Skip to content

Advertisement

  • Research note
  • Open Access

Women’s knowledge and associated factors on preconception care at Public Health Institution in Hawassa City, South Ethiopia

BMC Research Notes201811:841

https://doi.org/10.1186/s13104-018-3951-z

  • Received: 5 October 2018
  • Accepted: 23 November 2018
  • Published:

Abstract

Objective

Preconception care is pivotal to improve pregnancy and birth outcome. It is vital for the future health of mother, her child and her family, which is routinely practice. The study aims to assess knowledge of preconception care and associated factors in post natal women at public health institution in Hawassa city, South Ethiopia.

Results

In this study 20% (95% CI 16.9, 23.1) of post natal women at public health institution had a good level of knowledge on preconception care. Women who have secondary and above education level, urban residence, and have at least one ANC contact had significantly higher odds of good level of knowledge on preconception care. The finding of this study showed that level of women’s knowledge towards preconception care to be low compared to other studies. Having at least one ANC contact, urban residence and having secondary and above education are predictors of knowledge on preconception care. It shall be beneficial if the city health administration, regional and national health authorities work towards improving the knowledge of mothers towards preconception care as well as routine provision of preconception care in the health care system.

Keywords

  • Knowledge
  • Preconception care
  • Ethiopia

Introduction

Preconception care (PCC) is pivotal to improve pregnancy and birth outcome. It is vital for the future health of mother, her child and her family, preconception care (PCC) is used. Despite policy planners and stakeholders are given priority agenda for maternal and child health care, maternal and neonatal mortality reduction is not at the desired level [1, 2]. Preconception health care hasn’t become part of routine practice across the globe. In low income countries, the implementation of PCC is almost nil. Nevertheless in this region, there is higher maternal and neonatal death of which 90% are preventable [36].

Maternal and child health experts recommend that preconception health care is an essential intervention to modify biomedical, behavioural and social risks for better pregnancy and child birth outcome through risk assessment, health promotion, disease prevention and care provisions [7, 8]. Preconception care (PCC) is the provision of biomedical, behavioural and social health interventions to women and couples before conception and aims at improving their health status, and reducing behaviours and individual and environmental factors that contribute to deprive maternal and child health outcomes [9].

In 2015, an estimated 303,000 women died as a result of pregnancy and child birth related complications in the world, of which 99% occurred in low and middle-income countries, especially south Asia and sub-Saharan Africa. The frontline cause of maternal deaths globally are hemorrhage (27%), pre-existing medical conditions (15%), hypertension (14%), sepsis (11%), abortion (8%), and other indirect causes (7%) [10]. Under-five mortality in 2015 was 42.5 per 1000 live births [11, 12]. In Ethiopia maternal mortality ratio is estimated 412 deaths per 100,000 live births in 2016 and the under-five mortality at 67 per 1000 live birth in 2016 [13].

Preconception care is cardinal to alleviate different risk behaviours, exposures that affects conception, fetal development, and ultimately reduce subsequent adverse outcomes [14]. It is also important for different behavioural changes like maintaining normal body mass index, taking appropriate diet (daily vegetables and fruits), avoiding drinking alcohol, stop smoking, being away from hazardous area, and also attending to early a medical checkup to optimize maternal and neonatal health. For example, risk of neural tube defect can be lessened through supplementation of folic acid 3 months before conception. During the first 7 weeks of gestation (before 52 days of pregnancy) exposure to alcohol, tobacco and other drugs, lack of essential vitamins (e.g. folic acid) and workplace hazards can adversely affects pregnancy outcome and maternal and neonatal wellbeing [15, 16].

Knowledge of preconception care can be obtained from experience, health care providers, coffee ceremony (neighbour meeting to drink coffee and discuss any agenda during that time), family, reading books, newspapers, radio, television, and social media. Studies revealed that women who received pre-pregnancy care have more knowledge and often show risk alleviation behaviours [17].

Studies recommended that antenatal care should start before conception to alleviate bad obstetrics outcome. Maternal and child health planners, policy-makers and stakeholders should be cognizant of the values of PCC to attain the sustainable development goal (SDG) targets in relation to maternal, neonatal and child health. Therefore, evidence of knowledge and associated factors towards preconception care among mothers in Ethiopia is very rare. Hence, the aim of this study was to assess the level of knowledge and associated factors towards preconception care among mothers who gave birth at public health institution in Hawassa city, Southern Ethiopia.

Main text

Methods and materials

Study design and setting

Health institution based cross sectional study was carried out from March 01–30, 2017 among mothers who gave birth at public health institution in Hawassa city. Hawassa is administrative city of Southern Nations, Nationalities and Peoples Regional State (SNNPRS) and located 275 km South from Addis Ababa. According to the 2017 City Health Department estimation report, there were 359,358 people living in Hawassa. The city has 8 sub city and 32 kebeles, which have 83 public and private health institutions. These are one public referral and teaching hospital, one public general hospital, 4 private primary hospitals, 9 public health centers, 17 health posts and 51 private clinics. During the study period, there were 1452 health professionals working in the randomly selected public health institutions of the city.

Hawassa University referral and teaching hospital is the largest hospital in southern Ethiopia with more than 300 beds which renders service in the region and the neighbouring region. The outpatient department consists of 17 rooms and inpatient service which consisted of 5 main departments. The average number of patient flow at the OPD was more than 200 people per day. Hawassa University referral and teaching hospital and Adare general hospital are public health hospitals providing comprehensive essential obstetric care in the City. The remaining 9 PHC are giving basic essential obstetric care. In the past 6 months of the year 2016, there were a total of 4780 deliveries reported from Hawassa University referral and teaching hospital (2073), Adare general hospital (2022), Adare health center (313), Millennium health center (311), and Tilte health center (61).

The source populations were all pregnant women who live in the Hawassa City Administration. Whereas, the study populations were those who gave birth during the study period at public health institution in Hawassa city.

Sample size was determined using single population proportion formula with confidence interval 95%, p-valve 0.5, margin of error (α = 0.05), a design effect of 2 and 10% non-response rate. The total sample size is 580.

Five public health institutions were selected using simple random sampling technique. Multistage sampling technique was used to select a total of 580 study participants using random sampling methods. The calculated sampling interval (K) was 1.2. Based on the finding we consecutively recruited the study subject’s. The samples were taken proportionate to the number of expected deliveries from each selected PHIs. All participants included in the study were all consented to participate wilfully in the study.

The questionnaire was developed by reviewing different existing literatures. First developed in English and translated into Amharic and then back to English to check the accuracy. The socio-demographic factors are; age, parity, educational status, religion, occupation, partner’s occupation, and residence, gravidity, antenatal care attendee, gestation, previous history of adverse pregnancy outcomes such as history of baby with macrosomia and also history of pregnancy induced hypertension in the previous pregnancy, whereas dependent variable was the ‘Women’s Knowledge about PCH/C”.

Before the actual data collection, the questionnaire was tested on 10% care in post natal women at public health institutions in Shashemene city, which is 20 km away from Hawassa city.

Operational definitions: Women’s knowledge about preconception health and care was measured based on the individual study participant’s correct response of 17 items measuring their knowledge about PCC. Each question had one correct answer those who scored 50% and above of the items are labelled as women with “good PCH/C knowledge” whereas those remaining categorized as women with poor PCC knowledge.

Data were collected by 5 BSC female midwives and 5 BSC female nurses after 1-day training about informed consent, techniques of interviewing, and data collection procedures. Two health officers were assigned to supervisors for the data collectors.

Statistical analysis

The data were entered and cleaned using SPSS version 20 for analysis. Those factors found with their P value ≤ 0.20 in the bi-variable logistic regression model were fitted into the multivariable logistic regression model to control the effect of confounding variables. Multivariable analysis was carried out to evaluate the independent effect of each covariate on ‘good PCH/C knowledge’ by controlling the effect of others. P value < 0.05 is taken as statistically significant. For further analysis, descriptive statistics like frequencies and cross tabulation were performed. Tables and figure were used to present the findings of the study.

Result

Socio demographic characteristics

This study included 580 women who gave birth in public health institutions of Hawassa city. Most of the study participants were ethnic Sidama (40%), followed by Oromo (19.8%), and Wolayita (18.3%). One-fifth (20%) of the women never attended formal education and more than half (56%) attended primary level of education. About two-third (64.7%) of participants were urban residents (Table 1).
Table 1

Socio-demographic characteristics of women who gave birth in public health institutions of Hawassa (n = 580), Northern Ethiopia 2017

S. N.

Variables

Categories

Frequency(n)

Percent (%)

1

Age of the mother

< 20 years

45

8

20–34 years

492

84.6

35–49 years

43

7.4

2

Marital status

Married

560

96.6

Single

20

3.4

3

Ethnicity

Sidama

232

40

Amhara

42

7.2

Gurage

46

7.9

Oromo

115

19.8

Wolayta

106

18.3

Silte

39

6.8

4

Women’s education status

No formal education

110

19

Primary education (1–8 grade)

325

56

Secondary education (9–12 grade)

97

16.7

Tertiary (college or university)

48

8.3

5

Occupation

Housewife

399

68.8

Private business

87

15

Daily worker

14

2.4

Salaried employed

61

10.5

Student

19

3.3

6

Monthly income

< 1000 ETB

174

30

1001–2000 ETB

119

20

2001–3675 ETB

142

25

> 3675 ETB

145

25

7

Total family size

< 5

456

78.6

6-May

89

15.4

> 6

35

6

8

Residence

Urban

375

64.7

Rural

205

35.3

Prevalence of PCC knowledge

In this study 20%, 95% CI (16.9, 23.1) has good knowledge about preconception care among women who gave birth in the public health institutions of Hawassa city administration (Fig. 1).
Fig. 1
Fig. 1

Women’s knowledge about preconception health/care in Hawassa, South Ethiopia, 2017

Information about preconception health and care

Nearly all of the study participants reported that they never received information regarding preconception care. About one-third 182 (31.4%) of the study participants reported that they get advise on diet/nutrition prior to pregnancy, but only 9 (1.6%) of the study participants reported they were counselled about preconception folic acid supplementation. The other reported preconception care was advice about avoidance of alcohol. This was a case reported by only one participant (0.2%).

The analysis of this study also denoted, next to health professionals, mass media (Television and radio) (4%), Flier or brochures (1.6%), family or friend (2.2%), school or university (1.0%), and internet (0.2%) as source of information preconception health care.

Factors associated with women’s knowledge about preconception care

Results of the multivariable logistic regression showed that women who attended to at least one antenatal care clinic contact were four times knowledgeable about preconception care than counterpart (AOR = 4.0, 95% CI 1.1–12.6). Women who live in urban were two times knowledgeable about preconception care than counterpart (AOR = 2.0, 95% CI 1.1–3.3). Those women who attended high school and above were by two times knowledgeable about PCC than their counterparts (AOR = 2.0, 95% CI 1.1–3.3) (Table 2).
Table 2

Bivariate and multivariate analysis depicting factors associated with good preconception health/care knowledge among women giving birth in Hawassa, Ethiopia 2017

 

Client’s preconception knowledge

COR, 95% CI

AOR, 95% CI

Poor PCC knowledge

Good PCC knowledge

Women’s educational status

Elementary and below

372 (64%)

63 (11%)

1

1

High school and above

93 (16%)

52 (9%)

3.3 (2.1–5.1)***

2.0 (1.1–3.3)*

Husband’s educational Status

Elementary and below

295 (51%)

47 (8.1%)

1

1

High school and above

170 (29.3%)

68 (11.7%)

2.5 (1.7–3.8)***

1.3 (0.7–2.3)

Monthly house hold income

≤ 1000.0 birr

147 (25.4%)

27 (5.0%)

1

1

1001.0–2000.0 birr

98 (16.9%)

21 (3.6%)

1.2 (0.6–2.2)

1.4 (0.8–2.9)

2001.0–3675.0 birr

117 (20.2%)

25 (4.3%)

1.2 (0.6–2.1)

1.1 (0.6–2.1)

≥ 3676.0 birr

103 (17.8%)

42 (7.2%)

2.2 (1.3–3.9)*

1.5 (0.8–2.9)

Women’s place of residence

Rural

183 (31.6%)

22 (3.8%)

1

1

Urban

282 (48.6%)

93 (16.0%)

2.7 (1.7–4.5)***

2.0 (1.1–3.3)*

Attended ANC for at least one visit

Not attended ANC

56 (9.7%)

3 (0.5%)

1

1

Attended at least one ANC visit

409 (70.5%)

112 (19.3%)

5.1 (1.6–16.6)*

4.0 (1.1–12.6)*

\({\text{Hx}}^{\smallint }\)of previous infant with macrosomia

No history

414 (71.4%)

109 (18.8%)

1

1

Yes

51 (8.8%)

6 (1.0%

0.4 (0.9–1.1)

0.4 (0.2–1.0)

Hx of pregnancy Induced Hypertension

No

452 (77.9%)

107 (18.5%)

1

1

Yes

13 (2.2%)

8 (1.4%)

2.6 (1.1–6.4)*

1.7 (0.6–4.4)

\({\text{Hx}}^{\smallint }\): history

*p < 0.05, **p < 0.01 and ***p < 0.001

Discussion

Preconception care is a key means for reducing and preventing maternal and child morbidity and mortality. Nevertheless, it is not well practice in developing countries. This study showed that overall level of knowledge on preconception care among mothers who gave birth at public health institution in Hawassa city is 20%. This finding is higher than the study done in Nigeria (2.5%) [18], Iran (10.4%) [19] and Sudan (11.1%) [20]. The higher level of knowledge noticed in this study might be due to the fact that the current study took place immediately after the mothers gave birth.

On the other hand, it is lower than compared to other study done in Amhara region, northern Ethiopia (27.5%) [21], Saudi Arabia (37.9%) [22], United Arab Emirates (46.4%) [23], and Turkey (46.3%) [24], in Kelantan, Malaysia (51.9% [25], Qatar (53.7%) [26], Canada 70% [27], British Colombia 71% [28], in the USA among low income Mexican–American group (76%) [29], Saudi Arabia (84.6%) [30], Jordan (85%) [31].

The low knowledge identified level in this study might be due to the low socioeconomic conditions, due to low media coverage regarding preconception care, low habit of check-up for ANC, the low attention given to preconception care implementation by the health industry across the country, and lack of preconception clinic at health institution level.

In this study there was association of level of knowledge on preconception care with factors such as, level of education, place of residence, and ANC contact. Women who had above secondary education level had two times higher odds to have good level of knowledge on preconception care. This finding is consistent with the study done Ethiopia, Nigeria, Iran, Sudan, USA, Netherlands and Sri Lanka [18, 2022, 29, 32, 33]. This may be explained as the women’s educational status is increase, their health seeking behabour regarding preconception care will also increase. The more educated women might be eager to know about her own health status, and risks factors leading to ill health. These group of women do have better complication readiness plans. The more educated women might have interest to ask, read, listen, and watch any information sources related to her wellbeing.

Women who live in urban were two times higher odds to have good level of knowledge on preconception care than rural residents. This inconsistency is probably due to the fact that residents living in urban area might have better access to media and health institution. Women who attended at least one ANC contact had by four times higher odds to have good level of knowledge on preconception care. During ANC contact, women are informed about their health status, ways of disease prevention and health promotion, and birth preparedness and complication readiness.

Conclusion

The finding of this study showed that level of women’s knowledge towards preconception care to be low compared to other studies. Having at least one ANC contact, urban residence and having secondary and above education are predictors of good level of knowledge on preconception care. It would be beneficial if the city health administration, regional and national health authorities work towards improving the knowledge of mothers towards preconception care as well as routine provision of preconception care in the health care system.

Limitation

One possible limitation of this study is the fact that it didn’t include the husbands or spouses of the women. Results could also be to some extent affected by social desirability biases.

Abbreviations

ANC: 

antenatal care

AOR: 

adjusted odds ratio

BEmONC: 

basic emergency obstetrics and new-born care

Declarations

Authors’ contributions

AK conceived of and designed the study, participated in data collection, analysed the data and drafted the paper. ZY and AK critically reviewed the study protocol, participated in data acquisition and analysis and reviewed the draft manuscript. Both authors read and approved the final manuscript.

Acknowledgements

We are very grateful thankful to all mothers who participated in this study for their commitment in responding to our interviews. Hawassa city administration health office and public health institution for their assistance and permission to undertake the research.

Competent interests

The authors declare that they have no competing interests.

Availability of data and materials

All data on which this article is based are included within the article.

Consent for publication

Not applicable.

Ethics approval and consent to participate

Ethical clearance was obtained from Institution review board (IRB) of College of Medicine and Health Sciences (Ref No IRB/068/09). A letter of official support was taken to concerned facilities. Finally, each participant gave their informed verbal consent or parents and/or guardians provided consent on behalf of their new-born babies. Confidentiality was assured by making the questionnaire anonymous.

Funding and sponsorship

This research was funded by Hawassa University.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia

References

  1. Olayinka OA, Achi OT, Amos AO, Chiedu EM. Awareness and barriers to utilization of maternal health care services among reproductive women in Amassoma community, Bayelsa State. Int J Nurs Midwifery. 2014;6(1):10–5.View ArticleGoogle Scholar
  2. Nitert MD, Barrett H, de Jersey S, Matusiak K, McIntyre H, Callaway L. Preconception care and barriers to addressing overweight and obesity: a focus on weight loss advice and weight loss strategies. In: Hollins-Martin C, van den Akker O, Martin C, Preedy VR (eds) Handbook of diet and nutrition in the menstrual cycle, periconception and fertility. Wageningen, Netherlands: Wageningen Academic Publishers; 2014. p. 568. https://doi.org/10.3920/978-90-8686-767-7 View ArticleGoogle Scholar
  3. Boulet SL, Parker C, Atrash H. Preconception care in international settings. Matern Child Health J. 2006;10(1):29–35.View ArticleGoogle Scholar
  4. Ebrahim SH, Lo SS-T, Zhuo J, Han J-Y, Delvoye P, Zhu L. Models of preconception care implementation in selected countries. Matern Child Health J. 2006;10(1):37–42.View ArticleGoogle Scholar
  5. Ezegwui H, Dim C, Dim N, Ikeme A. Preconception care in south eastern Nigeria. J Obstet Gynaecol. 2008;28(8):765–8.View ArticleGoogle Scholar
  6. Frey KA, Files JA. Preconception healthcare: what women know and believe. Matern Child Health J. 2006;10(1):73–7.View ArticleGoogle Scholar
  7. Moos M-K. From concept to practice: reflections on the preconception health agenda. J Womens Health. 2010;19(3):561–7.View ArticleGoogle Scholar
  8. Curtis MG. Preconception care: clinical and policy implications of the preconception agenda. JCOM. 2010;17(4):30–8.Google Scholar
  9. Organization WH. Preconception care: maximizing the gains for maternal and child health. Geneva: World Health Organization; 2013.Google Scholar
  10. Black R, Laxminarayan R, Temmerman M, Walker N. Disease control priorities, (Volume 2): reproductive, maternal, newborn, and child health. The World Bank; 2016.Google Scholar
  11. Alkema L, Chou D, Hogan D, Zhang S, Moller A-B, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016;387(10017):462–74.View ArticleGoogle Scholar
  12. You D, Hug L, Ejdemyr S, Idele P, Hogan D, Mathers C, et al. Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. Lancet. 2015;386(10010):2275–86.View ArticleGoogle Scholar
  13. Central Statistical Agency (CSA) [Ethiopia], ICF. Ethiopia Demographic and Health Survey 2016. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA and ICF; 2016.Google Scholar
  14. Hood JR, Parker C, Atrash HK. Recommendations to improve preconception health and health care: strategies for implementation. J Womens Health. 2007;16(4):454–7.View ArticleGoogle Scholar
  15. Heyes T, Long S, Mathers N. Preconception care: practice and beliefs of primary care workers. Fam Pract. 2004;21(1):22–7.View ArticleGoogle Scholar
  16. James T. Preconception/inter-conception caretraining curriculum. Illions department of human services. 2015.Google Scholar
  17. Elsinga J, de Jong-Potjer LC, van der Pal-de KM, le Cessie S, Assendelft WJ, Buitendijk SE. The effect of preconception counselling on lifestyle and other behaviour before and during pregnancy. Womens Health Issues. 2008;18(6):S117–25.View ArticleGoogle Scholar
  18. Lawal TA, Adeleye AO. Determinants of folic acid intake during preconception and in early pregnancy by mothers in Ibadan, Nigeria. Pan Afr Med J. 2014;19:113.View ArticleGoogle Scholar
  19. Ghaffari F, Jahani Shourab N, Jafarnejad F, Esmaily H. Application of Donabedian quality-of-care framework to assess the outcomes of preconception care in urban health centers, Mashhad, Iran in 2012. J Midwifery Reprod Health. 2014;2(1):50–9.Google Scholar
  20. Ahmed K, Saeed A, Alawad A. Knowledge, attitude and practice of preconception care among Sudanese women in reproductive age about rheumatic heart disease. Int J Public Health. 2015;3(5):223–7.Google Scholar
  21. Ayalew Y, Mulat A, Dile M, Simegn A. Women’s knowledge and associated factors in preconception care in adet, west gojjam, northwest Ethiopia: a community based cross sectional study. Reprod Health. 2017;14(1):15.View ArticleGoogle Scholar
  22. Madanat AY, Sheshah EA. Preconception care in Saudi women with diabetes mellitus. J Fam Community Med. 2016;23(2):109.View ArticleGoogle Scholar
  23. Abdulrazzaq YM, Al-Gazali LI, Bener A, Hossein M, Verghese M, Dawodu A, et al. Folic acid awareness and intake survey in the United Arab Emirates. Reprod Toxicol. 2003;17(2):171–6.View ArticleGoogle Scholar
  24. Baykan Z, Öztürk A, Poyrazoğlu S, Gün İ. Awareness, knowledge, and use of folic acid among women: a study from Turkey. Arch Gynecol Obstet. 2011;283(6):1249–53.View ArticleGoogle Scholar
  25. Kasim R, Draman N, Abdul Kadir AA, Muhamad R. Knowledge, attitudes and practice of preconception care among women attending maternal health clinic in Kelantan. Educ Med J. 2016;8(4):57–68. https://doi.org/10.5959/eimj.v8i4.475.View ArticleGoogle Scholar
  26. Bener A, Al Maadid MG, Al-Bast DA, Al-Marri S. Maternal knowledge, attitude and practice on folic acid intake among Arabian Qatari women. Reprod Toxicol. 2006;21(1):21–5.View ArticleGoogle Scholar
  27. Einarson A, Koren G. A survey of women’s attitudes concerning healthy lifestyle changes prior to pregnancy. JFAS Int. 2006;4:e2.Google Scholar
  28. Morin VI, Mondor M, Wilson RD. Knowledge on periconceptional use of folic acid in women of British Columbia. Fetal Diagn Ther. 2001;16(2):111–5.View ArticleGoogle Scholar
  29. Coonrod DV, Bruce NC, Malcolm TD, Drachman D, Frey KA. Knowledge and attitudes regarding preconception care in a predominantly low-income Mexican American population. Am J Obstet Gynecol. 2009;200(6):686.View ArticleGoogle Scholar
  30. Gautan P, Dhakal R. Knowledge on preconception care among reproductive age women. Saudi J Med Pharm Sci. 2016;2(1):6.Google Scholar
  31. Al-Akour N, Sou’Ub R, Mohammad K, Zayed F. Awareness of preconception care among women and men: a study from Jordan. J Obstet Gynaecol. 2015;35(3):246–50.View ArticleGoogle Scholar
  32. Lawal TA, Yusuf B, Fatiregun AA. Knowledge of birth defects among nursing mothers in a developing country. Afr Health Sci. 2015;15(1):180–7.View ArticleGoogle Scholar
  33. Patabendige M, Goonewardene I. Preconception care received by women attending antenatal clinics at a Teaching Hospital in Southern Sri Lanka. Sri Lanka J Obstet Gynaecol. 2013;35(1):3–9.View ArticleGoogle Scholar

Copyright

© The Author(s) 2018

Advertisement