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Background: Improved knowledge of obstetric danger signs, birth preparedness practices, and readiness for emergency complications are among the strategies aimed at both enhancing utilization of maternal health services and increasing access to skilled care during childbirth, particularly for women with obstetric complications. It is unclear whether knowledge of danger signs translates into improved birth preparedness and complication readiness. The objective was to assess the association between knowledge of danger signs and birth preparedness among women admitted with pregnancy complications.Methods: The study included 810 women admitted in the antepartum period to Mulago hospital, Uganda. Data was collected on socio-demographic characteristics, reproductive history, pregnancy complications, knowledge of danger signs, and birth preparedness/complication readiness (BPCR). Logistic regression analyses were conducted to explore the relationship between knowledge of danger signs and birth preparedness.Results: Only about 1 in 3 women were able to mention at least three of the five basic components of BPCR, and could be regarded as ‘knowledgeable on BPCR’. One in every 4 women could not mention any of the five components. Women with history of obstetric problems during the previous pregnancy were more likely to be knowledgeable on danger signs when compared to those who had no complications in prior pregnancy. Women who were knowledgeable on danger signs were four times more likely to be knowledgeable on BPCR as compared to those who were not knowledgeable.Conclusions: Though awareness about danger signs was low, knowledge of danger signs was associated with knowledge of birth preparedness. More emphasis should be given to emergency/complication readiness during antenatal care sessions. There is a need to strengthen existing policy interventions to address birth preparedness and complication readiness for obstetric emergencies.
This research was part of a mixed-methods study assessing preventable factors associated with maternal and neonatal near-miss morbidity, from the perspective of patients and healthcare providers. The study was conducted at Mulago hospital, Uganda’s national referral hospital and the teaching hospital for Makerere University. It has over 1,500 beds, of which over 400 are maternity beds, and conducts over 35,000 deliveries per year. Participants were women consecutively admitted to hospital from 20 to 36 weeks of gestation for complications of pregnancy and all women with pregnancy complications were eligible for inclusion into the study. The main reason for admission was febrile illness (34%). Others were anemia, hypertensive disorders, preterm labor, false labor, urinary tract infections, and anemia in pregnancy. Data was collected as an exit interview after hospital discharge using the tool on monitoring birth preparedness from JHIPIEGO [16]. This tool is used to guide assessment and monitoring of safe motherhood programs by evaluating interventions at multiple levels by identifying indicators, referred to as the BPCR Index, for each of six levels: the individual woman, her family (husband/partner), the community, the health facility, the provider, and the policymaker [19]. This tool is used to derive these indicators and in tracking progress (extent to which the indicators have been realized). The behaviors or practices identified by the tool are also labelled ‘process indicators’, because they measure processes along the pathway to maternal death or survival [20]. The tool was adapted to the local context of a hospital by eliminating the policy maker component of the instrument. The data collected included socio-demographic characteristics such as age, marital status, level of education and occupation, number of pregnancies, number of deliveries, any abortions, number of living children, gestation age of the current pregnancy (obtained from a combination of the last normal menstrual period, the fundal height on abdominal palpation, and abdominal ultrasound examination). Other data included obstetric complications during the current and previous pregnancies. Women were asked to spontaneously cite six danger signs during pregnancy, childbirth, and immediate postpartum period, as well as two danger signs for newborns; these were open-ended questions. A woman who reported at least one danger sign in pregnancy, childbirth or postpartum period was considered to be ‘knowledgeable’ on danger signs. We also asked about awareness components of BPCR. Women who mentioned at least three of the five basic components of BPCR were regarded as ‘knowledgeable’ on BPCR. Data was entered and analyzed by using SPSS windows version 16. We compared the proportion of women who were knowledgeable about danger signs with knowledge on BPCR. The independent variables included socio-demographic characteristics, reproductive history, pregnancy complications, and being knowledgeable about danger signs (knowledge of at least one antepartum, intrapartum, and postpartum danger sign), while the independent variable was being knowledgeable on BPCR. Variables with a P value of <0.2 were further analyzed using the logistic regression analysis to assess factors independently associated with knowledge about BPCR. Ethical approval to conduct the study was obtained from the Ethics and research committees of Mulago hospital (REC 310–2012), the School of Medicine, Makerere University College of Health Sciences (REC 2012–172) and Uganda National Council for Science and Technology. Permission to conduct the study was obtained from the department of Obstetrics and Gynecology, Makerere University. All participants gave written informed consent to be interviewed.
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