Men and Women's knowledge and practices relating to pregnancy and post -natal care: a cross sectional study from Bungoma County , Kenya

1. Men and women’s knowledge and practices relating
to pregnancy and post-natal care: a cross sectional
study from Bungoma County, Kenya
Elegant Hotel, Bungoma
30th April 2019

3. Background
• Estimated that SSA registers about 13000 daily
deaths of mothers, newborns
and children
• Almost nine deaths every minute (Kinney et al.
2016)
• MMR in Kenya is 362/100,000 live births(MOH;
2015, KDHS 2014).
• Bungoma County neonatal mortality rate 31 per
1000 live births (National- 22/1000)

4. • Global Maternal deaths in 2015 were 303,000
• Out of these, 66% were from SSA, followed by South
Asia which contributed 22% (Alkema et al., 2015)
• By 2030, the global MMR to be less than 70 maternal
deaths per 100,000 live births (WHO, 2015)
• Countries should have less than 140 deaths
• Delays in seeking care for emergency obstetrics
emergency a major contributor of high MMR
• Birth preparedness can reduce delay in care seeking
(Thaddeus and Maine, 1994)

5. Importance of Male involvement in Pregnancy
• Involvement of men in maternal health programs has been
associated with improved maternal health outcomes
(Yargawa et al,. 2015)
• Males are important decision-makers
• key to preparations for birth and in case of an emergency
• Studies have shown that some women’s access and
utilization of Maternal and Child Health (MCH) services
depends upon their partners (Dudgeon&Inhornon, 2004;
Misrah et al.,2010; Alio et al.,2011; Nyandieka et al., 2016)

6. Model for fathers’ involvement during pregnancy
Based on the Lamb’s
theory of paternal
involvement in
childhood (1987).
The model
conceptualizes the 4
components of a
proposed framework
for paternal
involvement during
pregnancy.
Source: Alio et al., 2013

7. Methods
• Embedded in a larger intervention, ‘Collaborative Newborn
Support Project’(Gitaka et al., 2018).
• Descriptive cross-sectional design
• 82 males and 348 mothers from Bungoma County.
• Mothers were recruited at reproductive health units (ANC
and PNC) and Maternal and child health clinics
• Questionnaire based on the JHPIEGO birth preparedness
and complication readiness tool (JPHIEGO, 2004).

8. Male involvement outcome variables
 Father’s knowledge of post-natal danger signs
 Father’s knowledge of neonatal danger signs
 Father accompanying wife to ANC during recent
pregnancy
 Father reporting the woman’s most recent
delivery occurring in a healthcare facility.

9. Father’s knowledge of neonatal danger signs
• Only half of the men knew the neonatal danger signs
• 90.2% think that a man should not be involved in child
care
• 100% are aware that the wife attended Ante natal clinic
but only 3.9% had escorted the wives to ANC.
• Prata etal.,2009, has reported that parents are taught
danger signs during ANC visits
• 81% had never discussed the choice of the health care
provider with their partners

10. Factors associated with father’s self-reported knowledge of
obstetrics danger signs
• Knowledge of danger signs in pregnancy can eliminate the first level
of delay (Alam, 2005)
• More than half had knowledge of danger signs during pregnancy and
delivery(53.7% and 50% respectively)
• 49 men(59.8%) had no knowledge of post natal danger signs
• Dunn et al., 2011 in Muhoroni, 75% of the males had knowledge of
danger signs
• Furaha et al.,2015, in Rufiji, Tanzania, only 34.6% had knowledge of
one obstetrics danger sign
• Olugbenga et al., 2019, reported poor knowledge of post partum

11. Unadjusted OR (95%
CI)
P-value Adjusted OR
(95% CI)
P-value
Age (years)
<30
≥30
1.00
0.45 (0.17-1.22) 0.117
1.00
0.42 (0.09-1.82) 0.243
Highest level of education completed
Primary school
Secondary school or greater 1.00
0.63 (0.22-1.74) 0.368
1.00
0.25 (0.07-0.95) 0.042
Wife’s age (years)
<25
≥25
1.00
0.47 (0.18-1.24) 0.129
1.00
0.70 (0.18-2.67) 0.598
Wife’s highest education level
completed
Primary school
Secondary school or greater
1.00
2.08 (0.82-5.28) 0.122
1.00
3.45 (1.09-
11.28)
0.036
Monthly household income (Ks)
<10,000
≥10,000 1.00
1.06 (0.36-3.17) 0.913
1.00
1.56 (0.43-5.69) 0.504
Factors associated with fathers accompanying their wife to antenatal care
during her most recent pregnancy

12. Things that a woman can do to prepare for birth
50.6
21.2 21.2
17.1
30.7
11.7
35.4 32.9
7.9 6.7
0
10
20
30
40
50
60
%
%
Birth Preparedness

13. Male knowledge of danger signs
Knowledge of danger signs
during delivery
5050
%
Knowledge of danger signs
during postnatal period
40.2
59.8
Sales
Yes
No

14. Father’s knowledge of neonatal danger signs and
accompanying their wife to antenatal care.
• All the males were in support of ANC for their wives.
• Only 3 men (3.6%) said that they always accompanied
their wives always to ANC while 40 (48.8%) had never
• Education level, income levels and knowledge of danger
signs were significantly associated with accompanying
the wife.
• Fathers who reported knowing neonatal danger signs
had a 3.34 (95% CI: 1.35-8.27) fold increased odds of
accompanying their wife.

15. ANC AttendanceNo. %
Yes 320 96.4
No 12 3.6
<4 times 199 60.9
>4 times 128 39.1
ANC Attendance

16. Knowledge of Neonatal signs
Males Mothers
Poor breastfeeding, or not able to 34.2 66.1
Fast breathing 19.5 44.8
Severe chest in-drawing 4.8 6.3
Hypothermia 2.4 9.2
Fever 43.9 79.3
Difficult to
wake/lethargic/unconscious
12.2 25.3
Pustules on the skin 7.3 12.7
Severe umbilical infection 12.2 17.2
Jaundice 12.2 15.5
Congenital abnormalities 19.5 20.7

17. Unadjusted OR
(95% CI)
P-value Adjusted
OR (95%
CI)
P-value
Age of mother (years)
<25
≥25
1.00
4.44 (2.83-
6.96)
<0.001
1.00
1.67 (0.50-
5.62)
0.408
Mother’s highest level of education
completed
Primary school or less
Secondary school or greater
1.00
4.84 (3.07-
7.63)
<0.001
1.00
5.65 (1.88-
17.04)
0.002
Husband’s age (years)
<30
≥30
1.00
2.41 (1.35-
4.28)
0.003
1.00
0.92 (0.26-
3.29)
0.900
Husband’s highest education level
completed
Primary school or less
Secondary school or greater
1.00
2.26 (1.29-
3.97)
0.005
1.00
0.72 (0.22-
2.39)
0.592
Factors associated with mother’s self-reported knowledge
of neonatal danger signs

18. Monthly household income (Kshs)
<10,000
≥10,000 1.00
5.92 (3.22-
10.87)
<0.001
1.00
4.35 (1.74-
10.88)
0.002
Time to health care facility from
home
≤30 minutes
>30 minutes
1.00
0.60 (0.39-
0.92)
0.020
1.00
0.47 (0.21-
1.08)
0.075
Gravidity
Primigravida
Multigravida
1.00
3.70 (2.34-
5.89)
<0.001
1.00
4.66 (1.52-
14.36)
0.007
Age at first pregnancy
<18
≥18
1.00
8.99 (4.80-
16.83)
<0.001
1.00
3.24 (1.00-
10.52)
0.050
Shared decision making for health
service seeking between mother and
husband
No
Yes
1.00
3.25 (2.06-
5.13)
<0.001
1.00
1.43 (0.61-
3.36)
0.417

19. Birth preparedness
• Less than half (49.1%) had saved money
• 41.7% had prepared on the transport
• 71.3% had identified the place of delivery
• Only 39.1% had more than 4 ANC visits
• Mothers who attend antenatal care at least four times
during pregnancy have a 5.20 (95% CI: 2.38-11.39) fold
increased odds of delivery in a healthcare facility times.
This is in agreement with the study by Urassa et al., 2012
in Tanzania

20. Male knowledge of danger signs during pregnancy
17.5
65
5
25
2.5
20
0
10
20
30
40
50
60
70
%
%

21. • In our study, there were no factors which were
significantly associated with knowledge of obstetrics
danger signs.
• Pembe et al.,(2009) in Tanzania, Hailu & Berhe (2013)
in Ethiopia noted no association with economic status.
• This was unlike in Uganda where Kabakyenga et al.,
(2011), noted that economic status was significantly
associated with knowledge of obstetrics danger signs

22. Mother’s birth preparedness outcome variables
 Mother’s self-reported knowledge of neonatal danger
signs
 Attended antenatal care at least 4 times during the
most recent pregnancy
 The mother’s most recent delivery occurred in a
healthcare facility

23. Age of the mothers
%
<18 5
18-25 67.4
>18 7.6
85
226
26
<18
18-25
>18

24. Conclusions/Recommendations
 Almost all fathers reported certain perceptions of a
husband’s role in maternal and newborn health
 However this was not reflected in their practices.
 Shows low awareness of maternal danger signs.
 This compares with other study with the same results
(other parts of the world (Furaha et al., 2015, Tokhi et
al., 2018;, Rahman et al., 2018, Olugbenga et al., 2019)
 Education and income significantly influenced male
involvement
 There is need to give more health education on the need
for them to be involved in the birth process

25. Conclusion/Recommendations
• Mothers in households with a monthly income greater
than or equal to 10,000 Kshs have a 4.35 (95% CI: 1.74-
10.88) fold increased odds of reporting knowledge of
neonatal danger signs
• Mothers who have had two or more pregnancies have a
4.66 (95% CI: 1.52-14.36) fold increased odds of
reporting knowledge of neonatal danger signs,
compared to those in their first pregnancy.
• The study shows lack of preparedness in many areas.
• Most programs focus on women alone
• It is necessary to put measures that encourage male
involvement