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Adams YJ, Agbenyo JS. Improving the Quality of Postpartum Care in Ghana: Protocol for a Parallel Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e47519. [PMID: 37606965 PMCID: PMC10481215 DOI: 10.2196/47519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Although the postpartum period poses substantial risks and can result in significant maternal morbidity and mortality, postpartum care of the mother receives much less attention in transitional countries. OBJECTIVE We describe the protocol for a randomized controlled trial to implement and evaluate a postpartum care delivery model titled Focused-PPC (Focused Postpartum Care). METHODS Focused-PPC is an integrated group postpartum care model that meets the clinical care, education, and support needs of mothers up to 1 year after birth. The Focused-PPC intervention is a parallel randomized controlled trial with a total of 192 postpartum women at 4 health centers in Tamale, Ghana. Participants will be randomized into 1 of 2 trial arms at a 1:1 allocation ratio: (1) the control arm, which receives the standard postnatal care currently delivered in health facilities, or (2) the intervention arm, which receives the Focused-PPC model of care. Women enrolled in the intervention arm will receive postpartum clinical assessments and education for the first 6 weeks and will continue to receive education, measures of vital signs, and peer support for 12 months post partum during child welfare visits. Led by trained midwives, each postpartum group in the intervention arm will meet at 1-2 weeks, 6 weeks, and monthly thereafter for up to 1 year post partum, following the Ghana Health Service postnatal care schedule. RESULTS The Focused-PPC guide, data collection tools, and audiovisual education materials were successfully developed and translated into the local language. We have enrolled and conducted baseline surveys for 192 women (sample size met) in the Focused-PPC trial who have been randomized into intervention and control arms. We have established a total of 12 Focused-PPC groups in the intervention arm, 3 groups from each site, all of which have sessions underway. CONCLUSIONS Focused-PPC has the potential to change the postpartum care delivery model in Ghana and other countries in sub-Saharan Africa and beyond. TRIAL REGISTRATION ClinicalTrials.gov NCT05280951; https://clinicaltrials.gov/study/NCT05280951. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47519.
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Affiliation(s)
- Yenupini Joyce Adams
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, United States
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Yunitasari E, Matos F, Zulkarnain H, Kumalasari DI, Kusumaningrum T, Putri TE, Yusuf A, Astuti NP. Pregnant woman awareness of obstetric danger signs in developing country: systematic review. BMC Pregnancy Childbirth 2023; 23:357. [PMID: 37194036 DOI: 10.1186/s12884-023-05674-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 05/03/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Mother's awareness of obstetric danger signs is the degree of a pregnant woman to fully utilize her knowledge of the signs and symptoms of complications of pregnancy, which helps the mother and family to seek medical help immediately. High maternal and infant mortality rates in developing countries are due to a combination of a lack of quality, resources and access to health services coupled with mother's lack of awareness. The purpose of this study was to collect current empirical studies to describe the pregnant women awareness about the obstetric danger sign in developing country. METHOD This review employed the Prisma-ScR checklist. The articles searched in four electronic databases (Scopus, CINAHL, Science Direct, Google Scholar). Variables that used to search the articles (pregnant woman, knowledge, awareness, danger signs pregnancy). The Framework used to review is PICOS. RESULT The results of the article found 20 studies which met inclusion criteria. The determinants were high educational status, more pregnancy experience, more ANC visit, and labour in the health facility. CONCLUSION The level of awareness is low to medium, only some have fair awareness, in which related to determinant. The recommended effective strategy is to improve the ANC program by assess the risk of obstetric danger sign promptly, assess the barrier of health seeking related to the family support, i.e. the husband and the elderly. Additionally, use MCH handbook or mobile application to record the ANC visit and communicate with the family.
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Affiliation(s)
- Esti Yunitasari
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia.
| | - Filomena Matos
- Escola Superior de Saúde, University of Algarve, Faro, Portugal
- UICISA:E, Health Sciences Research Unit: Nursing, Coimbra, Portugal
| | | | | | | | | | - Ah Yusuf
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Nining Puji Astuti
- Department of Nursing, Faculty of Medicine and Health Science, Satya Wacana Christian University, Salatiga, Indonesia
- Student of Medical and Surgical Nursing Specialist Program, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
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Adams YJ, Ray HE, Sladek L, Amason J. Knowledge of immediate newborn care and management of complications among midwives in Ghana. Midwifery 2023; 121:103654. [PMID: 36965432 DOI: 10.1016/j.midw.2023.103654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/19/2022] [Accepted: 03/11/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Midwives are instrumental in improving maternal/newborn health outcomes. Since complications after childbirth are leading causes of maternal deaths, midwives' knowledge of how to manage complications and care for the newborn is important. This study assessed midwives' knowledge of immediate newborn care and management of postpartum complications. DESIGN A cross-sectional descriptive survey design was used. SETTING Four hospitals that provide inpatient maternity services in Tamale, Ghana. PARTICIPANTS 245 midwives who worked in the four hospitals. MEASUREMENTS Data were collected in December 2018 using an electronic survey questionnaire by the Johns Hopkins Program for International Education in Gynecology and Obstetrics, and analyzed using descriptive, bivariate, and multivariate statistics. FINDINGS About 98% of midwives were female. The mean age of midwives was 31.87 years. The percentage of midwives who responded correctly to questions on newborn care and management of postpartum complications ranged from 29.80% to 89.39%, and 32.17% to 91.43% respectively. Midwives were most knowledgeable about breastfeeding and immediate hemorrhage intervention, and least knowledgeable about cord care, thermal protection, newborn resuscitation, contraindications for vacuum extraction, treating metritis, and performing a cervical repair. Years of experience and age are predictive factors of midwives' knowledge. CONCLUSION/IMPLICATIONS There remains the opportunity for continuing education on complication management. Additional training of midwives on newborn resuscitation is recommended.
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Affiliation(s)
- Yenupini Joyce Adams
- Eck Institute for Global Health, University of Notre Dame, 915 Flanner Hall, Notre Dame, IN 46556, USA.
| | - Herman E Ray
- Analytics and Data Science Institute and Department of Statistics and Analytical Sciences, Kennesaw State University, Kennesaw, Georgia
| | - Lynn Sladek
- Labor and Delivery Unit, Piedmont Atlanta Hospital, Atlanta, Georgia
| | - Janeen Amason
- WellStar School of Nursing, Kennesaw State University, Kennesaw, Georgia
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Mesele TT, Syuom AT, Molla EA. Knowledge of danger signs in pregnancy and their associated factors among pregnant women in Hosanna Town, Hadiya Zone, southern Ethiopia. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1097727. [PMID: 36970710 PMCID: PMC10036572 DOI: 10.3389/frph.2023.1097727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/16/2023] [Indexed: 03/12/2023] Open
Abstract
BackgroundDanger signs in pregnancy can warn of maternal health problems. In developing African countries, including Ethiopia, the rate of maternal mortality is high. There is little knowledge of danger signs during pregnancy and their associated factors at the community level in the study area.MethodsA community-based, cross-sectional study was conducted to assess knowledge about danger signs among pregnant women in Hosanna Zuria Kebeles between 30 June and 30 July 2021. A simple random sampling method was used to select eligible pregnant women. The sample size was proportionally allocated based on the number of pregnant women in each kebele. Data were collected in face-to-face interviews using a pretested questionnaire. The descriptive results were presented as proportions, whereas the analytic results were presented as adjusted odds ratios (AOR).ResultsThe prevalence of good knowledge of danger signs in pregnancy was 259/410 (63.2%, 95% confidence interval (CI) 58.3–67.8). The most common known danger signs during pregnancy were severe vaginal bleeding (n = 227, 55.4%), followed by blurred vision (n = 224, 54.6%). In the multivariable analysis, the age of the respondent (AOR = 3.29, 95% CI 1.15–9.38), the tertiary education of the mother (AOR = 5.40, 95% CI 2.56–11.34), and the number of live births (AOR = 3.95, 95% CI 2.08–7.48) were statistically significant factors.ConclusionThere was an adequate prevalence of knowledge of danger signs in pregnancy among pregnant mothers compared with different studies in Ethiopia and different countries. Advanced maternal age, the respondent's level of education, and the number of live births were found to be independent determining factors for the level of knowledge on danger signs in pregnancy among pregnant mothers. Health facilities and healthcare providers should focus on antenatal care and the age and parity of the mother when giving information about danger signs in pregnancy. The Ministry of Health should provide reproductive health services in rural areas and encourage education for women. Further studies need to be conducted and include danger signs in the three trimesters using a qualitative study design.
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Affiliation(s)
- Tiruye Tilahun Mesele
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- Correspondence: Tiruye Tilahun Mesele
| | - Asmra Tesfahun Syuom
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Eshetie Amare Molla
- Department of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Mihret M, Wondimu H. Assessment of Knowledge about Obstetric Danger Signs and Associated Factors among Pregnant Women in Debre Tabor Town, Northwest Ethiopia. J Pregnancy 2023; 2023:1475500. [PMID: 36936999 PMCID: PMC10019974 DOI: 10.1155/2023/1475500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
Background World Health Organization estimates that 800 women die from pregnancy or childbirth-related complications around the world every day. With the assumption that "every pregnancy faces risk" women should be aware of the danger signs of obstetric complications during pregnancy, delivery, and postpartum. Indications on the prevalence of obstetric danger signs and risk factors were crucial in designing programs at different levels in reducing maternal morbidity and mortality. Objective To assess the knowledge about obstetric danger signs and associated factors among pregnant women in Debre Tabor town, Northwest Ethiopia, 2021. Methods A community-based cross-sectional study was conducted with 295 respondents to assess knowledge about obstetrical danger signs among pregnant women in Debre Tabor town from July to September 2021. Data were collected through self-administered questionnaires. Proportional followed by simple random sampling was used to select the study participants among the pregnant women in each of the six kebeles of the town. Adjusted odds ratios at 95% confidence interval and a value of p < 0.05 were used to identify the predictors. Results From a total of 295 interviewed, 61% of them were poorly knowledgeable about obstetric danger signs, but 39% of them were knowledgeable. According to our study, maternal age less than or equal to 30 years (adjusted odds ratio = 5.44; 95% confidence interval: 3.26,9.10), no formal education (adjusted odds ratio = 9.488; 95% confidence interval: 4.73, 13.14), one-time gravidity (adjusted odds ratio = 7.81; 95% confidence interval: 4.79, 9.19), and frequency of antenatal follow-up less than 4 times (adjusted odds ratio = 4.10; 95% confidence interval: 1.88, 8.96) were factors which significantly associated with the poor knowledge of obstetric danger signs. Conclusion As the knowledge of pregnant women towards obstetric danger signs was low, maternal age less than or equal to 30 years, no formal education, one-time gravidity, and less than 4 times the frequency of antenatal follow-up are associated factors for poor knowledge on obstetric danger signs.
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Kebede AA, Taye BT, Wondie KY. Factors associated with comprehensive knowledge of antenatal care and attitude towards its uptake among women delivered at home in rural Sehala Seyemit district, northern Ethiopia: A community-based cross-sectional study. PLoS One 2022; 17:e0276125. [PMID: 36223422 PMCID: PMC9555639 DOI: 10.1371/journal.pone.0276125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 09/29/2022] [Indexed: 11/07/2022] Open
Abstract
Background Despite the current sustainable development goal period (i.e. SDG 3), the prevention of maternal and neonatal mortality is not satisfactory in Ethiopia. Keeping women knowledgeable about antenatal care and maintaining a positive attitude towards its uptake, particularly in the marginalized rural community is crucial. However, evidence regarding the knowledge and attitude of women towards antenatal care uptake is scarce. Therefore, this study aimed to assess factors affecting comprehensive knowledge of antenatal care and attitude towards its uptake among women delivered at home in rural Sehala Seyemit district, northern Ethiopia. Methods A community-based cross-sectional study was conducted from September 1st to October 15th, 2020. A multi-stage sampling technique was used to select 653 women. The data were collected using a semi-structured interview guide. Data were entered into EPI INFO 7.1.2 and analyzed by SPSS version 25. Both bivariable and multivariable logistic regression analyses were undertaken to identify factors associated with women’s knowledge of antenatal care and attitude towards its uptake. The level of significant association in the multivariable analysis was determined based on a p-value of < 0.05. Results Women’s knowledge of antenatal care and positive attitude towards its uptake was 56.5% and 75.2%, respectively. Older age (AOR = 7.2; 95% CI: 3.43, 15.1), media exposure (AOR = 3.69; 95% CI: 2.41, 5.65), history of abortion (AOR = 11.6; 95% CI: 3.3, 14.6), time to reach health facility (AOR = 4.58; 95% CI: 3.05, 6.88), and history of obstetric danger signs (AOR = 7.3; 95% CI: 3.92, 13.64) were factors significantly associated with knowledge of antenatal care. Furthermore, higher decision-making power (AOR = 8.3; 95% CI: 4.8, 13.83), adequate knowledge of antenatal care (AOR = 2.2; 95% CI: 1.26, 3.71), delivery attended by health extension workers (AOR = 2.3; 95% CI: 1.1, 5.1), and media exposure (AOR = 2.27; 95% CI: 1.30, 3.97) were predictors of a favorable attitude towards antenatal care utilization. Conclusion Although the majority of women in the present study had a favorable attitude towards antenatal care uptake, their knowledge level was inadequate. Strengthening access to transportation, mass media, involvement in household decision-making, and encouraging women to deliver at a health facility by a skilled provider may increase women’s knowledge and attitude towards antenatal care uptake, thereby improving maternal healthcare service uptake.
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Affiliation(s)
- Azmeraw Ambachew Kebede
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Birhan Tsegaw Taye
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Kindu Yinges Wondie
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Santhoshkumari M, Sharmil SH. Efficacy of capacity building educational interventions in the management of obstetric complications: A systematic review. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:194. [PMID: 36003245 PMCID: PMC9393949 DOI: 10.4103/jehp.jehp_1392_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/01/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Delay in the diagnosis and management of obstetric complications lead to raised mortality rate. This can be curtailed by appropriate implementation of the educational intervention among the health-care providers. Hence, this review aimed to identify the literature evidence of the efficacy of various educational interventions training in the management of obstetric complications. MATERIALS AND METHODS We searched PUBMED, Web of Science, SCOPUS, Google Scholar, Cochrane, and maternity care databases with studies published from 2011 to 2021 for identifying studies related to this educational intervention review using MeSH terms and free terms. The search process was also done on the websites of the World Health Organization and the reproductive health library in the English language. From the 1823 abstracts reviewed, 16 studies were included (15 quasi-experimental, 01 randomized clinical trial, and 01 exploratory research design). We identified studies that included skill assessment of nurses, midwives, auxilliary nurse-midwives (ANMs), medical students, interns, and doctors after implementing various educational interventions. RESULTS According to the findings of this literature, achieving enhanced nursing management of obstetric complications has been developed. Especially, it suggests through better nursing training and education and also by providing sufficient resources, time, and coordination with obstetric specialists, nurses and midwives will be able to implement their care roles, which include proper diagnosis, appropriate intervention, advanced care, client education, and psychological support. The efficacy of each educational intervention varies and depends on the participants' understanding, interest, and the advancement of the teaching-learning method used. CONCLUSION This systematic review reveals abroad and logical move towards the evaluation of various educational interventions in the field of obstetric complications. Among all the educational interventions implemented, mobile application, and simulation-based training play a major role in improving the knowledge and skills of health-care providers in the management of obstetric complications.
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Affiliation(s)
- M Santhoshkumari
- PhD Nursing Candidate, Dr. M.G.R. Educational and Research Institute (Deemed to be University), Maduravoyal, Chennai, TamilNadu 600095, India
- Nursing Officer, Indira Gandhi Medical College & Research Institute, Puducherry, India
| | - S Hepsibah Sharmil
- PhD Research Study Supervisor in Nursing, Dr. M.G.R.Educational and Research Institute (Deemed to be University), Maduravoyal, Chennai, Tamil Nadu 600095, India
- Principal, Chettinad College of Nursing, Chettinad Academy for Research and Education (CARE) – Deemed to be University, Chettinad Health City, Rajiv Gandhi Salai, OMR, Kelambakkam, Tamil Nadu 603103, India
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Sudarmiati S, Prakoso T. Development of Smart Postpartum Care Application Based on Community Health Centers, as a Method for Mentoring Postpartum Mothers: A Mixed Method Approach. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2022; 27:188-192. [PMID: 36237957 PMCID: PMC9552582 DOI: 10.4103/ijnmr.ijnmr_58_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/10/2021] [Accepted: 01/11/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Early detection of postpartum problems can help reduce maternal mortality in Indonesia. Early detection can be achieved by monitoring postpartum mothers using a guidance system. The purpose of this study was to describe the development of a guidance system, namely, Smart Postpartum Care (SMAP CARE) and present its functional and acceptance tests. MATERIALS AND METHODS This study was a development study conducted in 2019 using a mixed-method approach. Data were collected through Focus Group Discussions (FGDs) and a literature study. The FGD participants consisted of six doctors, six nurses, and midwives from six community health Public health center in Semarang City, Indonesia. The collected data were analyzed using the Colaizzi method. The content of the postpartum mentoring application was based on input from the experts in health education and health services. Before widely applied, a feasibility study on the application was carried out in community health centers involving postpartum mothers and health care teams. RESULTS Five themes were generated from FGDs: (1) postpartum monitoring facilities; (2) monitoring postpartum mothers through visits to health centers and home care; (3) problems with postpartum mothers (including problems with mothers, babies, and the environment); (4) management of high-risk postpartum mothers; and (5) the risk of postpartum mothers, which could cause death. The SMAP CARE provides some features to educate postpartum mothers, for example (a) changes in the physiological aspects of postpartum mothers, (b) breast milk, (c) newborn care, (d) signs of danger in newborns, (e) problems with babies, (f) problems with postpartum mothers, and (g) signs of danger in postpartum mothers. CONCLUSIONS The application developed in this research, SMAP CARE, helps to facilitate mentoring for postpartum mothers and can be extended to community health centers in Indonesia.
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Affiliation(s)
- Sari Sudarmiati
- Nursing Department, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
| | - Teguh Prakoso
- Electrical Engineering Department, Faculty of Engineering, Universitas Diponegoro, Semarang, Indonesia
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Adams YJ, Sladek L. A descriptive, cross-sectional study of postpartum education: midwives' self-reported knowledge and teaching of postpartum complications in Ghana. Reprod Health 2022; 19:77. [PMID: 35346240 PMCID: PMC8962571 DOI: 10.1186/s12978-022-01376-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obstetric complications remain the leading causes of maternal deaths. Since it is not always possible to ascertain which women will develop complications and which women will not, all women who have a baby should be educated about warning signs of complications. In this study, we assessed postpartum education provided by midwives, midwives' knowledge to teach patients about complications and their skills to manage postpartum complications. METHODS Descriptive, cross-sectional study of 245 midwives in four hospitals in Tamale, Ghana, using an electronic questionnaire. Data analyzed in Stata 16 software using descriptive, bivariate, and multivariate statistics. RESULTS Majority of midwives were female (98%). Mean age of midwives was 32 years. Most midwives spent 6 to 15 min teaching patients on warning signs of complications (61.89%). Mode of discharge education was mostly individual (83.13%). Most midwives reported no reference materials given to patients (66.39%). About 93.45% of midwives strongly agreed or agreed it is their responsibility to teach all patients, regardless of risk factors, about warning signs of complications. However, midwives did not always teach patients about complications. The majority of midwives felt they were knowledgeable or very knowledgeable to teach patients about hemorrhage (95.08%), infection (94.67%), preeclampsia/ eclampsia (90.95%), and hypertension (89.35%). Similarly, most midwives felt they had the skills to manage these same four obstetric complications. Unsurprisingly, most midwives were more likely to always educate their patients about hemorrhage, infection, preeclampsia/ eclampsia, and hypertension-the complications they were more knowledgeable about. Many midwives felt not knowledgeable about and not competent to manage postpartum depression, cardiac events, pulmonary embolism, and venous thrombosis. In the same regard, many midwives did not teach patients about the life-threatening complications they were least knowledgeable about. CONCLUSIONS Midwives did not always teach patients about complications. Most midwives felt knowledgeable to teach and manage hemorrhage, infection, and preeclampsia/hypertension but not cardiac events, pulmonary embolism, and venous thrombosis. Additional training of midwives on life-threatening complications such as pulmonary embolism and cardiac events is recommended.
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Affiliation(s)
- Yenupini Joyce Adams
- Keough School of Global Affairs, University of Notre Dame, 4035 Jenkins Nanovic Halls, Notre Dame, IN, 46556, USA. .,Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA.
| | - Lynn Sladek
- Labor and Delivery, Piedmont Atlanta Hospital, Atlanta, GA, USA
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Taye BT, Kebede AA, Wondie KY. Intention to use maternal health services and associated factors among women who gave birth at home in rural Sehala Seyemit district: a community-based cross-sectional study. BMC Pregnancy Childbirth 2022; 22:213. [PMID: 35296274 PMCID: PMC8928666 DOI: 10.1186/s12884-022-04447-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/02/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Low maternal healthcare service utilization contributes to poor maternal and newborn health outcomes in rural Ethiopia. 'Motivational factors influence women's intention to perform a specific health behavior, and the intention of subsequent home delivery and related risks that may contribute to women's death is less known. Therefore, this study aimed to assess the intention of maternal health service utilization among women who gave birth at home in the rural Sehala Seyemit district. METHODS A community-based cross-sectional study was conducted from September 1st to October 15th, 2020, among 653 women. A two-stage sampling technique was used to select the study participants. First, a semi-structured, pretested, and interviewer-administered questionnaire were used. The mean of the sum score was also used to categorize the intention as intended and not intended. Second, multivariable logistic regression analysis was computed to identify factors associated with women's intention to use maternal health services. Adjusted odds ratio (AOR) with a 95% confidence interval at a p-value of ≤ 0.05 were used to declare statistical association. RESULTS Of the women who gave birth at home the intention to use maternal health service was 62.3% (95% CI; 59, 66). Women's age of > 30 years (AOR = 6.04; 95%CI: 2.34, 15.60), short time to reach health facility (AOR = 2.52; 95% CI: 1.57, 4.10), media exposure (AOR = 2.10; 95% CI: 1.16, 3.65), history of obstetric danger signs (AOR = 4.60; 95% CI: 2.33, 9.10), positive subjective norms (AOR = 11.20; 95% CI; 6.77, 18.50) and last delivery assisted by traditional birth attendants (AOR = 0.15; 95% CI: 0.06, 0.33) were factors associated with women's intention to use maternal health services. CONCLUSION In this study, maternal health service utilization intention is still unsatisfactory compared to the national target plan. Maternal age, media exposure, obstetric danger signs, distance to a health facility, positive subjective norms, and delivery assistant at delivery were predictors of women's intention to use maternal healthcare services. Improving women's awareness of maternal healthcare services and developing strategies to increase women's access to mass media, skilled birth attendants, and transportation for rural women may enhance their intention to use maternal healthcare services.
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Affiliation(s)
- Birhan Tsegaw Taye
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, PO. Box 445, Debre Berhan, Ethiopia.
| | - Azmeraw Ambachew Kebede
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kindu Yinges Wondie
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Risk factors of dropout from institutional delivery among HIV positive antenatal care booked mothers within one year postpartum in Ethiopia: a case-control study. Arch Public Health 2022; 80:69. [PMID: 35216631 PMCID: PMC8876812 DOI: 10.1186/s13690-022-00819-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/04/2022] [Indexed: 11/26/2022] Open
Abstract
Background The uptake of maternal healthcare services remains suboptimal in Ethiopia. Significant proportions of antenatal care attendees give birth at home in the context of HIV. However, in Ethiopia, evidence is scarce on the predictors of dropout from maternity continuum of care among HIV-positive mothers. Therefore, this study aimed to supply valuable information on risk factors regarding dropout of HIV-positive mothers for institutional delivery services in northwest Ethiopia. Methods A multicenter case–control study was conducted at governmental health facilities in Gondar City from May one to June 30/2018. A total of 222 HIV-positive women were included in the study. Data were collected using structured questionnaires and checklists through face-to-face interview and chart review; entered into EPI INFO version seven, and then exported to SPSS version 25. Both descriptive and analytical procedures were performed. Binary logistic regression analysis was undertaken. A significant association was declared based on the adjusted odds ratio (AOR) with its 95% CI and p-value of ≤ 0.05. Results This study illustrates that maternal age of ≥ 35 years (AOR = 2.37; 95%CI: 1.13,5.13), unmarried marital relation (AOR = 3.28; 95%CI: 1.51, 7.13), unemployed spousal occupation (AOR = 3.91; 95%CI: 1.54, 9.91), family monthly income of ≤ 36 US dollar (AOR = 4.87; 95%CI: 2.08, 11.42) and no obstetric complication in the index pregnancy (AOR = 13.89; 95%CI: 2.73, 27.71) were positively associated with dropout from institutional delivery among HIV positive antenatal care booked mothers. Conclusion In this study, the risk factors of dropout from institutional delivery in the context of HIV-positive women were connected to social determinants of health such as advanced maternal age, unmarried marital status, unemployed husband occupation, and low family income. Therefore, interacting with the health system by focusing on these women in lower socio-economic strata and unmarried HIV-positive ANC attendees, and increasing access to information on obstetric complications during the antenatal care visit would retain clients in the continuum of maternity services. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00819-0.
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Asferie WN, Goshu B. Knowledge of pregnancy danger signs and its associated factors among pregnant women in Debre Tabor Town Health Facilities, South Gondar Administrative Zone, North West Ethiopia, 2019: Cross-sectional study. SAGE Open Med 2022; 10:20503121221074492. [PMID: 35096393 PMCID: PMC8793113 DOI: 10.1177/20503121221074492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/24/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Pregnancy complications are one of the most common health problems and causes of death among women in developing countries. Knowledge of obstetric danger signs during pregnancy, labor, and postnatal period is an essential first step for the appropriate and timely referral. OBJECTIVE To assess knowledge of pregnancy danger signs and its associated factors among pregnant women at Debre Tabor Town Health Facilities, South Gondar Zone, Northwest Ethiopia, 2019. METHODS AND MATERIALS Facility-based cross-sectional study conducted from 30 December 2018 to 30 January 2019 among 340 pregnant women. Simple random sampling was used to select study subjects. Data entered to Epidata 4.2 and exported Statistical package for social science version 26 for analysis. Binary logistic regression analysis was performed to determine predictors of knowledge of pregnancy danger signs among pregnant women. Finally, a p-value less than 0.05 was used to identify the significant variables. RESULT Overall women's knowledge score on pregnancy danger signs was 74.4%. This finding is not satisfactory and affects pregnancy outcomes. Age, religion, women's educational status, family size, educational status, and antenatal care follow-up were identified as predictors of knowledge of pregnancy danger signs. CONCLUSION Overall knowledge scores of pregnancy danger signs among women were satisfactory compared with different researches in Ethiopia and different countries. Age, mother's occupation, and antenatal care visit were significant factors of knowledge of pregnancy danger signs among study participants.
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Affiliation(s)
| | - Bizunesh Goshu
- Debre Tabor Comprehensive Specialized Hospital, Debre Tabor, Ethiopia
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Nchimbi DB, Joho AA. Puerperal sepsis-related knowledge and reported self-care practices among postpartum women in Dar es salaam, Tanzania. WOMEN'S HEALTH 2022; 18:17455057221082954. [PMID: 35285367 PMCID: PMC9110962 DOI: 10.1177/17455057221082954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Knowledge and reported self-care practices of postpartum women are important
for early detection, prevention and treatment of puerperal sepsis. Objectives: This study analyzes the knowledge and self-care practices for prevention of
puerperal sepsis and their determinants among postpartum women. Methods: A hospital-based analytical cross-sectional study which included 343
postpartum women was conducted from February to March 2021. Data were
collected using interviewer-administered questionnaire. Predictors of
knowledge and self-care reported practice were determined using binary
logistic regression. p < 0.05 was considered
significant. Results: More than half (n = 213, 62.1%) of the postpartum women had
adequate knowledge on prevention of puerperal sepsis. Only 39 (11.4%) of the
women reported adequate self-care practices toward prevention of puerperal
sepsis. Secondary education (adjusted odds ratio = 0.18, 95% confidence
interval = 0.06–0.49, p = 0.001), tertiary education
(adjusted odds ratio = 0.52, 95% confidence interval = 0.19–1.38,
p = 0.021) and getting information from healthcare
providers (adjusted odds ratio = 1.06, 95% confidence interval = 0.55–2.06,
p = 0.049) were significant determinants of knowledge
on prevention of puerperal sepsis. Also, secondary education (adjusted odds
ratio = 0.11, 95% confidence interval = 0.04–0.30,
p = 0.001), tertiary education (adjusted odds ratio = 0.16,
95% confidence interval = 0.06–0.39, p = 0.001), and having
more than four antenatal care visits (adjusted odds ratio = 1.21, 95%
confidence interval = 0.49–3.27, p = 0.041) were
significant determinants of reported self-care practices for prevention of
puerperal sepsis. Conclusion: A significant gap in reported self-care practices to prevent puerperal sepsis
was evidence. Secondary and tertiary education were significant predictors
for both knowledge and self-care reported practices. Special attention
should be given to women with low education level.
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Affiliation(s)
- Dorice B Nchimbi
- Department of Clinical Nursing, School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania
- Maternal and Child Health Department, Kijitonyama Health Centre, Dar es Salaam, Tanzania
| | - Angelina A Joho
- Department of Clinical Nursing, School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania
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Bolanko A, Namo H, Minsamo K, Addisu N, Gebre M. Knowledge of obstetric danger signs and associated factors among pregnant women in Wolaita Sodo town, South Ethiopia: A community-based cross-sectional study. SAGE Open Med 2021; 9:20503121211001161. [PMID: 33786186 PMCID: PMC7958171 DOI: 10.1177/20503121211001161] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Obstetric complications continue to be the major causes of maternal mortality in low- and middle-income countries. Knowledge of women toward obstetric danger signs is an important part of improving maternal and fetal outcomes. However, the reported level of knowledge on obstetric danger signs is low and inconsistent. Methods Community-based cross-sectional study design was used. Data were collected from randomly selected 740 pregnant women. A pregnant woman said to have good knowledge of obstetric danger signs if she spontaneously mentioned at least two of the danger signs during each of the three periods (pregnancy, labor/childbirth, and postpartum) and otherwise said to have poor knowledge of obstetric danger signs. Adjusted odds ratio at 95% confidence interval and a value of p < 0.05 were used to identify the predictors. Results A total of 740 pregnant women participated in the study with the response rate of 97.5%. One hundred twenty-four (16.8%) of the respondents were knowledgeable about obstetric danger signs. According to our study, age range of 20-24 years (adjusted odds ratio = 6, confidence interval: 2.67-17.44) and 25-29 years old (adjusted odds ratio = 2.4, confidence interval: 1.14-5.10); being housewife (adjusted odds ratio = 0.5, confidence interval: 0.28-0.87); monthly income of ⩽1000ETB (adjusted odds ratio = 0.24, confidence interval: 0.12-0.46) and 1001-2500ETB (adjusted odds ratio = 0.24, confidence interval: 0.12-0.47); and primigravida (adjusted odds ratio = 0.09, confidence interval: 0.04-0.18) and primipara (adjusted odds ratio = 0.15, confidence interval: 0.07-0.30) were factors significantly associated with knowledge of obstetric danger signs. Conclusion Knowledge of obstetric danger signs among pregnant women was low. Maternal age, average monthly income, maternal occupation, parity, and gravidity were factors significantly associated with the knowledge of obstetric danger signs.
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Affiliation(s)
- Alemu Bolanko
- Ethiopia Transform: Primary Health Care (USAID), John Snow, Inc., Hawasa, Ethiopia
| | - Hussen Namo
- Department of Midwifery, College of Health and Medical Sciences, Arsi University, Assela, Ethiopia
| | - Kirubel Minsamo
- Department of Pharmacy, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
| | - Nigatu Addisu
- Department of Pharmacy, College of Health and Medical Sciences, Dilla University, Dilla, Ethiopia
| | - Mohammed Gebre
- School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Ossai EN, Alo C, Azuogu BN, Eze II. Spatial Differences in Knowledge and Perception of Key Danger Signs of Pregnancy among Mothers in Ebonyi State, Nigeria. Niger Med J 2021; 62:66-73. [PMID: 38505570 PMCID: PMC10937063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Background To determine knowledge and perception of key danger signs of pregnancy among mothers in urban and rural communities of Ebonyi state, Nigeria. Methodology A comparative cross-sectional study design was used. The two-stage sampling technique was used to select 660 women in four of thirteen local government areas in the state. The women have delivered in last one year irrespective of place of delivery. Outcome measure included good knowledge of danger signs and was assessed by proportion of respondents who recalled four of eight danger signs. Positive perception was assessed by proportion who were aware that danger signs of pregnancy were capable of causing death of women if unattended to immediately. Results The mean age of respondents was urban, 29.6±6.2 and rural, 28.6±5.1 years. The most recalled danger sign was bleeding before labour; urban, 280 (84.8%); rural,267 (80.9%). Comparable proportions - urban, 272 (82.4%); rural, 287 (87.0%) had good knowledge of danger signs. (p=0.105). Predictors of good knowledge of danger signs included residing in urban, (AOR=0.4; 95%C1:0.2-0.9), being <30 years, (AOR=0.6; 95%C1:0.3-0.9), having 2-4 children, (AOR=2.4; 95%C1:1.2-4.7) and not receiving antenatal care from a skilled provider. (AOR=0.2; 95%C1:0.08-0.4). There was an association between good knowledge and positive perception of danger signs. (p<0.001). Conclusions Majority of respondents in study area had good knowledge and positive perception of danger signs of pregnancy. Consolidating the understanding of danger signs will enhance maternal health outcome thus improving the maternal death burden in Nigeria. There is need to ensure that all women receive antenatal care from a skilled provider.
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Affiliation(s)
- Edmund Ndudi Ossai
- Department of Community Medicine, College of Health Sciences, Ebonyi State University Abakaliki
- Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria
| | - Chihurumnaya Alo
- Department of Community Medicine, College of Health Sciences, Ebonyi State University Abakaliki
- Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria
| | - Benedict Ndubueze Azuogu
- Department of Community Medicine, College of Health Sciences, Ebonyi State University Abakaliki
- Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria
| | - Irene Ifeyinwa Eze
- Department of Community Medicine, College of Health Sciences, Ebonyi State University Abakaliki
- Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria
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Yosef T, Tesfaye M. Pregnancy danger signs: Knowledge and health-seeking behavior among reproductive age women in southwest Ethiopia. WOMEN'S HEALTH 2021; 17:17455065211063295. [PMID: 34937457 PMCID: PMC8724992 DOI: 10.1177/17455065211063295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Warning signs of pregnancy are not reliably predictable. But, knowing these early warning signs is very important for pregnant women to eliminate serious complications and start treatment immediately. The higher level of maternal mortality can be reduced by providing quality maternity service and empowering women with good knowledge of the danger signs of pregnancy and promoting appropriate health-seeking behavior. Therefore, this study aimed to assess the knowledge of pregnancy danger signs and health-seeking behavior among reproductive age women in southwest Ethiopia. Method: A cross-sectional study was carried out with 526 randomly selected women from 1 to 30 January 2019. The data were collected through face-to-face interviews and analyzed using Statistical Package for the Social Sciences version 21. Both bivariate and multivariable logistic regression analyses were conducted to determine factors associated with the outcome variable. The level of significance was declared at a p-value < 0.05. Results: The proportion of mothers who had good knowledge of pregnancy danger signs were 43.2%. The majority (65%) of those surveyed mentioned vaginal bleeding as a pregnancy danger sign. The factors associated with good knowledge of pregnancy danger signs were husbands with secondary education and above (adjusted odds ratio = 2.52, 95% confidence interval (1.08–5.91) monthly income ⩾ 1000 Ethiopian Birr (adjusted odds ratio = 2.64, 95% confidence interval (1.48–4.71) being multigravida (adjusted odds ratio = 2.14, 95% confidence interval (1.17–3.94) and last delivery at the health facility (adjusted odds ratio = 6.84, 95% confidence interval (4.02–11.63) The proportion of mothers who experienced pregnancy danger signs and had good health-seeking behavior was 72.7%. Conclusion: The knowledge of pregnancy danger signs among reproductive age women was low in the study area. This indicates the large proportions of women who do not know the danger signs are likely to delay in deciding to seek care when they face the problem. Therefore, empowering women, improving the quality of health information about danger signs during antenatal care follow-up, and promoting institutional delivery are the recommended interventions.
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Affiliation(s)
- Tewodros Yosef
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
| | - Melkamsew Tesfaye
- Department of Nutrition and Reproductive Health, School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
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Adams YJ, Ray HE. Knowledge of postpartum care and postbirth warning signs among midwives in Ghana. Birth 2020; 47:357-364. [PMID: 31773795 DOI: 10.1111/birt.12472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND In Ghana, midwives are the primary maternity care practitioners. Their knowledge of postpartum care is critical for preventing and reducing maternal deaths because it affects the quality of care provided to women. In addition, midwives' knowledge of postbirth warning signs is important for early identification and management of complications. This study assessed midwives' knowledge of postpartum care and postbirth warning signs to develop interventions to improve patient care. METHODS A cross-sectional survey of 246 midwives was conducted in the four main hospitals of Tamale, Ghana. Data were collected using a postpartum care knowledge questionnaire developed by JHPIEGO. Data were analyzed in SAS version 9.4 using descriptive, bivariate, and multivariate statistics. RESULTS Mean age of midwives was 31.9 years. The percentage of midwives who responded correctly to each postpartum care question ranged from 41.6% to 84.9%. Most midwives were knowledgeable about breastfeeding-however, knowledge about fundus location, postpartum examination, and care during first 2 hours postpartum was low. Hospital was associated with knowledge of postpartum care (P < .001). Only 28.1% of midwives identified all nine warning signs of complications. Most midwives could identify severe bleeding, severe headaches, and high temperature as warning signs-however, knowledge of warning signs of some life-threatening complications such as chest pain, obstructed breathing, and thoughts of hurting oneself was low. More years of experience was associated with better knowledge of postbirth warning signs (P = .03). DISCUSSION Findings suggest a need for additional training of midwives in how to care for postpartum patients and accurately identify warning signs for life-threatening complications.
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Affiliation(s)
| | - Herman E Ray
- Analytics and Data Science Institute and Department of Statistics and Analytical Sciences, Kennesaw State University, Kennesaw, Georgia
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Kimani RW, Maina R, Shumba C, Shaibu S. Maternal and newborn care during the COVID-19 pandemic in Kenya: re-contextualising the community midwifery model. HUMAN RESOURCES FOR HEALTH 2020; 18:75. [PMID: 33028347 PMCID: PMC7539267 DOI: 10.1186/s12960-020-00518-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/02/2020] [Indexed: 05/07/2023]
Abstract
Peripartum deaths remain significantly high in low- and middle-income countries, including Kenya. The COVID-19 pandemic has disrupted essential services, which could lead to an increase in maternal and neonatal mortality and morbidity. Furthermore, the lockdowns, curfews, and increased risk for contracting COVID-19 may affect how women access health facilities. SARS-CoV-2 is a novel coronavirus that requires a community-centred response, not just hospital-based interventions. In this prolonged health crisis, pregnant women deserve a safe and humanised birth that prioritises the physical and emotional safety of the mother and the baby. There is an urgent need for innovative strategies to prevent the deterioration of maternal and child outcomes in an already strained health system. We propose strengthening community-based midwifery to avoid unnecessary movements, decrease the burden on hospitals, and minimise the risk of COVID-19 infection among women and their newborns.
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Affiliation(s)
- Rachel Wangari Kimani
- School of Nursing and Midwifery, Aga Khan University, PO Box 39340, Nairobi, 00623 Kenya
| | - Rose Maina
- School of Nursing and Midwifery, Aga Khan University, PO Box 39340, Nairobi, 00623 Kenya
| | - Constance Shumba
- School of Nursing and Midwifery, Aga Khan University, PO Box 39340, Nairobi, 00623 Kenya
- Department of Population Health, Aga Khan University, PO Box 39340, Nairobi, 00623 Kenya
| | - Sheila Shaibu
- School of Nursing and Midwifery, Aga Khan University, PO Box 39340, Nairobi, 00623 Kenya
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Jewaro M, Yenus H, Ayanaw Y, Abera B, Derso T. Knowledge of obstetric danger signs and associated factors among mothers in Bahir Dar district, northwest Ethiopia: an institution-based cross-sectional study. Public Health Rev 2020; 41:14. [PMID: 32626604 PMCID: PMC7329417 DOI: 10.1186/s40985-020-00132-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 05/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background Like other developing countries, in Ethiopia, obstetric complications contribute to about 50% of the maternal deaths. Thus, the aim of this study was to assess knowledge of obstetric danger signs and its associated factors among mothers attending the postnatal clinic at Felege Hiwot Referral Hospital, Bahir Dar district, northwest Ethiopia. Methods A hospital-based cross-sectional study was conducted on 410 postnatal mothers at Felege Hiwot Referral Hospital from June to September 2015. Knowledge of obstetric danger signs among postnatal clinic attending mothers was determined by using seventeen obstetric danger sign questions via interviewing. The binary logistic regression model was used to identify associated factors. In the multivariable analysis, variables with a P value of < 0.05 were considered statistically significant. Odds ratio with 95% confidence interval (CI) was calculated to show the strength of association. Results About 59% [95% CI 55, 63] of mothers were knowledgeable about obstetric danger signs. The odds of having good knowledge of obstetric danger signs were higher among mothers who were more educated [AOR = 6.86, 95% CI 2.47, 19.27], earned more than 3500 ETB household monthly income [AOR = 3.38, 95% CI 1.20, 13.96], and received information on danger signs from health extension workers (HEWs) [AOR = 4.23, 95% CI 1.83, 9.70] compared to their counterparts. However, mothers with service utilization decision power [AOR = 0.14, 95% CI 0.07, 0.27] with husband were 86% times less likely to be knowledgeable compared to mothers decided by themselves. Conclusion In this study, below two thirds of mothers had good knowledge of obstetric danger signs. Thus, improving educational status and obtaining health information on obstetric danger signs from health professionals should be intensified. This implies that lack of awareness may lead to delay in seeking care. Thus, improving mothers’ socio-economic status and self-decision-making power on utilization of health service are essential to mitigate the high burden of maternal morbidity due to obstetric complications. Also, obtaining health information on obstetric danger signs from health professionals should be intensified.
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Affiliation(s)
- Merina Jewaro
- Department of Gynecology and Obstetrics, Government Public Health Facility, Kersa District Hospital, Arsi, Ethiopia
| | - Hedija Yenus
- Department of Reproductive Health, Institute of Public health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yohanes Ayanaw
- Department of Reproductive Health, Institute of Public health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Birhanu Abera
- Department of Gynecology and Obstetrics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Terefe Derso
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
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Wulandari RD, Laksono AD. Determinants of knowledge of pregnancy danger signs in Indonesia. PLoS One 2020; 15:e0232550. [PMID: 32433645 PMCID: PMC7239433 DOI: 10.1371/journal.pone.0232550] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/16/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The maternal mortality rate in Indonesia is still quite high. It requires good knowledge for early prevention. The study aimed to analyze the determinants of knowledge of the pregnancy danger signs in Indonesia. METHODS The samples used were 85,832 women of childbearing age (15-49 years old). The variables included understanding of danger signs of pregnancy, types of residence, age, education, employment, marital status, wealth, parity, the autonomy of health, current pregnancy status, and media exposure. The determinant was pointed out by using binary logistic regression. RESULTS Urban women were 1.124 times more likely to understand the pregnancy danger signs of than rural women. Older women could identify pregnancy danger signs better than those aged 15-19 years. The more educated a woman is, the higher knowledge of the pregnancy danger signs she has. Married women or those who live with their partner were at 1.914 times likely to identify the pregnancy danger signs than unmarried ones or those who have never been in a relationship. If the wealth status gets higher, knowledge of the pregnancy danger signs will be better too. Grande multiparous women were at 0.815 times more likely to understand the pregnancy danger signs than primiparous. Women with the autonomy of health had 1.053 times chances to identify the pregnancy danger signs than those without autonomy. Women who were currently pregnant had 1.229 times better understanding of the pregnancy danger signs than women who were not currently pregnant. Media exposure had a good effect on women's understanding of the pregnancy danger signs. CONCLUSION All variables tested were the determinants of knowledge of the pregnancy danger signs in Indonesia. These include residence, age, education, employment, marital status, wealth, parity, the autonomy of health, current pregnancy status, and media exposure.
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Affiliation(s)
- Ratna Dwi Wulandari
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
- * E-mail:
| | - Agung Dwi Laksono
- National Institute of Health Research and Development, Indonesia Ministry of Health, Jakarta, Indonesia
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Dhital R, Silwal RC, Simkhada P, van Teijlingen E, Jimba M. Assessing knowledge and behavioural changes on maternal and newborn health among mothers following post-earthquake health promotion in Nepal. PLoS One 2019; 14:e0220191. [PMID: 31344147 PMCID: PMC6657877 DOI: 10.1371/journal.pone.0220191] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 07/10/2019] [Indexed: 01/20/2023] Open
Abstract
Introduction Disasters can disrupt the existing health system affecting the whole population, but especially vulnerable people such as pregnant women, new mothers and their babies. Despite the global progress in maternal, newborn and child health (MNCH) programmes over the years, emergency responses after a disaster are often poor. Post-disaster health promotion could play an important role in improving MNCH outcomes. However, evidence remains limited on the effect of post disaster health promotion activities in low-income countries such as Nepal. Methods This is an uncontrolled before and after study conducted in Dhading district which was severely affected by the 2015 earthquake in Nepal. The study participants were mothers who had a child in the previous 12 months. The intervention was implemented between 2016 and 2018 and included community-engagement health promotion activities where the local stakeholders and resources were mobilized. The outcome variables included: knowledge of danger signs of pregnancy, childbirth and in newborns; and behaviours including ever attending antenatal care (ANC), a minimum of four ANC sessions and having an institutional delivery. Data were analysed using chi-squared tests, independent sample t-tests and multiple logistic regression models. Results In total 364 mothers were recruited in the pre-intervention group and 377 in the post-intervention group. The post-intervention group was more likely to have knowledge of at least three danger signs in pregnancy (AOR [Adjusted Odds Ratio] = 2.96, P<0.001), at least three danger signs in childbirth (AOR = 3.8, P<0.001), and at least five danger signs in newborns (AOR = 1.56, P<0.001) compared to the pre-intervention group. The mothers in the post-intervention group were also more likely to ever attend ANC (AOR = 7.18, P<0.001), attend a minimum of four ANC sessions (AOR = 5.09, P<0.001), and have institutional deliveries (AOR = 2.56, P<0.001). Religious minority groups were less likely to have knowledge of all danger signs compared to the majority Hindu group. Mothers from poorer households were also less likely to attend four ANC sessions. Mothers with higher education were more likely to have knowledge of all the danger signs. Mothers whose husbands had achieved higher education were also more likely to have knowledge of danger signs and have institutional deliveries. Conclusion Health promotion intervention helped the disaster-affected mothers in improving the knowledge and behaviours related to MNCH. However, the vulnerable population would need more support to gain benefit from such intervention.
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Affiliation(s)
- Rolina Dhital
- Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Ram Chandra Silwal
- Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
- Green Tara Nepal, GPO, CPC, Kathmandu, Nepal
| | - Padam Simkhada
- Faculty of Education, Health and Community, Public Health Institute, Mount Pleasant, United Kingdom
| | - Edwin van Teijlingen
- Bournemouth University, Faculty of Health & Social Sciences, Bournemouth, United Kingdom
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
- * E-mail:
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WOMEN's Knowledge of Obstetric Danger signs in Ethiopia (WOMEN's KODE):a systematic review and meta-analysis. Syst Rev 2019; 8:63. [PMID: 30803443 PMCID: PMC6388496 DOI: 10.1186/s13643-019-0979-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 02/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND According to the 2015 World Health Organization report, globally, an estimated 10.7 million mothers died from 1990 to 2015 due to obstetric complications. This report showed that almost all global maternal deaths (99%) occurred in developing countries and two thirds of these deaths took place in sub-Saharan Africa where the majority of women lack knowledge about obstetric danger signs. In Ethiopia, in several research reports, it has been indicated that women have poor knowledge about obstetric danger signs. Although several studies have been conducted to assess women's knowledge of obstetric danger signs, to date, no systematic review has been conducted in Ethiopia. Therefore, this review is aimed at synthesising the existing literature about women's knowledge of obstetric danger signs. METHODS We systematically searched for articles from MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, Web of Science, Scopus, Google Scholar and Maternity and Infant Care databases. A combination of search terms including 'knowledge' or 'awareness' or 'information' and 'pregnancy danger signs' or 'obstetric danger signs' or 'obstetric warning signs' and 'Ethiopia' was used to locate appropriate articles. Two reviewers conducted article screening and data abstraction independently. Observational studies published in English and conducted in Ethiopia to date were assessed for quality using the adapted Newcastle Ottawa Scale for cross-sectional studies. The PRISMA checklist was used to present the findings of this systematic review. RESULTS From the 215 articles initially screened by abstracts and titles, 12 studies fulfilled the inclusion criteria. All the studies reported women's knowledge of obstetric danger signs during pregnancy, ten articles reported on the level of knowledge during delivery and eight studies reported on the level of knowledge of danger signs during the postpartum period. The pooled random effect meta-analysis level of women's knowledge about obstetric danger signs during pregnancy, delivery and postpartum was 48%, 43% and 32%, respectively. Maternal age, education, income, health service use, distance from facility and women's autonomy were reported in several studies as determinants of women's knowledge of obstetric danger signs. CONCLUSIONS Women's knowledge about obstetric danger signs in Ethiopia was very poor, which could hamper access to obstetric care when women encounter obstetric complications. Counselling services during antenatal care and community-based health information dissemination about obstetric danger signs should be strengthened. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017077000.
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Kassa ZY, Awraris T, Daba AK, Tenaw Z. Compliance with iron folic acid and associated factors among pregnant women through pill count in Hawassa city, South Ethiopia: a community based cross-sectional study. Reprod Health 2019; 16:14. [PMID: 30736812 PMCID: PMC6367743 DOI: 10.1186/s12978-019-0679-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background Iron deficiency anemia during pregnancy is a public health problem across the globe that adversely affects maternal and perinatal outcome. World Health Organization recommends that universal iron folic acid supplementation of pregnant women. Therefore, the aim of this study was to determine compliance and identify factors associated with Iron folic acid among pregnant women. Methods Community based cross-sectional study was conducted from November 01–December 30, 2015 on pregnant women from Hawassa city. An Interviewer administered questionnaire was used to collect data from 422 selected study subjects using simple random sampling technique. Data were entered in to Epi-Data version 3.1 and exported to SPSS version 20 for analysis. Bivariate and multivariable analyses were employed to test presence of association between dependent and independent variables. P value < 0.05 was considered as statistically significant. Result In this study prevalence of compliance with iron folic acid was reported 38.3% (95%CI: 33.1, 42.5). Women who know the importance of iron folic acid had 6 times higher odds of compliance with iron folic acid than counterpart (AOR = 6.1, 95% CI: 3.53, 10.24).Pregnant women who develop complication during the previous pregnancy had 0.34 times lower odds of compliance with counterpart (AOR = 0.34, 95% CI: 0.16–0.76), experiencing iron folic acid related side effects during the previous pregnancy had 8.5 time higher odds to decrease compliance with than those did not experience iron folic acid related side effects (AOR = 8.5, 95% CI: 4.65.-15.35). Conclusion In this study demonstrated that compliance with iron folic acid among pregnant women through pill count is low. Women who know the importance of iron folic acid, women who develop complications during previous pregnancy, experiencing iron folic acid related side effects during the previous pregnancy were independent predictor of compliance with iron folic acid. Health care providers shall strongly counsel the importance and side effect of iron folic acid before prescribing. The responsible bodies avail suitable iron folic acid pill and less side effect brands. Health care providers and health extension workers shall be monitored iron folic acid by pill count during their home to home visits.
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Affiliation(s)
| | - Tegibelu Awraris
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Alemneh Kabeta Daba
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Zelalem Tenaw
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Haleema M, Raghuveer P, Kiran R, Mohammed IM, Mohammed ISA, Mohammed M. Assessment of knowledge of obstetric danger signs among pregnant women attending a teaching hospital. J Family Med Prim Care 2019; 8:1422-1426. [PMID: 31143733 PMCID: PMC6510108 DOI: 10.4103/jfmpc.jfmpc_149_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Knowledge of obstetric danger signs among pregnant women is of paramount importance in improving maternal, and fetal health outcomes. This study aims to determine the knowledge of danger signs among pregnant women seeking antenatal care in a teaching hospital. Materials and Methods A cross-sectional study was carried out for two months among pregnant women who visited the antenatal clinic of a teaching hospital. A pre-tested and pre-designed proforma was used. Mean knowledge scores were computed and knowledge was classified into adequate and inadequate. Results A total of 170 pregnant women fulfilling the inclusion criteria were included. Mean age of the study participants was found to be 26.40 ± 4.14 years. Nearly 67.10% were aware of bleeding per vagina being a danger sign, 50.0% stated excessive vomiting as a danger sign, 23.50% knew that blurring of vision was a danger, while a mere 20.0% reported that convulsions were a danger sign. Overall, adequate knowledge (total knowledge score of 5 and above) was observed in 54.70% of the participants. Conclusion Majority of the study participants had adequate knowledge of danger signs in pregnancy. However, when knowledge about specific individual danger signs were further assessed, a high proportion had very poor knowledge. The mean knowledge scores were found to be low.
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Affiliation(s)
- Mubeena Haleema
- Department of Community Medicine, Yenepoya Medical College, Mangalore, Karnataka, India
| | - Pracheth Raghuveer
- Department of Community Medicine, Yenepoya Medical College, Mangalore, Karnataka, India
| | - R Kiran
- Department of Community Medicine, Yenepoya Medical College, Mangalore, Karnataka, India
| | - Ibrahim M Mohammed
- Department of Community Medicine, Yenepoya Medical College, Mangalore, Karnataka, India
| | | | - Mazina Mohammed
- Department of Community Medicine, Yenepoya Medical College, Mangalore, Karnataka, India
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Moshi FV, Ernest A, Fabian F, Kibusi SM. Knowledge on birth preparedness and complication readiness among expecting couples in rural Tanzania: Differences by sex cross-sectional study. PLoS One 2018; 13:e0209070. [PMID: 30592725 PMCID: PMC6310299 DOI: 10.1371/journal.pone.0209070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 11/29/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Inadequate knowledge of birth preparedness and complication readiness (BPCR) among expecting couples delays timely access to maternal emergency services. The aim of this study was to assess knowledge on birth preparedness and complication readiness and how men and women differ" among expecting couples in a rural setting of Rukwa Region, Tanzania. METHODS A community-based cross-sectional study targeting pregnant women and their partners was performed from June 2017 to October 2017. A total of 546 couples were sampled using three-stage probability sampling techniques and then interviewed using a structured questionnaire. The mean score difference was sought using independent t-test. Multiple linear regressions were performed to determine the predictors of knowledge. RESULTS There was a significant difference in mean knowledge scores between pregnant women (M = 5.58, SD = 4.591) and male partners (M = 4.37, SD = 4.285); t (1085) = -4.525; p<0.001. Among women, BPCR levels were positively influenced by age (β = 0.236; p<0.01), having ever heard about birth preparedness (β = 0.176;p<0.001), being of Mambwe ethnicity (β = 0.187; p<0.001), living near a health center rather than a dispensary (β = 0.101;p<0.05) and having had a prior preterm delivery (β = 0.086;p<0.05). Access to media through radio ownership negatively influenced BPCR levels among both women (β-.119; p<0.01) and men (β = -0.168; p<0.0001). Among men, the BPCR knowledge was only positively influenced by having ever heard about birth preparedness (β = 0.169;p<0.001), age at marriage (β = -0.103; p<0.05), and having completed either primary (β = 0.157;p<0.001) or secondary education (β = 0.131;p<0.01). CONCLUSION Some important predictors of knowledge were revealed among women and men, but overall knowledge about birth preparedness and complication readiness was low. This study demonstrates inadequate knowledge and understanding at the community level about key elements of birth preparedness and complication readiness. In order to improve access to life-saving care for women and neonates, there is a pressing need for innovative community strategies to increase knowledge about birth preparedness and complication readiness. Such strategies are essential in order to reduce maternal and neonatal mortality in rural Tanzania.
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Affiliation(s)
- Fabiola V. Moshi
- School of Nursing and Public Health, the University of Dodoma, Dodoma, Tanzania
| | - Alex Ernest
- School of Medicine and Dentistry, the University of Dodoma, Dodoma Tanzania
| | - Flora Fabian
- School of Medicine and Dentistry, the University of Dodoma, Dodoma Tanzania
| | - Stephen M. Kibusi
- School of Nursing and Public Health, the University of Dodoma, Dodoma, Tanzania
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Muhumuza Kananura R, Tetui M, Bua J, Ekirapa-Kiracho E, Mutebi A, Namazzi G, Namusoke Kiwanuka S, Waiswa P. Effect of a participatory multisectoral maternal and newborn intervention on birth preparedness and knowledge of maternal and newborn danger signs among women in Eastern Uganda: a quasi-experiment study. Glob Health Action 2018; 10:1362826. [PMID: 28849729 PMCID: PMC5645681 DOI: 10.1080/16549716.2017.1362826] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Knowledge of obstetric danger signs and adequate birth preparedness (BP) are critical for improving maternal services utilization. Objectives: This study assessed the effect of a participatory multi-sectoral maternal and newborn intervention on BP and knowledge of obstetric danger signs among women in Eastern Uganda. Methods: The Maternal and Neonatal Implementation for Equitable Systems (MANIFEST) study was implemented in three districts from 2013 to 2015 using a quasi-experimental pre–post comparison design. Data were collected from women who delivered in the last 12 months. Difference-in-differences (DiD) and generalized linear modelling analysis were used to assess the effect of the intervention on BP practices and knowledge of obstetric danger signs. Results: The overall BP practices increased after the intervention (DiD = 5, p < 0.05). The increase was significant in both intervention and comparison areas (7–39% vs. 7–36%, respectively), with a slightly higher increase in the intervention area. Individual savings, group savings, and identification of a transporter increased in both intervention and comparison area (7–69% vs. 10–64%, 0–11% vs. 0–5%, and 9–14% vs. 9–13%, respectively). The intervention significantly increased the knowledge of at least three obstetric danger signs (DiD = 31%) and knowledge of at least two newborn danger signs (DiD = 21%). Having knowledge of at least three BP components and attending community dialogue meetings increased the odds of BP practices and obstetric danger signs’ knowledge, respectively. Village health teams’ home visits, intervention area residence, and being in the 25+ age group increased the odds of both BP practices and obstetric danger signs’ knowledge. Conclusions: The intervention resulted in a modest increase in BP practices and knowledge of obstetric danger signs. Multiple strategies targeting women, in particular the adolescent group, are needed to promote behavior change for improved BP and knowledge of obstetric danger signs.
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Affiliation(s)
- Rornald Muhumuza Kananura
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda.,c Makerere University Centre of Excellence for Maternal and Newborn Health Research , Kampala , Uganda
| | - Moses Tetui
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda.,b Unit of Epidemiology and Global Health , Department of Public Health and Clinical Medicine Umeå University , Umeå , Sweden
| | - John Bua
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| | - Elizabeth Ekirapa-Kiracho
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| | - Aloysius Mutebi
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| | - Gertrude Namazzi
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda.,c Makerere University Centre of Excellence for Maternal and Newborn Health Research , Kampala , Uganda
| | - Suzanne Namusoke Kiwanuka
- b Unit of Epidemiology and Global Health , Department of Public Health and Clinical Medicine Umeå University , Umeå , Sweden
| | - Peter Waiswa
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda.,c Makerere University Centre of Excellence for Maternal and Newborn Health Research , Kampala , Uganda.,d Global Health Division, Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
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Geleto A, Chojenta C, Mussa A, Loxton D. Barriers to access and utilization of emergency obstetric care at health facilities in sub-Saharan Africa-a systematic review protocol. Syst Rev 2018; 7:60. [PMID: 29661217 PMCID: PMC5902829 DOI: 10.1186/s13643-018-0720-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nearly 15% of all pregnancies end in fatal perinatal obstetric complications including bleeding, infections, hypertension, obstructed labor, and complications of abortion. Between 1990 and 2015, an estimated 10.7 million women died due to obstetric complications. Almost all of these deaths (99%) happened in developing countries, and 66% of maternal deaths were attributed to sub-Saharan Africa. The majority of cases of maternal mortalities can be prevented through provision of evidence-based potentially life-saving signal functions of emergency obstetric care. However, different factors can hinder women's ability to access and use emergency obstetric services in sub-Saharan Africa. Therefore, the aim of this review is to synthesize current evidence on barriers to accessing and utilizing emergency obstetric care in sub-Saharan African. Decision-makers and policy formulators will use evidence generated from this review in improving maternal healthcare particularly the emergency obstetric care. METHODS Electronic databases including MEDLINE, CINAHL, Embase, and Maternity and Infant Care will be searched for studies using predefined search terms. Articles published in English language between 2010 and 2017 with quantitative and qualitative design will be included. The identified papers will be assessed for meeting eligibility criteria. First, the articles will be screened by examining their titles and abstracts. Then, two reviewers will review the full text of the selected articles independently. Two reviewers using a standard data extraction format will undertake data extraction from the retained studies. The quality of the included papers will be assessed using the mixed methods appraisal tool. Results from the eligible studies will be qualitatively synthesized using the narrative synthesis approach and reported using the three delays model. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist will be employed to present the findings. DISCUSSION This systematic review will present a detailed synthesis of the evidence for barriers to access and utilization of emergency obstetric care in sub-Saharan Africa over the last 7 years. This systematic review is expected to provide clear information that can help in designing maternal health policy and interventions particularly in emergency obstetric care in sub-Saharan Africa where maternal mortality remains high. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017074102 .
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Affiliation(s)
- Ayele Geleto
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia
| | - Catherine Chojenta
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia
| | - Abdulbasit Mussa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia
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Bintabara D, Mpembeni RNM, Mohamed AA. Knowledge of obstetric danger signs among recently-delivered women in Chamwino district, Tanzania: a cross-sectional study. BMC Pregnancy Childbirth 2017; 17:276. [PMID: 28851408 PMCID: PMC5576340 DOI: 10.1186/s12884-017-1469-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/23/2017] [Indexed: 11/10/2022] Open
Abstract
Background Low knowledge of danger signs has been shown to delay seeking obstetric care which leads to high maternal mortality and morbidity worldwide. In Tanzania about half of pregnant women are informed about obstetric danger signs during antenatal care, but the proportion of those who have full knowledge of these obstetric danger signs is not known. This study assessed the knowledge of obstetric danger signs and its associated factors among recently-delivered women in Chamwino District, Tanzania. Methods A community-based cross-sectional study was conducted in January 2014 in Chamwino District, Tanzania. A woman was considered knowledgeable if she spontaneously mentioned at least five danger signs in any of the three phases of childbirth (pregnancy, childbirth and postpartum) with at least one in each phase. Multistage cluster sampling was used to recruit study participants. Descriptive and bivariate analyses were conducted. Multivariable logistic regression analyses were performed to control for confounding and other important covariates. Results A total of 428 women were interviewed. The median age (IQR) was 26.5 (22–33) years. Only 25.2% of respondents were knowledgeable about obstetric danger signs during pregnancy, childbirth/labour and postpartum. Significant explanatory variables of being knowledgeable about obstetric danger signs were found to be maternal education (AOR = 1.96; 95% CI: 1.01, 3.82), maternal occupation (AOR = 2.23; 95% CI; 1.10, 4.52), spouse occupation (AOR = 2.10; 95% CI: 1.02, 4.32) and counseling on danger signs (AOR = 3.42; 95% CI: 1.36, 8.62) after controlling for the clustering effect, confounding and important covariates. Conclusion A low proportion of women was found to be knowledgeable about obstetric danger signs in Chamwino district. Therefore, we recommend the Ministry of Health to design and distribute the maternal health booklets that highlight the obstetric danger signs, and encourage antenatal care providers and community health workers to provide frequent health education about these danger signs for every pregnant woman in order to increase their level of knowledge about obstetric danger signs.
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Affiliation(s)
- Deogratius Bintabara
- Department of Public Health, College of Health Sciences, The University of Dodoma, P.O Box 259, Dodoma, Tanzania. .,Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Rose N M Mpembeni
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar Es Salaam, Tanzania
| | - Ahmed Abade Mohamed
- Tanzania Field Epidemiology and Laboratory Training Programme (TFELTP), Dar Es Salaam, Tanzania
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Hibstu DT, Siyoum YD. Knowledge of obstetric danger signs and associated factors among pregnant women attending antenatal care at health facilities of Yirgacheffe town, Gedeo zone, Southern Ethiopia. Arch Public Health 2017; 75:35. [PMID: 28811893 PMCID: PMC5554969 DOI: 10.1186/s13690-017-0203-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 06/06/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Obstetric danger signs are not the literal obstetric complications, merely symptoms that are well named by non-clinical personnel. The identification of these danger signs and its relation with complications during pregnancy would increase the capacity of women, their partners and families to seek for timely health care, following the appropriate steps to insure a safe birth and post-partum. The aim of this study was to assess the knowledge of obstetric danger signs and associated factors among pregnant women attending antenatal care in Yirgacheffe town, Gedeo zone, Southern Ethiopia. METHOD Institutional-based cross-sectional study was conducted from March 15-April 15, 2016. Data on pregnant women were collected using a pre-tested and interviewer administered structured questionnaire from 342 women using systematic random sampling technique. Bivariate and multivariate logistic regression was performed using SPSS version 20.0 software. RESULT A total of 342 (90%) pregnant women were included in the study. The level of obstetric knowledge of danger signs was 21.9% (95% CI: 20.2-55.65%). Maternal education (AOR = 0.26, CI: 0.08, 0.88), paternal education (AOR = 0.13, CI; 0.04, 04) and time taken to reach health facilities on foot (AOR = 0.06, CI: 0.02, 0.17) were negatively associated factors while maternal age (AOR = 3.68, CI: 1.30, 10.46), paternal occupation (AOR = 4.65, CI: 1.82, 11.87), place of residence (AOR = 2.61, CI: 1.35, 5.04) were positively associated factors with knowledge of obstetric danger signs. CONCLUSION Maternal and paternal education, maternal age, paternal occupation, place of residence and time taken to reach health facility on foot were the main factors for knowledge of obstetric danger signs. Increasing knowledge of key danger signs, creating and promoting income generating mechanisms need to be continuously done at the health facility and the community as it makes ready women and their families for prompt and appropriate decisions and measures in case of obstetric danger signs.
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Affiliation(s)
- Desalegn Tsegaw Hibstu
- Department of Reproductive Health, Hawassa University, College of Medicine and Health Sciences, School of Public and Environmental Health, Hawassa, Ethiopia
| | - Yadeshi Demisse Siyoum
- Department of Public Health, Hawassa University, College of Medicine and Health Sciences, School of Public and Environmental Health, Hawassa, Ethiopia
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Saaka M, Aryee P, Kuganab-Lem R, Ali M, Masahudu AR. The effect of social behavior change communication package on maternal knowledge in obstetric danger signs among mothers in East Mamprusi District of Ghana. Global Health 2017; 13:19. [PMID: 28327154 PMCID: PMC5361799 DOI: 10.1186/s12992-017-0243-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 03/08/2017] [Indexed: 11/26/2022] Open
Abstract
Background An understanding of maternal knowledge of the danger signs of obstetric and newborn complications is fundamental to attaining universal health coverage. In Northern Ghana, where maternal and newborn morbidity and mortality is high, little is known about the current knowledge level and associated determinants of these danger signs. This study assessed the effect of social behavior change communication (SBCC) package on knowledge of obstetric and newborn danger signs among mothers with children under 24 months of age. Methods This study used a non-randomized controlled community-based intervention design with pre and post-intervention household surveys in the intervention and comparison communities of the East Mamprusi District in Ghana. The study population were selected using a two-stage cluster sampling procedure. Result Only 521 (51.1%), 300 (29.4%) and 353 (34.6%) of the study participants knew at least three key danger signs during pregnancy, delivery and postpartum period respectively. The intervention had a positive effect on maternal knowledge of danger signs. Compared to their counterparts in the comparison communities, women in the intervention communities were about 2.6 times (AOR = 2. 58 [CI: 1.87, 3.57]), 3.4 times (AOR = 3.39 [CI: 2.31, 4.96]) and 2.2 times (AOR = 2.19 [CI: 1.68, 2.84]) more likely to have higher knowledge of danger signs of childbirth, postpartum and neonate, respectively. Having sought postnatal services at least once was significantly associated with the mentioning of at least three danger signs of postpartum (AOR = 3.90 [CI: 2.01, 7.58]) and childbirth (AOR = 1.75 [CI: 1.06, 2.85]). Conclusion There was a significant contribution of social and behavioral change communication as an intervention to maternal knowledge in obstetric danger signs after adjusting for confounding factors such as antenatal and post-natal care attendance. Therefore, provision of information, education and communication targeting women on danger signs of pregnancy and childbirth and associated factors would be an important step towards attaining universal health coverage.
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Affiliation(s)
- Mahama Saaka
- School of Allied Health Sciences, University for Development Studies, P O Box TL 1883, Tamale, Ghana.
| | - Paul Aryee
- School of Allied Health Sciences, University for Development Studies, P O Box TL 1883, Tamale, Ghana
| | - Robert Kuganab-Lem
- School of Allied Health Sciences, University for Development Studies, P O Box TL 1883, Tamale, Ghana
| | - Mohammed Ali
- 2Catholic Relief Services (Ghana) Program, Tamale, Ghana
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Bililign N, Mulatu T. Knowledge of obstetric danger signs and associated factors among reproductive age women in Raya Kobo district of Ethiopia: A community based cross-sectional study. BMC Pregnancy Childbirth 2017; 17:70. [PMID: 28222694 PMCID: PMC5320700 DOI: 10.1186/s12884-017-1253-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/15/2017] [Indexed: 12/07/2023] Open
Abstract
Background Knowledge of danger signs of obstetric complications during pregnancy, labour, and postnatal period is the first essential step for appropriate and timely referral. This study aimed to investigate predictors of knowledge about obstetric danger signs during pregnancy, delivery, and postpartum period among mothers of reproductive age women who gave birth in the last 12 months. Methods A quantitative community based cross-sectional study was employed during March 2016. The study included 493 mothers who were selected by multi-stage sampling technique. Data were collected by face-to-face interview. Logistic regression analyses were employed to identify factors associated with knowledge of obstetric danger signs. Variables with a p-value <0.05 were identified as statistically significant factors. Results About forty-seven percent (46.7%), 27.8%, and 26.4% of the mothers were knowledgeable about obstetric danger signs during pregnancy, delivery, and postpartum period, respectively. Vaginal bleeding was the most frequently cited danger sign during the three periods. Mothers’ secondary or above education level increased odds of knowledge about danger signs during pregnancy (AOR: 3.63; 95% CI 1.19, 11.07) and postpartum period (AOR: 5.31; 95% CI 2.13, 13.22). Additionally, being employed (AOR: 5.41; 95% CI 1.03, 28.32), delivery at health institution (AOR: 2.14; 95% CI 1.17, 3.92) and number of ANC visits were statistically significant factors. Conclusion Knowledge of mothers about obstetric danger signs was low in the study area. Empowering women, improving the quality of health information about danger signs during ANC follow up, and promoting institutional delivery are the recommended interventions.
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Affiliation(s)
- Nigus Bililign
- Department of Midwifery, Faculty of Health sciences, Woldia University, PO.box: 400, Woldia, Ethiopia.
| | - Tesfahun Mulatu
- Department of Public Health, Faculty of Health sciences, Woldia University, Woldia, Ethiopia
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von Dadelszen P, Magee LA. Strategies to reduce the global burden of direct maternal deaths. Obstet Med 2017; 10:5-9. [PMID: 28491124 DOI: 10.1177/1753495x16686287] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 11/28/2016] [Indexed: 12/14/2022] Open
Abstract
The leading direct causes of the estimated 196 maternal deaths per 100,000 live births globally are postpartum haemorrhage, the hypertensive disorders of pregnancy, obstructed labour, unsafe abortion and obstetric sepsis. Of the Sustainable Development Goals, one (Sustainable Development Goal 3.1) specifically addresses maternal mortality; by 2030, the goal is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births. Eleven other Sustainable Development Goals provide opportunities to intervene. Unapologetically, this review focusses the reader's attention on health advocacy and its central role in altering the risks that many of the world's women face from direct obstetric causes of mortality. Hard work to alter social determinants of health and health outcomes remains. That work needs to start today to improve the health and social equality of today's girls who will be the women delivering their babies in 2030.
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Affiliation(s)
- Peter von Dadelszen
- Molecular and Clinical Sciences Research Institute, St George's, University of London, UK.,Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, UK
| | - Laura A Magee
- Molecular and Clinical Sciences Research Institute, St George's, University of London, UK.,Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, UK
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