State of Knowledge and Awareness of Preconception Preparedness among Premarital Couples in Rwanda: A Quantitative Cross-Sectional Survey.

Background: Preconception preparedness (PP) is important for improving maternal and neonatal health outcomes by promoting health optimization before conception. However, awareness remains limited in sub-Saharan Africa. Furthermore, evidence on premarital couples as a distinct population is scarce. Aim: To assess the status, including level of knowledge and awareness (KA), of PP and identify associated factors among premarital couples in Rwanda. Methods: A cross-sectional survey was conducted between May and July 2024 among 600 couples (n = 1,200) recruited from civil and religious marriage registration offices in 15 districts of Rwanda. Data were collected using a structured questionnaire and analyzed using IBM SPSS Statistics for Windows version 29 (IBM Corp, Armonk, NY, USA). Descriptive statistics, independent t-tests, and multiple logistic regression were used to examine KA levels and associated factors. Results: The mean participant age was 29.5 years (SD, 5.5), 91.2% of participants demonstrated low PP KA, while only 8.8% had fair KA. At the couple level, 95.3% of them had both partners in the low KA category. Females were more likely than males to demonstrate fair KA (12.0% vs. 2.8%). Other factors associated with fair KA included female sex (AOR = 2.1; p = 0.007), secondary or higher education (AOR = 6.3; p = 0.004), and urban residence (AOR = 1.7; p = 0.009). Prior exposure to PP information was uncommon (3.3%) but was associated with higher odds of fair KA (AOR = 3.3; p = 0.002). Conclusion: Knowledge and awareness of PP are low among the majority of premarital couples in Rwanda. Strengthening community-based educational interventions, integrating PP into premarital counseling, and expanding information dissemination are needed to improve preconception health literacy among couples preparing for parenthood.