AWARENESS OF OBSTETRIC DANGER SIGNS AND ASSOCIATED FACTORS AMONG PREGNANT WOMEN ATTENDING OUTPATIENT DEPARTMENT OF HAYATABAD MEDICAL COMPLEX, PESHAWAR
Main Article Content
Keywords
Obstetric danger signs, Maternal mortality, Awareness, Antenatal care
Abstract
Background
Maternal mortality continues to pose a grave challenge in Pakistan, especially in Khyber Pakhtunkhwa despite ongoing efforts. Timely recognition of obstetric danger signs is key to reducing such deaths, yet local data on awareness levels among pregnant women are lacking.
Objective:
This study evaluated awareness of obstetric danger signs and associated factors among pregnant women attending the outpatient department of Hayatabad Medical Complex, Peshawar.
Methods:
A cross sectional study was carried at HMC from April to December 2024. Using systematic random sampling, 427 pregnant women were enrolled. Data were collected through a structured, interviewer administered questionnaire in Urdu and Pashto, assessing socio-demographic factors, obstetric history, knowledge of danger signs, and sources of information. Awareness was graded as good, fair , or poor based on recall. Statistical analyses included chi-square tests and multivariable logistic regression to identify predictors of good awareness.
Results:
Only 19.2% of women demonstrated good awareness (≥4 recalled signs), while 38.4% could not name any danger sign. The most recognized signs were severe vaginal bleeding (42.2%) and heavy postpartum bleeding (26.5%), with poor recall for convulsions and foul smelling discharge. Higher education, four or more antenatal visits, urban residence, history of obstetric complications, and counseling by healthcare providers were independently associated with good awareness.
Conclusion:
Awareness of obstetric danger signs among pregnant women at HMC, Peshawar, is insufficient. Focused interventions especially educational strategies integrated into antenatal care are urgently needed to enhance recognition of life threatening complications and promote timely healthcare seeking, ultimately reducing maternal morbidity and mortality.
References
2. Mwilike B, Nalwadda G, Kagawa M, Malima K, Mselle L, Horiuchi S. Knowledge of danger signs during pregnancy and subsequent healthcare seeking actions among women in Urban Tanzania: a cross-sectional study. BMC Pregnancy Childbirth. 2018;18(1):4.
3. Tamang ST, Dorji T, Yoezer S, et al. Knowledge and understanding of obstetric danger signs among pregnant women attending the antenatal clinic at the National Referral Hospital in Thimphu, Bhutan: a cross-sectional study. BMC Pregnancy Childbirth. 2021;21(1):104.
4. Nkamba DM, Wembodinga G, Bernard P, Ditekemena J, Robert A. Awareness of obstetric danger signs among pregnant women in the Democratic Republic of Congo: evidence from a nationwide cross-sectional study. BMC Women's Health. 2021;21(1):82.
5. Kumar A, Raj D, Gupta A, Kumar A. Assessment of knowledge of obstetric danger signs and its associated factors among pregnant women attending antenatal clinic of rural health training centre of a medical college: A cross-sectional study from Rajasthan. J Family Med Prim Care. 2022;11(10):6487-6492.
6. Karkee R, Lee AH, Khanal V, Binns CW. Awareness of obstetric danger signs in developing countries: a review of the literature. Women Birth. 2014;27(3):179-185.
7. Elhage JC, Mohamed Z, El Bizri N, Khalefa AB, Fakih N. Assessing awareness of danger signs of pregnancy and its associated factors among pregnant women in Libya: A cross-sectional study. Sex Reprod Healthc. 2024;38:101044.
8. Pandey S, Karki S, Ghimire A, et al. Awareness regarding obstetric danger signs among pregnant women attending teaching hospital in Chitwan, Nepal. Journal of College of Medical Sciences-Nepal. 2023;19(1):41-47.
9. Islam MM, Masud MS. Determinants of awareness of obstetric danger signs among pregnant women in Bangladesh: a multilevel analysis. BMC Pregnancy Childbirth. 2018;18(1):347.
10. Yeshita HY, Gebregziabher E, Girma Y. Knowledge of obstetric danger signs and associated factors among pregnant women in Hosanna Town, Southern Ethiopia. Reprod Health. 2023;20(1):12.
11. Singh P, Goli S, Parsuraman S. Maternal healthcare service utilization and knowledge of danger signs among women in South Asia: evidence from Demographic and Health Surveys, 2015–2021. BMC Pregnancy Childbirth. 2022;22(1):984.
12. Ibrahim IA, Garba SN, Ahmed H, et al. Awareness of obstetric danger signs and associated factors among pregnant women in Northern Nigeria: a cross-sectional study. BMC Pregnancy Childbirth. 2020;20(1):148.
13. Ezeanochie MC, Olagbuji BN. Obstetric danger knowledge among pregnant women in sub-Saharan Africa: a review. Int J Gynaecol Obstet. 2021;154(2):246–254.
14. Workineh Y, Hailu D, Gultie T, et al. Awareness of danger signs of pregnancy and its determinants among pregnant women in Debre Tabor, Northwest Ethiopia: a community-based cross-sectional study. BMC Res Notes. 2023;16(1):5.
15. Ijadunola MY, Orji EO, Adeyemi AB, et al. Impact of maternal danger sign awareness on health-seeking behavior: a systematic review. PLoS Glob Public Health. 2022;2(5):e0000316.
16. Mekonnen T, Dune T, Perz J. Maternal knowledge of obstetric danger signs and its association with maternal and neonatal outcomes: a systematic review. BMC Pregnancy Childbirth. 2022;22(1):647.
17. Alam N, Hajizadeh M, Dumont A. Socio-demographic determinants of knowledge of obstetric danger signs among Bangladeshi women: evidence from a nationally representative survey. Women Health. 2021;61(3):287-299.
18. Ahmad I, Khan SA, Ullah M, et al. Factors associated with knowledge and care seeking about danger signs during pregnancy among Afghan women: a cross-sectional study. Reprod Health. 2022;19(1):39.
19. Danso K, van der Wal DM, Anarfi JK. Education and obstetric knowledge among Ghanaian women: a multicenter study. Int Health. 2021;13(2):135–143.
20. Hassan H, Onyango R, Were V, et al. The impact of provider counseling on knowledge of obstetric danger signs among pregnant women in Kenya. Afr J Reprod Health. 2023;27(1):109-117.
21. Marquez J, Kim JH, O'Donnell E, et al. Digital health interventions for maternal health in LMICs: barriers, facilitators, and policy implications. JMIR Mhealth Uhealth. 2022;10(5):e36856.
22. Nasir M, Ahmed R, Noor A, et al. Bridging the digital divide: improving access to digital health information for maternal care in Pakistan. Front Public Health. 2023;11:1098271.
23. Wong JL, Poon LC, Steyn DW. Community health workers and mobile technology: improving maternal health knowledge in underserved regions. BMC Public Health. 2023;23(1):678.
24. World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience: 2022 update. Geneva: WHO; 2022.
25. Kabakyenga JK, Östergren P-O, Turyakira E, Pettersson KO. Knowledge of obstetric danger signs and birth preparedness practices among women in Uganda: a community-based cross-sectional study. Reprod Health. 2022;19(1):81.
26. Ejeta E, Nigussie T, Belachew T, et al. Knowledge of danger signs during pregnancy and associated factors among pregnant women in Goba District, Ethiopia: a community-based cross-sectional study. BMC Pregnancy Childbirth. 2023;23(1):114.