APPROVED

This thesis is submitted in partial fulfillment of the requirement for the degree of health science

department Midwifery in Daaru Salaam University.

Academic Year: 2022 – 2023

For Panel Committee

Name: ___________________________________________________________

Sign: ____________________________________________________________

Name: ___________________________________________________________

Sign: ____________________________________________________________

Name: ___________________________________________________________

Sign: ____________________________________________________________

Name: ___________________________________________________________

Sign: ____________________________________________________________

Dean of the faculty:

Sign: ___________________________

i
 DECLARATION A
We hereby declare that this research writing is our work and effort, and it has not been submitted
anywhere for any award previously and is not being concurrently submitted for any other bachelor
degree, that means this is my original work.

Name of candidate
Student Name: Maria Omar Ahmed User: 9121

Signature: .........................................Date: ..........................................................................

Student Name: Naima Abdullahi Abdi User: 9120

Signature: .........................................Date: ..........................................................................

Student Name: Fatima Osman Ali User: 9128

Signature: .........................................Date: ..........................................................................

Student Name: Meimun Ahmed Mohamed User: 9175

Signature: .........................................Date: ..........................................................................

Student Name: Hani Ali Ibrahim User: 9373

Signature: .........................................Date: ..........................................................................

ii
 DECLARATION B
I confirm that the candidate carried out the work presented in this paper:
…………………………………………………………………………………….
Under my supervision

Supervisor Name: Dr Muhudin Adam Mohamed

Signature....................................................................................................................
Date:……/…./……

iii
 DEDICATION
Many thanks to Allah, who made possible for us writing and bring out this study and also peace of Allah
and blessing, be up on our prophet Mohamed who guided us to the right way.

We hereby dedicate this book to my dear parents without their valuable support and contribution to my
educational background and this book may not have been achieved.

We were always remembering all the people who have kindly supported me to achieve educational our

supervisor Dr Muhudin Adam Mohamed

We request them to keep encouraging many other young Somalis to acquire good educational
background like me.

iv
 ACKNOWLEDGEMENT
All praise is due to Almighty Allah, who created us, made us Muslim an gave us the ability and chance to
accomplish this remarkable task work success fully. Next we would also like to think my beloved
parents, who were very help full and sympathetic in many of my situations. We would like to

acknowledge our dear supervisor Dr Muhudin Adam Mohamed for his valuable Suggestions
supports and guidance and to complete this thesis successfully we gratefully acknowledge to the faculty
of health science department Midwifery at university of Daaru Salaam, Also go to my most significant
academic lectures in The Midwifery Department for their tireless And ambitious efforts to educate as at
their pest level

v
 TABLE OF CONTENTS

Contents
APPROVED.........................................................................................................................................................i
DECLARATION A.............................................................................................................................................ii
DECLARATION B............................................................................................................................................iii
DEDICATION....................................................................................................................................................iv
ACKNOWLEDGEMENT...................................................................................................................................v
CHAPTER ONE..................................................................................................................................................1
1.0 Introduction....................................................................................................................................................1
1.1 Background of the study................................................................................................................................1
1.2 PROBLEM STATEMENT............................................................................................................................2
1.3 OBJECTIVE OF THE STUDY.............................................................................................................3
1.3.1 General objectives...................................................................................................................................3
1.3.2 Specific Objectives study.......................................................................................................................3
1.4 RESEARCH QUESTION..............................................................................................................................3
1.5 SIGNIFICNCY OFSTUDY...........................................................................................................................3
1.6 SCOPE OF STUDY.......................................................................................................................................4
1.7 Conceptual framework...................................................................................................................................5
CHAPTER TWO.................................................................................................................................................6
LITERATURE REVIEW....................................................................................................................................6
2.1 INTRODUCTION.........................................................................................................................................6
2.2 CLASSIFICATION...............................................................................................................................8
2.3 Major danger sign during pregnant Gestational hypertension...............................................................8
2.4 Symptoms..............................................................................................................................................9
2.5 Risk factors Maternal Couse..................................................................................................................9
4:pre-existing hypertension Pregnancy............................................................................................................9
Family history..................................................................................................................................................9
2.6 Treatment.............................................................................................................................................10
2.7 Major danger sign during labour..........................................................................................................10
2.7 Signs and symptoms............................................................................................................................10
2.8 Couse....................................................................................................................................................10
2.9 Mangement..........................................................................................................................................10
Complications................................................................................................................................................11
2.10 Major danger sign during postpartum Postpartum bleeding................................................................11
2.11 Couses..................................................................................................................................................11
2.12 Treatment.............................................................................................................................................11
2.13 Surgery.................................................................................................................................................11
CHAPTER THREE............................................................................................................................................12

vi
RESEARCHMETHODOLOGY........................................................................................................................12
3.0 Introduction..................................................................................................................................................12
3.1 Research Design...........................................................................................................................................12
3.2 Study area.....................................................................................................................................................12
3.3 The Target Population..................................................................................................................................12
3.4 Sample size..................................................................................................................................................13
3.5 Research Instrument...................................................................................................................................13
3.6 Data gathering procedure.............................................................................................................................13
3.7 Data Analysis...............................................................................................................................................14
3.8 Limitation.....................................................................................................................................................14
3.9 ETHICAL CONSIDERATIONS.................................................................................................................14
CHEPTER FOUR..............................................................................................................................................16
DATA ANALYSIS AND INTERPERTATION...............................................................................................16
4.0 Introduction..................................................................................................................................................16
4.1 Table: Respondents by age..........................................................................................................................16
4.2 Table Respondents by gender......................................................................................................................17
4.3 Table: Respondents by marital status...........................................................................................................18
4.3 Respondent by married status:.....................................................................................................................18
4. 4 Table Respondents by Educational level....................................................................................................19
4.5 Table Respondents by Occupation...............................................................................................................20
Respondent by occupational..............................................................................................................................20
4.6 Table If women and their families recognize these obstetric danger signs and seek timely health care.....21
4.7 Table In a woman’s life, pregnancy is regarded as a normal phenomenon.................................................22
4.8 Table However, around 40% of pregnancies re said to be high risk, which could lead to adverse maternal
and fetal outcomes.............................................................................................................................................23
4.9 Table informing women about obstetric danger signs is among the strategies designed to enhance the
utilization of skilled care whenever obstetrics complications are anticipated...................................................24
4.10 Table Obstetric danger signs are unexpected obstetric signs that can lead to maternal health
complications.....................................................................................................................................................25
4.11 The danger signs are mainly classified into three categories, Major danger signs during pregnancy
include: severe vaginal bleeding,.......................................................................................................................26
4.12 Table Major danger signs during labor and childbirth include severe vaginal bleeding, prolonged labor
(>12 h), convulsions, and retained placenta.......................................................................................................27
4.13 Table Women’s knowledge about these obstetric danger signs during pregnancy, delivery and
postpartum is still low in sub-Saharan African countries..................................................................................28
4.14 Table Knowledge of danger signs of obstetric complications is first step in the appropriate and timely
referral to essential obstetric care.......................................................................................................................29
4.15 Table although women’s knowledge about the obstetric danger signs is important for improving
maternal and child health...................................................................................................................................30
4.16 Table The majority of obstetric complications can be prevented if its occurrence is recognized and
women receive timely quality obstetric care......................................................................................................31
4.17 Table Lack of knowledge about obstetric danger signs often results in delays in seeking timely obstetric
care in order to obtain timely obstetric care.......................................................................................................32
4.18 Table Women’s knowledge about obstetric danger signs has been related to a number of factors...........33
4.19 Table Women who are employed and work for paid job are more knowledgeable about obstetric danger
signs compared to their unemployed counterparts.............................................................................................34
CHAPTER FIVE................................................................................................................................................35
DISCUSSION, CONCLUSION AND RECOMMENDATION.......................................................................35
vii
5.1 DISCUSSION..............................................................................................................................................35
5.2 Conclusion...................................................................................................................................................36
5.3 Recommendation.........................................................................................................................................36
Reference list......................................................................................................................................................37
APPENDIX I......................................................................................................................................................39
QUESTIONNAIRE...........................................................................................................................................39
APENDEX II map of Somalia...........................................................................................................................42
Appendix III map of Mogadishu........................................................................................................................43

TABLES
4.1 Table: Respondents by age

viii
4.2 Table Respondents by gender
4.3 Table: Respondents by marital status
4. 4 Table Respondents by Educational level
4.5 Table Respondents by Occupation
4.6 Table If women and their families recognize these obstetric danger signs and seek timely health
care
4.7 Table In a woman’s life, pregnancy is regarded as a normal phenomenon
4.8 Table However, around 40% of pregnancies re said to be high risk, which could lead to adverse
maternal and fetal outcomes.
4.9 Table informing women about obstetric danger signs is among the strategies designed to enhance
the utilization of skilled care whenever obstetrics complications are anticipated
4.10 Table Obstetric danger signs are unexpected obstetric signs that can lead to maternal health
complications.
4.11 The danger signs are mainly classified into three categories, Major danger signs during
pregnancy include: severe vaginal bleeding,
4.12 Table Major danger signs during labor and childbirth include severe vaginal bleeding,
prolonged labor (>12 h), convulsions, and retained placenta.
4.13 Table Women’s knowledge about these obstetric danger signs during pregnancy, delivery and
postpartum is still low in sub-Saharan African countries
4.14 Table Knowledge of danger signs of obstetric complications is first step in the appropriate and
timely referral to essential obstetric care.
4.15 Table although women’s knowledge about the obstetric danger signs is important for improving
maternal and child health
4.16 Table The majority of obstetric complications can be prevented if its occurrence is recognized
and women receive timely quality obstetric care
4.17 Table Lack of knowledge about obstetric danger signs often results in delays in seeking timely
obstetric care in order to obtain timely obstetric care
4.18 Table Women’s knowledge about obstetric danger signs has been related to a number of
factors.
4.19 Table Women who are employed and work for paid job are more knowledgeable about
obstetric danger signs compared to their unemployed counterparts

FIGURES

ix
4.1 Table: Respondents by age
4.2 Table Respondents by gender
4.3 Table: Respondents by marital status
4. 4 Table Respondents by Educational level
4.5 Table Respondents by Occupation
4.6 Table If women and their families recognize these obstetric danger signs and seek timely health
care
4.7 Table In a woman’s life, pregnancy is regarded as a normal phenomenon
4.8 Table However, around 40% of pregnancies re said to be high risk, which could lead to adverse
maternal and fetal outcomes.
4.9 Table informing women about obstetric danger signs is among the strategies designed to enhance
the utilization of skilled care whenever obstetrics complications are anticipated
4.10 Table Obstetric danger signs are unexpected obstetric signs that can lead to maternal health
complications.
4.11 The danger signs are mainly classified into three categories, Major danger signs during
pregnancy include: severe vaginal bleeding,
4.12 Table Major danger signs during labor and childbirth include severe vaginal bleeding,
prolonged labor (>12 h), convulsions, and retained placenta.
4.13 Table Women’s knowledge about these obstetric danger signs during pregnancy, delivery and
postpartum is still low in sub-Saharan African countries
4.14 Table Knowledge of danger signs of obstetric complications is first step in the appropriate and
timely referral to essential obstetric care.
4.15 Table although women’s knowledge about the obstetric danger signs is important for improving
maternal and child health
4.16 Table The majority of obstetric complications can be prevented if its occurrence is recognized
and women receive timely quality obstetric care
4.17 Table Lack of knowledge about obstetric danger signs often results in delays in seeking timely
obstetric care in order to obtain timely obstetric care
4.18 Table Women’s knowledge about obstetric danger signs has been related to a number of
factors.
4.19 Table Women who are employed and work for paid job are more knowledgeable about
obstetric danger signs compared to their unemployed counterparts

x
 CHAPTER ONE
1.0 Introduction
This study It will contain background of the study, problem statement, objective of the study, research questions,
significance of the study, scope of the study, operational definitions and conceptual framework .

1.1 Background of the study

In a woman’s life, pregnancy is regarded as a normal phenomenon. However, around 40% of pregnancies re
said to be high risk, which could lead to adverse maternal and fetal outcomes. If women and their families
recognize these obstetric danger signs and seek timely health care, maternal morbidity and mortality may be
significantly reduced. Furthermore, there is evidence suggesting that improvement in knowledge about
obstetric danger signs will facilitate early detection of problems and improve the decisin making to access
appropriate health care.(Haleema et al. 2019)

In 2013, there were an estimated 289 000 maternal deaths worldwide—most of which may be considered
preventable (World Health Organization (WHO), 2014).(Teng et al. 2015) Also World Health Organization
(WHO) estimates that about 300 million women in the developing countries suffer from short and long-
term illnesses due to complications related to pregnancy and childbirth. About 529,000 mothers die each year
from maternal causes, out of which 99% of deaths being from the developing world.(Hailu, Gebremariam, and
Alemseged 2011).

Informing women about obstetric danger signs is among the strategies designed to enhance the utilization of
skilled care whenever obstetrics complications are anticipated. Obstetric danger signs are unexpected obstetric
signs that can lead to maternal health complications.

The danger signs are mainly classified into three categories, Major danger signs during pregnancy include:
severe vaginal bleeding, swollen hands/face, and blurred vision.
Major danger signs during labor and childbirth include severe vaginal bleeding, prolonged labor (>12 h),
convulsions, and retained placenta. Major danger signs during the postpartum period include severe vaginal
bleeding, foul-smelling vaginal discharge, and fever

Women’s knowledge about these obstetric danger signs during pregnancy, delivery and postpartum is still low
in sub-Saharan African countries evidenced by studies conducted in Burkina Faso, Ethiopia, and rural
Tanzania.(Bintabara, Mpembeni, and Mohamed 2017)

1
Somalia has been defined by some as one of the worst places to be a woman. Maternal mortality ratio stands at
above 850/100,000 live births according to latest UNICEF, WHO and UNFPA estimates, with one out of every
12 women dying due to pregnancy related causes.

ARC International has been working in the health sector in Somalia since 2011, operating both fixed and
mobile health facilities throughout the country. In particular, ARC works in maternal and child health to
ensure that women are supported through their pregnancies, have safe deliveries and that their children have
access to health services. Their goal is to find the gaps in healthcare in Somalia and fill them, particularly in
the most remote areas. In addition to offering affordable health care, ARC also educates communities
regarding safe practices and maternal and child health.

Knowledge of danger signs of obstetric complications is first step in the appropriate and timely referral to
essential obstetric care. Although women’s knowledge about the obstetric danger signs is important for
improving maternal and child health, little is known about the current knowledge and influencing factors in
pastoral community of Ethiopia. This study, therefore, aims to fill this gap by assessing the current level of
knowledge and associated factors of pregnant women living in Erer district of Somali region, Ethiopia

1.2 PROBLEM STATEMENT

Death due to obstetric danger Signs has remained significant global public healthy problem in both developed
and developing countries Every day, approximately 830 women worldwide die from preventable causes related
to pregnancy and childbirth (WHO 2018). Maternal mortality rate in SOMALIA 732 deaths per 100,000 live
births (WHO 2015). One out of 12 women dies due to pregnancy related causes (UNICEF Somalia 2015).
Since the attitude comes after information thus continuing education of women’s in reproductive age, in order
to raise their awareness and to protect and promote their health and take care of their fetuses is required (WHO
2018).
However, little is known about the current knowledge and influencing factors in the Somalia, So This study
aims to asses the level of knowledge of obstetric danger Signs and associated factors among reproductive Age
women attending at banadir hospitals in Muqdisho - Somalia

2
1.3 OBJECTIVE OF THE STUDY
1.3.1 General objectives
To reduce maternal death related to lack of knowledge of obstetric danger signs and associated factors
among reproductive age women attending at banadir hospital
1.3.2 Specific Objectives study
i. To determine the level of knowledge about obstetric danger signs and associated factors
among reproductive age women attending at banadir hospital.
ii. To assess maternal factors associated with knowledge of obstetric danger sings among
reproductive age women attending at banadir hospital.
iii. To determine socio demographic factors associated with knowledge of obstetric danger
signs among reproductive age women attending at banadir hospital.

1.4 RESEARCH QUESTION

1. What is the level of knowledge of obstetric danger sign and associated factors among reproductive
age women attending at banadir hospital?
2. How to assess maternal factors associated with knowledge of obstetric danger sings among
reproductive age women attending at banadir hospital?

3. How to determine socio demographic factors associated with knowledge of obstetric danger signs
among reproductive age women attending at banadir hospital?

1.5 SIGNIFICNCY OFSTUDY

This study provides baseline information on the level of knowledge among reproductive age women
toward obstetric danger signs and associated factors

Also the Study will be helpful for the participants to know more about obstetric danger sign
As there is no adequate information on obstetric danger signs KAP, the study result will be vital and can be
used as an input for maternal health curriculum, strategy and package establishment.

3
 This study will provide basic data on the issue that may help policy makers and as baseline data for MOH to
reduce the highest maternal mortality rate of Ethiopia. In addition to this, this study can have the following
importance to different stake holders

The information from the research will also help to identify gaps in the provision of ANC which will call for
interventions that will encourage women to attend ANC. This information will also help to improve on the
ways of providing information to Antenatal mothers that will help to increase awareness on danger signs in
pregnancy. Families and individuals can be benefited from this study by reading the research findings and also
by taking part in the interventions that will be made by different stake holders. Since there is no tangible
research conducted in the study area, this research can provide baseline data for a researcher who is interested
in the area. The information generated from the study should benefit both service providers and district health
management teams in improving the quality of antenatal care (ANC) services, particularly the quality of
information provided to pregnant women in the health care facilities. The findings should provide information
to health care practitioners regarding the awareness of danger signs of obstetric complications among pregnant
women. Finally, the findings should help and guide the development of focused behavioral change strategies
for pregnant women.

1.6 SCOPE OF STUDY

1.2.1 Time of scope: the study was conducted between March 2023__July 2023

1.2.2 Content of scope: This study focuses knowledge of obstetric danger sign and associated factors
among reproductive Age women

1.2.3 Geographical scope: This study was conducted at banadir hospital in Mogadishu

4
1.7 Conceptual framework
Independent Variable (IV) Dependent variable (DV)

IV DV

Knowledge of obstetric

Personal factor

Age

Marital status
Among reproductive age

women

Socio economic factor

Income

Availability of transport

Health service related factor

ANC follow up

Place of residence

5
 CHAPTER TWO
LITERATURE REVIEW

2.1 INTRODUCTION

Maternal mortality refers to deaths due to complications from pregnancy or childbirth most pregnant mothers
develop a specific obstetric complication, the main obstetric complications that women could encounter during
pregnancy and childbirth include maternal hemorrhage, pregnancy-induced hypertension, maternal infections,
prolonged/obstructed labor and complications of abortion.(Geleto et al. 2019)(Geleto et al. 2019)

According to the 2015 World Health Organization report globally, an estimated 10.7 million mothers died
from 1990 to 2015 due to obstetric complications. Almost all of these deaths (99% of global maternal
mortalities) occurred in developing countries, and 66% of these deaths occurred in sub-Saharan African
countries. The majority of obstetric complications can be prevented if its occurrence is recognized and women
receive timely quality obstetric care

In developing countries, several factors are reported to hamper access to (emergency obstetric care) EmOC.
The most frequently reported deterrents include socio-economic and cultural factors, lack of knowledge about
obstetric danger signs and poor awareness of the availability of EmOC service. Lack of knowledge about
obstetric danger signs often results in delays in seeking timely obstetric care in order to obtain timely obstetric
care, women, families and the community at large need to know when to access healthcare.(Geleto et al. 2019)

In previous research in developing countries, it has been suggested women’s knowledge about obstetric danger
signs determines their health-seeking behaviour. For instance, (Kosum et al) reported that women with poor
knowledge of obstetric danger signs are less likely to attend a healthcare facility when they face obstetric
emergencies

6
Similarly (Jammeh et al) stated that an inability to identify danger signs during pregnancy by women was
reported to result in delays in accessing obstetric care. Several Researchers have indicated that women with
poor knowledge of obstetric danger signs are less likely to have better birth preparedness and complication
readiness, and as a result they usually delay seeking appropriate obstetric care.

At the global level, women’s knowledge about obstetric danger signs has been related to a number of factors.
Women who experienced obstetric complications during the previous pregnancies are more knowledgeable
about obstetric danger signs as compared to those who never experienced obstetric complications. Being
exposed to health education was also reported to improve women’s knowledge about obstetric danger signs.
In numerous studies, it has been shown that multiparous and those women who visited a health facility for
antenatal care (ANC) are more likely to be aware of obstetric danger signs as compared to nulliparous and
those who did not visit a health facility for ANC.

Maternal socio-economic factors are also reported in several studies as affecting women’s knowledge about
obstetric danger signs. Women who are employed and work for paid job are more knowledgeable about
obstetric danger signs compared to their unemployed counterparts. The result of numerous studies showed that
older women and educated mothers are more knowledgeable about obstetric danger signs than their
younger and uneducated counterparts.(Geleto et al. 2019)

Most causes of maternal mortality are preventable and attributed to three delays: delay in the decision to seek
care, delay in reaching the place of care, and delay in receiving appropriate care. Poor knowledge of danger
signs is a major contributor to delays in seeking obstetric care and hence to high maternal mortality and
morbidity. Informing women about obstetric danger signs is among the strategies designed to enhance the
utilization of skilled care whenever obstetrics complications are anticipated

Efforts have been made by the Tanzanian government to increase knowledge of obstetric danger signs among
women through implementation of focused antenatal care (FANC) in 2002 which provides free counseling on
these danger signs to all pregnant women attending to antenatal care (ANC) . The FANC strategy insists ANC
providers inform pregnant women about danger signs verbally with the help of visual aids such as brochures
and posters. Twelve years since implementation of FANC, only 53% of pregnant women in Tanzania were
found to have received information on signs of obstetric complications and about 51% utilized skilled
obstetric care.(Bintabara, Mpembeni, and Mohamed 2017)

7
2.2 CLASSIFICATION
Obstetric danger are mainly classified into three category

1 : major danger sign during pregnancy

Sever vaginal bleeding, Decreased fetal movements, swollen of hand and face, anemia, blurred

vision 2 : major danger sign during Labor and childbirth :

Sever vaginal bleeding, prolonged labour (>12hr), convulsion retaine placent

3 : major danger sign of postpartum

Severe vaginal bleeding, foul-smelling vaginal discharge, and fever

2.3 Major danger sign during pregnant

Gestational hypertension

Gestational hypertension or pregnancy induced hypertension (PHI) is the development of new

hypertension in pregnant women after 20 weeks of gestation without the presence of protein in urine or
other signs of pre eclamsia. Gestational hypertension is defines as having high blood pressure greater then
140/90 on two separate occasions at least 6 hours apart

Signs and symptoms

No single diagnostic test currently exists to predict the likelihood of developing gestational hypertension.

Highly blood pressure is major sign in diagnosing gestational hypertension. Some women with gestational
hypertension may present asymptomatic but number of symptoms is associated with the condition

8
 2.4 Symptoms

1: edema

2; increased blood pressure

3: sudden weight gain

4: blurred vision or sensitive to the light

5: nausea and vomiting

6: persistent head ache

7: increased blood pressure

2.5 Risk factors

Maternal Couse

1: obesity

2: mother under 20 or over 40 year

3: past history of diabetes mellitus hypertension (particular gestational hypertension) and renal disease

4:pre-existing hypertension

Pregnancy

1: multiple gestations

2: placental abnormalities

Family history

1: family history of pre eclampsia

9
2.6 Treatment

There is no specific treatment but is monitored closely to rapidly identify pre-eclampsia and life
threatening complications (HELLP syndrome and eclampsia)

Drug treatment options are limited as many antihypertensive may negatively affect the fetus, methyldopa
and hydralazine and labetalol are most commonly used for sever pregnant hypertension

2.7 Major danger sign during labour

Prolonged Labor : Is the inability of women to proceed with childbirth upon gong into Labor. Prolonged
labor typically lasts over 20 hours for the first time mothers and over 14 hours for women That have
already had children

2.7 Signs and symptoms

 Labor extend beyond 18 hours

 dehydration and exhaustion of the mother
 pain around back, sides, and thighs of the mother as result of extreme muscle pressure
 Sever pain when labor begins
 increase heart rate of the mother
 uterin rupture
 distress of the fetus

2.8 Couse
 fetal malpresentation
 cervical stenosis

2.9 Mangement
 assissted vaginal delivery
 ceserian section

10
Complications

 postpartum hemorrhage and infection

 damage to the birth canal
 distress of the fetus as result of decrease oxygen level
2.10 Major danger sign during postpartum

Postpartum bleeding

Depending on the source primary postpartum bleeding Is defined as blood loss excess of 500ml following
vaginal delivery or 1000ml following ceaserian section in the first 24 hours following birth, secondry
postpartum bleeding is what occur after the first day up to six weeks after childbirth

Signs and symptoms

1 : heavy bleeding from vaginal that does not slow or stop over time

2 : signs and symptoms of circulatory shock

2.11 Couses

 Uterine atony
 Truama
 Retained tissue

2.12 Treatment
 Intervenus oxytocin drug of choice for postpartum hemorrhage
 Ergotamine May also be used

2.13 Surgery

 If medication fails or in case of cervical laceration or tear or uterine rupture

2.7 Conclusion

The points raised here express the need that in order for adequate performance and the smooth delivery of
preeclampsia patient management to occur within a health care setting, the players involved need to
communicate effectively. Furthermore, health workers must show respect and have a clear understanding of
their roles and expectations to deliver the best management to the preeclampsia patient under their care.

11
 CHAPTER THREE
RESEARCHMETHODOLOGY

3.0 Introduction
This chapter presents a detailed description of the research methodology. Methodology refers to the detailed
procedure be followed to realize the research objectives. Methodology includes a description of the research design
study area, target population, sample size, sampling techniques, Research instrumentation/data collection, Data
Analysis, Validity and Reliability, limitation and Ethical consideration of the study as well as data analysis
techniques.

3.1 Research Design

The study was conducted through cross sectional study because; the cross-sectional study is in depth investigation of
an individual, group, institution or phenomena. The cross sectional helps the researcher to study multiple entities in
depth in order to gain insight into the larger case and to describe and explain rather than predict a phenomenon.

3.2 Study area

Banadir Region is an administrative region in southeastern Somalia. It covers the same area as the city
of Mogadishu, which serves as the capital. It is bordered to the northwest by the Shabelle river, and to the southeast
by the Indian Ocean. Although by far the smallest administrative region in Somalia, it has the largest population,
estimated at 3,650,227 (including 369,288 internally displaced persons) in 2014.

The territorial extent and scope of the term Banadir has varied in definition throughout its history, with medieval
usage extending Banadir to huge swaths of coast adjacent to Mogadishu stretching as far as hundreds of mile

3.3 The Target Population

The Target population of the study will focus on the people living in Mogadishu and targets knowledge of
obstetric danger sign and associated factors among reproductive Age women and also other Somali
intellectuals and individual who are concerned maternal and fetal situation after preeclampsia in Mogadishu
Somalia.
My target Population is 50 persons obstetric danger sign and associated factors among reproductive Age women the
population will be chosen because of suitability for the obstetric danger sign and associated factors among
reproductive Age women in Mogadishu Somalia.

12
3.4 Sample size
50 randomly selected the obstetric danger sign and associated factors among reproductive Age women in
Mogadishu-Somalia
Slovens Formula
 n = the desired sample size
 N = target population
 e = sampling error (0.5) constant.
N
n= 2
1+ N (e)

Where n= sample size, N= target population, 50and e = margin of error of 0.05

57
n= 2
1+57 (0.05)

n=50

3.5 Research Instrument

The researchers will use a structured Questionnaire tool as a collecting data; the selecting of this tool has been
guided by the nature of data to be collected. Questionnaire tool was administered to collect quantitative data from
the selected respondents. The researcher will prefer this method because it is the most appropriate in collecting view
respondents whose place was geographically spread. The questionnaire will create through the process of adapted
(mixed) in the literature and then will make pilot test on sample of expertise, and the researcher will make the results
that got a pilot test on re-modification, and finally though the operation, the study will used four points like scale.

3.6 Data gathering procedure

The researcher will prefer this method because it is the most appropriate in collecting view respondents whose place
was geographically spread.
The questionnaire will create through the process of adapted (mixed) in the literature and then will make pilot test
on sample of expertise, and the researcher will make the results that got a pilot test on re-modification, and finally
though the operation, the study will used four points like scale.

13
3.7 Data Analysis
Descriptive statistical measures such as percentages and frequencies used to analyze closed ended
questions/statements. These techniques are usually able to employ factual information about a situation to provide
an understanding of performance levels. The data collected will edit for accuracy, consistency, uniformity and
completeness and analyzed with the results presented in tables, bar charts and pie charts.
After that, tabulated and analyzed using frequencies, percentages, mean scores and standard deviation measures by
use of SPSS. Cross-tabulation analysis will also be applied to derive any relationships between the dependent and
independent variables.

3.8 Limitation
The language is also the greatest barrier in getting the most correct answers for the questionnaire.
Also there is other numbers of the problems that the researcher focused, including
1- Insecurity condition stopped a lot time of the researcher to reach the location of the immigration Centre.
2- Lack of enough founds it is very rare to get fact data as research.
3- Poor internet access the quality of internet range is poor.
4- Lack of reference and library in the country for finding literature review.
5- Time factor the time is very short though we have only two month and mid-exam is start at that time.
6- Lack of experience someone or something lacks a particular quality or that a particular quality is lacking in them,
we mean that they do not have any or enough of it.

3.9 ETHICAL CONSIDERATIONS

To carry out this study wholly as planned, the researcher was use of both personal and institutional data, therefore,
the data gathered was kept confidential and the information collected for these companies was only be used for an
academic purpose.
The researcher require permission of the respondents who participated in the research for their consent in the
intended study as such the researcher did not lie to subjects and record findings on hidden mechanical devices.
The researcher was made sure the researcher personal bias and opinions did not override other interests of the
research and gave both sides fair consideration.
The findings were confidential; the condition of anonymity was assured to avoid embarrassing and harming
respondents.

14
The researcher will require the approval of the university to make sure the research does not violate any ethical
considerations. The respondents was informed the content and purpose of the research before administration of any
instrument as maintained the above sections.
The only aim for this research is academic procedure and national positive to Expend all Somalia Community

15
 CHEPTER FOUR
DATA ANALYSIS AND INTERPERTATION
4.0 Introduction
This chapter presents analyses that were conducted on the data that were collected from the field. The data have
been analyzed and presented according to objectives of the study. Data was obtained from the respondents in this
study by using questionnaire.

4.1 Table: Respondents by age

VAR00001

Frequency Percent Valid Percent Cumulative Percent

Valid 20-30 30 60 60 60

31-40 20 40 40 40
Total 50 100.0 100.0

4.1 Respondents by age

The majority of respondents (60%) were between 20-30 years, while (40%) were between 31-40 years, while (0%)
were between 41-50 and the remaining (0%) are 51 above
4.1 Figure: respondents by age

16
4.2 Table Respondents by gender
VAR00002
Frequency Percent Valid Percent Cumulative Percent

Valid Male 30 60 60 60

Female 20 40 40 40
Total 50 100.0 100.0

4.2 Respondents by gander

Respondents by gender female

The majority of respondent were males 30(60%) and females were 20(40%) which are represented by (100%).

4. 2 Figure: Respondents by gender

17
4.3 Table: Respondents by marital status
VAR00003

Frequency Percent Valid Percent Cumulative Percent

Valid Married 35 70 70 70

Single 10 20 20 20
Divorce 5 10 10 10
Total 50 100.0 100.0

4.3 Respondent by married status:

The majority of respondent were married is represented by (70%) while (20%) of the respondents were single (10%)

were divorces

4.3 figure Respondent by married status:

18
4. 4 Table Respondents by Educational level
Qualification

Frequency Percent Valid Percent Cumulative Percent

Valid Bachelor level 25 50 50 50

Master level 17 34 34 34

Diploma or less 6 12 12 12

PHD level 2 4 4 4

Total 50 100.0 100.0

4.4 Respondents by Educational level

The majority of respondent by were at bachelor level which is represented by (50%), followed by master level

which is represented by (34%) while (12%) were diploma or less and the last (4%) were PHD level

4.4 Figure Respondents by Qualification level

19
4.5 Table Respondents by Occupation
Occupational level

Cumulative
Frequency Percent Valid Percent Percent

Valid Health worker 40 80.0 80.0 80.0

other employee 7 14.0 14.0 94.0

non employee 3 6.0 6.0 100.0

Total 50 100.0 100.0

Respondent by occupational

Most of respondents were health workers which is represented by (80%), while employee is represented by (14%),

and the last respondents (6%) were non-employee

4.5 Figure Respondents by Occupation

20
4.6 Table If women and their families recognize these obstetric danger signs and seek timely
health care
If women and their families recognize these obstetric danger signs and seek timely health care
Frequency Percent Valid Percent Cumulative
Percent
Valid strongly agree 20 40 40 40
Agree 10 20 20 20
Neutral 12 24 24 24
dis agree 5 10 10 10
strongly dis agree 3 6 6 6
Total 50 100.0 100.0

The majority of respondents were strongly agree 20(40%) while 10 (20%) were agree and 12(24%) were neutral

while 5(10%) were dis agree and remaining 3(6%) were strongly disc agree

4.6 Figure If women and their families recognize these obstetric danger signs and seek timely health care By
respondent

21
4.7 Table In a woman’s life, pregnancy is regarded as a normal phenomenon
In a woman’s life, pregnancy is regarded as a normal phenomenon
Frequency Percent Valid Percent Cumulative Percent

Valid strongly agree 15 30 30 30

Agree 15 30 30 30
Neutral 12 24 24 24
dis agree 5 10 10 10
strongly disagree 3 6 6 6
100.0
Total 50 100.0 100.0

The majority of respondents were strongly agree 15(30%) while 15 (30%) were agree and 12(24%) were neutral

while 5(10%) were dis agree and remaining 3(6%) were strongly disc agree

4.7 Figure, in a woman’s life, pregnancy is regarded as a normal phenomenon

22
4.8 Table However, around 40% of pregnancies re said to be high risk, which could lead to adverse maternal
and fetal outcomes.
However, around 40% of pregnancies re said to be high risk, which could lead to adverse maternal and
fetal outcomes.
Frequency Percent Valid Percent Cumulative Percent

Valid strongly agree 30 60 60 60

Agree 10 20 20 20
Neutral 5 10 10 10
dis agree 2 4 4 4
strongly dis agree 3 6 6 6
Total 50 100.0 100.0

The majority of respondents were strongly agree 30(60%) while 10 (20%) were agree and 5(10%) were neutral

while 2(4%) were dis agree and remaining 3(6%) were strongly disc agree

4.8 Figure However, around 40% of pregnancies re said to be high risk, which could lead to adverse maternal
and fetal outcomes.

23
4.9 Table informing women about obstetric danger signs is among the strategies designed to enhance the
utilization of skilled care whenever obstetrics complications are anticipated
informing women about obstetric danger signs is among the strategies designed to enhance the
utilization of skilled care whenever obstetrics complications are anticipated
Frequency Percent Valid Percent Cumulative Percent

Valid strongly agree 15 30 30 30

Agree 15 30 30 30
Neutral 12 24 24 24
dis agree 5 10 10 10
strongly disagree 3 6 6 6
100.0
Total 50 100.0 100.0

The majority of respondents were strongly agree 15(30%) while 15 (30%) were agree and 12(24%) were neutral

while 5(10%) were dis agree and remaining 3(6%) were strongly disc agree

4.9 Figure informing women about obstetric danger signs is among the strategies designed to enhance the
utilization of skilled care whenever obstetrics complications are anticipated

24
4.10 Table Obstetric danger signs are unexpected obstetric signs that can lead to maternal
health complications.
Obstetric danger signs are unexpected obstetric signs that can lead to maternal health
complications.
Frequency Percent Valid Percent Cumulative
Percent
Valid strongly agree 20 40 40 40
Agree 10 20 20 20
Neutral 12 24 24 24
dis agree 5 10 10 10
strongly dis agree 3 6 6 6
Total 50 100.0 100.0

The majority of respondents were strongly agree 20(40%) while 10 (20%) were agree and 12(24%) were neutral

while 5(10%) were dis agree and remaining 3(6%) were strongly disc agree

4.10 Figure Obstetric danger signs are unexpected obstetric signs that can lead to maternal health
complications.

25
4.11 The danger signs are mainly classified into three categories, Major danger signs during
pregnancy include: severe vaginal bleeding,
The danger signs are mainly classified into three categories, Major danger signs during pregnancy
include: severe vaginal bleeding,
Frequency Percent Valid Percent Cumulative Percent

Valid strongly agree 30 60 60 60

Agree 10 20 20 20
Neutral 5 10 10 10
dis agree 2 4 4 4
strongly dis agree 3 6 6 6
Total 50 100.0 100.0

The majority of respondents were strongly agree 30(60%) while 10 (20%) were agree and 5(10%) were neutral

while 2(4%) were dis agree and remaining 3(6%) were strongly disc agree

4.11 Figure the danger signs are mainly classified into three categories, Major danger signs during pregnancy
include: severe vaginal bleeding

26
4.12 Table Major danger signs during labor and childbirth include severe vaginal bleeding,
prolonged labor (>12 h), convulsions, and retained placenta.
Major danger signs during labor and childbirth include severe vaginal bleeding, prolonged labor (>12
h), convulsions, and retained placenta.

Frequency Percent Valid Percent Cumulative

Percent
Valid strongly agree 20 40 40 40
Agree 10 20 20 20
Neutral 12 24 24 24
dis agree 5 10 10 10
strongly dis agree 3 6 6 6
Total 50 100.0 100.0

The majority of respondents were strongly agree 20(40%) while 10 (20%) were agree and 12(24%) were neutral

while 5(10%) were dis agree and remaining 3(6%) were strongly disc agree

4.12 Figure Major danger signs during labor and childbirth include severe vaginal bleeding, prolonged labor
(>12 h), convulsions, and retained placenta.

27
4.13 Table Women’s knowledge about these obstetric danger signs during pregnancy, delivery
and postpartum is still low in sub-Saharan African countries
Women’s knowledge about these obstetric danger signs during pregnancy, delivery and postpartum is
still low in sub-Saharan African countries
Frequency Percent Valid Percent Cumulative Percent

Valid strongly agree 15 30 30 30

Agree 15 30 30 30
Neutral 12 24 24 24
dis agree 5 10 10 10
strongly disagree 3 6 6 6
100.0
Total 50 100.0 100.0

The majority of respondents were strongly agree 15(30%) while 15 (30%) were agree and 12(24%) were neutral

while 5(10%) were dis agree and remaining 3(6%) were strongly disc agree

4.13 Figure Women’s knowledge about these obstetric danger signs during pregnancy, delivery and
postpartum is still low in sub-Saharan African countries

28
4.14 Table Knowledge of danger signs of obstetric complications is first step in the appropriate
and timely referral to essential obstetric care.
Knowledge of danger signs of obstetric complications is first step in the appropriate and timely
referral to essential obstetric care.
Frequency Percent Valid Percent Cumulative Percent

Valid strongly agree 30 60 60 60

Agree 10 20 20 20
Neutral 5 10 10 10
dis agree 2 4 4 4
strongly dis agree 3 6 6 6
Total 50 100.0 100.0

The majority of respondents were strongly agree 30(60%) while 10 (20%) were agree and 5(10%) were neutral

while 2(4%) were dis agree and remaining 3(6%) were strongly disc agree

4.14 Figure Knowledge of danger signs of obstetric complications is first step in the appropriate and timely
referral to essential obstetric care.

29
4.15 Table although women’s knowledge about the obstetric danger signs is important for
improving maternal and child health
although women’s knowledge about the obstetric danger signs is important for improving maternal
and child health
Frequency Percent Valid Percent Cumulative
Percent
Valid strongly agree 20 40 40 40
Agree 10 20 20 20
Neutral 12 24 24 24
dis agree 5 10 10 10
strongly dis agree 3 6 6 6
Total 50 100.0 100.0

The majority of respondents were strongly agree 20(40%) while 10 (20%) were agree and 12(24%) were neutral

while 5(10%) were dis agree and remaining 3(6%) were strongly disc agree

4.15 Figure although women’s knowledge about the obstetric danger signs is important for improving
maternal and child health

30
4.16 Table The majority of obstetric complications can be prevented if its occurrence is recognized
and women receive timely quality obstetric care
The majority of obstetric complications can be prevented if its occurrence is recognized and women
receive timely quality obstetric care
Frequency Percent Valid Percent Cumulative Percent

Valid strongly agree 15 30 30 30

Agree 15 30 30 30
Neutral 12 24 24 24
dis agree 5 10 10 10
strongly disagree 3 6 6 6
Total 50 100.0 100.0 100.0

The majority of respondents were strongly agree 15(30%) while 15 (30%) were agree and 12(24%) were neutral
while 5(10%) were dis agree and remaining 3(6%) were strongly disc agree
4.16 Figure The majority of obstetric complications can be prevented if its occurrence is recognized and
women receive timely quality obstetric care

31
4.17 Table Lack of knowledge about obstetric danger signs often results in delays in seeking
timely obstetric care in order to obtain timely obstetric care
Lack of knowledge about obstetric danger signs often results in delays in seeking timely obstetric care
in order to obtain timely obstetric care
Frequency Percent Valid Percent Cumulative Percent

Valid strongly agree 30 60 60 60

Agree 10 20 20 20
Neutral 5 10 10 10
dis agree 2 4 4 4
strongly dis agree 3 6 6 6
Total 50 100.0 100.0

The majority of respondents were strongly agree 30(60%) while 10 (20%) were agree and 5(10%) were neutral

while 2(4%) were dis agree and remaining 3(6%) were strongly disc agree

4.17 Figure Lack of knowledge about obstetric danger signs often results in delays in seeking timely obstetric
care in order to obtain timely obstetric care

32
4.18 Table Women’s knowledge about obstetric danger signs has been related to a number of
factors.
Women’s knowledge about obstetric danger signs has been related to a number of factors.

Frequency Percent Valid Percent Cumulative

Percent
Valid strongly agree 20 40 40 40
Agree 10 20 20 20
Neutral 12 24 24 24
dis agree 5 10 10 10
strongly dis agree 3 6 6 6
Total 50 100.0 100.0

The majority of respondents were strongly agree 20(40%) while 10 (20%) were agree and 12(24%) were neutral

while 5(10%) were dis agree and remaining 3(6%) were strongly disc agree

4.18 Figure Women’s knowledge about obstetric danger signs has been related to a number of factors.

33
4.19 Table Women who are employed and work for paid job are more knowledgeable about obstetric
danger signs compared to their unemployed counterparts

Women who are employed and work for paid job are more knowledgeable about obstetric danger signs
compared to their unemployed counterparts
Frequency Percent Valid Percent Cumulative Percent

Valid strongly agree 30 60 60 60

Agree 10 20 20 20
Neutral 5 10 10 10
dis agree 2 4 4 4
strongly dis agree 3 6 6 6
Total 50 100.0 100.0

The majority of respondents were strongly agree 30(60%) while 10 (20%) were agree and 5(10%) were neutral

while 2(4%) were dis agree and remaining 3(6%) were strongly disc agree

4.19 Table Women who are employed and work for paid job are more knowledgeable about obstetric danger
signs compared to their unemployed counterparts

34
 CHAPTER FIVE
DISCUSSION, CONCLUSION AND RECOMMENDATION

5.1 DISCUSSION

Knowledge of obstetric danger signs and complications during pregnancy, labor and postnatal period is
the first essential step for appropriate and timely referral. The findings of this study has provided an
insight information on reproductive age women's knowledge about obstetric danger signs in the study
area, which could help in designing appropriate interventions and as a base for further wide scale studies
in other part of the country.

It was found that more than half of the study participants176 (54.7%) had good knowledge regarding
obstetric danger signs. The findings are comparable with findings on study done in India titled Assessment
of knowledge of obstetric danger signs among reproductive age women attending a teaching hospital, It
was found that more than half of the study participants (54.70%) had adequate knowledge of obstetric
danger signs.
This finding is higher than the studies done in Ethiopia titled Knowledge of obstetric danger signs among
child bearing age women in Goba district, Ethiopia: A cross-sectional study in which one third (31.9%) of
mothers were knowledgeable about danger sign . This difference could be resulted from the variation in
educational level of respondents and accessibility of information in these study settings

This study showed that in general our respondents had good level of knowledge on issues related obstetric
danger signs, since 45.3 %of the respondents had a poor level of knowledge. This is higher than the study
done in Ethiopia titled Level of Awareness on obstetric Danger Signs and Associated Factors, among
child bearing age women , Dire Dawa Administrative Public Health Facilities, Eastern Ethiopia In which
only 14.9% of the responder have poor knowledge regarding obstetric danger signs.

Dependent and independent variables were cross tabulated with each other. The is no significance
association between dependent and independent variable

35
5.2 Conclusion
More than half of the study participants, (54.7%), had good knowledge about obstetric danger signs. When
knowledge of specific obstetric danger signs was determined, a high proportion had very poor knowledge
of the individual danger signs. Less than half of the study participants had knowledge about important
Danger signs like convulsions, headache, vaginal bleeding, decreased fetal movements, and swelling of
feet. A high proportion of multigravida where aware of danger signs, when compared to primigravida.
However, none of the associated factors were found to be statistically significant. This very poor
knowledge of the specific danger signs may lead to a delay in seeking health care. Hence, it is imperative
to educate reproductive age women about obstetric danger signs, which could go a long way in improving
the maternal and fetal outcome

5.3 Recommendation

We recommend that ministry of health and MCH centers in Mogadishu to provide health
education programs related to obstetric danger signs.
Scaling up of health care providers (midwives, nurses, health extension professionals)
knowledge and skill by providing training on how to counsel and inform the mothers about
obstetric danger signs. Preparing and providing pamphlets, broachers that are supported by
pictures in order to make easy transfer of information.
A comparative study can be done between rural and urban set up.

36
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Obstetric Danger Signs among Recently-Delivered Women in Chamwino District, Tanzania: A
Cross-Sectional Study.” BMC Pregnancy and Childbirth 17 (1): 276.
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Mohammed, and Mazina Mohammed. 2019. “Assessment of Knowledge of Obstetric Danger
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5. Salem, Ania, Oriane Lacour, Stefano Scaringella, Josea Herinianasolo, Anne Caroline Benski, Giovanna
Stancanelli, Pierre Vassilakos, Patrick Petignat, and Nicole Christine Schmidt. 2018. “Cross-
Sectional Survey of Knowledge of Obstetric Danger Signs among Women in Rural Madagascar.”
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6. Teng, See Poh, Tey Chiao Zuo, Fauziah Binti Jummaat, and Soon Lean Keng. 2015. “Knowledge of
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 9. UNICEF Data: Monitoring the Situation of Children and Women (2015) Current status
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among Mothers in Tsegedie District, Tigray Region, Ethiopia 2013: Community Based Cross-
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9
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38
 APPENDIX I
QUESTIONNAIRE
INSTRUCTIONS

Do not write your name on this questionnaire

This research is only for academic purpose not for earning money
Please fill in the provided space to the best of your knowledge
All the information in this questionnaire will be kept confidential

SECTION A: SOCIO DEMOGRAPHIC DATA

1. Age of respondent:

a) 20-30 ( )

b) 31-40 ( )

c) 41-50 ( )

d) 51 above ( )

2. Gander:

a) Male ( )

b) Female ( )

3. Marital Status:

Married ( )

Single ( )

Divorce ( )

4. Educational level:

a) University level ( )

b) Secondary level ( )

c) Primary level ( )

d) None ( )

39
 5. Occupation:

a) Health Worker ( )

b) Other Employee ( )

c) Non employee ( )

Section B:
Responses
Strongly Agree Undecided Disagree Strongly
Agree Disagree
If women and their families recognize these
obstetric danger signs and seek timely health
care
In a woman’s life, pregnancy is regarded as a
normal phenomenon
However, around 40% of pregnancies re said to
be high risk, which could lead to adverse
maternal and fetal outcomes.
Informing women about obstetric danger signs
is among the strategies designed to enhance the
utilization of skilled care whenever obstetrics
complications are anticipated

Section C
Responses
Statements Strongly Agree Undecided Disagree Strongly
Agree Disagree
1. Obstetric danger signs are unexpected
obstetric signs that can lead to maternal
health complications.
2. The danger signs are mainly classified into
three categories, Major danger signs during
pregnancy include: severe vaginal bleeding,

3. Major danger signs during labor

and childbirth include severe
40
 vaginal bleeding, prolonged labor
(>12 h), convulsions, and retained
placenta.

4. Women’s knowledge about these obstetric danger

signs during pregnancy, delivery and postpartum is
still low in sub-Saharan African countries
5. Knowledge of danger signs of obstetric complications
is first step in the appropriate and timely referral to
essential obstetric care.

Section D
Responses
Statements Strongl Agree Undecided Disagree Strongly
y
Disagree
Agree
1. Although women’s knowledge about the
obstetric danger signs is important for improving
maternal and child health
2. The majority of obstetric complications can be
prevented if its occurrence is recognized and
women receive timely quality obstetric care

3. Lack of knowledge about

obstetric danger signs often
results in delays in seeking
timely obstetric care in order
to obtain timely obstetric care
4. Women’s knowledge about obstetric danger signs
has been related to a number of factors.

4. Women who are employed and work for paid job

are more knowledgeable about obstetric danger
signs compared to their unemployed counterparts

41
 APENDEX II map of Somalia

42
 Appendix III map of Mogadishu

43
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