MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCE (MUHAS)

SCHOOL OF NURSING

DEPARTMENT OF NURSING MANAGEMENT

RESEARCH PROPOSAL

THE RESEARCH TITLE; EXPLORING PREGNANT ADOLESCENTS’ BIRTH

PREPAREDNESS AMONG ANTENATAL ATTENDEES AT MWANANYAMALA
REGIONAL HOSPITAL

REGISTRATION NUMBER: 2020-04-14133

NAME OF STUDENT: AVITH.A.RICHARD

NAME OF SUPERVISOR: DR.KHADIJA I. YAHYA-MALIMA

AUGUST, 2023
i
ABSTRACT
Background; Adolescents girls are aged 15-19 years of age who under normal
circumstances are still growing, and should not become parents, though in our current
society, it has become a problem. In overcoming the problems resulting from this, is the
practice of birth preparedness for those adolescents that have entered adulthood prematurely
by providing enough knowledge by health care providers.

Objective; To explore birth preparedness among pregnant adolescent antenatal attendees at

Mwananyamala regional hospital.

Methodology; A quantitative descriptive cross-sectional study will be employed to examine

the level of birth preparedness among adolescents attending antenatal clinics at
Mwnanyamala Regional Hospital in Dar es Salaam. A stratified probability sampling
technique will be done to obtain 260 adolescents attending at antenatal clinic at
Mwananyamala Regional hospital depending on the days allocated for them to attend. A
structured questionnaire will be used to determine their level of birth preparedness at the
antenatal clinic.

Expected Findings: The level of knowledge on birth preparedness will be reported by a

proportion reported with a 95% confidence interval and the factors associated with that level
of knowledge will be determined and reported by odds ratio as well generated hypothesis will
be given.

Budget; This study will require about three hundred thirty-six thousand Tanzania shillings
[336,000 TZS] which will be self-sponsored.

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Contents

ABSTRACT...............................................................................................................................ii

ABBREVIATIONS..................................................................................................................iii

OPERATIONAL DEFINITIONS..............................................................................................v

1.2PROBLEM STATEMENT...............................................................................................3

1.3RATIONALE OF THE RESEARCH...............................................................................3

1.4.RESEARCH QUESTIONS..............................................................................................4

MAIN OBJECTIVE...............................................................................................................4

Conceptual framework...........................................................................................................5

CHAPTER TWO.......................................................................................................................6

LITERATURE REVIEW...........................................................................................................6

2.2 Literature review per study objective...............................................................................6

2.2.1.The magnitude of adolescent pregnancies recorded..................................................6

2.2.2.Birth preparedness among adolescents......................................................................7

2.2.3.Factors that affect birth preparedness among pregnant adolescents..........................7

CHAPTER THREE; MATERIALS AND METHODOLOGY.................................................8

3.1Study design......................................................................................................................8

3.2Study Site and Setting.......................................................................................................9

3.3 Study population...............................................................................................................9

3.4 Inclusion criteria...............................................................................................................9

3.5 Exclusion criteria..............................................................................................................9

3.6 Sample size.....................................................................................................................10

3.7 Sampling procedure........................................................................................................11

3.8 Data collection methods.................................................................................................11

iii
 3.8.1 Data collection tools................................................................................................11

3.9. Data analysis..................................................................................................................12

3.10. Ethical Consideration..................................................................................................12

3.11 Data quality assurance..................................................................................................12

3.12 Dissemination plan.......................................................................................................13

3.13 Study limitations and mitigations.................................................................................13

4.0. REFERENCES..................................................................................................................14

6. BUDGET AND ITS JUSTIFICATION...............................................................................15

7. WORK PLAN......................................................................................................................16

8. APPENDICES......................................................................................................................17

DATA COLLECTION TOOL..........................................................................................17

II; Consent form................................................................................................................20

iv
ABBREVIATIONS
BScN……………………………….Bachelor of Science in Nursing

CI…………………………………...Confidence Interval

MUHAS……………………………Muhimbili University of Health and Allied Sciences

OR………………………………… Odds Ratio

BPR………………………………..Birth Preparedness

BPCR………………………………Birth Preparedness and Complication Readiness

WHO……………………………… World Health Organisation

SPSS……………………………….Statistical Package for Social Sciences

ANC……………………………….Antenatal Care

MMR………………………………Maternal Mortality Ratio

MoH………………………………..Ministry of Health

TDHS……………………………….Tanzania Demographic and Health Survey

NMR………………………………..Neonatal Mortality Rate

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 OPERATIONAL DEFINITIONS
Adolescent; a fancy word for a teenager, someone who is no longer a child but is not yet an
adult aged 10-19 years according to WHO.

Birth preparedness; this is a strategy to promote the timely use of skilled maternal and
neonatal care, especially during childbirth, based on providing knowledge on danger signs
during various phases of pregnancy, involvement of males, preparation of blood donors
etc(1).

Antenatal Care [ANC]; Antenatal care refers to the healthcare services and check-ups
provided to pregnant women during pregnancy to monitor the health of the mother and the
developing foetus

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 CHAPTER ONE

INTRODUCTION

1.1. Background.

Under normal circumstances, adolescent girls are still growing and should not become
parents. The WHO defines an adolescent as boys and girls aged 15-19 years of age. Thus,
adolescent pregnancies are at a high risk of experiencing difficulties and even complications
at the time of delivery because their organs are not yet fully matured to accommodate the
physiological need. Thus they need higher level of readiness to be able to go through the
process with safer outcomes. Assessing their proper birth preparedness which is important in
ensuring their coping and survival, and if not properly managed, will usually present with
complications of childbirth and pregnancy as they are leading causes of death among women
of reproductive age. More importantly, most complications of birth occur in early
pregnancies and adolescents are the most vulnerable in this instance (2). In developing
countries including Tanzania where there is still inadequate access to health services, as the
system is overburdened, then adolescent pregnant women become more at risk. For this
reason, pregnancy-related deaths account for 99 per cent of women's deaths (1). Birth
preparedness is a strategy to promote the timely use of skilled maternal and neonatal care and
is based on the theory that preparing for childbirth and being ready to handle complications,
reduces delay in obtaining care (3). Birth preparedness knowledge is provided by competent
health care workers including nurses at antenatal care clinics per various visits of pregnant
women at the clinic. Informal education about giving birth is also common at the family level
but has not been measured. Birth preparedness help with a decrease in the delay of decision-
making to seek healthcare, in reaching a healthcare facility and in obtaining appropriate care.
(4). Sincerely knowledge of birth preparedness is one of the strategies towards reducing
maternal mortality rates.

According to research , the woman is considered as prepared for birth if reported at least
three of these; knows the expected date of delivery, saves money for the event, identified a
skilled birth attendant or health facility, and means of transport and identified two compatible
blood donors (5). The early booking of antenatal care services and proper follow-up of all
planned sessions provides a greater chance of contact between a pregnant mother and a nurse.
During the various contacts, all the important information about birth preparedness is
properly explained to the pregnant mother preventing complications during birth(6).

1
Also, the various research done found the significant determinants of birth preparedness were
found to be; maternal education, spouse employment, booking at ANC, four or more
antenatal visits, knowledge of key danger signs, and preparation for birth was also found to
be associated with institutional delivery.(5).Knowledge and information of the key obstetric
danger signs during pregnancy, childbirth and postpartum are also important information
provided during birth preparedness. These danger signs are grouped into three phases. Phase
1; danger signs during pregnancy include vaginal bleeding, swollen hands or face and blurred
vision, Phase 2 danger signs of labour or childbirth include severe vaginal bleeding,
prolonged labour, convulsion and retained to the reduction of Maternal Mortality Rates.
Phase 3 danger signs; danger signs during postpartum include; severe vaginal bleeding, foul-
smelling vaginal discharge and high fever.(5). All these danger signs are explained properly
to pregnant mothers making them aware of when to seek health care services and thus
reducing the maternal mortality rates, and this is what birth preparedness is.

The studies done in rural parts of Tanzania found that saving money was the most common
element of birth preparedness reported by the majority of participants. Also identifying
skilled birth attendants or health facilities for delivery emergencies. Unfortunately, a few
women could identify two potential blood donors in case needed in an obstetric emergency
(5). However, empowering of men with necessary information about emergency obstetric
conditions and engaging them in birth preparedness of their spouse is not commonly done in
Tanzania (7) . This has been addressed in other countries, one of the approaches employed in
Global North to reduce maternal and neonatal mortality has been to include expecting fathers
in the maternal and newborn healthcare system. (4)

This research is concentrating on estimating the level of birth preparedness among pregnant
adolescents and estimating associated factors around that fact. It will also look into if the
expecting fathers of the primigravida have any concerns and information about the birth
preparedness of their spouses as well as on identification of two potential blood donors who
would donate blood in case of an obstetric emergency. Other factors related with the level of
birth preparedness will be looked into, such as demographic factors and readiness for
parenthood as well as the intention to get pregnant will be assessed.

2
1.2PROBLEM STATEMENT
Inadequate birth preparedness among pregnant adolescent girls specifically lack of
knowledge on generally the factors to consider for proper birth preparedness is one factor that
is seen with negative consequences to adolescent mothers. This is a profound problem since
adolescent pregnancies are common in Tanzania despite the availability of free contraceptive
provision at public health facilities. The inadequacy of birth preparedness in this group is
seen in the lack of knowledge of some factors as shown in various studies and these include;
a lack of knowledge of the importance of the preparation of two compatible blood donors for
any obstetric emergency during delivery in one, but also lack of awareness of the importance
of involving fathers or men in birth preparedness (5). The Maternal and Neonatal Health
Program of the John Hopkins Program for International Education in Gynaecology and
Obstetrics developed the BPCR matrix(8), which explained the above-mentioned two
observed problems as among the criteria for proper birth preparedness. Inadequate birth
preparedness results in maternal and neonatal mortality which is an ongoing major public
health problem in developing countries including Tanzania. In 2015, the WHO estimates that
approximately 830 women die every day from preventable causes related to pregnancy and
childbirth and 99 per cent of all maternal deaths occur in developing countries. Most maternal
death is a consequence of complications during and following pregnancy and childbirth, most
of which are preventable or treatable when births are assisted by skilled birth attendants (8).
Despite the great ability of Birth preparedness in reducing maternal and newborn deaths, its
importance is not well-known in most areas of Tanzania. The low economic status of women,
decision-making abilities, beliefs and practices surrounding childbirth and delivery has a
great impact on women's health. Most of the reproductive health programs fail to address
these factors in Tanzania. Thus, this study will seek to explore the level of birth preparedness
among pregnant adolescents attending antenatal clinics in one of the most populated districts
in Dar es Salaam and determine if the status has changed given the widespread information
available in recent years.

1.3RATIONALE OF THE RESEARCH

The study aims to explore the level of birth preparedness of pregnant adolescents attending
antenatal care at Mwananyamala Regional Hospital in Dar es salaam. The magnitude of
pregnancy-related complications in adolescent mothers is very high as evidenced by studies
(9). Antenatal care is an important opportunity to identify and address potential risks and
provide education and support to expectant mothers. Identifying the specific needs and

3
challenges faced by adolescent mothers and identifying opportunities for improving antenatal
care and support for this vulnerable population would be important to be documented (10).
Ultimately this research could contribute to the generation of information on the prevailing
level of birth preparedness in the current age of information explosion and provide
hypotheses that can be used to either compose more evidence-generating studies or be used in
health care planning of the hospital in question to develop an effective intervention for
enhancing birth preparedness. of how this vulnerable group.

1.4.RESEARCH QUESTIONS
1. What is the magnitude of adolescent pregnancies attended at Mwananyamala Hospital in a
month?

2. What is the level of birth preparedness among pregnant adolescents at at Mwananyamala

Hospital?

3. What are factors associated with the level of birth preparedness among pregnant
adolescents at Mwananyamala Hospital

MAIN OBJECTIVE
To explore birth preparedness among pregnant adolescent antenatal attendees at
Mwnanyamala Regional Hospital

SPECIFIC OBJECTIVES

1. To estimate the magnitude of adolescent pregnancies attended at Mwananyamala Hospital

in one month.

2. To explore the level of birth preparedness among pregnant adolescents at Mwananyamala

Hospital

3. To identify factors associated with the level of birth preparedness among pregnant
adolescents at Mwananyamala Hospital

4
 Conceptual framework
Concepts that are directly and directly related to the major variables of the study that explains
the birth preparedness among women specifically pregnant adolescents attending
Mwananyamala regional hospital in this study include; male partner’s involvement and
preparation of two compatible blood donors for emergency referral which are developed from
different literature reviews and adapted from JHPIEGO tools and indicators in Maternal and
Neonatal Health, 2004. This conceptual framework considers person-related factors as well
as associated factors. The person-related factors include the male partner’s knowledge of
danger signs during pregnancy, labour, and postnatal time, knowledge of birth preparedness,
family health and decision-making power need of involving males in birth preparedness.
Women’s socio-demographic characteristics, saving money, transportation access, quality
care, health service access, community health and access to media mainly influence male
partners' involvement in the birth preparedness of their spouses.

INDIVIDUAL FACTORS SOCIAL FACTORS

 Age, Birth  Transportation access
 Gender, preparedness  Quality care at health
 Education level, among pregnant facilities provided to
 Knowledge on danger pregnant women
signs during pregnancy
adolescent  Health service
 Awareness on the expected antenatal access
date of delivery attendees  Access to media
 Planned pregnancy  Number of healthcare
workers specifically
Nurses at Antenatal
clinics
 Peer pressure influence
ECONOMIC FACTORS
Saving money for delivery expenses
and for the all pregnancy
period,employment status of partner

Conceptual framework on birth preparedness [Adopted from JHPIEGO tools and

indicators in Maternal and Neonatal Health,2004]

5
CHAPTER TWO

LITERATURE REVIEW

2.2 Literature review per study objective

2.2.1. The magnitude of adolescent pregnancies recorded

Adolescent girls between 15 and 19 years give birth to around 16 million babies each year (4)
which is around 11 per cent of births worldwide. Even though it is sought to determine
whether adolescent mothers are at higher risk of maternal and perinatal adverse outcomes
compared with mothers aged 20-24 years in a pro-respective, population-based observational
study of newborn outcomes in low-resource settings.

In Sub-Saharan Africa, adolescent pregnancy has been persistently high which suggested that
is contributed to sociocultural, environmental and economic factors [peer influences,
unwanted sexual advances from adult males coercive sexual relations, unequal gender power
relations, poverty, religion, and early marriage. (11)

According to the WHO, adolescent mothers [aged 10-19 years]face higher risks of eclampsia,
puerperal endometritis and systemic infections than women aged 20-24 years, and babies of
adolescent mothers face higher risks of low birth weight, preterm birth and severe neonatal
condition, Every year an estimated 21 million girls aged 15-19 years in developing regions
become pregnant and approximately 12 million of them give birth. Globally, ABR has
decreased from 64.5 births per 1000 women in 2000 to 41.3 births per 1000 women in 2023.
However, rates of change have been uneven in different regions of the world with the
sharpest decline in Southern Asia[SA], and slower declines in the Latin American and
Caribbean [LAC] and sub-Saharan Africa[SSA] regions. Although declines have occurred in
all regions, SSA and LAC continue to have the highest rates globally at 99.4 and 52.1 births
per 1000 women, respectively in 2022

In the WHO African Region, the estimated ABR was 97 per 1000 adolescents in 2022
compared to 13.1 per 1000 adolescent girls in the European Region, even within countries,
there are enormous variations, for example in Zambia the percentage of adolescent girls aged
15-19 who have begun childbearing [women who either have had a birth or are pregnant at
the time of interview]ranged from 14.9 per cent in Lusaka to 42.5 per cent in the Southern
Province in 2018.

6
 2.2.2.Birth preparedness among adolescents
Reducing the maternal mortality ratio is one of the united nations' sustainable development
goals. Birth preparedness is a strategy to make prompt decisions to seek care from skilled
birth attendants resulting in reduced maternal and neonatal mortality. In the study conducted
among adolescent pregnant women attending the antenatal clinic at the Department of
Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, a total of 134 adolescent
pregnant women were recruited and the proportion of good birth preparedness in adolescent
pregnant women in urban tertiary care hospital was 78.4 per cent, where most mentioned
birth preparedness aspects was planning to give birth with skilled health provider[92.5 per
cent], number of antenatal care attendance more than 4. The study demonstrated that the
proportion of good birth preparedness among adolescent pregnant women attending an urban
tertiary care hospital was high. (8)

In Tanzania, Birth preparedness is among the important strategy for reducing maternal
mortality rates in which various factors are assessed to determine whether a pregnant
adolescent is prepared for birth which is, if she reported at least three of these known expected
dates of delivery, saved money, identified a skilled attendant or health facility, mode of
transport, and identified two compatible blood donors in which 428 interviewed women, about
249 of the respondents were considered as prepared for birth and its complications were found
to be low(5). Birth preparedness among pregnant adolescent women also included knowledge
of the dangerous signs during pregnancy, labour and postnatal period among pregnant women
which is important to reduce maternal mortality(11), knowledge of danger signs during
pregnancy, labour, postpartum and in newborns, planning to attend at least four antenatal care
visits with a skilled provider, plan to give birth with a skilled provider, plan to save money for
childbirth, plan to identify a mode of transport to the place of delivery all these are the issues
assessed to determine whether an adolescent pregnant it is prepared for birth as is the study
done in Thailand at the Vajira hospital (12)

2.2.3.Factors that affect birth preparedness among pregnant adolescents.

Birth preparedness is a strategy that has been globally endorsed as an essential component of
safe motherhood programs to reduce delays in care to promote timely use. And this practice
as it has been explained in the above details encounters all activities done by a pregnant
mother in the effort to attain good delivery and prevent any necessary complications(7).
Though birth preparedness is done by all adolescents who are pregnant according to the
recent literature, there are differences in the quality and this is facilitated by what is called

7
factors affecting birth preparedness(2). The study done in the Kassena Nankana district of
Ghana among mothers who had given birth in the past 12 months before the study
demonstrated the various factors including high educational attainment of the woman, having
adequate knowledge about obstetric danger signs during pregnancy and women of low
household wealth index(13), Roles of the husbands which determine the time for the husband
to settle and discuss issues of birth with her wife but also the amount of money gained from
his roles, parity and absence of community-based support services, monthly income, ANC
visit, knowledge of obstetric complications, the culture of the individuals, where some
cultural beliefs and lack of awareness inhibit preparation in advance for delivery and
expected baby. Since no action is taken before the delivery, the family tries to act only when
labour begins something which limits birth preparedness and these all mentioned above have
been stipulated in this study as the factors affecting birth preparedness in the study (14)

Spouses' level of education, spouse occupation, place of residence, age, occupation, marital
status, level of education, religion, ethnicity and family type has been stipulated in the study
done in Benin City, Nigeria of birth preparedness evaluating the know do gap among women
receiving antenatal care in Benin city Nigeria 2022 as among the factors contributing to the
birth preparedness among the adolescent pregnant mothers(15)

8
CHAPTER THREE; MATERIALS AND METHODOLOGY

3.1Study design
The quantitative descriptive cross-sectional study will be employed to examine birth
preparedness among adolescent pregnant women attending antenatal clinics at
Mwananyamala Regional Hospital

3.2Study Site and Setting

The study will be conducted at Mwananyamala Regional Hospital specifically at the antenatal
clinic where adolescent mothers attend health services. This hospital is one among the
densely populated district and as a public hospital owned by the government, it caters for a
large catchment area with no limitations within the city. Mwananyamala Regional Referral
Hospital is located in Kinondoni Municipal Council serving a population of more than
2.2mill people, This Hospital is under the Ministry of Health. It was established in July 1973
as a Mother and Child Health Clinic (MCH Clinic). In 1983 it was upgraded as the District
Hospital, with four wards and a bed capacity of 112. Currently, the hospital bed capacity is
254 with a bed occupancy of 317. It is a referral hospital for other Kinondoni and Ubungo
Public and Private Health Facilities. The hospital attends 1,500 up to 1,800 patients per day.

3.3 Study population

The study will include pregnant adolescents girls who are attending an antenatal clinic at
Mwananyamala Regional Hospital. This population will be recruited in the study because
most adolescents who become pregnant in Tanzania lack enough standard levels of birth
preparedness knowledge and also a failure of men to involve themselves in the birth
preparedness of their spouses.

3.4 Inclusion criteria

1. All pregnant adolescent girls at age of 17 or less of sound mind and attending the
antenatal clinic be invited to participate

3.5 Exclusion criteria

All pregnant adolescent girls, who are seriously ill or not of sound mind will not be invited to
participate

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3.6 Sample size
For this particular study, the following statistical formula will be used to calculate sample
size,

2
Z P ( 1−P )
n=
d2

Where;

n=Sample Size

z=confidence level[Z=1.96]

p=Expected proportion of prevalence of participants

d=maximum likely error [margin of error]

For this study, the value of the 95 per cent spread limit will be used i.e., Z=1.96; because this
value is the preferred level of confidence for scientific comparison.

The expected proportion [p]will be obtained from a previous quantitative cross-sectional

study which was done among Pregnant Adolescents in Bangkok, Thailand which included a
total of 134 pregnant adolescents(9). From this study, it indicated that,78.4 percent proportion
of good birth preparedness and complication readiness among adolescent pregnant women in
an urban tertiary care hospital.

Therefore, the expected proportion for this study will be 78.4 per cent [0.784]

The margin of error that will be tolerated in this study i.e., d=5 percent [0.05]

Therefore;

2
1; 96 × 0.784 ( 1−0.784 )
Sample size=
0.05 2

=260

Adjusting for 10 per cent of non-response=26

Therefore the final sample size of 286 pregnant adolescent women attending the antenatal
clinic at Mwananyaala Regional hospital will be recruited for this study

10
3.7 Sampling procedure
The study will employ a stratified probability sampling technique. Under this technique, the
population under study will be divided into subgroups or strata based on the scheduled day
for attending the antenatal clinic. The aim is to enhance representativeness from each day of
attendance. For each stratum, a sampling frame will be created by enumerating all members
of the subgroup. Thereafter, from the determined sample size for each stratum, a sample by
lottery method will be drawn until the required sample size is obtained. This method ensured
that all individuals from each subgroup had an equal chance of being selected. In addition, it
avoided the bias of the researcher from conveniently selecting some individuals of the
studying population while leaving out the rest.

3.8 Data collection methods

3.8.1 Data collection tools.

A self-administered questionnaire Swahili in language will be used for data collection. The
questionnaire will be divided into three sections which has been self developed according to
the specified objectives.

Section A; will consist of social demographic variables which include age, marital status, and
residence.

Section B; Will consist of questions with 4 items for the assessment of the magnitude of
pregnant adolescents who attended Mwananyamala Regional hospital within a given day.

Section C; Will consist of questions with 10 items to describe the level of birth preparedness
among the pregnant adolescents attending the antenatal clinic at Mwananyamal Regional
hospital.

Section D; Will consist of questions with eight items on the factors that determine birth
preparedness among the adolescents attending the antenatal clinic at Mwananyamala
Regional hospital.

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3.9. Data analysis
The demographic characteristics will be presented by descriptive statics with means and
standard deviation for continuous variables and percentages. The level of birth preparedness
will be presented by a knowledge index based on the relevant questions and a cut-off point
for inadequate (No) or adequate knowledge (Yes) will be set to estimate the magnitude of
birth preparedness and presented by a proportion with 95% confidence intervals. Factors
associated with that level of knowledge, including demographics, will be analysed by logistic
regression analysis and presented as odds ratio and 95% confidence intervals too.

3.10. Ethical Consideration

The ethical clearance to perform this study will be obtained from the Muhimbili University of
Health and Allied Sciences [MUHAS] and the research committee through the dean school of
Nursing. Research consent will be obtained from research respondents before participating in
the study. Study participants will be given clear instructions and information before their
recruitment in this study.

Moreover, Participants in this study will be voluntary and the study participants will be free
and allowed to decide to drop out from the study at any time when they wish to do so,
dropping out of the study will not affect their relationship with the researcher. The
participant’s information will be handled confidentially; names or registration numbers will
not be included in the questionnaires. Only the serial number of participants will be used.No
any harm is expected in this study and a case of any needs, help or inquiries about the study,
the participants will be allowed to contact the researcher via mobile at 0627746324

3.11 Data quality assurance

To maintain the quality of data, questionnaires are designed carefully using a
Swahili to fit the adolescent pregnant mothers which are used during data collection. Before
the time of actual data collection, the research tool specifically the questionnaire in this study
will be checked for comprehensive, clarity and to ensure the validity of the data, the
instruments and tools will be developed with relevance to the research questions. Then will
first be tested for reliability on 10 adolescent pregnant women attending antenatal clinics at
Mwananyamala Regional hospital. Also the questionnaire can be kipped on modification and
clarity based on the findings and the collected data will be checked and reviewed for
completeness and consistency by the supervisor.

12
3.12 Dissemination plan
The research report will be submitted to the Muhimbili University of Health and Allied
Sciences, School of Nursing and Department of Community Nursing specifically nursing
research supervisors, then the results will be disseminated to the Mwananyamala regional
hospital research board for allowance to present the results to the maternity unit at
Mwananyamal regional hospital for the future use and improvement of provision of care to
pregnant mothers. Research findings will be presented to lecturers further, the findings from
this study will be shared in scientific conferences and academic workshops.

3.13 Study limitations and mitigations

This study will be limited since study participants will represent pregnant adolescents from
one hospital of Mwananyamala regional hospital. Therefore, the results might not be
generalizable to pregnant adolescents from other hospitals in Tanzania and they may not be
reflective of other pregnant adolescents at other hospitals. Including pregnant adolescents
from other hospitals may contribute to knowledge and a deeper understanding of the nature of
birth preparedness among pregnant adolescents. Another limitation of this study is based on
the study design which will be used [a cross-sectional study design]where data will be
collected at one point in time which will not provide a chance of following the pregnant
adolescents over a longer period to collect data at various times to determine if the levels of
birth preparedness and there may change over time among the selected population of
pregnant adolescents under study. Moreover, this study will base on a self-report
questionnaire, so there might be a response bias, which cannot be ignored.

13
4.0. REFERENCES
1. Knowledge , Attitude , and Practice of Primigravida Women on Birth Abstract :
2021;38–46.

2. Health JA. HHS Public Access. 2015;55(6 0):1–25.

3. Kamineni V, Murki AD, Kota VL. Birth preparedness and complication readiness in
pregnant women attending urban tertiary care hospital. 2017;297–300.

4. Id FVM, Ernest A, Fabian F, Kibusi SM. Knowledge on birth preparedness and

complication readiness among expecting couples in rural Tanzania : Differences by sex
cross-sectional study. 2018;1–15.

5. Bintabara D, Mohamed MA, Mghamba J, Wasswa P, Mpembeni RNM. Birth

preparedness and complication readiness among recently delivered women in
Chamwino district , central Tanzania : a cross sectional study Birth preparedness and
complication readiness among recently delivered women in chamwino district , central
Tanzania : a cross sectional study. 2015;12:1–8.

6. Article R. TH OR CO TH CO. 2015;8:1–8.

7. Health A. Birth Preparedness and Complication Readiness Practices Among Pregnant

Adolescents in Birth Preparedness and Complication Readiness Practices Among
Pregnant Adolescents in Bangkok , Thailand. 2022;

8. Press D. Birth preparedness and complication readiness among pregnant women

attending antenatal care at the Faculty of Medicine Vajira Hospital , Thailand.
2018;797–804.

9. Maria A, Ii LDS, Oliveira ER De. Is adolescent pregnancy a risk factor for low birth
weight ? Gravidez na adolescência é fator de risco para o baixo peso ao nascer ?
ABSTRACT. 2013;47(1):11–9.

10. Miller BC, Benson B, Galbraith KA. Family Relationships and Adolescent Pregnancy

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 Risk : A Research Synthesis. 2001;38:1–38.

11. Aini N, Muda A. Do pregnant women prepare and be ready for birth and its
complications ? 2023;20(1):1–5.

12. Mutea L, Were V, Ontiri S, Michielsen K, Gichangi P. Trends and determinants of

adolescent pregnancy : Results from Kenya demographic health surveys 2003 – 2014.
2022;1–11.

13. Saaka M, Alhassan L. Prevalence and predictors of birth preparedness and

complication Nankana readiness in the Kassena- district of Ghana : an analytical
cross- sectional study. 2021;1–9.

14. Ababa A. Knowledge about birth preparedness and complication readiness and
associated factors among primigravida women in Addis Ababa governmental health
facilities ,. 2020;1–13.

15. Ohenhen V, Oshomoh SA, Akpojaro E, Enobakhare E, Ovenseri C, Eboreime E. Birth

preparedness and complication readiness : Evaluating the “ know-do ” gap among
women receiving antenatal care in Benin City , Nigeria. 2023;

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6. BUDGET AND ITS JUSTIFICATION
This study will require about three hundred and thirty-six thousand shillings [336,000 TSH]

Which will be self-sponsored. This amount of money will help to run all costs required for
proposal development and data collection

ITEMS NUMBER PRICE PER EACH MARGINAL

ITEM COST
Meal allowances 10 days 6000 60,000
transport 10 days 1000 10,000
Notebook 1 3000 3000
Scientific 1 35000 35,000
calculator
Stapler machine 1 6000 6,000
Ball pen 5 200 1,000
Stapler pins 2 boxes 3000 6,000
files 1 2000 2,000
Envelope A4 5 500 2500
Handbag 1 10000 10000
Printing final 2 10000 20000
research proposal
and binding
Printing the final 3 15000 45000
research report
and binding
Questionnaire and 1050 pages 100 105000
consent form
printing
contingency - - 30,500

Total 336,000

16
7. WORK PLAN
ACTIVITY March- May May - August- December January- March
April 2023 Augus October 2023 February 2024
2023 t 2023 2023 2024
TIME
Preparation
for writing a
research
proposal
Writing and
submission
of the first
part of the
research
proposal
Writing,
presentation
and
submission
of final
Research
proposal
VACATIO
N
Ethical
clearance
Data
collection
Data
analysis and

17
 report
writing

8. APPENDICES
MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCE(MUHAS)
SCHOOL OF NURSING
DEPARTMENT OF NURSING MANAGEMENT

I;QUESTIONNAIRE

DATA COLLECTION TOOL

MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES

SCHOOL OF NURSING

Interview Guide

I am AVITH RICHARD a third-year student from Muhimbili University of Health and Allied
Sciences studying Bachelor of Science in Nursing. I am conducting research entitled
EXPLORING ADOLESCENTS’ PREGNANCIES AND THEIR BIRTH PREPAREDNESS
DURING ANTENATAL ATTENDANCE AT MWANANYAMALA REGIONAL
HOSPITAL. I assure you that all information provided will be confidential and will not be
shared with anyone other than for research purposes only.

PART A; DEMOGRAPHIC INFORMATION

01. Age……………………….

02. Marital status

A. Married B. divorced

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03. Education level

A. Secondary or below

B. University or higher

04. Occupation

A. Housewife B. employed

C. Student

05. Place of residence

A. Rural B. Urban

06. Monthly family income

A. Inadequate B. Adequate or more

PART B; Magnitude of adolescent pregnancies

Attended Mwananyamala regional hospital in a month.

07. Gestational age……………….

08. Time when ANC commenced……….

09. Number of ANC visits scheduled per month

……………………………………………………………….

10. Number of ANC already attended ………..

PART C; Identifying factors that affect birth preparedness among pregnant adolescents at
Mwananyamala regional hospital.

11. Are you aware of the concept of birth preparedness [YE OR NO],

12. Are you aware of the danger signs for a pregnant mother [YES OR NO], If yes go to
no.13

13. Mention at least five danger signs during the pregnancy period

I, …………………………………………………………………………………..

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 II, ……………………………………………………………………………………….

Ill, ………………………………………………………………………………….

IV, …………………………………………………………………………………..

V,
………………………………………………………………………………………………..

14. Are you aware of all four components of birth preparedness [YES OR NO] if yes, answer
questions 15-18

15. Have you prepared a specific skilled provider to assist you during delivery [yes OR no]

16. Have you saved money for delivery expenses [yes OR no]

17. Have you identified a place of delivery that will cover all needs [yes OR no]

18. Have you identified the mode of transport [yes OR no]

19. Is your husband involved in all processes of birth preparedness [yes OR no] if yes answer
questions 20-22

20. Do you attend the ANC clinic together with your husband [yes OR no]

21. Is your husband aware of the danger signs you are probably to encounter [yes OR no]

22. Is your husband facilitating all expenses in terms of economics during your pregnancy
[yes OR no]

23. Are you aware of Sexually Transmitted infections [yes OR no], if yes answer the
question

24. Identify at least three Sexually Transmitted infections you are aware of.

i………………………… ii……………………………………
iii…………………………………………..

25. Are you aware that Sexually Transmitted Infections are dangerous to pregnant mothers
that can affect the baby in the stomach [yes OR no]

26. Do you have in this period [yes OR no], if YES answer to question 27

27. Do you use condoms [yes OR no]

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Thank you very much for your participation

In case of misconception contact me. AVITH RICHARD [0627746324]

II; Consent form

MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES

DIRECTORATE OF RESEARCH, PUBLICATIONS AND INNOVATIONS.

CONSENT FORM

ID NO……………

Consent to participate in the study.

Greetings. My name is Avith A Richard. Am a university student pursuing a Bachelor of

Science in Nursing [BScN] at Muhimbili University of Health and Allied Sciences. On behalf
of Muhimbili University of Health and Allied Sciences[MUHAS]. I am researching
ASSESSING THE BIRTH PREPAREDNESS AMONG ADOLESCENTS ATTENDING
ANTENATAL CLINIC AT Mwananyamala Hospital

Purpose of the study

This study has the purpose of collecting information on birth preparedness among adolescents
attending the antenatal clinic at Mwananyamala Hospital

Confidentiality

I assure you any information you will provide shall be kept highly confidential and will not
be shared with anyone except for those directly engaging in this study and for the fulfilment
of this Research purpose. No names or registration numbers will be used instead only
identification numbers will be used to represent participants.

21
Requirement for the participation

If you consent to participate in this study, you will be required to answer a series of questions
that have been prepared for the study on BIRTH PREPAREDNESS AMONG
ADOLESCENTS ATTENDING ANTENATAL CLINIC AT MWANANYAMALA
HOSPITAL

Risk

I do not anticipate any harm to occur to you because you participated in this study

Benefits

Although there may be no direct benefit to participating in this study the information you
provide will help in understanding the birth preparedness among the adolescents attending
antenatal clinic MNH this will motivate the health on the improvement of the services
provided.

Payment

There is no payment for participation in the study.

Right to withdraw and alternatives

To participate in this study is entirely your choice. You are free to choose either to participate
in this study or not and no harm or punishment will occur in either of the two choices. You
can decide to stop participating in this study at any time you wish even if you have already
given your consent. Refusal to participate or withdraw from the study will not involve
penalty or loss of benefits to which you are entitled.

Whom to Contact

In case of any questions or queries concerning this study, please contact AVITH
RICHARD, Muhimbili University of Health and Allied Sciences School of Nursing
P.O.BOX 65001 Dar Es Salaam, through mobile number 0627746324. If you have questions
about your right as a participant, you may contact the Director of Research, Publications and

22
Innovation, at Muhimbili University Health and Allied Sciences or you can also contact the
Chairperson of the Research Senate and Publication Committee, DR. Nahya Salim at
+2550221596, P.O.BOX 65001 Dar Es Salaam.

Do you agree?

Participant agrees…………….. Participant does not agree…………………

I have read the content in this form, and my questions have been answered. I agree to
participate in this study.

Signature of the participant…………………………

Signature of the researcher…………………………….

Date of signed consent…………………………

23
 FOMU YA KUOMBA RIDHAA YA KUSHIRIKI

CHUO KIKUU CHA AFYA NA SAYANSI SHIRIKISHI

Idhini ya Kushiriki katika utafiti huu

Salamu.Jina langu ni AVITTH RICHARD,mwaka wa tatu shahada ya kwanza ya sayansi ya

uuguzi.Ninafanya utafiti na lengo na lengo la kutathimini hali ya maandalizi kabla ya
kujifungua,ikihusisha kuandaa vifaa na pia uelewa wa mambo mbali mbali muhimu kwa
akina mama wajawazito walio chini ya umri wa miaka ishirini wanaohudhuria kliniki
Hospitali ya Rufaa ya mkoa wa Mwananyamala.

Usiri

Ninakuhakikishia kuwa Habari na taarifa zote zitakazokusanywa kutoka kwako zitahifadhiwa

kwa siri.Ni watu wnaofanya kazi katika utafiti huu watapata Habari hiyo.Tutakuwa
tukikusanaya ripoti ambayo itakuwa na majibu kutoka kwa washiriki kadhaa bila kutaja
majina yao.Hatutaweka jina lako au Habari nyingine inayokutambulisha kwenye rekodi
Habari na taarifa utakazotoa.

Haki za kuondoa na mbadala

Kushiriki katika utafiti huu ni chaguo lako kabisa.Ikiwa utachagua kutoshiriki kwenye utafiti
au ukiamua kuacha kushiriki kwenye utafiti hautapata madhara yoyote.Unaweza kuacha
kushiriki katika utafiti huu wakati wowote,hata ikiwa tayari umeshatoa idhini yako.Kukataa
kushiriki au kujiondoa kutoka kwa utafiti hautahusisha adhabu au kupoteza faida yoyote
ambayo unastahiki vinginevyo.

24
Kama una maswali au swali lolote kuhusu utafiti huu,tafadhali wasiliana na AVITH
RICHARD ,Shule ya Uuguzi ya Chuo Kikuu cha Afya na Sayansi Shirikishi Muhimbili
P.O.BOX 650001 Dar Es Salaam,kupitia nambari ya simu 0627746324.

Kama una maswali kuhusu haki yako kama mshiriki ,unaweza wasiliana na Mkurugenzi wa
Utafiti ,Machapisho na Ubunifu ,katika Chuo Kikuu Cha Afya na Sayansi Shirikishi
Muhimbili au unaweza pia kuwasiliana na Mwenyekiti wa Kamati ya Seneti ya Utafiti na
Uchapishaji ,DK.Nahya S.L,P 65001 Dar es Salaam.

Mimi…………….nimesoma na nimeelewa yaliyo katika fomu hii.

Maswali yangu yamejibiwa.

Ninakubali kushiriki utafiti huu……….Au Nisingpendela kushiriki………………………….

Saini ya Mshiriki…………….

Saini ya msaidizi wa utafiti…………………

Tarehe ya idhini iliyosainiwa……………………..

25
Appendix III.Permission letter

Avit
h Richard
Reg Number2020-04-14133
School of Nursing,
P.o.Box 65001
Dar es Salaam
th
16 August 2023
Director of Research, Innovation and Publication
MUHAS,
P.o.box 65001
Dar es salaam.

U.F.S. The Dean,

School of Nursing.
MUHAS,

U.F.S. Research Supervisor,

Dr. Khadija I. Yahya-malima
School of Nursing.
MUHAS,

Dear Madam,
RE; REQUEST FOR ETHICAL CLEARANCE FOR AN UNDERGRADUATE
RESEARCH PROPOSAL
Kindly refer to the above heading and appended proposal.
I am a third-year student, Avit Richard……… pursuing a Bachelor of Sciences in Nursing
[BScN] with registration number 2020-04-14133. I am requesting an ethical clearance for a
proposal titled “Exploring adolescent pregnancies and their birth preparedness during
antenatal attendance at Mwananyamala Regional Hospital” to allow me to request

26
permission to do this study at Mwananyamala Regional hospital. So, I can proceed with
data collection.
I hope my request will be kindly considered positively in due time.

Yours sincerely,
…………………………..
AVITH RICHARD

27