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).
Highlights
Antenatal care (ANC) has the potential to identify and manage obstetric complications, educate women about risks during pregnancy and promote skilled birth attendance during childbirth
80% of maternal deaths worldwide are due to direct complications during pregnancy such as severe haemorrhage, obstructed labor, infections, pregnancy-related hypertension, and/or unsafe induced abortion
Karkee and colleagues reported that women who could spontaneously mention any danger sign during the antepartum, intrapartum or postpartum period were more likely to deliver in a health facility [6]
Summary
Antenatal care (ANC) has the potential to identify and manage obstetric complications, educate women about risks during pregnancy and promote skilled birth attendance during childbirth. 80% of maternal deaths worldwide are due to direct complications during pregnancy such as severe haemorrhage, obstructed labor, infections, pregnancy-related hypertension, and/or unsafe induced abortion. Indirect causes such as diabetes, malaria or anaemia can worsen the mother’s condition during pregnancy and lead to maternal death. As shown by Bogale and colleagues, women who attend antenatal care (ANC) are more likely to know obstetric danger signs during pregnancy and delivery [8]. ANC provides a unique opportunity to strengthen knowledge of obstetric danger signs and encourage institutional delivery
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