ASSESSMENT OF KNOWLEDGE OF OBSTETRIC DANGER SINGS AND

BIRTH PREPAREDNESS PRACTICE AMONG WOMEN AT SABIAN

PRIMARYHOSPITAL

RIFT VALLEY UNIVERSITY DIRE DAWA CAMPUS

DEPARTMENTOFPUBLIC HEALTH

A RESEARCH PROPOSAL SUBMITTED TO PUBLIC HEALT DEPARTMENT OF

RIFT VALLEY UNIVERSITY IN PARTIAL FULFILLMENT OF THE
REQUIREMENTFOR BACHELOR OF ART (BA) DEGREE IN PUBLIC HEALTH.

BY: GROUP TWO

NAME:

1.
2.
3.
4.
5.

ADVISER: -[Link] .G
February 2021
Dire Dawa Ethiopia
 ABSTRACT

Background:One of the reasons of high maternal mortality in sub-Saharan Africa is inadequacy

or lack of knowledge about obstetric danger signs and birth preparedness, which is a key
component of globally accepted safe motherhood programs. In Ethiopia, a country where
maternal morbidity and mortality is high little is known about knowledge level of pregnant
women on obstetric danger sing and birth preparedness practice.

Objective:The aim of the study is to assess the knowledge of obstetric danger signs and birth
preparedness practice among women in dire dawa administration city.

Method:A cross sectional study design will be used to conduct research on obstetric danger
signs and birth preparedness practice at ANC MCH/ clinics at sabian primary hospital.
333 women will be interviewed using pretested questionnaire. Convenient sampling will be used
to interview study participants.

I
 Acknowledgement
First of all we would like to thank Rift valley university ; Department of public Health, for
giving us this chance to practice proposal development and research report writing which will
help us to prepare our self for the future careers as research is a major concern in our field. Our
deepest gratitude also goes toour research [Link] for his valuable advice,
recommendations and comments. We are also thanking for Sabian primary hospital which allows
us We would like to thank all the mothers who participated in this study and without whom this
paper would not have been possible. Finally thanks to our families who supported us financially
and psychologically

Table of Contents
Acknowledgement...........................................................................................................................I
Table of Contents………………………………………………………………………………………………………………………..II

ILists of Acronyms..........................................................................................................................III
abstract………………………………………………………………………………………………………………………………………VI

CHAPTER ONE.................................................................................................................................1
1. INTRODUCTION..........................................................................................................................1
1.1 BACKGROUND.......................................................................................................................1
1.2. STATEMENT OF THE PROBLEM............................................................................................2
1.3. SIGNIFICANCE OF THE STUDY..............................................................................................2
CHAPTER TWO................................................................................................................................3
2. LITERATURE REVIEW...................................................................................................................3
CHAPTER THREE..............................................................................................................................5
3. OBJECTIVES.................................................................................................................................5
3.1 GENERAL OBJECTIVE.............................................................................................................5
3.2 SPECIFIC OBJECTIVE..............................................................................................................5
CHAPTER FOUR...............................................................................................................................6
4. METHODOLOGY AND MATERIALS...............................................................................................6
4.1. Study area............................................................................................................................6

4.2Study design and period……………………..................................................................6

4.3 Population……………………………………………………………………………7

4.3.1 Source population..........................................................................................................7

4.3.2 Study population............................................................................................................7
4.4 Inclusive and exclusive criteria.............................................................................................7
4.4.1. Inclusive criteria............................................................................................................7
4.4.2. Exclusion criteria..........................................................................................................7
4.5. Sampling..............................................................................................................................7
4.5.1 Sample size determination............................................................................................7
4.5.2 Sampling procedure…………………………………………………………......8

4.6. Variables..............................................................................................................................8
4.6.1 Dependent variables......................................................................................................8
 4.6.2. Independent variables..................................................................................................8
4.7. Plan for data collection........................................................................................................8
4.7.1. Instrument....................................................................................................................8
4.7.2. Data collection procedure (technique).........................................................................8
4.8. Data quality control.............................................................................................................9
4.9. Data processing and analyzing.............................................................................................9
4.10. Ethical consideration.........................................................................................................9
4.11. Dissemination of the result…………………………………….…………………………..9

5. REFERENCES........................................................................................................................10-12
8. Questionnaire...........................................................................................................................15

III
Lists of Acronyms & Abbreviations

ANC Antenatal Care

BPACR Birth Preparedness and Complication Readiness

C.I Confidence Interval

DHS Demographic and Health Survey

EDHS Ethiopian Demographic and Health Survey

EJHD Ethiopian Journal of Health Development

FMOH Federal Ministry of Health

HC Health Center

MDG Millennium Development Goal

SPSS Statistical Package for Social Science

WHO World Health Organization

MMRMaternal mortality rate

MNH maternal and neonatal health

IV
LIST OF TABLE

V
1 CHAPTER ONE -INTRODUCTION
1.1 BACKGROUND

Knowledge of danger signs of obstetric complications during pregnancy, labour and

postnatal period is the first essential step for appropriate and timely referral. Obstetric danger
signs are unexpected obstetric signs that can lead to maternal health complications. These danger
signs are mainly classified into three categories. Major danger signs during pregnancy include:
severe vaginal bleeding, swollen hands/face, and blurred vision. Major danger signs during labor
and childbirth include severe vaginal bleeding, prolonged labor (>12 h), convulsions, and
retained placenta. Major danger signs during the postpartum period include severe vaginal
bleeding, foul-smelling vaginal discharge, and fever(1)

Global maternal mortality rates were halved between 1990 and 2010. However, most of
the maternal deaths in the world occur in developing countries (2).The knowledge of obstetric
danger signs during pregnancy, delivery and postpartum is still low in sub-Saharan African
countries evidenced by studies conducted in Burkina Faso (3) Earlier studies have shown that
maternal health services do not reach those who most need them, and the quality of obstetric
services has been poor (4).

To help address these disparities and speed up progress in reducing maternal deaths, the
World Health Organization (WHO) and national governments have made health-care system
strengthening a key priority for improving maternal and child health and access to health care
(5)Maternal health has become one of the major public health concerns for developing countries
following the first safe motherhood conference held in Kenya in 1987. (6)

Millennium Development Goal 5a (MDG 5), improve maternal health, set the targets of
reducing maternal mortality by 75% and achieving universal access to reproductive health by
2015. But, so far progress in reducing maternal mortality in developing countries and providing
family planning services has been too slow to meet the targets. (7).

1
 The major direct causes of maternal morbidity and mortality include hemorrhage,
infection, high blood pressure, unsafe abortion, and obstructed labor. These complications may
arise unexpectedly. Investing in health systems - especially in training midwives and in making
emergency obstetric care available round-the-clock - is key to reducing maternal mortality.
Addressing the barriers to use of care and creating an environment within households and
community that support women in seeking the needed care is also key.(8).

With the assumption that "every pregnancy faces risks, women should be made aware of
danger signs of obstetric complications during pregnancy, delivery and the postpartum. The
knowledge will ultimately empower them and their families to make prompt decisions to seek
care from skilled birth attendants.(9).

Severe vaginal bleeding, swollen hands/face and blurred vision are the key danger signs
during pregnancy. The key danger signs during labor and childbirth include: severe vaginal
bleeding, prolonged labor (>12 h), convulsions and retained placenta. Additionally, severe
vaginal bleeding, foul-smelling vaginal discharge and high fever are the key danger signs during
the postpartum period.(10).

In Ethiopia, hemorrhage, hypertension in pregnancy, abortion and sepsis are the leading
causes of maternal deaths, which can be averted through recognition of danger signs of these
complications and skilled institutional care Moreover, in order for women to reach the place
where appropriate care is provided, certain preparations prior to birth are required. Birth
preparedness for a woman entails identifying a skilled attendant/health facility with delivery
services, making transportation plans, saving money and identifying a blood donor.(11)

1.2 STATEMENT OF THE PROBLEM

 Globally, every minute, at least one woman dies from complications related to
pregnancy or childbirth – that means 529 000 women a year. In addition, for every woman who
dies in childbirth, around 20 more suffer injury, infection or disease – approximately 10 million
women each year, About 529,000 mothers die each year from maternal causes, out of which
99% of deaths being from the developing world. As literatures indicate about 75% of maternal
deaths are due to direct obstetric complications such as hemorrhage, sepsis, hypertensive
disorders of pregnancy, obstructed and prolonged labor, and unsafe abortion.(12).

In 2015, about 99% (302,000) of the global maternal deaths were in developing regions , with
sub Saharan Africa accounting for 66% (201,000).(13)

For every 100,000 live births, 450 women died during the three periods (pregnancy,
childbirth, or postpartum) in developing countries.(14).

These life-threatening complications are treatable thus most of these deaths are avoidable
if women with the complications have timely access to appropriate emergency obstetric care.
(15).

The above mentioned conditions which contribute to maternal mortality word wide are
leading causes of maternal deaths in Ethiopia. Majority of women are found in rural areas where
the level of illiteracy is high. Maternal mortality rate in Ethiopia is 470 per 100,000 births(16)
Most maternal deaths in resource poor countries such as Ethiopia, are attributed to the three
delays; delay to make a decision to seek care, delay to reach place of care and delay in receiving
appropriate and adequate care. (17).

Preparation for childbirth helps ensure that the woman will get the support she will need
from the skilled attendant, the family, and the community. Because 15% of pregnant women
develop a life-threatening complication and most of those complications cannot be predicted,
every woman and her family must be ready to respond in case a problem occurs.(18). Thus,
mothers to survive, families and communities must recognize pregnancy danger signs, seek and
access maternal health services, and receive quality care. In Ethiopia, there is no extended study

3
on knowledge of obstetric danger signs and birth preparedness practice. Lack of
knowledge/awareness of the significance of symptoms of obstetric complications and birth
preparedness is one of the reasons of failure of women to identify and seek appropriate
emergency care.

1.2 Significance of the study

Findings of this study will enable program planners, implementers and policy makers to come
up with strategies that will improve maternal knowledge about obstetric danger signs and birth
preparedness practice which will in turn improve maternal health care seeking behaviors and
avoiding pregnancy related complications. It will provide important information to health care
facility and enable them to plan intervention program on obstetric complications. It will also
serve as base line data for future researches in this area. It will be used by different governmental
and non-governmental organization which work for obstetric and obstetric related complications.

4
 2: CHAPTER TWO LITERATURE REVIEW

Knowledge of obstetric danger signs and birth preparedness are strategies aimed at
enhancing the utilization of skilled care during low-risk births and emergency obstetric care in
complicated cases in low income countries.(19).

Maternal morbidly and mortality could be prevented significantly if women

andtheirfamilies recognize obstetric danger signs and promptly seek health care. The commonest
danger signs during pregnancy include severe vaginal bleeding, swollen hands/face and blurred
vision. Key danger signs during labor and childbirth include severe vaginal bleeding, prolonged
labor, convulsions, and retained placenta. Danger signs during the postpartum period include
severe bleeding following childbirth, loss of consciousness after childbirth, and fever. Raising
awareness of pregnant women on the danger signs would improve early detection of problems
and reduces the delay in deciding to seek obstetric care.(20).

Global MMR was 210 maternal deaths per 100,000 live births in 2010, this has declined
from 400 maternal death per 100,000 live births reported in the 1990s. Despite this global
achievement, MMR continues to be a major public health challenge in developing countries
where MMR can be up to 15 times higher than that in developed countries.(21).

A cross - sectional study conducted in rural Tanzania revealed maternal education level, number
of antenatal care (ANC) follow-ups and place of delivery were predictors of mothers’ awareness
about obstetric danger signs during pregnancy, delivery and postpartum period.(22)

A qualitative study in Kenya showed heavy vaginal bleeding before expected date of
delivery,
unpleasant vaginal discharge, water breaking before due date, abnormal presentations abdominal
pain an d dizziness were cited a s obstetric danger signs by the respondents.(23)

5
 A community- based cross -sectional study conducted in Jimma zone showed that the
study participants mentioned severe vaginal bleeding (26.7%), swollen hands / feet (14.7%) and
blurred vision (29.8%). Additionally, severe vaginal bleeding (49.5%), convulsion (16.3 %),
prolonged labor (14.9%) and retained placenta (15 .1%) were recognized a s danger sign s during
labour and delivery

During the postpartum period vaginal bleeding (45.3%), foul smelling vaginal bleeding (15.2 %)
and high fever were key danger sign s mentioned by the study participant s (12.1 %). (24)

Other studies in East Gojjam and Tsegedie district of Northern Ethiopia showed
institutional delivery were associated with increased odds of knowledge about danger signs
during pregnancy, delivery, and postpartum period.(25,26)

Another study conducted in Gobadistrict of Ethiopia showed that, 31.9%, 27% and 22.1%
of the study participants were knowledgeable about danger signsduring pregnancy, delivery, and
postpartum period respectively. Place of residence, mother an d husband educational status,
mothers’ occupation, and ANC follow-up were found to be significant factors for knowledge of
danger signs. (27)

The Maternal and Neonatal Health (MNH) Program of JHPIEGO developed the birth-
preparedness and complication readiness matrix to address these three delays at various levels,
including the pregnant woman, her family, her community, health providers, health facilities, and
policy-makers during pregnancy, childbirth, and the postpartum period. The concept of birth-
preparedness and complication readiness includes knowing danger signs, planning for a birth
attendant and birth-location, arranging transportation, identifying a blood donor, and saving
money in case of an obstetric complication . Birth-preparedness and complication readiness is a
key strategy in safe motherhood programmers; however, there is no evidence of its effectiveness
in improving maternal morbidity or mortality.(28).

6
Other studies have also indicated low rates of birth preparedness among women in Kenya [20],
Ethiopia [21] and Burkina Faso [15]. The low awareness of danger signs coupled with lack of
preparedness contributes to the delay in seeking skilled care henceforth leading to high levels of
maternal mortality and morbidity, With a maternal mortality ratio estimated to 470/100,000 live
births and with only 18% of women assisted by skilled attendants during birth, Ethiopia is one of
the countries still facing the burden of unsafe motherhood The country target derived from the
Millennium Development 5, countries have committed to reducing the maternal mortality ratio
by three quarters between 1990 and 2015. Following the commitment with thegoal, Ethiopia is
expected to reduce maternal mortality in 2015 to 267 maternal deaths per 100,000 live births(29).

7
 3: CHAPTER THRE OBJECTIVES

3.1. General Objective

 To assess knowledge of obstetric danger signs and birth preparedness practice among
women in sabian primary hospital in 2018

3.2. Specific Objectives

 To assess the knowledge of obstetric danger signs in pregnancy mothers attending ANC
/MCH at sapian primary hospital.
 To evaluate the level of birth preparedness and complication readiness practice among
mothers who attend at sabian primary hospital.

8
 4: CHAPTER FOUR: METHODOLOGY

4.1. Study area,

Ethiopia, located in horn of Africa lies between 3 and 15 degree latitude and 33 and 44 degrees
East longitude. With a total area of 1.1 million square kilometers,with a total population of 77
million. Ethiopia has become the second populous country in Africa next to Nigeria. The country
is administratively divided in to nine (9) regional states namely Oromiya, Amhara, Tigray,
Southern Nations, Nationalities and Peoples Regional State, Afar, Harari, Benshangul-Gumuz,
Gambella and Somali Regional States and two (2) city administrations namely Addis Ababa and
Dire Dawa.

Dire dawa is located in the eastern part of Ethiopia enclosed by the state of Somali and the state
of Oromo. It’s found at the distance of 515 kilometers from Addis Ababa. According to the 1994
census, the total population was 151,864 of which 127,286 were males and 124,578 females. The
proportion of males and females is about 50.5% to 49.5%.the urban residents of the
administrative council number 173,188 while its rural residents 78,676. Besides there were
52,245 households in dire dawa administrative council with an average of 4.7 persons per
households.

Dire dawa administration owned ten [10] health centers. One [1] primary hospital one [1]
referralhospital and more than five [5] Non govern mental hospitals and many other health
facilities.

Sabian primary hospital is one of the governmental hospitals and the only primary hospital in
dire dawa administration city. Our study will be conducted at sabian primary hospital in dire
dawa administration city.

4.2. Study design and period

An institutional based cross sectional quantitative study will be conducted 2018

9
4.3. Population

4.3.1. Source population

The source population will be all pregnant women in sabian primary hospital.

4.3.2. Study population

The study population will be all pregnant women attending ANC/MCH at sabian primary
hospitalwho is available during study time.

4.4. Inclusion and exclusion criteria.

4.4.1 Inclusion criteria: All pregnant mothers who attend ANC/MCH and who are
willing to participate in the study

4.4.2 Exclusion criteria: All women who are not willing to respond to our questionnaire,
and who are very sick so can’t respond.

4.5. Sampling

4.5.1. Sample size determination

The sample size will be calculated using the following formula:

n=Z2 p (1-p)/d2 with 95% confidence rate

Where z- Confidence interval

n - Sample size

d- Required size of standard error.

p – Population prevalence with knowledge of obstetric danger sign and birth preparedness
practice(27)

n= (1.96)2 0.319(1-0.319)/0.052 n=333

By adding 10% non response, sample size for this study will be--------------.

10
4.5.2. Sampling procedure
The sample will be taken among pregnant women attending ANC/MCH at sabian primary
hospital using convenient sampling technique because of the easy availability and accessibility of
the study subjects.

4.6. Variables
4.6.1. Independent variable

 Age
 Residence
 Marital status
 Parity
 Wt/ht
 Maternal educational status
 Socio economic status

4.6.2. Dependent variable

 Knowledge
 Practice

4.7. Plan for data collection

4.7.1instrument.
Self administered structured questioner.

4.7.2. Data collection procedure (technique)

Data will be collected byusingself administered questioner and will develop in English and will
translate to ahmaric and Somali questioner will be collected by the researchers.

4.7.3. Data collection method

The method will be face to face (i.e. by interviewing the respondents) and self administrative
questionnaire for those who can read and understand.

11
4.8. Data quality control
Quality assurance measure will be undertaken during questionnaire designing, data collection
and data management process by checking the consistency and completeness of each question.
Validity of the questionnaire will be maintained by using questionnaire adopted from different
literatures that were used by other researchers. The questionnaire prepared in English will be
translated to local language ahmaric).The instrument will be pre-tested on private clinics by
administering it to a small group of people (5 % of the total sample) before the actual
implementation of the study and appropriate adjustment and correction will be under taken
accordingly. Data from pre-test finding will be excluded from the actual data.

The purpose of the study will be explained for the mothers to make them frankly communicate
with the data collectors. Intensive training will be given for supervisors and data collectors.
Incorrectly filled or missed ones will be sent back to respective data collector for correction. In
order to crosscheck the collected data and to maintain the quality of data the principal
investigator also will randomly recheck five percent of the completed questionnaires daily. The
principal investigator will review the questionnaires on daily basis for completeness and
consistency and supervise the data collection sites throughout stay. Data edition will be done on
the same day. Cleaning and exploration of outlier responses will be done after data entry and
during analysis.

4.9. Data processing and analyzing

After data collection, each questionnaire will be coded separately and data will be tabulated.
Coding of different variables will be also carried out before analysis especially by using
manually and if possible using computer soft ware SPSS program.

Frequencies, measures of central tendencies and variation will be obtained for each variable and
displayed mainly on the tables. Obstetric danger sign knowledge and birth preparedness related
questions will scored in such a way that one point is given for the correct answer and zero for the
incorrect one based on the respondent’s response.

12
The mean score will then be calculated for those questions to know the knowledge status of the
study subjects about obstetric danger signs and birth preparedness practice when considered.
Contingency tables will be also used to see the association between the explanatory and outcome
variables. Odds ratio with 95% confidence interval and logistic regression were employed to
describe the strength of association between the selected study variables by controlling for the
effect of possible con

4.10. Ethical consideration

Ethical clearance will be obtained from the Ethical clearance committee of Rift Valley
University. Letter of Cooperation will be written to the Dire dawa administration health office,
Sabian primary hospital Verbal informed consent will be obtained from all participants with the
method of data collection. The consent form will be written in english and read to all
participants.

Women will be approached individually, giving information regarding the purpose of the study,
invited to participate, assuring of confidentiality and reassuring that opting out will not
compromise the care they would receive. Only those who are willing to participate will be
involved. Confidentiality of the interview results will be maintained and identifiers will not be
included and information given by respondents will be used only for this study purpose. The
right not to respond or refuse participation will be respected. Personal privacy and cultural norms
will be respected properly.

4.11. Dissemination of the result

Dissemination of findings is crucial in any study as it allows the timely utilization of findings.
Three copies of the result will be submitted to the Rift Valley University, one copy will be
submitted to administration health bureau. The final study report feedback will be communicated
to Sabian primary hospital and to all relevant bodies to incorporate the result of the finding of
this study in their future planning.

13
 Table 1: work plan

y Ma

y Ma

y 7, Ma

y 8 Ma

– Ma
v- No

ch/ Mar

ch- Mar
il Apr

il Apr

il/2 Apr
No Activities

18
20, y
1. Research title
selection
2 Research title
submission
3 Research title
approval
4 Proposal
development
and
submission
5 Approval of
proposal
ethical
clearance
6 Data
collection,
analysis
7 First draft
report
submission
8 Secound draft
report
submission
9 Defence
14

7. BUDGET PLAN
N o U n i t Q t y . U n i t p r i c e Total cost
1 . 0 S ta t i o n a r y m a t e r i a l
1.1 P e n Number 8 5 . 0 0 4 0
1.2 P e n c i l Number 4 2 . 0 0 8
1 . 3 A4 size paper N u m b e r 1 1 7 0 . 0 0 1 0 7
1.4 B i n d e r N u m b e r 5 3 5 . 0 0 1 5 7
1.5 N o t e b o o k N u m b e r 8 1 2 . 0 0 9 6
1.6 F l a s h d i s k N u m b e r 2 1 8 0 . 0 0 3 6 0
1.7 S t a p l e r N u m b e r 6 8 0 . 0 0 4 8 0
1.8 S h a r p e r N u m b e r 8 3 . 5 . 0 0 2 8
1 . 9 Printing& copying N u m b e r 3 5 1 5 . 0 0 5 2 5
2 . 0 P e r s o n a l
3 . 0 T r a n s p o r t a t i o n .
3.1 J o u r n e y D i s t a n c e Frequency Si ngl e p r i c e Total price
From---to---- i n K m * times B i r r
ashawa to sapian primary hospital 1 0 3 0 5 1 5 0

T O T A L 2 0 3 2

15

5: references

1. JHPIEGO. Monitoring birth preparedness and complication readiness: tools and

indicators for
maternalandnewbornhealth[Internet].[Link]:[Link]
[Link].
2. WHO. Trends in maternal mortality:1990 to 2010. WHO, UNICEF, UNFPA and The
World
 Bankestimates.[Link]
ssed1September201]2012..
3. Moran AC, Sangli G, Dineen R, Rawlins B, Yaméogo M, Baya B. Birthpreparedness for
maternal health: findings from Koupéla District, Burkina Faso. J Health PopulNutr
[Internet].
2006;24(4):[Link]:[Link]
artid=3001153&tool= pmcentrez&rendertype=abstract
4. Admasu K, Haile-Mariam A, Bailey P. Indicators for availability, utilization, and quality
of emergency obstetric care in Ethiopia, 2008. Int J Gynaecol Obstet. 2011;
115(1):101±5. Epub 2011/08/23. doi: 10. 1016/[Link].2011.07.010 PMID: 21855065
5. Girma M, Yaya Y, Gebrehanna E, Berhane Y, Lindtjorn B. Lifesaving emergency
obstetric services are inadequate in south-west Ethiopia: a formidable challenge to
reducing maternal mortality in Ethiopia. BMC health services research. 2013; 13(1):459.
Epub 2013/11/05.
6. Mahler H. The safe motherhood initiative: a call to action. Lancet. 1987; 1(8534):668
7. Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, et al. (2010) Maternal mortality
for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium
Development Goal 5. Lancet 375: 1609–23.
8. Barbara Deller, ACCESS, maternal health, globlaelearning center, September,2009
9. Graham W: Every pregnancy faces risks. Plan Parent Chall 1998(1):13-14.

16

10. JHPIEGO. Maternal and Neonatal health (MNH) Program, Birth preparedness and
complication readiness. A matrix of shared responsibilities. Maternal and Neonatal
Health. Baltimore: JHPIEGO; 2001. p. 23–31.
11. The federal democratic republic of Ethiopia Ministry of Health 2015: Health sector
transformation plan (HSTP). Addis Ababa: Minstry of Health (MOH); 2015
12. Pembe AB, Urassa DP, Carlstedt A, Lindmark G, Nystrom L, Darj E: Rural Tanzanian
women's awareness of danger signs of obstetric complications. BMC Pregnancy
Childbirth 2009, 9:12.
13. UNICEF. Trends in Maternal Mortality 1990 to 2015: Estimates by WHO, UNICEF,
World Bank, UNFPA and United Nations Population Division. Geneva: World Health
Organization; 2015.
14. JHPIEGO. Maternal and Neonatal Health Program. Birth Preparedness and Complication
Readiness: A Matrix of Shared Responsibilities. Maryland, USA: JHPIEGO; 2004
15. WHO Division of Family Health. Geneva: World Health Organization; 1994. Mother-
Baby Package: Implementing Safe Motherhood in Countries. Practical Guide: Maternal
Health and Safe Motherhood Programme.
16. 2010 WHO/UNICEF/UNFPA/World Bank MMR report.
17. Thaddeus S, Maine D: Too far to walk: maternal mortality in context. Soc Sci Med 1994,
38(8):1091-1110
18. Fessahaye A, Abebe G, Hailu M. Knowledge about obstetric danger signs among
pregnant women. Ethiop J Health Sci 2010 Mar;20(1):25-32.
19. Maternal and Neonatal Health Program Birth preparedness and complication readiness: a
matrix of shared responsibilities. Baltimore, MD: JHPIEGO; 2001. p. 12.
20. Stanton CK. Methodological issues in the measurement of birth preparedness in support
of safe motherhood. Eval Rev. 2004; 28:179–200.

17

21. The World Bank, World Health Organization, UNICEF, UNFPA. Trends in Maternal
Mortality : 1990 to 2010 [Internet]. Organization. 2010. Available from:
[Link]
22. Pembe AB, Urassa DP, Anders A, Lindmark G, Nyström L, Darj E. Rural Tanzanian
women’s awareness of danger signs of obstetric complications. BMC Pregnancy
Childbirth. 2009;9:12.
23. Echoka E, Makokha A, Dubourg D, Kombe Y, Nyandieka L, Byskov G. Barriers to
emergency obstetric care services: accounts of survivors of life threatening obstetric
complications in Malindi District. Kenya Pan Afr Med j. 2014;17 Suppl 1:4.
 24. Tura G Debelew, Afework MF, Yalew AW. Factors affecting birth preparedness and
complication readiness in Jimma Zone, Southwest Ethiopia: a multilevel analysis The
Pan African Medical Journal 2012 - ISSN 1937–8688.
25. Amenu G, Mulaw Z, Seyoum T, and Bayu B. Knowledge about Danger Signs of
Obstetric Complications and Associated Factors among Postnatal Mothers of Mechekel
District Health Centers, East Gojjam Zone, Northwest Ethiopia, 2014 Hindawi
Publishing Corporation Scientifica Volume 2016, Article ID 3495416

26. Hailu D, Berhe H. Knowledge about Obstetric Danger Signs and Associated Factors
among Mothers in Tsegedie District, Tigray Region, Ethiopia 2013: Community Based
Cross-Sectional Study. PLoS One. 2014;9(2):e83459

27. Bogale D, Markos D. Knowledge of obstetric danger signs among child bearing age
women in Goba district, Ethiopia: a cross-sectional study. BMC Pregnancy Childbirth.
2015;15:77.

28. Hiluf M, Fantahun M: Birth Preparedness and Complication Readiness among women in
Adigrat town, north Ethiopia. Ethiopian Journal of Health Development 2007, 22(1):14-2

29. Ministry of Finance and economic development (2008) Ethiopia: progress towards
achieving the millennium goals. Success, challenges and prospects. Addis Ababa:
Ministry of Finance and economic development.

18

Rift Valley University

Research and Publication Office
Annex 1: Informed consent form (to be taken by data collectors)

Hello, my name is --------------------------------------------------------------and I am from Rift Valley

University. I am here to enroll and take interview from eligible study participants like you and
fill in the questionnaire forms. I am glad to inform you that you are one of the chosen study
participants to participate in this study. The purpose of which is to assess the knowledge of
Obstetric danger sign and birth preparedness practice among women in dire dawa administration
city The information in this questionnaire will be kept strictly confidential. It will not be
divulged to any one and only the research group will have access to the information you give and
your name and address will not be recorded or identified even by the research team.
However, it is your right to terminate your participation at any time (from the very beginning or
you can answer some questions you like to do so). I will appreciate and respect whatever your
decision will be.
Thus, this questionnaire will be filled only if you agree to take part in the study and I sincerely
ask you to give your genuine and true responses to the questions, provided you would agree to
participate in the study.
So, would you like to participate in the study?

Yes/agree --------------

No/disagree ------------

Thank you!

Date {-------/--------------/-----------)

Signature of the interviewer/data collector to certify the informed consent verbally

Sign --------------------------------------------

19

Part I: Social Demographic

1. A. Gravida_________

B. Para____________

2. Age

A. < 18

B. 18-35.

C. >35

3. Ethnicity.
 A. Oromoo

B. Somali.

C. Ahmara.

[Link] (specify)

4. Religion.

A. Muslim

B. Orthodox

C. Protestant.

D. Others (specify)

5. Marital status.

A. Married.

B. Single.

C. Divorced.

20

6. Education status.

A. Illiterate.

B. Grade 1-4.

C. Grade 5-8.

D. G 9-10

E. Preparatory.

F. Higher education (>12)

7. Occupational status.
 A. House wife.

B. Merchant.

C. Daily laborer.

D .Gov’t employee

E. Others (specify)

8. Income level per month in ETH birr.

A. <500.

B. 500-1000.

C. >1000.

9. Area of resident.

A. Rural.

[Link] II: Knowledge of mothers about obstetric danger sings

1. Key danger signs during pregnancy

1.1. Do you know what is severe vaginal bleeding?
A. Yes. B. No
1.2. If yes, do you consider it as a danger sign?
A. Yes
B. No

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1.3. Are swollen hands/legs a danger sign of pregnancy?

A. Yes
B. No
1.4. Is blurred vision a danger sign?
A. Yes,
B. No.
2. Key danger signs during child birth
2.1. If labor lasts more than 8 hours is it a danger sign?
A. Yes
B. No
2.2. Is convulsion a danger sings?
A. Yes
B. No
 2.3. If the placenta is retained is it a danger sign?
A. Yes
B. No
3. Key danger signs during postpartum.
3.1. Is loss of consciousness a danger sign?
A. Yes
B. No
3.2. Is foul smelling vaginal discharge a danger sign?
A. Yes
B. No
3.3. Is fever a danger sign?

22

Part III: Birth preparedness practice.

1. Do you indentify skill birth attendant before birth?

A. Yes
B. No
2. Do you indentify the location of closest appropriate care facility?
A. Yes
B. No
3. Do you safe money for birth related and emergency expenses
A. Yes
B. No
4. Do you get transport to health facility for birth and obstetric emergency?
A. Yes
 B. No
5. Do you indentify compatible blood donors in case of emergency
A. Yes
B. No

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