Evaluation of the Impact of Maternal Training on Knowledge of Danger Signs in Sick Newborns and Health Seeking Behaviors Among Mothers in Enugu, South-east Nigeria- a Pre-and-post Interventional Study

Background: During the early weeks of life, the signs/symptoms of serious illness can be subtle, thus careful watching is crucial. The World health Organization has recognized nine “danger sign” which are closely associated with morbidity and mortality when not recognized early and given adequate care. This project was undertaken to assess mothers’ knowledge of these danger signs and health seeking behavior before and after training on newborn danger signs.Methodology: This community-based interventional study was carried amongst women in two rural communities of Enugu State. Participant’s knowledge of danger signs and care seeking behaviors were obtained using an interviewer administered questionnaire before and after training on the danger signs newborns using videos from the Integrated Management of Childhood Illnesses (IMCI). Pre- and post-training data were collated for analysis and comparison using SPSS version 20.Results: A total of 197 women were enrolled for the study. Among the socio-demographic indices examined, only the number of newborns nursed in the past significantly determined knowledge of danger signs in the sick newborn (P=0.032). Prior to the training, 47% of respondents could not recount offhand any danger sign compared to 1.5% after the training (P=0.001). Knowledge of up to 3 danger signs significantly increased after the training (P = 0.001) and participants who admitted seeking medical help within 24 hours of noticing any danger signs in newborn also significantly increased, (P= 0.043).Conclusion: Our study documented a strong impact of training of mothers on their knowledge of danger signs in the sick newborns and on their healthcare seeking behavior. Therefore, training and retraining of mothers and/or care givers could help improve newborn care and reduce overall infant mortality

Knowledge of danger signs during pregnancy and health seeking behaviours among women attending antenatal care; the case of two referral hospitals in Southwest Cameroon

Background: Danger signs of pregnancy are alerts of obstetric complications which commonly occur from mid to late pregnancy and can lead to maternal and/or fetal morbidity/mortality if appropriate care is not sort in a timely manner. Delay in seeking care is one of the key factors leading to maternal death, which can be associated with poor knowledge on obstetric danger signs. In Cameroon, published data on the assessment of knowledge of danger signs in pregnancy is rare, despite the burden of maternal morbidity and mortality. Objective: The aim of this study was to assess the knowledge of danger signs during pregnancy and health care seeking behaviours among women attending antenatal care at the Buea and Limbe Regional Hospitals, Cameroon. Methods: This was a hospital based, cross sectional study, conducted at the Antenatal Care unit of Buea and Limbe Regional Hospitals from 24th February 2020 to 24th May 2020. Convenient sampling was used to recruit participants, and data was collected using a structured questionnaire with closed and open-ended questions. Data analysis was done using SPSS Version 25. Multivariate logistic regression was used to assess the association between dependent and independent variables. Statistical significance was set at a 95% CI, with a P-value < 0.05. Results: A total of 400 pregnant women were enrolled in study, 117(29.3%) had experienced danger signs during pregnancy and reported the healthcare seeking behaviours after recognizing the danger sign. Among those who recognized danger signs, majority 91(77.8%) visited a healthcare facility. Almost two-thirds 246(61.5%) of respondents had poor knowledge of danger signs. The most commonly mentioned danger sign was vaginal bleeding 257(64.25%). Women who were older than 19 years (AOR=3.96; 95%CI: 2.8-4.1, P=0.006), and women who attended at least high school (AOR=3.02; 95%CI: 1.7-5.3), P= 0.001) were associated with good knowledge of danger signs. Conclusion: Knowledge of danger signs during pregnant was poor among antenatal care attendees in both hospitals. Age older than 19 years and at least high school attendance was associated with good knowledge. Also, women took appropriate healthcare seeking actions after recognizing danger signs during pregnancy. Thus, intervention programs aiming to improve women’s knowledge on pregnancy danger signs should be intensified during antenatal care visits.

DETERMINANTS OF FOCUSED ANTENATAL CARE USE AMONG PREGNANT WOMEN, ATTENDING DELIVERY, IN KARAMARA HOSPITAL, JIGJIGA TOWN, SOMALI REGION, EAST ETHIOPIA

Objective: The aim of the study was to assess the determinants of focused antenatal care (ANC) use among pregnant women attending delivery in Karamara Hospital at Jigjiga town, Somali region, East Ethiopia from February to March 2017. Methods: Unmatched case–control study was conduct in Karamara hospital at Jigjiga town. A total of 366 women 183 cases and 183 controls were selected by convenience sampling techniques. Data were collected by trained data collectors using face-to-face interview of women. Logistic regression model was used to determine the predictors of focused ANC nonuse. Variables with p<0.05 and 95% confidence interval were considered as statistically significant. Results: The study revealed that 80.3% of women had ANC follow-up in their last pregnancy. About 39.3% of women had FANC visit. Urban resident women (AOR=3.1, 95% CI [1.418, 7.211]), knowledge of danger signs of pregnancy (AOR=3.5, 95% CI [1.886, 6.832]), knowledge of days FANC services provision (AOR=4.4, 95% CI [1.86, 10.59]), existence of tradition believe about FANC (AOR=0.16, 95% CI [0.079, 0.347]), distance less than or equal 1 h (AOR=2.2, 95% CI [0.838, 5.850]), existence of health facility (AOR=3.14, 95% CI [1.38, 7.544]), information form health-care provider (AOR=3.6, 95% CI [1.04, 12.83]) delivery than their counterpart, and payment needed to use FANC (AOR=0.138, 95% CI [0.057, 0.331]) were significantly associated with FANC use. Conclusion: Being urban resident, knowledge about danger sign of pregnancy, time to reach nearest health facility, radio/Tv use and culture were significantly associated with FANC utilization among pregnant women. Thus, efforts should be made to improve accessibility and availability of the health facility, educating of pregnant women about danger signs of pregnancy physical, information education, and communication of the benefits of FANC service were also critical area that needs intervention.

Utilization of Individual Birth Plan Among Women Attending Postnatal Clinic at Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu Kenya

Background: Kenya has a maternal mortality rate (MMR) of 362 women per 100,000, partly attributed to inadequate or lack of birth and emergency preparedness, including the individual birth plan. Moreover, a paucity of data on determinants of individual birth plan use hampers its promotion and utility against MMR. This study assessed the determinants of individual birth plan use among women attending the postnatal clinic at Jaramogi Oginga Odinga Teaching and Referral Hospital in Kisumu, Kenya. Methods: Hospital-based survey was conducted among 354 expectant women between November 2018 and February 2019. Data were collected using questionnaires and a Focus Group Discussion guide. A Logistic regression model was also used to determine factors associated with IBP utilization, where only p-value's <0.05 were considered significant. Textual data were analyzed thematically using NVIVO. Results: Most mothers (68.6%) had an individual birth plan. Determinants for having birth plans included client factors such as education, OR 8.93, p<0.001, occupation, OR=2.40, p=0.020, and parity, AOR=3.29, p=<0.034; knowledge of danger signs, AOR 8.1, p=0.001. Health facility factors included birth plan counseling, OR=3.45, p=0.013, emergency preparedness, OR=2.06, p=0.034, access to motorized transport such as a car, OR=3.8, p=0.035 or motorcycle, OR=2.7, p=0.006 and attending a clinic in a referral hospital, OR=5.8, p=0.003 Conclusion: This study has demonstrated most women utilize individual birth plans. However, they were ill-prepared for an emergency. Determinants of IBP use included client factors such as education level, employment status, parity, knowledge of danger signs, maternal attitude; and facility factors including counseling, attending a clinic in a referral hospital, the use of an automobile to reach the hospital, and hostility by the health care providers. Therefore, we recommend that prenatal counseling should emphasize emergency preparedness among pregnant women. There is a need to empower women through education and employment to enhance IBP utilization.

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

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.

The Knowledge of Danger Signs of Obstetric Complications among Women in Rural India: Evaluating an Integrated Microfinance and Health Literacy Program

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 per cent 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.

The Knowledge of Danger Signs of Obstetric Complications among Women in Rural India: Evaluating an Integrated Microfinance and Health Literacy Program

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 per cent 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.