Level and factors associated with birth preparedness and complication readiness among semi-pastoral pregnant women in southern Ethiopia, 2016

Objective The objective of this study was to determine the level of birth preparedness and complication readiness (BPCR) and associated factors among semi-pastoral pregnant women in southern, Ethiopia. Result This dataset contains the full data collected from 746 pregnant women. Birth preparedness and complication readiness among women in southern Ethiopia was 27.1%. The main predictors for BRCP were attending formal education (AOR = 4.65, 95% CI 2.45–8.63), husband occupation [merchant (AOR = 3.83, 95% CI 1.52–9.64)], spouse attending formal education (AOR = 3.35, 95% CI (1.83–6.14), ANC visits > 4 times (AOR = 17.78, 95% CI 7.11–44.47). In addition, knowledge of women at least two danger signs during pregnancy, delivery and after delivery (AOR = 3.32, 95% CI 1.64–6.69), (AOR = 3.13, 95% CI 1.58–6.20) and (AOR = 3.75, 95% CI 1.93–7.28) respectively were significantly associated with BPCR. In conclusion, the proportion of BPCR among women in southern Ethiopia was found to be low. Electronic supplementary material The online version of this article (10.1186/s13104-018-3539-7) contains supplementary material, which is available to authorized users.


Introduction
Maternal mortality rate (MMR) remains a global public health concern especially in developing countries [1]. Worldwide, nearly 275,288 maternal deaths occurred due to pregnancy and related complications [2]. In 2000, millennium development goal (MDG) targeted for World Health Organization [1] member countries reducing MMR by 75% [3]. But still MMR was remains unacceptably high in developing countries particularly in sub-Sahara African countries [4,5] which is 920 per 100,000 live births, and the lifetime risk of maternal death is 1 in 16 compared to 1 in 2400 in Europe [5]. Ethiopia is a country that experience high MMR rate [1]. It is the most sensitive indicator of the health disparities between poorer and richer nations, and for general growth. The effects of MM also have influences on other families like children [4,[6][7][8][9]. The survival status of all under-five children has significant association with child nutrition and other vital child health care practices seeking maternal involvement [10].
Low institutional deliveries, shortage of birth preparedness, the poor competence of health care providers, shortage of emergency obstetric services at facilities and week referral systems for obstetric emergencies were the common factors [11][12][13][14]. In Ethiopia, there is a minimal utilization of necessary maternal health services by pregnant women [12,[14][15][16]. This can be related to many factors identified by different studies are socio-demographic, cultural, communal, limited access to health facilities and poor quality of care in health facilities [12,[14][15][16]. The cause of maternal death was recognized as the three delays model [17] which is a delay in deciding to seek care (delay 1), delay in reaching the health facility (delay 2), and delay in receiving quality care once at the health facility (delay 3). And therefore, to reduce maternal death different strategies were initiated at the  [12,[14][15][16]. In Ethiopia evidences show that the status of birth BPCR was low; Aleta Wondo district (17%) [18], Jimma Zone (23.3%) [19] and Basoliben District (26.9%) [20].

Study area and period, study design and populations
A community-based cross-sectional study was conducted at Southern Ethiopia on August 2016. The setting is located 470 km away from the capital city of Ethiopia, Addis Ababa. According to the projected population estimate of 2016 the district has a total of 282,912 populations of these 42,707 women's were expected to give birth [21]. All pregnant women who were permanently resided in the semi-pastoral of Bule Hora District were the study population.

Sample size and sampling procedure
Sample size was determined using single population proportion formula. We considered 17% level of compliance from the previous study [12]. We also considered a 5% level of significance (α) and 5% margin of error. Using these assumptions the sample size was calculated to be 339. After considering non-response rate (10%) and design effect (2), the final sample size obtained was 746. Participants were selected by multi-stage systematic random sampling from the population who were pregnant during the study period. The total number of pregnant women who lives in the study area was 3731 and we divided 3731 (sampling frame) by 746 (sample), so that a sampling fraction of 1/5 was obtained. To determine the order of the first respondent, we employed simple random sampling technique among the first five participants, and it was found to be the 3rd pregnant women. Thus, every 3rd participant starting from the first respondent was then included and interviewed until we get the required sample size.

Operational definition
Well prepared BPCR mother If she reported at least three of five variables that she identified place of delivery, saved money, identify skilled provider at birth, identified a means of transport and identification of compatible blood donors in case of emergency.
Birth preparation An arrangement, plan, or time preparing for delivery.
Complication readiness It is a state of being prepared or willing for something that makes the situation difficult or the act of doing this (source JHPIEGO).

Data collection and quality management
Structured and pretested questionnaire were used for data collection. To maintain the data quality; pretest, training and supervision was done. Ten diploma nurse as data collectors and 2 BSc holder nurses as a supervisor were participated.

Data-analysis
The data were collected by interview on variables like, dependent variable: birth preparedness and complication readiness. Independent variables: maternal-factors (age, marital status, occupation, ethnicity, education, income, family size), reproductive factors (parity and history of still birth), paternal factors (occupation, education), health service factors (ANC use), obstetrics factors (gravidity) and knowledge factors (key danger sign, transportation, delivery cost and ANC) characteristics using structured and pretested questionnaire. The collected data were entered to Epidata version 3.1 and analyzed using SPSS version 22. Data were checked for consistency and completeness, and then descriptive and analytic computations were carried out. Bivariable (P value < 0.2 considered as a candidate variable multivariable binary logistic regression model was fitted to the data to identify variables associated with the dependent variable. Variables with P < 0.05 were considered statistically significant. SPSS version 20 was used to perform the analysis.

Socio-demographic characteristics of respondents
A total of 746 pregnant women were interviewed. Almost half, 384 (51.5%) of them were found between 25 and 34 years of age. Majority, 535 (71.7%) of the participants were protestant and, reflecting the ethnic composition of study setting which is Oromo (93.4%). Slightly less than half 347 (46.5%) of the pregnant women were illiterate, the majority of the respondents, 724 (97%), were married, 651 (87.3) of respondents parent were farmer and while 332 (44.5%) attended elementary education ( Table 1).

Birth preparedness and complication readiness
Two hundred sixteen (29%) and 14 (1.9%) of the respondents had good knowledge on identifying place of delivery and blood donor respectively. In this study three and more steps from five where considered as a cutoff points to categorize whether pregnant women prepare for birth or not and that 202 (27.1%) of the study participants were found to be prepared for BPCR. One hundred seventytwo (23.1%) of the respondents were planned to identified a skilled birth attendant while 200 (26.8%) of the respondents were plan saving money in case of emergency. Similarly, 186 (24.9%) of the respondents arranged transport service for labor service (Additional file 1).

Role of husband during ANC and labour
Half, 366 (50.5%) and 404 (55.8) of the respondents Husband accompanied them to the Health facility visit. While, 108 (14.9%) and 102 (14.9%) of the husbands were cares children at homes and looked after the cattle at respectively (Additional file 2).

Factors associated with BPCR
Binary logistic regression showed that BPCR practice has a significant association with education status of pregnant women, educational and occupational status of their spouse, the frequency of the ANC is visiting as well as, knowledge of danger signs during pregnancy, labour and post-partum. The Multivariate logistic regression showed that BPCR was a significant association with variable like to attend formal education (AOR = 4.65, 95% CI 2.49-8.63), employment (AOR = 2.76 95% CI 1.10-5.54), merchant husbands (AOR = 3.83, 95% CI 1.52-9.64), the spouse with formal education (AOR = 3.35, 95% CI 1.83-6.14), ANC Visit more (Table 3).

Discussion
This study found that birth preparedness and complication readiness at western Oromia was accounted for 27.1% [22] of the pregnant women which is similar with studies done in Basoliben District, Goba district and Jima town of Ethiopia were 26.9, 29.9, and 23.3% respectively [15, 19,23]. The finding is higher than findings at Aleta wondo 18.1% and Adigrat town, Tigray 21.2% [17,24]. The discrepancy might have resulted from the difference between the residential areas in which the current incorporate mostly the rural kebeles than the previous one. In other way, the current finding was lower than findings observed at Debrebirehan town and southwest Nigeria which was 53.9 and 51.6% respectively [25,26]. This discrepancy might be due to the study area different. Debrebirehan is a zonal were most of the residents are educated compared with the current study area. In another case, the socio-economic status of Nigeria was better than Ethiopia.
This study also showed that women who had Knowledge about at least two danger signs during pregnancy, delivery and after delivering were 40.8, 37.5 and 34% respectively which is comparable to finding of Goba district danger signs during delivery and after delivery were 26 and 27% respectively but knowledge during pregnancy higher 66% [15]. The current finding has variation when compared with a study finding in Nepal knowledge on Obstetric danger signs during pregnancy, childbirth and postpartum were 34.8, 59.0 and 39.7% respectively [5,19]. However it compared slightly higher to other studies done in Jimma town, the difference may be due to the fact that unlike the current study the former study considers woman is knowledgeable if only mention there and more danger signs which could decrease the number of respondents [19].
Another encouraging finding were identifying the place of delivery and saving money 29 and 26.8% respectively which are the most common practice of BPCR. Lower than the finding in Jima town 73.5 and 60.2% of the respondents planned to save money and arrange transport [19]. And a study in Uganda, Mbarara, and majority of the respondents identified the place of delivery and saved money [13]. However, planned to arrange blood donor and planned to be attended by skilled were 1.9 and 23.1% respectively, which was still low. These low levels of preparations were also reported in other prior studies in Ethiopia and other abroad countries. In the study conducted in Jima town west Ethiopia, 19.9% planned to arrange blood donor and 21.9% identify skilled attendant [19]. Similarly, in the study conducted in Sidama Zone, South Ethiopia in 2007, plan to arrange blood donor and identify skilled attendant was 2.3, 8.1% respectively [22]. Being BPCR is a new strategy which is yet to expand, low education level of women and the population as a whole may explain this low practice of the indication of PBCR among the study population.
Women education and Husband occupation were determinant factors for BPCR. Attending formal education among woman was 5 times more likelihood to increase BPCR than the counterpart (OR = 4.65 95% CI 2.49-8.63). Moreover, having spouse who is a merchant formally educated increased the likelihood of BPCR by 1.5 and 3.88 respectively which is comparable with previous findings in Ethiopia and abroad; where education, occupation, and income were among the factors affecting birth preparedness and complication readiness [15,17,22]. The possible reason for this could be due to the fact that being educated, being a merchant and employed increases access to information and are able to prepare for birth and complication readiness respectively.
Women who have more than three ANC visit were 17.78 times more likely to prepare for BPCR than the counterpart (P < 0.001, AOR = 17.78, 95% 95% CI 7.11-44.4) which was supported by a study conducted in Nepal [5]. Moreover, this study found that pregnant women knowledge towards at least two danger signs during, pregnancy (AOR = 3.32, CI 1.64-6.69), labor (AOR = 3.13 95% CI 1.58-6.20) and after delivery (AOR = 3.75, CI 1.93-7.28) were predictor for BPCR and this was supported by study findings done at Ethiopian country and abroad knowledge of danger signs was the  [3,17,22,23]. This might be due to that knowledge of obstetric danger signs is essential to motivate women to seek skilled attendance at birth and prompt practices of another component of BPCR.

Conclusions and recommendations
This study found that birth preparedness and complication readiness among pregnant women at southern Ethiopia was lower. Women education, husband-education, occupation, knowledge on danger-sign, and ANC visits were identified as factors affecting BPCR.

Limitation
The limitation of this study was failing to consider temporal residence.