Factors associated with birth preparedness and complication readiness knowledge among pregnant women before implementation of a culturally adapted training intervention in rural Iringa, Tanzania.

BACKGROUND: Birth preparedness and complication readiness (BPCR) is an important strategy for reducing delays in recognizing obstetric complications and promoting timely use of maternal health services. However, evidence on factors associated with BPCR knowledge among pregnant women in rural Tanzania remains limited. This study aimed to identify factors associated with BPCR knowledge among pregnant women before implementation of a culturally adapted training intervention in rural Iringa, Tanzania. METHODS: A quantitative analytical cross-sectional study was conducted among pregnant women attending public antenatal care clinics in rural Iringa. Participants were selected using a multistage sampling procedure followed by systematic sampling from antenatal care registers. Data were collected using a structured interviewer-administered questionnaire assessing BPCR knowledge across six maternal and newborn health domains. Bivariate analyses were performed using the Mann-Whitney U and Kruskal-Wallis tests, while multivariable linear regression with heteroscedasticity-consistent standard errors was used to identify factors independently associated with BPCR knowledge. RESULTS: A total of 176 pregnant women participated. The mean age was 26.47 ± 6.13 years, and most participants were married (86.9%), multigravida (82.4%), and had primary education (68.8%). The mean BPCR knowledge score was 21.59 ± 8.38 out of 62 (34.8% of the maximum score), indicating suboptimal knowledge. Knowledge was highest for antenatal care (76.9%) and lowest for postpartum (20.4%), newborn (25.4%), and labor-related danger signs (28.6%). In bivariate analyses, age, marital status, living with a partner, and gravidity were significantly associated with BPCR knowledge. After adjustment, only maternal age below 20 years remained independently associated with lower knowledge scores (β = -6.15, 95% CI: -9.59 to -2.72; p < 0.001). The model explained 11.3% of the variability in BPCR knowledge (adjusted R2 = 7.0%). CONCLUSION: BPCR knowledge among pregnant women attending antenatal care in rural Iringa was suboptimal, particularly regarding the recognition of obstetric and neonatal danger signs. Pregnant women aged under 20 years had significantly lower BPCR knowledge and should be prioritized for targeted antenatal education. Strengthening culturally appropriate BPCR education within routine antenatal care may help address knowledge gaps among pregnant women in rural Tanzania.