Ignite Creation Date:
2024-06-16 @ 11:48 AM
Last Modification Date:
2024-10-26 @ 3:30 PM
Study NCT ID:
NCT06434974
Status:
COMPLETED
Last Update Posted:
2024-05-30
First Post:
2024-05-23
Brief Title:
Prevalence of Birth Before Arrival and Associated Factors Among Postpartum Women in Southern Ethiopia
Sponsor:
Wachemo University
Organization:
Wachemo University
Study Overview
Official Title:
Prevalence of Birth Before Arrival and Associated Factors Among Postpartum Women in Southern Ethiopia Community-Based Cross-Sectional Study
Status:
COMPLETED
Status Verified Date:
2024-05
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Background Birth before arrival is defined as unplanned deliveries without the attendance of skilled personnel just before arrival to a health facility It constitutes a high-risk newborn population and has high perinatal morbidity and mortality In Ethiopia most studies and health surveys done only look at home and hospital deliveries but do not consider deliveries taking place between the house and health facility The aim of this study is to assess the prevalence of birth before arrival and its associated factors among postpartum women in Lemo woreda Hadiya zone SNNPR Ethiopia 2023
Methods Community-based cross-sectional study was conducted among postpartum women in Lemo woreda Hadiya zone SNNPR Ethiopia from April 05 to May 20 2023 Three hundred eighty-two postpartum women who gave birth six months preceding this study were included Twelve out of 36 kebeles were selected randomly and simple random sampling was employed for the selection of participant women Interviewer-administered questionnaire was used for data collection A binary logistic regression analysis was computed and variables with a p-value of 025 were recruited to the final multivariable logistic regression analysis Model fitness was checked using Hosmer and Lemeshow goodness of fit test x2 1604 p-value 0250 Statistical significance was declared using odds ratios and 95 confidence intervals at p-value 005
Result The prevalence of birth before arrival among women who gave birth in the last six months preceding this study in the study area was 152 95CI 118 191 In the multi-variable analysis the variables found to have an association with birth before arrival in the final model were having no antenatal care AOR 263 95CI 123 563 dependent women autonomy status AOR 332 95CI 112 989 being not knowledgeable about labor symptoms AOR 215 95CI 111 418 and having birth preparedness towards index birth AOR 013 95CI 005 035
Conclusion The prevalence of birth before arrival in the study area was unacceptably high A statistically significant association was seen between birth before arrival and having no antenatal care dependent womens autonomy status being not knowledgeable about labor symptoms and having birth preparedness towards index birth Intervening to avert birth before arrival through effective antenatal care programs and enhancing womens autonomy may help to reduce birth before arrival and its adverse perinatal outcomes
Methods Community-based cross-sectional study was conducted among postpartum women in Lemo woreda Hadiya zone SNNPR Ethiopia from April 05 to May 20 2023 Three hundred eighty-two postpartum women who gave birth six months preceding this study were included Twelve out of 36 kebeles were selected randomly and simple random sampling was employed for the selection of participant women Interviewer-administered questionnaire was used for data collection A binary logistic regression analysis was computed and variables with a p-value of 025 were recruited to the final multivariable logistic regression analysis Model fitness was checked using Hosmer and Lemeshow goodness of fit test x2 1604 p-value 0250 Statistical significance was declared using odds ratios and 95 confidence intervals at p-value 005
Result The prevalence of birth before arrival among women who gave birth in the last six months preceding this study in the study area was 152 95CI 118 191 In the multi-variable analysis the variables found to have an association with birth before arrival in the final model were having no antenatal care AOR 263 95CI 123 563 dependent women autonomy status AOR 332 95CI 112 989 being not knowledgeable about labor symptoms AOR 215 95CI 111 418 and having birth preparedness towards index birth AOR 013 95CI 005 035
Conclusion The prevalence of birth before arrival in the study area was unacceptably high A statistically significant association was seen between birth before arrival and having no antenatal care dependent womens autonomy status being not knowledgeable about labor symptoms and having birth preparedness towards index birth Intervening to avert birth before arrival through effective antenatal care programs and enhancing womens autonomy may help to reduce birth before arrival and its adverse perinatal outcomes
Detailed Description:
Results Socio-demographic characteristics A total of 382 study participants were included in the analysis with a 100 response rate The mean age of participant women was 303 years 44 SD The majority of participant women were in the age group 23-26 years 283 but women in the age category of 27-30 were the most experienced birth before arrival 346 and three fourth of them were rural residents 762 Nearly half of women 455 attained secondary education grades 9-12 The majority of the participant mothers 838 were housewives in their occupation whereas 680 of their husbands were farmers The mean estimated monthly income of the family was 7216 birr 30734 SD The majority of participants 950 had media exposure and radio was the commonest media Table 2
Table 2 Socio-demographic characteristics of women who gave birth in the last six months in Lemo district Hadiya zone Southern Ethiopia n 382
Variables Category Frequency percentage Total
No BBA BBA Mothers age in years Range 23-38 23-26 27-30 31-34 35-38 105 972 70 654 78 886 71 889 3 28 37 346 10 114 8 101 108 283 107 280 88 230 79 207 Residence Urban Rural 74 813 250 859 17 187 41 141 91 238 291 762 Womens educational status No formal education Primary Secondary Higher education 31 608 154 885 126 894 13 813 20 392 20 115 15 106 3 187 51 134 174 455 141 369 16 42 Husbands educational status No formal education Primary Secondary Higher education 5 417 132 898 160 865 27 711 7 583 15 102 25 135 11 289 12 31 147 385 185 484 38 100 Womens occupation Housewife Maid Civil servant 272 850 38 864 14 778 48 150 6 136 4 222 320 838 44 115 18 47 Husbands occupation Farmer Merchant Civil servant 229 881 80 777 15 789 31 119 23 223 4 211 260 680 103 270 19 50 Housing characteristics Private Rented 295 853 29 806 51 147 7 194 346 906 36 94 The average estimated monthly income of the family in Birr 2000-6000 6001-11000 11001-15000 162 890 126 787 36 900 20 110 34 213 4 100 182 476 160 419 40 105 Media exposure Yes No 310 854 14 737 53 146 5 263 363 950 19 50 Type of media n 363 Radio Television Social media 277 888 28 651 5 625 35 112 15 349 3 375 312 817 43 112 8 21 BBA Birth Before Arrival birr Ethiopian currency Reproductive Health and Obstetric Characteristics The majority of participant women 767 of them had antenatal care ANC follow-up for their last pregnancy Two-thirds of women had 1-3 ANC contacts for their last delivery with a mean of 12 04 SD The proportion of women who used contraceptives before their last pregnancy was 264 Two-thirds of the participant women 717 had postnatal care PNC follow-up for their last birth and 762 of women had planned and wanted the type of last pregnancy The average value of the womens autonomy index was 068 and 267 of participant women were autonomous The proportion of women with grand multigravida was 210 the duration of labor of index birth 12 hours was 547 birth preparedness towards index birth of 861 women with knowledge of the expected date of delivery EDD of the index birth were 667 and 661 of women know labor symptoms The mean number of pregnancies was 30 16 SD and the median duration of labor of the last birth was 14 IQR 12-24 Table 3
Table 3 Reproductive health and obstetric characteristics of participant women by birth before arrival in Lemo district Hadiya zone Southern Ethiopia n 382
Variables Category Frequency percentage Total
No BBA BBA ANC for the last delivery Yes No 254 867 70 787 39 133 19 213 293 767 89 233 Number of ANC contacts n 293 1-3 contacts 4 contacts 178 860 76 884 29 140 10 116 207 706 86 294 Type of health facility for ANC n 293 At hospital At health centre At health post 14 824 177 872 63 863 3 176 26 128 10 137 17 58 203 693 73 249 Used contraceptive before last pregnancy Yes No 83 822 241 858 18 178 40 142 101 264 281 736 PNC for the last delivery Yes No 233 850 91 843 41 150 17 157 274 717 108 283 Type of pregnancy Planned and wanted Unplanned but wanted Unplanned unwanted 249 856 68 919 7 412 42 144 6 81 10 588 291 762 74 194 17 44 Women autonomy Non-autonomous Autonomous 231 825 93 912 49 175 9 88 280 733 102 267 Gravidity Multigravidae Grand multigravidae 259 858 65 813 43 142 15 187 302 790 80 210 Duration of labor of index birth 12 hours 12 hours 155 896 169 809 18 104 40 191 173 453 209 547 Know the EDD of the index birth Yes No 226 886 98 772 29 114 29 228 255 667 127 333 Birth preparedness towards index birth Yes No 285 866 39 736 44 134 14 264 329 861 53 139 Knowledge of labor symptoms n350 Not knowledgeable Knowledgeable 89 748 205 887 30 252 26 113 119 340 231 660 Mode of previous delivery SVD Instrumental delivery SVD with episiotomy Cesarean section 217 851 34 944 72 809 1 500 38 149 2 56 17 191
1 500 255 667 36 94 89 233 2 06 ANC Antenatal Care BBA Birth Before Arrival EDD Expected Date of Delivery PNC Postnatal Care SVD Spontaneous Vaginal Delivery Access to a healthcare facility The median time of the delay to seek health care was 14 hours IQR 12-24 and the mean duration of the second delay was 13 hours 06 SD One-fourth 259 of women delayed 24 hours in deciding to seek health care and one-third 338 travelled 2 hours to reach a health care facility The major reason for the first delay was not realising the problem 288 for women with birth before arrival and lack of transport 623 was the major reason for the second delay About means of transport 358 of women used HorseDonkey carts Regarding the condition of the road 293 of women replied that it is a wide road More than half of women 516 delivered their index birth at night Table 4
Table 4 Access to health care facility among women who gave birth in the last six months in Lemo district Hadiya zone Southern Ethiopia n382
Variables Category Frequency percentage Total
No BBA BBA First delay Delayed 24 hours Delayed 24 hours 246 869 78 788 37 131 21 212 283 741 99 259 Second delay n 317 Traveled 2 hours Traveled 2 hours 171 814 88 822 39 186 19 178 210 662 107 338 Reasons for 1st delay Underestimate severity Did not realize the problem Essential person for decision making not around 195 867 116 712 78 867 30 133 47 288 12 133 225 100 163 100 90 100 Reasons for 2nd delay n 317 Lack of money Lack of transport Distant health facility 61 871 159 807 38 776 9 129 38 193 11 224 70 221 197 623 49 156 Means of transport n 317 Motorbike Ambulance Public transport HorseDonkey cart On foot Carried by other people 39 1000 16 485 62 1000 83 735 14 583 44 978 0 00 17 515 0 00 30 265 10 413
1 22 39 123 33 104 62 196 113 358 24 76 45 142 Status of the roadroad All weather road Weather raod 225 833 99 884 45 167 13 116 270 707 112 293 Time of delivery of index birth Night Day 150 761 174 941 47 239 11 59 197 516 185 484 Women who delivered their last birth at home were not asked for the second delay and its reasons
Birth before arrival The prevalence of birth before arrival among women who gave birth in the last six months preceding this study in the study area was 152 95CI 118 191 Among them 845 of women gave birth on the route to a health care facility Table 5
Table 5 Profile of birth before arrival among women who gave birth in the last six months in Lemo district Hadiya zone Southern Ethiopia n 382
Variables Frequency Percentage Place of last delivery Home Before arrival to a health care facility Health care facility 67 58 257 175 152 673 The specific place of BBA to health care facility n58 On the route to health care facility In ambulance 49 9 845 155 BBA Birth before Arrival Factors associated with birth before arrival Using bivariate binary logistic regression analyses variables with a p-value of 025 were recruited to be included in the final model Thus in the multi-variable analysis the variables found to have an association with birth before arrival in the final model were having no antenatal care AOR 263 95CI 123 563 dependent women autonomy status AOR 332 95CI 112 989 being not knowledgeable about labor symptoms AOR 215 95CI 111 418 and having birth preparedness towards index birth AOR 013 95CI 005 035
Therefore this study found that women who have no antenatal care visits during the index pregnancy had three times higher odds of birth before arrival compared to women with antenatal care The probability of having birth before arrival to a health care facility was three times higher for women who were dependent on their autonomy status compared with those who were autonomous Moreover those women who were not knowledgeable about labor symptoms had two times more likely to experience birth before arrival compared to those who were knowledgeable Women who have birth preparedness towards index pregnancy were 87 less likely to experience birth before arrival compared to women with no birth preparedness plan Having first and second delay status of the road time of delivery and income were unrelated to the probability of birth before arrival Table 6
Table 6 Multivariate logistic regression showing factors associated with birth before arrival among women who gave birth in the last six months in Lemo district Hadiya zone Southern Ethiopia
Variables Category COR 95 CI AOR 95 CI P-value Media exposure Yes No 100 209 072 604 100 274 082 918 0103 Receive ANC in last pregnancy Yes No 100 177 096 325 100 263 123 563 0013 Women autonomy Unautonomous Autonomous 219 104 464 100 332 112 989 100 0031 Knowledge of labor symptoms Not knowledgeable Knowledgeable 266 149 475 100 215 111 418 100 0023 Birth preparedness for the last birth Yes No 043 022 086 100 013 005 035 100 0001 Used contraceptive before last pregnancy Yes No 131 071 240 100 170 078 369 100 0181 First delay Delayed 24 hours Delayed 24 hours 100 179 100 324 100 186 092 376 0082 ANC Antenatal Care AOR Adjusted Odds Ratio CI Confidence Interval COR Crude Odds Ratio Discussion The prevalence of birth before arrival among women who gave birth in the last six months preceding this study in the study area was unacceptably high In the current study the variables associated with birth before arrival in the Lemo district of Hadiya zone were having no antenatal care dependent womens autonomy status being not knowledgeable about labor symptoms and having birth preparedness towards index birth
Globally the prevalence of birth before arrival to a healthcare facility is estimated to be less than 1 of all deliveries in developed countries 15101415 But the prevalence of BBA rises exponentially in low-income countries to greater than 50 17 In the current study the prevalence of birth before arrival is 152 This is a high prevalence in the study area as the rate of BBA is used as an index of accessibility to perinatal care and a rate greater than 15 signals challenges in health care provision where appropriate interventions are praiseworthy 9 Births occurred between home and health care facilities either en route to health care facilities or in ambulances were given less attention and no recent evidence was found in Ethiopia that indicated its prevalence However according to the mini EDHS 2019 report 40 of the total live births were delivered in health facilities in rural areas and 587 were delivered at home and the gap 12 reported as other might be taken as the prevalence of BBA to health facility even though it was not reported 7
The current studys finding was higher than EDHSs report and this difference might be due to the misclassification bias Accordingly in the EDHS questionnaire there was no option indicated for BBA so the BBA prevalence might be misclassified to home or health facility delivery prevalence but in the current study option for birth before arrival to health facility was indicated in the questionnaire Yet the prevalence of BBA in South Africa is 54 and in rural Malawi was 9 419 As per the current studys finding the prevalence of BBA in Lemo district was higher than the prevalence in South Africa and rural Malawi The difference might be due to the variation of level of socio-economic status across countries
This study established that women who have no antenatal care visits during the index pregnancy had three times higher odds of birth before arrival compared to women with antenatal care Similarly a national register study in Finland documented that one of the predictors for deliveries before arrival to health care facility was fewer prenatal visits 26 Another study from Tharaka Nithi County of Kenya documented that the obstetric risk factors associated with BBA were ANC attendance timing of ANC attendance and number of ANC visits 20 A prospective case control study from Nkangala District South Africa concluded that being unbooked was found to predict the occurrence of BBAs 4 The findings of these studies were concurrent to the current studys finding Even though there is no similar evidence from Ethiopia our finding was supported by the 2019s mini EDHS report that showed seventy-four percent of births to mothers who attended four or more ANC visits were delivered in a health facility as compared with 14 of births to mothers with no ANC visits 7 This signals that the ANC program if properly delivered will be important for reducing birth before arrival to health care facilities and subsequently its adverse perinatal outcomes
Dependent women in their autonomy status compared with those who were autonomous had three times higher odds of giving birth before arrival to a health care facility as per the current study Similarly one study shows that womens autonomy was positively associated with health facility delivery in Ethiopia 27 Another study revealed the strongest association between delivery at healthcare facilities attended by skilled birth attendants in the Southern African region among women who made decisions on household income solely 28 Womens autonomy can influence their decision to seek health care and could result in delays in reaching as early as possible to a health care facility to give birth if she is not adequately autonomous So this results in birth before arrival We required policy actions that increase womens autonomy at home and this could be effective in helping assure womens delivery at health care facilites
Furthermore the current study reveals that those women who were not knowledgeable about labor symptoms had two times more likely to experience birth before arrival compared to those who were knowledgeable Our finding was supported by one study from Tharaka Nithi County of Kenya which documented that the obstetric risk factors associated with BBA were recognition of the onset of labor and knowledge of signs and symptoms of labor 20 The finding implies that having poor knowledge of labor symptoms could affect women in early and properly recognizing the onset of labor and seek for healthcare facility delivery in the early hours Therefore standard guidelines for ANC in Ethiopia were required and emphasised that every pregnant woman should receive ANC from a skilled provider7 which must include counselling and enter-personal education with women concerning labor symptoms
Additionally women who have birth preparedness towards index pregnancy were less likely to experience birth before arrival compared to women with no birth preparedness plan as per the current study Similarly one study from Tharaka Nithi County of Kenya documented that the obstetric risk factors associated with BBA were the identification of healthcare facility for delivery identification of means of transport financial preparation for hospital delivery and basic supplies for birth 20 These are the components of the birth preparedness plan that were revealed by the Kenya study and these were used in our study as constructs to measure and compute variables for birth preparedness As Ethiopia has adopted the WHOs goal-oriented focused antenatal care for promoting the health and survival of mothers and babies one of its basic components thats individualized birth plan complication readiness and emergency preparedness is expected to alleviate the problem of BBA if properly performed Having first and second delay status of the raod time of delivery and income were unrelated to the probability of birth before arrival
Strengths and limitations of the study Our study revealed the delivery of babies occurred between home and health care facilities and came up with the prevalence of BBA and its associated factors as this issue was given less attention by literature in Ethiopia The study has a limitation in that it was based on a cross-sectional design due to its unclearly indicated prevalence of BBA but we recommend it be based on a community-based case-control study The results obtained from the current study were based on womens interviews and cannot be free from recall and social desirability biases
Conclusion The prevalence of birth before arrival among women who gave birth in the last six months preceding this study in the study area was unacceptably high Statistically significant association was seen between birth before arrival and having no antenatal care dependent women autonomy status being not knowledgeable about labor symptoms and having birth preparedness towards index birth Intervening to avert birth before arrival through an effective antenatal acre program especially focusing on individualized counselling concerning knowledge of labor symptoms and birth preparedness plan and providing extra vigilant attention for enhancing womens autonomy in the community may help to reduce birth before arrival and its adverse perinatal outcomes
Data-Sharing Statement All data generated or analyzed during this study are included in the manuscript and are also available from the corresponding author upon request
Ethical Approval and Consent to Participate Ethical clearance was obtained from Wachemo University the faculty of medicine and the public health institution review board with reference no WCUNEMMCSH1822023 Permission was granted from the concerned bodies of Lemo woreda and selected kebele administrators Moreover written informed consent was obtained from each woman Confidentiality of the information was assured Moreover this study was conducted in compliance with the Declaration of Helsinki Anonymous data were taken and the confidentiality of participants information was secured
Acknowledgment We would like to forward our appreciations to health office and health extension workers of study area for their kind cooperation We are also thankful to data collectors and the study participants
Author Contributions All authors made substantial contributions to conception and design acquisition of data or analysis and interpretation of data took part in drafting the article or revising it critically for important intellectual content agreed to submit to the current journal gave final approval of the version to be published and agree to be accountable for all aspects of the work All authors reviewed the manuscript
Funding No funding was received for this work Disclosure The authors declare that they have no competing interests
Table 2 Socio-demographic characteristics of women who gave birth in the last six months in Lemo district Hadiya zone Southern Ethiopia n 382
Variables Category Frequency percentage Total
No BBA BBA Mothers age in years Range 23-38 23-26 27-30 31-34 35-38 105 972 70 654 78 886 71 889 3 28 37 346 10 114 8 101 108 283 107 280 88 230 79 207 Residence Urban Rural 74 813 250 859 17 187 41 141 91 238 291 762 Womens educational status No formal education Primary Secondary Higher education 31 608 154 885 126 894 13 813 20 392 20 115 15 106 3 187 51 134 174 455 141 369 16 42 Husbands educational status No formal education Primary Secondary Higher education 5 417 132 898 160 865 27 711 7 583 15 102 25 135 11 289 12 31 147 385 185 484 38 100 Womens occupation Housewife Maid Civil servant 272 850 38 864 14 778 48 150 6 136 4 222 320 838 44 115 18 47 Husbands occupation Farmer Merchant Civil servant 229 881 80 777 15 789 31 119 23 223 4 211 260 680 103 270 19 50 Housing characteristics Private Rented 295 853 29 806 51 147 7 194 346 906 36 94 The average estimated monthly income of the family in Birr 2000-6000 6001-11000 11001-15000 162 890 126 787 36 900 20 110 34 213 4 100 182 476 160 419 40 105 Media exposure Yes No 310 854 14 737 53 146 5 263 363 950 19 50 Type of media n 363 Radio Television Social media 277 888 28 651 5 625 35 112 15 349 3 375 312 817 43 112 8 21 BBA Birth Before Arrival birr Ethiopian currency Reproductive Health and Obstetric Characteristics The majority of participant women 767 of them had antenatal care ANC follow-up for their last pregnancy Two-thirds of women had 1-3 ANC contacts for their last delivery with a mean of 12 04 SD The proportion of women who used contraceptives before their last pregnancy was 264 Two-thirds of the participant women 717 had postnatal care PNC follow-up for their last birth and 762 of women had planned and wanted the type of last pregnancy The average value of the womens autonomy index was 068 and 267 of participant women were autonomous The proportion of women with grand multigravida was 210 the duration of labor of index birth 12 hours was 547 birth preparedness towards index birth of 861 women with knowledge of the expected date of delivery EDD of the index birth were 667 and 661 of women know labor symptoms The mean number of pregnancies was 30 16 SD and the median duration of labor of the last birth was 14 IQR 12-24 Table 3
Table 3 Reproductive health and obstetric characteristics of participant women by birth before arrival in Lemo district Hadiya zone Southern Ethiopia n 382
Variables Category Frequency percentage Total
No BBA BBA ANC for the last delivery Yes No 254 867 70 787 39 133 19 213 293 767 89 233 Number of ANC contacts n 293 1-3 contacts 4 contacts 178 860 76 884 29 140 10 116 207 706 86 294 Type of health facility for ANC n 293 At hospital At health centre At health post 14 824 177 872 63 863 3 176 26 128 10 137 17 58 203 693 73 249 Used contraceptive before last pregnancy Yes No 83 822 241 858 18 178 40 142 101 264 281 736 PNC for the last delivery Yes No 233 850 91 843 41 150 17 157 274 717 108 283 Type of pregnancy Planned and wanted Unplanned but wanted Unplanned unwanted 249 856 68 919 7 412 42 144 6 81 10 588 291 762 74 194 17 44 Women autonomy Non-autonomous Autonomous 231 825 93 912 49 175 9 88 280 733 102 267 Gravidity Multigravidae Grand multigravidae 259 858 65 813 43 142 15 187 302 790 80 210 Duration of labor of index birth 12 hours 12 hours 155 896 169 809 18 104 40 191 173 453 209 547 Know the EDD of the index birth Yes No 226 886 98 772 29 114 29 228 255 667 127 333 Birth preparedness towards index birth Yes No 285 866 39 736 44 134 14 264 329 861 53 139 Knowledge of labor symptoms n350 Not knowledgeable Knowledgeable 89 748 205 887 30 252 26 113 119 340 231 660 Mode of previous delivery SVD Instrumental delivery SVD with episiotomy Cesarean section 217 851 34 944 72 809 1 500 38 149 2 56 17 191
1 500 255 667 36 94 89 233 2 06 ANC Antenatal Care BBA Birth Before Arrival EDD Expected Date of Delivery PNC Postnatal Care SVD Spontaneous Vaginal Delivery Access to a healthcare facility The median time of the delay to seek health care was 14 hours IQR 12-24 and the mean duration of the second delay was 13 hours 06 SD One-fourth 259 of women delayed 24 hours in deciding to seek health care and one-third 338 travelled 2 hours to reach a health care facility The major reason for the first delay was not realising the problem 288 for women with birth before arrival and lack of transport 623 was the major reason for the second delay About means of transport 358 of women used HorseDonkey carts Regarding the condition of the road 293 of women replied that it is a wide road More than half of women 516 delivered their index birth at night Table 4
Table 4 Access to health care facility among women who gave birth in the last six months in Lemo district Hadiya zone Southern Ethiopia n382
Variables Category Frequency percentage Total
No BBA BBA First delay Delayed 24 hours Delayed 24 hours 246 869 78 788 37 131 21 212 283 741 99 259 Second delay n 317 Traveled 2 hours Traveled 2 hours 171 814 88 822 39 186 19 178 210 662 107 338 Reasons for 1st delay Underestimate severity Did not realize the problem Essential person for decision making not around 195 867 116 712 78 867 30 133 47 288 12 133 225 100 163 100 90 100 Reasons for 2nd delay n 317 Lack of money Lack of transport Distant health facility 61 871 159 807 38 776 9 129 38 193 11 224 70 221 197 623 49 156 Means of transport n 317 Motorbike Ambulance Public transport HorseDonkey cart On foot Carried by other people 39 1000 16 485 62 1000 83 735 14 583 44 978 0 00 17 515 0 00 30 265 10 413
1 22 39 123 33 104 62 196 113 358 24 76 45 142 Status of the roadroad All weather road Weather raod 225 833 99 884 45 167 13 116 270 707 112 293 Time of delivery of index birth Night Day 150 761 174 941 47 239 11 59 197 516 185 484 Women who delivered their last birth at home were not asked for the second delay and its reasons
Birth before arrival The prevalence of birth before arrival among women who gave birth in the last six months preceding this study in the study area was 152 95CI 118 191 Among them 845 of women gave birth on the route to a health care facility Table 5
Table 5 Profile of birth before arrival among women who gave birth in the last six months in Lemo district Hadiya zone Southern Ethiopia n 382
Variables Frequency Percentage Place of last delivery Home Before arrival to a health care facility Health care facility 67 58 257 175 152 673 The specific place of BBA to health care facility n58 On the route to health care facility In ambulance 49 9 845 155 BBA Birth before Arrival Factors associated with birth before arrival Using bivariate binary logistic regression analyses variables with a p-value of 025 were recruited to be included in the final model Thus in the multi-variable analysis the variables found to have an association with birth before arrival in the final model were having no antenatal care AOR 263 95CI 123 563 dependent women autonomy status AOR 332 95CI 112 989 being not knowledgeable about labor symptoms AOR 215 95CI 111 418 and having birth preparedness towards index birth AOR 013 95CI 005 035
Therefore this study found that women who have no antenatal care visits during the index pregnancy had three times higher odds of birth before arrival compared to women with antenatal care The probability of having birth before arrival to a health care facility was three times higher for women who were dependent on their autonomy status compared with those who were autonomous Moreover those women who were not knowledgeable about labor symptoms had two times more likely to experience birth before arrival compared to those who were knowledgeable Women who have birth preparedness towards index pregnancy were 87 less likely to experience birth before arrival compared to women with no birth preparedness plan Having first and second delay status of the road time of delivery and income were unrelated to the probability of birth before arrival Table 6
Table 6 Multivariate logistic regression showing factors associated with birth before arrival among women who gave birth in the last six months in Lemo district Hadiya zone Southern Ethiopia
Variables Category COR 95 CI AOR 95 CI P-value Media exposure Yes No 100 209 072 604 100 274 082 918 0103 Receive ANC in last pregnancy Yes No 100 177 096 325 100 263 123 563 0013 Women autonomy Unautonomous Autonomous 219 104 464 100 332 112 989 100 0031 Knowledge of labor symptoms Not knowledgeable Knowledgeable 266 149 475 100 215 111 418 100 0023 Birth preparedness for the last birth Yes No 043 022 086 100 013 005 035 100 0001 Used contraceptive before last pregnancy Yes No 131 071 240 100 170 078 369 100 0181 First delay Delayed 24 hours Delayed 24 hours 100 179 100 324 100 186 092 376 0082 ANC Antenatal Care AOR Adjusted Odds Ratio CI Confidence Interval COR Crude Odds Ratio Discussion The prevalence of birth before arrival among women who gave birth in the last six months preceding this study in the study area was unacceptably high In the current study the variables associated with birth before arrival in the Lemo district of Hadiya zone were having no antenatal care dependent womens autonomy status being not knowledgeable about labor symptoms and having birth preparedness towards index birth
Globally the prevalence of birth before arrival to a healthcare facility is estimated to be less than 1 of all deliveries in developed countries 15101415 But the prevalence of BBA rises exponentially in low-income countries to greater than 50 17 In the current study the prevalence of birth before arrival is 152 This is a high prevalence in the study area as the rate of BBA is used as an index of accessibility to perinatal care and a rate greater than 15 signals challenges in health care provision where appropriate interventions are praiseworthy 9 Births occurred between home and health care facilities either en route to health care facilities or in ambulances were given less attention and no recent evidence was found in Ethiopia that indicated its prevalence However according to the mini EDHS 2019 report 40 of the total live births were delivered in health facilities in rural areas and 587 were delivered at home and the gap 12 reported as other might be taken as the prevalence of BBA to health facility even though it was not reported 7
The current studys finding was higher than EDHSs report and this difference might be due to the misclassification bias Accordingly in the EDHS questionnaire there was no option indicated for BBA so the BBA prevalence might be misclassified to home or health facility delivery prevalence but in the current study option for birth before arrival to health facility was indicated in the questionnaire Yet the prevalence of BBA in South Africa is 54 and in rural Malawi was 9 419 As per the current studys finding the prevalence of BBA in Lemo district was higher than the prevalence in South Africa and rural Malawi The difference might be due to the variation of level of socio-economic status across countries
This study established that women who have no antenatal care visits during the index pregnancy had three times higher odds of birth before arrival compared to women with antenatal care Similarly a national register study in Finland documented that one of the predictors for deliveries before arrival to health care facility was fewer prenatal visits 26 Another study from Tharaka Nithi County of Kenya documented that the obstetric risk factors associated with BBA were ANC attendance timing of ANC attendance and number of ANC visits 20 A prospective case control study from Nkangala District South Africa concluded that being unbooked was found to predict the occurrence of BBAs 4 The findings of these studies were concurrent to the current studys finding Even though there is no similar evidence from Ethiopia our finding was supported by the 2019s mini EDHS report that showed seventy-four percent of births to mothers who attended four or more ANC visits were delivered in a health facility as compared with 14 of births to mothers with no ANC visits 7 This signals that the ANC program if properly delivered will be important for reducing birth before arrival to health care facilities and subsequently its adverse perinatal outcomes
Dependent women in their autonomy status compared with those who were autonomous had three times higher odds of giving birth before arrival to a health care facility as per the current study Similarly one study shows that womens autonomy was positively associated with health facility delivery in Ethiopia 27 Another study revealed the strongest association between delivery at healthcare facilities attended by skilled birth attendants in the Southern African region among women who made decisions on household income solely 28 Womens autonomy can influence their decision to seek health care and could result in delays in reaching as early as possible to a health care facility to give birth if she is not adequately autonomous So this results in birth before arrival We required policy actions that increase womens autonomy at home and this could be effective in helping assure womens delivery at health care facilites
Furthermore the current study reveals that those women who were not knowledgeable about labor symptoms had two times more likely to experience birth before arrival compared to those who were knowledgeable Our finding was supported by one study from Tharaka Nithi County of Kenya which documented that the obstetric risk factors associated with BBA were recognition of the onset of labor and knowledge of signs and symptoms of labor 20 The finding implies that having poor knowledge of labor symptoms could affect women in early and properly recognizing the onset of labor and seek for healthcare facility delivery in the early hours Therefore standard guidelines for ANC in Ethiopia were required and emphasised that every pregnant woman should receive ANC from a skilled provider7 which must include counselling and enter-personal education with women concerning labor symptoms
Additionally women who have birth preparedness towards index pregnancy were less likely to experience birth before arrival compared to women with no birth preparedness plan as per the current study Similarly one study from Tharaka Nithi County of Kenya documented that the obstetric risk factors associated with BBA were the identification of healthcare facility for delivery identification of means of transport financial preparation for hospital delivery and basic supplies for birth 20 These are the components of the birth preparedness plan that were revealed by the Kenya study and these were used in our study as constructs to measure and compute variables for birth preparedness As Ethiopia has adopted the WHOs goal-oriented focused antenatal care for promoting the health and survival of mothers and babies one of its basic components thats individualized birth plan complication readiness and emergency preparedness is expected to alleviate the problem of BBA if properly performed Having first and second delay status of the raod time of delivery and income were unrelated to the probability of birth before arrival
Strengths and limitations of the study Our study revealed the delivery of babies occurred between home and health care facilities and came up with the prevalence of BBA and its associated factors as this issue was given less attention by literature in Ethiopia The study has a limitation in that it was based on a cross-sectional design due to its unclearly indicated prevalence of BBA but we recommend it be based on a community-based case-control study The results obtained from the current study were based on womens interviews and cannot be free from recall and social desirability biases
Conclusion The prevalence of birth before arrival among women who gave birth in the last six months preceding this study in the study area was unacceptably high Statistically significant association was seen between birth before arrival and having no antenatal care dependent women autonomy status being not knowledgeable about labor symptoms and having birth preparedness towards index birth Intervening to avert birth before arrival through an effective antenatal acre program especially focusing on individualized counselling concerning knowledge of labor symptoms and birth preparedness plan and providing extra vigilant attention for enhancing womens autonomy in the community may help to reduce birth before arrival and its adverse perinatal outcomes
Data-Sharing Statement All data generated or analyzed during this study are included in the manuscript and are also available from the corresponding author upon request
Ethical Approval and Consent to Participate Ethical clearance was obtained from Wachemo University the faculty of medicine and the public health institution review board with reference no WCUNEMMCSH1822023 Permission was granted from the concerned bodies of Lemo woreda and selected kebele administrators Moreover written informed consent was obtained from each woman Confidentiality of the information was assured Moreover this study was conducted in compliance with the Declaration of Helsinki Anonymous data were taken and the confidentiality of participants information was secured
Acknowledgment We would like to forward our appreciations to health office and health extension workers of study area for their kind cooperation We are also thankful to data collectors and the study participants
Author Contributions All authors made substantial contributions to conception and design acquisition of data or analysis and interpretation of data took part in drafting the article or revising it critically for important intellectual content agreed to submit to the current journal gave final approval of the version to be published and agree to be accountable for all aspects of the work All authors reviewed the manuscript
Funding No funding was received for this work Disclosure The authors declare that they have no competing interests
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None