Top

Reproductive Health

Published in:

Open Access 01-12-2018 | Research

Evaluation of a family-oriented antenatal group educational program in rural Tanzania: a pre-test/post-test study

Authors: Yoko Shimpuku, Frida E. Madeni, Shigeko Horiuchi, Kazumi Kubota, Sebalda C. Leshabari

Published in: Reproductive Health | Issue 1/2018

Abstract

Background

To increase births attended by skilled birth attendants in Tanzania, studies have identified the need for involvement of the whole family in pregnancy and childbirth education. This study aimed to develop, implement, and evaluate a family-oriented antenatal group educational program to promote healthy pregnancy and family involvement in rural Tanzania.

Methods

This was a quasi-experimental 1 group pre-test/post-test study with antenatal education provided to pregnant women and their families in rural Tanzania. Before and after the educational program, the pre-test/post-test study was conducted using a 34-item Birth Preparedness Questionnaire. Acceptability of the educational program was qualitatively assessed.

Results

One-hundred and thirty-eight participants (42 pregnant women, 96 family members) attended the educational program, answered the questionnaire, and participated in the feasibility inquiry. The mean knowledge scores significantly increased between the pre-test and the post-test, 7.92 and 8.33, respectively (p = 0.001). For both pregnant women and family members, the educational program improved Family Support (p = 0.001 and p = 0.000) and Preparation of Money and Food (p = 0.000 and p = 0.000). For family members, the scores for Birth Preparedness (p = 0.006) and Avoidance of Medical Intervention (reversed item) (p = 0.002) significantly increased. Despite the educational program, the score for Home-based Value (reversed item) (p = 0.022) and References of SBA (p = 0.049) decreased in pregnant women. Through group discussions, favorable comments about the program and materials were received. The comments of the husbands reflected their better understanding and appreciation of their role in supporting their wives during the antenatal period.

Conclusions

The family-oriented antenatal group educational program has potential to increase knowledge, birth preparedness, and awareness of the need for family support among pregnant women and their families in rural Tanzania. As the contents of the program can be taught easily by reading the picture drama, lay personnel, such as community health workers or traditional birth attendants, can use it in villages. Further development of the Birth Preparedness Questionnaire is necessary to strengthen the involved factors. A larger scale study with a more robust Birth Preparedness Questionnaire and documentation of skilled care use is needed for the next step.

Trial registration

No.2013–273-NA-2013-101. Registered 12 August 2013.

United Nations. The millennium development goals report. New York: United Nations; 2015.

United Nations Development Group. 2014. Delivering the post-2015 development agenda: opportunities at the national and local levels. Available from: [cited 2016 April 30] Available at: http://www.worldwewant2015.org/file/459043/download/499855. Accessed 20 July 2017.

World Health Organization. 2015. WHO recommendations on health promotion interventions for maternal and newborn health. Available at: [cited 2017 January 14] http://apps.who.int/iris/bitstream/10665/172427/1/9789241508742_report_eng.pdf. Accessed 20 July 2017.

World Health Organization. 2004. Making pregnancy safer: the critical role of the skilled attendant. Available at: [cited 2016 April 30] http://www.who.int/maternal_child_adolescent/documents/9241591692/en/. Accessed 20 July 2017.

Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) [Tanzania Mainland], Ministry of Health (MoH) [Zanzibar], National Bureau of Statistics (NBS), Office of the Chief Government Statistician (OCGS), and ICF. Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS) 2015–16. Dar es Salaam, Tanzania, and Rockville, Maryland, USA: MoHCDGEC, MoH, NBS, OCGS, and ICF; 2016.

Hailu M, Gebremariam A, Alemseged F, Deribe K. Birth preparedness and complication readiness among pregnant women in southern Ethiopia. PLoS One. 2011;6:e21432.CrossRefPubMedPubMedCentral

Kabakyenga JK, Östergren PO, Turyakira E, Pettersson KO. Influence of birth preparedness, decision-making on location of birth and assistance by skilled birth attendants among women in south-western Uganda. PLoS One. 2012;7:e35747.CrossRefPubMedPubMedCentral

Moran AC, Sangli G, Dineen R, Rawlins B, Yameogo M, Baya B. Birth-preparedness for maternal health: findings from Koupela district, Burkina Faso. J Health Popul Nutr. 2006;24:489–97.PubMedPubMedCentral

World Health Organization 2006. Birth and emergency preparedness in antenatal care. Available at: http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/emergency_preparedness_antenatal_care.pdf. Accessed 20 July 2017.

10.

Kaso M, Addisse M. Birth preparedness and complication readiness in Robe Woreda, Arsi zone, Oromia region, Central Ethiopia: a cross-sectional study. Reprod Health. 2014;11:55.CrossRefPubMedPubMedCentral

11.

Markos D, Bogale D. Birth preparedness and complication readiness among women of child bearing age group in Goba Woreda, Oromia region, Ethiopia. BMC Pregnancy Childbirth. 2014;14:282. https://doi.org/10.1186/1471-2393-14-282.CrossRefPubMedPubMedCentral

12.

Mbalinda SN, Nakimuli A, Kakaire O, Osinde MO, Kakande N, Kaye DK. Does knowledge of danger signs of pregnancy predict birth preparedness? A critique of the evidence from women admitted with pregnancy complications. BMC Health Res Policy Syst. 2014;12:60. Available at: http://www.health-policy-systems.com/content/12/1/60. Accessed 20 July 2017.

13.

Tura G, Afework MF, Yalew AW. The effect of birth preparedness and complication readiness on skilled care use: a prospective follow-up study in Southwest Ethiopia. Reprod Health. 2014;11:60. https://doi.org/10.1186/1742-4755-11-60.CrossRefPubMedPubMedCentral

14.

Nyamtema AS, Urassa DP, van Roosmalen J. Maternal health interventions in resource limited countries: a systematic review of packages, impacts and factors for change. BMC Pregnancy Childbirth. 2011;11:30. https://doi.org/10.1186/1471-2393-11-30.CrossRefPubMedPubMedCentral

15.

Soubeiga D, Gauvin L, Hatem MA, Johri M. Birth preparedness and complication readiness (BPCR) interventions to reduce maternal and neonatal mortality in developing countries: systematic review and meta-analysis. BMC Pregnancy Childbirth. 2014;14:129. https://doi.org/10.1186/1471-2393-14-129.CrossRefPubMedPubMedCentral

16.

Mrisho M, Schellenberg JA, Mushi AK, Obrist B, Mshinda H, Tanner M, Schellenberg D. Factors affecting home delivery in rural Tanzania. Trop Med Int Health. 2007;12:862–72.CrossRefPubMed

17.

Pembe AB, Urassa DP, Darj E, Carlsted A, Olsson P. Qualitative study on maternal referrals in rural Tanzania: decision making and acceptance of referral advice. Afr J Reprod Health. 2008;12:120–31.PubMed

18.

Pembe AB, Carlstedt A, Urassa DP, Lindmark G, Nyström L, Darj E. Effectiveness of maternal referral system in a rural setting: a case study from Rufiji district, Tanzania. BMC Health Serv Res. 2010;10:326.CrossRefPubMedPubMedCentral

19.

Ganle, JK, Obeng B, Segbefia AY, Mwinyuri V, Yeboah JY, Baatiema L. How intra-familial decision-making affects women’s access to, and use of maternal healthcare services in Ghana: a qualitative study. BMC Pregnancy Childbirth 2015;15:173. Available at: http://doi.org/10.1186/s12884-015-0590-4. Accessed 20 July 2017.

20.

August F, Pembe A, Mpembeni R, Aximo P, Darj E. Men’s knowledge of obstetric danger signs, birth preparedness and complication readiness in rural Tanzania. PLoS One 2015. Available at: http://dx.doi.org/10.1371/journal.pone.0125978. Accessed 20 July 2017.

21.

Danforth EJ, Kruk ME, Rockers PC, Mbaruku G, Galea S. Household decision-making about delivery in health facilities: evidence from Tanzania. J Health Popul Nutr. 2009;27:696–703.PubMedPubMedCentral

22.

Magoma M, Requejo J, Campbell OM, Cousens S, Filippi V. High ANC coverage and low skilled attendance in a rural Tanzanian district: a case for implementing a birth plan intervention. BMC Pregnancy Childbirth. 2010;10(13) https://doi.org/10.1186/1471-239.

23.

Kruk ME, Paczkowski M, Mbaruku G, de Pinho H, Galea S. Women’s preferences for place of delivery in rural Tanzania: a population-based discrete choice experiment. Am J Public Health. 2008;99(9):1666–72.CrossRef

24.

Lugina HI, Lindmark G, Johansson E, Christensson K. Tanzanian midwives’ views on becoming a good resource and support person for postpartum women. Midwifery. 2001;17(4):267–78.CrossRefPubMed

25.

Mbekenga CK, Lugina HI, Christensson K, Olsson P. Postpartum experiences of first-time fathers in a Tanzanian suburb: a qualitative interview study. Midwifery. 2011;27(2):174–80.CrossRefPubMed

26.

Shimpuku Y, Patil CL, Norr KF, Hill PD. Women’s perceptions of childbirth experience at a hospital in rural Tanzania. Health Care Women Int. 2013;34:461–81.CrossRefPubMed

27.

The Planning Commission Dar es Salaam & Regional Commissioner’s Office Tanga Tanga Region Socio-Economic Profile 1997. Available at: http://www.tzonline.org/pdf/Tanga.pdf. Accessed 20 July 2017.

28.

Korogwe District. Demographic health survey 2. 2016.

29.

Ueda T. Statistics: approval and estimation. Tokyo Japan: Ohmsha.

30.

Madeni F, Horiuchi S, Iida M. Evaluation of a reproductive health awareness program for adolescence in urban Tanzania-a quasi-experimental pre-test post-test research. Reprod Health. 2011;8:21.CrossRefPubMedPubMedCentral

31.

Ajzen I. Theory of planned behavior. Organ Behav Hum Decis Process. 1991;50:179–211.CrossRef

32.

Pembe AB, Urassa DP, Carlstedt A, Lindmark G, Nystrom L, Darj E. Rural Tanzanian women’s awareness of danger signs of obstetric complications. BMC Pregnancy Childbirth. 2009;9:12.CrossRefPubMedPubMedCentral

33.

Urassa PD, Pembe BA, Mganga F. Birth preparedness and complication readiness among women in Mpwapwa district, Tanzania. Tanzanian J Health Res. 2012;14:1–7.

34.

Sandelowski M. Focus on research methods: whatever happened to qualitative description? Res Nurs Health. 2000;23:334–40.CrossRefPubMed

35.

Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, Bakken S, Kaplan CC, Squiers L, Fabrizio C, Fernandez M. How we design feasibility studies. Am J Prev Med. 2009;36(5):452–7. https://doi.org/10.1016/j.amepre.2009.02.002.CrossRefPubMedPubMedCentral

36.

Nonyane BA, KC A, Callaghan-Koru JA, Guenther T, Sitrin D, Syed U, et al. Equity improvements in maternal and newborn care indicators: results from the Bardiya district of Nepal. Health Policy Plan. 2016;31(4):405–14. https://doi.org/10.1093/heapol/czv077.CrossRefPubMed

37.

Thapa DK, Niehof A. Women’s autonomy and husbands’ involvement in maternal health care in Nepal. Soc Sci Med. 2013;93:1–10.CrossRefPubMed

38.

Becker S, Fonseca-Becker F, Schenck-Yglesias C. Husbands’ and wives’ reports of women’s decision-making power in western Guatemala and their effects on preventive health behaviors. Soc Sci Med. 2006;62(9):2313–26.CrossRefPubMed

39.

Njuki R, Kimani J, Obare F, Warren C. Using verbal and social autopsies to explore health-seeking behavior among HIV-positive women in Kenya: a retrospective study. BMC Womens Health. 2014;14:77. https://doi.org/10.1186/1472-6874-14-77.CrossRefPubMedPubMedCentral

40.

Kalisa R, Malande CO. Birth preparedness, complication readiness and male partner involvement for obstetric emergencies in rural Rwanda. Pan Afr Med J. 2016;17(25):91. https://doi.org/10.11604/pamj.2016.25.91.9710.CrossRef

41.

Kujawski S, Mbaruku G, Freedman LP, Ramsey K, Moyo W, Kruk ME. Association between disrespect and abuse during childbirth and women’s confidence in health facilities in Tanzania. Matern Child Health J. 2015;19(10):2243–50. https://doi.org/10.1007/s10995-015-1743-9.CrossRefPubMed

42.

Larson E, Hermosilla S, Kimweri A, Mbaruku GM, Kruk ME. Determinants of perceived quality of obstetric care in rural Tanzania: a cross-sectional study. BMC Health Serv Res. 2014;14:483. https://doi.org/10.1186/1472-6963-14-483.CrossRefPubMedPubMedCentral

43.

Sando D, Kendall T, Lyatuu G, Ratcliffe H, McDonald K, Mwanyika-Sando M, et al. Disrespect and abuse during childbirth in Tanzania: are women living with HIV more vulnerable? J Acquir Immune Defic Syndr. 2014;67(Suppl 4):S228–34. https://doi.org/10.1097/QAI.0000000000000378.CrossRefPubMedPubMedCentral

44.

Mushi D, Mpembeni R, Jahn A. Effectiveness of community based safe motherhood promoters in improving the utilization of obstetric care. The case of Mtwara rural district in Tanzania. BMC Pregnancy Childbirth. 2010;10(14) https://doi.org/10.1186/1471-2393-10-1.

Title: Evaluation of a family-oriented antenatal group educational program in rural Tanzania: a pre-test/post-test study
Authors: Yoko Shimpuku
Frida E. Madeni
Shigeko Horiuchi
Kazumi Kubota
Sebalda C. Leshabari
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Reproductive Health / Issue 1/2018
Electronic ISSN: 1742-4755
DOI: https://doi.org/10.1186/s12978-018-0562-z

ACC 2024 Congress

Springer Medicine

Evaluation of a family-oriented antenatal group educational program in rural Tanzania: a pre-test/post-test study

Abstract

Background

Methods

Results

Conclusions

Trial registration

ACC 2024 Congress

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2018

Associations between intimate partner violence and reproductive and maternal health outcomes in Bihar, India: a cross-sectional study

Providers’ perspectives on denial of abortion care in Nepal: a cross sectional study

Exploring mistreatment of women during childbirth in a peri-urban setting in Kenya: experiences and perceptions of women and healthcare providers

A comprehensive postpartum follow-up health care program for women with history of preeclampsia: protocol for a mixed methods research

Qualitative evaluation of the Saleema campaign to eliminate female genital mutilation and cutting in Sudan

Sex composition and its impact on future childbearing: a longitudinal study from urban Uttar Pradesh