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Sadore AA, Kebede Y, Birhanu Z. Pregnancy Risk Perception, Knowledge of Obstetric Danger Signs and Attitude Towards Skilled Delivery Service Utilization Among Pregnant Mothers in a Rural Setting in South Ethiopia: A Community-Based Cross-Sectional Study. Int J Womens Health 2023; 15:1845-1856. [PMID: 38046268 PMCID: PMC10691428 DOI: 10.2147/ijwh.s432447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023] Open
Abstract
Background Poor pregnancy risk perception, ignorance of obstetric risk symptoms, and attitudes toward institutional delivery services are factors that prevent pregnant women from choosing to receive emergency obstetric treatment. Objective To assess pregnancy risk perception, attitude towards skilled delivery service, and knowledge of obstetric danger signs and associated factors among pregnant mothers. Methods A cross-sectional community-based study design was used. The 668 pregnant women who participated in this study were chosen using a multi-stage sampling methodology. Data were gathered using a pretested questionnaire that was presented by an interviewer. To find independent factors, logistic regression analysis was used. With a p-value of less than 0.05, which denotes statistical significance, a corresponding 95% confidence interval (CI) was calculated. Results Pregnancy risk perception was shown to have a lower mean score (23) overall. Only 40.9% of the study participants had high pregnancy risk perception. Over 50% (337) of respondents had a positive attitude towards skilled delivery service utilization. In all categories of obstetric danger signs, only 153 respondents (or 22.9%) knew what the obstetric danger signs were. Maternal age (AOR = 1.966, CI: 1.185-3.261), maternal education (AOR = 1.965, 1.002-3.854), and parity (AOR = 0.534, CI: 0.305-0.933) were factors affecting knowledge of obstetric danger signs. Pregnancy risk Perception (AOR = 14.7, CI: 9.849-22.235) and parity (AOR = 2.27, CI: 1.381-3.733) were significantly associated with attitudes on the use of skilled delivery services. Conclusion This study found that pregnant women in rural locations had poor levels of knowledge of obstetric danger sign, attitude toward using skilled delivery services, and perception of pregnancy risk. The knowledge of obstetric danger indicators among pregnant women was considerably affected by the mother's age, education, and parity. The perception of pregnancy risk and parity were found to be substantially associated with attitudes towards skilled delivery services.
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Affiliation(s)
- Abinet Arega Sadore
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Yohannes Kebede
- Department of Health, Behaviour and Society, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Zewdie Birhanu
- Department of Health, Behaviour and Society, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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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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Imani Ramazani BE, Mabakutuvangilanga Ntala SD, Katuashi Ishoso D, Rothan-Tondeur M. Knowledge of Obstetric Danger Signs among Pregnant Women in the Eastern Democratic Republic of the Congo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085593. [PMID: 37107875 PMCID: PMC10139184 DOI: 10.3390/ijerph20085593] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 05/10/2023]
Abstract
A lack of awareness regarding obstetric danger signs (ODS) is one of the factors that delay a pregnant woman's decision to seek emergency obstetric care. In developing countries, this delay can lead to high morbidity and mortality among pregnant women. In eastern Democratic Republic of Congo (DRC), very few studies have been conducted to assess the level of knowledge of pregnant women about ODS. Therefore, this study aimed to assess the knowledge of pregnant women about ODS in health facilities in eastern DRC. This quantitative cross-sectional, descriptive, and analytical study was conducted in 19 health facilities in the Kasongo health zone in the south Maniema Province of eastern DRC. A total of 624 pregnant women aged 12-49 years were interviewed in this study. Of these, 60.6% were secondary school graduates, >99% were married, 85.5% were cultivators, and 67.9% were Muslims. The knowledge of ODS among pregnant women was low (21.9%). The most cited danger signs during pregnancy, labor/delivery, and postpartum included severe abdominal pain and severe vaginal bleeding. Additionally, pregnant women aged 30-39 years (p = 0.015) and those who had given birth once (p = 0.049), twice (p = 0.003), 3-5 times (p = 0.004), and >5 times (p = 0.009) were more likely to be aware of ODS than others. Our findings indicated that pregnant women have little knowledge of ODS, which makes it difficult for them to take prompt decisions to seek emergency obstetric care. Thus, strategies to increase the knowledge of pregnant women about obstetrical danger signs by healthcare providers during prenatal consultations (antenatal care) must be developed to improve their rapid decision-making skills during pregnancy, labor, and postpartum.
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Affiliation(s)
- Bin-Eradi Imani Ramazani
- Nursing Sciences Research Chair, Laboratory Educations and Health Practices (LEPS), (EA 3412), UFR SMBH, University Paris, Sorbonne Paris Cite, F-93017 Bobigny, France; (S.-D.M.N.); (M.R.-T.)
- Nursing Sciences Section, Institut Supérieur des Techniques Médicales de Kindu (ISTM-KINDU), PB.304, Kindu P.O. Box 9912, Democratic Republic of the Congo
- Center for Research in Nursing Sciences and Health Innovation (CReSIIS), K-012, Kinshasa P.O. Box 11850, Democratic Republic of the Congo;
- Correspondence: ; Tel.:+243-81-14-89-176
| | - Simon-Decap Mabakutuvangilanga Ntala
- Nursing Sciences Research Chair, Laboratory Educations and Health Practices (LEPS), (EA 3412), UFR SMBH, University Paris, Sorbonne Paris Cite, F-93017 Bobigny, France; (S.-D.M.N.); (M.R.-T.)
- Center for Research in Nursing Sciences and Health Innovation (CReSIIS), K-012, Kinshasa P.O. Box 11850, Democratic Republic of the Congo;
- Section of Nursing Sciences, Institut Supérieur des Techniques Médicales de Kinshasa, BP 774 Lemba, Kinshasa P.O. Box 11850, Democratic Republic of the Congo
| | - Daniel Katuashi Ishoso
- Center for Research in Nursing Sciences and Health Innovation (CReSIIS), K-012, Kinshasa P.O. Box 11850, Democratic Republic of the Congo;
- Department of Community Health, Kinshasa School of Public Health, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo
| | - Monique Rothan-Tondeur
- Nursing Sciences Research Chair, Laboratory Educations and Health Practices (LEPS), (EA 3412), UFR SMBH, University Paris, Sorbonne Paris Cite, F-93017 Bobigny, France; (S.-D.M.N.); (M.R.-T.)
- Center for Research in Nursing Sciences and Health Innovation (CReSIIS), K-012, Kinshasa P.O. Box 11850, Democratic Republic of the Congo;
- Assistance Publique-Hôpitaux de Paris (AP-HP), Nursing Sciences Research Chair, F-75005 Paris, France
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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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Asfaha BT, Gebremariam SH, Gebremariam GK, Weldemariam AG. Knowledge about Obstetric Danger Signs and Related Factors in Reproductive-Age Women in the Southeast Zone of Tigray, 2021: A Cross-Sectional Study. Int J Reprod Med 2022; 2022:7346618. [PMID: 35692452 PMCID: PMC9177252 DOI: 10.1155/2022/7346618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/24/2022] [Indexed: 12/02/2022] Open
Abstract
Background Pregnancy complications are the major health problems among women in developing countries. Globally, around 295,000 women die from pregnancy-related causes annually and 86% of these maternal deaths happen in developing countries. Objective To assess knowledge of obstetric danger signs among reproductive-age women living in southeastern zone of Tigray Region, Ethiopia, 2021. Methods A community-based quantitative cross-sectional survey was undertaken in southeastern zone of Tigray. A multistage random sampling technique was implemented to select total participants of 410 reproductive-age women. Two districts were randomly selected, and from those districts, 12 kebeles were selected randomly, and the calculated sample size (410) was proportionally allocated to each selected kebel. The data were collected by using face-to-face interview with a structured questionnaire from January 20 to February 20/2021 after ensuring that all requirements of ethical considerations were fulfilled. The collected data were entered into EpiData version 4.2 and then exported to SPSS version 20 for analysis. Descriptive statistics with frequency, percentage, table and graph, and cross-tabulation were used for presentation of result. Bivariable and multivariable analyses were used to examine the association. Odds ratios with 95% confidence interval and P value < 0.05 were used to determine the statistical association. Result Four hundred ten reproductive-age women participated in the study making a response rate of 100%. Leakage of fluid per vagina was the most commonly mentioned obstetric danger signs (61%). Overall, one hundred seventy-two (42%) had good knowledge on obstetric danger sign. Educational status of the mother (AOR (95%CI = 2.7 (1.189-6.24))), site of delivery (AOR (95%CI = 2.2 (1.6-3.432))), and having history of an ANC follow-up (AOR (95%CI = 2.4 (1.13-5.6))) were found to be independent predictors of knowledge of women about the obstetric danger sign. Conclusion and Recommendation. Educational status of the mother site of delivery and having history of an ANC follow-up were independently associated with knowledge of women about obstetric danger signs. Thus, provision of the Information, Education and Communication targeting women, family, and the general community on obstetric danger signs and associated factors was recommended.
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Affiliation(s)
- Berhane Teklay Asfaha
- Department of Midwifery, College of Health Sciences, Assosa University, Assosa, Ethiopia
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Yargawa J, Fottrell E, Hill Z. Women's perceptions and self-reports of excessive bleeding during and after delivery: findings from a mixed-methods study in Northern Nigeria. BMJ Open 2021; 11:e047711. [PMID: 34635515 PMCID: PMC8506868 DOI: 10.1136/bmjopen-2020-047711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To explore lay perceptions of bleeding during and after delivery, and measure the frequency of self-reported indicators of bleeding. SETTING Yola, North-East Nigeria. PARTICIPANTS Women aged 15-49 years who delivered in the preceding 2 years of data collection period (2015-2016), and their family members who played key roles. METHODS Data on perceptions of bleeding were collected through 7 focus group discussions, 21 in-depth interviews and 10 family interviews. Sampling was purposive and data were analysed thematically. A household survey was then conducted with 640 women using cluster sampling on postpartum bleeding indicators developed from the qualitative data; data were analysed descriptively. RESULTS Perceptions of excessive bleeding fell under four themes: quantity of blood lost; rate/duration of blood flow; symptoms related to blood loss and receiving birth interventions/hearing comments from birth attendants. Young and less educated rural women had difficulty quantifying blood loss objectively, including when shown quantities using bottles. Respondents felt that acceptable blood loss levels depended on the individual woman and whether the blood is 'good' or 'diseased/bad.' Respondents believed that 'diseased' blood was a normal result of delivery and universally took steps to help it 'come out.' In the quantitative survey, indicators representing less blood loss were reported more frequently than those representing greater loss, for example, more women reported staining their clothes (33.6%) than the bed (18.1%) and the floor (6.2%). Overall, indicators related to quantity and rate of blood flow had higher frequencies compared with symptom and intervention-related/comment-related indicators. CONCLUSION Women quantify bleeding during and after delivery in varied ways and some women do not see bleeding as problematic. This suggests the need for standard messaging to address subjectivity. The range of indicators and varied frequencies highlight the challenges of measuring excessive bleeding from self-reports. More work is needed in improving and testing validity of questions.
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Affiliation(s)
- Judith Yargawa
- Institute for Global Health, University College London, London, UK
| | - Edward Fottrell
- Institute for Global Health, University College London, London, UK
| | - Zelee Hill
- Institute for Global Health, University College London, London, UK
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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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Emeh AN, Atem AN, Humphrey AA, Gilbert TN, Landis FC. Antenatal care and determinants of obstetric danger signs awareness of immediate postpartum women at Buea Regional Hospital, Cameroon. Pan Afr Med J 2021; 38:247. [PMID: 34104295 PMCID: PMC8164428 DOI: 10.11604/pamj.2021.38.247.20977] [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: 11/14/2019] [Accepted: 03/01/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction a significant proportion of pregnancy related deaths result from delay in decision to seek care and this often stems from failure to identify obstetric danger signs earlier. Early identification of these danger signs will therefore reduce maternal mortality. However, studies on obstetric danger signs awareness are lacking in Cameroon. The objective of this study was to assess the determinants of obstetric danger signs awareness of women at immediate postpartum period. This will inform ANC providers´ practice. Methods between June and September 2019, women who delivered at the Buea Regional Hospital were interviewed within 24 hours following their delivery using a researcher-administered questionnaire that covered socio-demographic and obstetric variables. Data were entered into EpiData and analysis done using SPSS 16 and OpenEpi. Statistical significance was set at p-value < 0.05. Results of the 532 participants, majority (230/532: 43.2%) were those aged 26-35; danger signs awareness rate was 73.3%. There was a statistically significant relation between age and awareness of obstetric danger signs which showed that older women were more aware than their younger counterparts (p=0.00). Other statistically significant determinants of danger sign awareness included occupation, level of education, parity, trimester of onset of antenatal visits and the number of visits before delivery (p<0.05). Multiparity (370/490: 75.5%) and grand multiparity (14/22: 63.6%) were more likely to be aware of obstetric danger signs than primiparous women (6/20: 30%). Similarly, those who started antenatal visits earlier (first or second trimester) and those who attended more visits were more likely to be aware of obstetric danger signs than their counterparts who started later or had lesser antenatal visits before delivery. The most reported danger signs were severe vaginal bleed (71.4%), fever (62.0%) and reduced fetal movement. Conclusion conclusively, more focus should be placed on the sensitisation about obstetric danger signs when in contact with primiparous and younger parturient during ANC visits.
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Affiliation(s)
- Agbor Nathan Emeh
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Alpha Higher Institute of Douala, Douala, Cameroon.,Ministry of Public Health, Yaoundé, Cameroon
| | | | - Atongno Ashu Humphrey
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Alpha Higher Institute of Douala, Douala, Cameroon.,Ministry of Public Health, Yaoundé, Cameroon
| | - Tambetakaw Njang Gilbert
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Alpha Higher Institute of Douala, Douala, Cameroon.,Ministry of Public Health, Yaoundé, Cameroon
| | - Fongang Che Landis
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Department of Health Sciences, Cameroon Christian University, Cameroon
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Awareness of obstetric danger signs among pregnant women in the Democratic Republic of Congo: evidence from a nationwide cross-sectional study. BMC WOMENS HEALTH 2021; 21:82. [PMID: 33637065 PMCID: PMC7908745 DOI: 10.1186/s12905-021-01234-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/18/2021] [Indexed: 11/24/2022]
Abstract
Background Poor awareness of obstetric danger signs is a major contributing factor to delays in seeking obstetric care and hence to high maternal mortality and morbidity worldwide. We conducted the current study to assess the level of agreement on receipt of counseling on obstetric danger signs between direct observations of antenatal care (ANC) consultation and women’s recall in the exit interview. We also identified factors associated with pregnant women’s awareness of obstetric danger signs during pregnancy in the Democratic Republic of Congo (DRC) Methods We used data from the 2017–2018 DRC Service Provision Assessment survey. Agreement between the observation and woman’s recall was measured using Cohen’s kappa statistic and percent agreement. Multivariable Zero-Inflated Poisson (ZIP) regression was used to identify factors associated with the number of danger signs during pregnancy the woman knew. Results On average, women were aware of 1.5 ± 1.34 danger signs in pregnancy (range: 0 to 8). Agreement between observation and woman’s recall was 70.7%, with a positive agreement of 16.9% at the country level but ranging from 2.1% in Bandundu to 39.7% in Sud Kivu. Using multivariable ZIP analysis, the number of obstetric danger signs the women mentioned was significantly higher in multigravida women (Adj.IRR = 1.38; 95% CI: 1.23–1.55), in women attending a private facility (Adj.IRR = 1.15; 95% CI: 1.01–1.31), in women attending a subsequent ANC visit (Adj.IRR = 1.11; 95% CI: 1.01–1.21), and in women counseled on danger signs during the ANC visit (Adj.IRR = 1.19; 95% CI: 1.05–1.35). There was a regional variation in the awareness of danger signs, with the least mentioned signs in the middle and the most in the eastern provinces. Conclusions Our findings indicated poor agreement between directly observed counseling and women’s reports that counseling on obstetric danger signs occurred during the current ANC visit. We found that province of residence, provision of counseling on obstetric danger signs, facility ownership, gravidity and the number of ANC visits were predictors of the awareness of obstetric danger signs among pregnant women. These factors should be considered when developing strategies aim at improving women’s awareness about obstetric danger signs in the DRC
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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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Orwa J, Gatimu SM, Mantel M, Luchters S, Mugerwa MA, Brownie S, Subi L, Mrema S, Nyaga L, Edwards G, Mwasha L, Isangula K, Selestine E, Jadavji S, Pell R, Mbekenga C, Temmerman M. Birth preparedness and complication readiness among women of reproductive age in Kenya and Tanzania: a community-based cross-sectional survey. BMC Pregnancy Childbirth 2020; 20:636. [PMID: 33076869 PMCID: PMC7574438 DOI: 10.1186/s12884-020-03329-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/09/2020] [Indexed: 12/28/2022] Open
Abstract
Background Delayed health-seeking continues to contribute to preventable maternal and neonatal deaths in low resource countries. Some of the strategies to avoid the delay include early preparation for the birth and detection of danger signs. We aimed to assess the level of practice and factors associated with birth preparedness and complication readiness (BPCR) in Kenya and Tanzania. Methods We conducted community-based multi-stage cross-sectional surveys in Kilifi and Kisii counties in Kenya and Mwanza region in Tanzania and included women who delivered two years preceding the survey (2016–2017). A woman who mentioned at least three out of five BPCR components was considered well-prepared. Bivariate and multivariable proportional odds model were used to determine the factors associated with the BPCR. The STROBE guidelines for cross-sectional studies informed the design and reporting of this study. Results Only 11.4% (59/519) and 7.6% (31/409) of women were well-prepared for birth and its complications in Kenya and Tanzania, respectively, while 39.7 and 30.6% were unprepared, respectively. Level of education (primary: adjusted odds ratio (aOR): 1.59, 95% CI: 1.14–2.20, secondary: aOR: 2.24, 95% CI: 1.39–3.59), delivery within health facility (aOR: 1.63, 95% CI: 1.15–2.29), good knowledge of danger signs during pregnancy (aOR: 1.28, 95% CI: 0.80–2.04), labour and childbirth (aOR: 1.57, 95% CI: 0.93–2.67), postpartum (aOR: 2.69, 95% CI: 1.24–5.79), and antenatal care were associated with BPCR (aOR: 1.42, 95% CI: 1.13–1.78). Conclusion Overall, most pregnant women were not prepared for birth and its complications in Kilifi, Kisii and Mwanza region. Improving level of education, creating awareness on danger signs during preconception, pregnancy, childbirth, and postpartum period, and encouraging antenatal care and skilled birth care among women and their male partners/families are recommended strategies to promote BPCR practices and contribute to improved pregnancy outcomes in women and newborns.
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Affiliation(s)
- James Orwa
- Centre of Excellence Women and Child Health/MERL, Aga Khan University, P. O. Box 30270-00010, Nairobi, Kenya. .,Department of Population Health, Aga Khan University, Nairobi, Kenya.
| | | | - Michaela Mantel
- Centre of Excellence Women and Child Health/MERL, Aga Khan University, P. O. Box 30270-00010, Nairobi, Kenya.,Department of Population Health, Aga Khan University, Nairobi, Kenya.,Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya
| | - Stanley Luchters
- Department of Population Health, Aga Khan University, Nairobi, Kenya.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | | | - Sharon Brownie
- Centre for Health & Social Practice, Waikato Institute of Technology (Wintec), Hamilton, New Zealand.,School of Medicine, Griffith University, Brisbane, QLD, Australia.,Green Templeton College, Oxford University, Oxford, UK
| | - Leonard Subi
- Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Secilia Mrema
- Regional Reproductive and Child Health Office, Region, Mwanza, Tanzania
| | - Lucy Nyaga
- Centre of Excellence Women and Child Health/MERL, Aga Khan University, P. O. Box 30270-00010, Nairobi, Kenya
| | - Grace Edwards
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| | - Loveluck Mwasha
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania
| | - Kahabi Isangula
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania
| | | | | | | | - Columba Mbekenga
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania
| | - Marleen Temmerman
- Centre of Excellence Women and Child Health/MERL, Aga Khan University, P. O. Box 30270-00010, Nairobi, Kenya.,Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Klobodu C, Milliron BJ, Agyabeng K, Akweongo P, Adomah-Afari A. Maternal birth preparedness and complication readiness in the Greater Accra region of Ghana: a cross-sectional study of two urban health facilities. BMC Pregnancy Childbirth 2020; 20:566. [PMID: 32977757 PMCID: PMC7519482 DOI: 10.1186/s12884-020-03263-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background High maternal mortality ratios remain a critical public health concern in Ghana. Birth preparedness and complication readiness (BP/CR), which is a component of focused antenatal care, is a safe motherhood strategy intended to promote skilled birth attendance by helping women and their families plan for pregnancy and childbirth, thereby reducing maternal mortality. The objective of this study was to determine the level of BP/CR and to assess factors associated with maternal BP/CR in the Greater Accra Region of Ghana. Method A cross sectional descriptive quantitative study was carried out among 300 postnatal women attending the Adabraka Polyclinic and the Greater Accra Regional Hospital both within Accra, the capital city of Ghana. Data were collected with a structured questionnaire which assessed socio-demographic, health facility/provider and social support factors and their associations with BP/CR. Levels of BP/CR were assessed using validated tools. Data from 300 women were analyzed using STATA version 15.0. Logistic regression analysis was conducted to establish associations between BP/CR and socio-demographic, health facility/provider and social support factors. Results Approximately 234 (78%) of the women were birth prepared. Strong predictors of BP/CR included having ≥4 antenatal clinic visits (aOR 2.63; 95% CI 1.03–6.73), being employed (aOR 4.07; 95% CI 1.49–11.11) and belonging to maternal health promoting clubs or groups during the antenatal period (aOR 3.00; 95% CI 1.07–8.40) . Conclusion BP/CR is generally high among the study population. Predictors of BP/CR are multifactorial and found to cut across all aspects assessed in the study. Therefore, the creation of a BP/CR tool is recommended to routinely monitor trends in maternal birth preparedness in antenatal clinics. This may help to sustain and improve current levels and indicators of BP/CR.
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Affiliation(s)
- Cynthia Klobodu
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana - Legon, P.O. Box LG 13, University of Ghana, Legon, Ghana
| | - Brandy-Joe Milliron
- Department of Nutrition Sciences, Centre for Family Intervention Science, College of Nursing and Health Professions, Drexel University, 1601 Cherry Street. Suite 383, Philadelphia, PA, 19102, USA.
| | - Kofi Agyabeng
- Ministry of Education, National Inspectorate Board, Private Mail Bag 18, Ministries Post Office, Ameda Street, Yooyi Ln, Accra, Ghana
| | - Patricia Akweongo
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana - Legon, P.O. Box LG 13, University of Ghana, Legon, Ghana
| | - Augustine Adomah-Afari
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana - Legon, P.O. Box LG 13, University of Ghana, Legon, Ghana
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13
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Ameyaw EK, Ahinkorah BO, Seidu AA. Does knowledge of pregnancy complications influence health facility delivery? Analysis of 2014 Bangladesh Demographic and Health Survey. PLoS One 2020; 15:e0237963. [PMID: 32853211 PMCID: PMC7451572 DOI: 10.1371/journal.pone.0237963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 08/06/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction Only thirty-seven percent (37%) of deliveries occur in health facilities in Bangladesh despite the enormous benefits of health facility delivery. We investigated women’s recall of receiving counseling on pregnancy complications and how it affects health facility delivery in Bangladesh. Materials and methods Data from the 2014 Bangladesh Demographic and Health Survey was used for the study. After calculating the proportion of women who were informed about pregnancy complications during their last Antenatal Care (ANC) and the number of them who delivered in health facilities, Binary Logistic Regression was utilized in investigating chances of giving birth in health facilities among women who recalled they were told about pregnancy complications and those who were not told. The models were considered significant at 95%. Results A little above half of the women who were told about pregnancy complications during ANC delivered in health facilities (53.3%) and 43.6% of those who were not told delivered in health facilities. The findings revealed that women who were told about pregnancy complications during ANC were more likely to deliver at the health facility compared to those who were not told [COR = 1.56, CI = 1.31–1.87], and this persisted after controlling for the effect of covariates [AOR = 1.44, CI = 1.21–1.71]. Conclusion This study has stressed the importance of telling women about pregnancy complications during ANC by revealing that telling women about pregnancy complications during ANC is likely to result in health facility delivery. Health workers should intensify health education on pregnancy complications during ANC and motivate women to deliver in health facilities.
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Affiliation(s)
- Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- * E-mail:
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14
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Masoi TJ, Kibusi SM, Ibolinga AE, Lilungulu AG. The Pattern and Level of Knowledge on Obstetric and Newborn Danger Signs and Birth Preparedness among Pregnant Women in Dodoma Municipal: a Cross Sectional Study. East Afr Health Res J 2020; 4:73-80. [PMID: 34308223 PMCID: PMC8279159 DOI: 10.24248/eahrj.v4i1.624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/29/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Unacceptable high maternal mortality rates remain a major challenge in many low-income countries. Early detection and management of antenatal risk factors and good preparation for birth and emergencies are critical for improved maternal and infant outcomes. The aim of this study was to understand the pattern and level of knowledge on obstetric and newborn danger signs, Individual Birth Preparedness and Complication Readiness (IBPACR) among pregnant women in Dodoma Municipal. Methods: A quantitative cross sectional study was carried out between February and June 2018. A random selection of participants was employed to achieve a sample size of 450 pregnant women. A standard semi-structure questionnaire was used to collect data and descriptive analysis was carried out by using SPSS software to see the pattern and level of knowledge on obstetric danger signs and individual birth preparedness. Results: The mean age of participants was 25.6 years ranging from 16 to 48 years and majority 326 (72.4%) had 2 to 4 pregnancies. Only 203(45.1%) of the pregnant women were able to tell 8 and above danger signs with at least 1 from each of the 4 phases, with the most known obstetric danger signs being vagina bleeding during pregnancy 287(63.8), labour and delivery 234(52.0%), after delivery 278 (61.8) . 164 (36.4%) of the participants reported fever and difficult in feeding 182 (40.4%) as danger signs in newborn. Furthermore, only 75(16.7%) of the participants reported to be prepared for birth and complications. The most known component of birth preparedness was preparing important supply which are needed during birth 283 (62.9%). Conclusion: Results of this study showed a low level of knowledge on obstetric and newborn danger signs as well as poor individual birth preparedness and complication readiness. Important predictors of knowledge level and birth preparedness were found to be age, education level, gestation age at first visit and husband involvement in Antenatal visit and care.
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15
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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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16
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Masoi TJ, Kibusi SM. Improving pregnant women's knowledge on danger signs and birth preparedness practices using an interactive mobile messaging alert system in Dodoma region, Tanzania: a controlled quasi experimental study. Reprod Health 2019; 16:177. [PMID: 31831076 PMCID: PMC6909441 DOI: 10.1186/s12978-019-0838-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 11/20/2019] [Indexed: 12/02/2022] Open
Abstract
Background Unacceptably high maternal and perinatal mortality remain a major challenge in many low income countries. Early detection and management of danger signs through improved access to maternal services is highly needed for better maternal and infant outcomes. The aim of this study was to test the effectiveness of an interactive mobile messaging alert system on improving knowledge on danger signs, birth preparedness and complication readiness practices among pregnant women in Dodoma region, Tanzania. Methods A controlled quasi experimental study of 450 randomly selected pregnant women attending antenatal care was carried in Dodoma municipal. Participants were recruited at less than 20 weeks of gestation during the first visit where 150 were assigned to the intervention and 300 to the control group. The intervention groups was enrolled in an interactive mobile messaging system and received health education messages and were also able to send and receive individualized responses on a need basis. The control group continued receiving usual antenatal care services offered at the ANC centers. Pregnant women were followed from their initial visit to the point of delivery. Level of knowledge on danger signs and birth preparedness were assessed at baseline and a post test was again given after delivery for both groups. Analyses of covariance, linear regression were employed to test the effectiveness of the intervention. Results The mean age of participants was 25.6 years ranging from 16 to 48 years. There was significant mean scores differences for both knowleadge and birth preparedness between the intervention and the control group after the intervention (p < .001). The mean knowleadge score was (M = 9.531,SD = 2.666 in the intervention compared to M = 6.518,SD = 4.304 in the control, equivalent to an effect size of 85% of the intervention. Meanwhile, the mean score for IBPACR was M = 4.165,SD = 1.365 for the intervention compared to M = 2.631,SD = 1.775 in the control group with an effect size of 90% A multivariate linear regression showed a positive association between the intervention (p < 0.001) and level of knowledge (B = 2.910,95%CI = 2.199–3.621) and birth preparediness (B = 1.463,95%CI = 1.185–1.740). Conclusion The Interactive mobile messaging alert system demonstrated to be effective in increasing women’s knowledge on danger signs and improving their birth preparedness practices.
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Affiliation(s)
- Theresia J Masoi
- Department of Nursing and midwifery, College of Health Sciences, the University of Dodoma, P.O. Box 259, Dodoma, Tanzania. .,Department of Public Health, College of Health Scinces, the University of Dodoma, Dodoma, Tanzania.
| | - Stephen M Kibusi
- Department of Nursing and midwifery, College of Health Sciences, the University of Dodoma, P.O. Box 259, Dodoma, Tanzania.,Department of Public Health, College of Health Scinces, the University of Dodoma, Dodoma, Tanzania
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17
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Bintabara D, Nakamura K, Ntwenya J, Seino K, Mpondo BCT. Adherence to standards of first-visit antenatal care among providers: A stratified analysis of Tanzanian facility-based survey for improving quality of antenatal care. PLoS One 2019; 14:e0216520. [PMID: 31083696 PMCID: PMC6513091 DOI: 10.1371/journal.pone.0216520] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/23/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Despite the benefits of early antenatal care visits for early prevention, detection, and treatment of potential complications in pregnancy, a high level of provider adherence to first-visit antenatal care standards is needed. However, little information is available regarding provider adherence to antenatal care in Tanzania. This study was performed to assess provider adherence to first-visit antenatal care standards and to apply stratified analysis to identify associated factors in Tanzania. METHODS Data from the 2014-2015 Tanzania Service Provision Assessment Survey were used in this study. Provider adherence to first-visit antenatal care standards was measured using 10 domains: client history; aspects of prior pregnancies; danger signs of the current pregnancy; physical examination; routine tests; HIV testing and counseling; maintaining a healthy pregnancy; iron/folate supplements; tetanus toxoid vaccination, and preparation for delivery. A composite score was then created in which the highest quantile (corresponding to ≥60.5%) considered to provider adhering to first-visit antenatal care standards. Initially, a series of unadjusted logistic regression analyses according to the type of facility and managing authority were performed separately at each level (i.e., facility, provider, and client). Thereafter, all variables with P < 0.2 were fitted into the respective stratified multivariable logistic regression analysis using a 5% significance level. RESULTS A total of 1756 first-visit antenatal care consultations performed by 822 providers in 648 health facilities were analyzed. The overall median [Interquartile range, IQR] adherence to first-visit antenatal care was relatively low at 47.1% [35.7%-60.5%]. After adjusting for selected variables from each level in specific strata, at dispensary; female providers [AOR = 5.5; 95% CI, 1.8-16.4], at health centre; performance of quality assurance [AOR = 2.2; 95% CI, 1.3-3.9], at hospital; availability of routine tests [AOR = 2.5; 95% CI, 1.3-4.8] and basic medicine [AOR = 2.8; 95% CI, 1.4-5.7], at public facilities; availability of medicine [AOR = 1.8; 95% CI, 1.1-3.2] and receiving refresher training [AOR = 1.8; 95% CI, 1.1-3.1], and at private facility; receiving external fund from government [AOR = 3.0; 95% CI, 1.1-8.4] were significantly associated with better adherence to first-visit antenatal care standards. CONCLUSIONS The study highlighted the important factors, including the provision of refresher training, regular distribution of basic medicines, and diagnostics equipment which may influence provider adherence to first-visit ANC standards.
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Affiliation(s)
- Deogratius Bintabara
- Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
- Department of Public Health, College of Health Sciences, The University of Dodoma, Dodoma, Tanzania
| | - Keiko Nakamura
- Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
- * E-mail:
| | - Julius Ntwenya
- Department of Public Health, College of Health Sciences, The University of Dodoma, Dodoma, Tanzania
| | - Kaoruko Seino
- Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan United States of America
| | - Bonaventura C. T. Mpondo
- Department of Internal Medicine, College of Health Sciences, The University of Dodoma, Dodoma, Tanzania
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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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Jungari S, Paswan B. What he knows about her and how it affects her? Husband's knowledge of pregnancy complications and maternal health care utilization among tribal population in Maharashtra, India. BMC Pregnancy Childbirth 2019; 19:70. [PMID: 30760234 PMCID: PMC6373054 DOI: 10.1186/s12884-019-2214-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 02/04/2019] [Indexed: 11/26/2022] Open
Abstract
Background Husbands’ knowledge and awareness of pregnancy complications have a positive impact on their wives’ utilization of maternal health care services. In this study, we examined whether husbands’ knowledge and awareness of pregnancy complications can serve as determinants of maternal health service utilization among wives from the tribal population. Methods This cross-sectional study was conducted in the rural Gadchrioli district of Maharashtra, India, during November 2014–March 2015. This study included a representative population-based sample of 385 men whose wives had given birth in last 2 years at the age of 15–49 years. A multistage sampling strategy was adopted to select the respondents. Univariate, bivariate, and binary logistic regression analyses were applied to examine the association between men’s knowledge and maternal health service utilization. Results The result revealed that an increase in husbands’ education level increased the wives’ utilization of antenatal (ANC) care services. The type of tribe also contributed to significant differences in ANC utilization (OR: 2.64; 95% CI: 0.847–8.24). Regarding standard of living, husbands who were poor were 22% less likely than husbands in the rich category to report the utilization of ANC by their wives. Men with partial or complete knowledge of pregnancy, childbirth, and postpartum complications were more likely to utilize all maternal health services by their wives. Conclusions The wives are of men who aware of complications during pregnancy and childbirth are more likely to use maternal health services. Therefore, educating and empowering men about pregnancy complications will contribute to the reduction in maternal and neonatal deaths. Electronic supplementary material The online version of this article (10.1186/s12884-019-2214-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Suresh Jungari
- Interdisciplinary School of Health Sciences, Saritribai Phule Pune University, Pune, Maharashtra, 411007, India.
| | - Balram Paswan
- Department of Population Policies and Programmes, International Institute for Population Sciences, Mumbai, India
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20
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Vallely LM, Emori R, Gouda H, Phuanukoonnon S, Homer C, Vallely AJ. Women's knowledge of maternal danger signs during pregnancy: Findings from a cross-sectional survey in Papua New Guinea. Midwifery 2019; 72:7-13. [PMID: 30739884 DOI: 10.1016/j.midw.2019.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/29/2019] [Accepted: 02/03/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To explore knowledge of pregnancy related danger signs among women attending antenatal clinics in Papua New Guinea. DESIGN Cross-sectional survey undertaken as part of a wider integrated health and demographic survey. SETTING Three sites in Papua New Guinea: Hiri District (Central Province), Karkar (Madang Province) and Asaro (Eastern Highlands Province). PARTICIPANTS 482 women aged 15-44 years. FINDINGS Almost all (95.2%; 459/482) women attended for antenatal care at least once; 68.2% attended four or more times. Among women who attended the antenatal clinic, 53.6% (246/459) reported receiving information about danger signs in pregnancy from a health worker. Of these 60.2% (148/246) could recall at least one danger sign. In addition, 16.4% (35/213) of women who did not receive information from the antenatal clinic reported pregnancy related danger signs. Among the 183 women who reported danger signs, 47.5% (87/183) reported fever; 39.3% (72/183) reported vaginal bleeding and 36.6% (67/183) reported swelling of the face, legs and arms. Women who reported receiving information at the antenatal clinic were significantly more likely know any danger signs, compared with women who did not receive information at the antenatal clinic (OR 7.68 (95%CI: 4.93, 11.96); p = <0.001). Knowledge of danger signs was significantly associated with secondary school education, compared with none or only primary education (OR 3.08 (95% CI: 2.06, 4.61); p = <0.001). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Every antenatal clinic visit should be used opportunistically to provide women with information about key danger signs during pregnancy and childbirth. Recognising maternal danger signs, together with the importance of seeking early transfer to the health facility and the importance of attending for a health facility birth are critical to improving outcomes for mothers and babies especially in low income settings such as Papua New Guinea.
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Affiliation(s)
- L M Vallely
- Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, Sydney 2052, Australia; Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - R Emori
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - H Gouda
- School of Public Health, University of Queensland, Brisbane, Australia.
| | - S Phuanukoonnon
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Cse Homer
- Burnet Institute, Melbourne, Victoria, Australia; Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology, Sydney, Australia.
| | - A J Vallely
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; Kirby Institute, University of New South Wales, Sydney, Australia.
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Bintabara D, Nakamura K, Seino K. Improving access to healthcare for women in Tanzania by addressing socioeconomic determinants and health insurance: a population-based cross-sectional survey. BMJ Open 2018; 8:e023013. [PMID: 30209158 PMCID: PMC6144413 DOI: 10.1136/bmjopen-2018-023013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE This study was performed to explore the factors associated with accumulation of multiple problems in accessing healthcare among women in Tanzania as an example of a low-income country. DESIGN Population-based cross-sectional survey. SETTING Nationwide representative data for women of reproductive age obtained from the 2015-2016 Tanzania Demographic and Health Survey were analysed. PRIMARY OUTCOME MEASURES A composite variable, 'problems in accessing healthcare', with five (1-5) categories was created based on the number of problems reported: obtaining permission to go to the doctor, obtaining money to pay for advice or treatment, distance to a health facility and not wanting to go alone. Respondents who reported fewer or more problems placed in lower and higher categories, respectively. RESULTS A total of 13 266 women aged 15-49 years, with a median age (IQR) of 27 (20-36) years were interviewed and included in the analysis. About two-thirds (65.53%) of the respondents reported at least one of the four major problems in accessing healthcare. Furthermore, after controlling for other variables included in the final model, women without any type of health insurance, those belonging to the poorest class according to the wealth index, those who had not attended any type of formal education, those who were not employed for cash, each year of increasing age and those who were divorced, separated or widowed were associated with greater problems in accessing healthcare. CONCLUSION This study indicated the additive effects of barriers to healthcare in low-income countries such as Tanzania. Based on these results, improving uptake of health insurance and addressing social determinants of health are the first steps towards reducing women's problems associated with accessing healthcare.
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Affiliation(s)
- Deogratius Bintabara
- Division of Public Health, Department of Global Health Entrepreneurship, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
- Department of Public Health, College of Health Sciences, The University of Dodoma, Dodoma, Tanzania
| | - Keiko Nakamura
- Division of Public Health, Department of Global Health Entrepreneurship, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
| | - Kaoruko Seino
- Division of Public Health, Department of Global Health Entrepreneurship, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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