Birth preparedness and complication readiness among primigravida women attending antenatal clinic at Nakuru County Hospital, Kenya

Abstract

Background: Birth preparedness and complication readiness (BP/CR) promotes maternal healthcare service utilization to ensure safe motherhood by reducing the three-delay. Delay in seeking care, delay in reaching the health facility and delay in receiving timely care which are associated with poor maternal outcome for example antepartum or postpartum haemorrhage. Recognizing the crucial role in reducing maternal and neonatal deaths, the world health organization in 2001 promoted and recommended the birth preparedness and complication readiness interventions as a fundamental component of antenatal program and integrated management of pregnancy and childbirth. Objectives: This study sought to describe and explore birth preparedness and complication readiness among primigravida attending the Nakuru county hospital antenatal clinic. The specific objectives were: to explore the status of birth preparedness among primigravida women, to determine the level of birth preparedness in their family, and to determine birth preparedness in Nakuru facility county hospital during antenatal period. Methods: A descriptive cross-sectional study design using quantitative and qualitative methods. The target population was primigravida women aged 15-49 years who were attending antenatal clinic at Nakuru county hospital and nurse managers and in charges attending to these women. A sample of 262 primigravida women and six key informants were interviewed. The health belief model theoretical framework was used to categorize the variables for the study. Systematic sampling technique was used to select participants. Descriptive statistics was used to generate frequencies and proportions. The dependant variable was birth preparedness. The Chi square test was used to test the association of the independent and dependent variables at 95% confidence interval. Logistic regression was used to describe the relationships between variables. Qualitative findings comprised of coding of major themes using NVIVO 8 software into subthemes and themes respectively. Results: Majority of respondents were aged 18-25 years 82%. 90% of the respondents had transport available. Those who had identified mode of transport and had identified the facility to deliver were 90%. Majority of the women had low knowledge on danger signs during pregnancy were 21%, 86% during labour and 66% during postpartum. Those who had arranged for blood through the relatives were 23% and those who had blood in the blood bank were 5.6%. BP/CR was significantly associated with age with an odd ratio (OR 0.39, 95% CI 0.219- 6.96) and level of education with an odds ratio (OR 0.486, 95% CI 0.284-8.31). From the qualitative analysis three themes emerged including resources the need to improve infrastructure to handle emergencies and complication at the facility, health information and staffing. Conclusion: The study revealed low level of knowledge on danger signs, low levels on awareness on need of blood among pregnant women attending antennal clinic. There is need to improve laboratory services and avail a high dependency unit to manage complication. Provide trained staff to handle obstetric emergencies complications. Recommendation: There is need to come up with strategies to improve the knowledge of danger signs among pregnant women. Women need to be sensitized on need to arrange for blood through relatives. There is need for a 24 -hour working laboratory services and high dependency unit and trained personnel to handle obstetric emergencies.