MISRAKE GHION COLLEGE OF HEALTH SCIENCE DEPARTMENT OF

NURSING

ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE TOWARDS

OBSTETRIC DANGER SIGNS DURING PREGNANCY AMONG MOTHERS
ATTENDING ANTENATAL CARE IN WOLDIA COMPREHENSIVE
SPECIALIZED HOSPITAL IN WOLDIA TOWN, NORTH WOLLO ZONE,
AMHARA REGION, ETHIOPIA, 2015.

BY: ID
1. ROBEL SETITO----------------------------50/12
2. MULUNESH FASIL----------------------99/12
3. ABIRETSION BELAY--------------------95/12
4. ALEBACHEW TESEGA-----------------83/12
5. ABDU MUHAMMED---------------------122/12
6. SISAY ASME--------------------------------54/12

A PROPOSAL IS SUBMITTED TO MISRAKE GHION COLLEGE OF HEALTH SCIENCE

DEPARTMENT OF NURSING
ADVISORS: AKELE TEGEGNE(bCS,MSC)

JANUARY, 2015

DESSIE, ETHIOPIA
 MISRAKE GHION COLLEGE OF HEALTH SCIENCE DEPARTMENT OF
NURSING

ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE TOWARDS

OBSTETRIC DANGER SIGNS DURING PREGNANCY AMONG
MOTHERSIN WOLDIA COMPREHENSIVE SPECIALIZED HOSPITALIN
WOLDIA TOWN, NORTH WOLLO ZONE, AMHARA REGION, ETHIOPIA,
2015.

BY:
1. ROBEL SETITO
2. MULUNESH FASIL
3. ABIRETSION BELAY
4. ALEBACHEW TESEGA
5. ABDU MOHAMMED
6. SISAY ASME

A PROPOSAL IS SUBMITTED TO MISRAKE GHION COLLEGE OF MEDICINE

AND HEALTH SCIENCE DEPARTMENT OF NURSING

ADVISORS:AKELE TEGEGNE(BCS,MSC)

JANUARY, 2015

DESSIE, ETHIOPI
ACKNOWLEDGEMENTS

First of all we would like to praise and thank God for his grace and blessings, without him we
could not be here today. We would like to acknowledge Misrake ghion, College of Health
Sciences, Department of Nursing for assigning us to perform this research proposal. Our heartfelt
thanks goes to our advisors Mr. Akele tegegne(bcs,msc) for their continuous help equipping us
with the necessary knowledge, information, and encouragement and helping us to prepare this
research proposal.

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Contents
ACKNOWLEDGEMENTS..........................................................................................................................................i
ACRONYMS and/ ABBREVIATIONS......................................................................................................................iv
Summary..................................................................................................................................................................... vi
i................................................................................................................................................................................... vi
1. INTRODUCTION.......................................................................................................................................................1
1.1 BACKGROUND................................................................................................................................................... 1
1.2 STATEMENT OF THE PROBLEM..........................................................................................................................3
1.3 SIGINIFICANCE OF THE STUDY...........................................................................................................................5
2. LITERATURE RIVIEW............................................................................................................................................7
3. OBJECTIVE..............................................................................................................................................................11
3.1 GENERAL OBJECTIVE........................................................................................................................................11
3.2 SPECIFIC OBJECTIVE.........................................................................................................................................11
4. METHODOLOGY.....................................................................................................................................................13
4.1 Study Area and Period.....................................................................................................................................13
4.2 STUDY DESIGN.................................................................................................................................................13
4.3 SOURCE POPULATION......................................................................................................................................13
4.4 STUDY POPULATION........................................................................................................................................13
4.5 INCLUSION AND EXCLUSION CRITERIA.............................................................................................................13
4.5.1 INCLUSION CRITERIA:...............................................................................................................................13
4.5.2 EXCLUSION CRITERIA:...............................................................................................................................13
4.6 SAMPLE TECHNIQUE AND SAMPLE SIZE..........................................................................................................14
4.6.1 SAMPLE SIZE DETERMINATION.................................................................................................................14
4.6.2 SAMPLING PROCEDURE............................................................................................................................14
4.7 DATA COLLECTION...........................................................................................................................................15
4.8 DATA QUALITYASSESSMENT............................................................................................................................15
4.9 DATA PROCESSING AND ANALYSIS..................................................................................................................15
4.10 VARIABLES OF THE STUDY.............................................................................................................................16
4.10.1 DEPENDENT VARIABLE...........................................................................................................................16
4.10.2 INDEPENDENT VARIABLE........................................................................................................................16
4.11 OPERATIONAL DEFINITION............................................................................................................................16
4. 12 ETHICAL CONSIDERATION.................................................................................................................................17
5. Work plan...............................................................................................................................................................19
6. BUDGET PLAN........................................................................................................................................................ 20

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7. REFERENCES...........................................................................................................................................................21
ANNEXEX: የመረጃ ቅጽ.............................................................................................................................................23
Annex II: Questionnaires............................................................................................................................................32
DECLARATION.............................................................................................................................................................. 6

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ACRONYMS AND ABEREVIATIONS

ANC - Antenatal Care

HEW- Health Extension Worker

IEC- Information, Education and Communication

IMR- Infant Mortality Rate

KAP- Knowledge, Attitude and Practice

MDG- Millennium Development Goal

MMR- Maternal mortality rate

MOH- Ministry of Health

NMR-Neonatal mortality rate

SPSS -Statistical Package for Social Science

TV-Television

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List of table
t Table 1; Work plan to asses knowledge attitude and practice towards obstetric danger sign
during pregnancy among mothers attending antenatal care in woldia comprehensive specialized
hospital in woldia town amhara region, Ethiopia from December 2015 up to January 2015

Table 2; table that show budget plan to our study 2015

TABLE 3: age of mothers at woldia comprehensive specialized Hospital ,amhara region Ethiopia in
2015.

TABLE 4: marital status of mothers at woldia comprehensive specialized Hospital ;amhara region
Ethiopia in 2015.

TABLE 5; educational status of of mothers at woldia comprehensive specialized Hospital ;amhara

region Ethiopia in 2015.

TABLE 6: monthly income of of mothers at woldia comprehensive specialized Hospital ;amhara region
Ethiopia in 2015.

TABLE 7: gravidity and parity of of mothers at woldia comprehensive specialized Hospital ;amhara
region Ethiopia in 2015.

TABLE 8: knowledge about information of obstetric danger sign among of motheer at woldia
comprehensive specialized Hospital ;amhara region Ethiopia in 2015..

TABLE 9: knowledge prevalence among mothers at woldia comprehensive specialized Hospital ,

amhara region Ethiopia in 2015..

TABLE 10: attitude towards danger sign among mothers at woldia comprehensive specialized
Hospital ,amhara region Ethiopia in 2015.

TABLE 11: practice towards danger sign among of mothers at woldia comprehensive specailized
Hospital ;amhara region Ethiopia in 2015.

TABLE 12: time taken to reach nearby health center of of mothers at woldia comprehensive speciailzed
Hospital ,amhara region Ethiopia in 2015.

TABLE 13: for multi gravid, ANC follow up for the last pregnancy of mothers at woldia comprehensive
specialized Hospital ,amhara region Ethiopia in 2015.

TABLE 14: place where mothers who have delivered the last pregnancy at woldia comprehensive
spcieailzed Hospital ,amhara region Ethiopia in 2015.

v
Summary

Background: Pregnancy complications are the major health problems among women in
developing countries. Approximately half million women die from pregnancy related causes
annually and almost all of these maternal deaths occur in developing countries.

Objective: The objective of this study will be to assess knowledge attitude and practice of
obstetric danger sign during pregnancy among mothers attending antenatal care in woldia general
hospital.

Method: an institution based cross-sectional quantitative study will be conducted on a sample of

309 mothers who are at least 4 months pregnant will be selected from mothers who attend
durame general hospital during study period. Quantitative method of data collection will be
deployed by using pre tested structured interviewer administered questionnaire from a sample of
total respondents.

Work plan: The duration the research will be conducted from December to February 2015 E.C.

Budget plan: To study this research 7590 Ethiopia birr (ETB) will be needed.

vi
1. INTRODUCTION
1.1 BACKGROUND
Pregnancy complications are the major health problems among women in developing countries.
Approximately 529,000 women die from pregnancy related causes annually and almost all (99%)
of these maternal deaths occur in developing countries. The global maternal mortality is
unacceptably high (1). Although there was significant progress in all developing regions, the
average annual percentage decline in the global maternal mortality ratio (MMR) was 3.1%, short
of the millennium Development Goals (MDGs) target of 5.5%. Every day, almost 800 women
still die due to pregnancy or child birth, and for every woman who dies 20 or more experience
serious complications. One of the United Nations‟ MDGs is to reduce MMR by 75% by 2015
(2).

Developing countries account for 99% (284,000) of the global maternal deaths, the majority of
which are in sub-Saharan Africa (162,000) and Southern Asia (83,000). These two regions
accounted for 85% of global burden, with sub-Saharan Africa alone accounting for 56%.The
average maternal mortality ratio in developing countries in 2011 was 240 per 100,000 births
versus 16 per 100,000 in developed countries reflecting inequities in access to health services,
and highlighting the gap between rich and poor. Sub-Saharan Africa had the highest maternal
mortality ratio at 500 maternal deaths per 100,000 live births.
According to a systematic analysis of progress towards Millennium Development Goal 5 more
than 50% of all maternal deaths in 2008 were in only six countries (India, Nigeria, Pakistan,
Afghanistan, Ethiopia, and the Democratic Republic of the Congo) (3). The situation in Ethiopia
is similar to the situation in many developing countries. In Ethiopia the levels of maternal
mortality and morbidity are among the highest in the world and the current estimate of MMR
ratio for 7-year period preceding the 2016 EDHS is 412 deaths per 100.000 live births that
arefor every 1000 birth in Ethiopia. There are 4 maternal deaths. The 95 percent confidence
interval surrounding the maternal mortality estimate is 273 to 551 deaths per 100,000 live
births.1676 per 100,000 live birth 676 per 100, 000 live births. (4).

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Reduction of mortality and morbidity of both mother and newborn have been identified as
priority areas need urgent attention by the health sector.
Maternal morbidity and mortality could be prevented and minimized significantly if women and
their families recognize obstetric danger signs and promptly seek health care (6).
The commonest danger signs during pregnancy include severe vaginal bleeding, swollen
hands/face and blurred vision. Key danger signs during labor and childbirth include severe
vaginal bleeding, prolonged labor, convulsions, and retained placenta. Danger signs during the
postpartum period include severe bleeding following childbirth, loss of consciousness after
childbirth, and fever. Hemorrhage remains the leading cause of maternal mortality, accounting
for approximately one third of deaths (7). Many of the complications that result in maternal
deaths contributing to prenatal deaths are unpredictable, and their onset can be both sudden and
severe.

The complications leading to maternal death can occur without warning at any time during
pregnancy and childbirth (8). Low awareness of danger signs and symptoms during pregnancy,
labor, delivery and postpartum contribute to delays in seeking and receiving skilled care.

Awareness of the danger signs of obstetric complications is the essential first step in accepting
appropriate and timely referral to obstetric and newborn care. Knowledge of obstetric danger
signs and birth preparedness are strategies aimed at enhancing the utilization of skilled care
during low risk births and emergency obstetric care in complicated cases in low income
countries. Increased knowledge and awareness is essential for reducing delays in seeking health
care and in reaching a health facility. Communities and individuals should be empowered not
only to recognize pregnancy related risks, but they must also have the means to react quickly and
effectively once such problems arise (9-11).
The national reproductive strategy of Ethiopia has given emphasis to maternal and newborn
health so as to reduce the high maternal and neonatal mortality. The strategy focuses on the need
to empower women, men, families and communities to recognize pregnancy related risks, and to
take responsibility for developing and implementing appropriate response to them. One of the
targets in the strategies is to ensure that 80% of all families recognize at least three danger signs

2
associated with pregnancy related complications by 2010 in areas where health extension
program is fully implemented (12).

1.2 STATEMENT OF THE PROBLEM

Maternal mortality is the leading cause of the adult female deaths in many countries. Women
death during childbirth often means death for the newborn, and both death and disabilities
translate into emotional, social, and economic hardships for women’s older children, their entire
families, and even for communities (11). Every minute, a woman dies due to causes related to
pregnancy, childbirth and postnatal period (13).
Maternal deaths are avoidable, if women with complications are able to identify and seek
appropriate emergency obstetric care, which makes a difference between life and death (14).
Maternal deaths have both direct and indirect causes. Around 80% of maternal deaths worldwide
are brought about by direct obstetric complications.
The five major global causes of maternal death are: severe bleeding (mostly bleeding
postpartum), infections (also mostly soon after delivery), unsafe induced abortion, hypertensive
disorders in pregnancy (eclampsia) and obstructed labor. Globally, about 80% of maternal deaths
are due to these causes. Hemorrhage alone accounts for one third of all maternal deaths in Africa,
yet many of these deaths are preventable. Severe bleeding after birth can kill a healthy woman
within two hours if she is unattended. Obstetric fistula resulting from obstructed labor is a long-
term complication suffered by as many as two million women). Indirect causes such as malaria,
diabetes, hepatitis, anemia and other cardiovascular disorders, which are aggravated by
pregnancy, can also lead to maternal death (1, 3).

Awareness of the danger signs of obstetric complications is the essential first step in accepting
appropriate and timely referral to obstetric and newborn care. Raising awareness of women on
danger signs of pregnancy, childbirth and the postpartum period improve mothers’ attitude to
seek medical care and is crucial for safe motherhood (11).
When mothers do not recognize the danger signs in pregnancy, adverse effects can occur to the
mother, the unborn baby, or the pregnancy itself. Adverse effects include: Illness or death of the
mother, for instance, severe bleeding can lead to anemia or death of the mother, infection to the

3
unborn baby through prematurely ruptured membranes, when amniotic fluid leaks from the
vagina. If not attended to, this can lead to fetal or neonatal morbidity and mortality, termination
of a pregnancy before term in vaginal bleeding. Maternal hypertension or fever, can lead to
increased numbers of neonatal deaths or prematurely born babies who may eventually die due to
inadequate facilities to care for them (2). A mother’s death in childbirth denies her children their
natural, primary care giver and significantly increases the risk that her infant will die or fail to
survive to age 5.
A mother’s death also has an extremely detrimental effect on her children’s access to education
and health care. Many children who survive without mothers also risk being emotionally lost (1,
2, 3). Most maternal deaths are avoidable, as the health care solutions to prevent or manage
complications are well known. All women need access to antenatal care in pregnancy, skilled
care during childbirth, and care and support in the weeks after childbirth. It is particularly
important that all births are attended by skilled health professionals, as timely management and
treatment can make the difference between life and death (1, 2).
According to the Ethiopian Federal Ministry of Health, health professionals attend only10% of
the deliveries. In one nation where the maternal mortality ratio is 676 per 100,000 live and IMR
59/1000 and NMR 37/1000 live births which are the highest in the world.
In Ethiopia, there is little information about the knowledge, attitude and practice of obstetric
danger signs during pregnancy since the introduction of Health Extension Workers (HEWs),
despite the national Reproductive strategy aim to raise the awareness to 80% in the area in which
HEW are deployed (12). Studies conducted in AletaWondo district, indicated that the knowledge
level of pregnant women about obstetric danger signs (during pregnancy, childbirth and
postpartum period) was low and affected by residential area.

Therefore, the identified deficiencies in awareness should be addressed through maternal and
child health services by designing an appropriate strategies including provision of targeted
information, education and communication. In spite of great potential of knowledge, attitude and
practice of obstetric danger signs in reducing the maternal and newborn deaths its status, is not
well known in most of Sub-Saharan Africa including Ethiopia (15).
The study therefore aims to fill this gap by assessing the current status of knowledge, attitude
and practice of danger signs among mothers in the study area.

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1.3 SIGINIFICANCE OF THE STUDY

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.
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 stakeholders:
The outcome of the study can be an input for concerned policy makers in decision-making
process regarding obstetric danger signs for pregnant and delivered mothers. And also it serves
as an input for health education program undertaken by different organizations so as to keep the
pregnant and delivered mothers being aware of the consequence of obstetric danger signs.

It is also assumed to help the health sector management to notice the current situation of their
clients and pregnant mothers danger signs KAP and then to work accordingly with other
stakeholders like families, health professionals, governmental and nongovernmental
organizations and with the university students as well. It can be used as a stepping-stone for
health professionals if there is any possibility of intervention.

This study can be used as a base for other health professionals including midwives in
understanding the situation of the case and extending their intervention or work to different
institutions.
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.

5
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.

6
2. LITERATURE RIVIEW

Relative to other negative health outcomes, maternal mortality is not widely perceived to be a
major personal health risk. Many communities are declared to accept a certain level of maternal
and newborn mortality as a natural occurrence. Low knowledge of danger signs and symptoms
during pregnancy, labor, delivery and postpartum period contribute to delays in seeking and
receiving skilled care (18, 19).
The low status of women, poverty and background system also prohibit women from obtaining
maternal services. In most societies within the country there is little or no encouragement or
support for women with pregnancy complication to seek appropriate care. Furthermore, women
as well as the family members are often not aware of the life threatening danger signs of
pregnancy or birth related complications, on either the mother or the newborn (20).

Information, education and communication (IEC) strategies designed to increase the knowledge
of danger signs during pregnancy, child birth or postpartum period among women. Safe
motherhood programs can effectively increase knowledge of danger signs of pregnancy through
facility and community based educational strategies (21).

According to a study from Sidama Zone in Ethiopia, when asked to mention danger signs during
pregnancy the most common spontaneously mentioned danger signs were vaginal bleeding by
45.9%, difficulty of breathing by 14.1% and loss of consciousness by 12.7%. Other signs
mentioned include high fever accounting for 9.2%, severe headache for 7.4%, and severe
abdominal pain for 7.0%. 39.0% didn't know any danger signs of pregnancy. 30.4% mentioned at
least two danger signs during pregnancy and 63.6% believed that a woman could die of the
above-mentioned danger signs (15).

According to the study in Tsegedie District, vaginal bleeding was the most commonly
mentioned danger signs of pregnancy (49.1%) and childbirth (52.8%). 58.8% of respondents
mentioned at least two danger signs of pregnancy. 35.1% of respondents didn’t know any danger
signs of pregnancy (16).

7
Cross sectional study in Tanzania revealed as there were no differences in the awareness of
danger signs during pregnancy, delivery or after delivery as related to age, educational level,
number and place of deliveries. Number of antenatal care visits and woman informed of a
complication during antenatal care and having secondary education or above increase the
likelihood of awareness of obstetric danger signs. Moreover, the likelihood of awareness of
obstetric danger signs increased with age, number of deliveries, number of antenatal visits, when
deliveries was at a health institution.
According to this study marital status, occupation, and advice to deliver in hospital were not
associated with awareness of a danger sign during pregnancy, delivery and after delivery (19).
Study done in Tanzania Mpwapwa district women with primary education and above were twice
more likely to be prepared for birth and ready for complications (22).

A cross sectional study done in Gambia revealed that women who had four or more pregnancy
had good awareness about pregnancy danger sign than those with a few pregnancies. Apart from
this two to four children and higher number of visits were not significantly associated with
higher levels of awareness of danger signs. Pregnant women who received antenatal care in rural
areas and those that received antenatal care in urban areas were similar in most respects with
regard to knowledge of danger signs of pregnancy, delivery/ labor, and postpartum period. This
study also revealed; ANC follow up only will not make the women to have high awareness of
danger signs of obstetric complications. Better awareness of danger signs was strongly
associated with higher level of education of the woman.
Educated women are more likely to seek appropriate medical care during pregnancy and delivery
(25). Safe motherhood programs can effectively increase knowledge of danger signs through
clinic and community based educational strategies. IEC strategies designed to increase the
awareness of danger signs during pregnancy, delivery or the postpartum period among pregnant
or recently pregnant women (21).
A prospective community based intervention study in Pakistan revealed health education of
mothers in the community improves mother’s knowledge about danger sign of pregnancy (26).

Studies in Tanzania and Guatemala revealed the role of educational status in increasing women
awareness of obstetric danger signs. The difference was statistically significant between level of

8
awareness and level of education (19, 21). Occupation, number of family members, parity, and
places of previous delivery, attendance of ANC and women with pregnancy complication during
last pregnancy associated with knowledge of danger sign of pregnancy (8, 21, 23).
Socio-economic and cultural factors were among major barriers of knowledge on pregnancy
related complications and preventing mothers not to have knowledge about danger sign of
pregnancy (28). Women who are using health facilities, who had heard radio, TV message or
participated in women groups, are more likely to have heard of danger signs in pregnancy (21).
Un-educated women and those not using health facilities for delivery care are more likely to
have pregnancy complications in the later stage of pregnancy (26).

In most societies there is little or no encouragement or support for women who have a pregnancy
complication to seek appropriate care. Women, particularly in the poor socio-economic status
have the tendency of late reporting of morbidity episodes. Hence it is necessary to impart
knowledge about pregnancy related problems and to understand the root cause of generating
complications during delivery among such poor women (28).

Maternal and child survival are dependent up on recognition of the problem, decision making
about care, access to care, and quality of care (29). Anya et al (2008) who stated that, educated
women have better pregnancy outcome compared with un- educated women. The danger signs
occurring during pregnancy are predictive of poor outcome rather than historic risk factors (30).
Educated women have better pregnancy outcome compared with uneducated women (25).
A study done on Knowledge and Practice of maternal health care in Indonesia, revealed that
among the pregnant women who attended ANC, 36.6% of the respondents gave correct answers
to a question on common knowledge such as, it is necessary to go to the hospital when severe
headache or vision problems happens in pregnancy (32). This indicates that when women are
taught about danger signs, they develop positive attitude towards their own health and their
pregnancy.
In a related study done in Lusaka on Attitude and Practice of childbearing women towards
danger signs in pregnancy, revealed that the hindrances to positive attitude were low income and
noninvolvement of other relatives in decision-making when danger signs are observed. This

9
indicates that adequate income levels allow pregnant women to seek medical services early when
they face pregnancy related problems (31).

The study done in Karachi indicates a poor knowledge of common and serious pregnancy related
complications based on their perception related to danger signs. Five percent of the women
perceived absent/decreased fetal movement as a danger sign of pregnancy. Other reported danger
signs included premature uterine contraction by 3%, premature rupture of membranes by 3%,
convulsions by 13%, obstructed labor by 23% and bleeding by 39% (33).

In summary, low awareness of danger signs and symptoms during pregnancy, labor, delivery,
and post-partum contribute to delays in seeking and receiving skilled care. Safe motherhood
programs can effectively increase knowledge of danger signs through clinic and community
based educational strategies. Recognition of danger signs in pregnancy and subsequently getting
medical help can drastically affect maternal and newborn morbidity and mortality. Awareness of
obstetric danger signs increased with age, number of deliveries, number of antenatal visits, when
delivery was at a health institution.

Many studies revealed age, residence, marital status, occupation, educational level, gravidity,
parity, number of family members, places of previous delivery, attendance of ANC and women
with pregnancy complication during last pregnancy associated with knowledge of danger sign of
pregnancy. Studies revealed maternal and child survival rate dependent upon recognition of the
problem, decision making about care, access to care, and quality of care.

A study conducted in Debre Berhan shows that, out of the total respondents 75.9% knows about
danger signs during pregnancy. (35)

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 3. OBJECTIVE
3.1 GENERAL OBJECTIVE
Assessment of knowledge, attitude and practice towards obstetric danger signs during pregnancy
among mothers attending antenatal care in woldia comprehensive specialized hospital north
wollo zone, amhara region, Ethiopia 2022.

3.2 SPECIFIC OBJECTIVE

 To assess mothers level of knowledge on danger signs during pregnancy.
 To determine mothers attitude towards danger signs during pregnancy.
 To assess mothers practice on danger signs during pregnancy.

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4. METHODOLOGY
4.1 Study Area and Period
Our study will be conducted at Woldia comprehensive specialized hospital in
Woldia town, which is located at about 360 km from Bahir Dar and 520km far
from Addis Ababa, the capital city of Ethiopia and the town has an elevation of
2112 meters above sea level.Woldia has one general hospital, two health centers,
and four health posts. Woldia comprehensive specialized hospital is one of the best
served hospitals in Amhara region and its first name was RAS WELE BITUL. The
hospital was opened in 1953E.C by American missionary. It covers an area of
115,156.10 square meters.. The hospital located in the north from Waghimra, in the
west from south Gondar, in the east from Afar region and in the south from south
Wollo. The hospital serves about a population of more than 3 million people and
the patient flow from the following areas: East Afar region (Chifra, Kelewanete),
southern south Wollo (Ambasel and Delanta), Northern Tigray, Western north
Gondar (Gaynt) The hospitals has 262 beds in different wards like: in medical
ward, surgical ward, pediatrics ward, NICU, orthopedics, psychiatric ward,
obstetrics and gynecology ward, intensive care unit, ophthalmic ward etc.

The study will be conducted from December 2022 to February 2023

STUDYDESIGN

Institution based cross-sectional quantitative study will be conducted

4.3 SOURCE POPULATION
All pregnant women with gestational age of at least 4 months who attended ANC follow up
during study period.

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4.4 STUDY POPULATION
Randomly selected women of childbearing age who were with gestational age of at least 4
months on which time the actual study will be conducted in woldia comprehensive specialized
hospital.
4.5 INCLUSION AND EXCLUSION CRITERIA
4.5.1 INCLUSION CRITERIA:
Mothers who were mentally and physically capable of being interviewed and those who were
volunter to participate in the study.

4.5.2 EXCLUSION CRITERIA:

Mothers who were critically sick and involuntary to participate in the study.

4.6 SAMPLE TECHNIQUE AND SAMPLE SIZE

4.6.1 SAMPLE SIZE DETERMINATION
The sample size(n) required for the study will calculated by using single population
proportion based on the following assumptions: 95% confidence level;

Proportion 75.9% (a study conducyed in Debre Berhan, Ethiopia)

 n=number of sample required for the study

 p=Proportion of women aware of danger signs during pregnancy is 75.9%from
previous study
 Z α/2=(1.96) standard normal variable at 95% confidence interval
 d= margin of error I will like to tolerate (5%)

n= (1.96)2 (0.759) (1-0.759) /(0.05)(0.05) Therefore; n=281 mother

Then considering the non-response rate 5% the final sample size will be 295

4.6.2 SAMPLING PROCEDURE

The study units are all pregnant mothers who visit ANC clinic at public health institutions in
woldia town during the time of data collection period and they will be selected through

13
systematic sampling technique by keeping the sample fraction as follow ; Total population in the
previous last two month at woldia General hospital is 483 and then we divide this by the
calculated sample size and give us;483\295=1.6[approx. 2]so study participants will be taken
every two ANC mother until we get 295 respondants. The first mother is obtained by lottery
method.

4.7 DATA COLLECTION

Data will be collected with interview and questionnaire. The interview will be conducted for
those who can’t read and write and the self-administered questionnaire will be conducted for
those who can read and understand the questionnaire. Fourth year nursing students will collect
data. The questionnaire will be prepared in Amharic language. The questionnaire consists of six
parts with a total of 42 questions. The first part was about socio-demographic characteristics of
the study participants composed of 8 questions. The second part was about past obstetric history
and other part consisted of questions raised for assessment of obstetric danger signs knowledge,
attitude, and Practice and health service related. Questions about past obstetric history include-
gravidity, parity, number of children and decision maker during delivery .Questions about
knowledge -on obstetric danger signs consists of 7 questions focusing on information given,
meaning of obstetric danger signs, source of information, can any woman develop, mentioning
danger signs they know. The attitude aspect includes- importance of knowing danger signs and
health seeking behavior of mothers. Practice of obstetric danger signs include-experience of
obstetric danger signs, what danger signs they experienced and measure they took when they
faced obstetric danger signs. The last part was health service related question and it was
consisted of-time it takes to nearest health facility, ANC follow up, number of ANC visits, last
delivery place.

4.8 DATA QUALITY ASSESSMENT

To keep the quality of data pre testing of questionnaire will be conducted in with 5% of sample
size. The data collectors will be trained on the aspect of data collection tools, interview,
questioning techniques and ethical issue. The invalid questionnaire will be rejected.

14
 4.9 DATA PROCESSING AND ANALYSIS
Using SPSS software package for editing, cleaning, coding and check completeness and
consistency will enter data. The entered data will be analyzed systematically. Different version
of software will be used for data processing.

4.10 VARIABLES OF THE STUDY

4.10.1 DEPENDENT VARIABLE
- Knowledge
- Attitude
- Practice
4.10.2 INDEPENDENT VARIABLE
Socioeconomic and demographic factors:

 Age .Educational status

 Marital status
 Religion
 Ethnicity
 Monthly income
Obstetric factors
 Parity
 History of still birth
 Number of children,
 Live birth
Husband’s factors
 Occupation
Health service related factors
 Time taken to nearest health facility
 ANC follow up

15
4.11 OPERATIONAL DEFINITION
Danger signs: Presence of condition that increases the chances of pregnant woman and/ or her
unborn child dying or having poor health.
Mothers: Refers to women who are pregnant and/ or who have child. Knowledge: Knowledge of
obstetric danger signs means the basic information that the mothers have regarding obstetric
danger signs.
Good knowledge: refers to those participants who respond correctly to knowledge questions and
score above the median value.(36)
Poor knowledge: refers those participants who correctly respond to knowledge questions and
score median value and below the median value.(36).
Attitude: it is an opinion of study participants towards obstetric danger signs. Positive Attitude:
refers to those participants who respond correctly to attitude questions and score above the
median value
Negative Attitude: refers to those participants who respond correctly to attitude questions and
score median value and below the median value Practice: A woman’s activities in relation to
obstetric danger signs of pregnancy. (37).
Good practice: refers to those participants who seek medical care first when they experience
obstetric danger signs.
Poor practice: refers to those participants who seek care from a TBA and an older woman first,
and who stayed home when they experience obstetric danger signs.
Health personnel: (HEW, physicians, health officers, nurses/midwives) who can manage
normal deliveries and diagnose, manage or refer obstetric complications.
Not married፡ mother who were not in marital union during data collection.Informal education-
Mothers who were illiterate and can read and write only. Formal education- Mothers who were
primary and secondary school.
High level education: Mothers whose educational status were diploma and above

4. 12 ETHICAL CONSIDERATION
Ethical clearance letter will be obtained from misrake ghion collage, Faculty of Health Science;
department of nursing. The purpose of the study is to explain the participants and at the time of
16
data collection informed verbal consent will be taken from the participant to confirm whether
they are willing to participate or not. Those who are not willing to participate are will be given
the right to do so. Confidentiality of the information and privacy of the interviewee will be
ensured throughout the research process.

5. WORK PLAN
A GANTT chart showing a work plan to assessto knowledge attitude and practice towards
obstetric danger signs during pregnancy among mother in woldia health center in woldia town
amhara region,Ethiopia from December 2022 up to February 2023.

No Activities Dece Dece Dec De Ja Janu Febr Responsible

mber mber em ce n ary uary Body
2022 2022 ber mb ua 2023 2023
202 er ry
2 20 2

17
 22 0
2
3
1 Preparation of the thesis TWT
proposal
2 Preparation of data collection TWT
tools
3 Approval of ethical clearance TWT
and budget securing
4 Recruitment and training of TWT
supervisors and data collectors
5 Pre-testing TWT
6 Data collection TWT
7 Data coding, entry and cleaning TWT
8 Data analysis TWT
9 Preparation thesis report TWT
10 Thesis presentation and TWT
submission

6. BUDGET PLAN

Number Items Unit Quantity Unit price Total

1 Secretary work Per person 1 50 birr 1500

2 Questionnaire Piece 1124 0.75 birr 843 birr

18
 duplication
3 Printer paper Piece 4 4 birr 16

4 Pen Each 5 5 birr 25

5 Eraser Each 4 4 birr 16

6 Transportation Each 3 100 3000

7 Each 3 50 1500

Total 6900

Contingency (10%) 690

GrandTotal 7590

7. REFERENCES

1. UNICEF. A Global Overview of Maternal Mortality.2010

2. UNFPA. Safe Motherhood Stepping up Efforts to Save Mothers‟ Lives 2011.
3. WHO. Trends in Maternal Mortality: 1990 to 2010, WHO, UNFPA, UNICEF and World
Bank. Geneva 2012.
4. Central Statistical Agency and ORC Marco. Ethiopian Demographic and Health Survey,
2016.Addis Ababa, Ethiopia and Calverton, Maryland, USA; 2012.
5. Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Social Science
Medicine 1994; 38: 1091-1110

19
6. Jackson D. Love day M, Doherty T, Mbombo N, Wington A, MatizirifaL,et al.
Community Based Situation Analysis: Maternal and Neonatal Follow-up Care.Durban:
Health Systems Trust.2006. p. 9-13.
7. Dutta DC. Text Book of Obstetrics. 6th ed. Calcutta: New Central Book Agency (P) Ltd;
2004.p. 121-124.
8. Rashad WA, EssaRM.Women‟s Awareness of Danger Signs of Obstetrics Complications
in Egypt. Journal of American Science 2010; 6(10): 1299-1306.
9. Kabakyenga JK, Ostergren PO, TuryakiraE,Pettersson K. Knowledge of obstetric danger
signs and birth preparedness practices among women in rural Uganda. BMC pregnancy
and Child birth 2011,11: 73
10. Mihret H, Mesganaw F: Birth preparedness and complication readiness among women in
Adigrat town, northern Ethiopia. EthiopJHealthDev 2008, 22(1):14–20.
11. JHPIEGO. Monitoring birth preparedness and complication readiness: tools and
indicators for Maternal and Newborn health Baltimore.2004.
12. Federal Democratic Republic of Ethiopia, Ministry of Health. National Reproductive
Strategy, 2006-2015. Addis Ababa, Ethiopia: FMOH; 2006.p. 16-21.
13. Abouzahr C. Safe Motherhood:a brief history of the global movement. World Health
Organization, Geneva, Switzerland 1947-2002.
14. WHO. Why do so many women still die in pregnancy or childbirth? 2005.
15. MesayHailu et al, knowledge about obstetric danger signs among pregnant women in
AletaWondo district, Sidama zone, Southern Ethiopia. Ethiopian Journal of Health
Development 2007; 20(1); 25-32.
16. Hailu D, Berhe H (2014) Knowledge about Obstetric Danger Signs and Associated
Factors among Mothers in Tsegedie District, Tigray Region, Ethiopia
17. Gebrehiwot et al. Awareness of Danger Signs of Pregnancy and its Associated Factors
among Pregnant Women who Visit ANC in Mekelle Public Hospitals, 2014.
18. USAID. Family Planning and Reproductive Health Indicators Database.Existence of a
safe motherhood strategic plan to promote access and quality of safe motherhood
services.Measure Evaluation Population and Reproductive health 2010.
19. Pembe et al: Rural Tanzanian women‟s awareness of danger signs of obstetric
complications.BMC Pregnancy Child birth March 2009, 9; 12.

20
20. Nepal. Improving Maternal, Newborn and Child Health in the South East Asia Region.
2005. p. 63.
21. PerreiraKM,Bailey PE, De Bocaletti E, Hurtado E, Recinos de Villagran S, Matute J,
Increasing awareness of danger signs in pregnancy through community and clinic based
education in Guatemala. Maternal Child Health Journal 2002; 6(1): 19-28.
22. Urassa DP, Pembe AB and Mganga F. Birth preparedness and complication readiness
among women in Mpwapwa district, Tanzania. Tanzania Journal of Health Research
January 2012; 14(1): 3-6
23. Ali AA, RayisDA ,Abaker AO, Adam I. Awareness of danger signs and nutritional
education among pregnant women in Kassala, Eastern Sudan. Sudanese Journal of Public
Health 2010; 5(4): 179-181.
24. AlamAY,Qureshi AA, Adil MM, Ali H. Comparative study of Knowledge, Attitude and
Practices among Antenatal Care Facilities utilizing and non- utilizing women in
Islamabad. Journal of Pakistan Medical Association 2004; 55(2): 2-4.
25. Anya SE, Hydara A, Jaiteh LES. Antenatal care in The Gambia: Missed opportunity for
information, education and communication. BMC Pregnancy and Childbirth 2007, 8:9.
26. Agboatwalla M, Akram DS. Impact of Health education on mothers‟ knowledge of
preventive health practices, Karachi Pakistan. PubMed Journal of Pakistan Medical
Association 1997; 27(4): 199- 202.
27. Cham M, Sundby J, Vangen S. Maternal mortality in rural Gambia, a qualitative study on
access to emergency obstetric care BMC Reproductive Health 2005; 2:3.
28. Sarode VM. Does illiteracy influence pregnancy complications? Among women in the
slums of greater Mumbai. International Journal of Sociology and Anthropology 2010;
2(5): 82-94.
29. WHO. Maternal, Neonatal, and child health. Strategy Global Health program 2009.
30. Nikiema B, Beninguisse G, Haggerty JL.Providing information on pregnancy complications
during antenatal visits: unmet educational needs in sub- Saharan Africa. Health policy and
planning 2009; 34: 370-374.
31. Chongo C. A study to determine knowledge attitude and practice of women in child
bearing age towards danger signs in pregnancy in Lusaka, urban Lusaka 1885.
32. Marco A. Knowledge and practice of maternal health care in Indonesia 2003.

21
 33. I. J. Hasan, N. Nisar. Women‟s Perceptions regarding Obstetric Complications and Care
in a Poor Fishing Community in Karachi, 1999.
34. YinagerWorkineh, DestaHailu, TeklemariamGultie, NegaDegefu, MinaleMihrete,
MeleseShimeles ,MelkamuMahino, MekidesGuesh,MartaAlemu. Knowledge of Obstetric
Danger Signs and its Associated Factors in Arba Minch Town, Ethiopia.American
Journal of Health Research.Vol. 2, No. 5, 2014, pp. 255-259. doi: 10.11648/j.ajhr.20140205.16
35. NurgiS, Tachebele E, DibekuluW ,wondim MA (2017) Knowledge, Attitude and Practice
of Obstetric Danger signs during pregnanacy in Debre Berhan,Ethiopia. Health sci. J.
Vol.11 No.6:533.
36. Kassahunyimam assessment of hand hygiene practice and associated factor among under
graduate medical student in college of health science ;Addis Ababa University,
Tikuranbessa specialized hospital, Ethiopia, September 2014.
37. Owusu-ofori A,Jennings R, Burgess J, prasad PA,Acheampong f,coffin S.assessing hand
hygiene resource and compliance at a larg Africa teaching hospital . Infect control
hospepidemiol,2010; 31(8):802-8.

ANNEXEX: የመረጃ ቅጽ
ምስራቀ ግዮን ኮሌጅ
የህክምናና ጤና ሳይንስ ኮላጅ
የነርሲግ ትምህርት ክፍል
የጥናቱ መረጃ ቅጽ
በእናቶች ሊይ በእርግዝና፣በወሊድ እና በድሕረወሊድ ጊዜ ሊከሰቱ ስለሚችሉ አደገኛ ምሌክቶች የእናቶችን
ዕውቀት፣አመለካከት እና ተግባር ለመፈተሽ የተዘጋጀ መጠይቅ። የጥናቱ ርዕስ በ ወልድያ ሆስፒታል
በእርግዝና፣በወሊድ እና ከወሊድ በኋላ /ድሕረ ወሊድ/ ጊዜ ሊከሰቱ ስለሚችሉ አደገኛ ምሌክቶች የእናቶችን
ዕውቀት፣አመለካከት እና ተግባር መፈተሽ። የጥናቱ አላማ በእርግዝና ውቅት፣ በወሊድ ጊዜ እና ከወሊድ በኋላ
እናቶችን ሊያጋጥሙ ስለሚችሉ አደገኛ ምልክቶች የእናቶችን ዕውቀት፣አመለካከት እና ተግባር ለመፈተሽ ነዉ፡፡
የሚመለከተዉ የመንግስት አካል የእናቶችን ሞት ለመቀነስ አስፈላጊዉን እርምጃ እንዲወስዱ ለማድረግ ነዉ፡፡
ምስጢራዊነት በጥናቱ ላይ መሳተፍ በፈቃደኝነት ላይ የተመረኮዘ ና የምሠጡት መረጃም ለጥናቱ አላማ ብቻ የሚሆን

22
ነዉ፡፡ በጥናቱ ላይ አለመሳተፍ ወይም መሳተፍ ጀምረዉ ማቋረጥ ከፈለጉ ማቆም ይችላሉ፡፡እንዲሁም መመለስ
የማይፈልጉትን ጥያቄዎች አለመመለስ ይችላሉ። ነገር ግን በጥናቱ ላይ ባለመሳተፎ ምንም ዓይነት ተፅእኖ ወይም ጉዳት
የለውም፡፡ ይህን ጥናት በተመለከተ ጥያቄ ካለዎት በ 0943233730 ደውለው ይጠይቁ፡፡
robelsetito@gmail.com
የተሳታፊ ፊርማ__________________
ቀን_____________
አመሰግናለሁ።

የስምምነት ማስገንዘቢ ያቅጽ

መለያ ቁጥር_________________________
ጤና ይስጥልን! እኛ የነርሲንግ ተማሪ ስንሆን በእናቶች ላይ በእርግዝና፣በወሊድ እና በድሕረወሊድ ጊዜ ሊከሰቱ
ስለሚችሉ አደገኛ ምልክቶች የእናቶችን ዕውቀት፣አመለካከት እና ተግባር ለመፈተሽ የሚደረግ ነው::ጥናቱ የሚካሄደዉ
በቃለመጠይቅ ሲሆን የሚሰጡኝ መረጃዎች በሙሉ ምሰጥራዊነታቸዉ በሚገባ የተጠበቀና ለዚህ ጥናት ብቻ የሚዉሉ ናቸዉ።
የእርሶ ስም በየትኛዉም ቦታ ላይ አይጻፍም። በአጠቃላይ መጠይቁ በፍቃደኝነት ላይ የተመረኮዘ ነዉ።እርሶ በጥናቱ
ለመሳተፍ ሆነ ላለመሳተፍ ሙሉ መብት አለዎት። በዚህ ጥናት አልሳተፍም ቢሉ ምንም ዓይነት ችግር አይገጥሞትም፡፡
በመጨረሻም ይህን ጥናት በተመለከተ ጥያቄ ካለዎት በሞባይል ስሌክ ቁጥር 0943233730 መጠየቅ ይችላሉ፡፡
ለዚህመረጃጥናትእንዱውልመረጃለመስጠትፈቃደኛ ኖት?
አዎ ------- አይደለሁም -------
በዚህ ጥናት ላይ ስምምነቱን ያስሞላ ሰዉ
ስም_______________________ ቀን_____________ ፊርማ_________
ዉጤት
1. በሙሉ ተሞልቷል-----------------------------------------------
2. መርጃ ሰጪዋ ፍቃደኛ አይደለችም----------------------------
3. መርጃዉ በግማሸ ተሞልቷል------------------------------------
23
4. ሌላ ካለ ይግለጹ_______________________________
ያረጋገጠዉ፡ ስም_______________________ ቀን_____________ ፊርማ_________

በአማሪኛየተዘጋጀ ቃለመጠይቅ
1. መለያ ቁጥር________
2. ቀበሌ____
3. የቤት ቁጥር.________

ክፍሌ አንዴ፡ ስነ-ህዝብን (ዱሞግራፊን) የተመለከቱ ጥያቄዎች

ቁጥር ጥያቄ ምርጫዎች
1.1 ዕድሜ (በሙሉ ዓመት): ---------------
1.2 የጋብቻ ሁኔታ: 1) ያላገባች
2) ያገባች
3) ባልዋ የሞተባት
4) የፈታች
1.3 ሀይማኖት: 1) ኦርቶዶክስ
2) ካቶሊክ
3) ፕሮቴስታንት
4) ሙስልም
5) ለላካለይግለጹ-----------
1.4 ብሔር 1) ከሚባታ
2) ሀድያ
3) ሀላባ
4) ለላ
1.5 የስራሁኔታ 1) የቤት እመቤት
2) የመንግስት ሠራተኛ
3) የግል ሠራተኛ
4) ነጋዴ
5)ለላካለይግለጹ_______

1.6 የትምህርት ሁኔታ: 1) ያልተማረ

2)ማንበብና መጻፍየሚትችል

24
 3) የመጀመሪያ ደረጃ
4) ሁለተኛ ደረጃ
5) ዲፕልማና ከዚያ በሊይ
6)ለላካለይግለጹ_______
1.7 የወር ገቢ 1) <500 ብር
2) 500-1000 ብር
3) 1001-1500 ብር
4) 1501-2000 ብር

1.8 የባለቤትዎ የሥራ ሁኔታ: 1) የግል ሠራተኛ

2) የመንግስት ሠራተኛ
3) ነጋዴ

ክፍልሁለት: ያረገዙት እና የወለዱአቸዉ ልጆች ብዛት

ቁጥር ጥያቄ መልስ
2.1 በአጠቃላይ ስንት ጊዜ ነዉ ያረገዙት? 1 ኛ) 1
2 ኛ) 2 - 4
3 ኛ)ከ 4 ጊዜ በላይ
2.2 በመጀመሪያ እርግዝናዎት ጊዜ 1 ኛ) ከ 20 በታች
2 ኛ) 20-29
ዕድሜዎት ስንት ነበር?
3 ኛ) 30 ና ከዚያ በላይ
2.3 በአጠቃላይ የወለዱአቸዉ ልጆች ብዛት 1 ኛ) 0
2 ኛ) 1 – 4
ስንት ናቸዉ?
3 ኛ) >4
2.4 ካረገዙት ዉስጥ በህይወት የተወለዱት 1 ኛ) 0
2 ኛ) 1
ልጆች ብዛት ስንትናቸዉ?
3 ኛ) 2+
2.5 ካረገዙት ዉስጥ ሞተዉ የተወለዱት 1 ኛ) 0
ልጆች ብዛት? 2 ኛ) 1
3 ኛ) 2 +
2.6 ስንት ልጆች አሉሽ? 1 ኛ) ልጆች የለኝም
2 ኛ) 1-4 ልጆች
3 ኛ)5 እና በላይ

25
ክፍሌ 3: በእርግዝና ጊዜ ሊከሰቱ ስለሚችሉ አደገኛ ምልክቶችን የተመለከተ የዕዉቀት መጠይቆች
ቁጥር ጥያቄ መልስ
3.1 በእዝርግዝና ጊዜ ሊከሰቱ ስለሚችሉ 1 ኛ)አዎ(የለም ከሆነ ወደ ጥያቄ ቁጥር 4.1 ይለፉ)
አደገኛ ምልክቶች ሰምተዉ ያዉቃሉ? 2 ኛ) የለም
3.2 አዎ ከሆነ በእዝርግዝና ጊዜ ሊከሰቱ 1 ኛ)አንዲት እናት በእዝርግዝና ጊዜ የህመም ምልክቶችን
የሚችሉ አደገኛ ምልክቶች ስንል ምን ማለትም እንደ ከፍተኛ ራስምታት ከማህፀን ደም መፍሰስ እና
ማለት ነዉ? የመሳሳሉት ካላት
2 ኛ) ሌላ (ይጥቀሱ)
3 ኛ) አላዉቅም
3.3 በእዝርግዝና ጊዜ ሊከሰቱ የሚችሉ 1 ኛ) ከጤናባለሙያ
አደገኛ ምልክቶችን ከማነዉ የሰሙት? 2 ኛ) ከዘመድ
3 ኛ) ከገደኞቼ
4 ኛ) ከሚዲያ (ሬዴዮ፡ቲቪ)
5 ኛ) ሌላ (ይጠቀሱ) ----------------
3.4 በእዝርግዝና ጊዜ የምከሰቱት አደገኛ 1 ኛ) አዎ
ምልክቶች በሁሉም እናቶች ላይ ሊከሰቱ 2 ኛ) አይችልም(አይከሰትም)
ይችላሉን? 3 ኛ) አላዉቅም
3.5 በእርግዝና ጊዜ የምከሰቱትን አደገኛ 1 ኛ)በእርግዝና ወቅት በየትኛዉም ጊዜ ደም መፍሰስ
ምልክቶች የሚያዉቁትን ይጥቀሱልኝ ፡፡ 2 ኛ) ከማህፀን ፈሳሽ መፍሰስ
((የተጠቀሱትን በሙሉ ያክብቡ) 3 ኛ) የሰዉነት ማበጥ
4 ኛ) ከአራት ወር እርግዝና በኃላ የሆነና በተከታታይ
ማስመለስ
5 ኛ) ለረጅም ጊዜ የሚቆይ የእራስ ምታት ወይም በትክክል
ያለማየት ችግር (ብዥታ)
6 ኛ) ትኩሳት
7 ኛ) የጽንስ እንቅስቃሴ መቀነስ ወይም ማቆም
8 ኛ) መጥፎ ሽታ ያለዉ የማህፀን ፈሳሽ
9 ኛ) ከፍተኛ የድካም ስሜት
10 ኛ) ሽንት በሚሸናበት ጊዜ የህመም / የማቃጠል ስሜት
11 ኛ) በተከታታይ የጀርባ ህመም
12 ኛ) ያልተለመደ የሆድ ቁርጠት
13 ኛ) ሌላካለይግለጹ_____________
14 ኛ) አላዉቅም
3.6 ሊያገጥሙ ስለሚችሉ አደገኛ ምልክቶች 1 ኛ) አዎ
ከጤና ተቋም መረጃ ተሰቶት ነበር? 2 ኛ) አልተሰጠኝም
3 ኛ) አላዉቅም
3.7 አዎ ከሆነ ምን መረጃ ነዉ ያገኙት? 1 ኛ) ስለአደገኛ ምልክቶች ማብራሪያ አግኝቻለሁ; ምን ማድረግ

26
 እንዳለብኝም ምክር ሰጥተዉኛል
2 ኛ) ሌላ (ይጠቀስ)-----------------

ክፍሌ 4: በእርግዝና ጊዜ ሊከሰቱ ስለሚችሉ አደገኛ ምልክቶችን የተመለከተ አመለካከትን የሚዳስስ መጠይቅ
ቁጥ ጥያቄ መልስ
ር
4.1 ለአንድ እናት በእርግዝና ጊዜ ስለምከሰቱ አደገኛ ምልክቶች 1. በጣምእስማማለዉ
2. እስማማለዉ
ማወቃቸዉ ጠቀሜታ አለዉ፡፡
3. ገለልተኛ
4. አልስማማም
5. በጣምአልስማማም
4.2 ለአንድ እናት በእርግዝና ጊዜ ስለምከሰቱ አደገኛ ምልክቶች 1.በጣምእስማማለዉ
ማወቃቸዉ በጊዜ የሕክምና ዕርዳታ ለማግኘት ይረዳል፡፡ 2. እስማማለዉ
3. ገለልተኛ
4. አልስማማም
5. በጣምአልስማማም
4.3 ለአንድ እናት በእርግዝና ጊዜ ስለምከሰቱ አደገኛ ምልክቶች 1. በጣምእስማማለዉ
ማወቃቸዉ ያለሕክምና ዕርዳታ ምልክቶቹ ስለማይጠፉ ነዉ፡ 2. እስማማለዉ
3. ገለልተኛ
4. አልስማማም
5. በጣምአልስማማም
4.4 አንዲት እናት አደገኛ ምልክቶች መከላከል ትችላለች፡፡ 1. በጣምእስማማለዉ
2. እስማማለዉ
3. ገለልተኛ
4. አልስማማም
5. በጣምአልስማማም
4.5 በእርግዝና ጊዜ አደገኛ ምልክቶች የታዩባቸዉ እናቶች የሕክምና 1. በጣምእስማማለዉ
ዕርዳታ ማግኘት አለባቸዉ፡፡ 2. እስማማለዉ
3. ገለልተኛ
4. አልስማማም
5. በጣምአልስማማም
4.6 በእርግዝና ጊዜ አደገኛ ምልክቶች የታዩባቸዉ እናቶች ወደ ልምድ 1. በጣምእስማማለዉ
አዋላጆች መሄድ አለባቸዉ፡፡ 2. እስማማለዉ
3. ገለልተኛ
4. አልስማማም
5. በጣምአልስማማም
4.7 በእርግዝና ጊዜ አደገኛ ምልክቶች የታዩባቸዉ እናቶች ልምድ 1. በጣምእስማማለዉ
ወዳላቸዉ ሴቶች በመሄድ ዕርዳታ ማግኘት አለባቸዉ፡፡ 2. እስማማለዉ
3. ገለልተኛ
4. አልስማማም
5. በጣምአልስማማም

27
ክፍሌ 5፡ በእርግዝና ጊዜ ተግባርን በተመለከተ የተዘጋጀ መጠይቅ

ቁጥር ጥያቄ መልስ

5.1 በእርግዝና ጊዜ የምከሰቱት አደገኛ 1 ኛ) አዎ
ምልክቶች ተከስቶብዎት ያዉቃል? 2 ኛ) አልደረሰብኝም
5.2 አዎ ከሆነ የትኛዉ አደገኛ ምልክት 1) በእርግዝናወቅትበየትኛዉምጊዜደምመፍሰስ
ተከሰተቦት? 2) ከማህፀንፈሳሽመፍሰስ
3) የሰዉነትማበጥ
4) ከአራትወርእርግዝናበኃላየሆነናበተከታታይማስመለስ
5) ለረጅምጊዜየሚቆይየእራስምታትወይምበትክክልያለማየትችግር
(ብዥታ)
6) ትኩሳት
7) የጽንስእንቅስቃሴመቀነስወይምማቆም
8) መጥፎሽታያለዉየማህፀንፈሳሽ
9) ከፍተኛየድካምስሜት
10) ሽንትበሚሸናበትጊዜየህመም/የማቃጠልስሜት
11) በተከታታይየጀርባህመም
12) ያልተለመደየሆድቁርጠት
5.3 እኝህ አደገኛ ምልክቶች በደረሰብዎት 1 ኛ) ወደህክምናአገልግሎትነዉየሄድኩት
ጊዜ ምን ነበር ያደረጉት? 2 ኛ) ወደልምድአዋላጆችመሄድ
3 ኛ) የትምአልሄድኩም/ ምንምአላረኩም
4 ኛ) ከታላላቆችሴቶችእገዛአገኘሁ
5 ኛ) ሌላ (ይጠቀስ)-----------------------

ክፍልስድስት: የጤናተቋማትንየተመለከተመጠይቆች
ቁጥር ጥያቄ መልስ
6.1 በአቀራቢያዎ ወደሚገኝ ጤና ተቋም /ጣቢያ ለመድረስ የሚፈጀብዎት1 ኛ) ከ 1 ሰአትበታች
ሰዓት ስንት ነዉ? 2 ኛ) 1 ሰአትናከዚያበላይ
6.2 በመጨረሻ እርግዝናዎ ጊዜ የቅድመ ወሊድ ክትትል አድርገዋል 1 ኛ)አዎ
(አንዲና ከዚያ በላይ ለወለዱ እናቶች ብቻ) 2 ኛ) የለም(የለም ከሆነ ወደተ.ቁ. 6.6)
6.3 በዚህ እርግዝናዎ ወቅት የቅድመ ወሊድ ክትትል አድርገዋል 1 ኛ) አዎ (የለምከሆነወደ.ተ.ቁ. 6.6)
?/የመጀመሪያ እርግዝና ከሆነ ብቻ/ 2 ኛ) የለም
6.4 በመጨረሻ እርግዝናዎ ወቅት ስንት ጊዜ ነዉ የቅድመ ወሊድ ክትትል
1 ኛ) አንድ ጊዘ
ያደረጉት? 2 ኛ) ሁለት ጊዜ
3 ኛ) ሦስት ጊዜ
4 ኛ) አራት ጊዜ
5 ኛ)ከአራት ጊዜ በላይ (ምክናቱን ይግለፁ)
------------ላ
6.5 የመጨረሻ እርግዝናዎትን የት ነበር የወለዱት ((አንድና ከዚያ 1 ኛ) በጤናተቋም
በላይ ለወለዱ እናቶች ብቻ) 2 ኛ) በቤት

አመሰግናለዉ

Annex I QUESTIONNAIRE

28
MISRAKE GHION COLLAGE

FACULTY OF HEALTH SCIENCES

DEPARTMENT OF NURSING

Study Title: Assessment of knowledge attitude and practice towards obstetric

danger signs during pregnancy among mother in woldia health center in Woldia
town North wollo zone Amhara region, Ethiopia.

Read for the study participants

Introduction and Purpose of the study

Dear Mother:

Consent Form

My name is __________________________________I am interviewing pregnant mother’s

knowledge regarding warning signs in pregnancy. The objective of this study is to assess
knowledge regarding warning signs in pregnancy in durame town. I am going to ask you some
questions that are very important for the programmers in maternal health service to plan
improved intervention. Your name will not be written in this form and the information you give
is kept confidential. If you do not want to answer, all or some of the questions you do have the
right to do so. However, your willingness and support to answer all of the questions would be
appreciated and thank you on the behalf of the kambata tambaro zone, durame town mothers.

Would you participate in responding to questions in this questionnaire?

Yes__________________ No____________________

Name and signature of interviewer who sought consent_______________________

GENERAL INSTRUCTIONS (asking questions and recording answers)

29
All questions in this paper are based upon maternal recall. It is very important that you ask each
question exactly as it is written on the questionnaires. In addition to the questions, there are
statements that are appear in all bolded capital letters, indicating that they are interviewer
instructions and should not be read aloud to the mother.

Most questions have pre-coded responses. It is important that you do not read these
alternatives/choices aloud to the mother. When you ask a question, you should listen to the
mother’s response/answer, and then circle the code next to the category that best matches her
answer/response.

Questionnaire for assessment of knowledge attitude and practice towards obstetric danger signs
during pregnancy among mother in Woldia comprehensive specialized Hospital in woldia town
north wollo zone Amhraa region Ethiopia.

001 Record number._____________

002 House number____________ 003 Keble__________

Part I: Socio-demographic characteristics of all eligible mothers

S.N Socio-demographic variables. Response format Skip

to

Q10 Age 1. _______________

1

Q10 What is your religion? 1. Protestant

2 2. Orthodox
3. Muslim
4. Catholic
5. Others(specify)

Q10 What is your Ethnicity 1. Hadiya

3 2. Kembata
3. Gurage

4. Others(specify)

30
Q10 What is your marital status? 1. Single
4 2. Married
3. Divorced
4. Widowed

Q10 Have you ever attended formal school? 1. Yes →

5 2. No Q105

Q10 What is the highest grade you 1. Elementary level (1-8 grade)
6 completed? 2. Secondary level (9-12 grade)
3. University/collage diploma
4. University/collage degree
5. Other (specify)

Q10 Employment 1. Employed

7 2. non-employed

Q10 What is your current occupational status? 1. Government employee

8 2. Non-governmental employee
3. Business women
4. House wife
5. House maid
6. Student
7. Other(Specify)

Q10 How much is your monthly income 1. Unknown

9 2. <500birr
3. 501-1000 birr
4. 1001-1500 birr
5. >1500birr

Q11 Is your husband employed? 1. Yes

0 2. No

Q11 What is your husband’s educational 1. Illiterate

1 status? 2. Read and write
3. Elementary level (1-8)
4. Secondary level(9-12)
5. Collage level and above

Q11 Do you have radio/TV in your house? 1. Yes

2 2. No

Q11 Time taken to nearby health facility 1. <1 hour

31
3 2. >= 1 hour

Q11 Family size 1. ≤4

4 2. 5–6
3. ≥7

Part II: CORE QUESTIONS ON MATERNITY EXEPERIENCE

S.N Questions and filters Response coding categories

Q20 Now I would like to ask you some 1. Yes If

1 questions about your maternity 2. No no,..ski
experiences.
p

Q20 Age at first pregnancy 1. <20

2 2. 20–29
3. 30 & above

Q20 How many times in total you became 1. 1

3 pregnant? 2. 2-4
3. 5 & above

Q20 How many times in total you gave birth? 1. 0

4 2. 1
3. 2–4
4. 5 &above

Q20 How many of your pregnancies resulted 1. ________________

5 in a baby that was born alive?

Q20 How many of your pregnancies resulted 1. _________________

6 in a baby that was born dead?

Q20 Where did you give birth to the last child? 1. Own home
7 2. Government Hospital
3. Government Health center
4. Private Health Facility

32
 5. Other(Specify)

Q20 Who assisted with your last delivery? 1. HealthProfessional

8 2. Trained Traditional birth
attendant
3. Non Traditional birth attendant
4. Relatives/friends/ neighbors
5. Other(Specify)

Q20 What was the mode of delivery? 1. Normal vaginal delivery(NVD)

9 2. Caesarean section(c/s)
3. Instrumental delivery
4. Don’t know

Q21 Following your last delivery have you 1. Yes

0 attend postnatal clinic in any health 2. No
facility?

Q21 Trimester during interview 1. First

1 2. Second
3. Third

Q21 Duration of pregnancy(GA) 1. 3–6 months

2 2. 7–9 months

Q21 Have you attended Antenatal care during 1. Yes

3 previous pregnancies 2. No

Q21 Number of ANC visit during last 1. 1

4 pregnancy 2. 2–3
3. 4 & above

Q21 Antenatal care given today in this 1. 1st

5 pregnancy is 2. 2nd
3. 3rd
4. 4th

Part III: Mother’s knowledge about obstetric danger signs of pregnancy

S.N Questions and filters Response coding categories Skip to

Q30 Do you know any/some serious health 1. Yes

1 problem/s that can occur during 2. No

33
 pregnancy that could endanger the life of 3. Don’t know
a pregnant woman?

Q30 Do you get any information about 1. Yes

2 pregnancy danger signs in mass media? 2. No

If yes to Q302, what was source of 1. Radio/Tv

information? 1. Health institutions
2. Newspapers
3. Other (specify)

Q30 Can you mention them? 01.Vaginal bleeding .......... 1.Yes 2.No
3 (Probe: which of the following do you 02. Severe headache .......... 1.Yes 2.No
think a health problem/s?)
03. Blurred vision.............. 1.Yes 2.No

04. Convulsions................. 1.Yes 2.No

05. Swollen hands/face ...... 1.Yes 2.No

06.High fever ................... 1.Yes 2.No

07. Loss of consciousness ...1.Yes 2.No

08. Severe abdominal pain ... 1.Yes 2.No

09. Accelerated/reduced fetal

movement........... 1.Yes 2.No

10. Water breaks without labor. 1.Yes

2. No

11. Other .(Specify)

Q30 Have you ever faced danger signs of 1. Yes

4 pregnancy? 2. No

Q30 Among the danger signs which one 1. Vaginal bleeding

5 was faced on you? Listen to me 2. Sudden gush of fluid before
carefully and answer. labor
3. Severe head ache
4. Dizziness and blurred vision
5. Excessive vomiting
6. Swelling of hands, face

34
 7. Accelerated or reduced fetal
movement
8. Premature onset of
contraction
9. Severe unusual abdominal
pain

Q30 What are your views when you 1. Nothing

6
experience the following danger signs 2. Consulted a
during pregnancy? friend/relative
(Put the coded number of the action in
3. Self-care/treatment
the box for any danger sign)
4. Consulted a TBA
5. Went to a health
facility
6. Others (specify)

1. Severe vaginal bleeding ……………………

2. Convulsions ……………………

3. Severe headache with blurred vision ……………………

4. Severe abdominal pain ……………………

5. Reduced fetal movement ……………………

6. Sudden gush of fluid before labor ……………………

7. Severe abdominal pain ……………………

8. High Fever ……………………

9. Swelling of fingers, face and legs……………………

Q30 Are danger signs preventable? 1. Yes

7 2. No

Q30 How danger signs can be prevented? 1. ANC follow up

8 2. Early detection and need for
medical care
3. Others

35
THANK YOU

36
DECLARATION

We, the undersigned, declare that this thesis is our original work, has not been presented for a
degree in this or any other university and that all sources of materials used for the thesis have
been fully acknowledged.

Name:
1. ROBEL SETITO SIGNATURE
2. MULUNESH FASIL SIGNATURE
3. ABDU MOHAMMED SIGNATURE
4. ABIRETSION BELAY SIGNATURE
5. ALEBACHEW TESEGA SIGNATURE
6. SISAY ASME SIGNATURE

Name of the institution: MISRAKE GHION COLLAGE

Date of submission: _____________

Name and Signature of the first advisor

Mr.Akele tegegn(bsc,msc)

37
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