Birth Preparedness

Obstetric emergencies need prior preparation. ‘Birth Preparedness and Complication Readiness’ (BPCR) is a concept that promotes timely maternal care.

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Objectives This study assessed BPCR and associated factors among pregnant women attending antenatal clinics (ANCs) in MOH area Padukka.

Methods A descriptive cross-sectional study was carried out in 2014, among a random sample of 280 third trimester pregnant women, attending ANCs in MOH area Padukka. Data were collected using a pre-tested interviewer administered questionnaire. Satisfactory BPCR was if accomplished ≥6 components of 8; desired place of birth, closest care facility, birth-related expenses, emergency expenses, person to accompany, arrangements to look after other children, transport for birth, transport in an obstetric emergency.

Result Response rate was 95.9% (n=269). Median age was 29 years (IQR; 25–32). Pregnancy was planned by 84.0% (n=226), 81.0% (n=218) had registered with PHM ≤8 weeks, 58.4% (n=157) had attended ≥5 ANCs, 10.8% (n=29) had attended all ante-natal classes, 75.8% (n=204) had discussed BPCR plan with healthcare provider. Only 60.2% (n=162) had satisfactory knowledge on pregnancy, delivery and post-partum danger signs, 75.0% (n=207) had favourable attitudes towards BPCR, 68.6% (n=185) had favourable perceptions on BPCR services. Of them 86.2% (n=232) had satisfactory BPCR which was significantly associated with planned pregnancy, registration ≤8 weeks, ≥5 ANCs, ≥1 antenatal classes, discussing BPCR plan with healthcare provider, knowledge on pregnancy and post-partum danger signs, favourable attitudes and favourable perceptions (p<0.05).Birth Preparedness And Complication Readiness Among Couples Essay

Each day, for thousands of women and their families, the event of childbirth becomes a reason of unnecessary suffering due to acute obstetric complications and maternal deaths [1, 2]. In 2015 there were an estimated 303,000 maternal deaths globally, the majority of which occurred in sub-Saharan Africa (66%) followed by South Asia (22%)[3]. Bangladesh is one of ten countries that accounts for nearly 60% of the global burden of maternal mortality [4]. Although the maternal mortality ratio (MMR) in Bangladesh declined by 40% from 322 per 100,000 live births in 2001 to 176 per 100,00 live births in 2015 almost achieving the target for MDG 5, the burden of direct obstetric care deaths in the country remains high, comprising almost two-thirds of maternal deaths [4, 5].

To meet the recently agreed upon Sustainable Development Goal (SDG) of achieving a global MMR of 70 requires that countries attain an annual rate of reduction in maternal mortality of 7.5% per year between 2016 and 2030. For Bangladesh, this requires accelerating reductions from the current annual rate of 5.4% [5]. Most maternal deaths can be prevented by ensuring that every mother is attended by a skilled provider during birth, and that the birth takes place in a health facility where access to emergency obstetric care can be ensured [6]. In 2014, only 42% of women in Bangladesh delivered with a skilled birth attendant and 37% delivered at a health facility [7]. Being adequately prepared for birth and for emergency complications can be life-saving for mothers and their newborns, as it reduces delays associated with care-seeking for obstetric emergencies that contribute to the majority of maternal deaths in low-income settings [1].Birth Preparedness And Complication Readiness Among Couples Essay

Birth Preparedness and Complication Readiness (BPCR) is a key component of safe motherhood programmes and a comprehensive strategy aimed at reducing delays around care-seeking, reaching and receiving care during birth, and promoting skilled care at delivery and in the immediate postnatal period [8–10]. It encourages pregnant women to plan and prepare for birth during the antenatal period in the case that unexpected adverse events arise. In particular, BPCR encourages women and families to identify a birth attendant, place for delivery, and make arrangements for transport and money for every birth [11–13]. BPCR ensures that women will reach care before developing any potential complications during childbirth, thereby preventing both maternal and newborn deaths and contributing to progress towards achieving the Sustainable Development Goals to reduce these deaths [8, 14].

BPCR interventions have been widely used and accepted as a strategy for reducing maternal and newborn deaths in several countries [13, 15]. A recent meta-analysis demonstrated that exposure to BPCR interventions was associated with an 18% reduction in neonatal mortality risk and a 28% reduction of in maternal mortality risk [14]. Several studies have shown the positive impact of birth planning on facilitating use of SBAs and increasing facility deliveries [14, 16–18], however a recent systematic review found that although BPCR interventions can result in improved knowledge in preparation for birth and complication it does not always result in increased use of birth attendants [19]. In Nepal, newborn care practices increased significantly from 19 to 29 percentage points when women were exposed to birth preparedness messages [20]. BPCR also helps improve postnatal care (PNC) practices such as care seeking for newborn illness, clean cutting of the umbilical cord and breastfeeding within the first hour after birth [14].Birth Preparedness And Complication Readiness Among Couples Essay

Despite the low quality of existing evidence demonstrating its effectiveness for increasing skilled birth attendance and facility deliveries, BPCR interventions are recommended by the World Health Organization (WHO) to be included as an essential part of ANC packages for women [21]. The key components recommended for inclusion in BPCR interventions are: deciding on the place of birth, birth attendant, knowing the location of the nearest facility for the birth or if complication arise, preparing funds for expenses and any supplies or materials to take the facility, identifying support person to care for other children, arranging transportation to facility or in case of complications, and identification of blood donor. Generally countries adapt the components of BPCR interventions for their context and not all are included in BPCR packages.Birth Preparedness And Complication Readiness Among Couples Essay

BPCR packages can reduce maternal and child mortality through improvement in knowledge, practices and care seeking behavior, little is known about the current status of BPCR in Bangladesh, especially in low performing hard-to-reach districts which experience much higher rates of maternal mortality compared to national estimates [22]. In Bangladesh, hard-to-reach areas are those geographically very remote regions with difficult terrain that are accessible only by boat or foot. There are no paved roads and they are often prone to severe flooding and are particularly vulnerable to climate change. These include remote hilly, and low-lying areas referred to as Haor and Char areas. A Haor is a wet land ecosystem in the north-east of Bangladesh (approximately 80,000 km2) which physically is a bowl or saucer- shaped shallow depression also known as a back swamp area and floods every monsoon. Chars are vegetated islands within river banks and are also extremely difficult to access and prone to frequent flooding and erosion [23]. The Government of Bangladesh recognises 23 sub-districts in the country as hard-to reach and provides a hardship allowance to government service provider working in these regions. These areas comprise around 20% of the geographical area of Bangladesh and are home to an estimated 29 million people [24]. Health care access and coverage of key interventions is a major challenge in these areas, particularly during the rainy season when certain areas can be under water for half the year [25]. Geographical barriers, poor road conditions and the lack of transportation make it difficult to reach the health facility and contribute to low levels of utilization of skilled care during and after childbirth. Compounding these challenges is also a shortage of health service providers in these regions.Birth Preparedness And Complication Readiness Among Couples Essay

This paper presents the findings on BPCR practices of recently delivered women (RDW) from a paired cluster-randomized controlled trial conducted in 14 sub-districts of five low performing districts of Bangladesh to evaluate a Maternal, Neonatal and Child Survival intervention program. In the analysis presented here, we aimed to assess the magnitude of BPCR related activities, and identify determining factors of better birth preparedness and their effect on maternal and newborn health care practices in hard-to-reach populations in Bangladesh. The findings will inform policy and program makers around designing interventions to improve maternal and neonatal health outcomes in hard-to-reach areas of Bangladesh.

Methods

Study design and setting

This analysis uses data from the endline survey of a paired cluster-randomized controlled trial carried out in 14 sub-districts of five hard-to-reach districts (Bandarban, Gopalganj, Kishoreganj, Netrokona and Sunamganj) in Bangladesh between 2009 and 2012 (Fig 1). These sub-districts cover an area of approximately 4640 km2 with population around 2.5 millions. Each sub-district is characterized by a distinct terrain type;Alikadam and Naikhoncchari sub-district of Bandarban districts are hilly, Sulla and Tahirpur sub-district of Sunamgonj district, Mithamoin, Austogram of Kishorgonj and Khaliajuri of Netrokona districts are haors. Rest of the sub-districts of Sunamganj, Kishoreganj and Netrokona are partially haor. The Muksudpur and Kotalipara of Gopalganj district are riverine plain land with some chars. These sub-districts have very low levels of utilization of health services. In 2010 the percentage of births attended by skilled providers ranged from 10.6% in Sunamganj to 31.4% in Gopalganj, while the proportion of births conducted at health facilities was as low as 9.3% in Sunamganj and was highest in Gopalganj at 23.1% [26]. The aim of the trial was to evaluate an integrated package of Maternal, Neonatal and Child Survival (MNCS) interventions implemented by the Ministry of Health and Family Welfare, Government of Bangladesh (GoB) and UNICEF, in partnership with NGOs, with support from AusAID. The integrated package aimed to accelerate achievements towards meeting MDGs 4 and 5 and included (1) EPI-plus package that promoted immunization, de-worming and distributing vitamin A supplementation; (2) IMCI-plus package focusing on the prevention and treatment of newborn and child illnesses by families, communities and health facilities as well as appropriate feeding practices. (3) ANC-plus package that promoted minimum three antenatal care (ANC) and at least one postnatal care (PNC) from a trained health provider, referral and linkage to the existing GoB and NGO projects such as demand side financing, maternal voucher scheme etc. The channels for reaching the communities included home visits and community case management by community-based GoB/ NGO health workers and community support groups. In addition, local village practitioners (village doctors) were trained to reduce harmful practices and practice appropriate referral. Baseline (2009) and end line (2012) cross-sectional surveys were carried out in all sub-districts of the intervention and comparison arms for the evaluation.Birth Preparedness And Complication Readiness Among Couples Essay

CHAPTER ONE

INTRODUCTION

Background to the Study

It is true that birth of baby precedes celebration but it equally poses source of concern as pregnancy and childbirth is sometimes a perilous journey especially in the developing countries, where the risk of a woman dying from pregnancy and related complications is almost 40 times greater than that of her counterparts in developed countries (Benson & Yinger, 2002). Maternal mortality remains a public health challenge world wide, and the global maternal mortality ratio of 525 per 100,000 live births annually is still unacceptably high (Hogan, 2010). A disproportionately high burden of these maternal deaths is borne by developing countries including Nigeria, with a maternal mortality ratio of 500– 1,000 per 100,000 live births (World Bank, 2013). These deaths arise from pregnancy, childbirth or postpartum complications. According to WHO (2009), maternal deaths are thought to occur in developing countries due to delay in deciding to seek appropriate care, delay in reaching an appropriate health facility, and delay in receiving adequate emergency care once at a facility. These delays may be reduced if pregnant women and their families are prepared for birth and its complications. Birth preparedness and complication readiness strategy is therefore, very relevant in this regard.This strategy can reduce the number of women dying from complications due to such delays by making a birth plan that constitutes birth-preparedness and complication-readiness measures for pregnant women, their spouses and their families (McPherson, Khadka, Moore & Sharma, 2006). Birth Preparedness And Complication Readiness Among Couples Essay

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