Open access Original research

Knowledge of preconception care

BMJ Open: first published as 10.1136/bmjopen-2021-053855 on 2 May 2022. Downloaded from http://bmjopen.bmj.com/ on November 28, 2022 by guest. Protected by copyright.
among reproductive-­age women in
Debre Berhan Town, Ethiopia: a
community-­based, cross-­sectional study
Tesfanesh Lemma ‍ ‍, Mulualem Silesh ‍ ‍, Birhan Tsegaw Taye ‍ ‍

To cite: Lemma T, Silesh M, ABSTRACT

Taye BT. Knowledge of Strengths and limitations of this study
Objectives Preconception care can have a major public
preconception care among health impact by reducing maternal and childhood
reproductive-­age women in ► This study addresses women in the reproductive-­
mortality and morbidity. Despite this importance,
Debre Berhan Town, Ethiopia: age group and provides valuable baseline data in
preconception care is still not implemented in majority
a community-­based, cross-­ this area.
sectional study. BMJ Open of developing countries. Therefore, this study aimed to
► The research was conducted in a community set-
2022;12:e053855. doi:10.1136/ assess the proportion of knowledge of preconception care
ting, allowing the findings to be generalised to a
bmjopen-2021-053855 and its associated factors among reproductive-­age women
larger population.
in Debre Berhan Town, Ethiopia.
► Prepublication history and ► As a cross-­sectional design was used, the study
Design and methods A community-­based, cross-­
additional supplemental material does not establish a causal relationship between the
sectional study was employed from 1 March to 30
for this paper are available outcome variable and the predictors.
online. To view these files, March 2019 among reproductive-­age women. Data were
please visit the journal online collected via a face-­to-­face, interviewer-­administered
(http://dx.doi.org/10.1136/​ questionnaire. Data were entered into EpiData V.4.6 and
bmjopen-2021-053855). exported to SPSS V.25 for analysis. In a multivariable of enhancing pregnancy outcomes by opti-
logistic regression analysis, variables with p<0.05 were mising women’s health through biomed-
Received 26 May 2021 declared statistically significant. The strength of statistical ical and behavioural improvements before
Accepted 20 March 2022 association was measured using adjusted OR (AOR) and conception.2 PCC seeks to improve the long-­
95% CI. term health of newborns by reducing the
Setting and participants The study was conducted in risk of adverse pregnancy outcomes prior to
Debre Berhan Town, Ethiopia. A total of 414 reproductive-­ conception and during the first trimester.3
age women were enrolled in the study.
PCC refers to the aspect of healthcare that
Outcome Knowledge of preconception (good or poor).
includes provision of biomedical, behavioural
Results Of the total 414 participants, 71 (17.1%) had
good knowledge about preconception care. Women’s and social health interventions to women
occupation (AOR: 8.68, 95% CI 1.25 to 60.3), monthly of reproductive age and couples before
income (AOR: 9.89, 95% CI 1.93 to 50.76), gravidity they conceive.4 Preconception health is
(AOR: 0.28, 95% CI 0.14 to 0.58), contraceptive use about people having and remaining healthy
(AOR: 4.95, 95% CI 1.09 to 22.39), history of congenital overall across their lives and this can help
abnormality (AOR: 7.53, 95% CI 2.03 to 27.96), history any woman.5 Safe motherhood starts before
of neonatal death (AOR: 6.51, 95% CI 1.62 to 26.18) and conception and continues with proper
time to reach a health facility (AOR: 0.37, 95% CI 0.17 to prenatal care, resulting in the prevention and
0.79) were statistically associated with knowledge about treatment of complications and ensuring safe
preconception care.
© Author(s) (or their
delivery of the baby and a healthy postpartum
Conclusions In this study area, only less than one-­
employer(s)) 2022. Re-­use period.6
fifth of reproductive-­age women had good knowledge
permitted under CC BY-­NC. No
of preconception care. Therefore, to improve women’s Around the world, less than a third of
commercial re-­use. See rights women of childbearing age attend health
and permissions. Published by knowledge about preconception care, a strong
BMJ. collaborative effort including several sectors should be facilities to speak with a healthcare provider
Department of Midwifery, made. about their health status and possible effects
Asrat Woldeyes Health Science on pregnancy outcomes before becoming
Campus, Debre Berhan pregnant.7 Every year, approximately
University, Debre Berhan, INTRODUCTION eight million women experience pregnancy-­
Ethiopia Prepregnancy maternal health status may be related complications, with approximately
Correspondence to a major determinant of pregnancy outcomes half a million dying as a result.8 Every
Tesfanesh Lemma; and risk of maternal and child complica- year, nearly nine million children die, with
​tesfitimnt@​gmail.​com tions.1 Preconception care (PCC) is a method four million newborn babies dying in their

Lemma T, et al. BMJ Open 2022;12:e053855. doi:10.1136/bmjopen-2021-053855 1

Open access

BMJ Open: first published as 10.1136/bmjopen-2021-053855 on 2 May 2022. Downloaded from http://bmjopen.bmj.com/ on November 28, 2022 by guest. Protected by copyright.
first month of life.7 In both developed and developing Sample size determination and sampling technique
countries, PCC has a major public health impact by Sample size was calculated using the single population
significantly reducing maternal and childhood mortality proportion formula with the following assumptions: a
and morbidity and improving maternal and child proportion of 50% (p=0.5) considering no local study was
health.4 done during the study period, with 95% CI at 1.96, and a
Majority of pregnancy and childbirth complications margin of error.
( )
could be prevented if adequate PCC is given.9 Iron 2
‍n = Zα/2 p 1 − p d2 ‍
supplementation decreases the risk of anaemia by 27% After adding a 10% non-­response rate, the final sample
in non-­pregnant reproductive-­age women. Prenatal folic size was 422 reproductive-­age women.
acid supplementation prevents neural tube defects in All kebeles of Debre Berhan Town were included and
72% of cases and reduces the risk of recurrence in 68% the calculated sample size was proportionally allocated
of cases. Prenatal multivitamin supplementation reduces to each kebele based on the total number of house-
congenital defects by 42%–62% and pre-­ eclampsia by holds within each kebele. A systematic random sampling
27%.10 Preconception counselling about contraception technique was used to select allocated households. The
reduces first-­time teenage pregnancy by 15% and repeat calculated sampling interval (K=N/n) was 45. Therefore,
adolescent pregnancy by 37%.11 In addition, good blood the first household was selected using a simple random
sugar regulation before and after pregnancy decreases sampling method and consecutive households were
the risk of pre-­eclampsia, fetal macrosomia, congenital selected at a regular interval of 45 households. If more
malformations and stillbirth in women with diabetes.12 than one eligible woman was found within the selected
In developing countries such as Sudan, Nepal, Ethi- household, the woman who would be interviewed was
opia and Kenya, women’s knowledge of PCC is 11%,13 chosen by lottery.
15.4%,14 27.5%15 and 38.3%,16 respectively. According
to the findings of different studies, knowledge of PCC Data collection procedure and data quality control
is affected by age, educational status, geographical loca- Data were collected using a structured and pretested
tion, employment status, marital status, history of use of questionnaire through face-­to-­face interviews. The ques-
family planning services, previous miscarriage, stillbirth tionnaire was composed of four sections: sociodemo-
or termination due to fetal abnormality, pregnancy inten- graphic, obstetrics and maternal health service-­related
tion, parity, gravidity, and availability and accessibility of characteristics, women’s health status-­related character-
services.13 15–19 istics, and women’s knowledge of PCC14 15 17 (see online
Despite its importance in endorsing maternal and child supplemental file 1). The questionnaire was first prepared
health, majority of women lack any awareness of how in English and then translated to the local language
their health before conception may influence their risk (Amharic) for data collection and back to English to
of an adverse pregnancy outcome. Therefore, this study ensure clarity and consistency during translation.
intended to assess knowledge of PCC and the associated Five Diploma and two Bachelor of Science holder
factors among reproductive-­age women. midwives were involved in data collection and supervision,
respectively. Data collectors and supervisors were trained
for 1 day on the study’s objective, eligibility criteria, data
collection processes and ethical issues. In addition, all
METHODS AND MATERIALS filled questionnaires were checked daily for completeness
Study design and setting and consistency.
A community-­based, cross-­sectional study was conducted
in Debre Berhan Town from 1 March to 30 March 2019. Main outcome and measure of the study
Debre Berhan Town is located in North Shewa Zone in ► Preconception care: any PCC intervention such
Amhara Region, about 130 km northeast of Ethiopia’s as advice or treatment and lifestyle changes that a
capital city, Addis Ababa. Today the town is the adminis- woman received prior to being pregnant.15
► Knowledge of PCC: measured using 12 questions,
trative centre of North Shewa Zone and has nine kebeles,
with a total population of 103 450, of whom 46 553 are where participants were asked to answer ‘yes’ and
men and 56 897 are women. The town is also equipped ‘no’. A value of 1 and 0 was given for each ‘correct’
and ‘incorrect’ response, respectively. The total score
with one referral hospital and four health centres.
ranged from 0 to 12. Women who scored ≥50% were
categorised as having good knowledge of PCC and
Study population and eligibility criteria women who scored <50% were classified as having
All reproductive-­age women residing in Debre Berhan poor knowledge.15
Town during the study period were the study popula-
tion. Women of reproductive-­age who have resided in Data entry and analysis
Debre Berhan Town for at least 6 months were included. Data were entered into EpiData V.4.6 and exported to SPSS
Women with hearing problems and were critically ill were V.25 for analysis. Descriptive analysis was summarised using
excluded. proportion, mean and SD. Bivariate and multivariable

2 Lemma T, et al. BMJ Open 2022;12:e053855. doi:10.1136/bmjopen-2021-053855

 Open access

BMJ Open: first published as 10.1136/bmjopen-2021-053855 on 2 May 2022. Downloaded from http://bmjopen.bmj.com/ on November 28, 2022 by guest. Protected by copyright.
logistic regression analyses were employed. Variables analysis. However, in the multivariable logistic regres-
observed in the bivariate analysis with p value <0.25 were sion analysis, only women’s occupation, monthly income,
candidates for multivariable logistic regression analysis. gravidity, contraceptive use, history of congenital abnor-
In the multivariable logistic regression analysis, statistical mality, history of neonatal death and time to reach a
significance was declared considering a p value of <0.05, health facility were statistically significant with having
with adjusted OR (AOR) and 95% CI. good knowledge about PCC (table 3).
Daily labourer women were 8.7 times more likely to
Patient and public involvement have good knowledge about PCC than housewives (AOR:
Neither the public nor the patients were involved in this 8.68, 95% CI 1.25 to 60.3). Accordingly, women with
study, including recruitment, data collection, analysis, monthly income above 5000 ETB were 9.9 times more
interpretation, writing or editing of the manuscript, and likely to have good knowledge about PCC than women
dissemination of the results. with monthly income below 1000 ETB (AOR: 9.89, 95%
CI 1.93 to 50.76). Also, women who had a history of
RESULTS contraceptive use were five times more likely to have good
Sociodemographic characteristics knowledge about PCC than women who had no history of
A total of 414 reproductive-­age women participated in the contraceptive use (AOR: 4.95, 95% CI 1.09 to 22.39).
study, with a response rate of 98.1%. The mean age of the The odds of having good knowledge of PCC were 7.5
participants was 28.87 years (SD ±6.72), and majority (209, times higher among women who had a history of congen-
50.5%) were between the ages of 25 and 34 years. Of the ital abnormality compared with those who had no history
participants, 316 (76.3%) were of Amhara ethnicity and of congenital abnormality (AOR: 7.53, 95% CI 2.029
300 (72.5%) were Orthodox religious followers. Majority to 27.963). In addition, women who had a history of
(289, 69.8%) of the participants were married and 167 neonatal death were 6.5 times more likely to know about
(40.3%) had a monthly household income of 1000–3000 PCC than women who had no history of neonatal death
Ethiopian birr (ETB). Of the total respondents, 129 (AOR: 6.51, 95% CI 1.62 to 26.18).
(44.6%) and 147 (50.9%) husbands were government However, multigravida women were 72% (AOR: 0.28,
employees and had completed college and above, respec- 95% CI 0.14 to 0.58) less likely to know about PCC than
tively. Majority of the participants (209, 50.5%) have a primigravida women. Also, women who lived ≥34 min
family size of less than four (table 1). from a nearby health facility on foot were 63% less likely
to know about PCC than women who took less than
Obstetric and maternal health service-related characteristics 34 min (AOR: 0.37, 95% CI 0.17 to 0.79).
Majority (303, 73.2%) of the respondents had a history
of pregnancy. However, one-­tenth (9.9%) had a history
of abortion. More than half (66.7%) and 61.4% of the DISCUSSION
respondents were multigravida and multipara, respec- PCC is a key means for reducing and preventing maternal
tively. Of the women, 278 (67.1%) had a history of use of and child morbidity and mortality.17 The primary aim of
family planning services (table 2). this study was to look into the proportion of knowledge
about PCC and its associated factors. In this study, good
Women’s health status knowledge about PCC among reproductive-­age women
Of the total number of reproductive-­ age women, 63 was found at 17.1% (95% CI 13.4 to 20.3), which is
(15.2%) had a chronic health problem, of whom consistent with the results of studies conducted in Nepal
23 (36.5%) were known patients with hypertension (15.4%)14 and Hawassa (20%).17 However, our finding is
(figure 1). Of the total number of women with chronic higher than the studies done in India (6%)20 and Sudan
diseases, 33 (52.4%) had received preconception counsel- (11%).13 The variation might possibly be due to differ-
ling. Maintaining optimal weight control (51.5%), main- ences in study setting, sample size, study participants and
taining regular exercise programme (45.5%), ceasing the time the study was conducted.
tobacco, alcohol and drug use (36.4%), and maximising On the contrary, the finding of this study was lower than
diabetes mellitus control (30.3%) are the main areas the studies done in Iran (68.8%),21 Nigeria (65.3%),18
where women received counselling. Zambia (47.4%),19 Kenya (38.3%),16 West Gojjam
Knowledge of PCC (27.5%)15 and Jinka Town (51.1%).22 The discrepancy
Among 414 participants, 147 (35.5%) had ever heard might possibly be due to mainly the lack of preconception
about PCC. Healthcare providers were the main sources units at the health facilities in Ethiopia, as well as differ-
of information for majority (92, 62.6%) of the partici- ences in study setting, sample size and sociodemographic
pants. Of the reproductive-­age women in Debre Berhan characteristics. Time when the studies were conducted
Town, 71 (17.1%) had good knowledge of PCC (figure 2). could also be a reason for the difference; information
dissemination and community awareness strategies for
Factors associated with knowledge of PCC PCC have improved significantly over time.
In the bivariate logistic regression analysis, 13 variables Women who were daily labourers were 8.7 times more
were candidates for multivariable logistic regression likely to have good knowledge about PCC than women

Lemma T, et al. BMJ Open 2022;12:e053855. doi:10.1136/bmjopen-2021-053855 3

Open access

BMJ Open: first published as 10.1136/bmjopen-2021-053855 on 2 May 2022. Downloaded from http://bmjopen.bmj.com/ on November 28, 2022 by guest. Protected by copyright.
Table 1 Distribution of study subjects by sociodemographic characteristics in Debre Berhan Town, Ethiopia, March 2019
(N=414)
Characteristics Category Frequency (n) %
Age of the mother 15–24 114 27.5
25–34 209 50.5
35–49 91 22.0
Religion Orthodox 300 72.5
Protestant 62 14.9
Muslim 29 7.0
Catholic 23 5.6
Ethnicity Amhara 316 76.3
Oromo 57 13.8
Tigray 22 5.3
Guragie 19 4.6
Marital status Married 289 69.8
Single 101 24.4
Others* 24 5.8
Educational status of women No formal education 139 33.6
Primary school 142 34.3
Secondary school 73 17.6
College and above 60 14.5
Women’s occupation Housewife 139 33.6
Government employee 96 23.2
Market trade vendor 80 19.3
Student 73 17.6
Daily labourer 26 6.3
Husband’s education No formal education 16 5.5
Primary school 50 17.3
Secondary school 76 26.3
College and above 147 50.9
Husband’s occupation Government employee 129 44.6
Merchant 102 35.3
Daily labourer 42 14.5
Others† 16 5.5
Monthly household income (in <1000 70 16.9
Ethiopian birr) 1000–3000 167 40.3
3000–5000 112 27.1
>5000 65 15.7
Family size <4 209 50.5
≥4 205 49.5
*Divorced and widowed.
†Student and farmer.

who were housewives. This is supported by a study from monthly income was below 1000 ETB, and these could
Iran.21 This might be because women who were daily be women who can easily access healthcare and are more
labourers were more likely to be exposed to different likely to be exposed to PCC through different media.
sources of PCC information. Accordingly, women who The odds of having good knowledge about PCC were
had monthly income above 5000 ETB were more likely higher among women who had a history of contra-
to have good knowledge about PCC than women whose ceptive use compared with their counterparts. This is

4 Lemma T, et al. BMJ Open 2022;12:e053855. doi:10.1136/bmjopen-2021-053855

 Open access

BMJ Open: first published as 10.1136/bmjopen-2021-053855 on 2 May 2022. Downloaded from http://bmjopen.bmj.com/ on November 28, 2022 by guest. Protected by copyright.
Table 2 Distribution of study subjects by obstetric and
maternal health service-­related characteristics in Debre
Berhan Town, Ethiopia, March 2019
Variable Frequency (n) %
History of pregnancy
 Yes 303 73.2
 No 111 26.8
Number of pregnancy
 Primigravida 101 33.3
 Multigravida 202 66.7
Number of live births (n=399)
Figure 2 Women’s knowledge about preconception care
 Primiparous 117 38.6 (PCC) in Debre Berhan Town, Ethiopia, March 2019 (N=414).
 Multiparous 186 61.4
History of abortion
immunisation, HIV test and others, are being addressed
 Yes 30 9.9
through counselling in the family planning unit, which
 No 273 90.1 eventually results in women accessing information about
History of stillbirth PCC.
 Yes 17 5.6 Women who gave birth to a newborn with congenital
 No 286 94.4 abnormality were more likely to have good knowledge
about PCC than women who had no history of congen-
History of preterm birth
ital abnormality. In addition, women who had a history of
 Yes 14 4.6 neonatal death were more likely to have good knowledge
 No 289 95.4 about PCC than women who had no history of neonatal
History of congenital abnormality death. This finding is not consistent with the study done
 Yes 13 4.3 in Jinka Town.22 This could be because mothers who had
previous experience of adverse obstetric outcomes, such
 No 290 95.7
as congenital abnormality and neonatal death, were more
History of neonatal death likely to get advice from healthcare providers on when
 Yes 14 4.6 and how to prepare for subsequent pregnancies. Also,
 No 289 95.4 women with adverse obstetric outcomes were more likely
History of contraceptive use to be interested about possible causes and prevention
mechanisms of adverse obstetric outcomes, in the long
 Yes 278 67.1
run advancing their knowledge about PCC.
 No 136 32.9 Furthermore, multigravida women were 72% less likely
to have good knowledge about PCC than primigravida
consistent with the studies done in Sudan,13 Jinka Town22 women. This could be because primigravida women
and Adet woreda in Ethiopia.15 This might be because might be more fearful about being pregnant. This might
most of the components of PCC, such as tetanus toxoid be due to that primigravida might have more fear of
being pregnant which makes them highly prepared and
wondered to access preconception-­related information.
In addition, women who live ≥34 min from a nearby
health facility were 63.4% less likely to have good knowl-
edge about PCC compared with women who were residing
less than 34 min from a nearby health facility. This could
be because women living far away from health institu-
tions have less health-­seeking behaviour and less access
to information about health, including PCC. The health-­
seeking behaviour of a community determines how they
use healthcare services, including accessing healthcare
information.23

Limitations of the study

Figure 1 Types of chronic health problems among The findings of this study could help programmers, policy-
reproductive-­age women in Debre Berhan Town, Ethiopia, makers and other interested bodies in strengthening commu-
March 2019 (n=63). nity awareness about PCC. Besides, the study was conducted

Lemma T, et al. BMJ Open 2022;12:e053855. doi:10.1136/bmjopen-2021-053855 5

Open access

BMJ Open: first published as 10.1136/bmjopen-2021-053855 on 2 May 2022. Downloaded from http://bmjopen.bmj.com/ on November 28, 2022 by guest. Protected by copyright.
Table 3 Factors associated with knowledge of PCC among reproductive-­age women in Debre Berhan Town, Ethiopia, March
2019 (N=414)
Knowledge of PCC, n (%) P value
Variable Yes No (<0.05) COR (95% CI) AOR (95% CI)
Occupation of women
 Housewife 12 (11.7) 91 (88.3) 1 1
 Government employee 30 (25.4) 88 (74.6) 0.452 0.332 (0.160 to 0.688) 1.442 (0.556 to 3.741)
 Merchant 11 (12.3) 79 (87.7) 0.313 0.285 (0.126 to 0.646) 0.586 (0.207 to 1.654)
 Student 1 (1.4) 72 (98.6) 0.716 0.103 (0.013 to 0.783) 1.546 (0.149 to 16.075)
 Daily labourer 1 (3.9) 25 (96.1) 0.029 0.504 (0.245 to 1.037) 8.683 (1.250 to 60.304)*
Monthly household income (in ETB)
 <1000 1 (1.4) 69 (95.6) 1 1
 1000–3000 13 (7.8) 154 (92.2) 0.652 0.765 (0.309 to 1.895) 0.673 (0.120 to 1.895)
 3000–5000 20 (18.3) 89 (81.7) 0.253 1.685 (0.698 to 4.065) 2.555 (0.511 to 4.065)
 >5000 21 (32.8) 43 (67.2) 0.006 5.865 (2.421 to 14.210) 9.888 (1.926 to 50.758)*
Time to reach health facility (on foot) (min)
 <34 54 (21.5) 197 (78.5) 1 1
 ≥34 57 (28.1) 146 (71.9) 0.011 0.425 (0.237 to 0.763) 0.366 (0.169 to 0.792)*
Gravidity
 Primigravida 28 (27.7) 73 (72.3) 1 1
 Multigravida 25 (12.4) 177 (87.6) 0.001 0.368 (0.201 to 0.674) 0.280 (0.135 to 0.580)*
History of congenital abnormality
 Yes 6 (46.2) 7 (53.8) 0.003 4.432 (1.425 to 13.777) 7.532 (2.029 to 27.963)*
 No 47 (16.2) 243 (83.8) 1 1
History of neonatal death
 Yes 7 (50.0) 7 (50.0) 0.008 5.283 (1.769 to 15.755) 6.512 (1.624 to 26.117)*
 No 46 (15.9) 243 (84.1) 1 1
History of contraceptive use
 Yes 52 (18.7) 226 (81.3) 0.038 1.417 (0.801 to 2.508) 4.950 (1.094 to 22.391)*
 No 19 (14.0) 117 (86.0) 1 1
* Variables statistically significant at p< 0.05; 1 signifies reference category
AOR, adjusted OR; AOR, Adjusted Odds Ratio; COR, Crude Odds Ratio; ETB, Ethiopian birr; PCC, preconception care.

in a community setting, allowing the findings to be gener- Contributors TL has conceptualized and designed the study, carried out the
alised to a larger population. The study also has some limita- statistical analysis, supervised the oveall process of the study and writing and
editing of the original draft. MS and BTT has contributed in the investigation,
tions. First, due to its cross-­sectional nature, the cause and funding acquisition, data collection process, supervision of the study, and reviewed
effect relationship was not shown. In addition, there is a the final draft. MS has accepted full responsibility for the work and/or the conduct
risk of social desirability bias. Thus, the findings of the study of the study, had access to the data, and controlled the decision to publish. All
should be interpreted considering these limitations. authors made critical review, read, and approved the final manuscript.
Funding This study was supported by Jimma University.
Disclaimer The funder had no role in the design and conduct of the study, in the
CONCLUSIONS
collection, analysis and interpretation of the data.
The findings of this study showed that the level of
Competing interests None declared.
knowledge about PCC was low among women of repro-
ductive-­age living in Debre Berhan Town. Women’s occu- Patient and public involvement Patients and/or the public were not involved in
the design, or conduct, or reporting, or dissemination plans of this research.
pation, monthly income, gravidity, contraceptive use,
history of congenital abnormality, history of neonatal Patient consent for publication Not required.
death and time to reach a health facility were statically Ethics approval Jimma University's Institutional Review Board provided ethical
clearance and an approval letter to conduct this study (ref no: IHRPGC/688/017).
associated with knowledge of PCC. Therefore, to improve
Formal permission letters were also received from the administration of the North
women’s knowledge about PCC, a strong collaborative Shoa Zone Health Bureau. Informed written consent was obtained from each study
effort including several sectors should be made. participant after explaining the study’s objective. The information obtained from the

6 Lemma T, et al. BMJ Open 2022;12:e053855. doi:10.1136/bmjopen-2021-053855

 Open access

BMJ Open: first published as 10.1136/bmjopen-2021-053855 on 2 May 2022. Downloaded from http://bmjopen.bmj.com/ on November 28, 2022 by guest. Protected by copyright.
participants was kept confidential. In general, the study's methods were carried out 7 World Health Organization (WHO), UNICEF, UNFPA WB. Trends in
in compliance with the Helsinki Declaration, which sets out ethical standards for maternal mortality 2010 - 2015. WHO. World Heal Organ [Internet],
medical research involving human subjects. 2015: 92. http://www.who.int/ reproductivehealth/publications/
monitoring/maternal-mortality2015
Provenance and peer review Not commissioned; externally peer reviewed. 8 World Health Organization. Preconception care regional expert
group consultation. Neththanjali Mapitigama, case study. Sri Lanka,
Data availability statement Data are available upon reasonable request. The data
2013: 33–5.
that support the findings of this study are available but some restrictions may apply 9 Howson CP, Kinney MV, Lawn JE, eds. Born too soon: the global
to the provision of these data as there are some sensitive issues. However, data are action report on preterm birth. p133-­6. Vol. 25. Geneva: World Health
available from the corresponding authors upon reasonable request. Organization, 2012. https://www.who.int/pmnch/media/news/2012/​
201204_borntoosoon-report.pdf
Supplemental material This content has been supplied by the author(s). It has
10 Bhutta ZA, Das JK, Rizvi A, et al. Evidence-­Based interventions for
not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been improvement of maternal and child nutrition: what can be done and
peer-­reviewed. Any opinions or recommendations discussed are solely those at what cost? Lancet 2013;382:452–77.
of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and 11 Bhutta ZA, Yakoob MY, Lawn JE, et al. Stillbirths: what difference can
responsibility arising from any reliance placed on the content. Where the content we make and at what cost? Lancet 2011;377:1523–38.
includes any translated material, BMJ does not warrant the accuracy and reliability 12 Sataloff RT, Johns MM, Kost KM. Myles textbook for midwives.
of the translations (including but not limited to local regulations, clinical guidelines, Sixteenth Edition. ELSEVIER, 2014.
terminology, drug names and drug dosages), and is not responsible for any error 13 Ahmed K, Kamil MSaeed A. Knowledge, attitude and practice of
preconception care among Sudanese women in reproductive age
and/or omissions arising from translation and adaptation or otherwise. about rheumatic heart disease. Artic Int J Public Heal 2015;3:223–7
Open access This is an open access article distributed in accordance with the http://www.openscienceonline.com/journal/ijphr
Creative Commons Attribution Non Commercial (CC BY-­NC 4.0) license, which 14 Prashansa Gautam RD. Knowledge on preconception care among
permits others to distribute, remix, adapt, build upon this work non-­commercially, reproductive age women. Saudi J Med Pharm Sci 2016;1:1–6.
15 Ayalew Y, Mulat A, Dile M, et al. Women's knowledge and associated
and license their derivative works on different terms, provided the original work is
factors in preconception care in adet, West gojjam, Northwest
properly cited, appropriate credit is given, any changes made indicated, and the use Ethiopia: a community based cross sectional study. Reprod Health
is non-­commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. 2017;14:15–10.
16 Joyce C, Keraka M, Njagi J. Assessment of the knowledge on
ORCID iDs preconception care among women of reproductive age in Ruiru sub-­
Tesfanesh Lemma http://orcid.org/0000-0003-3038-5821 country, Kiambu country, Kenya. Glob J Health Sci 2018;3:82–100
Mulualem Silesh http://orcid.org/0000-0002-1943-041X https://www.iprjb.org/journals/index.php/GJHS/article/view/651
Birhan Tsegaw Taye http://orcid.org/0000-0003-2174-3797 17 Kassa A, Yohannes Z. Women’s knowledge and associated factors
on preconception care at Public Health Institution in Hawassa City,
South Ethiopia. BMC Res Notes 2018;11:1–6.
18 Olowokere AE, Komolafe A, Owofadeju C. Awareness knowledge
and uptake of preconception care among women in Ife central local
REFERENCES government area of Osun state Nigeria. J Community Med Prim Heal
1 Berglund A, Lindmark G. Preconception health and care (PHC)-­a Care 2015;27:83–92.
strategy for improved maternal and child health. Ups J Med Sci 19 Mutale P, Kwangu M, Muchemwa CMK, et al. Knowledge and
2016;121:216–21. preconception care seeking practices among reproductive-­age
2 Temel S, van Voorst SF, de Jong-­Potjer LC, et al. The Dutch national diabetic women in Zambia. Int. J. Transl Med Res Public Health
Summit on preconception care: a summary of definitions, evidence 2017;1:36–43.
and recommendations. J Community Genet 2015;6:107–15. 20 Pritesh P, Shah TA. Assessment of knowledge and attitude regarding
3 van VSF. Preconception care from policy to practice and back. Pre-­Conceptional care among newly married women residing at
International Journal of Public Health 2017;58:295–304. urban areas of Vadodara City, Gujarat, India. Natl J community Med
4 World Health Organization (WHO). Meeting to develop a global 2019;10:649–52.
consensus on preconception care to reduce maternal and childhood 21 Jafari F, Rashidi S. Iranian women ’ s knowledge and attitude
mortality and morbidity. World Heal Organ Headquarters, Geneva, regarding preconception health : 12 years after integration into the
6–7 [Internet, 2012: 78. https://apps.who.int/iris/handle/10665/78067 primary health care network, 2018.
5 Centers for Disease Control and Prevention. Women | Preconception 22 Tesema KF, Cheneka T, Alemu A, et al. Knowledge of preconception
Care | CDC [Internet], 2015. Available: http://www.cdc.gov/​ healthcare and associated factors: a study among mothers in
preconception/women.html Jinka town, southern region, Ethiopia. ScientificWorldJournal
6 Centers for Disease Control and Prevention. Division of Reproductive 2021;2021:1–10.
Health, National Center for Chronic Disease Prevention and 23 Musoke D, Boynton P, Butler C, et al. Health seeking behaviour and
Health Promotion [Internet], 2019. Available: https://www.cdc.gov/​ challenges in utilising health facilities in Wakiso district, Uganda. Afr
reproductivehealth/drh/about-us/index.htm Health Sci 2014;14:1046–55.

Lemma T, et al. BMJ Open 2022;12:e053855. doi:10.1136/bmjopen-2021-053855 7