Knowledge of pregnant adolescents with obstetric danger signs
Most of the pregnant adolescents (55.2%) knew obstetric danger signs and obstetric emergencies. The knowledge of these danger signs could be because the majority of them (92.7%) have had experience in childbirth. The increase in knowledge on obstetric danger signs and obstetric emergencies in the current study compared to previous studies could be due to policies put in place by the Ministry of Health which emphasizes continuous education with pregnant women about obstetric complications (maternal and child death) during ANC services. Again, most of the pregnant adolescents (81.5%) were able to notice danger signs in pregnancy due to easy access to information from health workers. Meanwhile, this is in sharp contrast with studies in other developing countries which revealed very low knowledge of pregnant women on danger signs during pregnancy. For instance, a study by Mbalinda et al. [18] showed that only about 1 in 3 pregnant women was able to mention at least three of the five basic components of birth preparedness and complication readiness (BPCR). Again, the work by Bogale et al. [19], revealed that less than half (31.9%, 27%, and 22.1%) of the pregnant women in the Goba district knew about danger signs during pregnancy, delivery and postpartum period, respectively.
Interestingly, women with a history of obstetric problems during the previous pregnancy were more likely to be knowledgeable about danger signs compared to those who had no complications in a prior pregnancy. This implies that health workers' education on obstetric danger signs to pregnant women is appreciated by pregnant women. However, this is in line with the findings of Kabakyenga et al. [20] which revealed that prior knowledge of obstetric danger signs and birth preparedness enhanced skill care by pregnant women during low-risk births and emergency obstetric care in low-income countries. Although full participation of male partners is very critical in achieving adequate birth preparedness, unfortunately, in sub-Saharan Africa, pregnancy and childbirth continue to be viewed as solely woman's issue [21]. Low levels of knowledge of pregnancy danger signs and birth preparedness have been blamed for the poor involvement of males in maternal health issues and several studies have confirmed it [22–24]. Again, although most pregnant adolescents know obstetric danger signs, the majority of them are unaware of the actions to be taken for obstetric emergencies which sometimes may lead to maternal and child death.
Meanwhile, vaginal bleeding was recorded as one of the most obstetric emergencies experienced by pregnant adolescents. This was also revealed by similar studies by Morhason-Bello et al. [5] and Adamu et al. [21]. According to Akpan et al. [25], most bleeding cases in pregnancy can lead to abortion, premature delivery of babies, and anaemia resulting in maternal mortality. Therefore, knowledge of the major obstetric danger signs, including severe vaginal bleeding, oedema on the face, blurred vision, prolonged labour, convulsions, retained placenta, foul-smelling vaginal discharge, and high-grade fever can help to facilitate timely healthcare access. In previous research in developing countries, it has been suggested that women’s knowledge of obstetric danger signs determines their health-seeking behaviour [26]. Hence, women with poor knowledge of obstetric danger signs are less likely to attend a healthcare facility when they face obstetric emergencies.
Obstetric Emergency Preparedness Of Pregnant Adolescents
A greater percentage (68.2%) of pregnant adolescents were prepared for delivery. However, the majority of them (53.6%) had not bought the essential items for delivery. Baby clothes (71.0%) were the most essential item bought by pregnant adolescents at birth. Meanwhile, the majority (72.5%) of them had not saved money towards delivery because they had valid National Health Insurance Cards for health care. The level of preparedness among pregnant adolescents for birth and its complications is higher in the current study compared to previous studies. For instance, about 49.4%, 24.7%, 86.2%, and 53.9% of women were prepared for birth and its complications in West Bengal, India, Northern Nigeria, Mpwapwa district of Tanzania, and Mbarara District of Southwest Uganda respectively [27–30]. Again, according to Bitew et al. [31], only 22% of pregnant women in Northern Ethiopia, 29.9% in Bale, and 16.5% in Arsi Zone, Central Ethiopia, and 17% in Southern Ethiopia were prepared for birth and its complications.
In the study, it was revealed that most of the pregnant adolescents (58.7%) had not identified a skilled provider for delivery and only (14.7%) had made plans for possible blood transfusion. Meanwhile, the majority of them (91.0%) had not arranged for transport for delivery or any obstetric emergencies. Most of the pregnant adolescents (54.5%) had selected a place of delivery. These findings support a similar study conducted in Ghana by Adamu et al. [21]. In their work, it was revealed that out of the 300 respondents, 78% were prepared for birth, 90% had valid health insurance, 64% had arranged for transport, whereas only 51% had made arrangements for a blood donor.
Unsurprisingly, BPCR is considered very low in developing countries due to many factors. One of the factors is the mother’s level of preparedness and complication readiness. This may be explained by women’s knowledge that having money in hand enables them to buy the necessary materials and to have access to transportation at times of referral in case of emergencies. In addition, the provision of a health worker with midwifery skills during ANC and at every birth is considered a crucial intervention for safe motherhood. Yet the WHO estimates that 47% of births in the developing world are assisted only by traditional birth attendants (TBAs), family members, or no one [32]. Besides, better information on obstetric danger signs, birth preparedness practices, and readiness for emergency complications are among the approaches aimed at enhancing the utilization of maternal health services and increasing access to skilled care during childbirth, particularly for women with obstetric complications [18].
Association Between The Socio-demographic Characteristics Of Pregnant Adolescents And Knowledge/preparedness On Obstetric Danger Signs
Concerning the association between sociodemographic characteristics of pregnant adolescents in Techiman Municipality and the knowledge of obstetric danger signs during pregnancy, age was significant with an unadjusted odds ratio (1.833) for noticing danger signs in pregnancy (p-value = 0.001). Moreover, educational status, ethnicity, religion, and marital status proved statistically significant. Again, in looking at the relationship between sociodemographic characteristics of pregnant adolescents and obstetric emergency preparedness, age, gestational age, educational status, ethnicity, and monthly income proved statistically significant (p-value = 0.000). However, religion, marital status, number of children, and employment status were not statistically significant.
Age plays an important role in birth preparedness. A study by Koşum et al. [26] in Nepal revealed that 70% of the respondents who were between ages 21 to 35 years reported having better preparedness and among respondents living in a nuclear family, 78% had better preparedness. In the same study, it was established that among educated respondents, 80% reported having better preparedness and the husband’s education played a significant role in BPCR. Women who were married after the age of twenty had better preparedness. According to Koşum et al. [26], women who had given birth to one child only are better prepared than those who had three and more children.
Again, Bitew et al. [31] think that women having secondary education or higher are 6.20 times more likely to be prepared than illiterates. Koşum et al. [26] established that, regarding employment status, mothers who were employed had ≥ 4 times higher odds of being birth prepared compared to unemployed women. The findings of the current study support that of Adelaja et al. [33] which revealed that the major risk factors of obstetric emergencies in the hospital were illiteracy, poverty, lack of antenatal care, poor transport facilities and inadequate equipment/staffing. In addition, a systematic review by Geleto et al. [34] on barriers to access and utilization of emergency obstetric care in health facilities in Sub-Saharan Africa revealed that younger age, illiteracy, lower income, unemployment, poor health service utilization, a lower level of assertiveness among women, poor knowledge about obstetric danger signs, and cultural beliefs, poorly designed roads, lack of vehicles, transportation costs, and distance from facilities were some of the factors which resulted in obstetric emergencies.
Meanwhile, a study in southern Ethiopia provided evidence that the odds of being well prepared for birth and its complications were 0.51 and 0.22 times lower among women with a parity of two to four than those with a parity of one. It has therefore become relevant ; policymakers have to collaborate to enhance the promotion of birth preparedness and complication readiness at different levels in the health sector by improving the socio-economic status of women.