Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb 26;21(1):82.
doi: 10.1186/s12905-021-01234-3.

Awareness of obstetric danger signs among pregnant women in the Democratic Republic of Congo: evidence from a nationwide cross-sectional study

Dalau Mukadi Nkamba  1   2 , Gilbert Wembodinga  3 , Pierre Bernard  4 , John Ditekemena  3 , Annie Robert  5
Affiliations

Awareness of obstetric danger signs among pregnant women in the Democratic Republic of Congo: evidence from a nationwide cross-sectional study

Dalau Mukadi Nkamba et al. BMC Womens Health. .

Abstract

Background: Poor awareness of obstetric danger signs is a major contributing factor to delays in seeking obstetric care and hence to high maternal mortality and morbidity worldwide. We conducted the current study to assess the level of agreement on receipt of counseling on obstetric danger signs between direct observations of antenatal care (ANC) consultation and women's recall in the exit interview. We also identified factors associated with pregnant women's awareness of obstetric danger signs during pregnancy in the Democratic Republic of Congo (DRC) METHODS: We used data from the 2017-2018 DRC Service Provision Assessment survey. Agreement between the observation and woman's recall was measured using Cohen's kappa statistic and percent agreement. Multivariable Zero-Inflated Poisson (ZIP) regression was used to identify factors associated with the number of danger signs during pregnancy the woman knew.

Results: On average, women were aware of 1.5 ± 1.34 danger signs in pregnancy (range: 0 to 8). Agreement between observation and woman's recall was 70.7%, with a positive agreement of 16.9% at the country level but ranging from 2.1% in Bandundu to 39.7% in Sud Kivu. Using multivariable ZIP analysis, the number of obstetric danger signs the women mentioned was significantly higher in multigravida women (Adj.IRR = 1.38; 95% CI: 1.23-1.55), in women attending a private facility (Adj.IRR = 1.15; 95% CI: 1.01-1.31), in women attending a subsequent ANC visit (Adj.IRR = 1.11; 95% CI: 1.01-1.21), and in women counseled on danger signs during the ANC visit (Adj.IRR = 1.19; 95% CI: 1.05-1.35). There was a regional variation in the awareness of danger signs, with the least mentioned signs in the middle and the most in the eastern provinces.

Conclusions: Our findings indicated poor agreement between directly observed counseling and women's reports that counseling on obstetric danger signs occurred during the current ANC visit. We found that province of residence, provision of counseling on obstetric danger signs, facility ownership, gravidity and the number of ANC visits were predictors of the awareness of obstetric danger signs among pregnant women. These factors should be considered when developing strategies aim at improving women's awareness about obstetric danger signs in the DRC.

Keywords: Awareness; DRC; Obstetric danger signs; Pregnancy.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Selection procedure for the sampling units included in this analysis
Fig. 2
Fig. 2
The number of dangers signs mentioned by pregnant women during the exit interview after antenatal care visit in the DRC. Mean (± SD) number of signs mentioned by pregnant women was 1.53 (± 1.34), with a median (IQR) of 1 (0–2)
Fig. 3
Fig. 3
Cumulative distribution of the number of danger signs reported by pregnant women during the exit interview after ANC visit, by gravidity in the DRC. a Related to first pregnant women, n = 1195 of which 664 were in their first ANC visit and 531 were in a subsequent visit. b Related to subsequent pregnant women, n = 3317 of which 1708 were in their first ANC visit and 1609 were in a subsequent visit
Fig. 4
Fig. 4
Percentage of women counseled on obstetric danger signs, and percentage of women reporting each sign in the DRC
See this image and copyright information in PMC

References

    1. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323–333. doi: 10.1016/S2214-109X(14)70227-X. - DOI - PubMed
    1. WHO . Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2019.
    1. Sk MIK, Paswan B, Anand A, Mondal NA. Praying until death: revisiting three delays model to contextualize the socio-cultural factors associated with maternal deaths in a region with high prevalence of eclampsia in India. BMC Pregnancy Childbirth. 2019;19:314. doi: 10.1186/s12884-019-2458-5. - DOI - PMC - PubMed
    1. Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med 1982. 1994;38(8):1091‑110. - PubMed
    1. World Health Organization . Managing complications in pregnancy and childbirth: a guide for midwives and doctors. 2. Geneva: World Health Organization; 2017.

LinkOut - more resources