Cross-sectional survey of knowledge of obstetric danger signs among women in rural Madagascar

Abstract

BackgroundAntenatal care (ANC) has the potential to identify and manage obstetric complications, educate women about risks during pregnancy and promote skilled birth attendance during childbirth. The aim of this study was to assess women’s knowledge of obstetric danger signs and factors associated with this knowledge in Ambanja, Madagascar. It also sought to evaluate whether the participation in a mobile health (mHealth) project that aimed to provide comprehensive ANC to pregnant women in remote areas influenced women’s knowledge of obstetric danger signs.MethodsFrom April to October 2015, a non-random, convenience sample of 372 women in their first year postpartum were recruited, including 161 who had participated in the mHealth project. Data were analyzed using bivariate and multivariate logistic regression.ResultsKnowledge of at least one danger sign varied from 80.9% of women knowing danger sign(s) in pregnancy, to 51.9%, 50.8% and 53.2% at delivery, postpartum and in the newborn, respectively. Participation in the mHealth intervention, higher household income, and receipt of information about danger signs during pregnancy were associated with knowledge of danger signs during delivery, in bivariate analysis; only higher household income and mHealth project participation were independently associated. Higher educational attainment and receipt of information about danger signs in antenatal care were associated with significantly higher odds of knowing danger sign(s) for the newborn in both bivariate and multivariate analysis.ConclusionsKnowledge of obstetric danger signs is low. Information provision during pregnancy and with mHealth is promising.Trial registrationThis trial was retrospectively registered at the International Standard Randomized Controlled Trial Register (identifier ISRCTN15798183; August 22, 2015).Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1664-x) contains supplementary material, which is available to authorized users.

Women's knowledge of maternal danger signs during pregnancy: Findings from a cross-sectional survey in Papua New Guinea

“…The specific danger signs mentioned by women in our study are similar to those from other low-middle income settings. Vaginal bleeding in pregnancy was mentioned consistently in a number of studies reporting danger signs during pregnancy (Hailu and Berhe 2014, Maseresha, Woldemichael et al 2016, Bintabara, Mpembeni et al 2017, Salem, Lacour et al 2018, including in our study. Swelling of the hands, feet and hands was also identified among women in Ethiopia Berhe 2014, Maseresha, Woldemichael et al 2016) and headaches and dizziness identified in rural Madagascar (Salem, Lacour et al 2018).…”

“…Vaginal bleeding in pregnancy was mentioned consistently in a number of studies reporting danger signs during pregnancy (Hailu and Berhe 2014, Maseresha, Woldemichael et al 2016, Bintabara, Mpembeni et al 2017, Salem, Lacour et al 2018, including in our study. Swelling of the hands, feet and hands was also identified among women in Ethiopia Berhe 2014, Maseresha, Woldemichael et al 2016) and headaches and dizziness identified in rural Madagascar (Salem, Lacour et al 2018). Although not identified as a danger sign directly relating to maternal outcomes, a number of studies, including ours, identified reduced fetal movement as a danger sign (Hailu and Berhe 2014, Maseresha, Woldemichael et al 2016, Salem, Lacour et al 2018).…”

“…In our study we identified that knowledge of danger signs was significantly associated with having attended secondary school. This finding has been noted in Tanzania (Pembe, Urassa et al 2009), however other studies have identified an association between secondary education and knowledge of danger signs in the newborn and postnatal period, but not during pregnancy (Hailu, Gebremariam et al 2010, Bogale and Markos 2015, Salem, Lacour et al 2018.…”

“…In Tanzania, 26% of 1118 women knew danger signs in pregnancy (Pembe, Urassa et al 2009); in Ethiopia 32% of 179 women reported danger signs (Hailu, Gebremariam et al 2010). Other settings have reported higher rates of knowledge of danger signs: from Uganda Kabakyenga et al report 52% of 764 women (Kabakyenga, Ostergren et al 2011) mentioned danger signs; and a recently published study from Madagascar reports 81% of 326 women knew at least one danger sign in pregnancy (Salem, Lacour et al 2018).…”

A cross-sectional study of the role of men and the knowledge of danger signs during pregnancy in southern Mozambique

“…Moreover, knowledge was very low and did not correlate with presence at ANC (either of the woman or her partner). Low knowledge of danger signs among women was also reported in studies in Madagascar, Tanzania and Ethiopia and often indicates overall poor quality of antenatal care [33,38,48]. Assessment of knowledge of danger signs among men is rarely carried out within maternal health care research, although it is well known that they play a major role in the referral of pregnant women in case of emergencies.…”