Optimising stocking rates on livestock farms neighbouring wetlands for sustainable productivity and ecological stability

Uganda’s wetlands, especially in south-western Uganda are increasingly being invaded by cattle herders, particularly during droughts. Such uncontrolled grazing is accelerating wetland degradation. The objective of this study was to assess seasonal forage availability on farms neighbouring Ekigaaga wetland in south-western Uganda, and to determine their optimum stocking for sustainable productivity and ecological stability. The grazed area on each side of the virgin wetland was taken as a block, giving two blocks. In each block, three square metre sampling plots were demarcated along a transect line cutting across farms adjacent to the wetland. Some of these plots were fenced and others were left open to grazing by livestock. Two months after setting up the study, vegetation samples were collected from the fenced and unfenced plots in each block once every month, for a period of six months. Livestock classes and numbers grazing on each block were established and standardised into Tropical Livestock Units (TLU); where one TLU is equivalent to a cow weighing 250 kg. During wet and dry seasons, Cynodon dactylon was the most abundant forage species in the unfenced plots in both blocks. Fencing increased the prevalence of Chloris gayana and Themeda triandra in block 2. Sporobolus pyramidalis was the most abundant weed in both blocks. Fenced and unfenced plots in block 1 had higher grazeable forage yields (488.05 and 399.97 kg ha-1, respectively) than block 2 (432.08 and 371.97 kg ha-1, respectively). The TLU that could be safely grazed on blocks 1 and 2 were 121 and 107, respectively compared to the TLU being grazed on blocks 1 (279) and 2 (381). Therefore, to sustain the productivity and ecological stability of these grazing areas, there is need to control weeds/thickets, improve forage resources by oversowing with quality forages, and to adjust livestock numbers to match with forage quantities available for grazing. &nbsp

Activity and Habitat Use of Chimpanzees (Pan troglodytes verus) in the Anthropogenic Landscape of Bossou, Guinea, West Africa

Many primate populations inhabit anthropogenic landscapes. Understanding their long-term ability to persist in such environments and associated real and perceived risks for both primates and people is essential for effective conservation planning. Primates in forest–agricultural mosaics often consume cultivars to supplement their diet, leading to potentially negative encounters with farmers. When crossing roads, primates also face the risk of encounters with people and collision with vehicles. Chimpanzees (Pan troglodytes verus) in Bossou, Guinea, West Africa, face such risks regularly. In this study, we aimed to examine their activity budget across habitat types and the influence of anthropogenic risks associated with cultivated fields, roads, and paths on their foraging behavior in noncultivated habitat. We conducted 6-h morning or afternoon follows daily from April 2012 to March 2013. Chimpanzees preferentially used forest habitat types for traveling and resting and highly disturbed habitat types for socializing. Wild fruit and crop availability influenced seasonal habitat use for foraging. Overall, chimpanzees preferred mature forest for all activities. They showed a significant preference for foraging at >200 m from cultivated fields compared to 0–100 m and 101–200 m, with no effect of habitat type or season, suggesting an influence of associated risk. Nevertheless, the chimpanzees did not actively avoid foraging close to roads and paths. Our study reveals chimpanzee reliance on different habitat types and the influence of human-induced pressures on their activities. Such information is critical for the establishment of effective land use management strategies in anthropogenic landscapes

Implications for school nurses using simulator dolls to manage unplanned teen pregnancy.

Background: School nurses are key professionals in the promotion of sexual and reproductive health which should include using high fidelity baby simulator dolls. Aim: To explore teenager’s perceptions of their practical parenting skills and their attitudes towards experiential learning from using high fidelity baby simulators. Methods: Virtual baby simulator dolls were used as part of sex and relationship education with school pupils (aged 15-16 years) to look after over a weekend. Pupils were recruited from a UK Academy and completed a diary of their experiences while parenting, received quantitative feedback simulator reports and completed a post-study evaluation questionnaire. Findings: Pupils saw the virtual baby project as beneficial and important in schools and perceived an improvement in their understanding of practical parenting skills, sexual health and contraception. Conclusion: The implications of this paper are towards involving school nurses more actively in sexual health education in schools via the use of high fidelity simulators as creative pedagogy in Personal Sexual Health Education (PSHCE)

Trench layering using indole-3-butyric acid and local organic substrate mixtures to enhance rooting and survival of apple rootstocks

Apples ( Malus domestica ) were introduced to enhance nutrition and improve livelihoods of famers in highlands of Uganda. However, adoption and commercialisation of apples is largely constrained by low quality rootstocks due to poor rooting and low survivability. This study determined the effect of organic substrate mixtures (OSM) and indole-3-butyric acid (IBA) on rooting, sprouting and survival characteristics of apple rootstocks propagated by trench layering. Four apple rootstock varieties (M106, M109, MM793 and bitten-felder) were planted in OSM (Site soil as control, TsaOm and TsdOm) then treated with IBA concentrations (IBA-0 ppm, IBA-4000 ppm and IBA-8000 ppm) in a factorial randomised block design with three replications. Results showed significant (P<0.001) variability among rootstocks for all characters. OSM significantly (P<0.01) increased rooting, root numbers and root length while IBA significantly (P<0.01) increased all traits, except rooting. The highest rooting (46.7%), root numbers (23.1) and root length (14.9cm), and sprout length (59.5cm) were obtained in bitten felder under TsaOm + IBA-4000ppm, TsaOm, and TsdOm, respectively. For M106, maximum rooting (28.1%) and root numbers (22.3) were obtained under TsaOm + IBA-8000ppm while root (14.3cm) and sprout (35.2cm) lengths under TsdOm. TsaOm gave the highest root numbers (14.2), root (12.8cm) and sprout (30.7cm) lengths in M109 likewise root (7.8cm) and sprout (38.3cm) lengths in MM793. Logistic regression revealed that rooting, sprout length, and IBA-4000ppm significantly (P<0.01) increased survival of apple rootstocks. The highest survival rates in bitten felder and M106 were 52.4% and 51.7% under TsdOm + IBA-4000 ppm and TsdOm + IBA-8000 ppm respectively; likewise 49.5% in M109 and 51.7% in MM793 both treated with IBA-8000 ppm. The results demonstrate that trench layering with OSM and IBA improves rooting and survival of apple rootstocks which might improve farmers\u2019 access to quality apple planting material.Les pommes ( Malus domestica ) \ue9taient introduites pour renforcer la nutrition et am\ue9liorer le niveau de vie des producteurs dans les r\ue9gions montagneuses d\u2019Ouganda. Toutefois, l\u2019adoption et la commercialisation des pommes sont largement limit\ue9es par la faible qualit\ue9 des porte-greffes \ue0 cause du pauvre enracinement et la faible capacit\ue9 de survie. Cette \ue9tude visait \ue0 d\ue9terminer l\u2019effet des m\ue9langes du substrat organique (OSM) et l\u2019acide indole-3-butyrique (IBA) sur l\u2019enracinement, la germination et les caract\ue9ristiques de survie des porte-greffes de la pomme propag\ue9e par le marcottage de tranch\ue9e. Quatre portes greffes des vari\ue9t\ue9s de pomme (M106, M109, MM793 et bitten-felder) \ue9taient plant\ue9es dans l\u2019OSM (site de sol servant de contr\uf4le, TsaOm et TSdOm) et trait\ue9e avec diff\ue9rentes concentrations de l\u2019IBA (IBA-0 ppm, IBA-4000 ppm et IBA-8000 ppm) dans un design factoriel \ue0 blocks compl\ue8tement al\ue9atoires avec trois r\ue9plications. Les r\ue9sultats ont montr\ue9 de variabilit\ue9 significative (P<0,001) entre les porte-greffes des vari\ue9t\ue9s pour tous les caract\ue8res. OSM significativement (P<0.01) a fait accro\ueetre l\u2019enracinement, le nombre de racines et la longueur de la racine; alors que IBA a augment\ue9 significativement (P<0.001) tous les traits, sauf l\u2019enracinement. Les plus grandes valeurs des caract\ue8res \ue0 savoir\ua0; l\u2019enracinement (46,7%), le nombre de racines (23,1), la longueur des racines (14,9 cm), et la longueur des pousses (59,5cm) \ue9taient obtenues sur bitten felder sous TsaOm + IBA-4000ppm, TsaOm, et TsdOm, respectivement. Pour M106, les valeurs maximales de l\u2019enracinement (28,1%) et de nombre de racines (22.3) \ue9taient obtenues sous TsaOm + IBA-8000ppm alors que les valeurs maximales de la longueur des racines (14,3 cm) et des pousses (35,2 cm) sous TsdOM. TsaOm ont donn\ue9 le plus grand nombre de racines (14,2), la plus grande longueur des racines (12,8 cm) et de pousses (30,7 cm) dans M109 pareillement \ue0 la longueur des racines (7,8 cm) et de pousses (38,3 cm) dans MM793. La r\ue9gression logistique a r\ue9v\ue9l\ue9 que l\u2019enracinement, la longueur de la pousse et IBA-400ppm ont augment\ue9 significativement (P<0,01) la survie des porte-greffes de la pomme. Les plus forts taux de survies sur le bitten felder et M106 \ue9taient 52,4% et 51,7% sous TsdOm+IBA-4000 ppm et TsdOm+IBA-8000 ppm, respectivement\ua0; de m\ueame 49,5% ont \ue9t\ue9 obtenus sur M109 et 51,7% sur MM793 tous trait\ue9s avec IBA-8000 ppm. Les r\ue9sultats ont d\ue9montr\ue9 que le marcottage de tranch\ue9e avec OSM et IBA am\ue9liore l\u2019racinement et la survie des porte-greffes qui pourrait am\ue9liorer l\u2019acc\ue8s des producteurs \ue0 des mat\ue9riels de plantation de pomme de qualit\ue9

The influence of internship training experience on Kenyan and Ugandan doctors’ career intentions and decisions: a qualitative study

Data availability statement: All data relevant to the study are included in the article or uploaded as supplementary information.Supplemental material is available online at: https://www.tandfonline.com/doi/full/10.1080/16549716.2023.2272390# .Background: Medical internship is a key period for doctors’ individual career planning and also a transition period for the broader labour market. Objectives: We aimed to understand the complex set of factors influencing the career intentions and decisions of junior doctors, post-internship in Kenya and Uganda. Methods: We conducted semi-structured interviews with 54 junior medical officers and 14 consultants to understand doctors’ internship experiences and subsequent employment experiences. We analysed the data using a mix of a direct content approach, informed by an internship experience and career intentions framework developed primarily from high-income country literature, alongside a more inductive thematic analysis. Results: Echoing the internship experience and career intentions framework, we found that clinical exposure during internship, work–life balance, aspects of workplace culture such as relationships with consultants and other team members, and concerns over future job security and professional development all influenced Kenyan and Ugandan doctors’ career preferences. Additionally, we added a new category to the framework to reflect our finding that interns might want to ‘fill a health system gap’ when they choose their future careers, based on what they witness as interns. However, often career intentions did not match career and employment decisions due to specific contextual factors, most importantly a shortage of job opportunities. Conclusion: We have shown how internship experiences shape medical doctors’ career intentions in Kenya and Uganda and highlighted the importance of job availability and context in influencing doctors’ career choices.This work is supported by an Africa Oxford travel grant (AfOx-209). YZ is supported by the University of Oxford Clarendon Fund Scholarship, an Oxford Travel Abroad Bursary and a Keble Association grant. ME is supported by the Wellcome Trust Senior Research Fellowship (#207522). CN receives funding from the Economic and Social Research Council Horizon Europe [grant number ES/T008415/1]. National Institute for Health Research Applied Research Collaboration Oxford and Thames Valley at Oxford Health NHS Foundation Trust. Consortium iNEST (Interconnected North-Est Innovation Ecosystem) funded by the European Union NextGenerationEU (Piano Nazionale di Ripresa e Resilienza (PNRR) – Missione 4 Componente 2, Investimento 1.5 – D.D. 1058 23/06/2022, ECS_00000043)

Makerere University College of Health Sciences’ role in addressing challenges in health service provision at Mulago National Referral Hospital

<p>Abstract</p> <p>Background</p> <p>Mulago National Referral Hospital (MNRH), Uganda’s primary tertiary and teaching hospital, and Makerere University College of Health Sciences (MakCHS) have a close collaborative relationship. MakCHS students complete clinical rotations at MNRH, and MakCHS faculty partner with Mulago staff in clinical care and research. In 2009, as part of a strategic planning process, MakCHS undertook a qualitative study to examine care and service provision at MNRH, identify challenges, gaps, and solutions, and explore how MakCHS could contribute to improving care and service delivery at MNRH.</p> <p>Methods</p> <p>Key informant interviews (n=23) and focus group discussions (n=7) were conducted with nurses, doctors, administrators, clinical officers and other key stakeholders. Interviews and focus groups were tape recorded and transcribed verbatim, and findings were analyzed through collaborative thematic analysis.</p> <p>Results</p> <p>Challenges to care and service delivery at MNRH included resource constraints (staff, space, equipment, and supplies), staff inadequacies (knowledge, motivation, and professionalism), overcrowding, a poorly functioning referral system, limited quality assurance, and a cumbersome procurement system. There were also insufficiencies in the teaching of professionalism and communication skills to students, and patient care challenges that included lack of access to specialized services, risk of infections, and inappropriate medications.</p> <p>Suggestions for how MakCHS could contribute to addressing these challenges included strengthening referral systems and peripheral health center capacity, and establishing quality assurance mechanisms. The College could also strengthen the teaching of professionalism, communication and leadership skills to students, and monitor student training and develop courses that contribute to continuous professional development. Additionally, the College could provide in-service education for providers on professionalism, communication skills, strategies that promote evidence-based practice and managerial leadership skills.</p> <p>Conclusions</p> <p>Although there are numerous barriers to delivery of quality health services at MNRH, many barriers could be addressed by strengthening the relationship between the Hospital and MakCHS. Strategic partnerships and creative use of existing resources, both human and financial, could improve the quality of care and service delivery at MNRH. Improving services and providing more skills training could better prepare MakCHS graduates for leadership roles in other health care facilities, ultimately improving health outcomes throughout Uganda.</p

Male partner attendance of skilled antenatal care in peri-urban Gulu district, Northern Uganda

<p>Abstract</p> <p>Background</p> <p>Male partner attendance of skilled Antenatal Care (ANC) is beneficial to improving maternal outcomes. This study investigated the level, perceived benefits and factors associated with male partner attendance of skilled ANC in a peri-urban community recovering from two decades of civil conflict.</p> <p>Methods</p> <p>This cross-sectional survey used multi-stage sampling in 12 villages of Omoro county to select 331 married male respondents aged 18 years or more, whose female spouses had childbirth within 24 months prior to the survey. A structured questionnaire elicited responses about male partner attendance of ANC during pregnancy at a public health facility as the main outcome variable. Analysis used Generalized Linear Model (GLM) in Stata version 10.0 to obtain Prevalence Risk Ratios (PRR) for association between the binary outcome and independent factors. All factors significant at p < 0.15 and potential confounders were included in the multivariable model.</p> <p>Results</p> <p>Overall, 65.4% (95%CI; 60.3, 70.5) male partners attended at least one skilled ANC visit. Mean age was 31.9 years [SD 8.2]. Perceived benefits of attending ANC were: HIV screening (74.5%), monitoring foetal growth (34%) and identifying complications during pregnancy (18.9%). Factors independently associated with higher ANC attendance were: knowledge of 3 or more ANC services (adj.PRR 2.77; 95%CI 2.24, 3.42), obtaining health information from facility health workers (adj.PRR 1.14; 95%CI 1.01, 1.29) and if spouse had skilled attendance at last childbirth (adj.PRR 1.31; 95%CI 1.04-1.64). However, factors for low attendance were: male partners intending their spouse to carry another pregnancy (adj.PRR 0.83; 95%CI 0.71, 0.97) and living more than 5 Km from a health facility (adj.PRR 0.83, 95%CI 0.70, 0.98).</p> <p>Conclusions</p> <p>Men who were knowledgeable of ANC services, obtained health information from a health worker and whose spouses utilised skilled delivery at last pregnancy were more likely to accompany their spouses at ANC, unlike those who wanted to have more children and lived more than 5 km from the health facility. These findings suggest that empowering male partners with knowledge about ANC services may increase their ANC participation and in turn increase skilled delivery. This strategy may improve maternal health care in post conflict and resource-limited settings.</p

‘We were treated like we are nobody’: a mixed-methods study of medical doctors’ internship experiences in Kenya and Uganda

What is already known on this topic: Ensuring appropriate and well-supported medical internship training is important for health workforce production and health systems’ quality of care, however, there is a scarcity of studies focusing on medical officer interns in low-ncome and middle-income countries where resources are most restrained thus education and working conditions are worst. What this study adds: Most interns are satisfied with their job but many reported working unreasonable hours as long as 72 hours due to staff shortage. Interns reported challenging scenarios where they had poor supervision and insufficient support due to consultants not being available, and sometimes interns were the only staff managing the wards or had to perform certain procedures unsupervised. Some consultants also expressed concerns with interns’ preparedness coming into the internship as well as competence postinternship. How this study might affect research, practice or policy: We highlighted the need to improve the resource availability and capacity of internship hospitals, ensure interns’ preparedness before internship, prioritise the well-being of individual doctors and ensure standardised supervision, support systems and conducive learning environments are in place. This study adds to the global literature on internship experiences of medical doctors and could also help others design evidence-based policies and interventions to address specific challenges during medical internships.Collaborators: Kenya & Uganda Medical Internship Experience Study Group: Dos Santos Ankomisyani, Mike English, David Gathara, Lyndah Kemunto, Wangechi King’ori, Daniel Mbuthia, Gilbert Munyoki, Joshua Munywoki, Catia Nicodemo, Jacinta Nzinga, Tom Richard Okello, Elizeus Rutebemberwa, Justus Simba, Raymond Tweheyo, Evelyn Wagaiyu, Fred Were, Yingxi Zhao.Data availability: statement Data are available on reasonable request. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.Supplementary files are available online at: https://gh.bmj.com/content/8/11/e013398#supplementary-materials .Objective: Medical interns are an important workforce providing first-line healthcare services in hospitals. The internship year is important for doctors as they transition from theoretical learning with minimal hands-on work under supervision to clinical practice roles with considerable responsibility. However, this transition is considered stressful and commonly leads to burn-out due to challenging working conditions and an ongoing need for learning and assessment, which is worse in countries with resource constraints. In this study, we provide an overview of medical doctors’ internship experiences in Kenya and Uganda. Methods: Using a convergent mixed-methods approach, we collected data from a survey of 854 medical interns and junior doctors and semistructured interviews with 54 junior doctors and 14 consultants. Data collection and analysis were guided by major themes identified from a previous global scoping review (well-being, educational environment and working environment and condition), using descriptive analysis and thematic analysis respectively for quantitative and qualitative data. Findings: Most medical interns are satisfied with their job but many reported suffering from stress, depression and burn-out, and working unreasonable hours due to staff shortages. They are also being affected by the challenging working environment characterised by a lack of adequate resources and a poor safety climate. Although the survey data suggested that most interns were satisfied with the supervision received, interviews revealed nuances where many interns faced challenging scenarios, for example, poor supervision, insufficient support due to consultants not being available or being ‘treated like we are nobody’. Conclusion: We highlight challenges experienced by Kenyan and Ugandan medical interns spanning from burn-out, stress, challenging working environment, inadequate support and poor quality of supervision. We recommend that regulators, educators and hospital administrators should improve the resource availability and capacity of internship hospitals, prioritise individual doctors’ well-being and provide standardised supervision, support systems and conducive learning environments.This work is supported by an Africa Oxford travel grant (AfOx-209). YZ is supported by the University of Oxford Clarendon Fund Scholarship, an Oxford Travel Abroad Bursary and a Keble Association grant. ME is supported by a Wellcome Trust Senior Research Fellowship (#207522). CN receives funding from the Economic and Social Research Council (grant number ES/T008415/1). National Institute for Health Research Applied Research Collaboration Oxford and Thames Valley at Oxford Health NHS Foundation Trust. Consortium iNEST (Interconnected North-Est Innovation Ecosystem) funded by the European Union NextGenerationEU (Piano Nazionale di Ripresa e Resilienza (PNRR)–Missione 4 Componente 2, Investimento 1.5 – D.D. 1058 23/06/2022, ECS_00000043), and Horizon Europe [grant number ES/T008415/1

Development and validation of a new measurement instrument to assess internship experience of medical doctors in low-income and middle-income countries

Summary: Internship experience can be challenging due to the rapid transition from medical school to clinical practice, especially long working hours, high workloads and constant new learning and assessment. Countries like the UK and US conduct routine surveys of their doctors in training, led by regulators, to understand their experiences and monitor and report on training quality. However, most low-income and middle-income countries (LMICs) do not have similar routine surveys and there is a relative lack of research on internship experiences in these countries. With collaborators from 9 LMICs, we developed a 50-item Medical Internship Experience Scale (MIES) based on data from 1646 medical interns and junior doctors from LMICs. MIES is reliable and valid and broadly covers six major constructs, that is, clinical learning and supervision, patient safety, job satisfaction, stress and burnout, mental wellbeing, fairness and discrimination, and this tool could be used by governments, medical schools and regulators to compare internship experiences across different training facilities and to identify specific areas where improvements are needed.Data availability statement: Data are available upon reasonable request. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.Supplemental material is available online at: https://gh.bmj.com/content/8/11/e013399#supplementary-materials .Routine surveys are used to understand the training quality and experiences of junior doctors but there are lack of tools designed to evaluate the training experiences of interns in low-income and middle-income countries (LMICs) where working conditions and resource constraints are challenging. We describe our process developing and validating a ‘medical internship experience scale’ to address this gap, work involving nine LMICs that varied in geographical locations, income-level and internship training models. We used a scoping review of existing tools, content validity discussions with target populations and an expert panel, back-and-forth translations into four language versions and cognitive interviews to develop and test the tool. Using data collected from 1646 interns and junior medical doctors, we assessed factor structure and assessed its reliability and validity. Fifty items about experiences of medical internship were retained from an initial pool of 102 items. These 50 items represent 6 major factors (constructs): (1) clinical learning and supervision, (2) patient safety, (3) job satisfaction, (4) stress and burnout, (5) mental well-being, and (6) fairness and discrimination. We reflect on the process of multicountry scale development and highlight some considerations for others who may use our scale, using preliminary analyses of the 1646 responses to illustrate that the tool may produce useful data to identify priorities for action. We suggest this tool could enable LMICs to assess key metrics regarding intern straining and initial work experiences and possibly allow comparison across countries and over time, to inform better internship planning and management.This work is supported by an Africa Oxford travel grant (AfOx-209). YZ is supported by the University of Oxford Clarendon Fund Scholarship, an Oxford Travel Abroad Bursary and a Keble Association grant. ME is supported by a Wellcome Trust Senior Research Fellowship (#207522). CN receives funding from the Economic and Social Research Council [grant number ES/T008415/1]. National Institute for Health Research Applied Research Collaboration Oxford and Thames Valley at Oxford Health NHS Foundation Trust. Consortium iNEST (Interconnected North-Est Innovation Ecosystem) funded by the European Union NextGenerationEU (Piano Nazionale di Ripresa e Resilienza (PNRR) – Missione 4 Componente 2, Investimento 1.5 – D.D. 1058 23/06/2022, ECS_00000043)

Male involvement in birth preparedness and complication readiness for emergency obstetric referrals in rural Uganda

<p>Abstract</p> <p>Background</p> <p>Every pregnant woman faces risk of life-threatening obstetric complications. A birth-preparedness package promotes active preparation and assists in decision-making for healthcare seeking in case of such complications. The aim was to assess factors associated with birth preparedness and complication-readiness as well as the level of male participation in the birth plan among emergency obstetric referrals in rural Uganda.</p> <p>Methods</p> <p>This was a cross-sectional study conducted at Kabale regional hospital maternity ward among 140 women admitted as emergency obstetric referrals in antenatal, labor or the postpartum period. Data was collected on socio-demographics and birth preparedness and what roles spouses were involved in during developing the birth plan. Any woman who attended antenatal care at least 4 times, received health education on pregnancy and childbirth danger signs, saved money for emergencies, made a plan of where to deliver from and made preparations for a birth companion, was deemed as having made a birth plan. Multivariate logistic regression analysis was conducted to analyze factors that were independently associated with having a birth plan.</p> <p>Results</p> <p>The mean age was 26.8 ± 6.6 years, while mean age of the spouse was 32.8 ± 8.3 years. Over 100 (73.8%) women and 75 (55.2%) of their spouses had no formal education or only primary level of education respectively. On multivariable analysis, Primigravidae compared to multigravidae, OR 1.8 95%CI (1.0-3.0), education level of spouse of secondary or higher versus primary level or none, OR 3.8 95%CI (1.2-11.0), formal occupation versus informal occupation of spouse, OR 1.6 95%CI (1.1-2.5), presence of pregnancy complications OR 1.4 95%CI (1.1-2.0) and the anticipated mode of delivery of caesarean section versus vaginal delivery, OR 1.6 95%CI (1.0-2.4) were associated with having a birth plan.</p> <p>Conclusion</p> <p>Individual women, families and communities need to be empowered to contribute positively to making pregnancy safer by making a birth plan.</p