Determinants of awareness of obstetric danger signs among women delivering at Webuye County Hospital, Western Kenya

Abstract

Background: Most maternal deaths in Kenya are attributable to preventable causes that could be managed if a pregnant woman received timely and quality antenatal care. A pregnant woman and her family can identify severe conditions that endanger her during pregnancy. According to the Kenyan health and demographic survey, there has been a significant increase in facility-based antenatal care utilization in the last decade. It is unclear if higher utilization translates to better awareness of Obstetric danger signs among pregnant women. Objectives: The study aimed to assess the level and determinants of awareness of obstetric danger signs among women delivering at Webuye County Hospital, Western Kenya. Methods: Using a systematic sampling method, this facility-based cross-sectional study was conducted at Webuye County Hospital, Kenya, where 328 post-partum women were recruited at the postnatal ward between August 2020 and January 2021. A pretested interviewer-administered questionnaire that included socio-demographic characteristics, Obstetric characteristics, and core questions about Obstetric danger signs were used for data collection, and only spontaneous responses were recorded. The questionnaires were checked for completeness, and data was cleaned, entered, and analyzed using R software. Descriptive statistics, including the mean, median, and standard deviation, were generated for continuous variables and proportions and frequencies for categorical variables. Pearson’s Chi-square test was used for associations between continuous and categorical variables. A multiple logistic regression model was used to test the significance of any associations between various study subject characteristics (categorical) and awareness of obstetric danger signs of pregnancy. In all analyses, the significance level was set at less than 0.05. Results: The overall awareness (spontaneous mention of one key danger sign in each phase of pregnancy) of obstetric danger signs was 43.8%, with awareness in each step; during pregnancy, childbirth/labour, and postnatal period being 77%, 62.2%, and 65.1%, respectively. Of the ten determinants assessed, marital status and educational level were significant explanatory variables of overall awareness of Obstetric danger signs. For marital status, it was found that the odds of unmarried women being aware of danger signs was 0.47 times that of married women (AOR=0.47 95%CI: 0.25, 0.87). For educational level where the odds of awareness of obstetric danger signs among those who have a university education was 3.3 times that of women who had primary education (AOR= 3.33, 95%CI = 1.38-8.27); the odds of awareness for women with vocational education was 3.05 times higher than that of those with primary level education (AOR=3.03, 95%CI:1.50,6.38). However, there was no statistically significant difference between secondary and primary levels of education. Conclusion: The findings showed that the awareness of Obstetric danger signs in pregnancy among women delivering at Webuye County Hospital was less than 50%. Being married and formally educated were significant determinants of awareness of obstetric danger signs in pregnancy. Recommendations: Strengthening health education while emphasizing key danger signs among pregnant mothers in antenatal clinics. More focus should be on those without formal education and spousal/partner support.