Background: Despite its benefit in promoting maternal health and the health of her developing fetus, little is known about preconception care practice and its associated factors in Ethiopia. Moreover, preconception care utilization in private hospitals is not known. The purpose of this study, therefore, is to determine the utilization of preconception health care services and its associated factors among pregnant women following antenatal care in the private Maternal and Child Health hospitals in Addis Ababa. Methods: A Hospital based cross-sectional study was conducted from April 1 to April 30,2022 among 385 women attending ANC in private MCH hospitals. Bestegah and Hemen MCH hospitals were selected by convenience method. Data were collected by a pretested self-administered semi-structured questionnaire. To identify the factors associated with the utilization of preconception care, bivariable and multivariable logistic regression analysis were performed. Adjusted odds ratios with 95% confidence interval were estimated to assess the strength of associations, and statistical significance was declared at a p-value < 0.05. Results: The utilization of preconception care among the pregnant mothers according to our study was 40%. Professional/technical/managerial occupation (AOR = 4.3, 95%CI = 1.13, 16.33, P < 0.032), having good knowledge on preconception care (AOR = 3.5, 95%CI = 1.92, 6.53, P < 0.000), having unintended pregnancy (AOR = 0.1, 95%CI = 0.03, 0.42, P < 0.001), history of family planning use before conception (AOR = 3.9, 95%CI = 1.20, 12.60, P < 0.023), having pre-existing medical disease(s) (AOR = 8.4, 95%CI = 2.83, 24.74, P < 0.002), and having adverse pregnancy outcome(s) in previous pregnancies (AOR = 3.2, 95%CI = 1.55, 6.50, P < 0.000) were significantly associated with preconception care utilization. Conclusions: This study found out that the utilization of preconception care in the private MCH hospitals is still low i.e., only 40%. Occupation, level of knowledge, having unintended pregnancy, history of family planning use before conception, having adverse pregnancy outcome(s) in previous pregnancy and having pre-existing medical disease(s) were independently associated with preconception care utilization. Lack of awareness about the availability of the services and having an unintended pregnancy were the main reasons for not utilizing preconception care.
Keywords: Preconception care; Utilization; Private MCH hospitals; Addis Ababa; Ethiopia
Preconception care(PCC) is defined as a set of interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman's health or pregnancy outcome through prevention and management [[
Ethiopia has achieved remarkable success in reducing neonatal and maternal mortality in recent decades, but still has very high neonatal mortality rates (29 deaths per 1,000 live births) and maternal mortality ratios (412 deaths per 100,000 live births) [[
Several studies conducted to look at the level of PCC across the world found the levels to be generally low. Utilization of preconception in China, Malaysia, and Sir Lanka is 40.0% [[
Based on different articles findings, utilization of preconception care is influenced by age, gender, educational status, income, marital status, history of family planning use, health condition, history of ANC visit, parity, pregnancy intention, and gravidity [[
In Ethiopia, several studies have been conducted to assess the utilization rate of preconception health care services among reproductive age women, pregnant and delivered women in community settings and public institutions, and the utilization rate was found to be low [[
A Hospital based study was conducted in two selected private MCH hospitals in Addis Ababa from April 1–30, 2022. As of 2018, the city has a total estimated population size of 7,823,600. Regarding health facilities and health services, there are 994 clinics, 99 health centers and 42 hospitals. Of the hospitals, 15 are registered public and 27 are registered private hospitals. Of the private hospitals, 8 are maternity specialty hospitals i.e., Maternal and Child Health hospitals.
Source population were all pregnant women who have been following ANC at Bestegah and Hemen MCH hospitals in Addis Ababa.
Study population were all sampled pregnant women who came for ANC at Betsegah and Hemen MCH hospitals in Addis Ababa during the data collection period.
Pregnant women who moved to Addis Ababa after conceiving were excluded from the study.
The sample size was calculated by using a single population proportion formula = Z2p(p-1)/d2 with assumptions of 35.1%, from Kenyan study [[
Graph
Adding 10% of no respondent participants; 350 + 0.1 × 350 = 385.
Secondly, factors associated with utilization of preconception care sample size was calculated using Open Epi Version 7 statistical software for two population proportions (Table 1).
Table 1 Second objective sample size calculation
Variables Factors associated with utilization of PCC CI Power OR Sample size References No Yes Age > 30 41.9% 58.07% 95% 80 2.1 260 [ Educational status (Formal Education) 52.67% 48.33% 95% 80 5.5 73 [ Multiparity 47.60% 52.40% 95% 80 2.3 258 [ Good knowledge on PCC 49.10% 50.90% 95% 80 6.2 65 [
When reviewed many studies done in a different part of the world and in Ethiopia, most of them revealed that women's education status, age of the women, multiparity and knowledge on PCC are the most determinant factors for utilization of preconception care.
After using the EPI-INFO version 7 to calculate the sample size using the above assumption with factors associated utilization of preconception care, maternal age was taken as it gives the maximum sample size i.e., 260 (by one-to-one ratio). Adding 10% non-response, the final sample size is 286.
By comparing the two sample sizes calculated using single proportion and double population formula, the larger sample size, which is 385 as the total sample for the study participants, was taken.
Of the Private MCH hospitals, Betsegah and Hemen MCH hospitals were selected by convenience method (Fig. 1). In selected hospitals, all pregnant women attending antenatal clinic within the study period were recruited and participants were selected consecutively until the desired sample size was achieved to ensure that the entire population of antenatal attendees seen at each facilities who consented to participate were involved.
Graph: Fig. 1Flow diagram showing how the two private MCH hospitals were selected
The dependent variable in this study was utilization of preconception care services among pregnant women following ANC. The independent variables were socio-demographic variables, previous adverse pregnancy outcome(s), preexisting medical disease(s), the knowledge level on preconception care, accessibility of health facilities, availability of preconception services, affordability of preconception care services and partner's support.
a pregnancy either mistimed or unwanted at a time of conception [[
Adverse Pregnancy outcome: patient-reported history of one or more of the following outcomes in a previous pregnancy; preterm delivery, low birth weight, stillbirth, abortion or birth defect [[
had a history of smoking or currently smoke regardless of amount [[
intake of alcoholic drinks of any amount or type other than holidays and culturally special ceremony days [[
those who have scored above or equal to 50% of the correct responses to preconception care knowledge questions [[
those who have scored less than 50% of the correct responses to preconception care knowledge questions [[
any interventions either advice or treatment, and lifestyle modification women received regarding components of preconception care before being pregnant [[
if women received at least one type of intervention, either advice or treatment, and lifestyle modification care i.e., mentioned above at least once before being pregnant will be considered as mother utilized PCC.
women's and children's specialty hospitals managed by individuals or groups, and which is not funded by the State, a public body or Non-governmental Organization.
A data from pregnant woman following ANC were collected by a self-administered semi-structured questionnaire developed from previous published literature after modification to fit the research objective. The questionnaire was initially prepared in English and then translated into Amharic (local language) by different language experts of both languages and then to English to check its consistency. The questionnaire was used to elicit information regarding sociodemographic characteristics, knowledge about PCC, utilization of PCC prior to the current pregnancy and factors affecting the utilization of PCC. The questionnaires were administered by nurses. The questionnaire was pretested two weeks before the actual data collection with 5% of the sample size (20 pregnant women) at Zewditu Memorial Hospital in Addis Ababa, and the necessary amendments were done on the questionnaire per the pretest result. To minimize recall bias, the respondents were informed to provide information on events related to 3 months prior to the current pregnancy, and a calendar was provided to assist their recall. The overall activities of data collection were supervised and coordinated by the investigators. The collected data were checked for consistency, completeness, and relevance daily during the entire data collection by the principal investigator. After the data were collected from the respondents, it was translated back to English and analyzed using the statistical package SPSS version 26.
The collected data were entered to Statistical Package for Social Science (SPSS) version 26.0 for analysis. Descriptive statistics were done to describe the data. Binary logistic regression analysis was employed to examine the statistical association between utilization of preconception care and every single independent variable. Variables that showed statistical significance during bivariable analysis at (p-value < 0.25) were entered into multivariable logistic regression to identify statistically significant variables. Multicollinearity was tested by using the variance inflation factor and tolerance test. The Hosmer-Lemeshow test was used to check the model fitness for analysis, with a significance level of 0.310 indicating a good fit model. Adjusted odds ratios (AOR) with 95% CI were estimated to assess the strength of associations and statistical significance was declared at a p-value < 0.05. Tables, figures, and texts were used to present the results.
Of the 385 participants studied, majority of the respondents (67.8%) were in the age group of 25–34 years, with the mean age and SD being 30.65 and ±4.87, respectively. Three-fourths of the participants completed tertiary level of education. More than 94.5% of them were married. The detailed sociodemographic characteristic are depicted in Table 2.
Table 2 The sociodemographic characteristics of study participants among pregnant women attending ANC in Betsegah and Hemen MCH hospitals in Addis Ababa, Ethiopia, 2022 (n-385)
Variables Category Frequency Percent Study Hospitals Betsegah Maternity and Children Hospital 193 50.1 Hemen Maternity and Children Hospital 192 49.9 Age ≤ 24 36 9.4 25–34 261 67.8 ≥ 35 88 22.9 Educational status Primary 26 6.8 Secondary 72 18.7 Tertiary 287 74.5 Religion Orthodox 261 67.8 Muslim 51 13.2 Protestant 59 15.3 Catholic 14 3.6 Marital Status Single 12 3.1 Married 364 94.5 Divorced 9 2.3 Occupation Professional/technical/managerial 152 39.5 Sales and Services 197 51.2 Skilled Manual 5 1.3 Housewife 31 8.1 Monthly income 37.5-60USD1 13 3.4 60-120USD 43 11.2 120-390USD 234 60.8 > 390USD 95 24.7
Regarding obstetric characteristics, 56% of the participants were multiparous followed by nulliparous (40.5%). With regard to ANC booking, 93.5% of them booked at gestational age less than 16 weeks. The detailed obstetric and medical characteristics of study participants are depicted in (Table 3).
Table 3 Obstetric and medical characteristics of pregnant women attending ANC at Betsegah and Hemen MCH hospitals, Addis Ababa, Ethiopia, 2022 (n = 385)
Variables Category Frequency Percent (%) Pregnancy intention Yes 229 59.5 No 156 40.5 Parity Nulliparous 156 40.5 1–4 214 55.6 Grandmultiparous (> 4) 15 3.9 GA1 at booking of current pregnancy ≤8 weeks 242 62.85 12-16 weeks 118 30.65 16 weeksand above 25 6.5% Adverse pregnancy outcomes in the previous pregnancies Yes 91 23.6 No 294 76.4 Any adverse pregnancy outcomes in the previous pregnancies Abortion 41 45.1 Stillbirth 17 18.7 Early neonatal death 5 5.5 Congenital anomaly 9 9.9 Preterm birth 11 12.1 Others 8 8.8 Preexisting medical diseases Yes 48 12.5 No 337 87.5 Any preexisting medical diseases Hypertension 22 45.8 Diabetes 16 33.3 Cardiac disease 5 10.4 Others 5 10.4
The findings of this study showed that, 58% (
Table 4 Participants response for knowledge questions regarding preconception care among pregnant women of Betsegah and Hemen MCH hospitals, AA, Ethiopia, 2022 (n = 385)
Variables (Knowledge Questions) Response Frequency Percent Ever heard of preconception care Yes 350 90.9 No 35 9.1 Where did you hear about PCC Health Facility 221 62.6 In the community 45 12.7 Mass media 80 22.7 Internet 7 2 Family planning is a component of PCC Yes 289 75.1 No 96 24.9 Immunization is a component of PCC Yes 210 54.5 No 175 45.5 Screening for medical conditions; diabetes, hypertension, asthma, epilepsy Yes 260 67.5 No 125 32.5 Stopping use of environmental toxins; alcohol and cigarette smoking Yes 220 57.1 No 165 42.9 Lifestyle changes; healthy weight, healthy diet, and folic acid supplementation Yes 214 55.6 No 171 44.4 Screening for infectious disease; HIV, Syphilis, Hepatitis B virus Yes 202 52.5 No 183 47.5 A woman should be on family planning during preconception period Yes 253 65.7 No 132 34.3 A woman should be vaccinated before she conceives Yes 137 35.6 No 248 64.4 A woman should be screened for medical conditions like hypertension and diabetes Yes 304 79.0 No 81 21.0 A woman should stop using alcohol and smoking cigarette before conception Yes 294 76.4 No 91 23.6 A woman should a healthy weight, healthy diet and use folic acid before conception Yes 262 68.1 No 123 31.9 A woman should be screened for familial diseases Yes 242 62.9 No 143 37.1 A woman should be screened for infectious diseases like HIV1, HBV2, Syphilis and Gonorrhea Yes 271 70.4 No 114 29.6
In this study, 40% (
Table 5 Characteristics of study participants by the study hospitals, AA, Ethiopia, 2022 n = 385
Variables Category Study Hospitals X2 test BMCH HMCH Age ≤ 24 20 16 0.135 25–34 137 124 ≥ 35 36 52 Education status Primary 15 11 0.605 Secondary 38 34 Tertiary 140 147 Religion status Orthodox 145 116 Muslim 17 34 Protestant 23 36 Catholic 8 6 Marital status Single 5 6 0.552 Married 181 183 Divorced 6 3 Widowed 1 0 Occupation Professional/Technical/Managerial 75 77 0.434 Sales and Services 94 103 Skilled Manual 3 2 Housewife 21 10 Monthly income 37.5-60USD (1955-3130ETB) 11 2 60-120USD (3130- 6260ETB) 28 15 120-390USD (6260-20,335ETB) 131 103 > 390USD (> 20,335ETB) 23 72 Parity Nulliparous 71 85 0.327 1–4 114 100 > 4 8 7 Pregnancy intention Yes 116 113 0.803 No 77 79 History of family planning use Yes 111 108 0.802 No 82 84 Folic acid supplementation Yes 52 68 0.073 No 141 124 GA at booking Early Initiation(< 16weeks of gestation) 184 176 0.064 Late Initiation (> 16weeks of gestation) 8 17 Knowledge Level Good 104 119 0.108 Poor 89 73 Previous adverse pregnancy outcomes Yes 56 35 No 137 157 Preexisting medical diseases Yes 26 22 0.550 No 167 170
Graph: Fig. 2Types of preconception care services utilized by pregnant women of Betsegah and Hemen MCH hospitals, AA, Ethiopia, 2022 (n = 385)
Other findings in this study were 20.3% (
Table 6 Utilization of preconception care services among pregnant women in Betsegah and Hemen MCH hospitals, AA, Ethiopia, 2022 (n = 385)
Variable Response Frequency Percent Family planning use before conception Yes 219 56.9 No 166 43.1 Vaccination before conception Yes 51 13.2 No 334 86.8 Screened for any medical conditions before conception Yes 146 37.9 No 239 62.1 Medical conditions screened for before conception Hypertension 137 35.6 Diabetes 124 32.2 HIV 136 35.2 Syphilis 94 24.4 Anemia 112 29.1 Advised on the effects of alcohol and cigarette smoking on pregnancy Yes 118 30.6 No 267 69.4 Were you using alcohol before conception Yes 78 20.3 No 307 79.7 When did you stop using alcohol 2 months before conception 27 34.6 2 months after conception 45 57.7 Never 6 7.7 Were you using cigarette before conception Yes 7 1.8 No 378 98.2 When did you to stop using cigarette smoking 2 months before conception 2 28.6 2 months after conception 5 71.4 When did you start using folic acid Before conception 120 31.2 After conception 100 26 Never 165 42.9 Advised to have a healthy weight before conception Yes 85 22.1 No 300 77.9
In this study 94% (
Table 7 Health facility and partner support among pregnant women in Betsegah and Hemen MCH hospitals, AA, Ethiopia, 2022 (n = 385)
Variables Category Frequency Percent Decision maker regarding utilization of reproductive health services Women 21 5.5 Partner 2 0.5 Joint 362 94 The type of support your partner offered during preconception Accompanying to the health facility 269 69.9 Financial support 234 60.8 Psychological support 258 67 Spiritual support 204 53 Were the following problems when you want to receive preconception care services Long distance from health facility 99 25.7 Availability of health care providers 58 15.1 Perception of being low risk 57 14.8 Transport money 38 9.9 Religion 7 1.8 How affordable is the cost Expensive 69 17.9 Fair 290 75.3 Cheap 26 6.7 If you did not receive any form of PCC services, what do you think is the reason Not aware that the service is available 136 58.9 The pregnancy was not expected 65 28.1 It is not important before conception 27 11.7 Others 3 1.3
The strength of association between independent variables and outcome variable (preconception care utilization) were measured using odds ratio and 95% confidence interval using binary logistics regression model. Accordingly, maternal age, educational status, marital status, occupation, monthly income, knowledge on preconception care, parity, use of family planning, unintended pregnancy, adverse pregnancy outcome(s) in previous pregnancy and preexisting medical condition had a p-value of ≤ 0.25 in the bivariable analysis and taken into the final model for multivariable analysis. In multivariable logistic regression analysis, occupation, knowledge on preconception care, use of family planning, unintended pregnancy, adverse pregnancy outcome(s) in previous pregnancy and preexisting medical condition(s) were significantly associated with utilization of PCC at p-value of ≤ 0.05 (Table 8).
Table 8 Bivariable and multivariable logistic regression analysis of factors affecting utilization of PCC among pregnant women having ANC in Betsegah and Hemen MCH hospitals, AA, Ethiopia, 2022 (n = 385)
Variable PCC P-value COR (95%CI) P-value AOR (95%CI) Yes No ≤ 24 11 25 1 1 25–34 100 161 0.369 1.4(0.67, 2.99) 0.690 0.8(0.26, 2.44) ≥ 35 43 45 0.065 2.2(0.95, 4.94) 0.656 0.7(0.23, 2.54) Primary 6 20 1 1 Secondary 22 50 0.471 1.5(0.52, 4.15) 0.946 1.0(0.22, 4.99) Tertiary 126 161 0.046 2.6(1.02, 6.69) 0.829 1.2(0.28, 4.91) Single 2 9 1 1 Married 148 217 0.155 3.0(0.65,14.40) 0.115 1.9(0.25,14.05) Divorced 4 5 0.214 3.6(0.48, 27.11) 0.176 1.5(0.07,31.41) Professional/Technical/Managerial 77 75 0.003 4.3(1.66, 11.02) Sales and Services 70 127 0.082 2.3(0.90, 5.86) 0.084 3.2(0.85, 12.03) Skilled Manual 1 4 0.973 1.0(0.10, 11.01) 0.874 1.8(0.001,2592) Housewives 6 25 1 1955-3130ETB 3 10 0.111 0.33(0.08,1.29) 0.127 0.2(0.03, 1.54) 3130- 6260ETB 13 30 0.061 0.48(0.22,1.03) 0.692 1.2(0.40, 3.93) 6260-20,335ETB 93 141 0.205 0.73(0.45,1.18) 0.805 1.1(0.55, 2.17) > 20,335ETB) 45 50 1 Good knowledge 124 99 0.000 5.5(3.42, 8.87) Poor Knowledge 30 132 1 1 Nulliparous 68 87 1 1 2–4 79 135 0.178 0.7(0.5, 1.14) 0.515 0.8(0.45, 1.50) ≥ 5 7 9 0.993 1.0(0.35, 2.8) 0.168 3.0(0.63,14.12) Yes 142 87 1 0.05(0.03, 0.10) No 12 144 0.000 Yes 140 79 0.000 19(10.4, 35.5) No 14 152 1 Yes 60 31 0.000 4.1(2.50, 6.77) No 94 200 1 1 Yes 36 12 0.000 5.5(2.8, 11.10) No 118 219 1 1
Pregnant woman whose occupation is professional/technical/managerial were 4.3 times more likely to receive preconception care when compared to the housewives (AOR = 4.3, 95%CI = 1.13, 16.33, P < 0.032).
Those pregnant women who had good knowledge on PCC were 3.5 times more likely to utilize PCC than those having poor knowledge (AOR = 3.5, 95%CI = 1.92, 6.53, P < 0.000).
Pregnant mothers who had an unintended pregnancy were 90% less likely to utilize PCC compared to whose pregnancy were intended and those who were using family planning before conception were 3.9 times more likely to seek preconception care than mothers who weren't using family planning before conception (AOR = 0.10, 95%CI = 0.03,0.42, P < 0.001).and (AOR = 3.9, 95%CI = 1.20, 12.60, P < 0.023).
Lastly, those having pre-existing medical disease(s) and adverse pregnancy outcome(s) in previous pregnancy were 8.4 and 3.2 times more likely to utilize PCC than those who had not (AOR = 8.4, 95%CI = 2.83, 24.74, P < 0.000) and (AOR = 3.2, 95%CI = 1.55, 6.50, P < 0.002).
Preconception care is an approach to optimize pregnancy outcomes which is crucial for many Sub-Saharan African countries, such as Ethiopia, where maternal and perinatal mortality remains alarmingly high.
This study found that the prevalence of preconception care utilization among the study participants was 40%. Our study findings showed higher utilization of preconception care compared to other community-based studies conducted in Ethiopia (Debre Birhan Town 13.4%, Mekelle City 18.2%, West Guji 22.3%) [[
The most common types of preconception services utilized by the pregnant women was family planning 219 (56.88%) and the least utilized preconception service was vaccination 51(13.2%). This finding is different from a study done Mekelle city in which the most common utilized component of PCC was micronutrient supplementation (i.e., iron, folic acid) [[
In addition, this study found that pregnant women whose occupation is professional/technical/managerial were 4.3 times more likely to receive preconception care when compared to housewives. This is consistent with the study done in France [[
Awareness and knowledge were significantly associated with the utilization of preconception care in several studies [[
In this study, pregnant women who had good knowledge about PCC were 3.5 times more likely to utilize PCC when compared to their counterparts who had poor knowledge about preconception care (AOR = 3.5, 95%CI = 1.92, 6.53, P < 0.000). This finding is consistent with two studies done in Ethiopia, Hosanna Town, which showed 82% reduced odds of utilizing preconception care among women, who had poor knowledge on preconception care than their counterparts [[
Similarly, pregnant mothers who had an unintended pregnancy were 90% less likely to utilize PCC compared to whose pregnancy were intended and those using family planning before conception were 3.9 times more likely to seek preconception care than mothers who weren't using family planning before conception. This finding is consistent with studies done in Hosanna Town [[
Another study in Los Angeles [[
Furthermore, pregnant women having preexisting medical disease(s) and adverse pregnancy outcome(s)(s) in previous pregnancy were 8.4 and 3.2 times more likely to utilize PCC than those who had not. These findings are consistent with studies done in Malaysia [[
Moreover, about 75% of the study participants found no problem accessing health facilities. This is similar to studies done in Hosanna Town and West Guji where majority of women found no problem accessing health facilities [[
Lastly, among the pregnant mothers who did not receive PCC services, when asked their reasons for not receiving the care, two-thirds stated, they were not aware that the service was available, one-thirds stated their pregnancy was not expected and about 11.7% thought it was not important to them. This finding is similar to studies done in Los Angeles [[
It is one of the very few studies conducted in Ethiopia in the area of PCC in private setting.
Recall bias is a limitation of the study due to the nature of problem under the study requiring the potential ability of respondents to remember information retrospectively.
Selection bias is also a limitation as the study hospitals were chosen by the convenience sampling method.
The impact of husband's educational attainment on PCC utilization was not included.
Certain components of preconception care, like optimization of psychological health, screening and management of intimate partner violence, and genetic counseling were not studied.
This study found that the utilization of preconception care in the private MCH hospitals is still low i.e., only 40%. Occupation, level of knowledge, having unintended pregnancy, history of family planning use before conception, having adverse pregnancy outcome(s)(s) in previous pregnancy and having pre-existing medical condition(s) were independently associated with preconception care utilization.
Lack of awareness regarding the availability of PCC services and having unintended pregnancy were the obstacles for not receiving PCC.
Health education regarding the importance and the availability of PCC services should be given to women of reproductive age in private MCH hospitals.
Interventions aimed at increasing the proportion of intended pregnancies will also be critical to promote the utilization of preconception care services in these hospitals.
Therefore, health education and providing information in the form of posters and displays about the components and importance of PCC in hospitals could potentially improve utilization of preconception care.
We would like acknowledge Addis Ababa University College of health science for allowing us to conduct this study. We would also like to thank the participants and Betsegah and Hemen MCH hospital administrators for their cooperation.
Conceptualization of the study was done A.G with help of A.B and S.K. A.B and S.K played supervision role during the study processes. A.G carried out the investigation and formal analysis of the data with help of A.B. A.G prepared the original draft of manuscript. All the authors contributed in reviewing and editing of the manuscript. All authors have read and agreed on the final manuscript.
The authors have no support or funding to report.
The dataset generated during/or analyzed during the current study are not publicly available due to the papers written using this dataset have not been published but are available from corresponding authors on reasonable request.
This study was approved by ethical review board of Department of Obstetrics and Gynecology, Addis Ababa University in accordance with Declaration of Helsinki and official letter of permission was obtained from each private Hospital's administration before data collection. Before participating in the study, the purpose of the study was explained to the study participants and written informed consent was obtained. The collected information was kept confidential through coding. All methods were carried out in accordance with relevant international and local ethical guidelines for research.
Not applicable.
The authors declare no competing interests.
• AA
- Addis Ababa
• AKUH
- Aga Khan University Hospital
• ANC
- Antenatal Care
• AOR
- Adjusted Odds Ratio
• BMCH
- Betsegah Maternity and Children Hospital
• CI
- Confidence Interval
• HBV
- Hepatitis B Virus
• HIV
- Human Immunodeficiency Virus
• HMCH
- Hemen Maternity and Children Hospital
• GA
- Gestational Age
• IOM
- Institute of Medicine
• MCH
- Maternal and Child Health
• MLFH
- Maragua Level Four Hospital
• OR
- Odds Ratio
• PCC
- Preconception Care
• PI
- Principal Investigator
• SLE
- Systemic Lupus Erythematosus
• SPSS
- Statistical Package for Health sciences
• WHO
- World Health Organization
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By Addisu Girma; Abera Bedada and Solomon Kumbi
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