
|
54.2%
|
Out of the 20 health workers, 11 were between the ages of 20 – 34 representing 55%. Most health workers (11) were Nurse-Midwife Technicians (Table 2).
Table 2
Socio demographic data of health workers for the qualitative study
Characteristics
|
Frequency
|
%
|
Age
20-34
35-40
45+
|
11
3
6
|
55%
15%
30%
|
Gender
Male
Female
|
6
14
|
30%
70%
|
Specialization
Gynaecologist
Medical Doctor
Clinical Officer
Nurse-Midwife Officer
Nurse-Midwife Technician
|
1
1
1
6
11
|
5%
5%
5%
30%
55%
|
Table 3
Health workers summarized correct responses in some key variables of preconception care
Variables
|
Frequency (n = 20)
|
%
|
Information to women intending to get pregnant
|
1
|
5
|
Management of women with chronic conditions
|
3
|
15
|
Management of women who delivered babies with congenital anomalies
|
6
|
30
|
Management of women with obstetric complications
|
3
|
15
|
Knowledge about preconception care
|
2
|
10
|
Role in preconception care
|
20
|
100
|
Predictors of PCC from Bivariate and multivariate logistic regression analysis
Perception
The association of categorical variables based on Pearson chi-square showed that marital status (Chi-stat = 27.83, p < 0.001), occupation (Chi-stat =9.78, P < 0.05), education level (Chi-stat = 9.62, P < 0.05) significantly associated with perception on PCC, Table 4.
Table 4
Predictors of PCC from Bivariate and multivariate logistic regression analysis (* p < 0.05, ** p < 0.01, *** p < 0.001)
|
Perception
|
|
|
Knowledge
|
|
|
|
positive
|
negative
|
Chi-stat
|
AOR
|
Good
|
Poor
|
Chi-stat
|
AOR
|
AGE
|
|
|
|
|
|
|
|
|
15-24
|
88
|
28
|
|
|
74
|
42
|
|
|
25-34
|
58
|
24
|
0.88
|
|
47
|
35
|
5.67
|
|
35-49
|
43
|
13
|
|
|
25
|
30
|
|
|
MARITAL STATUS
|
|
|
|
***
|
|
|
|
|
Single
|
59
|
34
|
27.83***
|
|
51
|
40
|
1.63
|
|
Married
|
145
|
15
|
|
4.29 (CI,1.97-9.37)
|
104
|
58
|
|
|
NUMBER OF CHILDREN
|
|
|
|
|
|
27.43***
|
|
NONE
|
73
|
20
|
|
|
47
|
46
|
|
|
1 to 2
|
39
|
13
|
|
|
25
|
27
|
|
|
3 to 4
|
18
|
6
|
1.94
|
|
7
|
17
|
|
|
5 plus
|
59
|
26
|
|
|
66
|
18
|
|
|
OCCUPATION
|
|
|
|
*
|
|
|
|
|
NONE
|
56
|
11
|
|
0
|
25
|
42
|
|
|
STUDENT
|
50
|
30
|
9.78*
|
3.27(CI, 1.06-10.12)
|
67
|
13
|
37.00***
|
|
BUSINESS
|
50
|
14
|
|
0.69(CI,0.25-1.89)
|
32
|
32
|
|
|
EMPLOYED
|
32
|
10
|
|
0.99(CI, 0.38-2.54)
|
21
|
20
|
|
|
FP HISTORY
|
|
|
|
|
|
|
|
|
YES
|
83
|
34
|
1.37
|
|
79
|
38
|
8.95**
|
|
NO
|
106
|
30
|
|
|
66
|
70
|
|
|
EDUCATION LEVEL
|
|
|
|
|
|
|
|
**
|
NONE
|
4
|
1
|
|
|
2
|
2
|
|
|
PRIMARY
|
60
|
16
|
9.62*
|
|
25
|
51
|
45.79**
|
0.67 (CI, 0.09-4.58)
|
SECONDARY
|
79
|
19
|
|
|
54
|
44
|
|
1.54 (CI, 0.23-10.53)
|
TERTIARY
|
46
|
29
|
|
|
65
|
10
|
|
4.72 (CI, 0.58-38.09)
|
Perception
|
|
|
|
|
|
|
|
*
|
Positive
|
|
|
|
|
96
|
92
|
11.68**
|
0.42(CI, 0.21-0.85)
|
Negative
|
|
|
|
|
49
|
16
|
|
|
After multivariate analysis was performed, marital status and occupation were found to be predictors of perception of PCC. Those that were married were more likely to have good perception towards PCC (AOR 4.29; CI=1.97-9.37) than those who were single. Those who were married and going to school were more likely to have positive perception than those who were housewives (AOR 3.27; CI=1.06-10.12).
Knowledge
There was no association between age and level of knowledge on PCC (Table 4). There was also no association between marital status and level of knowledge on PCC. Number of children is highly associated with level of knowledge on PCC (Chistat=27.43, P<0.001). Occupation was also highly associated with level of knowledge on PCC (Chistat=37.00, P<0.001). History of family planning use is associated with level of knowledge on PCC (Chistat=8.95, P<0.01). Education level was associated with level knowledge on PCC (Chistat= 45.79, P<0.01). Perception was associated with level of knowledge on PCC (Chistat=11.68, P<0.01).
After multivariate analysis was performed perception and level of education were found to be predictors of level of knowledge of preconception care. Those that had good knowledge were more likely to have a positive perception towards PCC (AOR 0.42; CI=0.21-0.85). The higher the level of education the greater the level of knowledge. Those with tertiary education were more likely to have good knowledge than those that had none (AOR 4.72; CI=0.58-38.09).
Most women were able to outline eating a balanced diet as one of the things needed to promote a healthy pregnancy (77.04%). A few outlined engaging the hospital (29.57%), conducting exercises (27.63%), avoiding smoking and alcohol (16.34%) and taking vitamins (15.95%) as a way of promoting a healthy pregnancy. Furthermore, women outlined drinking and smoking (37.35%), over the counter drugs (22.57%), use of herbs and chemicals (20.62%), trauma (20.62%) and lack of vitamins (19.07%) as some of the issues that can affect fetal development. 97.28% of the women did not know anything about folic acid and only 1.95% were able to say when it is to be taken.
Results from the qualitative interviews showed that most of the health workers knew the definition of preconception care “as the care which a woman receives before conceiving” but lacked details about the process and what services to offer to clients during preconception care (Table 3). The textual expressions of some of the health workers are reported below.
“Well I know that preconception care is care offered to a woman before she becomes pregnant in order to correct risks that were there but as a nurse I just refer to clinicians so I do not do much (laughs). (Respondent 3, Mzuzu Central Hospital).
“Mmmm, preconception care is the care that is offered to women before they conceive but due to capacity it is offered to high risk women. It prepares the woman before pregnancy, prepares psychologically, prepares complications and also helps to stabilize those that have condition like hypertension before they conceive.” (Respondent 4, Mzuzu central hospital).
ROLES AND RESPONSIBILITY OF HEALTH WORKERS ON PRECONCEPTION CARE
Qualitative results showed that the majority (100%) of health workers recognized that they have a role to play in preconception care services (Table 3). The respondents cited counselling, guidance and provision of the actual services, advocating with the government and other stakeholders, community sensitization and formulation of the preconception care package as some of the roles which they are supposed to do. They had a positive perception towards preconception care. Health workers felt that women also have a role to demand preconception care services and to seek the services. Some of the respondents were quoted as follows:
“As a health worker, it’s my duty to advocate for preconception care with the government, do sensitizations of health workers, and help formulate the preconception care package.” (Respondent 4, Mzuzu Central Hospital).
“I, am responsible to give health education to women on preconception care.” Respondent 13, Mzuzu Health centre”.