Birth Preparedness and Complication Readiness in Rural and Urban Communities of Rivers State, Nigeria: A Clinical Epidemiological Approach
Briggs, Nduye Christie Tobin
*
Department of Community Medicine, Faculty of Clinical Sciences, College of Medical Sciences, Rivers State University, Port Harcourt, Nigeria.
Abo, Inye Anthony
Primary Health Care Department, Port Harcourt City Local Government, Port Harcourt, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Introduction: The Birth Preparedness and Complication Readiness (BPCR) strategy, which aims to address the “three delays” in accessing, getting to, and receiving care in an obstetric emergency, is a key component of improving maternal health. Nigeria has a maternal morbidity and mortality rate that is unacceptably high, and rural-urban inequalities contribute to these outcomes. This study aimed to assess the clinical epidemiological patterns of birth preparedness and complication readiness among women of reproductive age in rural and urban communities of Rivers State.
Methods: A community-based cross-sectional study, utilising a clinical epidemiological approach, was conducted from April 22nd, 2025, to July 24th, 2025, and compared 584 women of reproductive age from rural and urban areas (292 in urban and 292 in rural areas). Participants were recruited through multistage sampling. A pretested, structured questionnaire, adapted from the Johns Hopkins Monitoring BPCR Index, was used to collect data. All analyses were conducted at a 95% level of confidence using descriptive statistics, chi-square analyses and multivariate logistic regression. Models were assessed for predictive performance through the Area Under the Receiver Operating Characteristic Curve (AUROC).
Results: The mean age of respondents was 28.7 ± 5.3 years. A larger proportion of urban respondents (41.8%, 122) attained tertiary education compared to rural respondents (17.1%, 50). Among respondents, a total of 300 (51.4%) had adequate BPCR practice. There was also a significant difference in practice according to residence, with 92 (31.5%) in rural areas and 208 (71.2%) in urban areas (χ² = 109.6; p < 0.001). Higher odds of good BPCR practices were observed among women with secondary education and above, 2.41 (95% CI: 1.65–3.51); women with 4+ antenatal visits, 3.12 (95% CI: 2.01–4.83); those in formal employment, 1.83 (95% CI: 1.22–2.74); women residing in urban areas, 2.09 (95% CI: 1.41-3.09); women with good knowledge of danger signs, 2.75 (95% CI: 1.82–4.16); those involving partners in BPCR, 1.98 (95% CI: 1.30–3.02). The model demonstrated excellent discrimination with an AUROC of 0.81, indicating strong predictive accuracy in identifying women likely to engage in BPCR.
Conclusion: BPCR knowledge and practices were found to be limited in Rivers State, with rural women being at a greater disadvantage. The results indicate that enhancing antenatal education to include maternal health, considering socio-economic related barriers, and greater emphasis on overall health infrastructure in rural areas need to be addressed.
Keywords: Birth preparedness, complication readiness, maternal health, AUROC, rural-urban comparison, Rivers State