Tsige
Tsige
Tsige
MAY 2018
ARBA MINCH
ETHIOPIA
0
Name of Investigator TSIGEREDS ABATHUN
ASSESSMENT OF BIRTH PREPAREDNESS
Full Title Of The Research Project AMONG ANTENATAL CARE CLIENTS.
1
Acknowledgements
I am grateful to God the almighty for giving me the knowledge and to prepare this proposal.
I also wish to express my deep appreciation to instructor Agegnehu Bante and Dinkalem for
the influence they have had on my professional growth
Lastly I would like to thank the south regional government health burro and my Hospital for
giving me the chance to study my BSC degree.
Acronyms
AMU -Arba Minch University
ANC -Antenatal care
BMO -Basic management of obstetric
CI -Confidence interval
EDHS -Ethiopian Demographic and Health Survey
EMOC –Emergency Management of Obstetric Care
JHPIEGO-Johns Hopkins Program for International Education in Gynecology and
Obstetrics
MMR -Maternal mortality ratio
NMR -Neonatal Mortality Rate
SNNPR -Southern nation’s nationalities and peoples region
OR -Odds Ratio
SBA -skilled birth attendance
SPSS -statistical package for social science
SSA -Sub Saharan Africa
WHO - World health organization
Summary
Introduction: Birth preparedness and complication readiness is the process of planning for
normal birth and anticipating the actions needed in case of an emergency. It promotes active
preparation and decision making for delivery by pregnant women and their families. Lack of
advance planning for use of a skilled birth attendant for normal births, and particularly
inadequate preparation for rapid action in the event of obstetric complications, are well
documented factors contributing to delay in receiving skilled obstetric care.
Study objective: To assess birth preparedness and associated factors among antenatal clients
in Arbminch hospital and two urban health center, Gamo Gofa zone, Ethiopia, 2018.
Methods: A quantitative cross -sectional study design will be conducted from May 2018 to
Jun 2018 in Arbaminch town . A A total of 354 pregnant mothers will be taken from
Arbaminch general hospital, Arbaminch Health center and Shecha health centre study
subjects will be selected by systematic sampling technique. Data will be collected using
structured interviewer administered questionnaire. Six diploma graduate nurse data
collectors. Descriptive, binary and multiple logistic regression analyses will be conducted.
Statistically significant tests will be declared at a level of P value < 0.05.
Budget and work plan: The study will be conducted from May2018 to November 2019
starting from data collection through final dissemination, with an estimated Budget of 18169
Eth birr.
Contents
Acknowledgements...................................................................................................................iii
Acronyms...................................................................................................................................iv
Summary.....................................................................................................................................v
1. INTRODUCTION..................................................................................................................1
1.1 BACK GROUND..............................................................................................................1
1.2 STATEMENT OF THE PROBLEM.................................................................................2
1.3. JUSTIFICATION OF THE PROPOSED STUDY...........................................................3
2. LITERATURE REVIEW........................................................................................................4
2.1 Definition and concepts of birth preparedness..................................................................4
2.2 Magnitude of maternal morbidity and mortality...............................................................4
2.3 Components of birth preparedness....................................................................................5
2.4 Causes for less preparedness for birth...............................................................................6
2.5 Factors affecting birth preparedness..................................................................................6
2.5.1 Socioeconomic and demographic factors:..................................................................6
2.5.2 Knowledge on danger signs during pregnancy...........................................................7
2.5.3 Obstetric factors:.........................................................................................................8
3. OBJECTIVES.........................................................................................................................9
3.1 General Objective..............................................................................................................9
3.2 Specific objectives.............................................................................................................9
4. METHODS...........................................................................................................................10
4.1 Study design and Study period........................................................................................10
4.2Study area.........................................................................................................................10
4.3Source population and Study population:........................................................................10
4.4 Sample size and Sampling procedures............................................................................10
4.5 Variables of the study......................................................................................................13
4.6 Operational definitions....................................................................................................13
4.7 Data collection tools and procedures..............................................................................13
4.8 Data quality management................................................................................................14
4.9Data processing and analysis............................................................................................15
5. ETHICAL CONSIDERATION.............................................................................................16
6. DISSEMINATION OF RESULTS........................................................................................17
7. WORK PLAN.......................................................................................................................18
8. COST OF THE PROJECT....................................................................................................19
9. REFERENCE........................................................................................................................21
10. ANNEXES..........................................................................................................................23
Annex-1: Declaration............................................................................................................23
Annex-2: Assurance of Investigator......................................................................................23
Annex 3፡Participant information sheet and consent form.....................................................25
Annex 4.English and Amharic version questionnaires..........................................................27
1. INTRODUCTION
As to researcher’s knowledge no study was found in Gamo Gofa Zone, therefore, this study
will provide basic data on the issue that may help health workers and policy makers to
implement and scale up safe mother hood program in an attempt to reduce the highest
maternal mortality rate and neonatal mortality rate of Ethiopia. Therefore, this paper is
designed to evaluate birth preparedness and factors associated with their practices among
antenatal care clients, in Arbaminch town governmental institutions
2. LITERATURE REVIEW
Pregnancy and childbirth and their complications are the leading causes of death, disease and
disability among women of reproductive age in developing countries more than any other
single health problem (16).
Globally, it is estimated that half a million women die each year during pregnancy and
childbirth, with over half of these deaths occurring in Africa. This is particularly worrying in
sub-Saharan Africa where more than 300,000 women still die each year during pregnancy and
childbirth; most of them die because they lack access to skilled delivery attendance and
emergency care (19, 20).
In Ethiopia, maternal mortality was still unacceptably high at 1.14 maternal deaths per 1000
woman-years in 2011.There was no significant reduction in the maternal mortality rate
between 2005 and 2011, according to the Ethiopian Demographic and Health Surveys (21,
22).
Based on the study done in different part of the world pregnant women were not found to be
well prepared for birth and its complication. For example only 47.8% women who have
already given birth in Indore city in India (12), 35% of pregnant women in Uganda (13) and
27.5% in Northern Nigeria were prepared for birth and its complication (23).
Additionally, studies conducted in some parts of Ethiopia showed that only 29.9% women
who have already given birth in Goba woreda of Oromia region (24), 16.5% women who have
already given birth in Robe woreda of Oromia region (25), and 22% of pregnant women in
Aleta wondo of Southern region were prepared for birth and its complication (15).
The components mostly used by researchers to measure birth preparedness and complication
readiness are varied, and some researchers used mean score by taking the three components;
plan where to give birth, plan to save money and plan for transportation (14, 26).
Identification of place of delivery is very important especially in the setting where the main
means to get a skilled provider is to deliver at health institutions. Money saved by woman or
her family can pay for health services and supplies, vital for transport, or others costs (7, 13).
A study done in rural Uganda, considering the four birth preparedness practices; 61% of the
respondents had identified a health professional, 91% had saved money, and 61% had
identified means of transport while 71% had bought delivery kits/birth materials during their
most recent pregnancy (13).
Additionally, cross-sectional studies conducted in Robe woreda and Adigrat town, of the total
respondents 76.3% ,68.9% saved money ,45.6%,78% identified place of
delivery,28.5%,24.7% identified a mode of transport and 3%,65% identified a skilled provider
respectively (25,14).
Regarding some of the factors affecting birth preparedness and complication readiness, the
study conducted in different parts of Ethiopia shows; age of the woman, marital status,
educational status of the women, husband's occupation of employed or merchant, third or
above wealth quintiles, were found to increase the likelihood of preparation for birth and its
complications. (14, 27)
Across sectional study conducted in Robe woreda of Oromia region indicated that educated
mothers were six time more likely to be prepared for birth and its complication than illiterate.
Similarly the study showed that monthly income also found to be predictor for birth
preparedness and complication readiness and mothers who had better income were two times
more likely to prepare for birth and its complication than mothers who had less monthly
income (25)
Obstetric Factors
Gravidity
Parity
ANC visit
Pregnancy outcome
Gestational age
4.2Study area
Arbaminch town is the administrative sit of Gamo Gofa Zone, located at 505Km in south of
Addis Ababa, the capital city of Ethiopia and 275km south west of Hawassa, the capital city
of Southern Nations Nationalities and Peoples of regional government. It has 2 subdivisions;
Secha and Sikela, each 5kms apart and it has a total population of 125,411, of which
reproductive age women accounted 29,220. The town has 1 zonal hospital & 2 governmental
health centers.
Inclusion criteria:
Pregnant mothers who are attending first and above ANC visits.
Exclusion criteria:
The required sample size of clients is determined by using the formula for single population
proportion= (z α/2)2* p (1-p)/d2.
The sample size is calculated using single proportion formula taking the following
assumption.
( Z α /2)2 P(1−P)
n=
d2
(1.96 )2 0.299( 1−0.299)
n=
( 0.05)2
n= 322*0.1=32+322=354
Adding 10% for non-response rate the final sample size becomes 354.
According to studies done in Ethiopia, proportion for birth preparedness is 25.3% for
educational status of mothers, 43.5% for history of still birth, 26.9% for parity (14) and 21.1%
for knowledge on danger sign during pregnancy (15).Assumed proportion in birth
preparedness of educational status of mothers 25.3 % is the bigger sample size than the other
independent variables. So the assumed total sample size will be 458 clients. Epi info Version 7
is applied to calculate the sample size.
Table1. Sample size calculated for different independent variables for birth
preparedness.
Sampling procedure
. A systematic population proportion sampling technique will be used to select study
participants from pregnant mothers attending ANC in all Governmental health institutions
during the time of data collection. From previous records there were around 750 recorded
ANC visits in Arbaminch general hospital, Arbaminch health center and Secha Health center
within a single month. Based on this assumption the same number of clients will be expected
to visit the ANC clinic within the study period. So that the sample population will be selected
from both areas proportional to their clients; which was 420, 250 and 40 clients in AMGH,
AMHC and SHC respectively. Therefore the interval for the sample will be total samples over
the sample size needed. i.e. k= 710/354 2. For each health institution the sampling will be
started from the client who comes first or second by determining in lottery method and the
next will be by adding the interval
322 participants
Independent
Socioeconomic and demographic factors:
Age
Marital status
Religion
Ethnicity
Education
Income
Family size
Husband’s factors
Age
Occupation
Education
Obstetric factors
Gravidity
Parity
knowledge on danger signs during pregnancy
History of still birth
The model will be evaluated using backward stepwise selection method. Factors that show
association in bivariate analysis and which has P-value less than 0.2 will be entered in to
multiple logistic regression models for controlling confounding factors and to identify
significant factors. Chi-square test and their p-values at the level of significance of 5% will be
used to define statistical associations between variables. The strength of statistical association
will be measured by adjusted odds ratios, 95% confidence intervals, and P-value <0.05 will be
considered as significant.
5. ETHICAL CONSIDERATION
The survey will be conducted after obtaining ethical clearance from IRB (Institutional Review
board) of AMU and a letter of permission from IRB will be obtained from AMU, and in turn
the town Administration Office will write a letter for study Hospital and HC to get
recognition and collaboration. Informed written consent will be obtained from respondents
after explaining the objective of the study. At the end of the interview health information
regarding birth preparedness and how to respond to them will be provided. In addition, all the
responses will be kept confidential and by making the questionnaire anonymous.
6. DISSEMINATION OF RESULTS
Official result will be approved by the Research Committee of Arba Minch University. The
results will be communicated to Arbaminch town health department hard and soft copy will
be available in the library of AMU for graduate students as well as for other concerned
readers. Identify different partners and potential contributors for solving the existed problem
to promote utilization of research findings and disseminating information through appropriate
channels.
7. WORK PLAN
Data Entry PI
Thesis defense PI
Finalizing thesis PI
Pens Number 8 4 32
CD rewriteable Each 2 25 50
Annex-1: Declaration
I, the undersigned, Neonatology student declare that this thesis is my original work in partial
fulfillment of the requirement for the degree.
Signature: ______________
Place of submission: Department of Nursing, College of Medicine and Health Sciences, Arba
Minch University.
Advisors
Name Signature
___________________
__
Annex-2: Assurance of Investigator
The undersigned agrees to accept responsibility for the scientific, ethical and technical
conduct of the research project and for provision of required progress reports as pre terms and
conditions of the research and publications office of the Arba Minch University.
Advisors
1. _ _______________ _______________
Department of Nursing
Introduction: Dear respondent, I am going to include you in my study if you are willing to
participate. Please understand the situation with this study before deciding to participate or
not. You have information below.
Purpose of the study: To assess practices and factors that affect birth preparedness. This
study will be beneficial to identify areas of improvement in birth preparedness and produce
relevant information for policy makers which will be helpful in the planning and
implementation of intervention activities to improve maternal and neonatal health.
Procedure: Today, I am going to conduct face to face interview with you and other randomly
selected members of antenatal clients. If you are willing to participate in our project, you will
be asked to give your response. The interview will take approximately 20 minute.
Benefits of the study: The information you provide will benefit the general public (pregnant
mothers) when the findings of this study is acted upon.
Incentives: You will not be provided any payment to take part in this study.
Confidentiality and Anonymity: The information that we will collect from this research
project will be kept confidential and stored in a file which will not have your name on it, but a
code number assign to it. And also it will not be revealed to anyone except the principal
investigator.
Right to refuse or withdraw: You have the full right to refuse from participating in this
research, if you do not wish to participate; and this will not affect your health services you get
from any health facilities.
Person to contact: If you have any questions or concerns or more explanation about the
research, you can contact at the following address.
I temporarily represent Arba Minch University, college of Medicine and health science,
Department of Nursing. The research is purely for the academic purpose. This is a study to be
conducted with the objective of assessing practices with respect to birth preparedness and
factors associated with their practices among women who are antenatal clients in Arbaminch
town . As this study is directly related to women who are antenatal clients, you are one of the
women who have been selected randomly to participate in this study. Participation to this
study is strictly voluntarily and anonymity will be respected.
You are required to fill this questionnaire with the options that best represent your response
and your responses will be kept confidential and there will be no way of linking your
individual responses to the final results of the study findings. We would like to inform you
that the responses that you provide to the questions are very essential, not only, for the
successful accomplishment of the study, but also for producing relevant information which
will be helpful in the planning and implementation of intervention activities to prevent delays
and improve maternal and neonatal health.
Yes; ----proceed with the interview No; ---- thank her and End.
302 If yes, what are the danger signs? Circle the 1. Swelling of leg/face
mentioned responses. 2. Vaginal bleeding
3. Reduced/absence of fetal movement
4. Severe headache
5. Severe abdominal pain
6. Excessive weight gain
7. Convulsion
8. Severe difficulty of breathing
9. Leakage of amniotic fluid without
labor
10. High fever
11. Blurring of vision
97.Other specify-----
የጥናቱ ርዕስ: ይህ ጥናት የሚካሄደው እርጉዞች ለወሊድ ዝግጅትና ልያጋጥሙ የሚችሉ ችግሮች ተዘጋጅቶ ስለመጥበቅ
ያላቸው እውቀትና ተግባር እንዲሁም ከተግባር ጋር የተያያዙ ጉዳዮችን ለመፈተሽ ነው።
የአጥኚው ስም፡
የጥናቱ ዓላማ: ጥናት ዉስጥ ለማጥናት የተፈለገዉ በእርግዝና ውቅት፣ በመውለድ ጊዜ እና ከውሊድ በኋላ ለሚያጋጥሙ
የጤና ችግሮች ለመፍታት ያለመዘናጋት ለመቀነስ አስፈላጊ የሆነ እቅድ ለማውጣትና በተግባር ለማዋል የእናቶችና አዲስ
ለሚወለዱ ህፃናት ህይወት ለማዳን የሚጠቅም ማስረጃ ለማግኘት ። ይህም ጥናት በአርባምንጭ ዩኒቨርስቲ ትምህርት
ዲግሪ ለሚሰጠዉ ትምህርት እንደማማያ ነዉ::
አደጋ/ጉዳት: በዚህ ጥናት ዉስጥ በመሳተፎ የሚደርስቦት ጉዳት ወይም አደጋ ምንም የለም::
ጥቅም: በዚህ ጥናት ዉስጥ በመሳተፎ ምክንያት በጥናቱ የተገኘዉን ወቅታዊ መረጃ ተጠቃሚና ለሕብረተሰቡ በሚደረገዉ
የተሻለ የኑሮ ዕቅድ የሚያበረክቱት አስተዋፅዖ ከፍተኛ ነዉ::
ሚስጥራዊነት: የተሰበሰበዉ መረጃ ሚስጥራዊነቱ የተጠበቀ ነዉ:: በዚህ የመጠይቅ ወረቀት ላይ ስሞትን አንፅፍም::
መብት: በጥናቱ ያለመሳተፍ ሊያገኙት ከሚገባዉ የትኛዉም ጥቅም አያጎድሎትም:: በየትኛዉም የጥናቱ ጊዜ የማቃረጥ
መብትዎ የተጠበቀና ምንም ዓይነት ጉዳት የማያደርስ ነዉ::
ካሳ: በዚህ ጥናት ዉስጥ በመሳተፎ ምክንያት የሚያወጡት ወጪ ምንም የለም:: ከመረጃ ሰቢሳቢዎች ጋር ከሚታሳልፉት
የመጠይቅ ጊዜ ዉጪ ምንም ዓይነት ወጪ አይኖርም:: እባኮትን ለተጨማሪ መረጃና የጥናቱን ሂደት ለመጠየቅ
አያንገራግሩ::
ለተማላ አድራሻ
ቦታ፡አርባምንጭ
SÓu=Á
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002. ወረዳ………………………………
003. k በለ……………………………….
004. ጠና ጣቢያ……………………..
103 1. ዐርቶዶክስ
የትኛው ሐይማኖት ተከታይ ነዎት? 2. እስልምና
3. ፕሮተስታነት
4. ባህላዊ
104 1. ጋሞ
የትኛው ብሔር አባል ነዎት? 2. ዎላይታ
3. Ôó
4. አማራ
97. ሌላ………………..
201
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203 የእርግዛናዎችዎ ዉጤቶች እንዴት ነበሩ; ጠቅላላ በህይወት የተወለዱ-------------
እርግዝናዎችን በማስታወስ ለእያንዳንዱ ሞቶ የተወለዱ --------------
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