Does knowledge of danger signs of pregnancy predict birth preparedness? A critique of the evidence from women admitted with pregnancy complications

Abstract

BackgroundImproved knowledge of obstetric danger signs, birth preparedness practices, and readiness for emergency complications are among the strategies aimed at both enhancing utilization of maternal health services and increasing access to skilled care during childbirth, particularly for women with obstetric complications. It is unclear whether knowledge of danger signs translates into improved birth preparedness and complication readiness. The objective was to assess the association between knowledge of danger signs and birth preparedness among women admitted with pregnancy complications.MethodsThe study included 810 women admitted in the antepartum period to Mulago hospital, Uganda. Data was collected on socio-demographic characteristics, reproductive history, pregnancy complications, knowledge of danger signs, and birth preparedness/complication readiness (BPCR). Logistic regression analyses were conducted to explore the relationship between knowledge of danger signs and birth preparedness.ResultsOnly about 1 in 3 women were able to mention at least three of the five basic components of BPCR, and could be regarded as ‘knowledgeable on BPCR’. One in every 4 women could not mention any of the five components. Women with history of obstetric problems during the previous pregnancy were more likely to be knowledgeable on danger signs when compared to those who had no complications in prior pregnancy. Women who were knowledgeable on danger signs were four times more likely to be knowledgeable on BPCR as compared to those who were not knowledgeable.ConclusionsThough awareness about danger signs was low, knowledge of danger signs was associated with knowledge of birth preparedness. More emphasis should be given to emergency/complication readiness during antenatal care sessions. There is a need to strengthen existing policy interventions to address birth preparedness and complication readiness for obstetric emergencies.

Effect of a participatory multisectoral maternal and newborn intervention on birth preparedness and knowledge of maternal and newborn danger signs among women in Eastern Uganda: a quasi-experiment study

“…Studies conducted in Sub-Saharan Africa have reported low levels of maternal and newborn care knowledge and birth preparedness practices among women [6,14–17]. In Eastern Uganda, a study revealed that only 25% of respondents had at least three components of the birth plan [10], while in rural communities of Western Uganda, only 19% had knowledge of three or more key danger signs during pregnancy, delivery, and the postpartum period [11].…”

Utilization of individual birth plan during pregnancy and its determinants in Makueni County, Kenya

“…3,4,15 The IBP concept is based on the assumption that lack of it or lack of awareness of it may lead to delay in seeking care, delay in transportation to a health facility and delay in receiving care from a skilled health provider and the possibility of resulting into undesirable birth outcomes both to the mother and baby. 6 In Kenya giving birth is free in public health facilities. However, the decision to seek care and arranging for transport, is the sole responsibility of the client and her family.…”

“…6,8,9 Women who are well prepared and have knowledge on danger signs in pregnancy, are more likely to: identify a skilled birth attendant, be financially ready to meet emergency costs and transportation and be ready with a potential blood donor thus improving chances of a positive birth outcome. 4,6,8,9 A number of socio-demographic factors have been found to be associated with birth-preparedness such as level of education; however, little is known on how socioecologic factors such as attitudes and perceptions of clients determine utilization of IBP in a rural area. 7,9 There is some evidence clients perceive birth preparedness negatively.…”

“…However, many studies in Africa have found nearly more than half of pregnant women do not prepare for birth an indication of unmet antenatal care needs. [3][4][5][6][7] Although there is little proof to demonstrate the direct association between having an IBP and reduction in morbidity or mortality for mothers and babies, some studies have revealed evidence that there is considerable benefit for birth preparedness. 6,8,9 Women who are well prepared and have knowledge on danger signs in pregnancy, are more likely to: identify a skilled birth attendant, be financially ready to meet emergency costs and transportation and be ready with a potential blood donor thus improving chances of a positive birth outcome.…”

“…[3][4][5][6][7] Although there is little proof to demonstrate the direct association between having an IBP and reduction in morbidity or mortality for mothers and babies, some studies have revealed evidence that there is considerable benefit for birth preparedness. 6,8,9 Women who are well prepared and have knowledge on danger signs in pregnancy, are more likely to: identify a skilled birth attendant, be financially ready to meet emergency costs and transportation and be ready with a potential blood donor thus improving chances of a positive birth outcome. 4,6,8,9 A number of socio-demographic factors have been found to be associated with birth-preparedness such as level of education; however, little is known on how socioecologic factors such as attitudes and perceptions of clients determine utilization of IBP in a rural area.…”