Title : Knowledge and Attitude of Antenatal Women regarding Birth Preparedness
 Knowledge and Attitude of Antenatal Women regarding Birth Preparedness: A Cross-Sectional Study
 

 

Abstract
A cross-sectional descriptive study was conducted to assess the knowledge and attitude of antenatal women regarding birth preparedness at an antenatal OPD of tertiary care hospital. The study sample of 200 antenatal women was selected purposively after meeting the inclusion and exclusion criteria. The structured knowledge questionnaire and attitude rating scale was used to assess knowledge and attitude of antenatal women regarding birth pre-paredness. The result of the study shows that 49.5 percent of antenatal women had good knowledge and 99 percent had positive attitude regarding birth preparedness. Demographic variables like age and religion had significant influence on the knowledge but parity had significant influence on attitude of antenatal women (p<0.05) regarding birth preparedness. Type of family had no significant effect on the knowledge and attitude of antenatal women regarding birth preparedness.
 

 

Birth-preparedness and complication-readiness is a comprehensive package aimed at promoting timely access to skilled maternal and neonatal services. The birth-preparedness package promotes active preparation and decision-making for delivery by pregnant women and their families (Kakaire et al, 2011). A birth and complications preparedness plan contains the following elements: the desired place of birth; the preferred birth attendant; the location of the closest facility for birth and in case of a complication expenses related to birth and complications, if any; supplies and materials necessary to bring to the facility; an identified labour and birth companion; an identified support to look after the home and other children while the woman is away; transport to a facility for birth or in the case of a complication; and the identification of compatible blood donors in case of emergency.
 
To have birth preparedness and complication readiness at the provider level, nurses, midwives, and doctors must have the knowledge and skills necessary to treat or stabilise and refer women with complications, and they must employ sound normal birth practices that reduce the likelihood of preventable complications (Kuganab-Lem et al, 2013).
 
The World Health Organization (WHO) has a vision of universal coverage of health care; however, there is persistent inequality in access to maternal health services and an estimated 800 women still die every day from preventable causes linked to pregnancy and childbirth, with 99 percent of those deaths occuring in developing countries (Braxton, 2014). WHO estimates that, of 536,000 maternal deaths occurring globally each year, 117,000 take place in India (WHO, 2007). Unfortunately, there is little evidence that maternity has become significantly safer in India over the last 20 years despite the safe motherhood policies and programmatic initiatives at the national level. Birth and emergency preparedness is considered by WHO and other agencies to be a useful and practical intervention with several advantages. Keeping this view a study was conducted to assess knowledge and attitude of antenatal women regarding birth preparedness.
 
Objectives
 
The objectives of the study were:
 
To assess the knowledge of antenatal women re-garding birth preparedness.
 
To assess the attitude of antenatal women re-garding birth preparedness.
 
To find out the association of knowledge and attitude with variables (age, parity, religion and type of family).
 
Review of Literature
 
Henok A (2015) conducted a cross sectional study on women of reproductive age from Mizan-Aman General Hospital of South West Ethiopia. Majority of respondents (n=231, 66%) mentioned at least one key danger sign during pregnancy and 67 (19%) mentioned at least two danger signs; 263 (75%) of the respondents had heard about birth preparedness and complication readiness. Among respondents 97 (37%), 78 (30%), 56 (21%), and 18 (7%) mentioned birth place &  assistance plan, arranging material necessary for safe delivery, identify pregnancy danger signs, and potential blood donor as elements birth preparedness and complication readiness, respectively.
 
In a descriptive cross-sectional study by Nawzia Y et al (2009) on 211 married women to assess knowledge, attitude and practices regarding hospital delivery in Bangladesh, 70.1 percent said that ANC is important; 29.9 percent were found to be informed of child birth complications, 16.1 percent knew the duration of pregnancy, 8.1 percent knew the danger signs of pregnancy, 4.7 percent about emergency obstetric care (EOC), 4.3 percent about expected date of delivery (EDD), 2.4 percent about safe motherhood and 28.4 percent about the access of health facilities in the village; 85.3 percent respondents showed a posi-tive attitude towards hospital delivery while 14.7 percent had a negative attitude. Most strikingly, only 6 percent had autonomy in health care seeking behaviour. Very few opined that hospital delivery is a sin or shameful practice (Yasmin et al, 2009).
 
Takahashi (2015) conducted a cross sectional study to assess knowledge, attitudes and practices of birth preparedness and complication readiness in relation to skilled birth attendant among 250 delivered women in Cambodia; 94.8 percent of women knew saving money for delivery and in case of emergency was an important birth preparation. On the other hand, only 2.0 percent mentioned the need to identify blood donor; 66.8 percent women thought they needed to identify the place of birth, 64.4 percent for identifying means of transportation for facility when contraction started, and 20.0 percent for identifying skilled birth attendant to assist her birth. 70.4 percent of respondents were classified into neutral atti-tudes towards birth preparedness and complication readiness. Safety was more important than expen-sive payment (69.2%), difficulty to access health facility (distance, road condition) (73.2%) and health staffs’ bad behaviour (66.8%).
 
Nurses Zone
 
 
Material and Methods
The cross-sectional descriptive study was conducted to assess knowledge and attitude of 200 antenatal women regarding birth preparedness in antenatal OPD of tertiary hospital of Ludhiana (Punjab). Non-randomised (purposive sampling) technique was adopted to select the antenatal women. Antenatal women with associated disorders or diseases were excluded from the study. Ethical committee permission was obtained before conducting the study. Consent was taken prior to data collection. Confidentiality of subject and data was ensured. The structured knowledge questionnaire and attitude rating scale was used to assess knowledge and attitude of antenatal women regarding birth preparedness. Content validity of the tool was obtained by 7 experts in the field of obstetric and gynaecological nursing. Reliability of tool was computed. Pilot study was conducted by taking 20 subjects.
 
Data was analysed using SPSS. The descriptive and inferential statistics such as percentage, mean, mean percentage, standard deviation (SD) and ANOVA test was used to identify significant relationship of knowledge and attitude of antenatal women regarding birth preparedness. The level of significance cho-sen was p<0.05.
 
Results
Maximum number (49.5%) of antenatal women obtained good knowledge score followed by average (36%), excellent (10.5%) and below average (4%) knowledge score respectively regarding birth preparedness (Table 1). Thus, the maximum number of antenatal women had good knowledge regarding birth preparedness. Maximum (99%) antenatal women had positive attitude regarding birth preparedness (Table 2).
 
Antenatal women who belonged to age group of 30-35 years scored maximum mean knowledge and at-titude score (21.06 and 56.0) followed by 24-29 years (20.60 and 54.66) and 18-23 years (19.19 and 53.8) respectively regarding birth preparedness (Table 3).
 
Antenatal women who were primi para had higher mean knowledge and attitude score (20.47 and 54.98) followed by secondary (20.23 and 54.47) and 3rd and above (19.05 and 51.88) respectively regarding birth preparedness (Table 3). Christian antenatal women scored maximum mean knowledge score (21.87), followed by Sikh (20.62), Hindu (20.13) and Muslim (13.50). The maximum attitude score was obtained by antenatal women who were Christian (54.62), followed by Hindu (54.58), Sikh (54.50) and Muslim (52.50).
 
Nurses Zone
 
Antenatal women who belonged to nuclear family scored maximum mean knowledge score (21.16), followed by joint family (20.13) and extended family (19.30). Mean attitude score obtained by the antenatal women who belonged to joint family was (54.72) followed by nuclear and extended family (54) regarding Birth preparedness.
 
Thus age and religion had significant influence on the knowledge but parity had significant influence on attitude of antenatal women (p<0.05) regarding birth preparedness. Type of family had no significant effect on the knowledge and attitude of antenatal.
 
Discussion
 
Our findings revealed that maximum number of antenatal women obtained good knowledge score regarding birth preparedness. Another study conducted in Nigeria also found that awareness of the concept of birth preparedness was high among the women (Ekabua et al, 2011).
 
Findings of present study indicate that 99 percent of antenatal women had positive attitude regarding birth preparedness, these are consistent with the study conducted in Padukka which concluded that that 75 percent pregnant women had favourable at-titude regarding birth preparedness and complication readiness (Rodrigo & Kumarapeli, 2011).
 
According to demographic variable maximum mean knowledge and attitude score was obtained by the higher age group 30-35 years. These find-ings are supported by the study conducted in Rural Tanzania on women’s awareness of danger signs of obstetric complications, which concluded that awareness increased with increasing age of women. According to religion, Christian and Sikh had more knowledge and attitude regarding birth preparedness as compared to Hindu and Muslim. These findings show that Hindu and Muslim women are almost alike in poorly availing the health care services. On the other hand, Christian and Sikh women maximally utilised the existing maternal health services (Pembe et al, 2009).
 
Our findings regarding parity revealed that knowledge and attitude regarding birth preparedness was higher in primi para as compared to multipara. Further, parity had significant effect on the attitude of antenatal women (p<0.05) regarding birth preparedness. Similar to these are the findings of other study conducted to assess status of birth preparedness & complication readiness in Madhya Pradesh which stated that birth preparedness/complication readiness were significantly higher in primi-para as compared to multipara (Kushwah et al, 2015). Nuclear family has more knowledge regarding birth preparedness as compared to joint and extended family. These findings are associated with the research conducted in West Bengal, which concluded that antenatal care of mother is high in nuclear family (Prabir et al, 2016).
 
Implications
 
The findings of the present study have several implications.
Nursing education: Continuing education and instructional programmes for antenatal women and for their child welfare should be organised at hospital level and community level by nursing students.
 
Nursing practice: Nurses working in antenatal OPD, wards and community area can educate the mother regarding birth preparedness and enhance their knowledge and good knowledge promote better practices.
 
Nursing administration: Nursing Administration need to take initiative in developing birth preparedness programme (workshop, community-based programme) for providing education to the patients during OPD visit and hospital stay.
 
Nursing research: Nursing personnel should take initiative not only in conducting the research but also discussing the findings of research study among nurses and encourage them to implement the findings.
 
Recommendations
 
1.    Quasi experimental study can be conducted to assess the effectiveness of self-structured health education on antenatal women/ health workers regarding birth preparedness.
 
2.    A comparative study between urban and rural community can be done to assess the knowledge and attitude regarding birth preparedness.
 
3.    The tool used for assessing birth preparedness can further be developed and field-tested for standardising it.
 
Conclusion
 
As maximum number of antenatal women had good knowledge and positive attitude regarding birth pre-paredness but still there is a need that knowledge should be provided to those women who lack knowledge regarding birth preparedness so that they can make an advance planning for childbirth and post-natal/ newborn period. The government officials and partners working in areas of maternal health should come up with strategies to improve birth preparedness at individual and community level.
 
References
 
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Author: Preety Narula
The author is Associate Professor, SPN College of Nursing, Mukerian, District Hoshiarpur (Punjab).