Jurnal Inter Tanda Bahaya Kehamilan
Jurnal Inter Tanda Bahaya Kehamilan
Jurnal Inter Tanda Bahaya Kehamilan
Abstract
Background: Tanzania is among the countries with a high maternal mortality ratio. However, it remains unclear
how information and education on danger signs of pregnancy translate into appropriate actions when a woman
recognizes danger signs. This study aimed to determine women’s knowledge of obstetric danger signs during
pregnancy and their subsequent healthcare seeking actions.
Methods: The study design was a health facility-based cross-sectional study. Quantitative data were collected through
interviewer-administered questionnaires. Descriptive and inferential statistics were used to analyze the data. The study
enrolled 384 women from two health centers in Kinondoni Municipality, Dar es Salaam, Tanzania. A woman who had
not mentioned any danger sign was categorized as having no knowledge, mentioned one to three danger signs as
having low knowledge, and mentioned four or more danger signs as having sufficient knowledge.
Results: Among the 384 participants, 67 (17.4%) had experienced danger signs during their pregnancy and reported
their healthcare seeking actions after recognizing the danger signs. Among those who recognized danger signs, 61
(91%) visited a healthcare facility. Among the 384 participants, five (1.3%) had no education, 175 (45.6%) had primary
education, 172 (44.8%) had secondary education, and 32 (8.3%) had post-secondary education as their highest
educational levels. When asked to spontaneously mention the danger signs, more than half of the participants (n = 222,
57.8%) were able to mention only one to three danger signs. Only 104 (31%) had correct knowledge of at least four
danger signs and nine (2.7%) were not able to mention any item. The most commonly known pregnancy danger signs
were vaginal bleeding (81%); swelling of the fingers, face, and legs (46%); and severe headache (44%). Older women
were 1.6 times more likely to have knowledge of danger signs than young women (OR 1.61; 95% CI 1.05-2.46)”.
Conclusion: Women took appropriate healthcare seeking action after recognizing danger signs during pregnancy.
However, the majority had low knowledge of pregnancy danger signs. Additional studies are warranted to address the
knowledge gap and to plan interventions for improving health education under limited resource settings.
Keywords: Knowledge, Danger signs, Pregnancy, Healthcare seeking action
© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
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Mwilike et al. BMC Pregnancy and Childbirth (2018) 18:4 Page 2 of 8
Background are recorded [4]. However, the antenatal card does not
In 2013, about 289,000 women across the world were re- usually include information on danger signs, thus such
ported to have died from pregnancy and childbirth-related information may be missed during a visit [11, 12].
complications [1]. It is estimated that the majority (62%) Women are advised to go to a nearby health facility and
of global maternal deaths occur in Sub-Saharan Africa [1]. seek care in case they experience any pregnancy danger
A high maternal mortality ratio usually characterizes most signs; however, visiting traditional healers, friends, or rel-
countries within the Sub-Saharan region, one of which is atives before going to a health facility is also apparent
Tanzania at 556 deaths per 100,000 live births [2]. Other [13]. In addition, women in South Africa [14] weighed
countries in the East African region with a high maternal the expected benefits against the anticipated costs before
mortality ratio include Kenya (510/100,000 live births) making a decision to avail of healthcare. Thus, travel
and Uganda (343/100,000 live births) [3]. The major com- time and perceptions of staff receptivity were also influ-
plications that account for 80% of all maternal deaths are ential in their decision-making.
severe bleeding, infections, high blood pressure during However, there are apparently no studies that have
pregnancy, obstructed labor, and unsafe abortion. How- found a link between women’s knowledge of danger signs
ever, many maternal deaths can be prevented if appropri- during pregnancy and their subsequent healthcare seeking
ate action is taken early and promptly. action if they recognize a danger sign. In this study, we
Tanzania’s ongoing efforts to improve maternity care assessed the knowledge of danger signs of pregnant
has resulted in the adoption of the World Health Orga- women in Tanzania and their subsequent healthcare seek-
nization’s focused antenatal care (FANC) program con- ing action after recognizing the danger signs.
sisting of only four visits for low-risk pregnancy without
complications. This version of an antenatal care (ANC) Methods
program included health promotion, prevention, detec- Study design
tion, and treatment of existing diseases. It contained crit- The study design was a health facility-based cross-
ical information for birth preparedness including the sectional study whereby data were gathered at one point
seven danger signs of pregnancy [4]. in time in a clinical setting. The researcher interviewed
Every woman needs to be aware of the danger signs that the participants using a Swahili questionnaire.
occur during pregnancy, as complications can be unpre-
dictable. These danger signs include vaginal bleeding, se- Study setting
vere headache, vision problems, high fever, swollen hands/ The study was performed in two health centers in Kinon-
face, and reduced fetal movement [4]. These danger signs doni municipality, an urban district located in the Dar es
usually indicate the presence of an obstetric complication Salaam region, Tanzania. The total population of this mu-
that may arise during pregnancy, delivery or postdelivery. nicipality is 1,775,049 (914,247 women and 860,802 men)
Knowledge of these danger signs will help women to make according to the 2012 national census report [15]. The ma-
the right decisions and take appropriate healthcare seek- ternal mortality ratio of this municipality was 529/100,000
ing actions [5]. Eventually, taking the right healthcare live births [16]. At the time of data collection, there were
seeking action means receiving immediate and appropri- two health centers available, and data were collected at the
ate care, which reduces maternal mortality and morbidity. Reproductive and Child Health Clinic (RCHC) of these
Therefore, women should receive health education about health centers from May 2013 to June 2013. These health
pregnancy including outcomes, danger signs during preg- centers provide reproductive and child health services as
nancy, nutrition and family planning, as well as other ser- well as maternity services for women who attend the clinic.
vices when they visit an ANC clinic [2]. Normally, antenatal education is provided in the form of a
The 2011 demographic health survey report of group session with women who have attended the clinic
Tanzania [2] showed that only 53% of pregnant women on a particular day. The total number of women who re-
were informed about the danger signs of pregnancy dur- ceive care at the RCHC ranged from 60 to 100 women per
ing their ANC visits. Other studies have also identified day. Nurse-midwives provide information about nutrition,
women’s lack of knowledge of these danger signs [5–12]. birth preparations, obstetric danger signs, and vaccinations
However, the healthcare seeking actions of women after following uniform guidelines for providing information ac-
recognizing a danger sign during pregnancy have not yet cording to the available FANC guidelines in the country.
been investigated. As all pregnant women are at risk of Women are advised to visit a nearby health facility for care
developing pregnancy-related complications, education when they recognize a danger sign during their pregnancy.
on danger signs of pregnancy should be provided to all
women who are attending an ANC clinic [3]. Study participants
During a visit to a clinic, women receive an antenatal Potential participants were 392 postpartum women who
card wherein all the services provided during each visit were seeking immunization services for their children in
Mwilike et al. BMC Pregnancy and Childbirth (2018) 18:4 Page 3 of 8
May and June 2013. The participants were selected by similar status were interviewed and appropriate modifi-
proportionate systematic random sampling. A woman cations were made to the questionnaire.
who had given birth within the past 6 weeks from the
day of data collection was eligible for the study.
Data collection
Instrument All the women enrolled in this study provided informed
We developed a questionnaire based on a previous ques- consent before participating. Using the questionnaire, the
tionnaire about awareness of danger signs among rural lead researcher and five trained research assistants inter-
women in a study conducted in Tanzania [5]. The ques- viewed women in Swahili at the health facilities. After the
tionnaire was translated from English to Swahili, which is a interview, the lead researcher collected the questionnaires
language most familiar to Tanzanians, by a trained research for data entry and cleaning. There were 384 pregnant
assistant and an experienced midwife. The questionnaire is women who agreed to participate in the study.
composed of four sections: socio-demographic characteris-
tics, experiences in the last pregnancy, knowledge of preg-
Data analysis
nancy danger signs, and healthcare seeking actions.
Descriptive and inferential statistics were used. The partic-
The section for knowledge of danger signs was
ipants’ characteristics were evaluated in terms of frequen-
adopted from a tool by Pembe et al. [5] and is composed
cies. The F-test was used to compare knowledge scores,
of five open-ended questions regarding general know-
demographic characteristics, and healthcare seeking ac-
ledge about danger signs during pregnancy, recognition
tions. The confounding variables that were controlled in-
of danger signs, and source of information. Based on the
cluded educational level, marital status, occupation, parity,
danger signs that a woman can recognize, a list of nine
gravidity, and ANC visit. A P-value <0.05 was considered
danger signs stated in the WHO guide for essential prac-
to indicate a statistically significant difference. Data were
tice (Childbirth, Postpartum and Newborn Care) [17]
analyzed using an SPSS statistical package.
was used. These danger signs included the following: (1)
severe vaginal bleeding, (2) convulsions, (3) severe head-
ache with blurred vision, (4) severe abdominal pain, (5) Results
too weak to get out of bed, (6) fast or difficulty in Of the 392 pregnant women who were eligible, 384
breathing, (7) reduced fetal movement, (8) fever, and (9) (98%) consented to participate in the study. The partici-
swelling of the fingers, face, and legs [5]. A woman was pating women responded to all the questions in the
considered to have sufficient knowledge if she was able questionnaire. Among these 384 women, 67 (17.4%) had
to spontaneously mention at least four of the nine dan- experienced danger signs during their pregnancy and re-
ger signs [12]. On the other hand, a woman was consid- ported their healthcare seeking actions after recognizing
ered to have low knowledge if she was able to the danger signs.
spontaneously mention one to three danger signs, and to
have no knowledge if she was not able to spontaneously
mention any danger sign. Characteristics of participating women
The section for healthcare seeking actions included six More than half of the participants (68.8%) were aged 21
questions (forced choice and open-ended) about the rec- to 30 years, and 329 (85.7%) were living with their part-
ognized danger signs and health actions women had taken ners. Among the participants, five (1.3%) had no educa-
for each danger sign. An example of an open-ended ques- tion, 175 (45.6%) had primary education, 172 (44.8%)
tion was to explain further why the woman decided to had secondary education, and 32 (8.3%) had post-
take a particular action after recognizing a danger sign. secondary education as their highest educational levels.
Visiting a health facility for care was considered as appro- About half (54.4%; n = 209) were either employed or en-
priate healthcare seeking action, whereas not doing any- gaged in business which was conducted outside of their
thing, visiting a traditional healer, self-medication, and home. A total of 374 (97.4%) participants had attended
going to a traditional birth attendant were considered as ANC at least once during their last pregnancy, and
inappropriate healthcare seeking actions. among these, 271 (70.6%) had visited an antenatal clinic
The ANC experience during their last pregnancy in- more than four times (Table 1). The gestational age at
volved answering a questionnaire consisting of nine the first ANC visit was 4 months or more for 204
questions (forced choice and open-ended) that queried women (54.4%). Furthermore, 34.9% (n = 134) of the re-
about the type of care women received during their spondents were primiparas. About 99% of the partici-
clinic visits including education and advice. pants delivered at a health facility (i.e., hospital,
The tool was pretested in another health center within healthcare center, or dispensary). The mean distance to
the municipality to check for clarity. Twenty women of the health facility was 2.4 km (SD = 3.1).
Mwilike et al. BMC Pregnancy and Childbirth (2018) 18:4 Page 4 of 8
Table 1 Characteristics of women and relationship with knowledge about danger signs (N = 384)
Variable Categories n (%) Knowledge Mean score F P
Age <20 30 (7.8) 1.77 4.05 0.018
21-30 264 (68.8) 2.64
>30 90 (23.4) 2.83
Education level No education 5 (1.3) 1.40 2.42 0.066
Primary 175 (45.6) 2.41
Secondary 172 (44.8) 2.80
Post-secondary 32 (8.3) 2.91
Marital status Living with partner 329 (85.7) 2.42 0.759 0.384
Not living with partner 55 (14.3) 2.65
Occupation With occupation 209 (54.4) 2.59 0.419 0.658
No occupation 163 (42.4) 2.61
Student 12 (3.2) 3.08
Parity 1 160 (41.7) 2.64 0.425 0.654
2-4 214 (55.7) 2.57
≥5 10 (2.6) 3.10
Gravidity 1 134 (34.9) 2.50 1.032 0.357
2-4 229 (59.6) 2.64
≥5 21 (5.5) 3.10
ANC visit <4 visits 113 (29.4) 2.05 1.747 0.187
≥4 visits 271 (70.6) 2.15
Knowledge of danger signs during pregnancy Only 104 (31%) had correct knowledge of at least four
A total of 335 (87.2%) women reported that they had danger signs and nine (2.7%) were not able to mention
heard about danger signs during pregnancy. The source any item. The mean score for knowledge of danger signs
of information about the danger signs during pregnancy was 3.0 (SD = 1.609). Figure 1 shows the danger signs in
was from the RCHC for 274 women (81.8%), social gath- ascending frequency. The most commonly known dan-
erings for 58 women (17.4%), and the radio for three ger signs were vaginal bleeding (81.2%), edema (46.3%),
women (0.8%). and headache (43.6%).
When asked to spontaneously mention the danger The rest of the participants (n = 49, 12.8%) were not
signs, more than half of the participants (n = 222, 57.8%) able to spontaneously mention the danger signs. These
were able to mention only one to three danger signs. participants were thus provided with a list of danger
Fig. 1 Recall of danger signs during pregnancy (n = 335). Vertical axis-Danger signs. Horizontal axis-Percentage
Mwilike et al. BMC Pregnancy and Childbirth (2018) 18:4 Page 5 of 8
signs to help them recall the signs. The most commonly = 1), convulsions (n = 1), and abdominal pain (n = 2), some
known danger signs in this group were vaginal bleeding of the women did not visit a health facility for care.
(65.3%) and abdominal pain (65.3%). Other danger signs such as fever, headache, and being
too weak to get out of bed were dealt with inappropri-
Knowledge scores and characteristics of women ately because the participants considered these signs as
There was a significant relationship between age and normal events during pregnancy and therefore they de-
knowledge of danger signs (P = 0.018). The women were cided to either not take any action or buy over-the-
classified into three age groups; young age: < 20 years; counter medicines. Women were asked to further ex-
middle age: 21-30 years; old age: > 31 years. Participants plain why they decided to take the actions they took,
who were older had higher scores than those who were and the majority of the participants (n = 53, 79.1%) who
younger (Table 1). The mean score for knowledge of experienced danger signs explained that they preferred
danger signs among women aged 30 years and above to be treated at the hospital because they believed that
was 2.83, whereas that among women aged 20 years and their problem would be solved in health facilities. More-
below was 1.77. The other variables, namely, educational over, seven (10.5%) participants explained that they were
level, marital status, occupation, parity, gravidity, and educated about the danger signs so they knew that they
ANC visit were not significantly related to knowledge of were supposed to go to the hospital; five women (7.5%)
danger signs during pregnancy. After performing further responded that their condition worsened and therefore
analysis and controlling for confounding variables using they had to rush to the hospital to save their lives and
logistic regression, it was determined that older women their babies. However, two women (3%) explained that
were 1.6 times more likely to have knowledge of danger the danger signs were normal events during pregnancy
signs than younger women (OR 1.61; 95% CI 1.05-2.46). and therefore they decided to stay at home.
because it is the most visible sign compared with other sign should be used. Although this study was conducted
signs such as reduced fetal movement. This finding is in an urban district where 97% of women visited an
similar to that of studies in Ethiopia [8] and Uganda [9] ANC clinic at least once, the present findings suggest
whereby most respondents spontaneously identified va- that the quality of antenatal health education was poor.
ginal bleeding as a danger sign more than others. How- During antenatal health education, a large group of
ever, some previous studies showed a contrasting finding more than 40 women usually gather, with only one or
whereby in rural Tanzania only 9.6% and Uganda 49% two nurse-midwives handling the hour-long session. The
women were aware of vaginal bleeding as a danger sign likelihood of some women missing or misinterpreting
during pregnancy [5, 9]. the educational information provided is higher in a large
This difference might be due to the study design and group than in a small group. A previous study on the
location differences as they were all community surveys. quality of antenatal care in rural Tanzania showed that
Nevertheless, emphasis should also be placed on other two out of every five women were not counselled on
danger signs that were not commonly mentioned such pregnancy danger signs [21]. Regarding the amount of
as abdominal pain and convulsions. A study by Hailu et time spent for antenatal care consultation in Tanzania,
al. in Ethiopia revealed that these danger signs were not the mean total duration for the initial ANC consultation
spontaneously mentioned even though they indicated was reported to be only about 20 min [22], which is not
the presence of (pre-)eclampsia [8]. Only 7% of the par- sufficiently long for proper counselling [11]. These find-
ticipants mentioned abdominal pain and 4.7% convul- ings imply a poor quality of counselling regarding the
sion as danger signs. danger signs during pregnancy for women who had
A significant relationship was found between having attended the antenatal clinic. Furthermore, there was an
knowledge about danger signs and age of the partici- apparent imbalance between demand and supply owing
pants. Similar findings were reported from studies in to the overwhelming numbers of women attending the
rural Tanzania and South Africa, which found increased clinics, inadequately skilled staff, and indifferent atti-
awareness among older and multiparous women [5, 10]. tudes of healthcare workers. Nyamtema et al. [11] found
Thus, older women have more experience with preg- substandard ANC in rural Tanzania owing to the lack of
nancy issues. The total fertility rate in Tanzania is 5.4 staff, equipment, and supplies. The lack of simplicity in
births per woman. The total fertility rate among rural the information delivery system for pregnant KwaZulu-
women on the mainland (6.1 births) is higher than that Natal women in South Africa [10]. Therefore, consider-
among urban women (3.7 births) [2]. Therefore, it was able and sustained efforts are needed to improve the
likely that they were more aware of danger signs either quality of health education provided at health facilities
from their own experience or from events in their soci- in Tanzania, aiming at increasing knowledge of danger
ety. This implies a need for special consideration among signs during pregnancy.
young women, particularly adolescents, when providing
health counseling and education at antenatal clinics. Healthcare seeking action
Being young and immature may likely affect the recep- The present findings revealed that the majority of
tion of antenatal education and the recognition of signs women who had recognized signs of complications dur-
of obstetric complications. WHO reported that adoles- ing their pregnancy visited a health facility for care and
cent pregnancy remains a major contributor to maternal management. They likely feared for the life of their in-
mortality and that obstetric complications are the sec- fant. Also, the majority were living less than five kilome-
ond cause of death among 15 to 19 year olds globally ters from the hospital, hence they could easily access the
[18]. Most pregnant adolescents lacked social support, services. They believed that being in a hospital environ-
experienced community stigmatization, and were treated ment could solve most of their health-related concerns.
improperly by health workers [19]. There is therefore a What was surprising was the decision of some women
need to introduce and implement special adolescent who experienced danger signs not to take any action.
friendly interventions to empower pregnant adolescents The results showed that those who experienced fever
by providing them health information on pregnancy as and headache decided to either do nothing or take over-
well as delivery and early childhood care [20]. Pregnant the-counter medicine. These findings in some respects
adolescents need to know and be assured that healthcare resemble those of a study conducted in Ghana reporting
workers care about them and that they can receive as- on obstetric danger signs and factors affecting the
sistance in using the available health facility services. healthcare seeking behavior which identified a traditional
Moreover, techniques such as producing pictorial gifts hierarchy of seeking care [23]. For symptoms such as va-
with health messages that can remind pregnant adoles- ginal bleeding, headache, and fever, women usually
cents of the danger signs during pregnancy and what ap- started with home remedies, progressed to consulting
propriate actions to take when they recognize a danger traditional healers, and ended up at a health facility.
Mwilike et al. BMC Pregnancy and Childbirth (2018) 18:4 Page 7 of 8
Furthermore, Kilewo et al. identified perceived delay in and subsequent healthcare seeking actions. In addition,
healthcare seeking in a study from Bangladesh [24]. the small number of those who recognized danger signs
They reported that only 33% of the patients sought and the use of only two health facilities limit the
treatment from a qualified health provider during their generalization of our findings. Also, other factors standing
pregnancy. More than 75% of the women with time- in between knowledge and action have not been clearly
sensitive complications of convulsions or vaginal bleed- stated and assessed systematically in the data collection
ing had either failed to seek any treatment or sought tool. As these other factors were not considered in this
treatment from an unqualified provider. study, additional studies are recommended to further as-
Therefore, factors that affect women’s healthcare seek- sess these factors. Our study was conducted in a clinical
ing should be thoroughly clarified and addressed in the setting and in facilities located in an urban district. There-
community. Studies have shown that women’s decision fore, the findings cannot be generalized to women who
to seek care could be greatly influenced by the perceived have failed to attend a clinic soon after delivery and to
severity of the condition, distance to the health facility, those living in rural areas. Our sample was biased by the
and financial status to cover hospital bills in case pay- fact that we did not include women who delivered at
ment was necessary [12, 24]. Furthermore, consideration home as well as women who experienced perinatal deaths,
must be given to the limited decision-making capability because we sampled after delivery in a clinic where
of women within marriage and family [4]. Women need women brought their newborns for immunization.
to be empowered with knowledge and birth prepared-
ness during the antenatal clinic visit. Conclusion
This is apparently the first study that assessed the know-
Implications for practice ledge of danger signs during pregnancy and subsequent
The present results imply that having knowledge of dan- healthcare seeking actions of women in urban Tanzania.
ger signs is not enough; additional changes in attitude The findings indicate their low knowledge of danger
and empowerment to take appropriate action are also signs during pregnancy and provide important insights
required. A lack of educational opportunities and poor into the possible underlying factors. Older participants
understanding of both danger signs and possible compli- had higher scores for knowledge of danger signs than
cations indicate that many women may not be familiar younger participants. Women’s knowledge of danger
with the presentation of complications and consider signs during pregnancy positively influenced their deci-
them normal appearances in pregnancy. Delay in seeking sions regarding when to seek medical care and when to
appropriate healthcare owing to lack of knowledge of take appropriate action. Further studies are recom-
danger signs can be reduced by improving access to mended to address the knowledge gap and to plan more
health information and education through the develop- effective interventions for improving antenatal care in
ment of community outreach projects that specifically limited resource settings.
provide information on childbearing issues particularly
danger signs for obstetric complications. Such informa- Abbreviations
tion should be given to individual women and their fam- ANC: Antenatal Care; FANC: Focused Antenatal Care; IRB: Institutional Review
Board; MUHAS: Muhimbili University of Health and Allied Sciences;
ilies to facilitate their collaboration when care is needed. RCHC: Reproductive and Child Health Clinic; WHO: World Health
The establishment of community-based programs is also Organization
of particular importance to assist women with limited
ability to visit health facilities. It will also be beneficial if Acknowledgements
We express our special thanks to the research assistants and midwives of the
other members of the community receive education and health facilities for their cooperation with the data collection.
eventually provide a community support group that will We gratefully thank NORAD’s Program for Master Studies (NOMA) from Bergen
offer help when a complication occurs. Importantly, the Norway for funding this study.
We appreciate Dr. Sarah E. Porter for the English editorial support and
quality of health education at the health facility should critique on behalf of St. Luke’s International University, Tokyo Japan.
be carefully checked for relevance and usability. We sincerely thank Dr. Edward Barroga (http://orcid.org/0000-0002-8920-
2607) for the comprehensive editorial review and detailed guidance in
writing the manuscript.
Limitations and further research
One main limitation of the present study was that the
Funding
structured interview format limited the ability to explore This research study was funded by NORAD’s Program for Master Studies
extensively the reasons for the subsequent actions the (NOMA) from Bergen Norway and the Japan Society for the Promotion of
women took after recognizing the danger signs and how Science (JSPS) Core-to-core program, Asia-Africa Science Platforms (2015-2018).
Authors’ contributions antenatal care visits and its decline among pregnant women in Tanzania
BM conceptualized the study design, collected the data, performed statistical between 1999 and 2010. PLoS One. 2014; https://doi.org/10.1371/journal.
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participated in conceptualizing the study design and data analysis. SH 8. Hailu M, Gebremariam A, Alemseged F. Knowledge about obstetric danger
co-conceptualized and supervised the whole study, crosschecked all data signs among pregnant women in Aleta Wondo District, Sidama Zone,
analysis, and provided important content revisions in the drafting of the Southern Ethiopia. Ethiopian J Health Sci. 2010; https://doi.org/10.4314/ejhs.
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Ethics approval and consent to participate obstetric danger signs and birth preparedness practices among women in
Ethical approval was provided by the Makerere University School of Health rural Uganda. Repro Health. 2011; https://doi.org/10.1186/1742-4755-8-33.
Sciences Research Ethical Committee and the Muhimbili University of Health 10. Hoque M, Hoque ME. Knowledge of danger signs for major obstetric
and Allied Sciences (MUHAS) IRB. Permission to conduct the study was complications among pregnant KwaZulu-Natal women implications for
obtained from the Kinondoni Municipality commissioner for health. A health education. Asia-Pacific J Publ Health. 2011;23(6):946–56.
description of the study was provided to the health workers of Magomeni 11. Nyamtema AS, Bartsch-de Jong A, Urassa DP, Hagen JP, van Roosmalen J.
and Sinza Health Centre to gain access and establish collaboration. Written The quality of antenatal care in rural Tanzania: what is behind the number
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interview on a voluntary basis with no compensation. The women were 12. Okour A, Alkhateeb M, Amarin Z. Awareness of danger signs and symptoms
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13. Dako-Gyeke P, Aikins M, Aryeetey R, Mccough L, Adongo PB. The influence
Consent for publication of socio-cultural interpretations of pregnancy threats on health-seeking
All authors have equally contributed to this work and have consented for its behavior among pregnant women in urban Accra, Ghana. BMC Pregnancy
publication. Childbirth. 2013; https://doi.org/10.1186/1471-2393-13-211.
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Competing interests women and the role of the midwife in Cape Town, South Africa. J
The authors declare that they have no competing interests. Midwifery Women’s Health. 2001; https://doi.org/10.1016/S1526-
9523(01)00138-6.
15. United Republic of Tanzania. 2012 population and housing census.
Publisher’s Note Population distribution by administrative areas. Dar-es-Salaam: National
Springer Nature remains neutral with regard to jurisdictional claims in published Bureau of Statistics; 2013.
maps and institutional affiliations. 16. Kinondoni Municipal Council. Kinondoni Municipal Profile 2011. Dar es
Salaam: Kinondoni Municipality. 2012. p. 38-40.
Author details 17. World Health Organization. Pregnancy, childbirth, postpartum and newborn
1
Muhimbili University of Health and Allied Sciences, School of Nursing, P.O. care: a guide for essential practice. 3rd ed. Geneva: B, QUICK CHECK, RAPID
Box 65004, Dar es salaam, Tanzania. 2Department of Nursing, Makerere ASSESSMENT AND MANAGEMENT OF WOMEN OF CHILDBEARING AGE; 2015.
University, P.O. Box 7072, Kampala, Uganda. 3Department of Obstetrics and https://www.ncbi.nlm.nih.gov/books/NBK326676/. Accessed 15 Aug 2017
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Received: 27 May 2016 Accepted: 13 December 2017 pregnant adolescents-voices from Wakiso district, Uganda. Afr Health Sci.
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