Knowledge and Understanding of Obstetric Danger Signs Among Pregnant Women Attending the Antenatal Clinic at the National Referral Hospital in Thimphu, Bhutan: A Cross-Sectional Study

Abstract

Background: The third Sustainable Development Goal aims to reduce maternal and newborn deaths. Pregnant women’s understanding of danger signs is an important factor in seeking timely care during emergencies. We assessed knowledge of obstetric danger signs using both recall and understanding of appropriate action required during obstetric emergencies.Methods: This was a cross-sectional study among pregnant women attending antenatal clinic at Bhutan’s largest hospital in Thimphu. Recall was assessed against seven obstetric danger signs outlined in the Mother and Child Health Handbook (7 points). Understanding of danger signs was tested using 13 multiple choice questions (13 points). Knowledge was scored out of 20 points and reported as “good” (≥80%), “satisfactory” (60 – 79%) and “poor” (<60%). Association between knowledge score and participant characteristics were tested using Chi-square, Fisher’s Exact and t-tests. Corresponding non-parametric tests were performed where appropriate. Correlation between participant characteristics and knowledge score as well as number of danger signs recalled was tested using Pearson’s correlation coefficient. Results with p<0.05 were considered significant.Results: Four hundred and twenty-two women responded to the survey (response rate = 96.0%). Mean (±SD) knowledge score was 12 (±2.5). Twenty women (4.7%) had “good knowledge”, 245 (58.1%) had “satisfactory knowledge” and 157 (37.2%) had “poor knowledge”. The median number of danger signs recalled was 2 (IQR 1, 3) while 68 (20.3%) women could not recall any danger signs. Women were most knowledgeable about pre-labour rupture of membranes (96.0%) and least knowledgeable about spotting during pregnancy (19.9%). Knowledge level was significantly associated with reading Mother and Child Health Handbook, mother’s education level, husband’s education level, number of antenatal care visits, gestational age and past surgery on reproductive tract. Both knowledge score and number of danger signs recalled significantly correlated with the period of gestation. Conclusions: Most pregnant women had satisfactory knowledge score but recognized the appropriate actions warranted during obstetric emergencies. The MCH Handbook has played a significant role in improving knowledge and understanding of danger signs.

Knowledge regarding obstetric danger signs among pregnant women

“…This finding is consistent with study findings of Bhutan where only 4.7% of women had good knowledge of obstetric danger signs. 12 Another study conducted in Nigeria also had nearly consistent findings to our study where only 6% of the respondents had good knowledge about obstetric danger signs. 13 Similarly, in a study conducted in Rwanda, very few respondents (6.6%) knew three or more key danger signs during the three periods; antenatal, intranatal and postnatal.…”

Women's attitude towards intimate partner violence and utilization of contraceptive methods and maternal health care services: an analysis of nationally representative cross-sectional surveys from four South Asian countries

“…Afghanistan had the lowest utilization for all maternal health care services, whereas Bhutan had the highest prevalence of family planning services, at least one ANC visit and four or more ANC visits among the four nations. Relatively high uptake of maternal health care services including ANC services in Bhutan could be attributed to the free health care service policy and priority set by the government to improve maternal and child health status in recent years [ 33 ]. These outcomes illustrate contextual differences across the South Asian countries in the distribution of women’s attitudes towards IPV and access to maternal health care services and hence the need to adjust for these differences with a multi-level analysis strategy as done in this study.…”