Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.4
,
No
.1
, Mar
c
h 201
5,
p
p
.
6
3
~
70
I
S
SN
: 225
2-8
8
0
6
63
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
Ass
o
ci
ati
o
n of M
e
n's Awaren
ess of
Dan
g
er Sign of
Obstetri
c
Complication an
d Mal
e
I
n
vol
vem
e
nt’s in Birth P
r
eparedn
e
ss
Practices at South Ethiopia
Alemu T
a
mis
o
, Be
hailu
Me
rd
ekio
s, Ma
relig
n
Tila
hun
Department o
f
P
ublic Health, Co
lleg
e
of
Medici
n
e
and
Health
Science, Arba Minch University
Arba Minch
,
So
uth Ethiopia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received
Ja
n 18, 2015
Rev
i
sed
Jan 30, 201
5
Accepted
Feb 12, 2015
The Ethiopian
Demographic and Hea
lth
Surve
y
(EDHS) i
ndica
te
tha
t
m
a
ternal m
o
rta
l
i
t
y
in
Ethiop
ia is
one of the high
est in the world.
This death
toll
can b
e
pr
evented partially
thr
ough
incr
easing
awareness of d
a
nger sign of
obs
tetri
c
com
p
l
i
ca
tions
and b
i
rth prep
aredn
e
s
s
practic
es
fo
r m
o
ther,
husbands and other family
me
mbe
r
s.
Community
ba
se
d c
r
oss sec
tiona
l study
was done. Adult males with a wife
or partner who had been through
childbir
t
h in
the
preced
ing 36 m
onths
were in
clu
d
ed in th
e s
t
ud
y. Dat
a
was
coll
ect
ed b
y
pr
etest
e
d structur
ed
questionnair
es and m
u
lti stage cluster
s
a
m
p
ling was
us
ed to reach 84
5 s
a
m
p
les
.
Collect
ed data was
cle
a
ned and
entered in to Epi Info 7 and exported to SPSS
(IB
M-20) for further analy
s
is.
Hierarch
ical log
i
stic r
e
gression
mode
l and ad
ju
sted odds ratio
with 95%
confiden
t inte
rva
l
were used to show
as
s
o
ciation b
e
tween m
e
n awa
r
enes
s
and
birth prepar
edness practices
. The total
numbers of men interviewed were 836
that makes response rate of 98.9%. Se
vere abd
o
minal pain (87%) was the
most recognized
danger
sign dur
ing pr
egn
a
ncy
and 17.9%
men involved
in
saving money
.
Forty
two po
int
two pe
rc
ent (42
.
2%) of m
e
n had
awaren
es
s
of danger
sign
and 9.4
%( 95
% CI: (7
.42,
11
.4) of men
invo
lved in
birth
preparedn
e
ss practice. Strong associa
tion b
e
tween men awareness of danger
sign of obstetric complications
and
involvements in birth preparedn
e
ss
practices persisted after ad
justin
g fo
r probable confounders. The prevalen
ce
of men awaren
ess of danger sign &
involvement in birth
preparedn
e
ss
pract
ice
was v
e
r
y
low.
Keyword:
Birth Prepa
r
edness
Practice
Chenc
h
a Distri
ct
Me
n
aw
a
r
en
e
s
s
Obstetric Da
nger
Si
gn
So
ut
he
rn
Et
hi
o
p
i
a
Copyright ©
201
5 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Alem
u Tam
i
so,
Dep
a
rtm
e
n
t
Pub
lic Health,
C
o
l
l
e
ge
of M
e
di
ci
ne a
n
d
He
a
l
t
h
Sci
e
nces
,
Ar
ba M
i
nc
h
U
n
i
v
e
r
si
t
y
, So
ut
her
n
Et
hi
o
p
i
a
.
Em
a
il: ale
m
u
t
a
m
iso
@
yah
o
o
.
co
m
1.
INTRODUCTION
Male p
a
rtn
e
r i
n
vo
lv
em
en
t in
wo
m
e
n
'
s sex
u
a
l an
d rep
r
od
u
c
tiv
e h
ealth as
well as m
a
tern
al an
d ch
i
l
d
h
ealth
care h
a
s attracted
co
nsid
erab
le attentio
n
sin
c
e th
e
In
tern
ation
a
l
Co
nferen
ce
was h
e
ld on
Pop
u
l
ation
and
De
vel
o
pm
ent
(IC
PD
) i
n
C
a
i
r
o,
19
9
4
[
1
]
and t
h
e
4t
h
Wo
rl
d C
o
n
f
ere
n
ce o
n
Wom
e
n
i
n
B
e
i
j
i
n
g,
[2]
whi
c
h
were
on
w
o
m
e
n’s
heal
t
h
a
nd t
h
e nee
d
t
o
ha
ve m
e
n m
o
re i
nvol
ved
i
n
t
h
e p
r
om
ot
i
on
of
sex
u
a
l
and
reprodu
ctiv
e health
. Bo
th
con
f
eren
ces em
p
h
a
sized
m
e
n
’
s sh
ared
respon
sib
ility an
d
activ
e p
a
rt
n
e
rship
in
sexu
al and
repro
d
u
c
tiv
e
h
ealth and
p
r
o
m
o
tio
n of
g
e
nd
er equality [1
],[2
].
M
a
t
e
rnal
deat
h
ari
s
es f
r
om
pr
egna
ncy
,
c
h
i
l
d
bi
rt
h
or
p
o
st
pa
rt
um
co
m
p
l
i
cati
ons
, b
u
t
t
h
ei
r
occu
rre
nce
s
coul
d be re
duc
ed by
i
m
part
i
ng kn
o
w
l
e
d
g
e
a
b
o
u
t
o
b
st
et
ri
c com
p
l
i
cat
i
on
and
m
a
ki
ng bi
rt
h pre
p
a
r
ed
ness
pl
a
n
s
fo
r p
r
e
gna
nt
wom
e
n, t
h
ei
r
part
ners a
n
d f
a
m
i
li
es as wel
l
.
[3]
Ant
e
nat
a
l
care,
bi
rt
h
pr
epare
d
ness
pl
ans
a
n
d
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:2252
-88
06
IJP
H
S
V
o
l
.
4,
No
. 1,
M
a
rc
h 20
1
5
:
6
3
– 70
64
com
p
lication-readiness are
crucial fo
r ti
m
e
l
y
access to skilled m
a
ternal an
d neonatal se
rvices. These
factors
prom
ote active prepa
r
ation a
n
d
d
ecisio
n
-m
aking f
o
r delive
r
y
[4]
.
The key ele
m
e
n
ts of the birt
h plan includes,
a plan
for skilled birth attendants, place of delivery, and
arra
ngem
e
nt
o
f
m
oney
for t
r
ans
p
ort
o
r
ot
her c
o
st
s [
5
]
.
The bi
rt
h pl
an i
s
a very
i
m
port
a
nt
st
rat
e
gy
i
n
devel
opi
ng
c
o
unt
ri
es w
h
e
r
e
obst
e
t
r
i
c
ser
v
i
ces are
wea
k
and
t
h
us c
o
nt
r
i
but
e si
gni
fi
cant
l
y
t
o
m
a
t
e
rnal
and
n
e
on
atal m
o
rbid
ity an
d
m
o
rtality [6
]. A husb
a
n
d
at an
tenatal clin
ic is rare in
m
a
n
y
co
mm
u
n
ities an
d
it is
unt
hinkable
to
find m
e
n accom
p
anying their pa
rtne
rs
during
Ante
natal ca
re a
n
d delive
r
y
[7].
Ho
we
ver
,
m
e
n
hol
d s
o
ci
al
and ec
o
nom
i
c
powe
r
an
d ha
ve
t
r
em
endo
us c
ont
rol
o
v
e
r
t
h
e
i
r part
ners
,
esp
ecially in
dev
e
lop
i
ng
co
un
tries
[8
],[9
].
Th
ey
d
ecid
e
t
h
e ti
m
i
n
g
and
co
nd
itio
ns
o
f
sex
u
a
l
relatio
ns,
fam
i
ly
size, an
d
u
tiliz
atio
n
of av
ailab
l
e h
ealth
care
serv
ices
o
f
th
ei
r spo
u
s
es [8
],[1
0
]
. Strateg
i
es fo
r invo
lv
i
n
g
men
in
maternal healt
h
se
rvices
should aim
at raising t
h
ei
r
aw
are
n
e
s
s
abo
u
t
eme
r
g
e
n
c
y
obst
etric com
p
lication, and
enga
gi
n
g
t
h
em
i
n
bi
rt
h pl
a
n
s and c
o
m
p
l
i
cat
ion r
eadi
n
ess [
5
]
.
M
e
n awa
r
e
n
ess o
n
re
pr
o
d
u
ct
i
v
e i
ssues e
n
abl
e
s
th
em
to
su
ppo
rt th
eir m
a
tes to
u
tilize o
b
stetric serv
ices an
d
ev
en
t
u
ally wou
l
d
h
e
lp coup
les ad
equ
a
tely p
r
ep
are
for b
i
rth
co
m
p
licatio
n
s
[11
]
. Th
is wou
l
d
lead
to
a redu
ction
in
all
th
ree ph
ases of d
e
lay:
d
e
lay
in
th
e decisio
n
to seek care; delay in reach
ing care; and finally, delay
in receiving ca
re.
The m
a
le
partner ca
n play a crucial
ro
le esp
ecially in
th
e first and
seco
nd
p
h
a
ses o
f
d
e
lay in
d
e
v
e
l
o
p
i
n
g
cou
n
t
ries and
th
ereb
y
p
o
s
itiv
ely i
m
p
act
bi
rt
h
o
u
t
c
om
es [
11]
.
Et
hi
o
p
i
a
ha
s c
u
l
t
u
ral
l
y
dy
na
m
i
c and
pat
r
i
a
rchi
c s
o
ci
eties. Th
e low status of
wo
m
e
n
,
so
cio-cu
ltural
b
a
rriers to
seek
ing
care: women
’
s m
o
b
ilit
y, ab
ility
to
comman
d
resou
r
ces, d
ecision
-mak
in
g
ab
ilitie
s, b
e
liefs
and
p
r
act
i
ces sur
r
o
u
ndi
n
g
c
h
i
l
dbi
rt
h a
nd
del
i
v
ery
has
great
i
m
pact
on
w
o
m
e
n’s heal
t
h
. M
o
st
of t
h
e
reprodu
ctiv
e health
p
r
o
g
ram
s
fail to
ad
d
r
ess th
ese f
act
o
r
s
i
n
Et
hi
opi
a [
10]
. I
n
c
r
easing m
a
le
awareness of
dange
r
sign
of obstetric c
o
m
p
lication and involvem
en
ts in
b
i
rth prep
aredn
e
ss
p
r
actices is n
ecessary in
cu
ltu
rally d
y
n
a
mic so
cieties li
k
e
Et
h
i
op
ia to
i
m
p
r
o
v
e
t
h
e
women
’
s
h
ealth
an
d redu
ce m
a
te
rn
al m
o
rtality.
There
f
ore t
h
is study trie
d to assess the as
socia
tion
between m
e
n’s awarenes
s of da
nger si
gn
of
o
b
s
tetric co
m
p
licatio
n
s
and in
vo
lvem
en
t in
b
i
rth
prep
ar
edness
practices at Che
n
c
h
a di
st
ri
ct
of
s
out
her
n
Ethiopia.
2.
R
E
SEARC
H M
ETHOD
Th
e stud
y w
a
s co
ndu
cted
in
C
h
en
ch
a d
i
str
i
ct o
f
G
a
m
o
G
o
f
a
Zon
e
o
f
so
u
t
h
Eth
i
op
ia. I
t
is l
o
cated
562
Km
sout
h we
st
of t
h
e capi
t
a
l
of Et
hi
o
p
i
a
, Ad
di
s A
b
ab
a, and
33
2 K
m
sout
h west
of R
e
gi
o
n
al
capi
t
a
l
,
H
a
w
a
ssa, w
i
t
h
to
tal p
o
p
u
l
atio
n
o
f
1
37,196 an
d
estim
ated
w
o
m
e
n
w
ith
ch
ild
b
e
ar
ing
ag
e of
31
,96
6
. Th
e
di
st
ri
ct
has
5
0
Kebel
e
s
(
d
i
s
t
r
i
c
t
s
’
sm
al
l
ad
m
i
ni
st
rat
i
v
e uni
t
)
, fi
ve u
r
ba
n
a
n
d
4
5
r
u
ral
wi
t
h
27
,9
9
9
ho
us
ehol
d
s
u
n
til th
e en
d
o
f
20
13
.
It h
a
s o
n
e d
i
strict
h
o
s
p
ital, si
x
health
cen
ters an
d
50
h
ealt
h
p
o
s
ts. Th
e stud
y was
co
ndu
cted
f
r
om
A
p
r
il to
May 2
014
. C
o
mmu
n
ity b
a
sed cross section
a
l stud
y w
a
s im
p
l
e
m
en
ted
.
All adu
lt m
a
le with
a wife or partn
e
r
wh
o
liv
es in
t
h
e
district and all male in the
selected ke
bele
s
(d
istricts’ sm
al
l ad
m
i
n
i
strativ
e un
it)
with
a
wife
o
r
p
a
rtn
e
r wh
o h
a
d
b
e
en th
rou
g
h
ch
ildb
i
rth in
t
h
e
p
r
eced
ing
36
m
ont
hs
wer
e
so
urce
an
d
st
udy
p
o
p
u
l
a
t
i
o
n
res
p
ect
i
v
el
y
.
The re
q
u
i
r
e
d
s
a
m
p
l
e
si
ze was det
e
rm
i
n
ed by
usi
n
g St
at
C
a
l
c
pr
og
ram
of Ep
i
Inf
o
versi
on
7 st
at
i
s
t
i
cal
packa
g
e
wi
t
h
5% de
si
red
p
r
e
c
i
s
i
on, Z sc
o
r
e
cor
r
esp
o
n
d
i
ng to
95
% conf
iden
ce in
te
rval,
50% m
a
le
awarenes
s
on
da
nge
r si
gn
of
o
b
st
et
ri
c co
m
p
li
cat
i
on (d
u
e
t
o
abse
nce
of
pre
v
i
o
us st
udy
on m
e
n awa
r
e
n
ess)
, t
e
n
pe
rc
ent
o
f
n
on-respo
n
s
e rate an
d d
e
sign
effect
o
f
two
resu
ltin
g in
a to
t
a
l o
f
845
stud
y
p
a
rticip
an
ts.
Mu
ltistag
e
stag
e cl
u
s
ter
samp
lin
g techn
i
que was used to reach
ho
u
s
eho
l
d lev
e
l.
Th
e d
i
strict
was
di
vi
de
d i
n
t
o
t
w
o;
ur
ba
n a
n
d
ru
ral
area
, t
h
en
ni
ne
ke
bel
e
s (sm
a
l
l
ad
m
i
ni
st
rat
i
v
e
uni
t
)
fr
om
rural
a
n
d
on
e
kebel
e
f
r
om
ur
ban
were sel
e
c
t
ed by
sim
p
l
e
ran
d
o
m
sam
p
l
i
ng
, co
nsi
d
e
r
i
n
g t
h
e assum
p
t
i
on
of sc
hol
a
r
nam
e
d
Hosm
er and L
e
m
e
-sho
w
(
20
% sug
g
est
i
o
n o
f
m
i
nim
u
m
sam
p
l
e
si
ze). Pro
p
o
r
t
i
o
nal
t
o
si
ze al
l
o
cat
i
on t
echni
que
was
use
d
t
o
al
l
o
cat
e t
h
e
sam
p
l
e
t
o
eac
h
kebe
l
e
s, an
d t
h
e
ke
bel
e
s
were
di
vi
ded
i
n
t
o
di
ffe
r
e
nt
cl
ust
e
rs
ba
sed
o
n
‘G
oti’
(sm
a
ll-
villages in
kebele) and num
b
er of pa
rticip
a
n
t in each cl
uster were e
n
umerated. Base
d
on t
h
e
allocated sam
p
le size, k clusters we
re selected from
each kebele a
nd t
o
tal participants
in each cluste
r were
aske
d
until we
collected the
a
d
equate sam
p
le from
each ke
bele.
Data co
llection
Data was collected by using face to fac
e
inte
rview techni
que
s using pr
eteste
d and struct
ure
d
que
stionnaires
.
The inform
a
tion collected was a
b
ou
t s
o
cio-dem
ogra
p
hic cha
r
acteri
s
tics (m
a
t
erna
l age,
pat
e
r
n
al
age,
m
a
ri
t
a
l
st
at
us, et
hni
ci
t
y
, rel
i
g
i
o
n
,
resi
den
ce and e
d
ucat
i
onal
st
at
us
o
f
w
o
m
a
n/
hus
b
a
nd
)
,
house
h
old c
h
a
r
acteristics (wealth inde
x/ec
onom
ic status, fam
i
ly size,
and tim
e to reach healt
h
fa
cilit
y),
reproductive c
h
aracteristics (gra
vid
ity, pa
rity, and
place of delive
r
y),
men awa
r
ene
ss
on
da
nge
r signs of
obst
e
t
r
i
c
c
o
m
p
l
i
cat
i
ons at
t
h
ree st
a
g
es a
nd
di
f
f
ere
n
t
com
pone
nt
s o
f
bi
rt
h
pre
p
are
dne
ss p
r
act
i
ces. Th
e
que
st
i
o
n
n
ai
re
was fi
rst
p
r
epa
r
ed i
n
E
ngl
i
s
h
and t
r
ansl
at
e
d
t
o
Am
hari
c (t
h
e
nat
i
o
n
a
l
l
a
ng
uage
) a
nd t
h
en
ba
c
k
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Associ
at
i
o
n
of
Men
's
Aw
a
r
en
ess
of
D
a
n
g
er
Si
g
n
of
O
b
st
et
r
i
c
C
o
m
p
l
i
c
at
i
o
n an
d Mal
e
..
..
(
A
l
e
mu Ta
mi
s
o
)
65
t
o
E
ngl
i
s
h
by
t
w
o
di
ffe
rent
l
a
ng
ua
ge e
x
p
e
rt
s
t
o
c
h
ec
k f
o
r c
onsi
s
t
e
ncy
an
d
cl
ari
t
y
. Ten
di
pl
om
a nu
rses
wer
e
hi
re
d as dat
a
col
l
ect
ors & s
upe
r
v
i
s
ed by
pri
n
ci
pal
i
nve
s
t
i
g
at
or w
h
e
n
con
d
u
ct
i
ng
h
o
m
e t
o
hom
e v
i
si
t
aft
e
r
th
ree d
a
ys
o
f
t
r
ain
i
ng
on
b
a
sic sk
ills o
f
in
terv
iew, ways
o
f
o
b
t
ain
i
n
g
verb
al con
s
en
t an
d
o
b
j
ectiv
e
o
f
th
e
st
udy
.
Data quality
assurances
To
m
a
in
tain
th
e q
u
a
lity o
f
data, th
e co
llecto
r
s were trai
n
e
d, Pre-test was
do
n
e
on
43
ind
i
v
i
du
als (5
%
o
f
th
e st
ud
y particip
an
ts)
ou
t o
f
th
e st
u
d
y
area with
sim
ila
r po
pu
lation
in o
r
d
e
r t
o
assess th
e v
a
lid
ity o
f
th
e
q
u
e
stio
nn
aires and
co
rrection
was m
a
d
e
after
p
r
elim
in
ar
y d
a
ta an
alysi
s
. Defin
ition
of con
c
ep
ts an
d term
s
were m
a
d
e
clear to
p
a
rticip
an
ts with
a commo
n
lan
g
u
a
ge o
f
th
e
d
i
strict to
av
o
i
d
am
b
i
g
u
ity. th
e superv
isor
u
n
d
e
rwen
t on
-site su
p
e
rv
ision
du
ri
n
g
d
a
ta co
llectio
n
p
e
ri
od
and
rev
i
ewed
all th
e filled
q
u
e
sti
o
nn
aires d
u
ring
t
h
e ne
xt
m
o
rn
i
ng
of
eac
h d
a
t
a
col
l
ect
i
on
so as
t
o
i
d
en
t
i
f
y
i
n
com
p
l
e
te an
d i
n
c
o
her
e
nt
res
p
ons
es.
Dat
a
was
cl
ea
ned
b
y
per
f
o
rm
i
ng fre
que
nci
e
s
a
n
d
c
r
o
ss t
a
bul
a
t
i
on fo
r al
l
cat
e
go
ri
cal
vari
abl
e
s by
usi
n
g SPS
S
(IBM
-
20
).
Da
ta
pr
ocessi
ng an
d an
al
ys
i
s
Each com
p
l
e
t
e
d q
u
est
i
o
nnai
r
es was chec
ke
d m
a
nual
l
y
for
com
p
l
e
t
e
ness bef
o
re
dat
a
ent
r
y
.
The dat
a
w
a
s cod
e
d and en
ter
e
d in
to Ep
i In
fo v
e
r
s
ion 7 and
clea
ne
d
u
p
t
o
c
h
eck
a
ccuracy
a
n
d c
o
nsi
s
t
e
ncy
was
m
a
de
and a
n
y error i
d
entifie
d was
corrected. Fi
na
l data wa
s exporte
d
to SPSS
(IBM-20) for furt
her clean up and
an
alysis. Fr
equen
c
y,
p
r
op
or
tio
n, m
ean
, and
stan
d
a
r
d
d
e
viation
we
re
used
to summ
arize results and ta
ble a
nd
figu
res were carried ou
t t
o
presen
ts im
p
o
r
tan
t
fi
n
d
i
n
g
s
.
Hierarch
ical log
i
stic regressi
on
m
o
d
e
l was fitted
to
kn
o
w
associ
at
i
on
bet
w
ee
n ex
pl
anat
o
r
y
an
d out
c
o
m
e
vari
abl
e
s. C
r
ude
od
d rat
i
o
an
d A
d
ju
st
ed o
d
d
s rat
i
o wi
t
h
95
% C
I
was u
s
ed t
o
det
e
rm
ine t
h
e pre
s
enc
e
and st
re
ngt
h of ass
o
ci
at
i
on
bet
w
ee
n m
e
n’s awarene
ss of
dan
g
e
r
signs
and i
n
vol
v
em
ent in birt
h prepa
r
edness
practices.
Ethical c
o
nsiderati
on
Eth
i
cal clearance fo
r th
e study w
a
s
ob
tain
ed fro
m
th
e In
stitu
tio
n
a
l
Eth
i
cal
Rev
i
ew Bo
ard of C
o
lleg
e
of m
e
di
ci
ne a
n
d
heal
t
h
Sci
e
nc
es o
f
A
r
ba M
i
n
c
h
Uni
v
ersi
t
y
,
perm
i
ssi
on l
e
t
t
e
r wa
s t
a
ke
n
fr
om
C
h
encha
di
st
ri
ct
heal
t
h
of
fi
ces,
and
i
n
f
o
rm
ed ver
b
al
co
nse
n
t
was t
a
ken
fr
o
m
i
ndi
vi
d
u
al
p
a
rt
i
c
i
p
ant
,
si
nc
e m
o
st
of t
h
e
m
were
u
n
a
b
l
e to
read
and
write. No
fo
rm
o
f
id
en
tifiers was in
clu
d
e
d
in
th
e qu
estion
n
a
i
r
es to
main
tai
n
co
nfid
en
tiality.
Particip
ation
was v
o
l
u
n
t
ar
y
an
d p
a
rticip
an
t
s
were inform
e
d
th
at t
h
ey could
withd
r
aw
fro
m
th
e
stu
d
y
at an
y st
ag
e if th
ey
d
e
sired
,
withou
t an
y in
tim
id
atio
n
.
At t
h
e en
d
o
f
in
terv
iew inform
at
io
n
was g
i
v
e
n
abo
u
t
dan
g
er
s
i
gns
of
o
b
st
et
r
i
c com
p
l
i
cati
on at
t
h
re
e st
ag
es (d
u
r
i
n
g p
r
e
gna
ncy
,
l
a
bo
r
and c
h
i
l
d
bi
rt
h
,
an
d
post
p
art
u
m
peri
o
d
).
In a
ddi
t
i
on pa
rt
i
c
i
p
ant
s
were i
n
fo
rm
ed ab
out
t
h
e i
m
port
a
nce o
f
i
n
v
o
l
v
em
ent
in bi
rt
h
pre
p
are
d
ness a
n
d
com
p
o
n
ent
s
o
f
bi
rt
h
p
r
epa
r
edne
ss
pl
an.
3.
R
E
SU
LTS AN
D ANA
LY
SIS
Soci
o
-
dem
o
gr
aphi
c
an
d E
c
o
n
omi
c
c
h
ar
act
eri
sti
c
s
Th
e to
tal nu
mb
ers
of m
e
n
i
n
terv
iewed
were 836
m
a
k
i
n
g
th
e resp
on
se
rate o
f
98
.9
%. Mean
and
st
anda
rd
de
vi
at
i
on o
f
a
g
e o
f
resp
o
nde
nt
s
w
e
re 3
7
.
4
(
r
a
nge
:
30
-4
0) a
n
d ±
8
.
95
res
p
ect
i
v
el
y
.
The m
a
jor
i
t
y
of
resp
o
nde
nt
s w
e
re m
a
rri
ed (9
7.
8%) a
nd fa
r
m
er (42
.
5%
).
Al
m
o
st
all
(97
.
8%
) of t
h
e
hu
sba
nds
were G
a
m
o
by
et
hni
ci
t
y
and
fi
ve h
u
n
d
r
e
d
ei
g
h
t
(
6
0
.
8%
) w
e
r
e
ort
h
o
d
ox
by
rel
i
g
i
o
n. M
e
a
n
age
o
f
wi
ves
of
resp
o
n
d
e
nt
s
’
we
re
34
.5 ± 10
.9
.
M
a
jo
ri
t
y
(7
4.
2
%
)
o
f
wi
ves o
f
resp
o
nde
nt
s w
a
s
h
ouse
wi
ves
by
occ
u
pat
i
o
n
and
ha
d not
at
t
e
nde
d
an
y lev
e
l
o
f
edu
catio
n (54
.
1
%
). Reg
a
rd
ing
eco
n
o
m
ic st
atu
s
; twen
ty po
in
t t
h
ree p
e
rcen
t (1
70
)
were co
n
s
titu
ted
in
seco
nd
weal
th
qu
in
tal
(as Tab
l
e 1).
Repr
oduc
ti
ve
char
acteri
s
t
i
c
s
Mean (a
vera
ge
) ti
m
e
taken to reach
health
facility
for delivery se
rvices i
s
40.5
±
34.9.
More tha
n
t
h
ree f
o
urt
h
(
9
3.
1%)
of
h
o
u
s
ehol
d ha
ve
ha
d t
w
o o
r
m
o
re chi
l
d
re
n. M
a
j
o
ri
t
y
(6
0.
6%
)
of
ho
use
h
ol
d
u
s
e l
o
cal
transportation/
Kareza t
o
pr
ovide
pre
g
nant
wom
e
n in labour to he
alth facility and al
m
o
st all (
9
6.3%
)
p
a
rticip
an
ts knew wh
ere to
go
if lab
o
u
r
commen
ce to
the
i
r wife
’s.
Fo
ur
hu
n
d
re
d
ninet
y
seven
(
5
9
.
6
%
)o
f th
e
respon
d
e
n
t
s’
wife h
a
s
d
r
i
v
en
b
i
rth
at home an
d
th
e rest 4
1
.
6
%
at d
i
fferen
t
p
u
b
lic health
facilities
su
ch
as
p
u
b
lic ho
sp
ital(16
.5
%),
pu
b
l
i
c
h
ealth
cen
ter
(16
.
4
%
) an
d
health
po
sts(7
.
7%) in th
e
p
a
st t
h
ree years.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:2252
-88
06
IJP
H
S
V
o
l
.
4,
No
. 1,
M
a
rc
h 20
1
5
:
6
3
– 70
66
Table
1.Socio-dem
ogra
phic a
n
d econom
i
c c
h
aracteris
tics of
r
e
spon
d
e
n
t
s, at
Ch
en
ch
a d
i
str
i
ct,
20
14
Variables Frequen
c
y
%
Residence
Rural
Ur
ban
Total
610
226
836
73
27
100
Marital
status
Mar
r
ied
W
i
dowed
Separated
818
7
11
97.
8
0.
8
1.
3
Religion
Pr
otestant
Or
thodox
Catholic
326
508
2
39.
0
60.
8
0.
2
E
t
hnic gr
oup
Ga
m
o
Others( Wolaita
)
833
3
99.
6
0.
4
Maternal
education
No education
Pri
m
a
r
y education
Secondar
y
education
Above secondar
y
education
452
206
112
66
54.
1
24.
6
13.
4
7.
9
Occupational status of Respon
dents
Far
m
e
r
Weaver
M
e
r
c
hant
Gover
n
m
e
nt e
m
ploy
ee
Private gainful work
W
ithout gain full wor
k
355
229
64
108
49
31
42.
5
27.
4
7.
7
12.
9
5.
9
3.
7
Age of r
e
spondent
s
<=19
20-
30
31-
40
41-
50
>50
5
171
378
164
37
0.
6
20.
5
45.
2
19.
6
4.
4
Paternal education
No education
Pri
m
a
r
y education
Secondar
y
-
e
ducation
Above secondar
y
education
330
235
151
120
39.
5
28.
1
18.
1
14.
4
Occupational status of wife
House wife
Far
m
e
r
Weaver
Gover
n
m
e
nts e
m
ploy
ee
Others(
m
erchant)
620
70
10
51
85
74.
2
8.
4
1.
2
6.
1
10.
2
W
ealth index quintal
Lo
west
Second
M
i
ddle
Four
th
Highest
167
170
164
167
168
20.
1
20.
3
19.
6
20.
0
20.
0
Men aware
n
e
ss
of obs
t
etric danger
si
gn
during
p
regn
a
ncy
,
la
bo
u
r
a
nd af
t
er ch
ild
b
i
rt
h
Th
ree
h
und
red th
irty six
[
(
42.2
%
, 9
5
%
C
I
:
(
0
.3
9, 0
.
46
)]
of t
h
e m
e
n kn
ew da
nge
r si
g
n
of
ob
st
et
ri
c
com
p
lications whic
h is
m
eas
ure
d
by above
avera
g
e m
ean
score at three s
t
ages.
The pe
r
cent
a
ge o
f
m
e
n w
h
o
kne
w
va
gi
nal
bl
ee
di
n
g
rel
a
t
e
d t
o
p
r
e
gna
ncy
(
3
4%)
,
i
n
rel
a
t
i
o
n
t
o
d
e
l
i
v
ery
(
6
0.
4
%
) a
n
d i
n
rel
a
t
i
on t
o
post
p
art
u
m
peri
o
d
we
re
3
2
.
2
%. Se
ve
re a
b
dom
i
n
al
pai
n
(
8
7
%
)
was t
h
e
m
o
st
recog
n
i
zed
dan
g
e
r
si
g
n
a
nd
water b
r
eak
s
b
e
fo
re
labo
ur (1.2
%) was
the
list
m
e
n
t
i
oned d
a
n
g
er
si
g
n
d
u
r
i
n
g p
r
e
g
nancy
.
Se
vere
vagi
nal
bl
eedi
n
g
was
t
h
e m
o
st
rec
o
g
n
i
zed
si
g
n
du
ri
ng
l
a
b
o
u
r
a
n
d
chi
l
d
bi
rt
h
an
d
aft
e
r
del
i
v
e
r
y
by
3
2
.
2
%
an
d
60
.4
%
resp
ectiv
ely. Lo
ss
o
f
co
n
s
ci
ou
sness was th
e list reco
gn
ized
sign
du
ri
ng
lab
o
u
r
(13
%
)
an
d
after ch
ild b
i
rth
(2
.8%
)
. P
r
ol
o
n
g
ed l
a
bo
r
was
kn
o
w
n
by
o
n
l
y
21
.4%
o
f
m
e
n, w
h
i
l
e
ret
a
i
n
e
d
pl
ace
nt
a was
reco
g
n
i
zed
by
19
.7%
(as Ta
bl
e
2).
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2-8
8
0
6
Associ
ation of
Men'
s
Awareness of
Da
nger
Sign of
Obstetr
i
c
Complication and Male
....
(Alemu Tamis
o
)
67
Tabl
e
2. M
e
n a
w
are
n
ess
o
f
ob
st
et
ri
c dan
g
e
r
s
i
gn
d
u
ri
ng
p
r
e
gna
ncy
,
l
a
bo
u
r
an
d a
f
t
e
r c
h
i
l
d
bi
rt
h,
2
0
1
4
Obste
t
ric danger sign
During pregnanc
y
n
%
During labor and
child bi
rth
n
%
After
child
birth(postpartu
m
)
n
%
Sever
e
vaginal bleeding
Yes
No
284
552
34.
0
66.
0
505
331
60.
4
39.
6
269
567
32.
2
67.
8
High Grade Feve
r
Yes
No
108
728
12.
9
87.
1
191
645
22.
8
77.
2
109
727
13.
0
87.
0
Loss of Conscio
u
s
n
ess
Yes
No
51
785
6.
1
93.
9
109
727
13.
0
87.
0
23
813
2.
8
97.
2
Pr
olonged labor
Yes
No
179
657
21.
4
78.
6
Retained placenta
Yes
No
165
671
19.
7
80.
3
Severe H
eadache
Yes
No
120
716
14.
4
85.
6
52
784
6.
2
93.
8
Blur
r
i
ng of Vision
Yes
No
155
681
18.
5
81.
5
120
716
14.
4
85.
6
Convulsi
ons
Yes
No
52
784
6.
2
93.
8
42
794
5.
0
95.
0
Swollen Hands/Face
Yes
No
81
755
9.
7
90.
3
43
793
5.
1
94.
9
Dif
f
i
culty of
Breathing
Yes
No
35
801
4.
2
95.
8
42
794
5.
0
95.
0
Sever
e
W
eakness
Yes
No
173
663
20.
7
79.
3
211
625
25.
2
74.
8
Sever
e
Abdo
m
i
nal Pain
Yes
No
107
729
87.
2
12.
8
Acceler
ated/ Reduced Foetal
M
ovem
e
nt
Yes
No
151
685
18.
1
81.
9
W
a
ter
Br
eaks with
out L
a
bor
Yes
No
10
826
1.
2
98.
8
M
a
lodor
ous Vaginal Dischar
g
e
Yes
No
35
801
4.
2
95.
8
Ma
le invo
lv
ements in birt
h preparedne
ss
prac
tices
The pre
v
al
e
n
ce
o
f
m
e
n
i
n
v
o
l
v
em
ent
s
i
n
bi
rt
h
p
r
epa
r
ed
ness
pract
i
ce was 9.
4
%
(
95
%C
I:
7
.
4
2
-
1
1.
4)
as Fi
g
u
re
1
.
A
m
ong t
h
em
sev
e
nt
een
p
o
i
n
t
ni
ne
perce
n
t
of
m
e
n i
n
v
o
l
v
e i
n
savi
ng
m
oney
and
o
n
l
y
zer
o
poi
nt
fiv
e
p
e
rcen
t
o
f
respon
d
e
n
t
s i
n
v
o
l
v
e
in id
en
tificatio
n
of sk
illed
h
ealth
p
r
o
f
essio
n
a
l as Fi
g
u
re
2
.
Figure
1. preva
l
ence of m
a
le involv
em
ent
s
i
n
bi
rt
h
pre
p
are
d
ness
pr
act
i
ce at
C
h
e
n
cha
di
st
ri
ct
of
so
ut
he
r
n
Eth
i
op
ia, 2
014
9.40%
90.60%
Male
involvement
in
birth
prepardness
practices
(Yes)
Male
involvement
in
birth
prepardness
practices
(No)
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:2252
-88
06
IJP
H
S
V
o
l
.
4,
No
. 1,
M
a
rc
h 20
1
5
:
6
3
– 70
68
Fi
gu
re
2.
Fre
q
uency
o
f
m
e
n i
n
v
o
l
v
em
ent
s
i
n
bi
rt
h
pre
p
are
d
ness
pr
act
i
ce at
C
h
e
n
cha
di
st
ri
ct
of
Gam
o
-G
o
f
a
zone
Ass
o
ciati
o
n be
tween men aw
areness
of
danger si
gn
of
obs
t
etric c
o
mplic
ati
o
n
and involvements in
birth
prepare
dness
prac
tice
The re
sults s
h
ow a clear
associ
ation be
tween m
e
n aware
n
ess
of
d
a
ng
er
sign
s o
f
ob
stetr
i
c
com
p
l
i
cat
i
on and
i
n
vol
vem
e
nt
i
n
bi
rt
h
p
r
epa
r
ed
ness
practice at the district. T
h
e a
ssociation rem
a
ined
statistically signi
ficant e
v
en after
co
nt
r
o
l
l
i
ng fo
r p
o
ss
i
b
l
e
co
nf
o
u
n
d
i
ng o
f
resi
de
nce, weal
t
h
i
nde
x
,
educat
i
o
nal
st
at
us and
occu
pa
t
i
onal
st
at
us of
wom
e
n. T
hus
resp
o
nde
nt
w
h
o ha
d aware
n
e
ss of da
n
g
er si
gns
of
o
b
s
tetric co
m
p
licatio
n
was two
ti
m
e
s [
(AO
R
: 1.
9
1
, 9
5
%
CI: (1
.0
6,
3.
4
1
)
]
m
o
re lik
ely to
b
e
in
vo
lv
ed
in b
i
rth
pre
p
are
d
ness
practice than re
sponde
n
ts who ha
d
no awa
r
e
n
ess of danger
signs of
obste
t
ric com
p
lication as
Tabl
e 3.
Tabl
e
3.
Ass
o
c
i
at
i
on (
O
dds
R
a
t
i
o
, 9
5
%
C
I
)
bet
w
ee
n m
e
n a
w
are
n
ess
o
n
da
nge
r si
gn
o
f
o
b
s
t
e
t
r
i
c
com
p
l
i
c
at
i
on
and
bi
rth pre
p
a
r
edness: Hiera
r
chical
log
i
stic regression
an
al
ysis
Male involve
m
e
nts in
Birth pr
eparedne
ss
practice
Crude odd
ratio
Model 1
(Adjus
ted for
Residences
)
Model 2
(Adjus
ted for
residence,
and
Wealth ind
ex)
Model 3
(Adjus
ted for
resi
d
ence,
Wealth ind
ex, ed
ucation
and occupat
i
onal
st
at
us)
M
e
n awar
e
ness
Had awa
reness
Had no awareness
1.
79(
1.
12,
2.
8)
1
2.
58(
1.
54,
4.
30)
1
2.
26(
1.
30,
3.
92)
1
1.
91(
1.
07,
3.
41)
*
1
Residences
Rural
ur
ban
-
0.
31(
0.
19,
0.
54)
1
0.
31(
0.
18,
0.
54)
1
0.
27(
0.
15,
0.
49)
**
1
W
ealth index quintal
Lowest
Second
M
i
ddle
Four
th
Highest
-
-
0.
12(
0.
02,
0.
99)
3.
37(
1.
55,
7.
32)
5.
29(
2.
44,
11.
5)
0.
86(
0.
29,
2.
49)
1
0.
19(
0.
23,
1.
64)
4.
38(
1.
93,
9.
92)
**
7.
04(
3.
01,
16.
5)
**
1.
21(
0.
39,
3.
77)
1
Paternal education
No education
Pr
im
ary
education
Secondar
y
-
e
ducation
Above secondar
y
education
-
- -
0.
77(
0.
28,
2.
13)
1.
71(
0.
68,
4.
28)
4.
61(
1.
91,
11.
1)
**
1
Maternal
occupation
Housewif
e
Farm
e
r
Weaver
Gover
n
m
e
nt e
m
ploy
Other
(
m
e
r
c
hant)
- -
-
1
0.
23(
0.
061,
0.
88)
1.
06(
0.
10,
10.
3)
0.
54(
0.
14,
2.
02)
0.
79(
0.
35,
1.
78)
No
te:
P-
v
a
l
u
e:
*<
0.
05
*
*
p
<
0.
00
1
DIS
C
USSI
ON
Alth
oug
h
research
h
a
s no
t p
r
ev
iou
s
ly
assessed
m
e
n’s a
w
are
n
ess
of obstetric da
nge
r
signs a
nd
association
between m
e
n awa
r
enes
s
of obste
t
ric da
nge
r
sign
s and
invo
lv
emen
t in
b
i
rth prepa
r
edness
practice
0
20
40
60
80
100
89.5
82.1
96.5
99.5
91.5
Involvement
in
birth
prepardness
No
Involvement
in
birth
prepardness
Yes
Evaluation Warning : The document was created with Spire.PDF for Python.
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6
Associ
at
i
o
n
of
Men
's
Aw
a
r
en
ess
of
D
a
n
g
er
Si
g
n
of
O
b
st
et
r
i
c
C
o
m
p
l
i
c
at
i
o
n an
d Mal
e
..
..
(
A
l
e
mu Ta
mi
s
o
)
69
i
n
Et
hi
o
p
i
a
, t
h
i
s
st
udy
p
o
t
e
nt
i
a
l
l
y
suggest
t
h
at
m
e
n woul
d
have a
n
eq
ual
un
de
rst
a
n
d
i
n
g
com
p
ared t
o
w
o
m
e
n
.
B
a
sed
on
t
h
i
s
a
ssum
p
t
i
on, t
h
i
s
st
u
d
y
use
d
st
u
d
y
d
o
n
e
on
w
o
m
e
n an
d m
e
n t
o
di
scuss
t
h
e
re
sul
t
s
.
The fi
n
d
i
n
g o
f
t
h
i
s
st
udy
re
veal
ed t
h
at
t
h
e l
e
vel
of
m
e
n aware
n
ess
o
f
dan
g
e
r
si
gn
of o
b
st
et
ri
c
com
p
lication was [42.2%
,
(95%CI (39%,
46%)] which
was assesse
d
by
avera
g
e m
e
an score, this i
s
lower
t
h
an fi
ndi
ng
s o
f
t
h
e st
u
d
y
do
n
e
am
ong m
e
n i
n
r
u
ral
area
of
Keny
a, a
n
d Ta
nzani
a
,
[9]
,
[1
2
]
and hi
g
h
e
r
t
h
an t
h
e
st
udy
co
n
duct
e
d i
n
Egy
p
t
,
Al
exan
d
r
i
a
and st
udy
i
n
U
g
a
nda
[1
3]
,[
14]
. T
h
e
l
o
w awa
r
enes
s coul
d be ex
pl
ai
ned
by
p
o
o
r c
o
un
s
e
l
i
ng
of
da
n
g
er
si
gn
s am
ong
t
hos
e w
h
o at
t
e
n
d
ed
ant
e
nat
a
l
cl
i
n
i
c
s as com
p
ared
t
o
st
udy
d
one
i
n
Tan
z
an
ia, th
at th
e
m
a
j
o
rity
o
f
th
e stud
y su
bj
ects atten
d
e
d
an
ten
a
tal clin
ics an
d
co
un
seled
for d
a
n
g
e
r sign.
[1
2]
The
hi
gh
er awa
r
e
n
ess i
n
t
h
i
s
st
udy
m
i
ght
be
d
u
e
t
o
Et
hi
o
p
i
a
n
Go
ve
rnm
e
nt
s em
phasi
s
of
o
n
heal
t
h
ext
e
nsi
on
pr
og
ram
,
t
h
at
awar
e t
h
e
m
a
jori
t
y
of m
e
n about
d
a
nge
r si
g
n
of
o
b
st
et
ri
c com
p
l
i
cat
i
on. [
1
0]
,[
1
5
]
,
[
16]
The di
scre
pa
n
c
y
i
s
al
so due
t
o
di
ffere
nce
i
n
t
h
e set
t
i
ng, sam
p
l
e
si
ze and m
easurem
ent
s
t
ool
of awa
r
eness
a
m
o
n
g
p
a
rticipan
ts, th
at t
h
is
stu
d
y
u
tilized
av
erag
e m
ean
sco
r
e fro
m
th
ree ph
ases(pregn
an
cy, ch
ildb
i
rth
and
post
p
art
u
m
)
an
d ot
he
rs use
d
m
e
nt
i
oni
n
g
of
t
w
o o
r
t
h
ree da
nge
r
si
gn
s of o
b
st
et
ri
c
com
p
l
i
cat
i
ons.
The m
a
gni
t
ude
of m
e
n i
nvol
v
e
m
e
nt
s i
n
bi
rt
h
prepa
r
e
dnes
s
pract
i
ces o
f
9.
4% est
i
m
a
t
e
d in o
u
r st
u
d
y
appea
r
s t
o
be hi
g
h
er t
h
a
n
w
h
at
was rep
o
rt
e
d
fr
om
Keny
a 7%[
1
7]
. B
u
t
l
o
wer t
h
a
n
(
2
0%
- 2
2
%)
, 4
4
.
3
%
,
48
%
repo
rted
in stud
ies fro
m
Eth
i
o
p
i
a, Ug
an
d
a
an
d In
d
i
a resp
ectiv
ely [18
]
-[2
1
]. Low lev
e
l
of in
vo
lv
em
en
t in
b
i
rt
h
pre
p
are
d
ness
m
i
ght
be
d
u
e
t
o
l
o
w
l
e
vel
of
econ
o
m
i
c st
at
us, i
n
t
h
e
di
st
ri
c
t
, w
h
i
c
h
i
n
t
u
r
n
ham
p
ers
hu
s
b
an
ds
not to invol
ve
in the birth prepa
r
ed
ness practices,
particularly
involvi
ng in saving m
oney. In a
ddition this
st
udy
s
h
owe
d
,
m
a
l
e
s gi
ve
d
u
e
em
phasi
s t
o
fo
o
d
a
n
d
cl
ot
h
p
r
epa
r
at
i
o
n f
o
r
upc
om
i
ng ba
by
an
d m
o
t
h
er
t
h
a
n
pre
p
ari
n
g
f
o
r t
r
ans
p
ort
a
t
i
o
n a
n
d
savi
ng
m
oney
,
t
h
i
s
m
i
ght
al
so d
u
e t
o
on
e way
am
bul
ance se
rvi
ce t
h
at
has
been provi
ded
freely for the l
a
boring m
o
ther an
d
delivery s
e
rvices i
n
the
health center [22].
The st
udy also s
h
owe
d
t
h
e
sign
ificant a
s
sociation bet
w
een m
e
n’s a
w
arenes
s
of da
nge
r si
gn
of
obst
e
t
r
i
c
c
o
m
p
l
i
cat
i
on and i
n
vol
vem
e
nt
i
n
bi
rt
h p
r
epa
r
e
dne
ss pract
i
ce.
Ac
cor
d
i
n
gl
y
m
a
l
e
wh
o
had a
w
ar
enes
s
of
da
nge
r si
g
n
of
o
b
st
et
ri
c c
o
m
p
l
i
cat
i
on w
a
s t
w
o t
i
m
es
m
o
re l
i
k
el
y
i
nvol
ved
i
n
bi
rt
h
pre
p
a
r
ed
ness
pract
i
c
e
t
h
an m
a
l
e
wh
o
had
n
o
a
w
ar
eness
of
da
n
g
e
r si
g
n
.
Thi
s
was e
v
i
d
e
n
ce
d
by
t
h
e
st
u
d
y
do
ne i
n
Uga
n
da t
h
at
wom
e
n
aw
are
n
ess
o
f
da
nge
r
s
i
gn p
r
edi
c
t
s
t
h
e
l
e
vel
of
bi
rt
h
p
r
epa
r
e
dnes
s
pract
i
ces [2
3]
. Thi
s
m
i
ght
be
due
t
o
o
n
th
e assu
m
p
tio
n
th
at
kn
owled
g
e
of dang
er sign
s lead
s t
o
g
r
eater an
ticip
atio
n
and
p
r
ep
aration
t
o
mitig
ate
effect
s
of
pre
g
nancy
a
n
d
chi
l
dbi
rt
h com
p
l
i
cat
i
ons
by
re
d
u
ci
n
g
t
h
e
fi
rst
t
w
o
del
a
y
s
and t
h
e t
h
i
r
d
d
e
l
a
y
i
f
h
ealth
facilities
are p
r
ep
ared
to
ad
dress ob
stetric co
m
p
licati
o
n
s
.
Furt
herm
ore e
ducat
i
o
nal
st
at
us, ec
o
nom
i
c
st
at
us w
h
i
c
h
w
a
s m
easured b
y
weal
t
h
i
n
dex
qui
nt
al
an
d
place of re
sidence ha
d significant effect on m
a
le
involvem
e
nts in birth
pr
e
p
are
d
ness practices,
but
occu
pat
i
o
nal
st
at
us
has
no
si
g
n
i
f
i
cant
e
ffect
on
m
a
l
e
i
nvol
v
e
m
e
nt
i
n
bi
rt
h
pre
p
are
d
ness
p
r
act
i
ces.
It
i
s
di
ffi
c
u
l
t
,
h
o
we
ve
r t
o
c
o
m
p
are
o
u
r st
udy
fi
n
d
i
n
gs wi
t
h
t
hos
e f
r
om
ot
he
rs as t
h
e m
easures us
ed t
o
det
e
rm
i
n
e bi
rt
h
pre
p
a
r
ed
nes
s
ha
d
som
e
v
a
ri
at
i
ons
an
d t
h
ere
i
s
al
s
o
di
ffe
rences
i
n
s
e
x.
Ne
vert
hel
e
ss, t
h
e
un
de
rl
y
i
ng p
r
i
n
ci
pl
es re
gar
d
i
ng bi
rt
h p
r
ep
ared
ness are t
h
e sam
e
and t
h
e
m
e
t
hods
use
d
t
o
st
udy
bi
rt
h
pre
p
are
d
ness
was t
h
e sam
e
[2
4]
. It
i
s
po
s
s
i
b
l
e
t
h
at
t
h
er
e
m
a
y
have b
een di
f
f
ere
n
t
deg
r
ees
of rec
a
l
l
bi
as
bet
w
ee
n m
e
n
wh
o di
d ha
ve
wi
fe w
h
o ga
ve
bi
rt
h be
f
o
re t
w
o y
ears a
n
d wi
t
h
i
n
t
w
o y
ears. T
h
i
s
m
a
y
int
r
od
uce
misclassificati
o
n
b
i
as, resu
ltin
g
in
po
sitiv
e/n
e
g
a
tiv
e asso
ciatio
n
.
Con
f
oun
d
i
n
g
was contro
lled
in
th
e an
alysis
by
st
epwi
se hi
erarc
h
i
cal
l
ogi
st
i
c
regressi
on
m
odel
.
Po
ssi
ble co
n
f
ou
nd
ers were in
trod
u
c
ed
in
to
th
e level an
d
t
h
ey
di
d n
o
t
have si
gni
fi
ca
nt
effect
o
n
t
h
e asso
ciation between m
e
n awa
r
en
ess o
f
d
a
ng
er
si
gn
s and
involvem
ent in birt
h
pre
p
are
d
ness
practices.
4.
CO
NCL
USI
O
N
O
u
r
st
u
d
y
show
ed low
lev
e
l of
aw
ar
en
ess of
ob
stetr
i
c
d
a
ng
er
si
g
n
s
an
d invo
lv
emen
t in b
i
r
t
h
pre
p
are
d
ness
p
r
act
i
ce am
ong
m
e
n i
n
C
h
e
n
cha
di
st
ri
ct
o
f
so
ut
he
r
n
Et
hi
opi
a.
T
h
e st
ud
y
al
so
dem
ons
t
r
at
ed
strong ass
o
ciation bet
w
een men a
w
are
n
ess
of
dange
r
s
si
gns
of
obstetric com
p
lica
tio
n
and m
e
n
in
vo
lv
emen
t
s
i
n
bi
rt
h p
r
e
p
ar
edne
ss. It
i
s
of param
o
u
n
t
i
m
port
a
nce i
f
h
u
sb
an
ds are ab
l
e
t
o
recog
n
i
z
e
t
h
e dan
g
er si
gns
of
o
b
s
tetric co
m
p
licatio
n
s
wh
ich
are an
ind
i
catio
n
th
at u
r
g
e
nt e
m
erg
e
n
c
y care n
e
ed
s to
be so
ug
h
t
fro
m
sk
illed
at
t
e
ndant
s
an
d
whi
c
h i
n
t
u
rn
i
n
crease
t
h
ei
r
i
n
vol
vem
e
nt
i
n
b
i
rt
h
pre
p
are
d
ne
ss p
r
act
i
ce.
ACKNOWLE
DGE
M
ENTS
The aut
h
ors are very grateful to
Chenc
h
a District health office, fo
r its administrative and technical
assistance. Res
earch
directora
t
e offi
ces o
f
A
r
ba M
i
nc
h U
n
i
v
ersi
t
y
dese
rve
s
especial acknowledgem
e
nt and
Essay
a
s Del
e
se
ack
no
wl
ed
ge
d
f
o
r
hi
s s
u
pp
o
r
t
wi
t
h
s
u
per
v
i
s
i
on
o
f
dat
a
col
l
ect
i
on.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:2252
-88
06
IJP
H
S
V
o
l
.
4,
No
. 1,
M
a
rc
h 20
1
5
:
6
3
– 70
70
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