key: cord-0025244-6rmfyqe3 authors: Wegene, Meron Admasu; Gejo, Negeso Gebeyehu; Bedecha, Daniel Yohannes; Kerbo, Amene Abebe; Hagisso, Shemsu Nuriye; Damtew, Solomon Abrha title: Utilization of preconception care and associated factors in Hosanna Town, Southern Ethiopia date: 2022-01-07 journal: PLoS One DOI: 10.1371/journal.pone.0261895 sha: 6f2063206f67b08f9fa40ac5c59217dc03382b80 doc_id: 25244 cord_uid: 6rmfyqe3 INTRODUCTION: There is substantial body of evidence that portrays gap in the existing maternal and child health continuum of care; one is less attention given to adolescent girls and young women until they get pregnant. Besides, antenatal care is too late to reduce the harmful effects that a woman’s may have on the fetus during the critical period of organogenesis. Fortunately, preconception care can fill these gaps, enhance well-being of women and couples and improve subsequent pregnancy and child health outcomes. Therefore, the main aim of the current study was to assess preconception care utilization and associated factors among pregnant women attending antenatal care clinics of public health facilities in Hosanna town. METHODS: A facility based cross-sectional study design was carried out from July 30, 2020 to August 30, 2020. Data were collected through face-to-face interview among 400 eligible pregnant women through systematic sampling technique. Epi-data version 3.1 and SPSS version 24 was used for data entry and analysis respectively. Both bivariable and multivariable logistic regression analysis was conducted to identify association between dependent and independent variables. Crude and adjusted odds ratio with respective 95% confidence intervals was computed and statistical significance was declared at p-value <0.05. RESULT: This study revealed that 76 (19%, 95% Cl (15.3, 23.2) study participants had utilized preconception care. History of family planning use before the current pregnancy (AOR = 2.45; 95% Cl (1.270, 4.741), previous history of adverse birth outcomes (AOR = 3.15; 95% Cl (1.650, 6.005), poor knowledge on preconception care (AOR = 0.18; 95% Cl (0.084, 0.379) and receiving counseling on preconception care previously (AOR = 2.82; 95% Cl (1.221, 6.493) were significantly associated with preconception care utilization. CONCLUSIONS: The present study revealed that nearly one-fifth of pregnant women have utilized preconception care services. History of family planning use before the current pregnancy, previous history of adverse birth outcomes, poor knowledge on preconception care and receiving counseling on preconception care previously were significantly associated with preconception care utilization. Integrating preconception care services with other maternal neonatal child health, improving women’s/couples knowledge & strengthening counseling services is pivotal. There is substantial body of evidence that portrays gap in the existing maternal and child health continuum of care; one is less attention given to adolescent girls and young women until they get pregnant. Besides, antenatal care is too late to reduce the harmful effects that a woman's may have on the fetus during the critical period of organogenesis. Fortunately, preconception care can fill these gaps, enhance well-being of women and couples and improve subsequent pregnancy and child health outcomes. Therefore, the main aim of the current study was to assess preconception care utilization and associated factors among pregnant women attending antenatal care clinics of public health facilities in Hosanna town. A facility based cross-sectional study design was carried out from July 30, 2020 to August 30, 2020. Data were collected through face-to-face interview among 400 eligible pregnant women through systematic sampling technique. Epi-data version 3.1 and SPSS version 24 was used for data entry and analysis respectively. Both bivariable and multivariable logistic regression analysis was conducted to identify association between dependent and independent variables. Crude and adjusted odds ratio with respective 95% confidence intervals was computed and statistical significance was declared at p-value <0.05. a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 Preconception care is the provision of biomedical, behavioral and social health interventions to women prior to the conception, intended to improve health status, and subsiding behavioral and environmental elements that could result in adverse maternal and child health outcomes [1] . According to the recommendation of World Health Organization, the packages of interventions for preconception care include but not limited to; maternal nutrition, cessation of tobacco and alcohol use, management of infertility and subfertility, prevention of too early, rapid and unwanted successive pregnancy and prevention and treatment of Sexually transmitted infections (STIs), Human immune-deficiency virus(HIV) counseling and treatment [2] . In 2017, globally there were 295,000 maternal deaths. Roughly, 86% of the estimated global maternal deaths is contributed by Sub-Saharan Africa and Southern Asia, while sub-Saharan Africa only contributing for nearly 66%. Similarly, 5.3 million deaths occurred in the first five years of life in 2018; of which, 2.5 million occurred in the first month of life. In Ethiopia, the maternal mortality ratio, under-five mortality rate and neonatal mortality rate is estimated at 412 per 100,000 live births,67 per 1000 live birth and 29 deaths per 1000 live births respectively [3] [4] [5] . Preconception care can make a substantial public health benefit contribution in decreasing maternal and childhood mortality and morbidity, and improving maternal and child health in both high-and low-income countries. In low-income countries, similar but larger effects may be realized through improving maternal and child health outcomes in large segments of the population [1] . Evidences portrays that existing maternal child health care continuum of care are essential to reduce maternal and childhood mortality. However, there is substantial body of evidence that shows gap in the existing continuum of care. One of the gap is that, antenatal care is too late to reduce the harmful effects that a woman's (and her partner's) health risks or health problems may have on the fetus during the decisive moment of organ formation. Preconception care completes the continuum, ensuring ongoing health surveillance and early intervention, so that women begin pregnancy in the best health possible [6] . Besides, preconception care offers the potential for earlier risk assessment and intervention that can help the woman or couple even before pregnancy and safeguard the healthiest possible beginning for their newborn child. Preconception care has also important health and social benefits. It could make a considerable role in subsiding maternal and childhood mortality and morbidity and to the health of babies as children as they grow into adolescence and adulthood. Moreover, by assisting women to make well-informed and decisive choices, preconception care could bring social and economic development for the families and society at large [7] . Preconception care in Nigeria, Sudan and Brazil was 10.3%, 9% and 15.9% respectively [8] [9] [10] . However, preconception care was relatively higher in developed countries like China, Maryland and London which was 20.6%, 33.1% and 27% [11] [12] [13] . Developed countries have strategies for preconception care at hand whereas disappointingly it's much abandoned maternal health care service that necessities urgent attention in developing nations. The intention among women and their parents to pursue preconception care is still insufficient in low income countries in spite of high pre-pregnancy risk factors [14] . In spite of preconception care is so essential to improve pregnancy and child health outcomes, relatively little is known about the pre-pregnancy health care of reproductive aged women. In Ethiopia, preconception care services are being provided in the maternal and child health care unit and other chronic disease follow up clinics. However, it is not expanded and given as per standard [15] [16] [17] . Therefore, the aim of this study is to assess preconception care utilization and factors associated with preconception care among pregnant women attending antenatal care clinics of public health facilities in Hosanna town. A facility based cross-sectional study design was carried out from July 30, 2020 to August 30, 2020.The study was conducted in Hosanna town, capital of Hadiya zone, Southern Nations Nationalities and People Regional State of Ethiopia. The town is situated 232 Kms southwest of Addis Ababa and 194 Kms northwest of the regional capital, Hawassa. The town has one referral hospital and three public health centers. The source population contained all pregnant women attending antenatal care (ANC) clinics of public health institutions of Hosanna town. The source population included all systematically selected pregnant women attending ANC clinics of public health institutions of Hosanna town during the study period. Sample size was determined using single population proportion formula by considering the following assumptions: 95% confidence level, 5% margin of error and prevalence of preconception care utilization by pregnant women which is 38.2% (taken from a research conducted in West Shoa Zone, Oromia region) [18] . There are four public health institutions in the town namely; Hosanna health center, Lichamba health center, Bobicho health center and Nigist Eleni Mohammed Memorial Referral Hospital; and all were incorporated in to this study. The monthly average number of women attending antenatal care in each public health institution was as follows; 254 in Hosanna health center, 225 in Lichamba health center, 205 in Bobicho health center and 300 in Nigist Eleni Mohammed Memorial Referral Hospital. Considering the above client flow per month in the respective health institutions, the total sample size determined (400) was distributed to the each health institutions through probability proportional to size allocation. Finally, study participants were selected by systematic sampling technique. Every 2 nd woman was taken and the first mother was selected using lottery method. The questionnaire was prepared in English, translated to Amharic, and then translated back to English to check for consistency before commencing data collection. Training was given to data collectors and supervisors. The data collection procedure was checked for completeness and consistency on the same day by the supervisors and principal investigator. The questionnaire was pre-tested on 5% (20) of the calculated sample size in Shurmo health center. The validity of the questionnaire was tested using pears correlation and found to be valid. Reliability was also tested using Cronbach's alpha co-efficient test and found to be reliable. Data were collected using structured and pretested questionnaire through face to face interview. The questionnaire was adapted from different related literatures to outfit the objectives of the study [18] [19] [20] [21] [22] . Information collected were socio-demographic characteristics, reproductive & medical characteristics, health care service related factor, knowledge and attitudes of mothers on preconception care and utilization of preconception care. Data were collected by 4 data collectors and 2 supervisors. [20] . If women reported receiving at least one preconception care services mentioned above either screening and treatment or follow-up and care for preexisting health problems or undertaken life style modification regarding preconception care before conceiving index pregnancy to 3 months after conceiving index pregnancy by health care providers [19] . If women reported not receiving any of preconception care services mentioned above either screening and treatment or follow-up and care for preexisting health problems or undertaken life style modification regarding preconception care before conceiving index pregnancy to 3 months after conceiving index pregnancy by health care providers [19] . Women level of knowledge was measured using 17 questions measuring level of knowledge on preconception care. Each question has one correct answer. The score for each correct answer was one point and the score for each incorrect answer was zero point. Responses for each question was added and the total score ranged from 0-17 points. Those respondents who scored � mean were labeled as "adequate knowledge" and those respondents who scored < mean were labeled as "inadequate knowledge" [20, 21] . Women attitude towards preconception care was measured using 12 likert scale questions with five scales (strongly agree, agree, neutral, disagree, and strongly disagree). The score was (strongly agree = 5, agree = 4, neutral = 3, disagree = 2, and strongly disagree = 1) for positive statements and vice versa for negative statements and the total score ranged from 12-60 points. Responses for each question was added & divided by 12; which was the total number of questions to compute for mean. Those respondents who scored �mean&