Birth Preparedness and Complication Readiness Practice and Associated factors among Women Attending Antenatal care Follow up in Yirgalem


 Background: Birth preparedness and complication readiness is an approach that inspires pregnant women, their families and individuals to successfully design strategy for childbirths and deal with emergencies. In developing countries, world health organization estimates that more than 300 million women suffer from short-term and long-term complications related to pregnancy and child birth. In Ethiopia only 32% women have birth preparedness. The aim of this study is to assess practice and Associated factors of birth preparedness and complication readiness among Women Yirgalem General Hospital, Sidama Zone, Southern Ethiopia, 2019Methods: Facility based cross-sectional study was conducted from September 1st to 30th, 2019. A total of 422 pregnant women were randomly selected and interviewed by using pretested structured questionnaire. Data was entered by Epi-data version 3.1 and the analysis was done by SPSS version 21. Bivariate and multivariable logistic regression was performed to identify factors associated with birth preparedness and complication readiness.Result: From 422 study participants, 356(48.6%) (95% CI: 46.9%, 49.8%) have birth preparedness and complication readiness practice. Age of respondent ≥ 37 years (AOR =4.2, 95% C.I =1.23, 14.24) and between 25 to 30 (AOR=2.35, 95% C.I =1.1, 5.1); level of education College and above(AOR=5.59, 95% C.I 2.8, 11.2)and secondary school (AOR=9.5, 95% C.I 3.99-22); previous history of ANC follow up (AOR=4.33, 95% C.I = 2.46, 7.61) and history of birth at health facility (AOR=3.09, 95% C.I= 1.72, 5.56) where factors associated with birth preparedness and complication readiness practice. Conclusion: Relatively higher birth preparedness and complication readiness practice was observed in this study when compared with previous studies. Health extension workers and health care provider should encouraged women to actively utilize the health services and the governments with other stakeholders should works on antenatal care and institutional delivery by focusing on women those has no formal education.

maternal and neonatal care, especially during the time of pregnancy, labor and child birth. This can be achieved by one of the essential components of a globally accepted safe motherhood program; birth preparedness and complications readiness is maternal health care services during pregnancy and for potential complications (4,5).
Birth preparedness and complication readiness is amongst the main involvement with the objective to reduce neonatal and maternal mortality through promoting health care seeking behavior and utilization of appropriate skilled personal for delivery and health care facilities (6). The maternal and neonatal health program of Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHIEGO) developed the birth preparedness and complication readiness matrix to address these three delays; (A) is the delay in deciding to seek care for an obstetric complication; (B) Delay to go to health facility after the decision has been made to seek care; and (C) Is the delay in obtaining care once present at the facility (7).From study done in Ethiopia; age, Antenatal Care (ANC) follow up, place of residence, educational status, birth at health facility, history of still birth and knowledge of birth preparedness and complication readiness plan are factors associated with birth preparedness and complication readiness practice (8,9).
Birth preparedness and complication readiness encourages active planning and decision making birth between women and their families and encourages to choice a skill birth attendant; arranging and identifying the appropriate health care facility; preparing transportation to health care facilities for birth and obstetrics emergencies; save money for emergency and birth expenses; identifying an individual to take care for the rest of family when the expectant mother absence; preparing any needed supplies for mother during birth and postnatal period, being aware of the expected date of birth and obstetrics danger signs (10 Source and study population All pregnant women who came to Yirgalem general hospital for ANC visit was source population and all pregnant women who ful ll the inclusion criteria and selected pregnant women was study population.

Eligibility criteria
Pregnant women who can hear and communicate and who are volunteer to participate are included and a Pregnant women with mental problem or seriously ill/ unable to hear and speak was excluded.
Sample size determination and sampling procedure The sample size was estimated by using sample size determination for a single population proportion formula. Therefore, the total sample size was calculated with the marginal error of 0.05, with 95% con dence interval and p-value 48.5% from study conducted in Sodo town, Wolaita Zone, SNNPR, Ethiopia (12). A possibility of 10 % of the total sample size was considered for non-respondents. And the nal sample size was 422.

Data collection procedure and instrument
Data was collected by face to face interview method with structured questionnaire and subjects were selected by systematic random sampling technique. The questionnaire was rst developed in English and translated into Amharic; which include; socioeconomic and demographic characteristics, obstetric, health services related factors, means of information, and availability of transport. The questionnaire was taken from maternal and child health program of Johns Hopkins Program for International Education in Gynecology and Obstetrics. The outcome of this study this study is practice of birth preparedness and complication readiness(7).

Operational de nition
Birth preparedness and complication readiness: A women was considered as prepared for birth and its complication if she save money for birth-related and emergency expense; identi ed place of delivery; skill birth attendants; arrange transport to health institution for delivery and obstetric urgent situation, and prearranged blood donor in cases of obstetrics emergency. The 5 variable were transformed on SPSS in to one variable that is "Birth preparedness and complication readiness practice" women who found at least 3 of the 5 Birth preparedness and complication readiness component were considered as" prepared for birth and its complication" coded as 1. The remain women who found less than three were considered as "not prepared for birth and its complication" and coded as 0. This scoring has been previously used in studies that assessed women's Birth preparedness and complication readiness practice (12)(13)(14).

Data processing and Analysis
Data was checked for completeness and entered in to Epi data version 3.1 and SPSS window version 21 was used for analysis. Descriptive analysis was done and results were presented in the form of narrative and table. Bivariate and multivariable logistic regression was done to identify factors associated with birth preparedness and complication readiness. All variables with p-value less than 0.25 in bivariate logistic regression model were entered to multivariable logistic regression model for controlling possible confounding and variable with p-value less than or equals to 0.05 in multiple logistic regression model were considered as statistically signi cant.      (18), and the study done in Goba, East Ethiopia (29.9%) (19). The difference might be due to the time, the current study conducted after a lot of work done by multi-sectoral collaboration to enhance mother birth preparedness and complication readiness through one -to-ve networks health extension workers.

Result
Birth preparedness and complication readiness practice is higher among older age group than younger age group; age group ≥ 37 where four time (AOR =4.2, 95% C.I =1.23, 14.24) and age group from 25 to 30 where more than two fold (AOR=2.35, 95% C.I =1.1, 5.1) more likely practicing birth preparedness and complication readiness than age group 18-24. The nding is in line with the study conducted in India among women bene ciaries of selected rural primary health center of Dakshina district, Karnataka (20). The possible reason is that younger women may have no previous obstetrics complication that makes them to prepare themselves but the old women they have a history of obstetrics complication they prepare themselves for their current pregnancy (not assessed in study). This study nding differ from study conducted in Wolaita Zone, Sodo town, that indicated younger age groups are more likely to birth preparedness and complication readiness practice (12). The observed difference might be because of older women in Sodo town may be traditional and they might accept as they feel safe as they deliver at home and the older women are less likely to birth preparedness and complication readiness.
Educational level was another signi cantly associated with birth preparedness and complication readiness practice. From the respondents those whose educational level college, University and above are more than 5 time (AOR=5.59, 95% C.I 2.8, 11.2), educational level with secondary school more than 9 time (AOR=9.5, 95% C.I 3.99-22) and primary school education more than 2.8 time (AOR=2.8, 95% C.I 1.46-5.38) more likely to have birth preparedness and complication readiness practice than no formal education. The nding of this study was in line with the study done in Wolaita zone, Sodo town, Southern Ethiopia and Robe Woreda, Arisi zone, Central Ethiopia (12,21). The reason might be Education give a greater health care seeking behaviors of women and education build self-con dence and decision making ability that enhance their birth preparedness and complication readiness.
History of ANC has a positive association with birth preparedness and complication readiness practice; those who have previous history of antenatal care follow up have 4.33 time more likely to had birth preparedness and complication readiness practice (AOR=4.33, 95% C.I = 2.46, 7.61) than those who have no history of antenatal care follow up. This study is in line with a study done in Adigrat town, Ethiopia and Wolaita Zone, Sodo town, southern Ethiopia (12,22). The reason might be during ANC the health provider gives health education in birth preparedness and complication readiness and their previous exposure will increase women's knowledge and practice. Women who say "ANC is useful" have 3.99 time more likely to have birth preparedness and complication readiness practice (AOR=3.99, 95% C.I = 2.06, 7.72) than those who have say antenatal care is not useful. This is due to if they agree as ANC is useful, they have birth preparedness and complication readiness.
Birth at health facility was another factor have signi cantly associated with birth preparedness and complication readiness practice. Those who have a history of birth at health facility have more likely to have birth preparedness and complication readiness practice (AOR=3.09, 95% C.I= 1.72, 5.56) than those who have no history of birth at health facility. The nding of this study is similar with study done in Dale District, Southern Ethiopia (23). The reason might be their contact to health institution help the women to get health education for birth preparedness and complication readiness practice.
This study has a few limitations. First it is institution based study that addresses only women who come to health institution those women who doesn't come to health institution missed to assess their birth preparedness and complication readiness practice. The cross sectional nature of this study may not elucidatetemporal relationship between the dependent and independent variable.

Conclusion
Relatively higher birth preparedness and complication readiness practice was observed in this study when compared with previous study. age of respondents, level of education, age at rst pregnancy, outcome face during pregnancy and child birth, previous antenatal care follow up and birth at health facility were found to be signi cantly associated with birth preparedness and complication readiness practice.
The government has to work in collaboration with different stockholder universal coverage of education and health education by strengthen the communication system with community to increase BPCR practice and focus on younger women and increase ANC follow up and institutional delivery coverage from health care provider also expected to do not miss the opportunity to disseminate all information related BPCR practice.