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Birth preparedness and complication readiness - a qualitative study among community members in rural Tanzania
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
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2015 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, 1-U12 p., 26922Article in journal (Refereed) Published
Abstract [en]

Background: Birth preparedness and complication readiness (BP/CR) strategies are aimed at reducing delays in seeking, reaching, and receiving care. Counselling on birth preparedness is provided during antenatal care visits. However, it is not clear why birth preparedness messages do not translate to utilisation of facility delivery. This study explores the perceptions, experiences, and challenges the community faces on BP/CR. Design: A qualitative study design using Focused Group Discussions was conducted. Twelve focus group discussions were held with four separate groups: young men and women and older men and women in a rural community in Tanzania. Qualitative content analysis was used to analyse the data. Results: The community members expressed a perceived need to prepare for childbirth. They were aware of the importance to attend the antenatal clinics, relied on family support for practical and financial preparations such as saving money for costs related to delivery, moving closer to the nearest hospital, and also to use traditional herbs, in favour of a positive outcome. Community recognised that pregnancy and childbirth complications are preferably treated at hospital. Facility delivery was preferred; however, certain factors including stigma on unmarried women and transportation were identified as hindering birth preparedness and hence utilisation of skilled care. Challenges were related to the consequences of poverty, though the maternal health care should be free, they perceived difficulties due to informal user fees. Conclusions: This study revealed community perceptions that were in favour of using skilled care in BP/CR. However, issues related to inability to prepare in advance hinder the realisation of the intention to use skilled care. It is important to innovate how the community reinforces BP/CR, such as using insurance schemes, using community health funds, and providing information on other birth preparedness messages via community health workers.

Place, publisher, year, edition, pages
2015. Vol. 8, 1-U12 p., 26922
Keyword [en]
perceptions, birth preparedness and complication readiness, rural Tanzania
National Category
Environmental Health and Occupational Health
Identifiers
URN: urn:nbn:se:uu:diva-258057DOI: 10.3402/gha.v8.26922ISI: 000356351900001PubMedID: 26077145OAI: oai:DiVA.org:uu-258057DiVA: diva2:841075
Available from: 2015-07-10 Created: 2015-07-10 Last updated: 2017-12-04Bibliographically approved
In thesis
1. Effect of Home Based Life Saving Skills education on knowledge of obstetric danger signs, birth preparedness, utilization of skilled care and male involvement: A Community-based intervention study in rural Tanzania
Open this publication in new window or tab >>Effect of Home Based Life Saving Skills education on knowledge of obstetric danger signs, birth preparedness, utilization of skilled care and male involvement: A Community-based intervention study in rural Tanzania
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Use of skilled care during antenatal visits and delivery is recommended to address the burden of maternal mortality. However there are few facility deliveries and insufficient knowledge of danger signs, especially in rural Tanzania. 

The aim of this thesis was to explore the perceptions and challenges that the community faces while preparing for childbirth and to evaluate an intervention of the Home Based Life Saving Skills education programme on knowledge of danger signs, facility delivery and male involvement when delivered by rural community health workers in Tanzania.

In Paper I, Focus Group Discussions explored the perceptions and challenges that the community encounters while preparing for childbirth. Structured questionnaires assessed men’s knowledge of danger signs and birth preparedness and complication readiness in Paper II. The effect of the Home Based Life Saving Skills education programme in the community was assessed with a before-and-after evaluation in two districts; one intervention and one comparison. Paper III assessed the effect of the programme on knowledge of danger signs and birth preparedness and facility delivery among women, while Paper IV evaluated its effect on male involvement.

The community perceived that all births must be prepared for and that obstetric complication demands hospital care; hence skilled care was favoured. Men’s knowledge of danger signs was limited; only 12% were prepared for childbirth and complications. Preparedness was associated with knowledge of obstetric complications (AOR=1.4 95% CI 1.8 – 2.6). The intervention showed women utilizing antenatal care (four visits) significantly more (43.4 vs 67.8%) with a net effect of 25.3% (95% CI: 16.9 – 33.2; p < .0001). The use of facility delivery improved in the intervention area (75.6 vs 90.2%; p = 0.0002), but with no significant net effect 11.5% (95% CI: -5.1 – 39.6; p = 0.123) when comparing the two districts. Male involvement improved (39.2% vs 80.9%) with a net intervention effect of 41.1% (CI: 28.5 – 53.8; p < .0001). Improvements were demonstrated in men’s knowledge level, in escorting partners for antenatal care and delivery, making birth preparations, and shared decision-making.

The intervention, in educating this rural community, is effective in improving knowledge, birth preparedness, male involvement and use of skilled care.

 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. 76 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1174
Keyword
Birth Preparedness and Complication Readiness, Obstetric danger signs, Male Involvement, Community Health Workers, Maternal Health, Rural, Tanzania
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-272245 (URN)978-91-554-9457-5 (ISBN)
Public defence
2016-03-03, Rosensalen, Akademiska sjukhuset, Entrance 95/96, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2016-02-09 Created: 2016-01-12 Last updated: 2016-02-12

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August, FurahaPembe, Andrea B.Axemo, PiaDarj, Elisabeth

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