| dc.description.abstract | Background: While other health indicators in Sub-Saharan Africa have improved over the years,
maternal morbidity and mortality rates and ratios have not. Many safe motherhood strategies so far
employed are facility based and there is no literature that links birth preparedness to maternal and
fetal outcomes. Birth and emergency preparedness was defined as adequate preparation for action
in the event of complication and a plan for a desired place of birth, use of a preferred skilled birth
attendant and companion for routine birth. This study aimed to evaluate birth preparedness and its
influence on maternal and fetal outcomes.
Objective: To evaluate birth preparedness and its influence on maternal/fetal outcome
Design: Cross-sectional descriptive study
Setting: Postnatal wards of Pumwani Maternity Hospital, Nairobi
Subjects: Postnatal mothers and their newborn babies
Materials and methods: The Kenyatta National Hospital and Pumwani maternity Hospital ethics
and research committees approved the study. A crossectional study involving three hundred and
seventy five respondents who delivered after 28 weeks gestation were interviewed at the Pumwani
Maternity Hospital, Nairobi. 27 women (7.2%) had eventful outcomes (i.e. Morbidity and
mortality) and of these, 22 (81.5%) had morbidity outcome and 5 (18.5%) were mortality cases.
Every other bed occupant was included in the study. A structured questionnaire was administered
through face-to-face interviews by the principal investigator and two assistants who were final year
medical students. Data was collected between June and August 2006 then entered and tabulated
using SPSS 11.5 for windows software. Pearson Chi-square, Odds ratio and logistic regression were
used to determine associations, the likelihood of occurrence and the birth preparedness model
respectively.
Main outcome measures: The mam outcome measures were socio-demographic factors,
birth/emergency preparedness and maternal and fetal outcome.
Results: ANC attendance in this study was 98% with 43.8% attaining at least 4 visits that are
recommended in the WHO focused antenatal care models. Most of the non attendances (85.7%)
were under 20 years of age (P value <0.001) and were all primigravidae (P value 0.001). Low level
of education and teenage pregnancy were two most important determining factors for lack of
knowledge of danger signs (P value <0.001 and <0.001 respectively). 77.1 % women had an upfront
choice of delivery and 80% of women made decisions on their own. Teenagers were unlikely to
have made arrangements for emergency transport (P value <0.008). Higher level of education and
mean time taken to hospital (.:s 30 minutes) were other important determinants of having emergency
transport (P value < 0.001 and 0.04 respectively). Parity was not a factor in determining prior
emergency transport arrangements. Education level of primary and below was associated with less
likelihood of setting aside emergence money (P value <0.001), but married women were likely to
set aside emergency money and have emergency transport arrangements (P value <0.001 and 0.001
respectively). PPH was the biggest cause of maternal morbidity and mortality (22.7% and 40%
respectively). Decision making other than self was associated with poor maternal outcome (P value
0.006). ANC non attendance was associated with the likelihood of a mother having a stillbirth [OR
7.3 (1.3-40.4) P value 0.008]. Primigravidity and ANC non attendance were risk factors for preterm
delivery [OR 0.4 (CI 0.2-0.9) P value 0.024, OR 6.8 (CI 1.1-42.5) P value 0.017 respectively).
Conclusions: By use of logistic regression model, this study shows that educational level of the
woman is the single most important determining factor in determining maternal and fetal outcome
followed by the woman's individual income and marital status. Age, parity, and the spouses' socioeconomic
status did not affect maternal and fetal outcome. | en |
