Effects of maternal education on birth preparedness and complication readiness among Ethiopian pregnant women: a systematic review and meta-analysis

Daniel Bekele Ketema, Cheru Tesema Leshargie, Getiye Dejenu Kibret, Moges Agazhe Assemie, Pammla Petrucka, Animut Alebel, Daniel Bekele Ketema, Cheru Tesema Leshargie, Getiye Dejenu Kibret, Moges Agazhe Assemie, Pammla Petrucka, Animut Alebel

Abstract

Background: Birth preparedness and complication readiness are broadly endorsed by governments and international agencies to reduce maternal and neonatal health threats in low income countries. Maternal education is broadly positioned to positively affect the mother's and her children's health and nutrition in low income countries. Thus, this systematic review and meta-analysis aims to estimate the effect of maternal education on birth preparedness and complication readiness.

Methods: This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. We conducted an electronic based search using data bases of PubMed /MEDLINE, Science direct and google scholar. STATA™ Version 14.1 was used to analyze the data, and forest plots were used to present the findings. I2 test statistics and Egger's test were used to assess heterogeneity and publication bias. Pooled prevalence and pooled odd ratios with 95% confidence intervals were computed. Finally, Duval and Tweedie's nonparametric trim and fill analysis using random-effects meta-analysis was conducted to account for publication bias.

Results: In this meta-analysis, 20 studies involving 13,744 pregnant women meeting the inclusion criteria were included, of which 15 studies reported effects of maternal education on birth preparedness and complication readiness. Overall estimated level of birth preparedness and complication readiness was 25.2% (95% CI 20.0, 30.6%). This meta-analysis found that maternal education and level of birth preparedness and complication readiness were positively associated. Pregnant mothers whose level of education was primary and above were more likely to prepare for birth and obstetric emergencies (OR = 2.4, 95% CI: 1.9, 3.1) than non-educated mothers.

Conclusion: In Ethiopia, the proportion of women prepared for birth and related complications remained low. Maternal education has a positive effect on the level of birth preparedness and complication readiness. Therefore, it is imperative to launch programs at national and regional levels to uplift women's educational status to enhance the likelihood of maternal health services utilization.

Keywords: Birth preparedness; Complication readiness; Maternal education; Meta-analysis; Systematic review.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram shows the studies selection of the meta-analysis of the effect of maternal education on birth preparedness and complication readiness among pregnant women in Ethiopia
Fig. 2
Fig. 2
Forest plot displaying the pooled result of birth preparedness and complication readiness among pregnant women in Ethiopia
Fig. 3
Fig. 3
Forest plot of the pooled effect of maternal education on BP/CR practice among pregnant women in Ethiopia

References

    1. Alkema L, Chou D, Hogan D, Zhang S, Moller A-B, Gemmill A, Fat DM, Boerma T, Temmerman M, Mathers C. 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):462–474. doi: 10.1016/S0140-6736(15)00838-7.
    1. Maternal mortality fact sheets. . Accessed 4 Dec 2018.
    1. WHO, UNFPA, UNICEF a, Reduction of maternal mortality: a joint WHO. UNFPA/UNICEF/World Bank statement WHO 1999, 20:11–12.
    1. Starrs AM. Safe motherhood initiative: 20 years and counting. Lancet. 2006;368(9542):1130–1132. doi: 10.1016/S0140-6736(06)69385-9.
    1. Lawrence AL, Jimmy JA, Okoye V, Abdulraheem A, Igbans RO, Uzere M. Birth preparedness and complication readiness among pregnant women in Okpatu community, Enugu state, Nigeria. Int J Innov Appl Stud. 2015;11(3):644.
    1. Mbalinda SN, Nakimuli A, Kakaire O, Osinde MO, Kakande N, Kaye DK. Does knowledge of danger signs of pregnancy predict birth preparedness? A critique of the evidence from women admitted with pregnancy complications. Health Res Policy Syst. 2014;12(1):60. doi: 10.1186/1478-4505-12-60.
    1. August F, Pembe AB, Kayombo E, Mbekenga C, Axemo P, Darj E. Birth preparedness and complication readiness–a qualitative study among community members in rural Tanzania. Glob Health Action. 2015;8(1):26922. doi: 10.3402/gha.v8.26922.
    1. Hailu M, Gebremariam A, Alemseged F, Deribe K. Birth preparedness and complication readiness among pregnant women in southern Ethiopia. PLoS One. 2011;6(6):e21432. doi: 10.1371/journal.pone.0021432.
    1. Gebre M, Gebremariam A, Abebe TA. Birth preparedness and complication readiness among pregnant women in Duguna Fango District, Wolayta zone, Ethiopia. PloS One. 2015;10(9):e0137570. doi: 10.1371/journal.pone.0137570.
    1. Soubeiga D, Sia D, Gauvin L. Increasing institutional deliveries among antenatal clients: effect of birth preparedness counselling. Health Policy Plan. 2013;29(8):1061–1070. doi: 10.1093/heapol/czt089.
    1. Soubeiga D, Sia D. Birth preparedness in antenatal care: effects of health center characteristics. Revue d’epidemiologie et de Sante Publique. 2013;61(4):299–310. doi: 10.1016/j.respe.2012.12.019.
    1. Karkee R, Lee AH, Binns CW. Birth preparedness and skilled attendance at birth in Nepal: implications for achieving millennium development goal 5. Midwifery. 2013;29(10):1206–1210. doi: 10.1016/j.midw.2013.05.002.
    1. Onayade A, Akanbi O, Okunola H, Oyeniyi C, Togun O, Sule S. Birth preparedness and emergency readiness plans of antenatal clinic attendees in Ile-ife, Nigeria. Nigerian Postgraduate Med J. 2010;17(1):30–39.
    1. Del Barco R. Monitoring birth preparedness and complication readiness. Tools Indicators Matern Newborn Health. 2004.
    1. Udofia EA, Obed SA, Calys-Tagoe BN, Nimo KP. Birth and emergency planning: a cross sectional survey of postnatal women at Korle Bu teaching hospital, Accra, Ghana. Afr J Reprod Health. 2013;17(1):27–40.
    1. Ekabua JE, Ekabua KJ, Odusolu P, Agan TU, Iklaki CU, Etokidem AJ. Awareness of birth preparedness and complication readiness in southeastern Nigeria. ISRN Obstetr Gynecol. 2011;2011.
    1. Kaso M, Addisse M. Birth preparedness and complication readiness in robe Woreda, Arsi zone, Oromia region, Central Ethiopia: a cross-sectional study. Reprod Health. 2014;11(1):55. doi: 10.1186/1742-4755-11-55.
    1. Gaym A. Maternal mortality studies in Ethiopia--magnitude, causes and trends. Ethiop Med J. 2009;47(2):95–108.
    1. Tessema GA, Laurence CO, Melaku YA, Misganaw A, Woldie SA, Hiruye A, Amare AT, Lakew Y, Zeleke BM, Deribew A. Trends and causes of maternal mortality in Ethiopia during 1990–2013: findings from the global burden of diseases study 2013. BMC Public Health. 2017;17(1):160. doi: 10.1186/s12889-017-4071-8.
    1. Central Statistical Agency (CSA): Ethiopia Demographic and Health Survey avalaible from . In. Addis Ababa, Ethiopia; 2016. Accessed 6 Dec 2018.
    1. Seble T. Awareness on birth preparedness and complication Readines s among antenatal care clients in Federal Police Referral Hospital Addi s Ababa, Ethiopia. Am J Health Res. 2015;3:362–367. doi: 10.11648/j.ajhr.20150306.18.
    1. Kakaire O, Kaye DK, Osinde MO. Male involvement in birth preparedness and complication readiness for emergency obstetric referrals in rural Uganda. Reprod Health. 2011;8(1):12. doi: 10.1186/1742-4755-8-12.
    1. Uganda Bureau of Statistics (UBOS) Uganda Bureau of Statistics and ORC Macro. 2007. Uganda Demographic and Health Survey.
    1. Tafa A, Hailu D, Ebrahim J, Gebrie M, Wakgari N. Birth preparedness and complication readiness plan among antenatal care attendants in Kofale District, South East Ethiopia: A Cross Sectional Survey. 2018.
    1. Zepre K, Kaba M. Birth preparedness and complication readiness among rural women of reproductive age in abeshige district, guraghe zone, snnPr, Ethiopia. Int J Women's Health. 2017;9:11. doi: 10.2147/IJWH.S111769.
    1. Berhe AK, Muche AA, Fekadu GA, Kassa GM. Birth preparedness and complication readiness among pregnant women in Ethiopia: a systematic review and meta-analysis. Reprod Health. 2018;15(1):182. doi: 10.1186/s12978-018-0624-2.
    1. Miltenburg AS, Roggeveen Y, van Roosmalen J, Smith H. Factors influencing implementation of interventions to promote birth preparedness and complication readiness. BMC Pregnancy Childbirth. 2017;17(1):270. doi: 10.1186/s12884-017-1448-8.
    1. Xue D, Qian C, Yang L, Wang X. Risk factors for surgical site infections after breast surgery: a systematic review and meta-analysis. Eur J Surg Oncol. 2012;38(5):375–381. doi: 10.1016/j.ejso.2012.02.179.
    1. Rücker G, Schwarzer G, Carpenter JR, Schumacher M. Undue reliance on I 2 in assessing heterogeneity may mislead. BMC Med Res Methodol. 2008;8(1):79. doi: 10.1186/1471-2288-8-79.
    1. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. Bmj. 1997;315(7109):629–634. doi: 10.1136/bmj.315.7109.629.
    1. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994:1088–101.
    1. Dimtsu B, Bugssa G. Assessment of knowledge and practice towards birth preparedness and complication readiness among women in Mekelle, northern Ethiopia: descrptive crossectional. Int J Pharm Sci Res. 2014;5(10):4293.
    1. Tura G, Afework MF, Yalew AW. The effect of birth preparedness and complication readiness on skilled care use: a prospective follow-up study in Southwest Ethiopia. Reprod Health. 2014;11(1):60. doi: 10.1186/1742-4755-11-60.
    1. Andarge E, Nigussie A, Wondafrash M. Factors associated with birth preparedness and complication readiness in southern Ethiopia: a community based cross-sectional study. BMC Pregnancy Childbirth. 2017;17(1):412. doi: 10.1186/s12884-017-1582-3.
    1. Mekuaninte AG, Worku A, Tesfaye DJ. Assessment of magnitude and factors associated with birth preparedness and complication readiness among pregnant women attending antenatal clinic of Adama town health facilities, Central Ethiopia. Eur J Prev Med. 2016;4(2):32–38. doi: 10.11648/j.ejpm.20160402.12.
    1. Hiluf M, Fantahun M. Birth preparedness and complication readiness among women in Adigrat town, North Ethiopia. Ethiop J Health Dev. 2008;22(1):14–20. doi: 10.4314/ejhd.v22i1.10057.
    1. Hailemariam A, Nahusenay H. Assessment of Magnitude and Factors Associated with Birth Preparedness and Complication Readiness among Pregnant Women Attending Antenatal Care Services at Public Health Facilities In Debrebirhan Town, Amhara, Ethiopia. Glob J Med Res. 2015;2016.
    1. Belda SS, Gebremariam MB. Birth preparedness, complication readiness and other determinants of place of delivery among mothers in Goba District, bale zone, south East Ethiopia. BMC Pregnancy Childbirth. 2016;16(1):73. doi: 10.1186/s12884-016-0837-8.
    1. Markos D, Bogale D. Birth preparedness and complication readiness among women of child bearing age group in Goba woreda, Oromia region, Ethiopia. BMC Pregnancy Childbirth. 2014;14(1):282. doi: 10.1186/1471-2393-14-282.
    1. Debelew GT, Afework MF, Yalew AW. Factors affecting birth preparedness and complication readiness in Jimma zone, Southwest Ethiopia: a multilevel analysis. Pan Afr Med J. 2014;19.
    1. Iyasu A, Hordofa MA, Zeleke H, Leshargie CT. Level and factors associated with birth preparedness and complication readiness among semi-pastoral pregnant women in southern Ethiopia, 2016. BMC Res Notes. 2018;11(1):442. doi: 10.1186/s13104-018-3539-7.
    1. Bitew Y, Awoke W, Chekol S. Birth preparedness and complication readiness practice and associated factors among pregnant women, Northwest Ethiopia. Int Sch Res Notices. 2016;2016.
    1. Endeshaw DB, Gezie LD, Yeshita HY. Birth preparedness and complication readiness among pregnant women in Tehulederie district, Northeast Ethiopia: a community-based cross-sectional study. BMC Nurs. 2018;17(1):10. doi: 10.1186/s12912-018-0278-y.
    1. Begashaw B, Tesfaye Y, Zelalem E, Ubong U, Kumalo A. Assessment of birth preparedness and complication readiness among pregnant mothers attending ante Natal Care Service in Mizan-Tepi University Teaching Hospital, south West Ethiopia. Clinics Mother Child Health. 2017;14(257):2.
    1. Bishaw W, Awoke W, Teshome M: Birth Preparedness and Complication Readiness and Associated Factors among Pregnant Women in Basoliben District, Amhara Regional State, Northwest, Ethiopia, 2013. Primary Health Care: Open Access 2014.
    1. Musa A, Amano A. Determinants of birth preparedness and complication readiness among pregnant women attending antenatal care at Dilchora referral hospital, Dire Dawa City, East Ethiopia. Gynecol Obstetr. 2016;6:2.
    1. Tilahun T, Sinaga M. Knowledge of obstetric danger signs and birth preparedness practices among pregnant women in rural communities of eastern Ethiopia. Int J Nurs Midwifery. 2016;8(1):1–11.
    1. Jatta FO, Lu Y-Y, Chang C-L, Liu C-Y. Pregnant women’s awareness of antenatal danger signs and birth preparedness in rural Gambia. Afr J Midwifery Womens Health. 2014;8(4):189–194. doi: 10.12968/ajmw.2014.8.4.189.
    1. Mutiso SM, Qureshi Z, Kinuthia J. Birth preparedness among antenatal clients. East Afr Med J. 2008;85(6):275–283. doi: 10.4314/eamj.v85i6.9625.
    1. Bintabara D, Mohamed MA, Mghamba J, Wasswa P, Mpembeni RN. Birth preparedness and complication readiness among recently delivered women in chamwino district, Central Tanzania: a cross sectional study. Reprod Health. 2015;12(1):44. doi: 10.1186/s12978-015-0041-8.
    1. Mandal T, Biswas R, Bhattacharyya S, Das D. Birth preparedness and complication readiness among recently delivered women in a rural area of Darjeeling, West Bengal. India AMSRJ. 2015;2(1):14–20.
    1. Agarwal S, Sethi V, Srivastava K, Jha PK, Baqui AH. Birth preparedness and complication readiness among slum women in Indore city, India. J Health Popul Nutr. 2010;28(4):383. doi: 10.3329/jhpn.v28i4.6045.
    1. Kiataphiwasu N, Kaewkiattikun K. Birth preparedness and complication readiness among pregnant women attending antenatal care at the Faculty of Medicine Vajira Hospital, Thailand. Int J Women's Health. 2018;10:797–804. doi: 10.2147/IJWH.S185589.
    1. Kabakyenga JK, Östergren P-O, Turyakira E, Pettersson KO. Knowledge of obstetric danger signs and birth preparedness practices among women in rural Uganda. Reprod Health. 2011;8(1):33. doi: 10.1186/1742-4755-8-33.
    1. Mpembeni RN, Killewo JZ, Leshabari MT, Massawe SN, Jahn A, Mushi D, Mwakipa H. Use pattern of maternal health services and determinants of skilled care during delivery in southern Tanzania: implications for achievement of MDG-5 targets. BMC Pregnancy Childbirth. 2007;7(1):29. doi: 10.1186/1471-2393-7-29.
    1. Organization WH . Birth and emergency preparedness in antenatal care. 2006. pp. 1–6.
    1. McPherson RA, Khadka N, Moore JM, Sharma M. Are birth-preparedness programmes effective? Results from a field trial in Siraha district, Nepal. J Health Popul Nutr. 2006;24(4):479.
    1. Fullerton JT, Killian R, Gass PM. Outcomes of a community–and home-based intervention for safe motherhood and newborn care. Health Care Women Int. 2005;26(7):561–576. doi: 10.1080/07399330591004881.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever