Pregnancy is a period when women’s bodies go through serious physiological changes which may be entirely normal throughout pregnancy, childbirth, and postpartum period. However, this normal process may sometimes be overcome by serious complications which may affect the life of mothers and newborns contributing to maternal mortality and morbidity to the highest level [
World health organization (WHO) reported that, globally, an estimated number of 289,000 women died during and following pregnancy and childbirth related problem in 2013 alone, showing a decline of 45% from 1990 report. Developing countries like sub-Saharan (62%) and South Asia (24%) together contribute 86% of the problem [
Maternal mortality in resource poor nations has been attributed to three delays: delay in deciding to seek care, delay in reaching to seek care on time, and delay in receiving adequate treatment. Among all, the major cause for first delay is lack of awareness about obstetric danger signs to decide to seek care among mothers and community [
Women’s knowledge about danger signs of obstetric complications is profoundly important to enhance utilization of skilled care during delivery and to seek emergency obstetric services. Lack of information on the warning signs of complications during pregnancy, parturition, and postpartum period hampers women’s ability to partake fully in safe motherhood initiatives. As awareness of danger signs of obstetric complications is the essential first step in accepting appropriate and timely referral to obstetric care, it is vitally important that women and their families should have knowledge regarding danger signs of obstetric complications to enable them to respond appropriately [
National reproductive strategy of Ethiopia has given emphasis to raising mother’s knowledge about danger signs of obstetric complications. According to this strategic plan by federal ministry of Ethiopia (FMOH), 80% of all families including mothers should recognize at least three danger signs associated with pregnancy related complications [
An institutional based cross-sectional study was conducted in Mechekel district health centers from August 1 to October 30, 2014, among postnatal mothers in six health centers. The district is located 328 km northeast of Addis Ababa, the capital city of Ethiopia. The potential study population comprised all postnatal mothers at Mechekel district health centers at the time of data collection irrespective of place of delivery.
Systematic sampling technique was used to select study participants at postnatal clinics of the six health centers at Mechekel district proportionally. The sample size was determined using a single population proportion formula considering the following assumptions: 58.8% proportion of knowledgeable women on danger signs and 5% level of significance (
Data was collected by six diploma midwives through face to face interviews using a structured and pretested questionnaire after one-day training was given for them with their respective B.S. midwife supervisor.
Data analysis was performed using SPSS version 20.0. Variables reaching a
Ethical clearance was obtained from the Institutional Review Board (IRB) of University of Gondar, College of Health Sciences. A formal letter of cooperation was sent to Mechekel district health bureau and a formal letter of permission was obtained. Finally, written informed consent was obtained from each pregnant woman.
Four hundred five participants responded to the questionnaire, giving a response rate of 98.5%. The mean age of the study participants was 28.9 years (sd 5.63). The majority of women were married (383, 94.6%) and orthodox Christian (375, 92.6%). Two hundred thirty (56.8%) of the pregnant women had attended at least primary education (Table
Sociodemographic characteristics of postnatal mothers of Mechekel district health centers (
Variables category | Frequency | Percentage |
---|---|---|
|
||
15–19 | 36 | 8.9 |
20–24 | 117 | 28.9 |
25–29 | 111 | 27.4 |
30–34 | 98 | 24.2 |
≥35 | 43 | 10.6 |
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Married | 383 | 94.6 |
Single | 9 | 2.2 |
Widowed | 7 | 1.7 |
Divorced | 6 | 1.5 |
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Orthodox | 375 | 92.6 |
Muslim | 20 | 4.9 |
Protestant | 8 | 2.0 |
Others | 2 | 0.5 |
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No schooling | 175 | 43.2 |
Primary school | 86 | 21.2 |
Secondary school | 74 | 18.3 |
Above secondary school | 70 | 17.3 |
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Gvt/private employ | 90 | 22.2 |
Housewife | 173 | 42.7 |
Farmer | 60 | 14.8 |
Trader | 58 | 14.3 |
Others | 24 | 5.9 |
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Urban | 175 | 43.2 |
Rural | 230 | 56.8 |
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One hour or less | 256 | 63.2 |
Greater than an hour | 149 | 36.8 |
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No schooling | 125 | 30.9 |
Primary school | 72 | 17.8 |
Secondary school | 61 | 15.1 |
Above secondary school | 125 | 30.9 |
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≤500 | 60 | 14.8 |
501–1000 | 143 | 35.3 |
1001–1500 | 136 | 33.6 |
≥1501 | 66 | 16.3 |
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Self | 231 | 57.0 |
With husband | 112 | 27.7 |
Other persons | 62 | 15.3 |
For 219 (54.1%) of the mothers, the index birth was their first, while 196 (48.4%) of them had experienced pregnancy 2 to 4 times. Of the respondents, 358 (88.4%) had antenatal follow-up during their last pregnancy and 264 (65.2%) gave their last birth at health institution. Among the respondents, 140 (34.6%) have experienced obstetric complications among which obstructed/prolonged labour, 56 (13.8%), takes over the majority followed by hemorrhage, 51 (12.6%) (Table
Obstetric characteristic of postnatal mothers (
Variables category | Frequency | Percentage |
---|---|---|
|
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One | 176 | 43.5 |
Two–four | 196 | 48.4 |
Five and above | 33 | 8.1 |
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One | 219 | 54.1 |
Two–four | 168 | 41.5 |
Five and above | 18 | 4.4 |
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Yes | 358 | 88.4 |
No | 47 | 11.6 |
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Government hospital/HC | 306 | 85.5 |
Private hospital/clinic | 52 | 14.5 |
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Within 4th month and before | 178 | 49.7 |
Within 4th-5th month | 67 | 18.4 |
Within 6th-7th month | 33 | 9.2 |
Within 8th month and after | 8 | 2.2 |
Do not know | 73 | 20.4 |
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One time | 36 | 10.1 |
Two times | 75 | 20.9 |
Three times | 92 | 25.7 |
Four or more | 155 | 43.3 |
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Home | 141 | 34.8 |
Health institution | 264 | 65.2 |
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Spontaneous vaginal delivery | 297 | 73.3 |
Cesarean delivery | 23 | 5.7 |
Assisted vaginal delivery | 79 | 19.5 |
Others | 6 | 1.5 |
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Normal/alive | 334 | 82.5 |
Abnormal/diseased | 54 | 13.3 |
Dead | 17 | 4.2 |
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Yes | 140 | 34.6 |
No | 265 | 65.4 |
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Hemorrhage | 51 | 12.6 |
PIH | 31 | 7.7 |
Sepsis | 12 | 3.0 |
Obstructed labour | 56 | 13.8 |
Abortion | 35 | 8.6 |
Others | 32 | 7.9 |
More than half, 55.1%, of study participants were knowledgeable about overall danger signs of obstetric complications that can occur during pregnancy, delivery, and postpartum/puerperium period.
Of the respondents, 211 (52.1%), 216 (53.3%), and 188 (46.4%) were stated above the calculated mean of danger signs of obstetrics complication during pregnancy, labour/delivery, and postpartum periods, respectively. On the other hand vaginal bleeding is the most frequently recalled danger sign of obstetrics complications by 244 (60.2%), 230 (56.8%), and 218 (53.8%) respondents during pregnancy, labour/delivery, and postpartum periods, respectively (Table
Proportion of recalled danger signs of obstetric complications among postnatal mothers of Mechekel district health centers, East Gojjam zone, Northwest Ethiopia, 2014 (
Danger sign of obstetric complications | Proportion of mentioned danger sign during the following | |||||
---|---|---|---|---|---|---|
Pregnancy | Childbirth | Postpartum period | ||||
|
% |
|
% |
|
% | |
Vaginal bleeding | 218 | 53.8 | 230 | 56.8 | 244 | 60.2 |
Severe headache | 212 | 52.3 | 169 | 41.7 | 120 | 29.6 |
Convulsion | 122 | 30.1 | 95 | 23.5 | 89 | 22.0 |
Loss of consciousness | 124 | 30.6 | 107 | 26.4 | 93 | 23.0 |
Epigastric pain | 127 | 31.4 | 105 | 25.9 | 85 | 21.0 |
Blurring of vision | 141 | 34.8 | 127 | 31.4 | 97 | 24.0 |
Increased/decreased fetal movement | 176 | 43.5 | 137 | 33.8 | ||
Fast or difficult breathing (dyspnea) | 80 | 19.8 | ||||
Excessive vomiting | 43 | 10.6 | ||||
Preterm labour (onset of labour before 37 weeks of gestation) | 150 | 37.0 | ||||
Premature rupture of membrane | 165 | 40.7 | ||||
Prolonged labour (lasting > 12 hours) | 190 | 46.9 | ||||
Severe abdominal pain | 126 | 31.1 | 91 | 22.5 | ||
Retained placenta | 180 | 44.4 | ||||
Foul-smelling vaginal discharge | 156 | 38.5 | ||||
High fever with or without abdominal pain | 149 | 36.8 | ||||
Others | 44 | 10.9 | 24 | 5.9 | ||
Do not know any danger sign | 100 | 24.7 | 91 | 22.5 | 95 | 23.5 |
The most frequently reported sources of information were health service providers (including health extension workers), 309 (76.3%), followed by mass media (20.5%), friends (24.0%), and community (10.9%).
Among study participants, majority of them, 166 (41.0%), were informed about danger sign of obstetric complications at specific period of pregnancy and 97 (23.7%) were not informed about any obstetric complications during pregnancy, delivery, and postpartum or puerperium period. About 167 (41.2%) responded that they met with health extension workers by schedule to discuss their health issue and majority of them, 238 (58.8%), responded that there was no availability of health extension workers at their homes.
A bivariate analysis was done to assess any association between independent variables and knowledge of obstetrics complications danger signs. After controlling the effect of other variables, family monthly income, maternal educational level, husband educational level, gravidity, ANC follow-up during last pregnancy, and place of last delivery were found to be significantly associated with missed opportunity of institutional delivery (
Those whose monthly family income was >1500 ETB were about 3 times more likely knowledgeable than those whose income was less than 500 ETB (AOR = 2.954, 95% CI: 1.289, 6.770). Those mothers who attended more than secondary school were about 2 times more likely knowledgeable about obstetric danger signs than those who had no schooling at all (AOR = 1.921, 95% CI: 1.004, 3.676). Similarly mothers whose husbands finished more than secondary school were about 3 times more likely knowledgeable than those whose husbands had not attended formal school (AOR = 3.163, 95% CI: 1.860, 5.3770).
Grand multipara mothers were also about 7 times more likely knowledgeable than primiparous (AOR = 7.463, 95% CI: 1.301, 12.800). Mothers who had antenatal follow-up during their last pregnancy were two times more likely knowledgeable than those who had no ANC (AOR = 2.184, 95% CI: 1.137, 4.196). In case of place of last delivery, those who gave birth to their recent infants at health institution were about two times more likely knowledgeable than those who delivered their neonates at home (1.955, 95% CI: 1.214, 3.150) (Table
Bivariate and multivariate analysis of factors associated with knowledge about danger sign of obstetric complications among postnatal mothers of Mechekel district health centers, East Gojjam zone, Northwest Ethiopia, 2014 (
Variables category | Knowledge level | COR (95% CI) | AOR (95% CI) | |
---|---|---|---|---|
Yes | No | |||
|
| |||
Urban | 108 (61.7%) | 67 (38.3%) | 1.612 (1.081, 2.404) | |
Rural | 115 (50.0%) | 115 (50.0%) |
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|
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| |||
Housewife | 88 (50.9%) | 85 (49.1%) |
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|
Farmer | 29 (48.3%) | 31 (517%) | 2.514 (0.993, 6.368) | |
Government employ | 48 (70.6%) | 20 (29.4%) | 5.829 (2.095, 16.215) | |
Trader | 37 (63.8%) | 21 (36.2%) | 2.272 (0.823, 6.272) | |
Other | 7 (29.2%) | 17 (70.8%) | 4.279 (1.527, 11.989) | |
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||||
|
24 (40.0%) | 36 (60.0%) |
|
1 |
501–1000 | 74 (51.7%) | 69 (48.3%) | 1.609 (0.872, 2.966) | 1.712 (0.866, 3.386) |
1001–1500 | 85 (62.5%) | 51 (37.5%) | 2.500 (1.342, 4.658) | 2.246 (1.091, 4.625) |
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No schooling | 79 (45.1%) | 96 (54.9%) |
|
1 |
Primary | 48 (55.8%) | 38 (44.2%) | 1.535 (0.913, 2.580) | 1.222 (0.674, 2.216) |
Secondary | 47 (63.5%) | 27 (36.5%) | 2.115 (1.209, 3.700) | 1.921 (1.004, 3.676) |
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| |||
Less than 1 hour | 152 (59.4%) | 104 (40.6%) | 1.606 (1.069, 2.412) | |
Greater than 1 hour | 71 (47.7%) | 78 (52.3%) |
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No schooling | 51 (40.8%) | 74 (59.2%) |
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|
Primary | 40 (55.6%) | 32 (44.4%) | 0.334 (0.193, 0.545) | 1.343 (0.744, 2.423) |
Secondary | 37 (60.7%) | 24 (39.3%) | 0.588 (0.324, 1.069) | 1.838 (0.978, 3.453) |
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One | 103 (58.5%) | 73 (41.5) |
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|
Two–four | 108 (55.1%) | 88 (44.9%) | 2.469 (1.143, 5.333) | 2.473 (0.478, 12.780) |
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|
No | 16 (34.0%) | 31 (66.0%) | 1 | |
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| |||
<4 months | 65 (36.5%) | 113 (63.5%) | 1.516 (0.873, 2.632) | |
4-5 months | 39 (59.1%) | 27 (40.9%) | 1.259 (0.643, 2.467) | |
6-7 months | 14 (42.4%) | 19 (57.6%) | 0.642 (0.280, 1.472) | |
8+ months | 2 (25.0%) | 6 (75.0%) | 0.291 (0.055, 1.536) | |
Do not know | 39 (53.4%) | 34 (46.6%) |
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| |||
One time | 19 (52.8%) | 17 (47.2%) |
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|
Two times | 39 (52.0%) | 36 (48.0%) | 0.969 (0.437, 2.148) | |
Three times | 47 (51.1%) | 45 (48.9%) | 0.935 (0.432, 2.021) | |
Four and above | 102 (65.8%) | 53 (34.2%) | 1.722 (0.827, 3.586) | |
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Home | 61 (43.3%) | 80 (56.7%) |
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| |||
Yes | 79 | 87 | 1.669 (1.119, 2.490) | |
No | 95 | 144 |
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The current study revealed that only 55.1% of postpartum women were knowledgeable about danger signs of obstetrics complications which is slightly consistent with research evidence from rural Tanzania (51.1%) [
Maternal knowledge is still not in line with coverage of ANC follow-up in the area, like studies done in Uganda and Nigeria [
Consistent with previous studies conducted in the Kwazulu-Natal province in South Africa, India, and Ethiopia [
In line with studies done in India, Tanzania, Uganda, Nigeria, South Africa, Egypt, and Ethiopia [
There was statistical difference between family monthly income and women’s knowledge level of danger signs of obstetric complications. Women with family monthly income of >1500 were more knowledgeable than women with <500 monthly family income. This is in line with study done in Nigeria [
Similarly, like studies done in Egypt, Tanzania, and Ethiopia [
ANC follow-up has significant association with mother’s knowledge of obstetric danger signs. Those mothers who had ANC follow-up during their last pregnancy were about two times more likely knowledgeable than their counterparts. This is consistent with studies done in Egypt, Uganda, Tanzania, and Ethiopia [
In line with studies done in Tanzania and Ethiopia, there is significant statistical association between knowledge of obstetric danger sign and place of last delivery [
According to the finding of this study, a significant number of mothers are still not knowledgeable about danger signs of obstetric complications.
Health service providers, including health extension workers, were the most frequently reported source of information for obstetric complications danger signs.
Maternal educational level, husband educational level, ANC follow-up during last pregnancy, family monthly income, being multiparous, and place of last delivery were factors found to be significantly associated with mothers’ knowledge of obstetric danger signs.
The authors declare that there are no competing interests regarding the publication of this paper.
Zerfu Mulaw, Tewodros Seyoum, and Hinsermu Bayu contributed equally to this work.
The authors are very grateful to University of Gondar College of Health Science for sponsoring this research project. Their sincere and deepest gratitude goes to Mechekel woreda health office and all woreda health centers staff for their special guidance and support during data collection process. They would also like to extend their heartfelt appreciation to the study participants for their participation, the data collectors, and all their associates.