|Year : 2016 | Volume
| Issue : 2 | Page : 24-29
Knowledge, attitude and perception of pregnancy danger signs among women of childbearing age in samaru community Northwestern Nigeria: Results from a cross-sectional survey
Muawiyyah Babale Sufiyan1, Nasirudeen Adam1, Ahmed Ayuba Umar1, Jimoh Mohammed Ibrahim2, Suleiman Saidu Bashir1, Gerida Birukila3
1 Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
2 Department of Community Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
3 United Nation Children Funds, “C” Field Office Kaduna State, Nigeria
|Date of Web Publication||20-Apr-2017|
Muawiyyah Babale Sufiyan
Department of Community Medicine, Ahmadu Bello University, Zaria
Source of Support: None, Conflict of Interest: None
Context: The birth of a baby is a major reason for celebration worldwide. Yet, in most countries of the world, pregnancy and childbirth is a perilous journey. In Kaduna State, Northwestern Nigeria, the estimated maternal mortality ratio figure is 1025/100,000 live births. Despite the higher rates of maternal deaths, there is no empirical evidence on women's knowledge, perception, and attitudes toward pregnancy danger signs in Kaduna State. Aims: To determine the knowledge, attitude, and perception of pregnancy danger signs among women of childbearing age (15–49 years) in Samaru community Sabon-Gari Local Government Area in Kaduna State. Settings and Design: A community-based descriptive, cross-sectional study was conducted among 185 women of reproductive age group. Subjects and Methods: Participants were randomly selected using a multistage sampling technique. Pretested structured interviewer administered questionnaire was used for data collection. The completed questionnaires were cleaned, coded, the data entered into a computer and SPSS version 20.0 was used for analysis. Statistical Analysis Used: Frequency, percentage, and descriptive summaries were used to describe the study variable using univariate analysis, while bivariate analysis was carried out to test for a relationship between categorical variables. Results: Only 4.9% of the respondents had good knowledge about danger signs in pregnancy while 3.8% of them have good attitude and one in ten respondents only (10.3%) has good perception of pregnancy danger signs. Conclusions: Our findings show that majority of women in childbearing age have poor knowledge, attitude, and perception on danger signs of pregnancy. Hence, the need to train and involve them on pregnancy dangers signs to curb the unnecessary deaths occurring during such period.
Keywords: Childbearing age, knowledge, perception, pregnancy danger signs, women
|How to cite this article:|
Sufiyan MB, Adam N, Umar AA, Ibrahim JM, Bashir SS, Birukila G. Knowledge, attitude and perception of pregnancy danger signs among women of childbearing age in samaru community Northwestern Nigeria: Results from a cross-sectional survey. Arch Med Surg 2016;1:24-9
|How to cite this URL:|
Sufiyan MB, Adam N, Umar AA, Ibrahim JM, Bashir SS, Birukila G. Knowledge, attitude and perception of pregnancy danger signs among women of childbearing age in samaru community Northwestern Nigeria: Results from a cross-sectional survey. Arch Med Surg [serial online] 2016 [cited 2019 Jun 19];1:24-9. Available from: http://www.archms.org/text.asp?2016/1/2/24/204801
| Introduction|| |
The birth of a baby is a major reason for celebration worldwide. Societies expect women to bear children and honor women for their role as mothers. Yet, in most of the world, pregnancy and childbirth is a perilous journey. Avoidable morbidity and mortality remain formidable challenge in many developing countries. Poor health-seeking behavior, the times to making decision is a longer process, and those happen to be with the pregnant woman encountering complications having to do a lot of consultation before the appropriate decision is made. Delay in deciding to seek care may also be due to financial constraint, tried at home with traditional treatment, absence of house hold head, failure to recognize the seriousness of the illness and lack of emergency preparedness lead to maternal, and neonatal morbidity and mortality.
Pregnancy-related complications cannot be reliably predicted, and it is necessary for a pregnant woman to have knowledge about pregnancy danger signs and seek immediate help if needed. Knowledge of danger signs during pregnancy, childbirth, and postpartum period is crucial for safe motherhood. Therefore, pregnant mothers and women in reproductive age group need to have adequate knowledge about the signs indicating these problems. Women and their families are more likely to seek care in the event of an emergency if they are aware of signs of obstetrics complications.
Pregnancy danger signs are those symptoms that may signal danger to a pregnant woman or her fetus and therefore require immediate medical attention. The most common danger signs during pregnancy are severe vaginal bleeding, swollen face/hand, and blurred vision. Maternal mortality due to obstetrics complication could be prevented if pregnant women recognize danger signs and seek immediate care. Low awareness may be a cause of failure to recognize the complication when it occurs thus delaying the decision to seek care. In many developing countries, women deliver alone or with a relative. Therefore, it is important that people are trained to recognize danger signs and develop plans for emergencies that include transport to hospitals or skilled care, access to financial resources, and community support. Informing, educating, and mobilizing people regarding danger signs and working with communities to improve access would help reduce maternal mortality. Maternal mortality rate in Nigeria is the second highest in the world (after India) and is estimated at 1100/100,000 live birth. This equates to 54,000 Nigerian women dying each year from pregnancy-related complications, which represent 10% of global maternal mortality. Within Nigeria, the northwest region has one of the worst maternal mortality ratio in the world.
Despite the higher rates of maternal deaths, there is no empirical evidence on women's knowledge, perception, and attitudes toward pregnancy danger signs in Kaduna State. This study seeks to fulfill this need.
| Subjects and Methods|| |
Samaru is a community that constitute Samaru ward in Sabon-Gari Local Government Area (LGA) of Kaduna State Northwest Nigeria. Sabon Gari LGA covers a land area of about 600 km 2 and made up of two administrative districts (i.e., Basawa and Sabon Gari districts). The LGA also comprised a total of eleven political wards (6 in Basawa district and 5 in Sabon Gari district). Samaru ward is the largest of all the wards under Basawa district and comprises of many communities. Samaru community is located opposite the Ahmadu Bello University, Zaria and it has an area of about 300 km 2 with an estimated population of 45,897 from the 2006 national census. It has a total of 10,097 women of reproductive age group and 2295 pregnant women which constitute 22% and 5% of the total population respectively. The community also has a primary health-care center, three registered private clinics, two maternity homes and a family health center all of which provide maternal and child healthcare services.
Study design and population
This study is a community-based cross-sectional descriptive study that was carried out in July 2012 to determine the knowledge, attitude, and perception of pregnancy danger signs among women of reproductive age group. The study included all women within the reproductive age group (15–49 years) who are permanent resident of the community and excluded women who are not desired to have baby and are currently using modern family planning method.
Sample size determination and sampling technique
Sample size was determined using single population proportion formula  considering the following assumption: 95% confidence level (Zα/2), 5% margin of error (d) and proportion (p) of women of reproductive age group with knowledge of two danger signs from a previous study taken as 14.0%.
Multistage sampling technique was employed in this study and involves four stages: Stage 1: Sabon Gari LGA was purposively selected out of all the LGAs in Kaduna State. Stage 2: a list of all the wards in Sabon gari LGA was drawn, and Samaru ward was selected by simple random sampling using balloting. Stage 3: a list of all the villages in Samaru ward was drawn. Five villages were then randomly selected by simple random sampling using balloting also. The villages selected were Samaru, Kurmin Bomo, Hayin Dogo, Hayin Malam Tsoho and Hayin Sabo. Stage 4: Houses were then subsequently numbered after which a systematic sampling technique was employed to select the houses that were visited in the selected villages. One household in each of the selected houses was recruited into the study, and a questionnaire was only administered to any eligible woman within the household.
Data collection tool and procedure
Tool for data collection was a pretested, structured interviewer-administered questionnaire that was administered to 185 respondents. All the administered questionnaires were returned completed, giving a response rate of 100%. The data collection was conducted by the researcher and five trained research assistants from 24th to 28th of July 2012. The researcher supervised the overall data collection process and checks the filled questionnaires for consistency and completeness. The questionnaire was prepared in English language and translated to Hausa language/local language/and back to English to maintain the consistency of the data. Training was given to research assistants/data collectors for 2 days. During and after the data collection, questionnaires were reviewed and checked for completeness and relevance by the researcher. The questionnaire consists of five section that sought information on sociodemographic profile of women of reproductive age group, fertility profile, knowledge on danger signs, attitude, perception and practice toward danger signs of pregnancy.
The knowledge of respondents on danger signs of pregnancy was assessed using 12 questions, attitude with 6 questions and perception with 3 questions from the questionnaire. Each correct response to the question scores one mark while incorrect response scores zero. Based on this, the respondents knowledge were categorized into poor (0–5), fair (6–8) and good (9–12), the attitude into poor (0–2), fair (3–4) and good (5–6) while the perception was categorized into poor (0–1) and good (2–3).
Data processing and analysis
Data collected was entered, validated, and analyzed using Statistical Package for Social Sciences (SPSS, IBM Corporation USA) software version 20.0. For the descriptive aspect of the analysis, frequency distributions were generated for all categorical variables. Means and standard deviations and other descriptive measures were determined for quantitative variables. Chi-square test was applied for the comparison of proportions and for evaluating associations of categorical variables in contingency tables. Statistical significance was said to be achieved where P< 0.05.
Approval to carry out the study was obtained from the research ethics committee of Ahmadu Bello University Teaching Hospital. Permission to conduct the study was also sought from the Sabon-Gari Local Government Authority and the ward head of Samaru. The study participants were informed about the purpose of the study and were equally informed that they can voluntarily withdraw from the study at anytime if they wish to do so. Both written and verbal consent was taken from the participants before administering the questionnaire to them.
| Results|| |
The sociodemographic characteristics of the respondents are shown in [Table 1]. About a quarter of the respondents 48 (25.9%) were between the ages of 20 and 24 years, and at least two in ten 43 (23.2%) were between 25 and 29 years. More than one-third of the respondents 82 (44.3%) were Hausas, followed by other tribes constituting 40 (36.8%), while 18 (9.7%) were Yorubas and Ibos constituted 17 (9.2%). A total of 77 (41.6%) and 57 (30.8%) of them had Secondary and Tertiary levels of education respectively. Over two-third of the respondents, 160 (86.5%) were married, 11 (5.9%) are singles while 10 (5.4%) of them are widowed. Occupation of respondents included trading 65 (35.1%), 50 (27.0%) were full-time homemakers, civil servants 43 (23.2%), and students accounted for 15 (8.1%).
Ever pregnant respondents
At least, four out of ten respondents who were ever pregnant (41.1%) had their first pregnancy between ages 15 and 19 years, 2.5% had theirs between ages 10 and 14 years, while 3.9% had theirs between ages 30 and 34 years as depicted in [Table 2] below.
|Table 2: Respondent's age at the first pregnancy for those who were ever pregnant (n=158)|
Click here to view
Respondents knowledge on pregnancy danger signs
The majority of respondents 115 (62.2%) knew vaginal bleeding as a danger sign of pregnancy, persistent vomiting 89 (48.1%), convulsion 65 (35.1%), and only 59 (31.9%) knew baby not moving as a danger sign as seen in [Table 3].
[Table 4] shows overall knowledge score of the respondents and depicts that majority 152 (82%) of the respondents have poor knowledge on pregnancy danger signs, 24 (13.0%) have fair knowledge. Only 9 (4.9%) have good knowledge on danger signs of pregnancy.
|Table 4: Categorization of respondents knowledge, attitude, and perception of danger signs in pregnancy based on scores (n=185)|
Click here to view
Respondents attitudes and perceptions toward pregnancy danger signs
The majority of the respondents 161 (87.0%) have a poor attitude toward seeking care at a health facility on danger signs of pregnancy, while 17 (9.2%) have a fair attitude toward seeking care at a health facility. Only 7 (3.8%) have good attitude toward seeking care at health facilities due to pregnancy danger signs based on the scoring criteria. On respondent's perception of pregnancy danger signs, 166 (89.7%) of them have poor perception while only 19 (10.3%) of them have good perception. The overall respondents' attitude and perception scores are as depicted in [Table 4].
Respondents' perception on causes of danger signs during pregnancy
Concerning the perception of respondents toward causes of pregnancy danger signs, a little over half 98 (53.2%) of them who were not aware of pregnancy danger signs as a complication, perceive it to be normal changes occurring in pregnancy, 66 (35.5%) perceive it to result from heavy domestic work and 15 (8.1%) to witchcraft while 6 (3.2%) to spiritual causes as shown in [Figure 1].
|Figure 1: Respondents' perception on causes of danger signs during pregnancy (n = 185).|
Click here to view
Respondents' perception on why a pregnant woman with a danger sign should seek care at a health facility
Over half 92 (52.3%) of the respondents perceived that in order for them not to encounter fetal death was their major reasons for seeking care at health facilities when danger sign is noticed during pregnancy, 74 (42.0%) perceived fear of death of the pregnant woman, 37 (21%) perceived fear of recurrence in subsequent pregnancy while 20 (11.4%) of them perceived fear of infertility as the major reason for seeking care at the health facility as depicted in [Table 5].
|Table 5: Respondents' perception on why a pregnant woman with a danger sign should seek care at a health facility (n=185)|
Click here to view
Test of statistical significance
The Pearson's Chi-square test conducted in [Table 6] below showed that there is no statistically significant relationship between respondents' number of pregnancy and knowledge on pregnancy danger signs (P > 0.05).
|Table 6: Relationship between number of pregnancy and respondents knowledge on pregnancy danger signs (n=185)|
Click here to view
| Discussion|| |
The majority of the respondents were married while some insignificant proportion were either singles or widowed. This finding is similar to that of a study in Rufiji district Tanzania which found that 80% of the respondents were married. All the respondents had at least one form of education or the other: with majority of them having attained secondary and tertiary levels of education, respectively, while only about two in ten respondents 36 (19.5%) had Quranic form of education. This high level of secondary and tertiary education might be due to the fact the study area is mostly inhabited by the students and staff of Ahmadu Bello University which influences the quest for education in the community. A study conducted in Rufiji district Tanzania among women of reproductive age showed that having secondary or higher education increased the likelihood of awareness of obstetrics danger signs to about sixfold.
The median age at first pregnancy was 20 years. The majority of the respondents, i.e. at least four in ten had their first pregnancy between 15 and 19 years, and between 20 and 24 years, while only minor proportion had theirs between 30 and 34 years and 10 and 14 years, respectively. At least four in ten women in the community had their first pregnancy at a younger age without adequate education, knowledge, and experience. This may probably predisposes them to not knowing some danger signs in pregnancy when they do occur.
Most of the respondents were aware of vaginal bleeding as a danger sign of pregnancy, which was closely followed by vomiting, convulsion, severe headache, and swollen hand/face. This is similar to the result of a study in Haiti among women of reproductive age which found that approximately 50%–60% of all respondents had knowledge of hemorrhage, fluid leaking, swollen feet, and headache as danger signs during pregnancy. However, the finding of our study is far higher than the one reported in Sudan and Jordan where 88% and 84.8% of women interviewed were not aware of the signs and symptoms of pregnancy complication respectively., Failure to recognize the danger signs of obstetrics complications may result to delay in seeking appropriate care and reaching health facility which may subsequently lead to maternal and neonatal morbidity and mortality.
As regards the overall knowledge on pregnancy danger signs, majority of the respondents have poor knowledge of pregnancy danger signs. This could be attributed to poor antenatal care services as only one-third (35%) of the respondents were told about danger sign during their antenatal visit and inadequate community awareness about danger signs. This may result to increase in maternal morbidity and mortality.
Health-seeking behavior is determined by the knowledge and awareness of obstetrics danger signs. Women and their families are more likely to seek care in the event of an emergency if they are aware of obstetrics complications. Many factors such as health-seeking behavior and utilization of appropriate care are dependent on individual and community recognition of illness and warning signals.
Majority of the respondents have experienced one or more danger signs during pregnancy. This is similar to the study conducted in Nairobi Kenya among women which reported that about 54% of the women had at least one complication during pregnancy. Thus, it is expected that women who have had complication in their previous pregnancy would be more aware of danger signs compare to those who have not had any complication.
About two-third of the respondents are aware of danger signs as features of pregnancy complication, while the remaining one-third are unaware of danger signs as a complication. Majority of the respondents who were not aware of danger signs as complication, attributed it to normal change in pregnancy, followed by heavy domestic work, witchcraft, and then to evil spirit. In Egypt, Indonesia, and Pakistan, eclamptic convulsions may be associated with supernatural causes (e.g., possession by spirit) requiring exorcism by faith healers rather than medical.
Recognition of and perceived severity of danger signs of pregnancy would influence women's decision to seek care at a health facility. This is due to varied ability to recognize the potential severity and perception that illness does or does not require hospital-based treatment. This study showed that majority of the respondents have poor or negative attitude toward pregnancy danger signs. This is very worrying as poor or negative attitude toward pregnancy danger signs put the life of the woman experiencing it at risk and can ultimately lead to resultant increase in maternal and neonatal morbidity and mortality.
Recognition involves more than awareness of the danger signs of major obstetric complications. It also requires an accurate perception of severity of the complication. Beliefs associated with major obstetric complication affect the interpretation of their severity and the decision to respond appropriately. Majority of the respondents have poor perception of pregnancy danger signs, while about half of them perceived that in order for them not to encounter fetal death was their major reasons for seeking care at health facilities when danger sign is noticed during pregnancy, about four in ten perceived fear of death of the pregnant woman, two in ten perceived fear of recurrence in subsequent pregnancy while about one in ten of them perceived fear of infertility as the major reason for seeking care at the health facility. In Malawi study, health workers stated that patients do not perceive complications such as convulsion and bleeding as a complication. The symptoms are seen as part of normal delivery process, and therefore, the affected women delay their arrival and consultations in health facilities.
Findings from this study showed that there is no statistically significant relationship between respondents' number of pregnancy and knowledge on pregnancy danger signs (P > 0.05). The lack of relationship between number of pregnancy and knowledge of danger signs is not in consonance with the study by Anya et al., which reported a positive relationship between number of pregnancy and knowledge of danger signs of pregnancy among women attending antenatal clinics in Gambia.
| Conclusions|| |
This study found poor knowledge on danger signs of pregnancy among women of reproductive age group despite the fact that majority of them were aware of the danger signs. There was equally poor or negative attitude and perception toward danger signs of pregnancy, which ultimately affects the interpretation of its severity and the decision to respond appropriately. There is, therefore, the need for the health-care workers to educate the pregnant women and those women of reproductive age on obstetric danger signs during antenatal care through health talk and counseling sessions. In addition, the LGA in collaboration with State Government should step up mass awareness campaign on obstetric danger signs, birth preparedness, and health facility utilization on noticing any obstetric danger signs.
We wish to acknowledge the head of the health department, Sabon-Gari LGA and the ward head of Samaru ward for making the implementation of the research in the community so easy.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hiluf M, Fantahun M. Birth preparedness and complication readiness among women in Adigrat Town, North Ethiopia. Ethiop J Health Dev 2008;22:14-20.
Morsheda B, Hashima EN, Sarawat R. Stakeholders' Knowledge in Obstetric Complications and Role of Health Care Providers in Accessing Emergency Obstetric Care: Experiences from Nilphamari District, Bangladesh. Working Paper No. 18; 2011. Available from: http://www.brac.net/research
. [Last accessed on 2012 Apr 04].
Geubbels E. Epidemiology of maternal mortality in Malawi. Malawi Med J 2006;18:206-25.
BabyCenter: Ten Signs of Danger During Pregnancy Exercise; 2009. Available from: http://www.babycenter.com
. [Last accessed on 2012 Apr 04].
Agboola A. Text Book of Obstetrics and Gynaecology for Medical Student. 2nd
ed. Heinemann Educational Books Plc, Ibadan Oyo State, Nigeria; 2008. p. 305.
Igboanugo GM, Martin CH. What are pregnant women in a rural Niger Delta community's perceptions of conventional maternity service provision? An exploratory qualitative study. Afr J Reprod Health 2011;15:59-72.
Iliyasu Z, Abubakar IS, Galadanci HS, Aliyu MH. Birth preparedness, complication readiness and fathers' participation in maternity care in a northern Nigerian community. Afr J Reprod Health 2010;14:21-32.
Local Government Area (LGA) Secretariat: History of Zaria and its Districts. An Official Publication of Information unit, Zaria Local Government Area, Kaduna State Nigeria; 1998. p. 1 4.
Singha P. An introductory Text on Demography. 2nd
ed. Gadza (NIG) Limited, NJ4 Jama'a Road Kaduna state Nigeria; 2002. p. 5-6.
Nikiéma B, Beninguisse G, Haggerty JL. Providing information on pregnancy complications during antenatal visits: Unmet educational needs in Sub-Saharan Africa. Health Policy Plan 2009;24:367-76.
Ali AA, Rayis DA, Abaker AO, Adam I. Awareness of danger signs and nutritional education among pregnant women in Kassala, Eastern Sudan. Sudan J Public Health 2010;5:179-81.
Okour A, Alkhateeb M, Amarin Z. Awareness of danger signs and symptoms of pregnancy complication among women in Jordan. Int J Gynaecol Obstet 2012;118:11-4.
African Population and Health Research Center and World Bank 2006. Averting Preventable Maternal Mortality: Delays and Barriers to the Utilisation of Emergency Obstetric Care in Nairobi's Informal Settlements. Available from: http://www.aphrc.org
. [Last accessed on 2012 Apr 18].
Adeleke NA, Olowookere SA. Pattern of maternal mortality in a general hospital in South Western Nigeria. Niger Med Pract 2011;59:71.
Chodzaza E, Bultemeier K. Service providers' perception of the quality of emergency obsteric care provided and factors indentified which affect the provision of quality care. Malawi Med J 2010;22:104-11.
Anya SE, Hydara A, Jaiteh LE. Antenatal care in the Gambia: Missed opportunity for information, education and communication. BMC Pregnancy Childbirth 2008;8:9.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]