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Birth preparedness and complication readiness (BPCR): Is the process of taking a series of steps prior to birth to ensure that pregnant women prepared for normal birth and complications.
Antenatal care(ANC); Is the routine health control of the presumed healthily pregnant women without symptoms (screening) in order o diagnose a disease or complicating obstetric conditions and to improve information about lifestyle, pregnancy and delivery
Knowledge; Is the familiarly with someone or something which can include facts, information, descriptions or skills acquired through experience or education.
Practice; Is a fact of doing something as opposed to thinking or talking about it .
1.0 INTRODUCTION
1.1. Background
For a long time, effective improvements in maternal health and reductions in maternal mortality in developing countries have been slower than anticipated and remain far from the MDG5 target of a 75% reduction in the maternal mortality ratio (MMR) from in 2015. Globally, it is estimated that 10.7 million of women died in the 25 years between 1990 and 2015 due to maternal causes. Sub-Saharan Africa has the highest maternal mortality ratio (MMR) averaging about 500 maternal deaths per 100,000 live births (WHO,2O15).
In the study that was done to evaluate the impact of Birth Plan and Complication Readiness interventions involving women, families and communities during the prenatal, postnatal and neonatal periods to reduce maternal and neonatal mortality in low or middle income countries it shows that with adequate population coverage, BPCR interventions are effective in reducing maternal and neonatal mortality in low-resources settings (Soubeiga, Gauvin, Hatem, & Johri, 2014).

Tanzania is among the developing countries with the highest MMR. The estimated MMR in the 2015-16 TDHS was 556 per 100000 live births higher than that recorded in the TDHS of 2010 TDHS which was 454 per 100000 live births as it was also recorded in the 2012 Population and Housing Census which was 432 per 100000 live births( TDHS, 2015-2016). Among the reason which cause this the this high rate is shortage or lack of birth and emergency preparedness which is a crucial component of globally recognized safe motherhood programs (Magoma et al., 2013).

Introduction of FANC in 2002 in Tanzania as recommended by WHO in which individual counselling to pregnant women on BPCR during antenatal visits is one of its components and is among of strategy which. was addressed to reduce MMR in Tanzania(August, Pembe, Kayombo, Mbekenga, Axemo, Darj, et al., 2015). In the study effectiveness of birth plan and complications preparedness was assessed and it showed that birth preparedness is effective in promoting safe mother hood(August, Pembe, Mpembeni, Axemo, & Darj, 2016; Magoma et al., 2013 )so a lot of emphasis are needed in order to make sure every pregnant woman especially in developing country where maternal mortality is high practice birth preparedness and complication readiness.
Therefore to sum up on those studies birth preparedness is effective in promoting safe mother hood, however in the study done to assess birth preparedness among community members in rural Tanzania it showed that in those community socio-demographic factors like marital status affect birth preparedness negatively as unmarried women are stigmatized even in receiving health facility(August, Pembe, Kayombo, Mbekenga, Axemo, Darj, et al., 2015)

1.3. Statement of the problem
Maternal mortality is a major global problem. Africa region has the highest maternal mortality ratio (MMR) averaging about 500 maternal deaths per 100,000 live births (WHO,2015) . Tanzania is among the developing countries with the highest MMR The estimated MMR in the 2015-16 TDHS is 556 per 100000 live births lower than that recorded in the TDHS was 578 per 100000 ( TDHS, 2004-20O5) but is higher than the ratios reported in the 2010 TDHS which was 454 per 100000 live births and in the 2012 Population and Housing Census which was 432 per 100000 live births( TDHS, 2015-2016) Among the reasons for this high rate is inadequacy or lack of birth and emergency preparedness, which is a vital component of globally recognized safe motherhood program and positive birth experience(August, Pembe, Kayombo, Mbekenga, Axemo, & Darj, 2015).
Birth preparedness and complications readiness includes attending antenatal care at least four times during pregnancy, identifying a skilled provider and making a plan for reaching the facility during labor, setting aside personal funds to cover the costs of travelling to and delivering with a skilled provider and any required supplies; recognizing signs of complications, ensuring emergency transport, funds, communications are available in case of emergencies; identifying person(s) to accompany to the hospital and/or to stay at home with family and identifying a blood donor (Magoma et al., 2013).
Study was done to assess birth preparedness and complication readiness in rural community in Tanzania where a qualitative study was conducted and it was found that many community members accepted that there is a greater need of having individualized birth plan however the study showed that in those community socio-demographic factors like marital status affect birth preparedness negatively as unmarried women are stigmatized even in receiving health facility(August, Pembe, Kayombo, Mbekenga, Axemo, Darj, et al., 2015)
This study will determine level of knowledge and practice of birth preparedness as no study has been conducted in urban areas to look on association of socio demographic factors with birth preparedness practice in urban areas but socio demographic factors like marital status has shown to have impact on birth preparedness as it interfered negatively with birth preparedness practice especially to unmarried women (August, Pembe, Kayombo, Mbekenga, Axemo, Darj, et al., 2015)

1.3. Broad objectives
To assess knowledge and practice of birth preparedness and complication readiness among women attending antenatal clinics at Mnazi Mmoja Hospital from December 2018 up to March 2019.
1.4. Specific objectives
i. To determine the proportion of women with knowledge on specific obstetrics danger signs among pregnant women attending antenatal clinics at Mnazi Mmoja Hospital
ii. To identify the practice of birth preparedness among women attending antenatal clinics at Mnazi Mmoja Hospital
iii.To determine the proportion of the women with a plan of practice birth preparedness and complication readiness
Iv.To determine the factors associated with birth preparedness and complication readiness

1.5. Research questions
(a) What are the percentage of women who are knowledgeable about effective birth preparedness and complication readiness?.
(b)What are the percentage of women practising birth preparedness and complication readiness?.

1.6. Hypothesis
Pregnant women having attended school to at least secondary education up to higher education are more likely to have effective birth preparedness and complication readiness plans compared to those having education less than secondary school.

1.7.Conceptual framework
Fig. Conceptual framework of factors affecting Birth preparedness and complication readiness (BPCR)

UF

DESCRIPTION OF CONCEPTUAL FRAMEWORK
Socio-demographic factors and knowledge in relation to birth preparedness and complication readiness practice.
Socio-demographic factors include age, residence, occupation, religion and level of education. An Individual or combination of many factors may influence the practice of birth preparedness plan. The level of education may have impact on decision making, and also religion religious affiliation may influence acceptability of health services in health facility.

2. LITERATURE REVIEW
AN OVERVIEW
Birth preparedness and complication preparedness (BPCR) is a key component of globally accepted safe motherhood programs (Magoma et al., 2013). It identifies the following; Knowledge on danger signs, attending antenatal care at least four times during pregnancy, identifying a skilled provider and making a plan for reaching the facility during labor, setting aside personal funds to cover the costs of travelling to and delivering with a skilled provider and any required supplies; Recognizing signs of complications, ensuring emergency transport, funds, communications, are available in case of emergencies;, identifying person(s) to accompany to the hospital and/or to stay at home with family and identifying a blood donor (Magoma et al., 2013).
Regarding birth plan and complication preparedness economical ,social, psychological and environmental factors are likely to interfere with birth plan .In different studies it was found that challenges were related to the consequences of poverty ,though the maternal health care should be free, they perceived difficulties due to informal user fees(August, Pembe, Kayombo, Mbekenga, Axemo, & Darj, 2015) . Also in the study done in Bangladesh it show that women who failed to have birth plan was less formal educated ,married at younger age, and less exposed to media (Soubeiga et al., 2014).

KNOWLEDGE AND PRACTICE OF INDIVIDUALIZED BIRTH PREPAREDNESS PLAN AND COMPLICATIONS READINESS
Information, education and counseling during ANC visits play a vital role in prevention of maternal deaths. These create an awareness of the sequence of events ranging from recognition of danger signs from pregnancy, labor, and postpartum period. An appropriate BPCR improve maternal health and pregnancy outcome (Soubeiga et al., 2014).
A study was done in India where a cross-sectional descriptive study was carried out among 225 women between June – July 2011 to assess knowledge of birth plan and complication readiness and the findings was (1%), (4.8%), and (7.2%) of women were aware of key danger signs for labor and child birth, postpartum period and pregnancy period, respectively. Knowledge of key danger signs was associated with repeated, recent and practical training. People in rural Karnataka, India, are poorly equipped to identify obstetric complications and to help expectant mothers prepare a birth preparedness plan. Due to this there is critical need for implementation of appropriate training and follow up supervision with supportive, functioning and responsive health care system (Kochukuttan, Ravindran, & Krishnan, 2013).
Study was done to assess the association between knowledge of danger signs and birth preparedness among women admitted with pregnancy complications. The study included 810 women admitted in the ante partum period to Mulago hospital, Uganda. Data was collected on socio-demographic characteristics, reproductive history, pregnancy complications, knowledge of danger signs, and birth preparedness/complication readiness (BPCR). The results was only about 1 in 3 women were able o mention at least three of five basic components of BPCR and could be regarded as knowledgeable about BPCR. One in every 4 women could not mention any of the five components. Women with history of obstetric problems during the previous pregnancy were more likely to be knowledgeable on danger signs when compared to those who had no complications in prior pregnancy. Women who were knowledgeable on danger signs were four times more likely to be knowledgeable on BPCR as compared to those who were not knowledgeable .Therefore awareness about danger signs was low, knowledge of danger signs was associated with knowledge of birth preparedness (Mbalinda et al., 2014).
In Nepal study has been done to explore the factors associated with male involvement in ANC, birth plans, exclusive breastfeeding and immunization of children. The findings was the study determined the percentage of males who accompanied their partners for ANC (39.3%), birth plan (47.9%) and accompanied them for child immunization (10.9%). Factors found associated with respect to different activities were as follows: accompanied their partners on antenatal visits uneducated or primary level education ,income NPR 5001 (1USD = 85 NPR) or above (1.47, 1.20-1.80) and aged above 25 years (2.51, 1.89-3.33); arranged money for delivery uneducated or primary level education (7.34,5.84-9.23), income NPR 5001 or above (1.80, 1.48-2.20) and aged above 25 years (1.55, 1.18-2.03); arranged Men who were uneducated or had primary level education, aged above 25 years, had higher income, formal employment, came from Hindu religion and non-indigenous ethnicities demonstrated greater involvement (Bhatta, 2013).
Also in India a study has been done to assess birth preparedness practice and it was found that only about one third of women i.e. 32.8 % were prepared for birth were 67.8% were not prepared. it was found that 86.2% of them planned for the skilled birth attendant, 59.6% women planned for saving money, about one third of women i.e. 37.6% had planned for transportation and only 2.7%women had planned for blood donor in case of emergency. Religion Hindu, literacy of women and their husbands, higher socio-economic status, advice given during pregnancy were some positive factors associated with birth preparedness (Nimavat, Mangal, Unadkat, & Yadav, 2016).

In the study done in Nigeria to assess birth preparedness among women it was found that more than half (51.3%) of respondents of were in the 30-39 age category. Only 40.3% of these respondents were reported well prepared for births and were complication ready. The proportion of women who had BP/CR was significantly higher among those in the middle socio-economic group (51.6%, p

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