title: Strategies for helping families prepare for birth: experiences from eastern central Uganda.
abstract: BACKGROUND
  Promotion of birth preparedness and raising awareness of potential complications is one of the main strategies to enhance the timely utilisation of skilled care at birth and overcome barriers to accessing care during emergencies.
  
  
  OBJECTIVE
  This study aimed to investigate factors associated with birth preparedness in three districts of eastern central Uganda.
  
  
  METHODS
  This was a cross-sectional baseline study involving 2,010 women from Iganga [community health worker (CHW) strategy], Buyende (vouchers for transport and services), and Luuka (standard care) districts who had delivered within the past 12 months. 'Birth prepared' was defined as women who had taken all of the following three key actions at least 1 week prior to the delivery: 1) chosen where to deliver from; 2) saved money for transport and hospital costs; and 3) bought key birth materials (a clean instrument to cut the cord, a clean thread to tie the cord, cover sheet, and gloves). Logistical regression was performed to assess the association of various independent variables with birth preparedness.
  
  
  RESULTS
  Only about 25% of respondents took all three actions relating to preparing for childbirth, but discrete actions (e.g. financial savings and identification of place to deliver) were taken by 75% of respondents. Variables associated with being prepared for birth were: having four antenatal care (ANC) visits [adjusted odds ratio (ORA)=1.42; 95% confidence interval (CI) 1.10-1.83], attendance of ANC during the first (ORA=1.94; 95% CI 1.09-3.44) or second trimester (ORA=1.87; 95% CI 1.09-3.22), and counselling on danger signs during pregnancy or on place of referral (ORA=2.07; 95% CI 1.57-2.74). Other associated variables included being accompanied by one's husband to the place of delivery (ORA=1.47; 95% CI 1.15-1.89), higher socio-economic status (ORA=2.04; 95% CI 1.38-3.01), and having a regular income (ORA=1.83; 95% CI 1.20-2.79). Women from Luuka and Buyende were less likely to have taken three actions compared with women from Iganga (ORA=0.72; 95% CI 0.54-0.98 and ORA=0.37; 95% CI 0.27-0.51, respectively).
  
  
  CONCLUSIONS
  Engaging CHWs and local structures during pregnancy may be an effective strategy in promoting birth preparedness. On the other hand, if not well designed, the use of vouchers could disempower families in their efforts to prepare for birth. Other effective strategies for promoting birth preparedness include early ANC attendance, attending ANC at least four times, and male involvement.
authors.affiliation: Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; ligatimsha@hotmail.com.
authors.forename: Līga
authors.initials: L
authors.lastname: Timša
authors.affiliation: Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Marrone
authors.affiliation: Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ekirapa
authors.affiliation: Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.|Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda.
authors.forename: Peter
authors.initials: P
authors.lastname: Waiswa
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D003153:Community Health Services / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009035:Mothers / Q000523:psychology; D016017:Odds Ratio; D011247:Pregnancy / Q000523:psychology*; D011295:Prenatal Care / Q000458:organization & administration*; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014454:Uganda; D055815:Young Adult
keywords: Uganda; antenatal care; birth preparedness; community health worker; maternal health; newborn health
references.citation: J Perinatol. 2008 Dec;28 Suppl 2:S2-8
references.pmid: 19057564
references.citation: Sex Reprod Healthc. 2010 Nov;1(4):189-94
references.pmid: 21122620
references.citation: BMC Pregnancy Childbirth. 2008;8:21
references.pmid: 18570672
references.citation: J Health Popul Nutr. 2010 Aug;28(4):383-91
references.pmid: 20824982
references.citation: Trials. 2012;13:213
references.pmid: 23153395
references.citation: J Health Popul Nutr. 2006 Dec;24(4):489-97
references.pmid: 17591346
references.citation: Indian J Pediatr. 2009 Jul;76(7):691-3
references.pmid: 19381514
references.citation: PLoS One. 2012;7(4):e35747
references.pmid: 22558214
references.citation: BMC Pregnancy Childbirth. 2009;9:12
references.pmid: 19323836
references.citation: Health Policy Plan. 2012 Jul;27 Suppl 3:iii104-117
references.pmid: 22692413
references.citation: Trop Med Int Health. 2010 Aug;15(8):964-72
references.pmid: 20636527
references.citation: ISRN Obstet Gynecol. 2011;2011:560641
references.pmid: 21808742
references.citation: Reprod Health. 2011;8:33
references.pmid: 22087791
references.citation: PLoS One. 2013;8(11):e81610
references.pmid: 24312326
references.citation: Int J Gynaecol Obstet. 2009 Jul;106(1):85-8
references.pmid: 19439297
references.citation: PLoS One. 2011;6(6):e21432
references.pmid: 21731747
references.citation: BMC Int Health Hum Rights. 2011 Mar 09;11 Suppl 1:S11
references.pmid: 21410998
references.citation: Trop Med Int Health. 2013 Jul;18(7):898-906
references.pmid: 23551394
references.citation: Lancet. 2014 Jul 12;384(9938):174-88
references.pmid: 24853603
references.citation: Soc Sci Med. 1994 Apr;38(8):1091-110
references.pmid: 8042057
references.citation: J Midwifery Womens Health. 2011 Jan-Feb;56(1):8-17
references.pmid: 21323845