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Knowledge of Danger Signs of Pregnancy, Labour and Post Partum Period


among Mothers in Rural Pondicherry

Article  in  Indian Journal of Public Health Research and Development · April 2017


DOI: 10.5958/0976-5506.2017.00094.8

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DOI Number: 10.5958/0976-5506.2017.00094.8

Original Article

Knowledge of Danger Signs of Pregnancy, Labour and Post


Partum Period among Mothers in Rural Pondicherry

Abhijit V Boratne1, Shib Sekhar Datta2, Yogesh A Bahurupi3, Murugavangini E4,


Hema Priya5, Rajkumar Patil6

Associate Professor, Dept of Community Medicine, MGMCRI, Pondicherry, 2Associate Professor, Dept of
1

Community Medicine, TMC & Dr. BRAM Teaching Hospital, Agartala, Tripura, 3Assistant Professor, IGMCRI,
Pondicherry, 4Intern, MGMCRI, Pondicherry, 5Assistant Professor, Dept of Community Medicine, Vinayaka
Mission Kripananda Variyar Medical College, Salem, 6Professor, Dept of Community Medicine,
MGMCRI, Pondicherry

ABSTRACT

Background: The pregnant woman may face sudden, unpredictable complications that could end her life or
injury to herself or to her infant. Thus, the current study has been planned with an aim to study knowledge of
danger signs in pregnancy, labour and post partum period among mothers of infants in rural Pondicherry.

Method: The present study is community based cross-sectional study, conducted during May and June 2013
in the department of Community Medicine, where 4 villages of Bahour Commune Panchayat in Pondicherry
were selected by multi stage sampling method. The mothers of infants in the respective villages who were
present and consented were interviewed.

Result: Majority 76 (55.9%) of the mothers of infants were in the age group of 19-25 years, 87.5% were
housewives and belonging to class IV (34.6%) and class V (31.6%) and were literate. They had better
knowledge about danger signs of pregnancy [absent foetal movements after 20 wks 136 (100%), excessive
vaginal bleeding after 1st trimester 135 (99.3%), lower abdominal pain 135(99.3%)], labour [excessive
vaginal bleeding 135 (99.3%), prolonged labour 134 (98.5%)] and post partum period [excessive vaginal
bleeding 136 (100%), lower abdominal pain 130 (95.6%) and breast problems 123 (90.4%)].

Conclusion: The present study observed better knowledge regarding danger signs of pregnancy, labour and
post partum period among mothers of infants in study area.

Keywords: knowledge, pregnancy, pregnancy complications, labour, post partum period, infant.

INTRODUCTION India.1 Reducing maternal mortality has been included in


the Millennium Development Goals.2
The developing countries have significant number
of maternal mortality. Sample registration system (SRS) Pregnant woman may face sudden, unpredictable
2012 found maternal mortality rate (MMR) as 212 for complications that could end her life or injury to herself
or to her infant. It is very difficult to predict pregnancy
Corresponding author: related complications.3
Dr. Abhijit V Boratne
Dept of Community Medicine, MGMCRI, The people are lacking awareness related to danger
Pillaiyarkuppam, Pondicherry, Pin: 607403, signs in pregnancy, during labour and in post partum
Email:drabhijitb@rediffmail.com, period which delays treatment and affect the outcome.
Contact No.: 09751416389 These delays have many causes, including financial
Indian Journal of Public Health Research & Development, April-June 2017, Vol. 8, No. 2 117

concerns, available infrastructure and services, as well Sample size n = [Np(1-p)]/ [(d2/Z2 )1-α/2*(N-1)+p*(1-p)]
as inadequate awareness and knowledge about maternal
Confidence level (95%) = 205
health issues in community and family.
But as per the birth record available in Bahour
Knowledge of danger signs of pregnancy, labour
Primary Health centre, there were 181 births in these
and post partum period to the woman, her husband and
four villages. Investigator had visited homes of all
family members is a key in maternal and child health.
these mothers and at the end 136 mothers could be
Ethopian study demonstrated that less than a quarter
included in the study (75.13 % response rate). About
respondent mothers had knowledge regarding danger
26 mothers (14.36%) were not at home even after
signs of pregnancy, labour/childbirth and post partum
two visits by investigator/s and rest of the families 19
period.4 Kushwah SS et al from Rewa, Madhya Pradesh
(10.50%) were shifted to some other place of residence.
also experienced similar findings.5
A predesigned and pre-tested questionnaire was used
Thus, the current study has been planned with an by trained medical student by house-to-house survey
aim to study knowledge of danger signs of pregnancy, and interviewing mothers for about 15-20 minutes.
labour and post partum period among mothers of infants All mothers of infant in the specified area who were
in rural Pondicherry. not willing to give consent for the said study and
those mothers of infant, who were absent during visit
MATERIAL AND METHOD to their house were excluded. Information regarding
socio-demographic characteristics, mothers’ knowledge
The present study is community based cross-
regarding danger signs related to pregnancy, labour and
sectional study, conducted during May and June 2013 in
post partum period was collected.
the department of Community Medicine. The multistage
sampling technique was followed for the study. There Statistical analysis: The data entry was done
are five commune panchayats in Puducherry. In first using Microsoft excel 2007. Statistical Package for
stage, out of 5 commune Panchayats, Bahour commune the Social Sciences for Windows (SPSS Inc., Chicago,
Panchayat (total population) was selected by random Illinois, USA) version 17.0 was used for data analysis.
sampling technique (lottery method). In the second Descriptive statistics was done by using proportions.
stage, sampling units were villages in Bahour commune The independent variable includes age, respondent’s
Panchayat. Out of 14 villages in Bahour commune education, family type and socio-economic status etc.
Panchayat, about quarter villages (4 villages) were
again selected by random sampling technique (lottery Ethical consideration: After acceptance of study
method). The villages were Bahour Main, Seliamedu, proposal by Indian Council of Medical Research
Seliamedu Pet and Kudiyarupupalayam. Birth in one (ICMR), New Delhi, ethical permission was obtained
year i.e. mothers who gave births between 1st April from Institutional Human Ethical Committee (IHEC)
2012 to 31st March 2013 were included in study. During before conducting the present study. All the personal
data collection, an attempt was made to interview all information collected was kept confidential by the
the mothers of infants in the respective villages who researcher and study guide during the study period and
were willing and consented to participate in the present after the study.
study.
RESULTS
Sample size: Considering birth rate of 16.1 per
The current cross sectional study has been
1000 population in the study area (Census 2011, Govt.
conducted among 136 mothers of infants in selected
of India), the expected number of births in the selected 4
villages of Puducherry. Majority 76 (55.9%) of the
villages (total population 11891) was calculated as,
mothers of infants were in the age group of 19-25 years.
Population size (N) :11891 All the participants were literate. Majority of mothers
(87.5%) were housewives while fathers (66.2%) of
Hypothesized % frequency of outcome factor in the infants were labourers. About one third of the families
population (p): 16.1% were belonging to class IV (34.6%) and class V (31.6%)
of modified Prasad’s classification where as more than
Confidence limit as % of 100 (absolute +/-%) (d):
5%
118 Indian Journal of Public Health Research & Development, April-June 2017, Vol. 8, No. 2

half (56.6%) were joint families. (Table 1) current status of knowledge among mother as knowledge
is usually followed by change in behaviour in long run.
When we enquired mothers of infants about
knowledge of danger signs of pregnancy, we found that In present cross sectional study knowledge
almost everyone had better knowledge about danger regarding danger signs of pregnancy like vaginal
signs of pregnancy like absent foetal movements after 20 bleeding (99.3 %), blurred vision (67.6), and oedema
wks 136 (100%), followed by excessive vaginal bleeding of face/hands (94 %) among mothers of infants was
after 1st trimester 135 (99.3%), lower abdominal pain found better than reported by Mihret Hiluf et al. from
135(99.3%), excessive vomiting 133 (97.8%) while Ethiopia where it was only (10.9%), 2.2% and 5.2%
nearly half of the mothers knew about convulsions 80 respectively.4 Mazummdar R et al. from Bankura district
(58.8%) and fever during pregnancy 69 (50.7%) as of West Bengal also reported similar findings as that of
dangers sings of pregnancy. (Table 2) our study.7 A study by Agarwal S et al. from Indore,
Madhya-Pradesh, revealed that awareness of the mothers
When we enquired mothers of infants about
about at least one danger-sign of pregnancy, delivery,
knowledge of danger signs of labour, we found that the
and newborn-related complications was 79.2%, 78.5%,
mothers of infants had knowledge about danger signs
and 82.1% respectively.8
during labour. Like excessive vaginal bleeding 135
(99.3%), prolonged labour 134 (98.5%), cord around Wanboru AW from Ethopia reported that awareness
neck 133 (97.8) identified in better way while about of pregnant mothers regarding danger signs of
half of them had knowledge about retained placenta 56 pregnancy, labour and post partum period was very
(41.2%) and very few 35 (25.7%) knew green colour poor.9 Another author, Mengesha E from Ethiopia, also
fluid i.e. meconium stained fluid as the danger signs of revealed that awareness of danger signs of pregnancy
pregnancy. (Table 3) was poor and affected by education and occupation of
mothers while Hailu M et al. from southern Ethiopia
Mothers of the infants were also inquired about their
demonstrated that such awareness is associated with
knowledge of danger signs of post partum period. We
place of residence.10,11
found that they had good knowledge regarding excessive
vaginal bleeding 136 (100%), lower abdominal pain Similarly, current study shows better knowledge
130 (95.6%) and breast problems like inverted nipples, among mothers of infants regarding dangers signs
engorged breast/swelling of breasts in 123 (90.4%). of labour like excessive vaginal bleeding (99.3%),
(Table 4) prolonged labour (98.5%), retained placenta (41.2%)
and convulsions (66.9%) whereas in Ethiopian study by
Mean years of maternal education of respondent
Mihret hiluf’s it was only found in 16.5%, 11%, 7.1%
who had adequate knowledge about danger signs
and 0.6% respectively.4
of pregnancy, labour and post partum period was
significantly higher than those who had inadequate Knowledge regarding dangers signs of post partum
knowledge. The mean years of father’s education where period like severe vaginal bleeding and high fever
mother had adequate knowledge about danger signs of among mothers of infants was found to be 100% and
labour was 12.0 years of schooling (+-3.1) significantly 52.2 respectively in the current study where as it is
higher than those who had inadequate knowledge. The grossly less in Ethiopian mothers i.e. 16.7% and 1.1%
family monthly income of the respondent who had respectively.4 North Indian study by Sibley L et al.
adequate knowledge about danger signs of post partum established the fact that mother had poor knowledge of
period was significantly higher than those who had danger signs of post partum period.12 Tanzanian study
inadequate knowledge. (Table 5) by Pembe AB also stated less percentage of women who
knew at least one danger sign during pregnancy was
DISCUSSION
26%, during delivery 23% and after delivery 40%.13
Current study has been conducted among 136 This may be attributed to better educational status
mothers of infants in rural Pondicherry to study among women in study area where more than half
knowledge regarding danger signs of pregnancy, labour (54.4%) of the mothers have studied up to secondary
and post partum period. This was necessary to see the levels and rest had graduate and above. Mangesha E
Indian Journal of Public Health Research & Development, April-June 2017, Vol. 8, No. 2 119

from North Ethopia reported that knowledge regarding


Father’s education
danger signs in pregnancy was poor and affected by Secondary 72 52.9
education and occupation of mothers.7 Hailu M from Higher secondary 24 17.6
south Ethopia also revealed that maternal education, Graduate and above 40 29.5
residence were associated with knowledge of danger Father’s occupation
signs in pregnancy.8 Maternal education is a common Labour 90 66.2
factor found to be associated with knowledge of danger Service/business 46 33.8
signs of pregnancy, labour and post partum period in our Modified Prasad’s
study. This indicates that a higher educational level for classification of SES*
mothers is an essentially important indicator to improve Class I 6 4.4
upon knowledge relate to danger signs during pregnancy, Class II 20 14.7
birth and post partum period. Class III 20 14.7
Class IV 47 34.6
Though the knowledge on danger signs was Class V 43 31.6
better as compared to other studies, we still expect Family type
more improvement in overall knowledge and possible Nuclear 59 43.4
behavioural changes. 4,10,11 We feel that while imparting Joint 77 56.6
health education to health workers must focus on danger
• B.G. Prasad modifies Socio-economic
signs in pregnancy, labour, post partum period and
classification (modified as per July 2013 All India
more emphasis on early reporting of such health issues
Consumer Price Index)
to health care facility. The timely identification and
interventions for these danger signs will definitely help Table 2: Mothers’ knowledge regarding danger
in reducing morbidity and mortality among mothers. signs of pregnancy, labour & post partum period
(PPP)
Table 1. General characteristics of Mothers of
infants Number Percentage
Danger signs
N=136 %
Number (%) Percentage
General characteristics Excessive vomiting 133 97.8
N=136 %
Mother’s Age (Years) Fever 69 50.7
19-25 76 55.9
High blood pressure 101 74.3
26-30 47 34.6
30-35 12 8.8 Headache 101 74.3
Above 35 1 0.7
Blurred vision 92 67.6
Mother’s education
Secondary 74 54.4 Oedema 128 94.1
Higher secondary 27 19.9
Convulsions to mother 80 58.8
Graduate and above 35 25.7
Absent foetal movements after
Mother’s occupation 136 100
20wks
Housewife 119 87.5
Labour 2 1.5 Excessive vaginal bleeding
135 99.3
after 1st trimester
Service/Business 15 11.0
Father’s Age (Years) Lower abdominal pain 135 99.3
19-25 21 15.4 Anaemia 126 92.6
26-30 59 43.4
30-35 43 31.6
Above 35 13 9.6
120 Indian Journal of Public Health Research & Development, April-June 2017, Vol. 8, No. 2

Table 3: Mothers’ knowledge regarding danger Table 4: Mothers’ knowledge regarding danger
signs of in labour signs of in post partum period

Number
During labour Percentage % Number Percentage
N=136 During PPP
N=136 %
Excessive vaginal bleeding 135 99.3
Foul smelling discharge 59 43.4 Excessive vaginal bleeding 136 100
High grade fever 75 55.1
Prolonged labour 134 98.5 High grade fever 71 52.2
Cord prolapsed 108 79.4
Cord around neck 133 97.8 Lover abdominal pain 130 95.6
Convulsion to mother 91 66.9
Green leaking fluid Retained placenta 59 43.4
35 25.7
(meconium stained)

Table 5: Comparison of demographic determinants with adequacy of knowledge regarding danger signs
in pregnancy, labour pain and post partum period among mothers

Knowledge level Knowledge in pregnancy Knowledge in Labour Knowledge in post partum period

N Mean (SD) P value N Mean (SD) P value N Mean (SD) P value

Inadequate 5 23.8 (2.5) 42 25.0 (3.4) 60 24.9 (3.3)


Mother age 0.288 0.236 0.081
Adequate 131 25.6 (3.8) 94 25.8 (3.8) 76 26.0 (4.0)

Mother’s Inadequate 5 8.8 (3.1) 42 10.4 (2.6) 60 10.5 (2.5)


0.038* 0.003* 0.0001*
education Adequate 131 11.6 (2.9) 94 12.0 (3.0) 76 12.3 (3.0)

Inadequate 5 28.8 (4.3) 42 29.4 (3.8) 60 29.8 (4.3)


Father’s age 0.516 0.283 0.546
Adequate 131 30.1 (4.3) 94 30.3 (4.5) 76 30.2 (4.3)

Father’s Inadequate 5 10.4 (2.7) 42 10.1 (3.2) 60 10.3 (3.0)


0.496 0.002* 0.001*
education Adequate 131 11.4 (3.3) 94 12.0 (3.1) 76 12.2 (3.2)

Inadequate 5 20.6 (3.0) 42 22.3 (2.9) 60 21.8 (2.8)


Mother’s age at
0.271 0.823 0.239
marriage Adequate 131 22.3 (3.3) 94 22.2 (3.4) 76 22.5 (3.6)

Inadequate 5 1.6 (0.6) 42 1.3 (0.6) 60 1.4 (0.7)


No of Children 0.560 0.175 0.683
Adequate 131 1.4 (0.6) 94 1.5 (0.6) 76 1.5 (0.6)

Inadequate 5 4200.0 (1303.8) 42 6523.8 (7771.9) 60 6041.7 (6160.5)


Monthly Income 0.204 0.056 0.001*
Adequate 131 8490.1 (7480.4) 94 9140.4 (7104.8) 76 1.01E4 (7803.6)

*Statistically significant Source of Funding: Indian Council of Medical


Research has funded this study through Short Term
CONCLUSIONS Studentship project ICMR STS 2013 (Ref. No. 2013-
The mothers of infants had good knowledge 02269).
regarding danger signs of pregnancy, labour and post
Conflict of Interest: None
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