**1. Introduction**

Birth assisted with skilled personnel is the foundation for reducing maternal Mortality. However, it is low in low and middle-income countries [1, 2]. Behavioral changing community-based interventions are globally recommended to increase institutional delivery by increasing obstetric danger signs and birth preparedness knowledge among women and the community [3, 4]. Low and middle-income countries have recently worked on behavior change interventions and mobilization of the community to increase institutional delivery and other maternal service utilization [5–7].

To improve institutional delivery the public authority of Ethiopia has strived by introducing innovative practices like community participation such as the establishment of health development army at the village level, the adaptation of cultural practices at the health facility level such as preparation of "maternal waiting home", making the service free of charge and provision of charge-free transport service for pregnant women during labor and delivery. In this manner, acquires incredible changes in the use of maternal and childcare [8–11], however, still lagging behind the target. To overcome this challenge, the Ethiopian minister of health also launched recently a community-based intervention called "pregnant women's conference" (PWC) to enhance obstetric danger sign awareness and institutional skilled maternal health service utilization. The goal of PWC is to increase skilled maternal health care service, by reducing two delays (delay in deciding to seek care and delay to reach a health facility) through enhancing obstetric danger signs knowledge that may occur during pregnancy, childbirth, and postpartum period and inspire the women to prepare to childbirth and against the occurrence of any obstetric complication ahead of time.

The assigned Nurse/Midwifery provides education about Obstetric danger signs, antenatal care, institutional delivery, postnatal care, child care, child feeding, and immunizations. Each woman is expected to attend at least three conferences during each pregnancy. The service is delivering at their kebele level/the smallest administrative in Ethiopia/monthly and coordinated by community health workers called health Extention workers. As far as the authors are aware no study evaluated PWC intervention effectiveness on institutional delivery. Hence, this study was tried to evaluate the effect of PWC on institutional delivery by compared the prevalence of institutional delivery among women who attended PWC and women who did not attend the PWC during their last pregnancy in rural Northwest, Ethiopia.

#### **2. Main body**

#### **2.1 Material and methods**

#### *2.1.1 Study area and period*

The study was conducted in rural Libo Kemkem District Northwest Ethiopia from February 15 to March 26, 2017. It is 645 km away from Addis Ababa's capital city of Ethiopia. The district has 29 rural Kebeles & 5 urban Kebeles [12].

#### *2.1.2 Study design, study population, and sample size*

A comparative community-based cross-sectional study was carried out in women who gave birth within the last 12 months before the survey. For each group, the sample size was calculated using the two-sample comparisons of proportion formula using Epi-Info V.7, by considering the following assumptions: confidence level 95%, power 80, and the prevalence of institutional delivery in the intervention and the controlled group was 56% and 36%, respectively from the Burkina Faso study, as there is no similar study done in the study area [11]. Adding of 5% non-response rate and multiplied by 2 since we used the multistage sampling technique, the final minimum sample size calculated for each group was 450.

#### *2.1.3 Sampling technique, data collection tool, process, and analysis*

We used a multistage sampling technique to select 450 women for each group and each selected kebele. The first Seven rural kebele were selected using the lottery *Effect of Community-Based Intervention (Pregnant Women's Conference) on Institutional… DOI: http://dx.doi.org/10.5772/intechopen.97315*

method of simple random sampling technique. Then women who gave birth in the last year prior to the survey at each selected kebele were grouped into two: pregnant women conference "attendants" and "non-attendants" using their family matrix book found from health post. After proportional allocation was done for each kebele computer generating simple random sampling technique was used to select study participants. A structured and pre-tested interviewer-administered questionnaire was used for data collection. The data was collected by trained data collectors using the local language Amharic. The tool was first developed in the English language then translated to the Amharic language. The collected data were coded and entered into EPI-Info version 7 and export to SPSS version 23 for analysis. Both descriptive and regression analyses were performed using binary logistic regression model. In the bivariate analysis variables with a P-value ≤0.20 were kept in the multivariable analysis to control the effect of confounders. Before doing independent logistic regression analysis for PWC attendants and non-attendants, a significant difference between the two groups was confirmed. Chi-square testing was done to see if there was a difference in institutional delivery utilization between the two groups (PWC attendants VS non-attendants) and a statistically significant difference was observed between the two groups (x2 = 17.98, df = 1, p = <0.001), suggesting separate analysis. Odds ratios (AOR) with their 95% CI was calculated to measure the strength of association, and P-value ≤0.05 was considered as statistically significant.

#### **2.2 Results**

#### *2.2.1 Socio-demographic and other characteristics of the respondents*

About 96.7% of questionnaires distributed for PWC attendants and 96.9% of questionnaires distributed for PWC non-attendants were filled and analyzed. The mean age of women who attended the conference and did not attend the conference was 30.9 ± 5.5 years and 31.6 ± 5.1 years, respectively. Three-fourth (75.8%) of women who attended PWC and 60.9% of women who did not attend the PWC their age was 25–34 years. Above half (56.8%) and 45% of women who attended PWC and did not attend PWC were living with in1 hr. of walking from the nearest health facility. The majority of women, 92.2% of women who attended the PWC and 78.0% of women who did not attend the PWC were had at least one ANC visit during their last pregnancy. Three-fourth (72.6%) of women who attended the PWC and 55% of women who did not attend the PWC had discussed the place of delivery. Half of the women who attended the PWC and 56.4% of women who did not attend the PWC gave birth at a health institution before the index birth. About 1.4% of women who attended PWC and 3.4% of women who did not attend the PWC had experienced stillbirth (**Table 1**).

#### *2.2.2 Awareness of obstetric danger signs*

Each woman was asked to mention the key danger signs that can happen during pregnancy, childbirth, and the postpartum period. Accordingly, about 99.8% and 95.4% of women who attended and did not attend the PWC were committed to mention at least one obstetric key danger sign that may occur during pregnancy, childbirth, or postpartum periods. About 62% and 40% of women who attended and did not attend the PWC were mentioned severe vaginal bleeding as a dangerous sign during pregnancy, respectively (**Table 2**).

#### *2.2.3 Obstetric danger signs knowledge*

In this study, a mother was considered as *knowledgeable on pregnancy danger signs* if she mentioned at least two of the three key danger signs (severe vaginal bleeding,


#### **Table 1.**

*Socio-demographic characteristics of women who gave birth in the last 12 months, in the context of attending PWC, Northwest Ethiopia, 2017.*


#### **Table 2.**

*Awareness of obstetric danger signs among women who gave birth in the last 12 months, in the context of attending PWC, Northwest Ethiopia, 2017.*

*Effect of Community-Based Intervention (Pregnant Women's Conference) on Institutional… DOI: http://dx.doi.org/10.5772/intechopen.97315*

#### **Figure 1.**

*Knowledge of obstetric danger signs among women who gave birth in the last 12 months, in the context of attending PWC, Northwest Ethiopia, 2017.*

swollen hands/face, and blurred vision) that may occur during pregnancy, *knowledgeable on childbirth danger signs* if she mentioned at least two of the four key danger signs (severe vaginal bleeding, prolonged labor (>12 hours), convulsion, and placenta retained) may happen during labor, and *knowledgeable on postpartum danger signs* if she mentioned at least two of the three key danger signs (severe vaginal bleeding, foul-smelling vaginal discharge, and high fever) may happen during the postpartum period. According to this definition, about 41% and 24% of women who attended and did not attend PWC were knowledgeable (mentioned at least two danger signs) on pregnancy danger signs, respectively (**Figure 1**).

#### *2.2.4 Birth and its complication readiness practice during their last pregnancy*

All women were asked what they prepared before the onset of labor during their last pregnancy. Almost three-fourth (73.3%) of women who attended the PWC and half (54.4%) of women who did not attend the PWC, reported that they were planned health facilities for delivery. About 42% of PWC attendants and 29% of PWC nonattendants were saved money for an emergency before the onset of labor (**Figure 2**).

#### **Figure 2.**

*Birth preparedness and complication readiness practice among women who gave birth in the last 12 months, in the context of attending PWC, Northwest Ethiopia, 2017.*

**Figure 3.**

*Well-preparedness during their last pregnancy among women who gave birth in the last 12 month, in the context of attending PWC, Northwest Ethiopia, 2017.*

### *2.2.5 Well-preparedness practice during their last pregnancy*

A mother was considered as "*well-prepared for institutional delivery* "if she prepared at least three items from the four key items (identified the skilled provider, saved money, planned health facility for delivery, and identified the mode of transportation) during her last pregnancy before the onset of labor. According, to the total, 38.9% of women who attended the PWC (95%CI: 33.8-43.7), and 25.7% of women who didn't attend the PWC (95% CI: 22.2-29.4) were "well-prepared" for birth and its complication during their last pregnancy before the onset of labor (**Figure 3**).

#### *2.2.6 Place of planned for delivery and delivery*

Every woman was expected to choose a health institution for delivery, however, about 73.3% of PWC attendants and 54.4% of PWC non-attendant women only were planned health institutions to birth. Close attention from their families or relatives was the most frequently mentioned reason why they preferred home for birth (**Table 3**).


#### **Table 3.**

*The planned place for delivery and reasons to plan among women who gave birth in the last 12 months, in the context of attending PWC, Northwest Ethiopia, 2017.*

*Effect of Community-Based Intervention (Pregnant Women's Conference) on Institutional… DOI: http://dx.doi.org/10.5772/intechopen.97315*


#### **Table 4.**

*Institutional delivery among women who gave birth in the last 12 months, in the context of attending PWC, Northwest Ethiopia, 2017.*

#### *2.2.7 Institutional delivery*

Overall institutional delivery was 47.1%(95%CI:43.4–50.9). It was 54.3% (95%CI: 49.9–59.1) among women who attended the PWC and 39.9% (95%CI: 35.3%- 44.7%) among women who did not attend the PWC. Regarding postnatal follow up visits, only 22.3% of PWC attendants and 13.5% of PWC non-attendant were had two or more visits during the index birth (**Table 4**).

#### *2.2.8 Factors associated with institutional delivery*

Both bivariate and multivariable analyses were performed. As **Table 5** showed that during multivariable analysis variables such as knowledge on childbirth and postpartum danger signs, traveling time to reach the nearest health facility, well prepared for birth and its complication, and discussion with partners/families about the place of birth were significantly associated with institutional delivery in women who attended the PWC. Whereas among women who did not attend the conference knowledge on pregnancy danger signs, traveling time to reach the nearest health facility, and well prepared for birth and its complication were significantly associated with institutional delivery. Among women who attended the PWC those who were knowledgeable on childbirth danger signs were 1.7 times more likely to deliver at health institutions compared to women who were not knowledgeable on childbirth danger signs (AOR = 1.7, 95%CI: 1.2, 2.8).


*Empowering Midwives and Obstetric Nurses*
