NURSING AND MIDWIFERY TRAINING COLLEGE, PANTANG

ASSESSING THE LEVEL OF KNOWLEDGE, PERCEPTION AND HEALTH

SEEKING ACTIONS OF PREGNANT WOMEN AT PANTANG ANTENATAL

CLINIC ON DANGER SIGNS IN PREGNANCY

BY

REGINA KORANTEMA ABOAGYE

VANNESSAH ACHEAMPONG

PRISCILLA KARLEY ACQUAYE

DEBORAH GYIMAH

A RESEARCH WORK SUBMITTED TO KWAME NKRUMAH UNIVERSITY OF

SCIENCE AND TECHNOLOGY, FACULTY OF ALLIED SCIENCES,

DEPARTMENT OF NURSING; IN PARTIAL FULFILMENT OF THE

REQUIREMENTS FOR THE AWARD OF DIPLOMA IN MIDWIFERY

NOVEMBER, 2022
 KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOGY

COLLEGE OF ALLIED SCIENCES

FACULTY OF ALLIED HEALTH SCIENCES

DEPARTMENT OF NURSING

DIPLOMA PROGRAMS

TOPIC:

TOPIC:

ASSESSING THE KNOWLEDGE ON THE CAUSES AND EFFECT OF ANAEMIA

AMONG PREGNANT WOMEN AT ABOKOBI HOSPITAL

BY:

REGINA KORANTEMA ABOAGYE

VANNESSAH ACHEAMPONG

PRISCILLA KARLEY ACQUAYE

DEBORAH GYIMAH

NURSING AND MIWIFERY TRAINING COLLEGE – PANTANG

AFFILIATED TO KNUST, KUMASI

ii
 DECLARATION

We hereby declare that this project work was originally produced by me with the exception

of information gathered from other sources for which references have been duly made and

no part of it has been presented for the award of a diploma in this college or elsewhere

NAME INDEX NUMBER SIGNATURE DATE

……………………. ……………

REGINA KORANTEMA ABOAGYE 5105421

……………………. ……………
VANNESSAH ACHEAMPONG 5111621

PRISCILLA KARLEY ACQUAYE 5114721 ……………………. ……………

DEBORAH GYIMAH 5320721 …………………….. ………………

i
 ABSTRACT

The purpose of the study was to access the knowledge, perception and health seeking behaviour

of pregnant women on danger signs of pregnancy. The target population was pregnant women

at the Pantang antenatal clinic of Ga East Municipality in the Greater Accra Region.

The study used a descriptive cross-sectional design which was explored quantitatively. The

sample size chosen for the study was 30 participants. Participants were obtained using the

random sampling technique and a structured questionnaires developed by researchers was

administered to participants for data collection.

Questionnaires filled by participants were collected and data analysed using the Statistical

Package for Service Solution (SPSS) version 13.0.

The areas assessed were knowledge, perception and health seeking behaviours on danger signs

of pregnancy. The study revealed various levels of the pregnant women on the phenomenon of

danger signs in pregnancy.

TABLE OF CONTENTS

ii
DECLARATION ...................................................................................................................... i

ABSTRACT .............................................................................................................................. ii

ACKNOWLEDGEMENT...................................................................................................... vi

DEDICATION ........................................................................................................................ vi

CHAPTER ONE ...................................................................................................................... 1

INTRODUCTION .................................................................................................................. 1

1.1Background to the Study ................................................................................................... 1

1.2 Statement of the problem ................................................................................................. 3

1.3 Purpose of the study ......................................................................................................... 4

1.4 Specific Objectives ........................................................................................................... 4

1.5 Research Question ............................................................................................................ 4

1.6 Operational definitions of terms ....................................................................................... 4

CHAPTER TWO ..................................................................................................................... 6

LITERATURE REVIEW ....................................................................................................... 6

2.0 Introduction ...................................................................................................................... 6

2.1 Concept of danger signs in pregnancy ............................................................................. 6

2.2 Knowledge on danger signs of pregnancy ....................................................................... 6

2.3 Health seeking behaviors of pregnant women on danger signs of pregnancy. ................ 7

2.4 Perception of pregnant women on danger signs of pregnancy......................................... 9

CHAPTER THREE ............................................................................................................... 10

MATERIALS AND METHODS .......................................................................................... 10

3.1 Research design .............................................................................................................. 10

3.2 Study area and study population .................................................................................... 10

iii
 3.3 Sample size and sampling technique .............................................................................. 11

3.4 Data collection tool ........................................................................................................ 11

3.5 Data collection procedure............................................................................................... 11

3.6 Data analysis .................................................................................................................. 12

3.7 Ethical considerations .................................................................................................... 12

3.8 Limitations of the study.................................................................................................. 12

CHAPTER FOUR.................................................................................................................. 13

DATA ANALYSIS AND FINDINGS ................................................................................... 13

4.0 Introduction ............................................................................................................... 13

4.1 Socio-demographic and Reproductive characteristics .............................................. 13

4.2 Knowledge on danger signs during pregnancy .............................................................. 14

4.2 Knowledge on danger signs during pregnancy .............................................................. 15

4.3 Health seeking behaviors on danger signs during pregnancy ........................................ 16

CHAPTER FIVE ................................................................................................................... 19

DISCUSSION, SUMMARY, CONCLUSION AND RECOMMENDATIONS ............... 19

5.0 Introduction .................................................................................................................... 19

5.1 Socio- demographic and Reproductive characteristics .................................................. 19

5.2 Knowledge on danger signs during pregnancy .............................................................. 20

5.3 Association between knowledge and socio-demographic characteristics ...................... 20

5.4 Health seeking behaviors after experiencing a danger sign ........................................... 21

5.6 SUMMARY ................................................................................................................... 22

5.7 CONCLUSION .............................................................................................................. 22

iv
 5.8 RECOMMENDATIONS ............................................................................................... 22

REFERENCES....................................................................................................................... 24

APPENDIX: A........................................................................................................................ 27

LIST OF TABLES

Table 1: Socio-demographic and Reproductive characteristics ....................................... 13

Table 2: Knowledge on Danger signs during pregnancy ................................................. 16

Table 5: Health actions taken when respondents recognized a danger sign ..................... 17

v
 ACKNOWLEDGEMENT

We want to express our sincere gratitude to God for giving us the strength, wisdom and grace

to complete the research.

Secondly, acknowledgement goes to our research participants, for partaking and giving us the

opportunity to acquire information from them.

Very big thanks also goes to the Principal of Nursing and Midwifery Training College

(NMTC)-Pantang and especially, Miss Lina Kafui Hobenu (supervisor) for her patience and

exceptional guidance during the course of carrying out this research.

Lastly, we acknowledge all publishers and authors who were cited for the information we got

from their publications and articles.

DEDICATION

We sincerely dedicate this project to our family for their support, advice, prayers and

encouragement and also to our supervisor, Miss Lina Kafui Hobenu for dedicated time.

CERTIFICATION

We certify that the research work conducted by this group in accordance with the guidelines

designed for doing the research work in the Nursing and Midwifery Training College-

Pantang.

vi
 CHAPTER ONE

INTRODUCTION

This chapter presents the background to the study, problem statement, and purpose of the

specific objectives, research questions and operational definition of terms.

1.1Background to the Study

The National Institute of Child Health and Human Development (2013), states that pregnancy

is the term used to describe the period in which a fetus develops inside a woman’s womb or

uterus Pregnancy usually lasts about 40 weeks, or just over 9 months, as measured from the

last menstrual Period to delivery.

According to World Health Organization (WHO), maternal death is defined as the death of

woman while pregnant or within 42 days of termination of pregnancy, irrespective of the

duration or site of the pregnancy, from any cause related to or aggravated by the pregnancy or

its management, but not from accidental causes. Maternal death could be prevented if action is

take early and promptly.

Adequate health care provision and utilization for women during pregnancy is essential to

ensure the normal, healthy evolution of the pregnancy and to prevent, detect, or predict

potential complications during pregnancy and delivery (Berrin, Okka, Yasemin, Durduras

2016) According to Binns (2013), Good quality care must be provided by skilled health who

are well trained and equipped to detect potential complications and provide the necessary

attention or referral. Unfortunately, many women in developing countries of the world,

including Ghana, face increased risk of morbidity and mortality from pregnancy and other

pregnancy related issues (Moran 2006). A survey made by Sunnyvale, City, Musa, and Amario

(2016) revealed that worldwide, 800 women die every day due to pregnancy or child birth

related complications. Almost all maternal deaths (99%) occur in developing countries and

more than half of these deaths occur in Sub- Saharan Africa.

1
In Ghana, 52% of childbirths were assisted by skilled personnel in 2012 (Adu-Gyamfi, 2012).

This means that a significant number of women give birth alone or are assisted by unskilled

birth attendants such as Traditional Birth Attendance (TBAs) and mother-in-laws. Ghana is

one of the countries with a very high maternal mortality rate, (319 per 100,000 live births) and

is striving hard to reduce the numbers in maternal mortality (World Bank Report, 2015).

The United Nations (UN) as well as the international community has resolved through the 5 th

Millennium Development Goal (MDG) to reduce the high maternal mortality ratio by three

quarters by 2015; however, this goal was largely unachieved (WHO, 2015).

Cultural beliefs, lack of awareness of availability of maternal health care utilities, and crippling

poverty inhibit preparation for safe delivery and the post-delivery health guarantees of the

mother and baby in advance (Byford-Richardson 2013).

The majority of pregnant women and their families do not know how to recognize the danger

signs

In pregnancy (Ekabua 2011). This often results in avoidable delays in obtaining life-saving

emergency services that could prevent maternal deaths.

According to Kaso and Addisse, (2014) the major causes of maternal deaths include postpartum

haemorrhage, hypertension, anaemia, unsafe abortions, infections and obstructed labour.

Although these are the easily and most identifiable causes of maternal deaths, there are several

other determinants associated with maternal deaths.

Ghana Health Service survey report (2011) shows that 53 percent of pregnant women were told

about danger signs of pregnancy during ANC visits. Additionally, the issue of health seeking

actions after identifying a danger sign and perceptions about these signs during pregnancy was

not investigated.

The danger signs that normally occur during pregnancy include vaginal bleeding, severe

headache, trouble with vision, high fever, swollen hands, face or feet, and reduced fetal

2
movement (Moran, 2006). It was further revealed most pregnant women have some myths

about these serious and life threatening danger signs. For instance, it is perceived that if a

pregnant woman falls down on her stomach when walking the child is a girl, a swollen feet or

face or hand is an indication of twins, severe abdominal pains indicates the child is stubborn

and for that matter is a male in there.

During attendance at the clinic women are given an antenatal card where all the information

about the services provided during each visit are recorded. The risk factors for pregnancy

complications are listed. For example; maternal age below 18 years and age above 35 years,

history of chronic diseases such as hypertension and diabetes mellitus among others.

However, there are many danger signs that are not listed in the antenatal card and hence for

those pregnant women who are able to read will still lack the information.

Women are also told to go to a nearby health facility so as to seek care in case they experience

any danger signs but everyone tends to behave differently. Some can take no action while others

do go to a health facility. Others can visit a traditional birth attendant or healer while others ask

help from a friend or relative (Ahmed, Tomson, Petzold, and Kabir, 2002).

1.2 Statement of the problem

Lack of information on danger signs, poor attitude and perceptions during pregnancy is one of

the factors that contribute to delay in seeking care and hence increase in maternal mortality

(WHO, 2012). A woman may die because they have not understood the need to seek care

(Lewis, 2003),

The low knowledge is compounded by the limited access to health care in rural areas, less

skilled health workers in rural areas, but the problem still persists even in urban areas where it

is acknowledged to have more health facilities, improved infrastructure and transport.

Irrespective of cost and easier access of health facilities, low level of knowledge is also highly

likely caused by inadequate dissemination of information on danger signs at the health facilities

3
(Mwaikambo, 2010). Perceptions contributes to significant delay in seeking health care and

compromises the survival of the mother and the unborn child.

Maternal mortality is still high and one of the contributing factors is low knowledge on the

danger signs of pregnancy, negative attitude towards these signs and perceptions people have

about these signs. Over the years no research has been conducted on this topic in the Ga East

Municipality, therefore this study seeks to assess the knowledge, perception and health seeking

behaviors of pregnant women at the Pantang antenatal clinic on the danger signs of pregnancy.

1.3 Purpose of the study

The purpose of the study is to assess the level of knowledge, perception and health seeking

actions of pregnant women at Pantang antenatal clinic on danger signs in pregnancy.

1.4 Specific Objectives

The objectives of the study are:

1. Assess expectant mother’s knowledge on danger signs in pregnancy

2. Determined the perception of pregnant women on danger signs

3. Assess the health seeking actions of pregnant women on danger signs.

1.5 Research Question

1. What is the knowledge of pregnant women on danger signs of pregnancy?

2. What is the perceptions pregnant women have on danger signs of pregnancy?

3. What are the health seeking behaviors of pregnant women on danger signs of

pregnancy?

1.6 Operational definitions of terms

1. A pregnant women is defined as a woman who has tested positive to HCG and with

gestational age between six to thirty-six weeks.

4
2. Danger signs of pregnancy refers to those signs which when seen or experienced

during pregnancy, should be reported to the health facility immediately to prevent

any complications to both mother and baby.

3. Antenatal deals with the time a female is pregnant, before birth occurs.

5
 CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction

This chapter talks about the review of related literature in line with the topic under study. This

chapter will be presented according to the following order,

1. Concept of danger signs in pregnancy.

2. Knowledge on danger signs of pregnancy.

3. Health seeking behaviors of pregnant women.

4. Perception of pregnant women on danger signs of pregnancy.

2.1 Concept of danger signs in pregnancy

Danger signs in pregnancy are life-threatening signs, which indicate that something is going

wrong with pregnant woman or the pregnancy itself. The danger signs in pregnancy include

vaginal bleeding, severe headache, blurred vision, severe abdominal pain, swollen hand or face,

fever, reduced fetal movement, weakness and difficulty of breathing (Mengesha and Taye,

2014). Damme (2016) stated that, vaginal bleeding, swollen hands or face and blurred vision

are the three key danger signs of pregnancy.

2.2 Knowledge on danger signs of pregnancy

Most studies have shown low level of knowledge on danger signs not only during pregnancy

but also during delivery and after childbirth. In a study done in Uganda and Ethiopia,

knowledge of danger signs was relatively low (Hoque & Hoque, 2011, Kabakyenga, Ostergren,

Turyakira, and Pettersson, 2011), During antenatal care, health care workers are expected to

educate pregnant women on danger signs of pregnancy so that women could understand and

seek help immediately when they experience one or more of the symptoms.

6
The same was also found in Tanzania on a study on rural women’s awareness of danger signs

(Pembe, et al., 2009). The study recommended to improve the quality of counseling and also

to involve family members in the care of pregnant women during pregnancy and delivery.

A study on knowledge about danger signs in pregnancy among pregnant women was conducted

in Southern Ethiopia. It indicated that the knowledge was low and affected by residential area

whereby those who lived in urban were more knowledgeable than those who lived in rural areas

(Hailu, Gebremariam, and Alemseged, 2010). The most common danger sign to be mentioned

was vaginal bleeding. Additionally, another study in Uganda shows similar results about

knowledge and residential area (Kabakyenga, et al., 2011).

Some studies have shown the relationship between level of education and knowledge on danger

signs of pregnancy. Women with higher education level have been found to have more

knowledge on danger signs compared to those with no formal education (Raj, 2005).

This is speculated to be due to having high literacy hence an ability to understand the

information given and also be able to look for details from other sources such as the internet

and magazines.

In Ghana, a delay in recognizing danger signs of pregnancy or decision to seek care outside the

home was the second important contributor of perinatal deaths (Jammeh, 2011). A study was

also conducted by Rashad (2010) in Albeheira Governorate, the researcher suggested that there

is a need to establish strategic plan to increase the awareness to shape health seeking actions of

the public related to signs of obstetric complications.

2.3 Health seeking behaviors of pregnant women on danger signs of pregnancy.

A study conducted in Uganda revealed poor health seeking behavior among adolescent

mother’s reproductive health services and faced more challenges during pregnancy and early

motherhood compared to adult mothers. This explains age as a factor in determining health

seeking (Atuyambe et al., 2008). Adolescent mothers were more likely to attend antenatal care

7
less than four times compared to adult mothers and hence miss an opportunity to be educated

a danger signs during pregnancy, delivery and post-delivery.

Likewise in Bangladesh young mothers were significantly less likely to seek professional

healthcare at the time of birth (Chakraborty, 2007).

In Turkey cultural influences were linked to delay in seeking care when they experience

complications (Ay et al., 2009). The decision regarding whether a pregnant woman is seriously

sick or not was the responsibilities of elder women, which delays the use of health care service.

Another study in Turkey showed that women who experienced antenatal bleeding faced

difficulties to decide whether or not to seek care (Kosum and Yurdakul, 2012).

And this was contributed by factors such as age, level of education, lack of health insurance,

receiving antenatal care, nuclear family structure and knowledge of the danger signs during

pregnancy. This shows the impact of knowledge on health seeking actions among pregnant

women.

Another study conducted in Bangladesh shows that most women do not seek antenatal care

except for confirmation of pregnancy, and no prior preparation for childbirth was taken.

Financial constraints, coupled with traditional beliefs and rituals, delayed care-seeking in cases

where complications arose (Choudhury & Ahmed, 2011). Similar study revealed that cultural

beliefs and practices also reinforced these health seeking behaviors, including home delivery

without skilled assistance (Choudhury 2012).

The possession of assets emerged as an important predictor of health actions by seeking care

from health professionals at the time of birth as revealed by a study conducted in Bangladesh

(Chowdhury, 2007). Those with more assets used as an alternative for income visited trained

healthcare providers more often and were more likely to use healthcare facilities provided by

trained personnel at the time of delivery.

8
The woman's age may be related to her attitude about which health action she could take. This

was found in a study conducted in India which was looking at pregnancy complications and

health-seeking behavior among married women. Women who are pregnant for the first time

with young age are more likely to suffer from eclampsia, which can be life-threatening to

mother and baby while pregnancy at older age above 35 years pose more risk to complications.

A study conducted In Haiti by White et al (2006) revealed a delay in seeking or absence of care

during times when illness does arise. Women recognize that they are ill and that lack of care

can lead to death, yet they continue to delay obtaining medical assistance or do not seek care

at all either within the formal health sector or among lay and spiritual healers.

A study done in Bangladesh (Koenig et al., 2007) has found out that only one in three sought

treatment from a qualified provider. More than three-fourths of women with the time sensitive

complications of convulsions or excessive bleeding either failed to seek any treatment or sought

treatment from an unqualified provider. The principal reason cited for failing to seek care for

life- threatening complications was concern over medical costs, and pronounced

socioeconomic disparities.

2.4 Perception of pregnant women on danger signs of pregnancy.

Some pregnant women believe that when they have swollen hands, face and feet, it is a sign

that she is expecting twins, severe abdominal pains is an indication that the unborn child is

stubborn and for that matter it is a boy (Ahmed, Tomson, petzold, Kbir, 2002).

9
 CHAPTER THREE

MATERIALS AND METHODS

This chapter presents the research design, study area and population, sampling and sample size,

data collection tool, data analysis, ethical considerations and limitations of the study.

3.1 Research design

The study design was health facility-based cross-sectional study. Cross sectional study design

involves the collection of data at one point in time and is especially appropriate for describing

the status of phenomena or relationships among phenomena at a fixed point in time (Polit and

Hungler, 1997). Quantitative research approach was used during data collection and analysis.

3.2 Study area and study population

The study was conducted at Pantang antenatal clinic in the Ga East Municipal, one of the 261

Metropolitan, Municipal and District Assemblies (MMDAs) in Ghana, and forms part of the

29 MMDAs in the Greater Accra Region. The Ga East Municipal Assembly is located at the

norther part of Greater Accra Region. The Administrative capital of the Municipality is

Abokobi.

Pantang is one of the small towns in the Ga East Municipality, it has a nursing training college

and a nursing and midwifery training college, with the Pantang hospital as an important

landmark. The Pantang hospital was built in 1975 by General I.K. Acheampong. It was at first

a psychiatric hospital rendering only psychiatry services but now renders services such as;

antenatal and maternity, outpatient services, medical, dental, eye and throat services, etc.

The study population is pregnant women attending antenatal services at Pantang antenatal

clinic in the Ga East Municipality during the time of data collection. All pregnant women who

are seeking health care will be selected by proportionate random sampling for participation in

the study.

10
3.3 Sample size and sampling technique

In this study the sample size will be 30 pregnant women and the sampling technique will be

the simple random sampling technique,

3.4 Data collection tool

The main data collection tool for the study will be questionnaires. A structured questionnaire

will be personally developed and self-administered to participants who meet the eligibility

criteria of the study within the period of data collection. Although the original questionnaires

will be in English language, questions will be translated into the local languages during the

data collection for those participants who can neither read nor speak English.

The questionnaire will comprise of four sections (A-D), section A comprises of items on socio-

demographic characteristics, section B will be made up of items on knowledge on danger signs

of pregnancy, section C will comprise of perceptions on danger signs and section D will be

made up of items on health seeking behaviors on danger signs.

3.5 Data collection procedure

Before the data collection, permission to conduct the research will be sought from the hospital

administration and the in charge at the antenatal clinic. Permission will also be sought from the

respondents before carrying out the research. The objectives of the research will be

communicated to the respondents, and those who are willing to participate in the research will

be given the research questionnaires. Participants who can read and write will be given

questionnaires to complete it but participants who cannot read and write will be guided by the

researchers to complete the questionnaires by translating the questions into the local dialect.

After completion of the questionnaires, the researchers will collect all questionnaires from

participants for data analysis,

11
3.6 Data analysis

The statistical analysis will be done through descriptive and inferential analysis. In descriptive

analysis; frequency table for selected variables such as age, marital status, highest level of

education, occupation, parity, gravidity, distance from the facility and number of antenatal

clinic attendance produced to study the characteristics of the respondents.

3.7 Ethical considerations

1. The study will consider the need to protect the dignity and privacy of respondents, therefore

their names will not be written on the questionnaires.

2. Participants can redraw from the study at any point in time without being questioned.

3. Respondents will be assured that their identity will be protected so that they will be more

open to share ideas in a more relaxed manner. This will be done with the utmost hope that

it will promote trust between the researcher and the respondents. Confidentiality and

anonymity will be an essential element on the research agenda and will be adhered to

throughout the entire research period.

3.8 Limitations of the study

Some of the limitations of the study are funds and time.

12
 CHAPTER FOUR

DATA ANALYSIS AND FINDINGS

4.0 Introduction

This chapter presents the analysis of the collected data. Statistical analysis was done using

SPSS statistical package version 13.0. The results are presented in frequency distribution tables

and pie chart.

4.1 Socio-demographic and Reproductive characteristics

Table 1: Socio-demographic and Reproductive characteristics (N=30)

Variable Category Frequency Percentage (%)

Age ≤ 20 2 6.6%
21-30 21 70%
31-39 7 23.3%

Marital status Living with partner 26 86.6%

Not living with 4 13.3%
partner
Education level No formal education 1 3.3%
Primary 14 46.6%
Secondary 13 43.3%
Tertiary 2 6.6%

Occupation Employed 3 10%

Unemployed 14 46.6%
Self-employed 13 43.3%
ANC Attendance < 4 visits 13 43.3%
≥ 4 visits 17 56.6%
Majority of the respondents were between the ages of 21-30 (70%). Most women (86.6%)

were married and living with their partners, and regarding educational level, 14 (46.6%) had

only primary education and 14 (46.6) were unemployed. Also 17 (56.6%) had more than four

antenatal visits.

13
4.2 Knowledge on danger signs during pregnancy

About 96.6 percent (n=27) of women had attended ANC during their pregnancy. The median

number of visits was four (4.00); and the age at first ANC visit was four month or more for

55.1 percent (n=16). The study participants were asked if they have ever heard of danger signs

that occur during pregnancy. More than half of the respondents (86.6%; n=26) had ever heard

about danger signs during pregnancy and the main source of information was from the antenatal

clinic (81.8%). The knowledge was categorized into three namely no knowledge, low

knowledge and sufficient knowledge.

A woman who had not mentioned any danger sign was categorized into no knowledge;

mentioned 1-3 danger signs low knowledge; and mentioned 4 or more was categorized as

having sufficient knowledge. The following figure (Figure 1) shows the knowledge on danger

signs during pregnancy for each category. When asked to spontaneously mention the danger

signs, only 31 percent (n=9) were able to mention at least four danger signs correctly. This

means that actually more than half (66.3%) had low knowledge on danger signs during

pregnancy. Some of the respondents (2.7%) who reported that they have ever heard about

danger signs during pregnancy were not able to mention even one danger sign correctly.

14
 3%
31%

66%

no knowledge low knowledge sufficient knowledge

4.2 Knowledge on danger signs during pregnancy

The remaining participant (3.4%, n=1) was not included in identifying their knowledge level

since the participant has not heard of danger signs during pregnancy. When prompted on the

stated danger signs 63.3 percent were aware of four or more danger signs.

The following table (Table 2) shows the frequency of the stated danger signs that may occur

during pregnancy as a sign for obstetric complications. The commonly mentioned danger signs

were vaginal bleeding (82.7%, n=24); swelling of fingers, face, and legs (44.8%, n=13); and

severe headache (34.4%, n=10). Few women stated vaginal discharge and anemia as danger

signs of pregnancy. The main source of information was from the health facility (93.1%, n=

27) followed by 3.4% (n=1) who heard from friends and 3.4% (n=1) from the television.

Generally, this population had some information about danger signs during pregnancy.

15
Table 2: Knowledge on Danger signs during pregnancy

Danger signs during pregnancy Yes % Yes No % No

Vaginal bleeding 24 82.7% 5 17.3%

Severe abdominal pain 9 31% 20 69%

Convulsions 4 13.7% 25 86.3%

Fever 8 27.6% 21 72.4%

Swelling of fingers, face and legs 13 44.8% 16 55.2%

Difficulty in breathing 3 10.3% 26 89.7%

Severe headache with blurred vision 13 44.8% 16 55.2%

Too weak to get out of bed 3 10.3% 26 89.7%

Reduced fetal movement 10 34.5% 19 65.5%

4.3 Health seeking behaviors on danger signs during pregnancy

18% OF women have reported to recognize several danger signs during their pregnancy. The

following multiple response table shows the frequency of actions women took after recognizing

any of the listed danger signs.

Majority of the respondents (75.3%) who had recognized danger signs went to the health

facility for care and treatment followed by 10.3 percent who had self-treated. These actions

were most prevalent in vaginal bleeding (96.2%), reduced fetal movement (100%) and swelling

of fingers, face and legs (100%). See table 2 below.

16
Table 5: Health actions taken when respondents recognized a danger sign

DANGER SIGNS ACTIONS Total

Did Consulted a Self-care/treatment Went to a health

nothing friend/relative facility

Vaginal bleeding 1 0 0 25 26

Convulsions 0 0 1 4 5

Severe headache with 1 0 5 14 20

blurred vision

Severe abdominal pain 0 1 2 9 12

Reduced fetal movement 0 0 0 5 5

Too weak to get out of 4 1 1 1 7

bed

Fast or difficulty in 1 3 1 3 8

breathing

Fever 2 0 0 3 5

Swelling of fingers, face 0 0 0 3 3

and legs

When asked in an open-ended question why they took that action, the responses were coded

and then analyzed descriptively. Most of the women preferred to be attended at the hospital

because they believe that they can receive extra care in case of complications.

A few were educated at the health facility about danger signs and they also preferred to seek

care from the health facility. Furthermore, others went to the health facility after their condition

worsened where as some thought it was a normal event in pregnancy so there was no need to

take any action.

17
Although majority of women had low knowledge about danger signs during pregnancy, their

health seeking behavior was appropriate. They feel like hospital is the place where all their

health issues can be taken care of therefore it was better to visit the health facility.

The open-ended question about outcomes for their health seeking actions was coded and about

88 percent of those who seek care had been attended by health care workers; they received

medication, counseled and were cured of the presenting problems after recognizing a danger

sign. Some women (5.8%, n= 4) were attended in the health facility but the problem persisted

while the other (2.9%, n=2) were admitted due to worsening of the situation and had a preterm

delivery.

For those who had not recognize any danger signs during their last pregnancy more than 80

percent perceived that it is better to visit the health facility for care and management when you

recognize a danger sign.

18
 CHAPTER FIVE

DISCUSSION, SUMMARY, CONCLUSION AND RECOMMENDATIONS

5.0 Introduction

This chapter focuses on the discussion, summary, conclusion and recommendation of the study.

The chapter will be presented in the following order.

a. Discussion

b. summary

c. Conclusion

d. Recommendations

Discussion

5.1 Socio- demographic and Reproductive characteristics

Majority of the respondents (68.8%) are at the age of 21-30 years (range 14-39 years) and the

median age of the study group was 26. The other 7.8 percent (n=30) belongs to the age group

less than 20 years old while 23.4 percent belong to the age group of 21 to 30 years.

Most women were living with their partners (86.6%; n=26) while the others (13.3%, n=4) were

not living with partners. The group of those not living with partners includes women who were

either; single, separated, divorced.

Regarding education level it was observed that majority were educated to secondary school

level or less; 3.3% (n= 1), 46.6% (n= 14), and 43.3% (n= 13) having no education, primary and

secondary education respectively. The remaining 6.7% (n= 2) had a post- secondary education

level (either university or vocational training). Majority of the women were unemployed

(46.6%; n=14), while 43.3% (n= 13) were self- employed and only 10 percent (n= 3) were

employed.

The obstetric characteristics that were looked at include parity, gravidity and antenatal clinic

attendance. About 60 percent (n=18) of the study group have attended antenatal clinic four

19
times or more during their pregnancy where as 33.3 percent (n=10) attended less than four

ANC visit.

Furthermore about 33.3 percent (n= 10) respondents had carried pregnancy once, while 60

percent (n= 18) had been pregnant twice to four times and 6.6 percent (n=2) had been pregnant

five times or more.

5.2 Knowledge on danger signs during pregnancy

The finding revealed that there is a low knowledge on danger signs during pregnancy in Ghana

is similar to the finding of a study conducted in rural Tanzania (26%), Ethiopia (30.9%) and

South Africa (2%) (Hailu, Gebremariam, and Alemseged, 2010; Hoque and Hoque, 2011).

Low level of education can be one of the major reasons for low knowledge of danger signs of

pregnancy. However, the results imply that having knowledge on danger signs is not enough

without additional change of attitude and empowerment to take appropriate action.

Variables such as marital status, ANC attendance and number of ANC visits were not

significantly related to knowledge on danger signs during pregnancy. The level of education

has been found to be not statistically significant with knowledge of danger signs during

pregnancy. This is in contrast to a study conducted in rural Tanzania and Uganda (Pembe, et

al, 2009; Kabakyenga, et al., 2011) whereby; having secondary education or higher increases

the likelihood of having knowledge on danger signs during pregnancy.

5.3 Association between knowledge and socio-demographic characteristics

Older age was significantly associated with knowledge of danger signs compared to younger

age. Respondents who were aged 31-39 years were eight times more likely to have knowledge

on danger signs. This was in contrast with a study conducted in Ethiopia (Hailu, 2010; Nisar

& White, 2003) whereby age was not significantly associated with knowledge on danger signs

during pregnancy. Age may mean more exposure and experience about matters concerning

pregnancy.

20
Moreover, being self-employed has shown association with knowledge of danger signs during

pregnancy by two-fold compared to being employed. It is speculated that women who were

self-employed can reduce the barriers to access the services such as costs and time to attend to

the facilities. They can easily make decision to seek health information and also services since

they have the ability to do so compare to those who were employed. Those who were employed

might had tight schedule at work and therefore unable to have time to visit a health facility

unless there was a complication.

5.4 Health seeking behaviors after experiencing a danger sign

The findings of this study have surprisingly shown three quarter of women who had recognized

signs for complications during pregnancy had attended health facility for care and management.

This is explained further by the reasons women gave that they have been told to go to hospital

if they recognize any danger sign. More than three-fourths of women with the time-sensitive

complications of convulsions or excessive bleeding either failed to seek any treatment or sought

treatment from an unqualified provider. The principal reason cited for failing to seek care for

life-threatening complications was concern over medical costs, and pronounced socioeconomic

disparities. Also, it contrasts the findings of a study in

Haiti (White et al., 2006) whereby women continue to delay obtaining medical assistance or

did not seek care at all either within the formal health sector or among lay and spiritual healers

5.5 Association between knowledge and health seeking behaviors

One of the unique findings of this study is lack of significant relationship between knowledge

and health actions. Having low or sufficient knowledge has not shown an impact of the

appropriate actions among women who experienced danger signs. Their actions may be

influenced by the severity of the condition and advise from significant others. Medically

oriented knowledge may help to dispel traditional beliefs about the inevitability of obstetric

complications and women’s susceptibility to them. A decision to take action is not simply a

21
result of believing that one’s condition requires treatment. It is usually influenced by many

factors not explored in details in this study. These factors may include financial status,

perceived threat and severity of the condition, time and distance to the facility. All these have

to be taken into account when helping women during antenatal clinic and arrange an

individualized birth plan.

5.6 SUMMARY

The study sought to investigate the knowledge, perception and health seeking behaviors of

pregnant women at the Pantang antenatal clinic on danger signs of pregnancy in the Greater

Accra Region of Ghana. Respondents were drawn from pregnant women at the Pantang

hospital using simple random sampling technique. A closed-ended typed questionnaires

developed by the researchers was used and it comprised four sections. 30 questionnaires were

shared to the pregnant women and all 30 retrieved.

5.7 CONCLUSION

Based on the findings of this study, it can be concluded that there is low level of knowledge on

danger signs of pregnancy in urban area. Age and employment status had significant

association with knowledge on danger signs during pregnancy. The findings provided insight

information on women's knowledge about danger signs in the urban area, which could help in

designing appropriate interventions and as a base for further exploratory studies in other parts

of the country. Knowledge about danger signs during pregnancy has been found not to have a

significant relationship to health seeking behaviors.

5.8 RECOMMENDATIONS

Based on the study findings, the following recommendation were made.

1. Access to health information and education should be improved.

2. Posters and banners on danger signs should be simple terms for easy understanding even

among illiterate people.

22
3. There should be an increased in the number of skilled health workers at all levels of health

care.

4. There should be policies to emphasize the best way of interactions between health providers

and clients.

5. The quality of health education at the health facilities should be evaluated.

23
 REFERENCES

Ahmed, S. M., Tomson, G., Petzold, M., & Kabir, Z. N. (2002). Socioeconomic status

overrides age and gender in determining health seeking behavior in rural Bangladesh.

Atuyambe, L., Mirembe, F., Tumwesigye, N. M., Annika, J., Kirumira, E. K., & Faxelid, E.

(2008). Adolescent and adult first time mothers' health seeking practices during

pregnancy and early motherhood in Wakiso district, central Uganda. Reprod Health, 5,

13. doi: 10.1186/17424755-5-13

Ay, P., Hayran, O., Topuzoglu, A., Hidiroglu, S., Coskun, A., Save, D., Eker, L. (2009). The

influence of gender roles on health seeking behaviour during pregnancy in Turkey. Eur

J Contracept Reprod Health Care, 14(4), 290-300. doi: 10.1080/13625180902925211

Bulletin of the WHO, 83(2). doi: http://dx.doi.org/10.1590/S0042- 96862005000200011

Choudhury, N., Moran, A. C., Alam, M. A., Ahsan, K. Z., Rashid, S. F., & Streatfield, P. K.

(2012). Beliefs and practices during pregnancy and childbirth in urban slums of Dhaka,

Bangladesh. BMC Public Health, 12(1), 791. doi: 10.1186/1471-2458-12-791

Chowdhury, R. I., Islam, M. A., Gulshan, J., & Chakraborty, N. (2007). Delivery complications

and healthcare-seeking behaviour: the Bangladesh Demographic Health Survey, 1999-

2000. Health Soc Care Community, 15(3), 254-264. doi: 10.1111/j.1365-

2524.2006.00681.x

Chrisman, N. J. (1977). The health seeking process: An approach to the natural history of

illness Vol. 1. Culture, Medicine and Psychiatry (pp. 351-377).

doi:10.1007/BF00116243

Currie, D., & Wiesenberg, S. (2003). Promoting Women's Health-Seeking Behavior: Research

And The Empowerment Of Women. Health Care for Women International, 24(10),

880-899.

24
Hailu, M., Gebremariam, A., & Alemseged, F. (2010). Knowledge about obstetric danger signs

among pregnant women in Aleta Wondo District, Sidama Zone, and Southern Ethiopia.

Ethiopian journal of health sciences, 20(1).

Hoque, & Hoque. (2011). Knowledge of Danger Signs for Major Obstetric Complications

among Pregnant KwaZulu-Natal Women Implications for Health Education.

AsiaPacific Journal of Public Health, 23(6), 946-956.

Kabakyenga, J. K., Ostergren, P. O., Turyakira, E., & Pettersson, K. O. (2011). Knowledge of

obstetric danger signs and birth preparedness practices among women in rural Uganda.

Reprod Health, 8, 33. doi: 10.1186/1742-4755-8-33

Kabakyenga, Östergren, P., Turyakira, E., & Pettersson, K. (2011). Knowledge of obstetric

danger signs and birth preparedness practices among women in rural Uganda.

Reproductive health, 8(1), 33.

Longman dictionary of contemporary english. (2003) (4th ed.). England: Pearson education

limited.

Raj, P. (2005). Pregnancy complications and health-seeking behaviour among married women

in Uttar Pradesh, India Research and Practice in Social Sciences, Vol.1 (No.1), 48-63.

Rashad, W. A., & Essa, R. M. (2010). Women’s Awareness of Danger Signs of Obstetrics

Complications. Journal of American Science, 6(11). Utilization (fourth ed.): Lippincott-

Raven Publishers.

White, K., Small, M., Frederic, R., Joseph, G., Bateau, R., & Kershaw, T. (2006). Health

seeking behavior among pregnant women in rural Haiti. Health care for women

international, 27(9), 822-838.

WHO, UNFPA, UNICEF, & Group, W. B. (2003). Pregnancy, Childbirth, Postpartum and

Newborn Care: A guide for essential practice Quick check, Rapid Assessment and

25
Management of women of child bearing age (pp. B2-B7). Geneva, Switzeland: WHO

publication library.

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 APPENDIX: A

NURSING AND MIDWIFERY TRAINING COLLEGE-PANTANG

QUESTIONNAIRE

Dear Participants,

We are students from Nursing and Midwifery Training College-Pantang. We are carrying out

a study on “” you are kindly invited to spend few minutes of your time to answer the

questionnaire below as a participant. Any information given will be treated confidentially and

it will only be used for academic purposes only. To participate in this study is voluntary and

you can quit at any time during the study without penalty.

If you agree to participate in this study, please give your consent. Tick, I agree

SECTION A: SOCIODEMOGRAPHIC AND OBSTETRIC CHARACTERISTICS

1.1 What is your current age?

a. 15 – 20 b. 21 – 25 c. 26 - 30

d. 31 – 35 e. 36 – 40 f. above 40

1.2 What is your current marital status? (Circle the response)

a) Single b) Married c) Separated

d) Cohabiting e) Divorced

1.3 What is your highest level of education?

a) None b) Primary c) Secondary

d) Vocational e) University

27
1.4 What is your occupation?

a) Peasant b) House wife

c) Employed by the government d) Petty trader

e) Employed by a private institution f) Others (Mention)_________________

1.5 How many pregnancies have you had in your entire life time (including abortions, still and

live births)?

a. 1 – 2 b. 3 – 4 c. 5 – 6 d. 7 – 10

1.7 How many times have you given birth in your life time? (Remember: A pregnancy which

reached 7 months or more will be regarded as a delivery?)

a. 1 – 2 b. 3 – 4 c. 5 – 6 d. 7 – 10

SECTION B: KNOWLEDGE ON DANGER SIGNS DURING PREGNANCY

3.1 Have you ever heard about danger signs during pregnancy?

a) Yes b) No

3.2 Where did you hear about danger signs during pregnancy?

a. Family b. Friends c. Internet

d. Medical Professionals

3.3 What danger signs do you know that occur during pregnancy? (Tick as many as applicable)

a) Severe vaginal bleeding b) Convulsions

c) Severe headache with blurred vision d) Severe abdominal pain

e) Reduced fetal movement f) Too weak to get out of bed

g) Fast or difficulty in breathing h) Fever

i) Swelling of fingers, face and legs

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3.4 Have you ever heard about these danger signs during pregnancy?

a) Severe vaginal bleeding TRUE FALSE

b) Convulsions TRUE FALSE

c) Severe headache with blurred vision TRUE FALSE

d) Severe abdominal pain TRUE FALSE

e) Reduced fetal movement TRUE FALSE

f) Too weak to get out of bed TRUE FALSE

g) Fast or difficulty in breathing TRUE FALSE

h) Fever TRUE FALSE

i) Swelling of fingers, face and legs TRUE FALSE

3.5 Which among the danger signs you have mentioned would have greater danger to the life

of the mother?

a) Severe vaginal bleeding b) Convulsions

c) Severe headache with blurred vision. d) Severe abdominal pain

e) Reduced fetal movement f) Too weak to get out of bed

g) Fast or difficulty in breathing h) Fever

i) Swelling of fingers, face and legs

SECTION D: HEALTH SEEKING ACTIONS

4.1 Have you ever experienced any of the following danger signs in this pregnancy?

1. Severe vaginal bleeding a) Yes b) No

2. Convulsions a) Yes b) No

3. Severe headache with blurred vision a) Yes b) No

4. Severe abdominal pain a) Yes b) No

5. Reduced fetal movement a) Yes b) No

6. Too weak to get out of bed a) Yes b) No

29
 7. Fast or difficulty in breathing a) Yes b) No

8. Fever a) Yes b) No

9. Swelling of fingers, face and legs a) Yes b) No

4.2 Tell us your actions when you experienced the danger signs in this pregnancy:

DANGER SIGN ACTION TAKEN

Nothing Consulted Self-care Consulted a Went to

a friend /Treatment TBA/ a health

/Relative traditional facility

healer

Severe vaginal bleeding

Convulsions

Severe headache with blurred vision

Severe abdominal pain

Reduced fetal movement

Fast or difficulty in breathing

Too weak to get out of bed

Fever

Swelling of fingers, face and legs

THANKS FOR THE PARTICIPATION

30