Obstetric danger signs among pregnant women in urban field practice area of Bengaluru Medical College

INTRODUCTION

One of the most important goal that is relevant to RMNCH+A strategic approach is reduction of Maternal Mortality Rate to 100 per 1,00,000 live births by 2017 India still has a MMR of 174 per 1,00,000 live birth by 2015¹ . Important causes of maternal mortality are severe bleeding (25%), infection (15%), eclampsia, obstructed labour, unsafe abortion. Identification of danger signs by the pregnant women becomes the key to reduce maternal mortality and also foetal loss by appropriate and timely referral. Various studies have shown that there is a lack of knowledge among pregnant women pertaining to this.² It is of utmost importance to rationalize the health seeking behaviour of the pregnant women. Hence, this study was conducted with the prime objective of assessing the knowledge of pregnant women about the danger signs during pregnancy, delivery and postpartum and secondary objective to assess the factors associated with knowledge of pregnant women.

Materials and Methodology

This is a cross sectional study conducted at Urban field practise area under the department of Community Medicine of Bangalore Medical College and Research Institute, India. This study was conducted on pregnant women who aged not less than 18 years. The study was conducted on the women attending OPD services on Friday between the month of June to August 2017. Institute ethics committee permission was obtained for carrying out the study. Also, written informed consent from all the participants was taken and those not willing to give consent were excluded from the study. A sample size of 180 was calculated based on knowledge assessment as found by Nithya et al.³ Systematic random sampling method with every 10th pregnant women who fulfilled the criteria was approached. The questionnaire was a pretested validated semi structured questionnaire with both open and close ended. Components included demographic details, knowledge about danger signs, and health seeking behaviour etc. A standardized tool used for testing the knowledge about danger signs was as stated in safe motherhood needs assessment of world health organisation. The criteria to consider as knowledgeable was mentioning of at least 3 danger signs in pregnancy, 2 during labour and at least 1 of the danger signs postpartum. 

Statistical Analysis: data was analysed using Microsoft excel and SPSS version 20.0. Data was analysed using descriptive and inferential statistics.

Results

180 out of 183 consented for the study which accounts to 98.3% of response rate. Maximumwomen104 (57.7%) interviewed were in the age group 21-25 years. 98 women were Hindus and 82 Muslims. Majority were found to be from a nuclear family, 82 (26.6%). About 100 (55.55%) were educated up-to high school. And 46.6% belonged to class IV Kuppuswamy classification. Every mother quoted to have received support by husband with respect to nutrition, financial support and also morally. 85.5% of them quoted to have mothers as their care givers and the rest said husbands as their care givers. It was an unplanned pregnancy in 34 women(18.88%).

Majority 162 (90%) women had Tayi card. 72 (40%) women were primi gravida. 10 (5.55%) were in 1st trimester, 60 (33.33%) were in second trimester and 110 (61.11%) were third trimester. The mean gestational age is 29.43 weeks (SD=8.18). In 146 women (81.11%) the present pregnancy was a planned pregnancy.

Knowledge of danger signs: About 120 (66.66%) women had Knowledge of at least 3 danger signs in pregnancy. Highest knowledge was for bleeding followed by severe headache and then by pain abdomen. Knowledge of at least 2 danger signs during labour was among 32(17.77%) women. Highest knowledge again for bleeding. Knowledge of at least 1 danger sign postpartum was among 32(17.77%) women. Here also, knowledge about bleeding ranked first. Figure 1 shows the providers of knowledge. 36.6% of the women availed knowledge from doctors, 31.11% of the women gained the knowledge from mothers, while the rest of them knew danger signs from tayi card (p<0.05)

Table 4 shows that there is a significant difference in knowledge if the women possess tayi card p=0.035 (p<0.05)

Disscussion

Our study shows knowledge of danger signs in pregnancy, during labour, and postpartum to be 66.66%, 17.44%, 17.44% respectively. Study conducted by Nithya et al showed knowledge to be 42.9%, 27.2%, 21.2%. Another study conducted by Nikita et al stated it at 20%. This variability could be attributed to different sample population selected. Deepa R in her study in Chennai found only 10%4 knowledge. In a study conducted by Nikita et al, knowledge about obstetric danger signs was found to be 61% and major source of knowledge was health care personnel 57%.⁵

Conclusion

Our study shows that there is significantly less awareness about obstetric danger signs. Certain modifiable factors were identified to improve the knowledge about danger signs like formal education, SES, availability of MCP card and its proper utilization. As we have witnessed increased maternal mortality and infant mortality there is a utmost need to educate and empower women about the danger signs at the grass root level.

Recommendations: We recommend structured mandatory health awareness sessions focusing on danger signs of pregnancy to all pregnant women.⁶ This could be addressed by sensitizing the women at various levels of health care by health care professionals. At community level, role plays and mass media could be used. Also, knowledge of ASHA workers at grass root level must be reinforced to identify these danger signs.⁷