Knowledge about child birth and postpartum obstetric danger signs and associated factors among mothers in Dale district, Southern Ethiopia

BMC Pregnancy and Childbirth, Volume 20, No. 1, Year 2020

Interpretation

Background: Globally, every day, approximately 800 women die from preventable causes related to pregnancy and childbirth. The majority of these deaths occur after childbirth (post-partum period) mostly within 24 h. Raising awareness of women on obstetric danger sign of childbirth and postpartum, are crucial for safe motherhood initiative and to reduce maternal mortality. Methods: A community based cross sectional study was conducted from December 15, 2017 up to February 10, 2018 on randomly selected sample of 782 women who had at least one delivery in the last 12 months. Multi stage sampling technique was used to select the study participants. Pre tested structured questionnaire was used to collect quantitative data. Bivariate and multivariate logistic regression analyses were performed using SPSS version 20.0 software. Results: Total 732 women who had at least one birth prior to this survey were interviewed and making a response rate of 93.6%.The most common spontaneously mentioned danger signs during childbirth was Severe vaginal bleeding by 281 (68.4%). Women who could mention at least two danger signs during child birth and post-partum period were 333 (45.5%), 213(29.1%) respectively. Being urban (AOR = 3.54, 95% of CI: [2.20-5.69] and delivered previous birth at health institution (AOR = 3.35, 95% of CI: [2.38-4.72]) were factors found to be significantly associated with knowledge of danger signs during postpartum. Being Attended secondary level and above (AOR = 2.41, 95% of CI: [1.02-7.76]) and use of ANC during last pregnancy (AOR = 3.63, 95% of CI: [2.51-5.25]), were factors found to be significantly associated with knowledge of danger signs during childbirth. Conclusions: The level of knowledge about danger signs of child birth and postpartum were low. This indicates that many mothers are more likely to delay in deciding to seek health care. Also, knowledge about danger signs of childbirth and postpartum were affected by place of residence, formal education, use of ANC and place of delivery. Therefore, the identified gap in awareness should be addressed through effective maternal health services by strengthening and designing appropriate strategies including provision of targeted health information, education and communication. The study was conducted in Dale district of Southern Ethiopia, which was one of 19 woreda of Sidama zone, SNNPR region, Ethiopia and which is located 308 km Southeast of Addis Ababa. Dale is one of 19 Districts in Sidama Zone of South Nations and Nationalities Regional State. As projected from the 1994 Ethiopian census, the district had a total population of 264, 544 and 61,639 women of age 15–49 years [23]. Administratively, the District was subdivided into 36 rural and 6 urban Kebeles in which 264,544 and 45,528 population respectively. The study was conducted from December 15, 2017 up to February 30, 2018. Community based cross-sectional study was conducted to measure the level of knowledge about danger signs of childbirth, postpartum and associated factor among mothers who gave birth in the last 12 months prior to the survey on randomly selected kebeles in Dale district of southern Ethiopia. The required sample size was determined using Statcalc program of the EpiInfo statistical package, which was estimating a single population proportion with the assumption that the proportion of knowledge about the obstetric danger signs (36.4%) [18], 5% of margin of error, 95% of confidence interval and design effect of 2, which gives 711 study participants and 10% of expected non response rate, which gives sample size of total 782 study participants. Multistage sampling was used to select the study subjects. First, all the kebeles/ sub-districts in the district were stratified into urban and rural. Then 2 out of 6 urban and 11 out of 36 rural Kebeles were randomly selected. The calculated sample size was proportionally allocated to urban (n = 120) and rural (n = 662) according to their number of households. Then, sampling frames of households was prepared for each kebele in collaboration with the administrators of respective kebeles. Households with a woman who gave birth in the last 12 months prior to the survey were selected and grouped into the village and the villages were selected by using simple random sampling. For selecting the study participants, eligible women who found in the selected villages were the part of the study until sample size allocated for each kebele was enough. Whenever more than one eligible respondent were found in the same selected household, only one respondent was chosen by lottery method. Pretested and structured interviewer administered questionnaire, which was first prepared in English and translated into local language (Sidamigna) was employed to obtain information on socio-demographic, obstetric history, and knowledge of women about danger signs of childbirth and postpartum. Diploma clinical nurse interviewers, they were fluent in the local language (Sidamigna) and familiar with the local customs, were employed to collect the data and supervised by one bachelor degree graduated nurse professional and one bachelor degree graduated Public health professional who were currently working in the catchment health centers and by the principal investigator as well. The data collectors and supervisors were trained for 1 day on data collection. The questionnaire was pre-tested on 39 mothers who gave birth in the last 12 months in Wonsho district to assess for its clarity, length, and completeness and skip patterns. Then after some adjustment was done in the questionnaire and extra briefing were given to the data collectors and supervisors. To insure the quality of the data, daily meeting was held between the principal investigator and data collectors to troubleshoot any problems that arose. In addition, inspection for completeness and quality of data collection was carried out daily by the supervisors and detailed feedback was provided to data collectors. Questionnaire was prepared in English version and translated in to Sidamigna local language and back to English. It was pre-tested on 5% of the calculated sample size in Wonsho district that was not select in the study. Additional adjustment on questionnaire was made based on the results of the pre-test. Data collection was carried out by trained nurses who were selected from the catchment health facilities. Ten percent of the collected data was check by the supervisor daily for completeness and finally the principal investigator monitored the overall quality of data collection. The collected data was cleaned, coded, and entered into Epi Info and then exported to SPSS version 20.0 window program for further analysis. Frequencies and cross tabulations were used to check for missed values and variables. Errors were identified and corrected after revising the original questionnaires. Frequencies, proportions, measure of central tendency and measure of variation were used to describe the study subjects. Descriptive statistics was used to measure level of knowledge about danger signs of childbirth, postpartum and frequencies of respondents’ socio demographic characteristics. Multivariate and bivariate logistic regressions were computed to identify associated factors of knowledge about danger signs of childbirth and postpartum. Odds ratio was calculated both to assess the association and measure the strength of the association between explanatory and outcome variables. Finally, the results were presented using crude odds ratio (COR), adjusted odds ratio (AOR) and confidence level (95% CI). In all analyses, P value < 0.05 were considered as a level of significance. Spontaneous knowledge: refers to the respondent’s naming a sign without being asked about that sign by name. Knowledgeable about danger signs of childbirth Women who can spontaneously mentioned at least two danger signs of childbirth from seven danger signs. Knowledge about danger signs of postpartum: Women who can spontaneously mentioned at least two danger signs of postpartum from ten danger signs. Danger signs: refers to the alert of obstetric complications those occur commonly in the middle and late pregnancy, labor/child birth and post-partum period. The danger signs that was looked at in this study include severe vaginal bleeding, convulsions, severe headache, blurred vision, severe abdominal pain, high fever, loss of consciousness, labor lasting greater than 12 h, accelerated/reduced fetal movement, swelling of fingers, face and legs [2, 7, 24]. Ethical clearance was obtained from research ethical clearance board of Addis continental institute of public health and Adama science and Technology University, and permission and support letter was obtained from Dale woreda health office. Before enrolling any of the eligible study participants, the purpose, the benefits, and the confidential nature of the study was described and discussed for each participant. Written informed consent was obtained from all participants. In the case of age less than 18 years verbal consent was obtained from their family and approved by ethics review committee. The discussions between the data collectors and the respondents were takes place privately and individually. Only those consented and proved their willingness to take part in the study was enrolled and interviewed. To keep confidentiality, the information collected from this research project was kept confidential and information from the participant was collected by this study was stored in the file, without participant’s name. In addition, it was not revealed to anyone except the investigator and all responses given by participants was kept confidential by using key and locked system like computer pass word whereby no one have an access to see it and at the end of the data analysis and thesis presentation, the questionnaire was burned. The women who had no knowledge about danger signs of pregnancy, health information was given about possible danger signs that can occur during childbirth and postpartum and if any one of danger sign happens, they should have go to health institution urgently and report immediately to health professionals to obtain emergency obstetric care.

AI Digest

Study Justification:

– Maternal mortality is a global issue, with approximately 800 women dying every day from preventable causes related to pregnancy and childbirth.
– The majority of these deaths occur in the postpartum period, within 24 hours after childbirth.
– Raising awareness among women about obstetric danger signs during childbirth and postpartum is crucial for safe motherhood and reducing maternal mortality.

Study Highlights:

– The study was conducted in Dale district, Southern Ethiopia.
– A community-based cross-sectional study was conducted from December 15, 2017, to February 10, 2018.
– A total of 732 women who had at least one birth prior to the survey were interviewed, resulting in a response rate of 93.6%.
– The most commonly mentioned danger sign during childbirth was severe vaginal bleeding.
– Only 45.5% of women could mention at least two danger signs during childbirth, and 29.1% could mention two danger signs during the postpartum period.
– Factors significantly associated with knowledge of danger signs during postpartum included urban residence and delivering previous births at a health institution.
– Factors significantly associated with knowledge of danger signs during childbirth included secondary level education or higher and the use of antenatal care during the last pregnancy.
– The level of knowledge about danger signs of childbirth and postpartum was found to be low, indicating a potential delay in seeking healthcare.

Recommendations for Lay Readers and Policy Makers:

– Improve awareness and knowledge among mothers about danger signs during childbirth and postpartum.
– Strengthen maternal health services to address the identified gap in awareness.
– Design and implement appropriate strategies to provide targeted health information, education, and communication to mothers.
– Encourage the use of antenatal care services during pregnancy to improve knowledge of danger signs.
– Promote institutional deliveries to enhance knowledge and access to emergency obstetric care.

Key Role Players:

– Health professionals: Nurses, doctors, midwives, and community health workers.
– Community leaders and volunteers: To assist in disseminating health information and education.
– Local government authorities: To support and coordinate efforts in improving maternal health services.
– Non-governmental organizations (NGOs): To provide resources and support for awareness campaigns and education programs.

Cost Items for Planning Recommendations:

– Training programs for health professionals and community volunteers.
– Development and dissemination of educational materials.
– Awareness campaigns through various media channels.
– Support for antenatal care services.
– Infrastructure improvements in health facilities.
– Monitoring and evaluation of the implemented strategies.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong, but there are some areas for improvement. The study was conducted using a community-based cross-sectional design, which allows for data collection from a representative sample. The sample size was determined using a statistical package, and the response rate was high. The study used structured questionnaires and performed bivariate and multivariate logistic regression analyses. However, there are some limitations to consider. The study was conducted in a specific district in Southern Ethiopia, which may limit the generalizability of the findings. The study relied on self-reported knowledge, which may be subject to recall bias. Additionally, the abstract does not provide information on the validity and reliability of the questionnaire used. To improve the evidence, future studies could consider using a larger and more diverse sample, utilize objective measures of knowledge, and provide information on the validity and reliability of the instruments used.

Abstract

The study was conducted in Dale district of Southern Ethiopia, which was one of 19 woreda of Sidama zone, SNNPR region, Ethiopia and which is located 308 km Southeast of Addis Ababa. Dale is one of 19 Districts in Sidama Zone of South Nations and Nationalities Regional State. As projected from the 1994 Ethiopian census, the district had a total population of 264, 544 and 61,639 women of age 15–49 years [23]. Administratively, the District was subdivided into 36 rural and 6 urban Kebeles in which 264,544 and 45,528 population respectively. The study was conducted from December 15, 2017 up to February 30, 2018. Community based cross-sectional study was conducted to measure the level of knowledge about danger signs of childbirth, postpartum and associated factor among mothers who gave birth in the last 12 months prior to the survey on randomly selected kebeles in Dale district of southern Ethiopia. The required sample size was determined using Statcalc program of the EpiInfo statistical package, which was estimating a single population proportion with the assumption that the proportion of knowledge about the obstetric danger signs (36.4%) [18], 5% of margin of error, 95% of confidence interval and design effect of 2, which gives 711 study participants and 10% of expected non response rate, which gives sample size of total 782 study participants. Multistage sampling was used to select the study subjects. First, all the kebeles/ sub-districts in the district were stratified into urban and rural. Then 2 out of 6 urban and 11 out of 36 rural Kebeles were randomly selected. The calculated sample size was proportionally allocated to urban (n = 120) and rural (n = 662) according to their number of households. Then, sampling frames of households was prepared for each kebele in collaboration with the administrators of respective kebeles. Households with a woman who gave birth in the last 12 months prior to the survey were selected and grouped into the village and the villages were selected by using simple random sampling. For selecting the study participants, eligible women who found in the selected villages were the part of the study until sample size allocated for each kebele was enough. Whenever more than one eligible respondent were found in the same selected household, only one respondent was chosen by lottery method. Pretested and structured interviewer administered questionnaire, which was first prepared in English and translated into local language (Sidamigna) was employed to obtain information on socio-demographic, obstetric history, and knowledge of women about danger signs of childbirth and postpartum. Diploma clinical nurse interviewers, they were fluent in the local language (Sidamigna) and familiar with the local customs, were employed to collect the data and supervised by one bachelor degree graduated nurse professional and one bachelor degree graduated Public health professional who were currently working in the catchment health centers and by the principal investigator as well. The data collectors and supervisors were trained for 1 day on data collection. The questionnaire was pre-tested on 39 mothers who gave birth in the last 12 months in Wonsho district to assess for its clarity, length, and completeness and skip patterns. Then after some adjustment was done in the questionnaire and extra briefing were given to the data collectors and supervisors. To insure the quality of the data, daily meeting was held between the principal investigator and data collectors to troubleshoot any problems that arose. In addition, inspection for completeness and quality of data collection was carried out daily by the supervisors and detailed feedback was provided to data collectors. Questionnaire was prepared in English version and translated in to Sidamigna local language and back to English. It was pre-tested on 5% of the calculated sample size in Wonsho district that was not select in the study. Additional adjustment on questionnaire was made based on the results of the pre-test. Data collection was carried out by trained nurses who were selected from the catchment health facilities. Ten percent of the collected data was check by the supervisor daily for completeness and finally the principal investigator monitored the overall quality of data collection. The collected data was cleaned, coded, and entered into Epi Info and then exported to SPSS version 20.0 window program for further analysis. Frequencies and cross tabulations were used to check for missed values and variables. Errors were identified and corrected after revising the original questionnaires. Frequencies, proportions, measure of central tendency and measure of variation were used to describe the study subjects. Descriptive statistics was used to measure level of knowledge about danger signs of childbirth, postpartum and frequencies of respondents’ socio demographic characteristics. Multivariate and bivariate logistic regressions were computed to identify associated factors of knowledge about danger signs of childbirth and postpartum. Odds ratio was calculated both to assess the association and measure the strength of the association between explanatory and outcome variables. Finally, the results were presented using crude odds ratio (COR), adjusted odds ratio (AOR) and confidence level (95% CI). In all analyses, P value < 0.05 were considered as a level of significance. Spontaneous knowledge: refers to the respondent’s naming a sign without being asked about that sign by name. Knowledgeable about danger signs of childbirth Women who can spontaneously mentioned at least two danger signs of childbirth from seven danger signs. Knowledge about danger signs of postpartum: Women who can spontaneously mentioned at least two danger signs of postpartum from ten danger signs. Danger signs: refers to the alert of obstetric complications those occur commonly in the middle and late pregnancy, labor/child birth and post-partum period. The danger signs that was looked at in this study include severe vaginal bleeding, convulsions, severe headache, blurred vision, severe abdominal pain, high fever, loss of consciousness, labor lasting greater than 12 h, accelerated/reduced fetal movement, swelling of fingers, face and legs [2, 7, 24]. Ethical clearance was obtained from research ethical clearance board of Addis continental institute of public health and Adama science and Technology University, and permission and support letter was obtained from Dale woreda health office. Before enrolling any of the eligible study participants, the purpose, the benefits, and the confidential nature of the study was described and discussed for each participant. Written informed consent was obtained from all participants. In the case of age less than 18 years verbal consent was obtained from their family and approved by ethics review committee. The discussions between the data collectors and the respondents were takes place privately and individually. Only those consented and proved their willingness to take part in the study was enrolled and interviewed. To keep confidentiality, the information collected from this research project was kept confidential and information from the participant was collected by this study was stored in the file, without participant’s name. In addition, it was not revealed to anyone except the investigator and all responses given by participants was kept confidential by using key and locked system like computer pass word whereby no one have an access to see it and at the end of the data analysis and thesis presentation, the questionnaire was burned. The women who had no knowledge about danger signs of pregnancy, health information was given about possible danger signs that can occur during childbirth and postpartum and if any one of danger sign happens, they should have go to health institution urgently and report immediately to health professionals to obtain emergency obstetric care.

Materials

Innovations

Based on the provided description, here are some potential innovations that can be used to improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop and implement mobile applications that provide information on obstetric danger signs, postpartum care, and access to emergency obstetric care. These apps can be easily accessible to women in rural areas, where healthcare facilities may be limited.

2. Community Health Workers: Train and deploy community health workers to educate and raise awareness among women about obstetric danger signs and the importance of seeking timely healthcare. These workers can provide information and support at the community level, bridging the gap between healthcare facilities and women in remote areas.

3. Telemedicine: Establish telemedicine services to enable remote consultations between healthcare providers and pregnant women. This can help address the issue of limited access to healthcare facilities by providing virtual consultations and guidance on obstetric danger signs.

4. Health Information Campaigns: Conduct targeted health information campaigns to educate women and their families about obstetric danger signs and the importance of seeking timely care. These campaigns can utilize various channels such as radio, television, and community gatherings to reach a wider audience.

5. Maternal Health Vouchers: Introduce maternal health vouchers that provide subsidized or free access to maternal healthcare services, including antenatal care, delivery, and postpartum care. This can help overcome financial barriers and improve access to essential maternal health services.

6. Transportation Support: Provide transportation support for pregnant women in remote areas to access healthcare facilities for antenatal care, delivery, and postpartum care. This can involve partnerships with local transport providers or the provision of ambulances in areas with limited transportation infrastructure.

7. Strengthening Health Systems: Invest in strengthening healthcare systems, including improving infrastructure, training healthcare providers, and ensuring the availability of essential medical supplies and equipment. This can help ensure that healthcare facilities are equipped to provide quality maternal healthcare services.

It is important to note that the implementation of these innovations should be context-specific and tailored to the needs and resources of the specific region or community.

AI Innovations Description

Based on the study conducted in Dale district, Southern Ethiopia, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Strengthening Health Education: Develop targeted health information, education, and communication strategies to raise awareness among women about obstetric danger signs during childbirth and the postpartum period. This can be done through various channels such as community health workers, antenatal care visits, and community outreach programs.

2. Enhancing Access to Antenatal Care (ANC): Promote the use of ANC services by emphasizing the importance of regular check-ups during pregnancy. ANC visits provide an opportunity to educate women about danger signs and ensure early detection and management of complications.

3. Improving Health Facility Delivery: Encourage women to deliver their babies at health institutions, as this has been found to be significantly associated with knowledge of danger signs during postpartum. This can be achieved by addressing barriers such as transportation, cost, and cultural beliefs through targeted interventions.

4. Addressing Socioeconomic Factors: Recognize that knowledge about danger signs of childbirth and postpartum is influenced by factors such as place of residence and formal education. Implement interventions that address these socioeconomic factors, such as providing access to education and improving infrastructure in rural areas.

5. Strengthening Health Systems: Ensure that health facilities have the necessary resources, trained healthcare providers, and equipment to provide emergency obstetric care. This includes establishing referral systems and improving the quality of care provided during childbirth and the postpartum period.

By implementing these recommendations, it is expected that access to maternal health services will be improved, leading to early detection and management of obstetric complications, ultimately reducing maternal mortality rates.

AI Innovations Methodology

Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Strengthening Health Education: Develop and implement targeted health education programs to raise awareness among women about obstetric danger signs during childbirth and the postpartum period. This can be done through community-based interventions, antenatal care visits, and health promotion campaigns.

2. Enhancing Antenatal Care (ANC) Services: Improve access to ANC services by ensuring that all pregnant women receive comprehensive information about danger signs during childbirth and postpartum. ANC visits can be used as an opportunity to educate women about the importance of seeking timely medical care.

3. Promoting Institutional Deliveries: Encourage women to deliver their babies in health institutions by addressing barriers such as transportation, cost, and cultural beliefs. Providing incentives and ensuring the availability of skilled birth attendants can help increase the utilization of health facilities for delivery.

4. Strengthening Referral Systems: Establish and strengthen referral systems between community health centers and higher-level health facilities to ensure timely access to emergency obstetric care. This can involve training healthcare providers, improving communication channels, and providing necessary resources for transportation.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Baseline Data Collection: Collect data on the current level of knowledge about obstetric danger signs, utilization of ANC services, place of delivery, and other relevant indicators in the target population.

2. Intervention Implementation: Implement the recommended interventions, such as health education programs, ANC service improvements, promotion of institutional deliveries, and strengthening referral systems.

3. Data Collection after Intervention: Collect data after the interventions have been implemented to assess changes in knowledge, ANC utilization, place of delivery, and other relevant indicators.

4. Data Analysis: Analyze the collected data to determine the impact of the interventions on improving access to maternal health. This can be done by comparing the baseline data with the post-intervention data and conducting statistical analyses to identify significant changes.

5. Evaluation and Recommendations: Evaluate the effectiveness of the interventions and make recommendations for further improvements. This can involve assessing the reach and impact of the interventions, identifying any challenges or barriers, and suggesting strategies for sustainability and scalability.

By following this methodology, it will be possible to simulate the impact of the recommended interventions on improving access to maternal health and make evidence-based decisions for future interventions.

Author

Dima Health

Statistics:

Citations: 1

Identifiers:

DOI: 10.1186/s12884-020-02989-7

Research Areas:

Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Technology and Innovations

Study Countries:

Ethiopia

Study Design:

Case-Control Study, Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative

Participants Gender:

Female