Abstract
Background
Husbands' participation in maternal health care, as seen by an appropriate birth plan and readiness for complications, reduces maternal death by avoiding delays in recognizing danger signs, reaching a site of care, and seeking aid. As a result, this study aimed to determine the husband's participation in birth preparation and complication readiness, as well as its predictors, among men whose wives were referred to obstetric referral in the South Gondar Zone of North West Ethiopia.
Methods
A hospital-based cross-sectional study was conducted among husbands whose wives were admitted with obstetric referrals in the selected hospitals from February to March 2021. A total of 393 individuals were chosen proportionally from the selected hospitals using a systematic random sampling technique. An interviewer-administered structured questionnaire was used to collect data, which was then entered into Epi Data Version 3.1 and exported to Stata version 14 for analysis. To find predictors of the outcome variable, a binary logistic regression model was used. The final model's results were expressed as adjusted odds ratios, 95% confidence intervals, and P-values.
Result
The magnitude of husband participation in birth preparedness and complication readiness among obstetric referrals was 282 (71.8%). Planned pregnancy [AOR, 95% CI: 2.78 (1.68–4.62)], discussion with their wife [AOR, 95% CI: 2.85 (1.72–4.71)], and good knowledge of danger signs during pregnancy, delivery, and postpartum [AOR, 95%CI:2.71 (1.67–4.42)] were significantly associated with husband participation as compared to its counterparts.
Conclusion and Recommendation
The husband's participation in birth preparedness and complication readiness for obstetric referrals in the South Gondar zone were reasonably good. For good husband participation in birth preparedness and complication readiness, knowledge of danger signs, pregnancy planning status, and discussion with wife about pregnancy were responsible. Healthcare providers should support mothers in discussing the danger signs of pregnancy, birth preparedness, and complication readiness with their husbands during ANC visits.
Keywords: Husband participation, Birth preparedness, Complication readiness, Obstetric referral, Factors, Ethiopia
1. Introduction
Despite a major effort to reduce maternal death for more than two decades, maternal death continues to be unacceptably high, with an estimated 303,000 women dying each year owing to pregnancy and childbirth-related problems. The majority of maternal deaths occurred in low-resource areas such as Sub-Saharan Africa and Southern Asia, accounting for about 86% (254,000) of all maternal deaths worldwide. Around two-thirds of maternal deaths (196,000) occurred in Sub-Saharan Africa [1,2].
Male partners’ and families' participation in a Birth-Preparedness and Complication Readiness (BPCR) plan for pregnant women is a prioritized intervention to accomplish the Sustainable Development Goal (SDG) of reducing maternal mortality ratios to fewer than 70 per 100,000 births by 2030 [2,3].
The principal causes of maternal morbidity and mortality are preventable and can be attributed to a lack of recognition of danger signs, getting to a site of care, and seeking help. To avoid these delays, moms and husbands must be educated on how to spot risk indications during pregnancy and childbirth [4]. Birth preparedness and complication readiness are typical methods used in developing nations when implementing safe motherhood initiatives to prevent maternal death, which may be influenced by male-partner engagement because husbands are the family's most powerful decision-makers [4]. Inadequate husband involvement in birth preparation and complication readiness impairs skilled care service during Anti Natal Care (ANC) or delivery, creates delays in receiving necessary services and contributes to the mother and neonatal death [5].
The responsibility of the husband or male partner in birth preparation and complication readiness is to recognize danger signs, come up with a plan for a birth attendant, make a plan for the delivery location, save money for transportation, and find a potential blood donor. These initiatives promote early access to skilled maternal and neonatal care [6,7]. Male involvement in maternal health care reduces maternal death by avoiding delays through a well-planned birth and complication readiness [8].
The high rate of maternal death and morbidity, as well as health system challenges in poor countries such as Ethiopia, necessitate family support and partner participation in all maternity care services. Participation of the husband in Birth Preparedness and Complication Readiness (BPCR), for instance, improves the use of skilled birth attendants and emergency obstetric care. Access to emergency obstetric care and the use of skilled birth attendants have both been shown to reduce maternal mortality [9,10].
According to the Ethiopian Demographic and Health Survey (EDHS) 2016 data, just 62% of pregnant mothers received skilled antenatal care, and only 32% of mothers had four or more antenatal care consultations [11]. In Ethiopia, about four women die during pregnancy for every 1000 live births. Unprepared families, including male partners, are a common contributors to maternal morbidity and mortality by failing to take timely action such as locating a source of funds and arranging transportation to attend the appropriate referral institution when labor begins or difficulties arise [12,13]. Poverty or low-income status, distance to facilities, insufficient information, inadequate and poor-quality services, cultural beliefs, and habits all contribute to a husband's absence from birth plans, which affects access to adequate health care services [2,14].
Every pregnant woman, as is well known, is in danger of unexpected and life-threatening complications that could result in the death or loss of her child. Pregnancy and childbirth are still mostly seen as women's issues in impoverished nations like Ethiopia, even though their husbands play an important role in social and economic difficulties. Male involvement in maternal health care, as seen by a sufficient birth plan and readiness for complications, has a significant impact on lowering maternal mortality, particularly by avoiding the three delays. Despite the benefits, male participation in birth preparation and complication readiness in East Africa, especially Ethiopia, is inadequate [[15], [16], [17], [18]].
In Africa, particularly Sub-Saharan Africa, husbands have tremendous social and economic authority to decide the size of their family, the timing and condition of sexual relations, whether their partner would use accessible maternal health care, and have significant control over their partner. Pregnancy and labor, on the other hand, are viewed as purely a woman's issue, and husbands' engagement in perinatal care is uncommon in many communities [10,19,20]. The main research questions were what proportion of husbands participate in birth preparedness and complication readiness, and what are the factors that influence the husband's participation when his wife was referred to an obstetric referral in the South Gondar Zone?
Even though some studies on male partner involvement in birth preparedness and complication readiness were undertaken in Ethiopia, they were not comprehensive since they did not take into account varied socio-demographic and socio-cultural viewpoints, and that study was contingent on the mother's memory. In terms of the study's nobility, we investigated unexplored independent variables, and to obtain reliable data for the study variables, we evaluated the husbands rather than the mothers. The study also comprises a multi-center with three healthcare facilities. Furthermore, even though the sociocultural and lifestyle practices associated with the study variable vary from place to place, there are no published data regarding it in the local catchment area or study zone. As a result, the purpose of this study was to assess husbands' involvement in birth preparedness and complication readiness in wives admitted to hospitals due to obstetric emergency referrals in the south Gondar zone of North West Ethiopia, as well as the factors that influenced it.
2. Methods
2.1. Study area and period
This study was conducted in the South Gonder zone of Ethiopia's Amhara Regional State from February to March 2021. South Gondar zone is bounded on the south by East Gojam, on the southwest by West Gojam and Bahir Dar, on the west by Lake Tana, on the north-by-North Gondar, on the northeast by Wag Hemera, on the east by North Wollo, and on the southeast by South Wollo; the Abbay River divides the two Gojam Zones. It is 195 km from Bahir Dar, the capital of the Amhara Regional State, and 724 km from Addis Ababa, Ethiopia's capital. According to the population census report from 2007 E C, the overall population of the South Gondar zone is around 2,578,906, with 1, 041,061 males and 1,010,677 women. With a surface area of 14,095 square kilometers. There is currently one specialized referral hospital and eight primary hospitals in the South Gondar zone [21].
2.2. Study design and population of the study
An institution-based multi-center cross-sectional study was conducted among husbands whose wives were hospitalized at the selected hospitals as an obstetric emergency referral in the third trimester, labor, or the postpartum period during the study period. All men, whose wives were admitted to the hospital for an obstetric emergency in South Gondar Zone were the source population. While those men whose wives were admitted to the selected hospital for obstetric referral during the data collection period were the study population.
2.3. Eligibility criteria
The men, whose wives were admitted to the hospital for an obstetric emergency, were included. While the men or partners, whose wives were admitted to the hospital for an obstetric emergency but he is not available (women whose husbands or partners is not available) or the husband who can't hear or speak is excluded from the study.
2.4. Sample size and sampling technique
For this study, the sample size was computed for each objective, with the larger sample serving as the required representative sample. The sample size for the first objective was determined using the single population proportion formula. We assumed a source population of fewer than 10,000 people, a 95% confidence level, and a 5% margin of error. In Sodo Christian General Hospital and Wolayita Sodo University Teaching and Referral Hospital (P), 30.9% of husbands were involved in birth preparation and complication readiness [22]. The sample size was increased to 360 b y adding a 10% non-response rate.
The double population proportion formula was used in the Epi info version 7 Stat calc software application to calculate the required sample size for the second objective. It was assumed that the level of confidence would be 95% and that the power would be 80%. Significantly linked variables (antenatal care visit, distance to health facility, husband's educational status) were examined to generate a representative sample, whereas the bigger sample was obtained from the educational status of spouses (P1 = 51.4% and OR = 1.6) [22]. In the last quarter or three months, 990 mothers were admitted to the three hospitals owing to obstetric referrals (Debre Tabor referral hospital (480), Mekane-Yesus primary hospital (240), and Nefasmewcha primary hospital (270)). We used a correction formula, which yielded 368 because the study's source population was less than ten thousand. The overall sample size was 405, assuming a ten percent non-response rate. The one that yields a bigger sample size (405) was chosen as the final sample size from the two estimations.
In the South Gonder zone, there are nine hospitals (one specialized referral and eight primary hospitals). Debre Tabor's specialized referral hospital was selected purposively since it is the sole referral hospital in the South Gondar Zone and provides tertiary health care by Ethiopian health tiers. Mekane-Yesus and Nefas Mewcha primary hospitals were chosen at random from the eight primary hospitals based on the homogeneity of the health care delivery system, as they are all primary level health care under Ethiopia's health tier system. Based on the flow of study participants (using the formula: ni = [n/N] ni), the sample size was allocated proportionally to the three hospitals: 197 for Debre Tabor specialized referral hospital, 110 for Nefas Mewcha, and 98 for Mekane Eyesus hospital. During the study period, a systematic random sampling technique was used to pick study units from the admitted emergency referral women of their husbands who met the inclusion criteria. The Kth interval was estimated using a list of admitted mothers from the admission registry. The lottery approach was used to determine the first random start, and every Kth interval from that point was chosen until the final sample was completed.
2.5. Variables of the study
2.5.1. Dependent variable
Husband participation in birth preparedness and complication readiness.
2.5.2. Independent variables
Socio-demographic factors: age of spouse, religion, occupational status, educational status, Husband's number of wives.
Respondent's wife Obstetric history: Antenatal care visit, history of previous obstetric complication, maternal status, Parity, and planning status of pregnancy.
Respondents' behavioral factors: Knowledge of pregnancy danger signs, Knowledge of birth preparedness and complication readiness components, Discussion with wife about pregnancy, husband's perception of pregnancy as a woman's issue.
Infrastructure-related factors: Distance to the nearby health facility, and source of information.
2.5.3. Operational definition
Birth preparedness and complication readiness components: husband's involvement in the joint decision of their wife attend at four antenatal care visits, identify skilled birth attendant, save money for delivery or emergency, identify a mode of transport to a place of birth, and arrange potential blood donor in case of emergency. Husband participation in birth preparedness and complication readiness: If a husband or partner followed at least three of the five birth preparedness and complication readiness components, he is considered to have good birth preparedness and complication readiness participation. If the husband followed two or less than two of the five components it is considered as poor husband participation. Knowledge of pregnancy danger signs: A husband is deemed to have good knowledge if he mentions at least three pregnancy danger signs, which include vaginal bleeding, blurred vision, severe headache, high-grade fever, convulsion or loss of consciousness, and swollen hands or face. Otherwise, he has poor knowledge of danger signs. Knowledge of birth preparedness and complication readiness components: If a husband mentioned three or more of the birth preparedness and complication readiness components, he was deemed to have good knowledge. Otherwise, it is assumed that the husband has poor knowledge of birth preparedness and complication readiness if he mentions two or fewer of the five components [23,24].
2.6. Data collection tools and procedures
The data were collected by a structured questionnaire and a face-to-face interview technique. The questionnaire was adapted from the Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO) maternal and newborn health program's safe motherhood questionnaire for assessing birth preparedness and complication readiness tools and indicators [24]. This was supplemented by variables from relevant research, which were then modified to fit the local context and study objectives. The survey was divided into four sections. The respondent's sociodemographic attributes or personal data are presented in the first part. The tool's second section contains information on the mother's obstetric history. Understanding of pregnancy danger signs, the perspective of pregnancy as a woman issue, discussion or contact with wife about pregnancy, knowledge of birth preparedness and complication readiness components, referral reason, and infrastructure-related variables are all included in the third section of the questionnaire. The fourth section focused on the participation of the husband or male partner in birth preparedness and complication readiness activities. Medical records or charts were checked in addition to face-to-face interviews to obtain correct data for some of the variables, such as the mother's obstetric history and the reason for the emergency referral. The data was collected by seven midwifery practitioners, while three degree-holding health professionals supervised data collectors in the three sites or hospitals.
2.6.1. Data quality assurance
Structured questionnaires were created following an intensive search and assessment of relevant research on the topic to ensure data quality. Before data collection, the questionnaires were delivered to specialists, primarily health professionals working in the area, to examine the face and content validity, as well as to determine whether the instrument met the study objectives. Another native language translator retranslated the questionnaire into English once it had been translated into Amharic (the Ethiopian local language) to ensure consistency. The actual data gathering was done in the native tongue (Amharic version). Two days of training were given to the supervisor and data collectors on the fundamentals of data collecting, questionnaires, and how to interview and record the data. For clarity and understandability, the questionnaire was pretested on 5% of the sample outside of the study location (Addis Zemen hospital). Difficult questions were updated and revisions were made after the pre-test. Throughout the data-collecting period, strict daily oversight of the data-gathering procedure was maintained. Supervisors visited research sites daily and received completed surveys after double-checking their accuracy.
2.7. Data processing and analysis
The collected data were validated for completeness and internal consistency before being analyzed. The data were coded and entered into Epi Data version 3.1 before being exported to Stata version 14 for analysis. To arrive at the correct total figures, there were separate sections for no answer or missing data. To display the results, descriptive and inferential statistics were used. The features of study participants with variables were described using frequency, percentage, mean, and standard deviation. Bi-variable logistic regression was carried out and all variables with a P-value ≤0.25 were taken into consideration in the multivariable model to control for all possible confounders. The model assumption was tested and fitted using the Hosmer and Lemeshow goodness of fit test. Finally, the Adjusted Odds Ratio (AOR) with 95% confidence intervals was used to describe the results of multivariable logistic regression analysis. A p-value of less than 0.05 was judged statistically significant. Text and tables were used to present the findings.
2.8. Ethical consideration
Ethical approval was obtained from Debre Markos University Research Ethics Committee (DMUREC), with ethical approval number DMU HSC/1558/2021. Following the authorization by the research ethics committee, the hospital managers were informed about the study through a support letter. Concerned bodies in the study area were briefed about the study before the start of data collection. Informed written consent was obtained from all study participants for this particular study. The confidentiality of information and privacy of participants’ interviews will be respected. The names of the informants will not be included in the questionnaire. The methods and procedures were conducted according to Debre Markos University regulations and guidelines.
3. Result
3.1. Sociodemographic characteristics of the respondent
The study had 393 participants, with a response rate of 97%. Due to the lack of availability of husbands during the data collecting period, a 3% non-response rate was obtained. The majority of study participants (181 (46.1%)) were between the ages of 30 and 39, with a mean age of 37 years and an 8-year standard deviation. Of the respondents, 347 (88.3%) of them were devout Christians, whereas 146 (37.2%) and 123 (31.3%) were farmers and businessmen, respectively. A higher proportion of respondents (114, or 29%) had completed tertiary education, whereas 112 (28.5%), had no formal education. The majority of the participants 325 (82.7%), had a monthly salary of more than 1000 ET B, and 222 (56.5%) percent, were urban residents. The family arranged 245 (54.7%) of the respondents' marriages. In terms of the number of wives, 330 (84%) of the husbands were monogamous, while 63 (16%) had more than one wife (Table 1).
Table 1.
Sociodemographic characteristics of the respondent in the South Gondar zone,2021.
| Variable | Category | Frequency | Percent (%) |
|---|---|---|---|
| Age | 20–29 | 76 | 19.2 |
| 30–39 | 181 | 46.1 | |
| 40–59 | 136 | 34.6 | |
| Religion | Orthodox | 347 | 88.3 |
| Muslim | 41 | 10.4 | |
| Protestant | 5 | 1.3 | |
| Total | 393 | 100 | |
| Education | No formal education | 112 | 28.5 |
| Primary education | 93 | 23.7 | |
| Secondary education | 74 | 18.8 | |
| Tertiary education | 114 | 29 | |
| Total | 393 | 100 | |
| Occupation | Government employee | 87 | 22.1 |
| Private employee | 18 | 4.6 | |
| Merchant | 123 | 31.3 | |
| Daily laborer | 19 | 4.8 | |
| Farmer | 146 | 37.2 | |
| Total | 393 | 100 | |
| Residency | Rural | 171 | 43.5 |
| Urban | 222 | 56.5 | |
| Total | 393 | 100 | |
| Monthly income | <500 | 14 | 3.6 |
| 500–1000 | 54 | 13.7 | |
| >1000 | 325 | 82.7 | |
| Total | 393 | 100 | |
| Marriage status | Arranged | 215 | 54.7 |
| Loved marriage | 178 | 45.3 | |
| Total | 393 | 100 | |
| Number of wives | Monogamous | 330 | 84 |
| Polygamous | 63 | 16 | |
| Total | 393 | 100 |
3.2. Respondent's wife's obstetric history
Nearly half of the respondent's wives 184 (46.8%) were multiparous. A higher proportion of pregnancies 327 (83.2%) were unplanned. A greater number of mothers 242 (61.4%) had less than four ANC visits. Only 90 (22.9%) of mothers had a history of obstetric complications among these bleeding was common and accounted for 53 (58.9%) (Table 2).
Table 2.
Respondents' wife's obstetric history in South Gondar zone,2021.
| Variable | Category | Frequency | Percent (%) |
|---|---|---|---|
| Parity | Nulli parous | 55 | 14 |
| Primi parous | 117 | 29.8 | |
| Multiparous | 184 | 46.8 | |
| Grand multiparous | 37 | 9.4 | |
| Planning status of pregnancy | Planned | 66 | 16.8 |
| Unplanned | 327 | 83.2 | |
| ANC visit | < four visits | 242 | 61.4 |
| ≥ four visit | 151 | 38.4 | |
| Maternal status | Pregnant | 206 | 52.4 |
| Recently delivered | 187 | 47.6 | |
| History of Obstetric complication | Yes | 90 | 22.9 |
| No | 303 | 77.1 | |
| Type of obstetric complication | Bleeding | 53 | 58.9 |
| preeclampsia | 18 | 20 | |
| Obstructed Labor | 19 | 21.1 |
3.3. Husbands’ perception and knowledge related to danger signs, birth preparedness, and complication readiness components
A higher proportion of respondents 354 (90.1%) had heard about birth preparedness and complication readiness. Among these majorly source of information was interpersonal sources 164 (46.3%) and television 18 (33.4%). A higher proportion of respondents 335 (85.2%) had poor knowledge about birth preparedness and complication readiness. A greater proportion of husbands 328 (83.5%) didn't believe pregnancy was the only issue for women. Almost two-thirds of Husbands 296 (75.3%) discussed with their wives regarding ANC visits and 248 (63.1%) of them believe that pregnant mothers can attend ANC without their husband's permission. A higher proportion of husbands had poor knowledge regarding danger signs during pregnancy 292 (74.3%). The overall knowledge of husbands regarding danger signs of pregnancy, labor and delivery and postpartum was 281 (71.8%). In addition, a greater proportion, of husbands 355 (90.3%) had poor knowledge of referral reasons during pregnancy, labor, and postpartum (Table 3).
Table 3.
Husbands’ perception and knowledge related to pregnancy, danger signs, and birth preparedness and complication readiness in South Gondar zone,2021.
| Variable | Category | Husband participation in BPCR |
Total frequency (%) | |
|---|---|---|---|---|
| frequency (%) | ||||
| Poor | Good | |||
| Have you heard about birth preparedness and complication readiness | Yes | 124 (31.6) | 230 (58.5) | 354 (90.1) |
| No | 19 (4.8) | 20 (5.1) | 39 (9.9) | |
| Source of information | Radio | 17 (4.8) | 25 (7.0) | 42 (11.8) |
| Television | 42 (11.9) | 76 (21.5) | 118 (33.4) | |
| Written source | 13 (3.7) | 17 (4.8) | 30 (8.5) | |
| Interpersonal source | 52 (14.7) | 112 (31.6) | 164 (46.3) | |
| Knowledge about birth preparedness and complication readiness | Good | 16(11.2) | 42(16.8) | 58 (14.8) |
| Poor | 127(88.8) | 208(83.2) | 335 (85.2) | |
| Do you believe pregnancy is only an issue for women | Yes | 33(23.1) | 32(12.8) | 65 (16.5) |
| No | 110(76.9) | 218(87.2) | 328 (83.5) | |
| Have you discussed with your wife regarding ANC | Yes | 87(60.8) | 209(83.6) | 296 (75.3) |
| No | 56(39.2) | 41(16.4) | 97 (24.7) | |
| Knowledge of pregnancy danger signs | Good | 78(54.5) | 203(81.2) | 101 (25.7) |
| Poor | 65(45.5) | 47(18.8) | 292 (74.3) | |
3.4. Infrastructure and referral reason for the pregnancy
A higher percentage of mothers gave birth at a health institution, with 268 (68.2%) giving birth in a hospital and 43 (10.9%) giving birth at home. A larger proportion of mothers who gave birth at home reported a lack of transportation as a reason 12 (27.9%). The most common reason for referral was Eclampsia 90 (22.9%). The distance to the health facility was indicated by a higher percentage of respondents as being greater than 5 km 226 (57.5%) (Table 4).
Table 4.
Infrastructure and referral reason of the pregnancy among emergency referrals in South Gondar zone,2021.
| Variable | Category | Frequency | Percent (%) |
|---|---|---|---|
| Where did you give birth to a recent baby | Home | 43 | 10.9 |
| Health facility | 268 | 68.2 | |
| Not deliver | 82 | 20.9 | |
| Why didn't you deliver to a health facility | Cost too much | 3 | 7 |
| Facility not opened | 5 | 11.7 | |
| Facility to far | 10 | 23.2 | |
| No transportation | 12 | 27.9 | |
| Husband didn't allow | 10 | 23.2 | |
| Other | 3 | 7 | |
| Total | 43 | ||
| Referral reason | Anemia | 29 | 7.4 |
| Eclampsia | 90 | 22.9 | |
| Fetal distress | 40 | 10.2 | |
| Antepartum hemorrhage | 45 | 11.5 | |
| Obstructed labor | 32 | 8.1 | |
| Poor obstetric history | 6 | 1.5 | |
| Malpresentation | 51 | 13 | |
| Multiple pregnancies | 29 | 7.4 | |
| Previous CS | 9 | 2.3 | |
| Uterine rupture | 7 | 1.8 | |
| Preterm labor | 33 | 8.4 | |
| Postpartum hemorrhage | 22 | 5.6 | |
| How long to reach a health facility | <5 km | 167 | 42.5 |
| >5 km | 226 | 57.5 | |
| Did you experience health problems during this pregnancy other than referral reason | Yes | 91 | 23.2 |
| No | 302 | 76.8 |
3.4.1. Husband participation in birth preparedness and complication readiness
Overall, 250 husbands had good participation in birth preparation and complication readiness (63.6% [95% CI:58.8–68.4]). A total of 255 people (64.9%) had identified the delivery location. Of the respondents, 321 (81.7%) and 326 (83%) of them saved money for delivery and emergencies, respectively. Only 66 (16.8%) of husbands recognized skilled delivery attendants, whereas 44% identified possible blood donors (11.2%). While more men recognized modes of transportation 296 (75.3%) and assisted their wives to attend an ANC visit 293 (74.6%) (Table 5).
Table 5.
Husband participation in birth preparedness and complication readiness in South Gondar zone,2021.
| Variables | Category | Frequency | Percent (%) |
|---|---|---|---|
| Did you save money for delivery | Yes | 321 | 81.7 |
| No | 72 | 18.3 | |
| Did you identify a skilled birth attendant | Yes | 66 | 16.8 |
| No | 327 | 83.2 | |
| Did you arrange a mode of transportation | Yes | 296 | 75.3 |
| No | 97 | 24.7 | |
| Did you identify a potential blood donor | Yes | 44 | 11.2 |
| No | 349 | 88.8 | |
| Did you assist your wife to attend the ANC visit | Yes | 293 | 74.6 |
| No | 100 | 25.4 | |
| Husband participation in birth preparedness and complication readiness | Good | 250 | 63.6 |
| Poor | 143 | 36.4 |
3.5. Factors associated with husband participation in birth preparedness and complication readiness among emergency referrals
The level of statistical significance for the bivariable analysis was set to 0.25, thus variables for multivariable logistic regression were taken into consideration. The multivariable model included variables such as age, residency, respondent's occupational status, number of wives, mother's parity status, previous history of obstetric complication, knowledge of danger signs, knowledge of birth preparedness, pregnancy plan, perception of pregnancy as a woman issue, and discussion about pregnancy with wife.
According to the multivariate logistic regression model, husband participation in birth preparedness and complication readiness was significantly associated with knowledge of danger signs, pregnancy planning status, and discussion with wife about pregnancy.
Planned pregnancies had a 2.8 times higher likelihood of husbands participating in birth preparation and complication readiness than unplanned pregnancies. When comparing individuals with good knowledge of pregnancy danger signs to those with poor knowledge, the odds of husbands participating in birth preparedness and complication readiness were 2.7 times greater. Furthermore, respondents who have discussed pregnancy with their wives were 2.9 times higher to participate in birth preparedness and complication readiness than those who haven't discussed it (Table 6).
Table 6.
Bivariable and multivariable logistic regression analysis result for factors associated with husband participation in birth preparedness and complication readiness among emergency referrals in South Gondar Zone,2021.
| Variable | Husband participation in BPCR frequency (%) |
COR, 95% CI | AOR,95% CI | P-value | |
|---|---|---|---|---|---|
| Poor | Good | ||||
| Age category in years | |||||
| 20–29 | 17 (11.9%) | 59 (23.6%) | 1.0 | 1.0 | 0.06 |
| 30–39 | 70 (49%) | 111 (44.4%) | 0.45 (0.24–0.84) | 0.50 (0.24–1.04) | 0.07 |
| 40–59 | 56 (39.2%) | 80 (32%) | 0.41 (0.21–0.77) | 0.45 (0.19–1.09) | |
| Occupational status of the respondent | |||||
| Government employed | 24 (16.8%) | 63 (25.2%) | 1.62 (0.91–2.89) | 0.85 (0.32–2.23) | 0.7 |
| Private employed | 8 (5.6%) | 11 (4.4%) | 0.85 (0.32–2.24) | 0.61 (0.16–2.27) | 0.4 |
| Merchant | 45 (31.5%) | 78 (31.2%) | 1.07 (0.65–1.76) | 0.83 (0.35–1.93) | 0.6 |
| Daily laborer | 11 (7.7%) | 9 (3.6%) | 0.51 (0.19–1.29) | 0.36 (0.11–1.23) | 0.1 |
| Farmer | 55 (38.5%) | 89 (35.6%) | 1.0 | 1.0 | |
| Residency | |||||
| Urban | 75 (52.4%) | 147 (58.8%) | 1.29 (0.85–1.95) | 1.14 (0.52–2.50) | 0.73 |
| Rural | 68 (47.6%) | 103 (41.2%) | 1.0 | 1.0 | |
| Number of wives | |||||
| Monogamous | 126 (88.1%) | 204 (81.6%) | 0.59 (0.32–1.08) | 0.63 (0.31–1.25) | 0.18 |
| Polygamous | 17 (11.9%) | 46 (18.4%) | 1.0 | 1.0 | |
| Parity status | |||||
| Nulliparous | 22 (15.4%) | 33 (13.2%) | 1.23 (0.63–2.39) | 1.0 | 0.50 |
| Primiparous | 41 (28.7%) | 76 (30.4%) | 1.48 (0.79–2.77) | 1.27 (0.59–2.73) | 0.06 |
| Multiparous | 57 (39.9%) | 127 (50.8%) | 0.4 (0.17–0.95) | 2.17 (0.96–4.89) | 0.70 |
| Grand multiparous | 23 (16.1%) | 14 (5.6%) | 0.81 (0.25–2.61) | ||
| Obstetric complication history | |||||
| Yes | 40 (28%) | 50 (20%) | 0.64 (0.39–1.03) | 0.70 (0.39–1.26) | 0.24 |
| No | 103 (72%) | 200 (80%) | 1.0 | 1.0 | |
| Pregnancy plan | |||||
| Planned | 85 (59.4%) | 210 (84%) | 3.58 (2.22–5.76) | 2.78 (1.68–4.62) | 0.001* |
| Unplanned | 58 (40.6%) | 40 (16%) | 1.0 | 1.0 | |
| Perception of pregnancy solely as a woman issue | |||||
| Yes | 33 (23.1%) | 32 (12.8%) | 1.0 | 1.0 | 0.11 |
| No | 110 (76.9%) | 218 (87.2%) | 2.04 (1.19–3.49) | 1.67 (0.87–3.18) | |
| Discussion with wife | |||||
| Yes | 87 (60.8%) | 209 (83.6%) | 3.28 (2.04–5.27) | 2.85 (1.72–4.71) | 0.001* |
| No | 56 (39.2%) | 41 (16.4%) | 1.0 | 1.0 | |
| Danger sign knowledge | |||||
| Good | 78 (54.5%) | 203 (81.2%) | 3.59 (2.27–5.68) | 2.71 (1.67–4.42) | 0.001* |
| Poor | 65 (45.5%) | 47 (18.8%) | 1.0 | 1.0 | |
| Knowledge of birth preparedness | |||||
| Good | 16 (11.2%) | 42 (16.8%) | 1.60 (0.86–2.96) | 2.02 (0.97–4.20) | 0.059 |
| Poor | 127 (88.8%) | 208 (83.2%) | 1.0 | 1.0 | |
4. Discussion
One of the strategies employed in implementing safe motherhood programs to prevent maternal death is husband participation in birth preparation and complication readiness. Since the husband is the family's most powerful decision-maker. The purpose of the study was to see how common husband participation in birth preparation and complication readiness was among obstetric emergency referrals, as well as the factors that influenced it.
In obstetric referrals, the overall prevalence of husband participation in birth preparedness and complication readiness was (63.6% [95% CI:58.8–70.4]). According to a study conducted in Yangon, Myanmar, 69.7% of husbands were included in the birth preparation decision-making process [25]. However, when compared to a study conducted in Uganda and Wolayitam Sodo, Ethiopia, the result is higher [8,26]. The discrepancy could be owing to respondents' good knowledge of danger signs in the area as a result of health extension workers' efforts. The variation could be due to differences in sample size, setting, and measuring equipment. Three out of four husbands identified a mode of transportation and set aside money for delivery and emergency. Most men were well-prepared in terms of transportation and emergency savings. This meant that the husband's preparation for such issues could reduce maternal and infant deaths by reducing the time it took to reach healthcare facilities and make the decision to seek help.
Only one in five and one in ten husbands, respectively, recognized skilled birth attendants and blood donors. In this study, the husbands were less prepared in terms of identifying skilled birth attendants and blood donors as compared to the other components of birth preparedness and complication readiness. This implied that mothers were at risk for hemorrhaging and were cared for by unskilled birth attendants. This will result in the mothers suffering from the risk of birth complications and death due to the husbands' inadequate participation and preparation.
In general, husband involvement in birth preparedness and complication readiness has a vital role in maternal and neonatal mortality reduction through encouraging early access to skilled maternity and newborn care and preventing delays since the family's most powerful decision-makers are the husbands.
Our study showed that respondents who have discussed pregnancy with their wives were nearly three times higher to participate in birth preparedness and complication readiness than those who haven't discussed it. Other research in Wolayita Sodo, Ethiopia, corroborated the findings [27]. This could be due to appropriate health information regarding maternal health care, as 90% of spouses have heard of BPCR and the majority of them learned about it via healthcare providers and the media. Furthermore, because husbands are the primary decision-makers in most family matters, open communication between husband and wife has a beneficial impact on BPCR membership.
Husbands with a good knowledge of danger signs were four times more likely to participate in BPCR than those with poor knowledge. The findings are in line with those of a study conducted in Southern Ethiopia [28]. This could be because men who are familiar with danger signs can anticipate and prepare for pregnancy complications during pregnancy, labor and delivery, and postpartum by avoiding the three delays. On the other hand, when spouses become informed about the dangers of pregnancy, birth, and postpartum, they are more likely to pay attention to pregnancy-related emergencies and make healthcare services more accessible to women, particularly in emergencies [23]. Besides planned pregnancy was associated with the husband's participation in birth preparedness and complication readiness. However, in this study, age category, educational status of the respondent, occupational status of the respondent, number of wives, parity and gravidity status of the mother, previous obstetric complication history, and perception of pregnancy as a woman issue had no direct effect on the husband's participation in birth preparedness and complication readiness. These factors were related to the husband's participation in another study that was carried out in the Kucha district of the Gamo zone in southern Ethiopia [29] and the Dang district of Nepal [30]. The difference may result from variations in the study population's lifestyle style or culture, setting, and sample size.
5. Limitations of the study
In our study, the behavior change in the husband was not investigated in depth. So, more research is required to pinpoint how the husband's knowledge of danger signs, birth preparedness, and complication readiness changes, especially with the use of a qualitative study design. Some independent social variables have not been associated with the dependent variables, so it is better to further investigate these predictors with large sample sizes, including heterogeneous populations and different designs or methods.
6. Conclusion and Recommendation
In general, the husband's participation in birth preparedness and complication readiness for obstetric referrals was reasonably high in the South Gondar Zone. However, they performed a poor role in identifying skilled birth attendants and blood donors. Husband participation in birth preparedness and complication readiness was positively associated with knowledge of danger signs, pregnancy planning status, and discussion with wife about pregnancy. During ANC visits, healthcare professionals should strengthen counseling for mothers about the danger signs of pregnancy and encourage them to discuss with their husband's danger signs of pregnancy, birth preparedness, and complication readiness. In home-to-home visits, the zonal health office, with the help of health extension workers, should strengthen husband counseling by focusing on identifying skilled birth attendants and blood donors during pregnancy.
Author contribution statement
Getaneh Atikilt Yemata: Conceived and designed the experiment; Performed the experiment; Analyzed and interpreted the data; Wrote the paper.
Gojjam Dessibellew, Yilkal Tafere, Atsede Alle: Analyzed and interpreted the data; Wrote the paper.
Abirham Wallelign Bayabil, Eyaya Habtie Dagnaw: Contributed reagents, materials, analysis tools or data; Wrote the paper.
Funding statement
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Data availability statement
Data will be made available on request.
Acknowledgments
The authors would like to acknowledge Debre Markos University for approving the ethical review process. The authors also wanted to express gratitude to data collectors, Debre Tabor, Mekane Eyesus, and Nefas Mewcha hospital staff, supervisors, and study participants.
Abbreviations and acronyms
- ANC
Ante-Natal Care
- BPCR
Birth Preparedness and Complication Readiness
- FMOH
Federal Ministry of Health
- HEW
Health Extension Worker
- JHPIEGO
John Hopkins Program for International Education in Gynecology Obstetrics
- MCH
Maternal and Child Health
- MMR
Maternal Mortality Ratio
- SBA
Skill Birth Attendant
- SDG
Sustainable Development Goal
- TBA
Traditional Birth Attendant
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data will be made available on request.