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

among Mothers in Rural Pondicherry

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

DOI: 10.5958/0976-5506.2017.00094.8

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 DOI Number: 10.5958/0976-5506.2017.00094.8

Original Article

Knowledge of Danger Signs of Pregnancy, Labour and Post

Partum Period among Mothers in Rural Pondicherry

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

Hema Priya5, Rajkumar Patil6

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

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

ABSTRACT

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

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

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

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

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

INTRODUCTION India.1 Reducing maternal mortality has been included in

The developing countries have significant number
of maternal mortality. Sample registration system (SRS)
2012 found maternal mortality rate (MMR) as 212 for
Corresponding author:
Dr. Abhijit V Boratne
Dept of Community Medicine, MGMCRI,
Pillaiyarkuppam, Pondicherry, Pin: 607403,
Email:drabhijitb@rediffmail.com,
Contact No.: 09751416389
the Millennium Development Goals.2
Pregnant woman may face sudden, unpredictable
complications that could end her life or injury to herself
or to her infant. It is very difficult to predict pregnancy
related complications.3
The people are lacking awareness related to danger
signs in pregnancy, during labour and in post partum
period which delays treatment and affect the outcome.
These delays have many causes, including financial
 Indian Journal of Public Health Research & Development, April-June 2017, Vol. 8, No. 2
concerns, available infrastructure and services, as well
as inadequate awareness and knowledge about maternal
health issues in community and family.
Knowledge of danger signs of pregnancy, labour
and post partum period to the woman, her husband and
family members is a key in maternal and child health.
Ethopian study demonstrated that less than a quarter
respondent mothers had knowledge regarding danger
signs of pregnancy, labour/childbirth and post partum
period.4 Kushwah SS et al from Rewa, Madhya Pradesh
also experienced similar findings.5
Thus, the current study has been planned with an
aim to study knowledge of danger signs of pregnancy,
labour and post partum period among mothers of infants
in rural Pondicherry.
MATERIAL AND METHOD
The present study is community based cross-
sectional study, conducted during May and June 2013 in
the department of Community Medicine. The multistage
sampling technique was followed for the study. There
are five commune panchayats in Puducherry. In first
stage, out of 5 commune Panchayats, Bahour commune
Panchayat (total population) was selected by random
sampling technique (lottery method). In the second
stage, sampling units were villages in Bahour commune
Panchayat. Out of 14 villages in Bahour commune
Panchayat, about quarter villages (4 villages) were
again selected by random sampling technique (lottery
method). The villages were Bahour Main, Seliamedu,
Seliamedu Pet and Kudiyarupupalayam. Birth in one
year i.e. mothers who gave births between 1st April
2012 to 31st March 2013 were included in study. During
data collection, an attempt was made to interview all
the mothers of infants in the respective villages who
were willing and consented to participate in the present
study.
Sample size: Considering birth rate of 16.1 per
1000 population in the study area (Census 2011, Govt.
of India), the expected number of births in the selected 4
villages (total population 11891) was calculated as,
Population size (N) :11891
Hypothesized % frequency of outcome factor in the
population (p): 16.1%
Confidence limit as % of 100 (absolute +/-%) (d):
5%
117
Sample size n = [Np(1-p)]/ [(d2/Z2 )1-α/2*(N-1)+p*(1-p)]
Confidence level (95%) = 205
But as per the birth record available in Bahour
Primary Health centre, there were 181 births in these
four villages. Investigator had visited homes of all
these mothers and at the end 136 mothers could be
included in the study (75.13 % response rate). About
26 mothers (14.36%) were not at home even after
two visits by investigator/s and rest of the families 19
(10.50%) were shifted to some other place of residence.
A predesigned and pre-tested questionnaire was used
by trained medical student by house-to-house survey
and interviewing mothers for about 15-20 minutes.
All mothers of infant in the specified area who were
not willing to give consent for the said study and
those mothers of infant, who were absent during visit
to their house were excluded. Information regarding
socio-demographic characteristics, mothers’ knowledge
regarding danger signs related to pregnancy, labour and
post partum period was collected.
Statistical analysis: The data entry was done
using Microsoft excel 2007. Statistical Package for
the Social Sciences for Windows (SPSS Inc., Chicago,
Illinois, USA) version 17.0 was used for data analysis.
Descriptive statistics was done by using proportions.
The independent variable includes age, respondent’s
education, family type and socio-economic status etc.
Ethical consideration: After acceptance of study
proposal by Indian Council of Medical Research
(ICMR), New Delhi, ethical permission was obtained
from Institutional Human Ethical Committee (IHEC)
before conducting the present study. All the personal
information collected was kept confidential by the
researcher and study guide during the study period and
after the study.
RESULTS
The current cross sectional study has been
conducted among 136 mothers of infants in selected
villages of Puducherry. Majority 76 (55.9%) of the
mothers of infants were in the age group of 19-25 years.
All the participants were literate. Majority of mothers
(87.5%) were housewives while fathers (66.2%) of
infants were labourers. About one third of the families
were belonging to class IV (34.6%) and class V (31.6%)
of modified Prasad’s classification where as more than
118 Indian Journal of Public Health Research & Development, April-June 2017, Vol. 8, No. 2
half (56.6%) were joint families. (Table 1)
When we enquired mothers of infants about
knowledge of danger signs of pregnancy, we found that
almost everyone had better knowledge about danger
signs of pregnancy like absent foetal movements after 20
wks 136 (100%), followed by excessive vaginal bleeding
after 1st trimester 135 (99.3%), lower abdominal pain
135(99.3%), excessive vomiting 133 (97.8%) while
nearly half of the mothers knew about convulsions 80
(58.8%) and fever during pregnancy 69 (50.7%) as
dangers sings of pregnancy. (Table 2)
When we enquired mothers of infants about
knowledge of danger signs of labour, we found that the
mothers of infants had knowledge about danger signs
during labour. Like excessive vaginal bleeding 135
(99.3%), prolonged labour 134 (98.5%), cord around
neck 133 (97.8) identified in better way while about
half of them had knowledge about retained placenta 56
(41.2%) and very few 35 (25.7%) knew green colour
fluid i.e. meconium stained fluid as the danger signs of
pregnancy. (Table 3)
Mothers of the infants were also inquired about their
knowledge of danger signs of post partum period. We
found that they had good knowledge regarding excessive
vaginal bleeding 136 (100%), lower abdominal pain
130 (95.6%) and breast problems like inverted nipples,
engorged breast/swelling of breasts in 123 (90.4%).
(Table 4)
Mean years of maternal education of respondent
who had adequate knowledge about danger signs
of pregnancy, labour and post partum period was
significantly higher than those who had inadequate
knowledge. The mean years of father’s education where
mother had adequate knowledge about danger signs of
labour was 12.0 years of schooling (+-3.1) significantly
higher than those who had inadequate knowledge. The
family monthly income of the respondent who had
adequate knowledge about danger signs of post partum
period was significantly higher than those who had
inadequate knowledge. (Table 5)
DISCUSSION
Current study has been conducted among 136
mothers of infants in rural Pondicherry to study
knowledge regarding danger signs of pregnancy, labour
and post partum period. This was necessary to see the
current status of knowledge among mother as knowledge
is usually followed by change in behaviour in long run.
In present cross sectional study knowledge
regarding danger signs of pregnancy like vaginal
bleeding (99.3 %), blurred vision (67.6), and oedema
of face/hands (94 %) among mothers of infants was
found better than reported by Mihret Hiluf et al. from
Ethiopia where it was only (10.9%), 2.2% and 5.2%
respectively.4 Mazummdar R et al. from Bankura district
of West Bengal also reported similar findings as that of
our study.7 A study by Agarwal S et al. from Indore,
Madhya-Pradesh, revealed that awareness of the mothers
about at least one danger-sign of pregnancy, delivery,
and newborn-related complications was 79.2%, 78.5%,
and 82.1% respectively.8
Wanboru AW from Ethopia reported that awareness
of pregnant mothers regarding danger signs of
pregnancy, labour and post partum period was very
poor.9 Another author, Mengesha E from Ethiopia, also
revealed that awareness of danger signs of pregnancy
was poor and affected by education and occupation of
mothers while Hailu M et al. from southern Ethiopia
demonstrated that such awareness is associated with
place of residence.10,11
Similarly, current study shows better knowledge
among mothers of infants regarding dangers signs
of labour like excessive vaginal bleeding (99.3%),
prolonged labour (98.5%), retained placenta (41.2%)
and convulsions (66.9%) whereas in Ethiopian study by
Mihret hiluf’s it was only found in 16.5%, 11%, 7.1%
and 0.6% respectively.4
Knowledge regarding dangers signs of post partum
period like severe vaginal bleeding and high fever
among mothers of infants was found to be 100% and
52.2 respectively in the current study where as it is
grossly less in Ethiopian mothers i.e. 16.7% and 1.1%
respectively.4 North Indian study by Sibley L et al.
established the fact that mother had poor knowledge of
danger signs of post partum period.12 Tanzanian study
by Pembe AB also stated less percentage of women who
knew at least one danger sign during pregnancy was
26%, during delivery 23% and after delivery 40%.13
This may be attributed to better educational status
among women in study area where more than half
(54.4%) of the mothers have studied up to secondary
levels and rest had graduate and above. Mangesha E
 Indian Journal of Public Health Research & Development, April-June 2017, Vol. 8, No. 2 119

from North Ethopia reported that knowledge regarding

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

*Statistically significant Source of Funding: Indian Council of Medical

Research has funded this study through Short Term
CONCLUSIONS Studentship project ICMR STS 2013 (Ref. No. 2013-
The mothers of infants had good knowledge 02269).
regarding danger signs of pregnancy, labour and post
Conflict of Interest: None
partum period in the study area. The absent foetal
movements and excessive vaginal bleeding were most REFERENCES
common while passing of meconium stained liquor,
1. Government of India. Sample Registration
retained placenta and fever were less common danger
System Statistical Report 2012.[Online]. 2013
signs known to mothers.
 Indian Journal of Public Health Research & Development, April-June 2017, Vol. 8, No. 2
[cited2013Jan10]; Available from: URL:http//
www.censusindia.gov.in/vital_statistics/srs_4_
_2010.pdf.
2. NIHFW. A study for assessing birth preparedness
and complication Readiness intervention in Rewa
district of Madhya Pradesh.2008-09. p.8.
3. JHIPEGO. Maternal and neonatal health (MNH)
program. Birth preparedness and complication
readiness: A Matrix of shared responsibilities.
MNH; 2002; 1-5.
4. Mihret Hiluf,, Mesganaw Fantahun. Birth
Preparedness and Complication Readiness
among women in Adigrat town, north Ethiopia.
Ethiop.J.Health Dev. 2008; 22(1).
5. Kushwah SS et al. Status of birth preparedness
& complication readiness in Rewa District of
Madhya Pradesh. Indian J Public Health. 2009 Jul-
Sep;53(3):128-32.
6. Government of India. Registrar General of India.
Sample Registration System Statistical Report
2011. New Delhi. [Online]. 2012 [cited 2016 June
16]; Available from: URL:http://censusindia.gov.in/
vital_statistics/SRS_Bulletins/SRS_Bulletin-
October_2012.pdf
7. Mazumdar R, Mukhopadhyay DK, Kole S, Mallik
D, Sinhababu A. Status of birth preparedness and
complication readiness in a rural community: a
study from West Bengal, India. Al Am een J Med
Sci 2014;7(1):52-57.
8. Agarwal S, Sethi V, Srivastava K, Jha PK, Baqui
AH. Birth Preparedness and Complication
View publication stats
121
Readiness among Slum Women in Indore City,
India. J Health Popul Nutr 2010 Aug;28(4):383-
391.
9. Wanborn AW. Awareness of danger signs of
obstetric complications among pregnant women
attending antenatal care in East Wollega, Ethiopia.
[Online] 2016 [cited 2016 Mar25]; Available from:
URL:http://uir.unisa.ac.za/bitstream/handle/10500/
13315/dissertation_abera_ww.pdf?sequence=1
10. Mengesha E. The Level of Awareness on Danger
Signs of Pregnancy and Associated Factors among
ANC Attendant Pregnant Women in Debark Town,
North West Ethiopia. Translational medicine and
biotechnology 2014:2(5):1-12.
11. Hailu M, Gebremariam A, Alemseged F.
Knowledge about obstetric danger signs among
pregnant women in Aleta Wondo district, Sidama
zone, southern Ethiopia. Ethiop J Health Sci. 2010
March;20(1):25-32.
12. Sibley L, Varkey LC, Upadhyay J, Prasad R,
Saroha E, Bhatla N et al. Recognition of and
Response to Postpartum Hemorrhage in Rural
Northern India. Journal of Midwifery & Women’s
Health.2005;50(4):301-308.
13. Pembe AB, Urassa DP, Carlstedt A, Lindmark
G, Nyström L, Darj E. Rural Tanzanian
women’s awareness of danger signs of obstetric
complications. BMC Pregnancy and Childbirth.
2009;9(12):1-8.