[Birth preparedness in antenatal care: effects of health center characteristics]

Counseling relating to birth preparedness is an essential component of the WHO Focused Antenatal Care model. During the antenatal visits, women should receive the information and education they need to make choices to reduce maternal and neonatal risks. The objective of this study conducted among women attending antenatal visits in rural Burkina Faso was to search for a link between the characteristics of the center delivering the health care and the probability of being exposed to information and advice relating to birth preparedness.

A multilevel study was performed using survey data from women (n=464) attending health centres (n=30) in two rural districts in Burkina Faso (Dori and Koupela). The women were interviewed using the modified questionnaire of the Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO).

Women reported receiving advice about institutional delivery (72%), signs of danger (55%), cost of institutional delivery (38%) and advice on transportation in the event of emergency (12%). One independent factor was found to be associated with reception of birth preparedness advice: number of antenatal visits attended. Compared with women from Dori, women from Koupela were more likely to have received information on signs of danger (OR=3.72; 95%CI: 1.26-7.89), institutional delivery (OR=4.37; 95%CI: 1.70-10.14), and cost of care (OR=3.01; 95%CI: 1.21-7.46). The reduced volume of consultations per day and the availability of printed materials significantly remain associated with information on the danger signs and with the institutional delivery advices. Comparison by center activity level showed that women attending health centers delivering less than 10 antenatal visits per day were more likely to receive information on signs of danger (OR=2.63; 95%CI: 1.12-6.24) and to be advised about institution delivery (OR=6.30; 95%CI: 2.47-13.90) compared to health centers delivering more than 20 antenatal visits per day. Women attending health centres equipped with printed materials (posters, illustrated documents) were more likely to receive information on signs of danger (OR=4.25; 95%CI: 1.81-12.54) and be advised about institutional delivery (OR=6.85; 95%CI: 3.17-14.77).

Efforts should be made to reach women with birth preparedness messages. Rural health centres in Burkina Faso need help to upgrade their organizational services and provide patients with printed materials so they can improve antenatal care delivery.