Study area
This study was conducted in Mtwara region. The Region covers the total area of 16,710km2 (6,450sqmi). Administratively the Region divided into nine districts that are Mtwara Municipal, Newala DC, Tandhimba, Masasi DC, Nanyumbu, Masasi TC, Mtwara DC, Newala TC, and Nanyamba TC. The region has a total of 253 health facilities among those Hospitals are 6 whereby 5 public and 1 faith based organization. Health centres are 22, public 15, FBO 2, and 5 are private. Dispensaries are 225 whereby 195 public, 13 FBOs and 17 private. Almost all facilities are providing ANC services like physical examination of pregnant women, Health education about danger signs of pregnancy, testing and counseling for HIV/AIDS, Vaccination of Tetanus toxoid, micronutrients provision and checking for Hemoglobin level etc.
Based on 2012 National population and Housing Census, the Region had a population of 1,270,854, which was lower than the Pre- census projection of 1, 374, 767 people of whom 599, 648 were male and 671, 206 were female. The estimated average household size is 3.7 [15]. The majority of people depend on agricultural activities to sustain their lives. They have mainly planted cassava, sorghum, paddy and maize. Cash crops are Cashew nuts, simsim and groundnuts. But the economic status of Mtwara mainly depends on Cashew nuts.
Setting
The study involved 4 districts namely Mtwara DC, Newala, Nanyumbu, and Masasi. In each District two wards were involved, making a total of eight wards, At village level three villages from each ward were involved making a total of 24 villages.
Study design
A community based analytical cross sectional study was conducted. The study employed a quantitative research approach. This design was chosen so as to assess the community myths about preeclampsia and eclampsia towards Antenatal services utilization.
Study population
Pregnant women who were in second and third trimester with their Male partners. This group was at risk group for preeclampsia and eclampsia since the women were pregnant and were the one who expected to utilize ANC services. Furthermore male partners are the decision maker in family level even regarding the health of their spouse.
Inclusion criteria
All pregnant women including prime gravid and multigravid who were in the second and third trimester, gestation age of 24 weeks and above who lived together with their male partners who were willing to participate in the study. These groups provided valid information on their knowledge and myths about preeclampsia and eclampsia.
Exclusion criteria
Pregnant women and their partners who were very sick, mentally incapability and who refused to be involved in this study.
Sample size calculation
Since there was no any documented study done in Mtwara Region showing the prevalence of preeclampsia and eclampsia, hence, this study used a prevalence of 50% as a standard to calculate the sample size. By using the Kish Leslie formula as follows: -
Whereby
N= sample size
Z= Confident interval to 95% (1.96)
P= Prevalence (50%)
E= Worst acceptable margin error (0.05)
HENCE:
N= 384.16. Therefore the sample size was 384 couples.
Sampling technique
The region was selected purposively because of an increasing number of preeclampsia and eclampsia and women reported at the health facility while already had eclamptic fit as seen earlier in RCH report of 2018. Then districts, wards, and villages employed multistage sampling. The first stage was a selection of four Districts (Mtwara DC, Nanyumbu, Newala and Masasi DC) out of nine districts within Mtwara Region. Simple random sampling using the lottery method was used to select the districts. A list of all districts was obtained and the names of the districts were listed. Pieces of paper were divided according to the number of districts and the names of the district were written in each small piece of paper then each piece of paper was folded and put together in a box. Then the box was shaken and four pieces were picked at random and names of districts were identified. The second stage was a selection of wards whereby all wards in each district (21 Wards of Mtwara DC, 17 Wards of Nanyumbu district, 22 Wards of Newala district and 34 Wards of Masasi district) were listed. By using the lottery method two wards from each district were selected randomly to obtain a total of 8wards. The third stage was selection of three villages from each selected ward by repeating the same procedure to obtain a total of 24 villages. The fourth stage was a selection of participants from each village whereby a list of pregnant women with gestation age of 24 weeks and above who lived with a male partner was obtained from a ten cell leader and eligible participants were given a number, thereafter by the use of lottery method simple random procedure was employed to select 16 expecting couples who met inclusion criteria from each village.
Research instruments
The tool used to collect data was a structured questionnaire, with closed ended questions and open-ended questions. The questionnaire was divided into four sections. Social-demographic and social economic characteristics, questions for measuring knowledge, myths and Antenatal service utilization.
Social demographic and social economic characteristics adapted from NBS, 2015. The questions were translated in Swahili language and the whole questionnaire took 30 minutes to complete.
Data collection process.
Data were collected through interviewer structured questionnaires. A researcher together with research assistants interviewed the eligible respondents whereby the researcher and research assistant filled the questionnaire the response from the participants. Ten research assistants were involved in data collection after being trained before the process commenced.
Data processing and analysis
Data obtained were coded manually and then were entered into the computer and cleaned. Data analysis was finally done by using statistical package for the social sciences (SPSS) computer software version 20. Frequencies and cross tabulations were done. Data were summarized into frequency tables, figures and chi square was done to look for an association between demographic variable and outcome variables. Logistic regressions were used to determine the strength of association between selected variables and outcome variable. Moreover, a P-value and confidence interval used to verify the significance of the differences found. A P-value < 0.05 was considered to be statistically significant. The principal component analysis was also done to find out the weighted score of the questions asked. A weighted score of >0.3 was regarded as relevant.
Measurements of the variables.
Knowledge on preeclampsia and eclampsia was measured by nominal scale involved 38 items on knowledge with yes/no answers which were then converted into correct and incorrect. Then one score for each correct answer and zero score for each wrong answer (Savage & Hoho, 2016). Principal component analysis was done to analyze knowledge. Mean was used to categorize the level of knowledge. Below the mean inadequate knowledge and above the mean Adequate knowledge.
Myths on preeclampsia /eclampsia adapted and modified from (Boene et al., 2016). This involved with 6 open ended questions regarding myths on preeclampsia and eclampsia. Difference responses were obtained from the respondents. Similar answers were grouped and then coded. Therefore myths was measured by employing principle component analysis and median was used as a cutoff point to categorize whereby those below the median had weak myths and above the median had strong myths.
Antenatal service utilization involved 7 items adapted and modified from (Doe, 2013). Utilization was measured by number of recommended antenatal visits by WHO guideline. Therefore if the women attended ANC less than two visits was graded as inadequate utilization of ANC services and if attended two or more visits graded as adequate utilization of ANC service. (Hijazi, Alyahya, Sindiani, Saqan, & Okour, 2018).
Ethical consideration
The proposal was approved by Institutional research review board of the University of Dodoma. Furthermore, letter of permission was obtained from the Mtwara Regional Administration. Both written and verbal consents were sought from study participants after explaining the study objectives and procedures and their right to refuse to participate in the study at any time they were assured.