Academic literature on the topic 'Birth preparedness'

Background. According to the Theory of Planned Behavior, an intention to carry out a certain behavior facilitates action. In the context of planning for birth, certain preparations and planning may better ensure maternal and neonatal survival. Little is known on the predictors of birth preparedness intention among expecting couples. The aim of this study was to determine the predictors of birth preparedness intentions among expecting couples. Methods. A community based cross-sectional study targeting pregnant women and their partners was performed from June until October 2017. A three-stage probability sampling technique was employed to obtain a sample of 546 couples A structured questionnaire based upon the Theory of Planned Behavior was used. The questionnaire explored three main domains of birth preparedness intentions. These three domains included (1) attitudes towards birth preparedness, (2) perceived subjective norms towards birth preparedness, and (3) perceived behavior control towards birth preparedness. Results. The vast majority of study participants had birth preparedness intentions. This included 521 (95.4%) pregnant women and 543 (99.5%) of their male partners. After adjusting for the confounders, the predictors of birth preparedness intentions among pregnant women were attitude (AOR=70.134, 95% CI=12.536-392.360, p<0.001) and perceived behavior control (AOR=7.327, 95% CI=1.545-34.761, p<0.05) which were significant. Among male partners, only attitudes (AOR=31.315, 95% CI=1.497-655.149, p<0.05) influenced the birth preparedness intention. Conclusion. Birth preparedness intention among male partners was higher compared to their female partners. The reason for the difference could be the concern each group puts on the issue of birth preparedness. Among the three domains of intention, attitude and perceived behavior control were statistically significant predictors of birth preparedness intention among pregnant women. Attitude was the only domain which influenced birth preparedness intention among male partners. Therefore, interventional studies are recommended targeting attitudes and perceived behavior control in order to boost birth preparedness intention.

Introduction. Birth preparedness is crucial for health quality of mother and newborn and acts as a strong contributor in mitigating maternal and newborn mortalities. Different factors are predicted to have an influence upon birth preparedness practice. This paper aims at exploring relationship between various factors and birth preparedness practice. Methods. A cross-sectional study design was used to find out the relationship between various factors and birth preparedness practice. One hundred sixty-five women residing at ward number 1 of Rapti Municipality, Chitwan who delivered in the last twelve months were selected consecutively and interviewed using a semistructured questionnaire. The collected data were analyzed using descriptive and bivariate techniques. Results. Three quarters (75.2%) of the respondents had better birth preparedness, institutional delivery was 63.0%, antenatal care (ANC) visit as per protocol was about 62.0%, and about 90% of the respondents had received counseling during ANC. Age, religion, family types, education, age at marriage, parity, number of children, knowledge on birth preparedness, knowledge on danger sign, place for ANC and delivery, and decision-makers were found to be statistically significant (P value < 0.05) with birth preparedness practice. Conclusion. Better knowledge on birth preparedness led to a better preparedness status. Age, religion, family type, education of women and partners, parity, and number of children were the factors that influence birth preparedness. Counseling during ANC played a significant role in birth preparedness.

Continuity of midwifery care (CoC) is one of midwifery care that’s given by the same midwife during antenatal care to get birth preparedness. Birth preparedness includes recognize danger signs, identifying skilled birth attendant, identifying birth location, saving money, arranging for transportation and identifying blood donors. The objective of this study was to know the relationship of CoC during antenal with birth preparedness in working area of seberang padang public health center 2017.This study is An observational analitycs with cross sectional design to 58 respondents in working area of Seberang Padang Public Health Center during December 2016 – September 2017 that are taken with consecutive sampling technique. Data collection by using a validated questionnaire and MCH book observation. Data were analyzed using Chi-square.From the results of the study there are 51.7% respondents who did CoC during ANC and 41.4% considered being prepared in birth preparedness. The result of statistic test showed that there is relation between CoC during antenatal and birth preparedness (p=0,001; OR=8,250; 95%CI 2,541-26,781). So it can be concluded that There is relation between CoC during antenatal and birth preparedness

Background: Maternal health and healthy outcome of a pregnancy are the core focus of all the programmes related to maternal and child health. Most of the causes of maternal morbidity and mortality are preventable. So we need to introduce new strategies according to the need of beneficiaries to reduce the underlying causes which ultimately lead to morbidities or complications during pregnancy. Birth preparedness is a kind of strategy which can help the mothers to plan out their pregnancy to combat the complications arising during pregnancy, childbirth or puerperium. The aims and objectives were to study the birth preparedness amongst the women, to study effect of various socio demographic determinants on birth preparedness and to find out relation between maternal morbidity and mortality with birth preparedness. Methods: Cross sectional study was conducted in Jamnagar. 450 women were selected by 30 cluster sampling. Data analysis was done with Microsoft office Excel and SPSS 20, Chi square test was applied. Results: 11.33% women were fully prepared, 67.33% were partially prepared while 96 women were not prepared at all. Education, place of delivery, parity and knowledge of danger signs has statistically significant association with birth preparedness in cases of both maternal mortalities, women were not at all prepared. Conclusions: Birth preparedness practices need to be improved. Education, parity, place of delivery, knowledge about danger signs are associated with birth preparedness practices. Birth preparedness can help in decreasing maternal morbidities and mortalities.

Birth Preparedness and Complication Readiness (BP/CR) is a strategy to promote optimal care related to the management of obstetric complications. Ideally, maternal health is the joint responsibility of married couples. In the concept of Suami SIAGA, the husband is expected to be ready and aware of risks, to keep his wife from doing things that interfere with her pregnancy, and to accompany her to the nearest referral if signs of complications arise. The role of SIAGA is carried out with the aim of preventing the 3 delays that cause maternal death. This study aims to assess the effectiveness of counseling on birth preparedness and obstetric complication readiness to improve husband's preparedness in dealing with labor and obstetric complications. This was a prospective quasi experimental study with a one group pre-test-post test design. The samples were 32 husbands from pregnant women, taken using a proportional systematic random sampling technique. This sutdy was conducted in the Bandarharjo Community Health Center, Semarang City in April-July 2018. Data collection used a questionnaire given 2x (pretest and posttest) during pregnancy and a follow-up questionnaire during the puerperium. Univariate analysis yields frequency and percentage distribution. Bivariate analysis was performed using paired sample t-test. There was a significant difference in the mean score of knowledge and perceptions of husbands about the practice of BP/CR before and after the intervention (p=0.000). BP/CR counseling was effective in increasing husband's preparedness in dealing with childbirth and obstetric complications.

Male in patriarchal societies of developing countries are identified as decision makers in all aspects of life. Every pregnant woman faces risk of life-threatening obstetric complications. A birth-preparedness package promotes active preparation and assists in decision-making for healthcare seeking in case of such complications. The present study attempted to assess the involvement of male in birth preparedness in Tulsipur Municipality of Dang District. A Descriptive Cross Sectional Study was conducted among 125 male including husbands of pregnant women and fathers of under one children in 2011, to assess the involvement of male in birth preparedness. Purposively record was reviewed from the Rapti Zonal Hospital as well as Municipality office, and respondent were identified using snowball sampling from community. More than half 52.8% of the respondents heard about Birth Preparedness. Nearly half 44.36% of the respondents plan for preparedness of birth, more than half 56.8% had thought to plan if emergency situation or complication arises during pregnancy and childbirth. Most 69.6% of the respondent has planned the place for giving birth to their child. Nearly half 51.8 % of respondent have plan for visiting their wives to Skill Birth Attendants. Only few 12.5% of the husbands had planned for transportation facility and identified Blood Donors if required’. About half 48% of the husbands are accompanying their wife for Antenatal Care. Most 88% of the husbands help their wives in household activities during pregnancy and childbirth. It shows that about half of the male were involved in Birth Preparedness.

Background. Rukwa Region has the highest maternal mortality ratio, 860 deaths per 100,000 live births in Tanzania. The region has neonatal mortality rate of 38 deaths per 1,000 live births. Previous interventions to promote maternal and neonatal health targeted access to maternal services by removing financial barriers and increasing the number of health facilities. However, maternal service utilization remains very low, especially facility delivery. The proposed intervention was sought to address deep-rooted behavioral beliefs, normative beliefs, control beliefs, and knowledge empowerment to determine their effect on improving birth preparedness, male involvement, and maternal services utilization. The study tested the effectiveness of a Community-Based Continuous Training (CBCT) intervention that was based upon the theory of planned behavior and was sought to promote positive behaviors. Methods. The study used a quasi-experimental design. The design consisted of pre- and postintervention assessments of two nonequivalent groups. Two districts were selected conveniently using criteria of high home birth. A district to hold intervention was picked randomly. Study participants were expecting couples at gestation age of 24 weeks and below. After obtaining informed consents, participants were subjected to baseline assessment. Expecting couples in the intervention group had two training sessions and two encounter discussions. The three primary outcomes of the study were changes in the level of knowledge about birth preparedness, male involvement, and use of maternal services. Data were collected at preintervention, midintervention, and postintervention. Policy Implications of the Results. The aim of this paper was to describe the study protocol of a quasi-experimental study design to test the effectiveness of an interventional program on promoting positive behaviors on birth preparedness, male involvement, and maternal services utilization among expecting couples. This study has a potential to address the challenge of low birth preparedness, male involvement, and use of maternal health services in Rukwa Region.

Background. Compared to average maternal mortality ratio of 8 per 100,000 live births in industrialized countries, Ethiopia has an estimated maternal mortality ratio of 676 per 100,000 live births. Maternal deaths can be prevented partially through increasing awareness of danger signs of obstetric complications and involving husbands (male) in birth preparedness practice.Methods. Community based cross-sectional study was done. All adult males with a wife or partner who lives in the selected kebeles were our study population. Data was collected by pretested and structured questionnaires and two-stage cluster sampling procedure was used in order to collect study samples. Data was cleaned and entered into Epi Info 7 and exported to SPSS (IBM-21) for further analysis. Ordinary and hierarchical logistic regression model were used and AOR with 95% CI were used to show factors and the effect of men’s awareness of danger sign on men’s involvement in birth preparedness practice.Results. Total numbers of men interviewed were 836 making a response rate of 98.9%. 42% of men had awareness of danger sign and 9.4% (95% CI: (7.42, 11.4) of men were involved in birth preparedness practice. Respondents who live in the rural area [(AOR: 8.41; (95% CI: (4.99, 14.2)], governments employee [(AOR: 3.75; (95% CI: (1.38, 10.2)], those who belong to the highest wealth quintile [(AOR: 3.09; (95% CI: (1.51, 6.34)], and husbands whose wives gave birth in the hospital [(AOR: 2.09; (95% CI: (1.29, 3.37)], health center [(AOR: 1.99; (95% CI: (1.21, 3.28)], and health post [(AOR: 2.2; (95% CI: 2.16 (1.06, 404)] were positively associated and those who had no role in the health development army [(AOR: 0.43; (95% CI: (0.26, 0.72)] were negatively associated with men’s awareness of danger signs of obstetric complications.Conclusion. The prevalence of men awareness of danger sign was low and male involvement in birth preparedness practice was very low. Since there is a low level of awareness (17.1%) particularly in the urban area and men act as gatekeepers to women’s health, the respective organization needs to review urban health extension program and give due emphasis to husband education in order that they are able to recognize danger signs of obstetric complications in a way to increase their involvement in birth preparedness practice.

Background: Birth preparedness is the advance preparation made by an expectant mother which ensures access to skilled care. In Africa, the risk of pregnancy related deaths is 300 times more than in the developed world. In Kenya, out of 10 expectant mothers who access antenatal care services only 4 deliver in a health facility.Methods: This was a descriptive cross sectional study conducted at outpatient Maternal Child Health and Family Planning Clinic at Kerugoya County Hospital. The study utilized convenience sampling technique to determine the study population. The research instruments were an In-depth interview guide and semi-structured questionnaires. Data was managed using SPSS and analysis done using descriptive statistics and Chi-square tests. Statistical significance was set at p<0.05.Results: A sample of 202 women participated in the study. 47.5% of the participants were adequately prepared for birth. Having a higher level of education was significantly associated with birth preparedness (p=0.021). The number of children per woman had a significant influence on level of birth preparedness with women who had no children less likely to be prepared for birth compared to those with one or more children (p=0.002). Clients who attended Antenatal Care (ANC) at least 3 times were prepared for birth compared to those who visited either once or twice (p=0.027).Conclusions: Overall, women of reproductive age lack birth preparedness. There is therefore need to enhance birth preparedness awareness campaigns at ANC visits targeting women in their third trimester.

Philosophiae Doctor - PhD
Pregnancy-related poor maternal health and maternal death remain major problems in most Nigerian states including Cross River State. The acute impact of these problems is borne more heavily by rural communities where the majority of births take place at home unassisted or assisted by unskilled persons. These problems are due to a mixture of problem recognition and decision-making during obstetric emergencies leading to delayed actions. Every pregnancy faces risk, and prenatal screening cannot detect which pregnancy will develop complications. If the goal of reducing maternal morbidity/mortality is to be achieved, increasing the number of women receiving care from a skilled provider (doctor/nurse/midwife) during pregnancy, delivery, and post-delivery and prompt adequate care for obstetric complications has been identified as the single most important intervention. One of the strategies identified in many countries is engaging and working with individuals, families, and communities as partners to improve the quality of maternal healthcare. This strategy is thought to remove the barriers that dissuade women from using the services that are available, empowering the community members to increase their influence and control of maternal health, promote ownership and sustenance, as well as increase access to skilled care. The aim of the study: The overall aim of this PhD study was to develop a model of community engagement to facilitate the prevention of maternal health complications in the rural areas of Cross River State, Nigeria. To develop this model, the study specifically sought to: 1. Understand the current situation in Cross River State by exploring the knowledge gap of women of child-bearing age (pregnant and new mothers) regarding obstetric danger signs, birth preparedness and complication readiness, delivery practices of women, the action of family/community members, and the role of community-based maternal health initiatives, if any, in emergencies, as well as explore participants’ opinions on actions to be taken by the community to promote the utilisation of orthodox healthcare facilities by rural women of Cross River State (Phase 1). 2. Engage community members through a participatory approach (Photovoice) to highlight problems regarding pregnancy and birth practices, identify possible solutions, and make recommendations on communities’ roles in the prevention of maternal health complications (Phase 2). The older women of the study communities were also engaged to verify and validate the findings from phases 1 & 2 analyses. 3. Develop a model of community engagement to improve maternal health literacy by increasing knowledge on early detection of obstetric complications, birth preparedness, complication readiness, and improved access to skilled birth attendance (Phase 3). Methods: The study was conducted using a qualitative descriptive research approach that combined qualitative semi-structured interviews and focus group discussions within the Photovoice participatory approach. Purposive sampling was employed to select 20 participants, 10 each from the Idundu (Community A) and Anyanganse (Community B) rural communities of Akpabuyo Local Government Area of Cross River State, Nigeria. The participants comprised pregnant women and new mothers (babies aged 12 months and younger) who met the eligibility criteria. Data collection was by means of semi-structured interviews (Phase1), focused group discussions and Photovoice (Phase 2). Trustworthiness of the data was ensured by means of applying Guba’s model of credibility, transferability, and authenticity. The ethical principles of respect for human dignity, beneficence, confidentiality, and justice were applied throughout the study. The Citizenship Healthcare and Socio-Ecological Logic models were used to direct the study. Permission was obtained from participants for all the phases of the study while approval for the study was obtained from the Senate Higher Degrees Committee of the University of the Western Cape and the Cross River State Ministry of Health Ethical Committee. Data was analysed using Tesch’s method of content analysis. Based on the findings of Phases 1 & 2 of the study, themes emerged that were then validated by the older women in the study communities. The model was then developed by means of the four steps of the theory generation process. Step one was concept development that consisted of the identification, definition, validation, classification, and verification of the main and related concepts. Step two was model development consisting of the sub-steps, namely model guidelines and definitions. The communities’ stakeholders were engaged at this phase to verify and validate the concepts, as well as contribute to the drafting of the model guidelines and the definitions. Step three was a model description whereby the structure, definition, relation statements, and the process of the model were described. A visual application of the model that depicts the main concepts, the process, and the context was shown. Step four dealt with the development of guidelines for the operation of the model. A critical reflection of the model was done using Chinn and Kramer’s five criteria for model evaluation. Results: The study revealed that Idundu and Anyanganse’s rural women have limited knowledge of obstetric danger signs and very few of them acknowledged the importance of hospital delivery. They also exhibited poor understanding of what birth preparedness and complication readiness entailed. There was a high preference for traditional birth attendant care during pregnancy and delivery with their reasons being belief and trust in traditional birth attendants, a long standing tradition to deliver with them, assumptions that orthodox healthcare is expensive, poor attitude of healthcare providers towards women, unavailability of 24-hour services in healthcare facilities, fear of hospital procedures and operations, communal living in traditional birth attendant’s homes, spirituality in traditional birth attendant services, and the consideration of proximity to service points. These factors exacerbated the delays in seeking care and in referrals for skilled care in phases of emergency. The study also revealed that in the study communities, heavy household chores carried out by pregnant women is culturally accepted and seen as exercise to ease labour, there is lack of proper information regarding maternal and child health issues, men are sole decision-makers, they are ignorant of availability of free treatment in health centres, there is an ignorance regarding care of the new-born, and a lack of community structures to support women’s health. Based on the above findings, the women made the following suggestions towards finding a solution: improving maternal health literacy, increasing spirituality in service delivery, involving of husbands in antenatal care for proper information on maternal health issues, accessing community support through the use of community structures (town announcers, women groups, churches, etc.) with the purpose of emphasising facility delivery, constitution of influential groups to monitor the activities of pregnant women to ensure utilisation of skilled attendants, access to healthcare through free services and availability of providers, trust of health services, and traditional birth attendant training/traditional birth attendant facility collaboration. A total of eight concepts were identified from the concluding statements of steps 1 & 2, and used to develop the Maternal Health-Community Engagement Model (MH-CEM). These were: maternal health literacy, spirituality in healthcare, integrated traditional birth attendants’ role (value, training, and traditional birth attendants/hospital collaboration), trust in health services (by addressing previous experiences, attitude, and fear), improving access to healthcare, culturally acceptable care, husbands’ involvement in women’s health issues, and community support. These concepts formed the core components for the Maternal Health-Community Engagement Model which was developed as the main recommendation to address the core concepts. Central to this Model was the Community Engagement Group (CEG) which was established during the process of engaging the community stakeholders in validating the concepts and drawing up of the guidelines for the Model development. Conclusions and Recommendations: It is believed that the activities of the Community Engagement Group may bring about improved maternal health literacy, a process for working with traditional birth attendants through training and re-orienting them to be promoters of facility delivery when appropriate, and a model for involving husbands, and indeed the entire community, in maternal health issues. Limitations were identified and recommendations for nursing practice, education, and research concluded the study.

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.

Background Pregnancy and childbirth are normal physiological processes but the internal and external circumstances in which the child is conceived and born affect the life of the mother and child. Every pregnancy is associated with unpredictable risks and complications. Therefore, having a birth preparedness and complication prevention plan including safe motherhood are paramount to reduce maternal and infant mortality rates. Purpose of the study This study aimed to establish the pregnant women’s knowledge, perceptions and practices regarding birth preparedness planning, complication readiness and safe motherhood at Raleigh Fitkin Memorial Hospital to help reduce some of the avoidable causes of maternal and infant mortality rates. Research design and methods An exploratory, descriptive and qualitative research design was used for the study. Women who had delivered within a period of one week were purposively selected from the research site and interviewed using a structured interview guide until saturation of data. Ethical considerations were adhered to and measures of trustworthiness were applied. Giorgi’s analytic method was used for data analysis. Findings The findings revealed that most participants were not well informed about birth preparedness although some had managed to save for baby requirements and hospital fees. Transportation to the hospital for ANC and delivery was a problem to those who ended up delivering their babies at home or on the way to hospital. Knowledge about complications of birth was poor and only a few participants could name bleeding and prolonged labour. Most participants were not sure about safe motherhood, whilst some mentioned contraception and post-natal care. Conclusion Evidence from the study reveal that as much as pregnant women prepare baby’s clothes and money for labour and delivery, psychological preparation and transport preparation seemed poor. Complication readiness was not known by most participants.
Health Studies
M.A. (Health Sciences)

碩士
國立臺北護理健康大學
護理研究所
104
Background: For there to be meaningful socio-economic development in any nation, the wellbeing of women and children should be the priority. Women and children need to be empowered; hence they are the most vulnerable to morbidity and mortality in our societies. The entire childbearing period is termed crucial to the health and survival of the mother and her newborn. In the absence of provision of adequate care during these crucial periods often results in complications, disabilities and death. Purpose: This study purpose was designed to assess knowledge of postpartum women and to explore factors associated with birth preparedness and complication readiness in rural and urban health regions of the Gambia. Method:A correlational study design was conducted in two health regions in the Gambia between July and August 2015 on BP/CR among postpartum women in rural and urban Gambia. A convenient sampling technic was used to select participants and a total of 197 postpartum women were recruited for the study out of which 98 were resided in rural areas and 99 of the respondent were resided in the urban areas of the Gambia. Structured questionnaire was used and the data was analyzed using SPSS software version 20. Result:Majority (71.4%, 83.8%) of respondents in rural and urban Gambia were within the age 20 -34 and substantial amount (53.3%) booked for ANC during second trimester (13 – 27 weeks). Follow-up visits during postpartum period was also low (4.6%) among rural and urban respondents but lower in rural (0.0%) areas than urban (9.1%). Respondents resided in both rural and urban Gambia had low knowledge of birth preparedness and complication readiness in pregnancy, labour and postpartum period. Greater proportion (90.9%) in rural and urban areas had never heard the term birth preparedness and 71.6% mentioned save money. Severe vaginal bleeding was the most common danger signs mentioned in pregnancy (48.2%), labour (33.5%), and postpartum period (40.6%). Place of residence, mother’s educational level, distance and identify skilled birth attendant in last delivery were found to be predictors of knowledge of BP/CR, and multivariate analysis revealed residence as the major contributor among the four variables (R² = 0.25, F = 15.64, p ˂ 0.001). Respondents resided in urban areas had higher mean score (8.46 ± 1.172) of knowledge than those in the rural areas (7.57 ± .732). Conclusion:postpartum follow-up visits was low in rural and urban areas studied but lower in rural areas than in urban and late ANC booking was also high in both areas. Knowledge of preparation of birth and danger signs during pregnancy, labour and postpartum was low in studied areas of rural and urban Gambia. Therefore, strengthening health education during clinic visits coupled with effective collaboration on implementation of health strategies will avail in improving services and reduce the rate of morbidity and mortality.

碩士
國立臺北護理健康大學
護理研究所
102
Awareness of ante-partum danger signs and birth preparedness is an important step in efforts aimed at reducing the high levels of reproductive morbidity and mortality. The objectives of this study were to explore pregnant women’s awareness of antepartum danger signs and birth preparedness as well as to identify associated factors in rural Gambia. A clinic based cross-sectional study design was conducted at 7 public-health centers in North Bank East involving a convenient sample of 145 pregnant women attending antenatal care services. Data was analyzed using SPSS version 18.0. Our study showed that (61%) of the pregnant women are aware of antepartum danger signs. In stepwise multiple linear analyses, awareness of antepartum danger signs was significantly predicted by age, marital status and advised on danger signs. However birth preparedness was low (14%) and multivariate logistic analysis showed that preparation was higher among literate women (OR = 7.04), employed women (OR=6.17), women with four or more antenatal visits (OR = 4.49) and women with high awareness (OR = 1.24). In conclusion awareness of antepartum danger signs is high despite deficiencies in some life threatening ones. However level of birth preparedness is low in the rural population studied. A need exits to provide antenatal care that includes sufficient information about pregnancy danger signs and birth preparedness to meet the need for safe motherhood, as pointed out by the Millennium Development Goals.

Les taux de mortalité maternelle et néonatale restent importants dans les pays en développement. L’ampleur de ces phénomènes est liée à une constellation de facteurs. Mais une part importante des issues défavorables de la grossesse et de la naissance est attribuable à des causes évitables et des comportements modifiables. Les interventions éducatives prénatales ont été élaborées dans le but d’adresser les facteurs affectant la demande de soins maternels et néonatals efficaces. Les stratégies éducatives ciblant les femmes enceintes incluent les conseils individuels, les sessions de groupes et la combinaison des deux stratégies. Ces stratégies visent à améliorer les connaissances sur les questions de santé maternelle et néonatale et à favoriser l’utilisation adéquate de soins qualifiés et les pratiques hygiéniques à domicile. L’Organisation Mondiale de la Santé (OMS) a diffusé dans les pays en développement des guides de pratiques en soins maternels et néonatals incluant les conseils de préparation à la naissance, lors des visites prénatales de routine. Toutefois, peu de données sont disponibles quant à l’efficacité et l’implantation effective de l’éducation prénatale dans les dits pays. Cette thèse cherche à mieux comprendre l’impact des programmes d’éducation prénatale implantés dans deux contextes à risques maternels et néonatals élevés au Burkina Faso. Rédigée sous forme d’articles, la thèse propose trois objectifs spécifiques : 1) examiner l’efficacité théorique des programmes d’éducation prénatale pour réduire la mortalité maternelle et néonatale dans les pays en développement; 2) évaluer l’association entre différents facteurs organisationnels et l’exposition des femmes aux conseils de préparation à la naissance qui font habituellement partie intégrante des programmes d’éducation prénatale implantés dans les services prénatals de routine; et 3) déterminer l’impact de recevoir des conseils de préparation à la naissance sur la probabilité d’accouchement institutionnel. Pour répondre au premier objectif, une méta-analyse de données issues d’essais randomisés a été effectuée. Concernant les réponses aux deux autres objectifs, les données d’une étude de cohorte rétrospective ont été utilisées. Cette étude observationnelle, conçue spécialement pour la thèse, a été menée dans deux districts à risques maternels et néonatals élevés (Dori et Koupela) du Burkina Faso. Les résultats observés à travers les trois investigations sont utiles pour l’avancement des connaissances et la pratique. La méta-analyse révèle que les interventions éducatives expérimentales sont associées à une réduction de 24% de la mortalité néonatale. Cette réduction atteint 30% dans les milieux à très forte mortalité néonatale. En situation de routine, divers facteurs organisationnels peuvent limiter ou faciliter la transmission des conseils éducatifs aux femmes usagères de soins prénatals. Au, Burkina Faso, les données analysées indiquent des fortes disparités entre les deux districts à l’étude. Les femmes du district de Koupela étaient significativement plus exposées aux conseils que celles de Dori. Au delà de cette disparité régionale, deux autres facteurs organisationnels sont fortement associés à l’exposition des femmes aux conseils de préparation à la naissance lors des visites prénatales de routine. Il s’agit de la disponibilité de supports de communication imagés dans l’établissement et le volume réduit de consultations par jour (moins de 20 consultations en moyenne versus 20 ou plus) augurant de moindres charges de travail pour le personnel. Enfin, les conseils reçus par les femmes sur les signes de complications obstétricales et sur les coûts des soins sont significativement associés à une probabilité plus élevée d’accoucher en institution; et ce, seulement dans le district de Dori où le taux d’accouchements institutionnels était relativement faible. En conclusion, l’éducation prénatale est bénéfique pour la sante maternelle et néonatale. Cependant, l’implantation et les effets sont hétérogènes selon les milieux. D’autres études expérimentales et observationnelles sont requises pour renforcer les évidences et investiguer plus en profondeur les facteurs de réussite afin de mieux orienter l’intervention. Les expérimentations futures devraient mesurer des issues de grossesses relatives à la mère (l’assistance qualifiée, les soins postpartum et la mortalité maternelle). Des études de cohorte prospectives avec des grands échantillons représentatifs permettraient de documenter de façon plus valide les événements et les expositions aux interventions durant la grossesse, l’accouchement et le postpartum.
Maternal and neonatal mortality remain high in developing countries. The magnitude of these phenomena is related to a constellation of factors. But a significant proportion of adverse pregnancy and birth outcome, in poor area, are attributable to preventable and behaviourally modifiable causes. Prenatal educational interventions have been developed in order to address the factors affecting the demand for effective maternal and neonatal care. Educational strategies targeting pregnant women include individual counselling, group sessions, and the combination of both strategies. These strategies aim to improve knowledge on issues related to maternal and newborn health and to promote the appropriate use of skilled care and hygiene practices at home. The World Health Organization (WHO) released practice guidelines in developing countries related to maternal and neonatal care including birth preparedness, during routine prenatal visits. However, few data are available about the effectiveness and implementation of effective prenatal education in these countries. This thesis aims to understand the impact of prenatal education programs in two contexts in Burkina Faso where maternal and neonatal risk are high. Written in the form of articles, the thesis addresses three specific objectives namely to: 1) examine the efficacy of prenatal education programs to reduce maternal and neonatal mortality in developing countries, 2) assess the association between different organizational factors and women’s exposure to birth preparedness messages during routine antenatal care, and 3) determine the impact of receiving birth preparedness advice on the likelihood of institutional delivery. For the first objective, a meta-analysis of data from randomized trials was conducted. To achieve the two other objectives, data from a retrospective cohort study were used. This observational study, designed specifically for the thesis, was conducted in two districts (Dori and Koupela) in Burkina Faso. The meta-analysis showed that educational interventions are associated with a 24% reduction in neonatal mortality. This reduction reached 30% in areas with very high neonatal mortality. In routine situations, organizational factors may limit or facilitate the transmission of educational advice to women using prenatal care. In Burkina Faso, the data indicate significant disparities between the two districts in the study. Women from Koupela district were significantly more exposed to advice than those from Dori. Beyond this regional disparity, two other organizational factors were strongly associated with exposure of women to birth preparedness counselling during routine prenatal visits. The first factor was the availability of print materials and aids (e.g., posters, pictures…), used by health professionals as communication support to provide prenatal clients with advice. The second factor was a lower volume of daily consultations (i.e., less than 20 consultations versus 20 or more) which meant lower workload for staff. Finally, advice received by women concerning signs of obstetric complications and costs of care were associated with a significantly higher likelihood of institutional deliveries but only in the district of Dori where the initial rate of institutional deliveries was relatively low. In conclusion, prenatal education is beneficial for maternal and newborn health. However, implementation and effect heterogeneities exist across contexts. Others experimental and observational studies are required to strengthen the evidence and more thoroughly investigate success factors in order to support policies. Future experiments should focus on maternal outcomes (i.e., skilled birth attendance, postpartum care, and maternal mortality). Prospective cohort studies with large and representative samples would allow for examination of events and exposures to interventions during pregnancy, childbirth, and post-partum.

ABSTRACT Background: Mothers experienced enormous physical and emotional changes, especially during childbirth. Birth support role of husbands reassured both husband and wife about labor and birth. This study aimed to review the first-time advisory experience of husbands during labor time of primigravida wife. Subjects and Method: A scoping review method was conducted in eight stages including (1) Identification of study problems; (2) Determining priority problem and study question; (3) Determining framework; (4) Literature searching; (5) Article selection; (6) Critical appraisal; (7) Data extraction; and (8) Mapping. The search included ScienceDirect, Wiley Online Library, ProQuest, and grey literature through Google Scholar search engine databases. The inclusion criteria were English/ Indonesian-language and full-text articles in peer-reviewed journals published between 2009 and 2019. A total of 543,111 articles were obtained by the searched database. After the review process, six articles were eligible for this review. The data were reported by the PRISMA flow chart. Results: Six articles from developed countries (Australia, Sweden, Singapore, Israel, and England) met the inclusion criteria with qualitative and quantitative (cross-sectional) studies. Three main aspects discussed were support, challenges, and psychological conditions of experience of husbands during labor time of pregnancy. Support of husbands was identified as physical and moral. Challenges faced by husbands included lack of preparedness, knowledge, and encouragement from health care professionals. Psychological conditions of satisfaction and concern were found in husbands’ transition to fatherhood. Conclusion: Responsibility, emotion, experience, and barrier of husbands are related to maternal health problems. Better involvement of fathers will be able to enhance better quality of relationships and family health through understanding, experience, and assistance, especially in the childbirth process. Keywords: advisory, husbands, experience, labor, pregnancy Correspondence: Nuristy Brillian Ainindyahsari Winarna. Universitas ‘Aisyiyah Yogyakarta. Jl. Siliwangi (Ring Road Barat) No 63 Mlangi, Nogotirto, Gamping, Sleman, Yogyakarta, 55292. Email: nuristybrillian02@gmail.com. Mobile: +6285338800207. DOI: https://doi.org/10.26911/the7thicph.03.66