Provision of individualised obstetric risk advice to increase health facility usage by women at risk of a complicated delivery: a cohort study of women in the rural highlands of West Ethiopia. Issue 8 (6th March 2013)

• Record Type: Journal Article
• Authors: Ballard, K; Gari, L; Mosisa, H; Wright, J
• Is Part Of: BJOG. Volume 120:Issue 8(2013:Aug.)
• Page Start: 971
• Page End: 978
• Publication Date: 2013-03-06
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.12190
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" xml:lang="en" id="bjo12190-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo12190-sec-0001" sec-type="section"> <title>Objective</title> <p>To determine whether the provision of individualised obstetric risk advice would increase health facility usage in women at life‐threatening risk of a complicated delivery in Ethiopia, where maternal mortality has remained high and static for a decade and where, although the government has increased the number of health facilities, 90% of women deliver their babies at home.</p> </sec> <sec id="bjo12190-sec-0002" sec-type="section"> <title>Design</title> <p>A prospective cohort study.</p> </sec> <sec id="bjo12190-sec-0003" sec-type="section"> <title>Setting</title> <p>Rural Ethiopian highlands.</p> </sec> <sec id="bjo12190-sec-0004" sec-type="section"> <title>Population</title> <p>A total of 294 pregnant women at 32 weeks or more of gestation.</p> </sec> <sec id="bjo12190-sec-0005" sec-type="section"> <title>Methods</title> <p>Before being provided with individualised risk advice, women were asked about their birth plans, and in particular, their planned delivery place. Those identified as being at risk of a complicated delivery were followed up to find out whether they altered their birth plans.</p> </sec> <sec id="bjo12190-sec-0006" sec-type="section"> <title>Main outcome measure</title> <p>A change in birthplace.</p> </sec> <sec id="bjo12190-sec-0007" sec-type="section"> <title>Results</title> <p>Women identified as being at high risk of a complicated delivery significantly changed their plans (<italic>P </italic>< 0.01), with 34 (89%) women delivering in hospital. Women with a medium risk did not significantly change their birth plans (<italic>P</italic> = 0.082), with 35 (36%) delivering at home. Women with a high parity were less likely to change their birth plans compared with primigravid women (odds ratio 0.53; 95% confidence interval 0.34–0.83) and high‐risk women were more likely to change their plans compared with medium‐risk women (odds ratio 6.2; 95% confidence interval 1.8–21.6).</p> </sec> <sec id="bjo12190-sec-0008" sec-type="section"> <title>Conclusions</title> <p>Providing simple, individualised advice about the risks of a complicated delivery leads to high‐risk women delivering in hospital. Embedding this into the current antenatal care system in Ethiopia could significantly decrease maternal mortality.</p> </sec> </abstract>