Dataset Information

The knowledge of danger signs of obstetric complications among women in rural India: evaluating an integrated microfinance and health literacy program.

ABSTRACT:

Background

Maternal mortality can be prevented in low-income settings through early health care seeking during maternity complications. While health system reforms in India prioritised institutional deliveries, inadequate antenatal and postnatal services limit the knowledge of danger signs of obstetric complications to women, which delays the recognition of complications and seeking appropriate health care. Recently, a novel rapidly scalable community-based program combining maternal health literacy delivery through microfinance-based women-only self-help groups (SHG) was implemented in rural India. This study evaluates the impact of the integrated microfinance and health literacy (IMFHL) program on the knowledge of maternal danger signs in marginalised women from one of India's most populated and poorer states - Uttar Pradesh. Additionally, the study evaluates the presence of a diffusion effect of the knowledge of maternal danger signs from SHG members receiving health literacy to non-members in program villages.

Methods

Secondary data from the IMFHL program comprising 17,232 women from SHG and non-member households in rural Uttar Pradesh was included. Multivariate logistic regression models were used to identify the program's effects on the knowledge of maternal danger signs adjusting for a comprehensive range of confounders at the individual, household, and community level.

Results

SHG member women receiving health literacy were 27% more likely to know all danger signs as compared with SHG members only. Moreover, the results showed that the SHG network facilitates diffusion of knowledge of maternal danger signs from SHG members receiving health literacy to non-members in program villages. The study found that the magnitude of the program impact on outcome remained stable even after controlling for other confounding effects suggesting that the health message delivered through the program reaches all women uniformly irrespective of their socioeconomic and health system characteristics.

Conclusions

The findings can guide community health programs and policy that seek to impact maternal health outcomes in low resource settings by demonstrating the differential impact of SHG alone and SHG plus health literacy on maternal danger sign knowledge.

SUBMITTER: Ahmad D

PROVIDER: S-EPMC7824939 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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Publications

The knowledge of danger signs of obstetric complications among women in rural India: evaluating an integrated microfinance and health literacy program.

Ahmad Danish D Mohanty Itismita I Hazra Avishek A Niyonsenga Theo T

BMC pregnancy and childbirth 20210123 1

<h4>Background</h4>Maternal mortality can be prevented in low-income settings through early health care seeking during maternity complications. While health system reforms in India prioritised institutional deliveries, inadequate antenatal and postnatal services limit the knowledge of danger signs of obstetric complications to women, which delays the recognition of complications and seeking appropriate health care. Recently, a novel rapidly scalable community-based program combining maternal hea ...[more]

PMID: 33485310

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Project description:Men's involvement in reproductive health is recommended. Their involvement in antenatal care service is identified as important in maternal health. Awareness of obstetric danger signs facilitates men in making a joint decision with their partners regarding accessing antenatal and delivery care. This study aims to assess the level of knowledge of obstetric complications among men in a rural community in Tanzania, and to determine their involvement in birth preparedness and complication readiness.A cross-sectional survey was conducted where 756 recent fathers were invited through a two-stage cluster sampling procedure. A structured questionnaire was used to collect socio-demographic characteristics, knowledge of danger signs and steps taken on birth preparedness and complication readiness. Data were analyzed using bivariate and multivariable logistic regression to determine factors associated with being prepared, with statistically significant level at p<0.05.Among the invited men, 95.9% agreed to participate in the community survey. Fifty-three percent could mention at least one danger sign during pregnancy, 43.9% during delivery and 34.6% during the postpartum period. Regarding birth preparedness and complication readiness, 54.3% had bought birth kit, 47.2% saved money, 10.2% identified transport, 0.8% identified skilled attendant. In general, only 12% of men were prepared. Birth preparedness was associated with knowledge of danger signs during pregnancy (AOR = 1.4, 95% CI: 1.8-2.6). It was less likely for men living in the rural area to be prepared (AOR=0.6, 95% CI; 0.5-0.8).There was a low level of knowledge of obstetric danger signs among men in a rural district in Tanzania. A very small proportion of men had prepared for childbirth and complication readiness. There was no effect of knowledge of danger signs during childbirth and postpartum period on being prepared. Innovative strategies that increase awareness of danger signs as well as birth preparedness and complication readiness among men are required. Strengthening counseling during antenatal care services that involve men together with partners is recommended.

Project description:BackgroundAccording to the 2015 World Health Organization report, globally, an estimated 10.7 million mothers died from 1990 to 2015 due to obstetric complications. This report showed that almost all global maternal deaths (99%) occurred in developing countries and two thirds of these deaths took place in sub-Saharan Africa where the majority of women lack knowledge about obstetric danger signs. In Ethiopia, in several research reports, it has been indicated that women have poor knowledge about obstetric danger signs. Although several studies have been conducted to assess women's knowledge of obstetric danger signs, to date, no systematic review has been conducted in Ethiopia. Therefore, this review is aimed at synthesising the existing literature about women's knowledge of obstetric danger signs.MethodsWe systematically searched for articles from MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, Web of Science, Scopus, Google Scholar and Maternity and Infant Care databases. A combination of search terms including 'knowledge' or 'awareness' or 'information' and 'pregnancy danger signs' or 'obstetric danger signs' or 'obstetric warning signs' and 'Ethiopia' was used to locate appropriate articles. Two reviewers conducted article screening and data abstraction independently. Observational studies published in English and conducted in Ethiopia to date were assessed for quality using the adapted Newcastle Ottawa Scale for cross-sectional studies. The PRISMA checklist was used to present the findings of this systematic review.ResultsFrom the 215 articles initially screened by abstracts and titles, 12 studies fulfilled the inclusion criteria. All the studies reported women's knowledge of obstetric danger signs during pregnancy, ten articles reported on the level of knowledge during delivery and eight studies reported on the level of knowledge of danger signs during the postpartum period. The pooled random effect meta-analysis level of women's knowledge about obstetric danger signs during pregnancy, delivery and postpartum was 48%, 43% and 32%, respectively. Maternal age, education, income, health service use, distance from facility and women's autonomy were reported in several studies as determinants of women's knowledge of obstetric danger signs.ConclusionsWomen's knowledge about obstetric danger signs in Ethiopia was very poor, which could hamper access to obstetric care when women encounter obstetric complications. Counselling services during antenatal care and community-based health information dissemination about obstetric danger signs should be strengthened.Systematic review registrationPROSPERO CRD42017077000.

Project description:BackgroundGlobally, every day, approximately 800 women die from preventable causes related to pregnancy and childbirth. The majority of these deaths occur after childbirth (post-partum period) mostly within 24?h. Raising awareness of women on obstetric danger sign of childbirth and postpartum, are crucial for safe motherhood initiative and to reduce maternal mortality.MethodsA community based cross sectional study was conducted from December 15, 2017 up to February 10, 2018 on randomly selected sample of 782 women who had at least one delivery in the last 12?months. Multi stage sampling technique was used to select the study participants. Pre tested structured questionnaire was used to collect quantitative data. Bivariate and multivariate logistic regression analyses were performed using SPSS version 20.0 software.ResultsTotal 732 women who had at least one birth prior to this survey were interviewed and making a response rate of 93.6%.The most common spontaneously mentioned danger signs during childbirth was Severe vaginal bleeding by 281 (68.4%). Women who could mention at least two danger signs during child birth and post-partum period were 333 (45.5%), 213(29.1%) respectively. Being urban (AOR?=?3.54, 95% of CI: [2.20-5.69] and delivered previous birth at health institution (AOR?=?3.35, 95% of CI: [2.38-4.72]) were factors found to be significantly associated with knowledge of danger signs during postpartum. Being Attended secondary level and above (AOR?=?2.41, 95% of CI: [1.02-7.76]) and use of ANC during last pregnancy (AOR?=?3.63, 95% of CI: [2.51-5.25]), were factors found to be significantly associated with knowledge of danger signs during childbirth.ConclusionsThe level of knowledge about danger signs of child birth and postpartum were low. This indicates that many mothers are more likely to delay in deciding to seek health care. Also, knowledge about danger signs of childbirth and postpartum were affected by place of residence, formal education, use of ANC and place of delivery. Therefore, the identified gap in awareness should be addressed through effective maternal health services by strengthening and designing appropriate strategies including provision of targeted health information, education and communication.

Project description:BackgroundMen's involvement in obstetrics care is an important strategy in reducing preventable maternal morbidity and mortality. This is particularly important in developing countries where men often make decision on financial, health and other family issues. Hence, the objective of this study was to assess men's knowledge and involvement in obstetric danger signs; birth preparedness and complication readiness in Burayu town administration, Oromia, Ethiopia.MethodsA community based cross-sectional study was conducted in Burayu town administration, Oromia Region from May 2016 to July 2016. Multistage with systematic random sampling techniques were employed. Bivariate and multivariate logistic regression analyses were performed using SPSS version 20. P-value less than 0.05 were taken as a cutoff point to declare significant association.ResultA total of 523 men were involved in the study. The mean and ± SD age of the study participant was 36.6 ± 7 years. Majority of the participants were Orthodox religion followers and, employees of private organization, regarding residency majority were residing in urban setting. Pregnancy related vaginal bleeding was the most familiar danger sign recognized by the study participants which was 342(65.4%). From the total, 441(84.3%) of men were highly involved in preparation of arranging for postpartum cultural food expenses, 345(66.0%) for clean clothes both for the baby and mother; and 71-76% participants were involved in availing transport money for antenatal, delivery and postnatal care. The study revealed that educational status of men, monthly income, knowledge of pregnancy danger sign, delivery and post-delivery care, and knowledge of birth preparedness and complication readiness (BP/CR) were significantly associated with men's involvement in BP/CR.ConclusionMajority of participants had knowledge on obstetric danger sign. Men showed low interest to donate blood to their wives during antenatal, delivery and postpartum care. There is a need continued awareness creation on danger sings as well as birth preparedness.

Project description:BackgroundMale involvement in maternal, newborn and child health contributes to better health outcomes for women and their children, especially in restrictive societies. There is evidence that when men have better understanding of women's health needs, attitudes toward utilization of maternal and child health services, of both women and men, are improved. Given the role of men as the ultimate decision makers in families in northern Nigerian society, this study assessed the determinants of men's knowledge of danger signs in pregnancy and the continuum of obstetric care, and their perceptions of the importance of antenatal care utilization and health facility delivery.MethodsThis was a cross-sectional descriptive study. Structured questionnaires with close ended questions were administered to 1627 married men who had at least one wife younger than 25 years in communities in Nigeria northern states of Kaduna and Katsina. We use crosstabulations and means to compare characteristics of study respondents in the two states, assessing statistical significance of the differences with χ2-square and Anova tests as appropriate, and logistic regressions to assess the determinants of knowledge and perceptions.ResultsKnowledge of obstetric danger signs, especially during the postpartum period, was poor overall, but respondents were relatively more knowledgeable about danger signs during pregnancy and delivery compared with the postpartum period. Most perceived that antenatal care can reduce the risk of complications. Literate men were twice more likely to have positive health-behaviour perceptions. Wealth was positively associated with the perception that women should deliver in a health facility or hospital but did not have a statistically significant effect on the perception that antenatal care can reduce the risk of complications.ConclusionsWhile knowledge of obstetric danger signs was poor, literacy and household wealth significantly influenced knowledge of obstetric danger signs and perceptions that women should deliver at a health facility. Male involvement programmes need to ensure that men are empowered to understand obstetric danger signs along the continuum of obstetric care to improve perception and utilization of maternal health services for better maternal and newborn health outcomes.

Project description:ObjectiveRecently, a novel community health programme-the integrated microfinance and health literacy (IMFHL) programme was implemented through microfinance-based women's only self-help groups (SHGs) in India to promote birth preparedness and complication readiness (BPCR) to improve maternal health. The study evaluated the impact of the IMFHL programme on BPCR practice by women in one of India's poorest states-Uttar Pradesh-adjusting for the community, household and individual variables. The paper also examined for any diffusion of knowledge of BPCR from SHG members receiving the health literacy intervention to non-members in programme villages.DesignQuasi-experimental study using cross-sectional survey data.SettingsSecondary survey data from the IMFHL programme were used.ParticipantsSurvey data were collected from 17 244 women in households with SHG member and non-member households in rural India.Primary outcomesMultivariable logistic regression was used to estimate main and adjusted IMFHL programme effects on maternal BPCR practice in their last pregnancy.ResultsMembership in SHGs alone is positively associated with BPCR practice, with 17% higher odds (OR=1.17, 95% CI 1.07 to 1.29, p<0.01) of these women practising BPCR compared with women in villages without the programmes. Furthermore, the odds of practising complete BPCR increase to almost 50% (OR=1.48, 95% CI 1.35 to 1.63, p<0.01) when a maternal health literacy component is added to the SHGs. A diffusion effect was found for BPCR practice from SHG members to non-members when the health literacy component was integrated into the SHG model.ConclusionsThe results suggest that SHG membership exerts a positive impact on planned health behaviour and a diffusion effect of BPCR practice from members to non-members when SHGs are enriched with a health literacy component. The study provides evidence to guide the implementation of community health programmes seeking to promote BPCR practise in low resource settings.

Project description:Obstetric danger signs are not the literal obstetric complications, merely symptoms that are well named by non-clinical personnel. The identification of these danger signs and its relation with complications during pregnancy would increase the capacity of women, their partners and families to seek for timely health care, following the appropriate steps to insure a safe birth and post-partum. The aim of this study was to assess the knowledge of obstetric danger signs and associated factors among pregnant women attending antenatal care in Yirgacheffe town, Gedeo zone, Southern Ethiopia.Institutional-based cross-sectional study was conducted from March 15-April 15, 2016. Data on pregnant women were collected using a pre-tested and interviewer administered structured questionnaire from 342 women using systematic random sampling technique. Bivariate and multivariate logistic regression was performed using SPSS version 20.0 software.A total of 342 (90%) pregnant women were included in the study. The level of obstetric knowledge of danger signs was 21.9% (95% CI: 20.2-55.65%). Maternal education (AOR = 0.26, CI: 0.08, 0.88), paternal education (AOR = 0.13, CI; 0.04, 04) and time taken to reach health facilities on foot (AOR = 0.06, CI: 0.02, 0.17) were negatively associated factors while maternal age (AOR = 3.68, CI: 1.30, 10.46), paternal occupation (AOR = 4.65, CI: 1.82, 11.87), place of residence (AOR = 2.61, CI: 1.35, 5.04) were positively associated factors with knowledge of obstetric danger signs.Maternal and paternal education, maternal age, paternal occupation, place of residence and time taken to reach health facility on foot were the main factors for knowledge of obstetric danger signs. Increasing knowledge of key danger signs, creating and promoting income generating mechanisms need to be continuously done at the health facility and the community as it makes ready women and their families for prompt and appropriate decisions and measures in case of obstetric danger signs.

Dataset Information

The knowledge of danger signs of obstetric complications among women in rural India: evaluating an integrated microfinance and health literacy program.

Background

Methods

Results

Conclusions

Publications

The knowledge of danger signs of obstetric complications among women in rural India: evaluating an integrated microfinance and health literacy program.

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