Birth preparedness and place of delivery among mothers in Koboko district, Uganda

Abstract

Birth Preparedness (BP) and Complication Readiness (CR) has been pointed out to have a critical role in increasing use of professional obstetric care or health facility childbirth. But there is still limited evidence on the extent to which BP and CR contributes to health facility childbirth or use of professional obstetric care. A community based unmatched case control study was conducted among 346 mothers, 108 cases and 238 controls with a non-response rate of 4.7% in Koboko district, Uganda to examine the relationship between BP/CR and health facility use for childbirth. The sample size was estimated using two population proportions formulae: - “Epi-info7 Stat Calc sample size for unmatched case control study”. Respondents were selected using simple random sampling technique. An interviewer administered, pre-tested and standardized questionnaire was used to collect data. Data was entered and analyzed using SPSS version-22.0 for windows. Results were expressed in frequencies, proportions for Cases and controls. Bivariate and multivariate analysis was performed to assess the relationship between BP/CR and place of delivery. Ethical approval was obtained from Uganda National Council of Science and Technology (UNCST). Generally, cases and controls showed uniform socio-demographic characteristics; 103 (95.4%) cases and 229 (96.2%) married, 34 (31.5%) cases and 79 (33.2%) controls in age group 20 – 24 years, 10 (9.3%) cases and 33 (13.9%) had secondary and post-secondary education. After adjusting for the effect of other variables, the odds of facility delivery in mothers who had adequate Birth Preparedness and Complication Readiness were almost 6 times the odds of health facility delivery for mothers who had inadequate Birth Preparedness and Complication Readiness (aOR = 5.849, p = <.001, 95% CI: 3.009 - 11.371). The odds of Health facility delivery in respondents whose spouses made the final decision on place of delivery or made decision on place of delivery together with their spouses were 5.2 times the odds of health facility delivery for respondents who made the decision themselves (aOR = 5.266, p = <.001, 95% CI: 2.369 - 11.705). Finally, the odds of health facility delivery increased as the number of ANC visits increased, respondents who had 1-3 ANC visits had 2.5 times odds of health facility delivery compared to xvii the respondents who had no ANC visit in their last pregnancy (aOR = 2.496, p = .036, 95% CI: 1.062, 5.870) while the odds of health facility delivery for respondents who made up to 4 and more ANC visits were 4 times compared to respondents who had no ANC visit (aOR = 3.964, p = < .019, 95% CI: 1.254, 12.536). Mother’s level of birth preparedness and complication readiness ahead of childbirth had an independent effect on place of delivery. A mother who had adequate level of birth preparedness and complication readiness had a better chance of health facility delivery than one with no or inadequate BPCR. The study also showed increased number of ANC visits and involvement of spouse in decision making on place of delivery as other important predictors of place of birth. Increase sensitization on BP/CR and ANC among women and communities so that pregnant women have adequate preparation ahead of childbirth, begin attending ANC early and complete recommended visits. Increased awareness for male involvement for reproductive health at health facility and community level.