The uptake of WHO-recommended birth preparedness and complication readiness messages during pregnancy and its determinants among Ethiopian women: A multilevel mixed-effect analyses of 2016 demographic health survey

Abstract

Background Birth preparedness and complication readiness (BPCR) is a package of interventions recommended by the World Health Organization to improve maternal and newborn health and it is provided and implemented through a focused antenatal care program. This study aimed at assessing the uptake of birth preparedness and complication readiness messages, and compliance with each key message, among Ethiopian women during their recent pregnancies using the 2016 demographic health survey report. Methods The data for this study was taken from the Ethiopian Demographic and Health Survey, which was conducted from January to June 2016 and covered all administrative regions. STATA version 16 was used to analyze a total of 4,712 (with a weighted frequency of 4,771.49) women. A multilevel mixed-effects logistic, and multilevel mixed-effect negative binomial regressions were fitted, respectively. Adjusted odds ratio (AOR) and Incidence rate ratio (IRR) with their corresponding 95% confidence interval (CI) were used to report significant determinants. Results More than half, 56.02% [95% CI: 54.58, 57.41] of women received at least one birth preparedness and complication readiness message. Being in the richest wealth quintiles (AOR = 2.33; 95% CI: 1.43, 3.73), having two birth/s in the last five years (AOR = 1.54; 95% CI: 1.13, 2.10), receiving four or more antenatal visits(AOR = 3.33; 95% CI: 2.49, 4.45), and reading a newspaper at least once a week (AOR = 1.27; 95% CI: 1.07, 1.65) were the individual‑level factors, whereas regions and residence(AOR = 1.54; 95% CI: 1.11, 1.96) were the community-level factors associated with the uptake of at least one BPCR message. On the other hand, receiving four or more antenatal visits (IRR = 2.78; 95% CI: 2.09, 3.71), getting permission to go to a health facility (IRR = 1.29; 95% CI: 1.028, 1.38), and not covered by health insurance schemes (IRR = 0.76; 95% CI: 0.68, 0.95) were identified as significant predictors of receiving key birth preparedness and complication readiness messages. Conclusion The overall uptake of the WHO-recommended birth readiness and complication readiness message and compliance with each message in Ethiopia was found to be low. Managers and healthcare providers in the health sector must work to increase the number of antenatal visits. Policymakers should prioritize the implementation of activities and interventions that increase women’s autonomy in decision-making, job opportunity, and economic capability to enhance their health-seeking behavior. The local administrative bodies should also work to enhance household enrollment in health insurance schemes.

Spatial variation and predictors of missing birth preparedness and complication readiness (BPCR) messages in Ethiopia

“…Failure to listen to the radio was found to be strongly associated with an increased risk of missing BPCR messages in Somali (southern, northern, and western parts), Afar (eastern and southern parts), and Gambella (northern and southern parts). This was supported by studies conducted in Uganda [59], and Ethiopia [12,60,61]. As a result of not tuning in to the radio, women may remain unaware of and miss out on services available to them throughout pregnancy and childbirth, becoming alienated or feeling more lonely and less supported during…”

“…Based on the responses, a composite index of BPCR was created, which had a minimum and maximum value of 0 and 6 respectively. The women with '0' values were regarded as 'missing BPCR messages,' whereas those with one or more messages were considered to have received BPCR [12,20].…”

“…A systematic review and meta-analysis conducted in Ethiopia revealed that BPCR uptake was 25.2% [11]. On the other hand, a recent study from nationally representative data showed that more than half (56.02%) of women received at least one BPCR message [12]. Small-scale studies conducted in the country showed that there was a positive association between the receipt of BPCR messages and educational status, occupation, being in a higher wealth quintiles, receipt of ANC visits, previous history of health facility delivery, history of adverse birth outcomes, number of living children (parity), knowledge of key danger signs during pregnancy and postpartum, and male partner involvement in BPCR plan [13][14][15][16][17][18].…”