Front. Public HealthFrontiers in Public HealthFront. Public Health2296-2565Frontiers Media S.A.10.3389/fpubh.2024.1466218Public HealthOriginal ResearchKnowledge of obstetric danger signs and its associated factors among husbands residing in the Raya Kobo district, EthiopiaDerbewJemal1YesufAdem2*MihreteAbebe3AbdallahAmira4MohammedAbdurehman5SirageNurye2MollaBogale21Bati Primary Hospital, Bati, Ethiopia2School of Midwifery, College of Health Sciences, Woldia University, Woldia, Ethiopia3Department of Nursing, College of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia4Department of Nursing, College of Medicine and Health Sciences, Worabe University, Worabe, Ethiopia5Department of Public Health, College of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
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Background
The term “danger signs” refers to any symptoms or indicators that suggest a pregnant woman may be at risk during pregnancy. Mothers are often burdened with responsibilities, and the majority of them do not even receive treatment for potential complications, which can ultimately lead to the loss of their lives. This situation highlights the barriers that prevent them from being properly prepared for potential risks. In Ethiopia, various studies have been conducted on male involvement in pregnancy, but none have assessed knowledge of obstetric danger signs (ODS). While a few studies have focused on husbands’ knowledge of obstetric danger signs, there is still variation in the variables examined.
Objectives
The objective of the study was to assess the level of knowledge about obstetrical danger signs and the associated factors among husbands whose wives were pregnant and gave birth within the last 12 months in the Raya Kobo district, North Wollo, Amara Ethiopia, in 2023.
Methods
A community-based cross-sectional study was conducted from 29 April to 30 May 2023 in the Raya Kobo district. A multi-stage stratified random sampling technique was used to select 626 samples. The data were analyzed using SPSS version 26.00 statistical software. Independent variables with a p-value of ≤0.25 in the bivariate analysis were considered candidates for multivariate analysis, and a p-value of ≤0.05 was considered statistically significant.
Results
Regarding knowledge about obstetric danger signs, 46.3% (95% CI: (42.6 to 50.3%)) of the respondents had good knowledge. The variables significantly associated with knowledge about obstetric danger signs included husbands who attended secondary school (adjusted odds ratio (AOR) = 4.77, 95% CI, (1.42–16.04)), those living in urban areas (AOR = 3.00, 95%CI = (1.59, 7.57)), those with an average monthly income between 3,001 and 5,000 birr (AOR = 3.35, 95% CI = (1.58, 7.12)), and those with more than five children (AOR = 0.15, 95% CI = (0.05–0.46)).
Conclusion and recommendations
The knowledge of obstetric danger signs among husbands in the Raya Kobo district was limited. The educational status of the husband, average family income, residence, and number of children were significantly associated with the husbands’ knowledge of obstetric danger signs. Therefore, these findings highlight the importance of addressing knowledge gaps through targeted educational programs aimed at improving awareness of obstetric danger signs.
husbands’ knowledgeobstetrical danger signscross-sectionalRaya Kobo districtEthiopiasection-at-acceptancePublic Health Education and PromotionIntroduction
The term “danger signs” refers to any symptoms or indicators that suggest a pregnant woman may be at risk during pregnancy. They are referred to as obstetric danger signs (ODS) and include symptoms such as loss of consciousness, persistent vomiting, severe persistent abdomen pain, vaginal bleeding, swelling of the face, fingers, and feet, blurred vision, severe recurring frontal headache, and high-grade fever (1, 2).
Every pregnant woman is at risk of experiencing unanticipated, sudden problems related to ODS (1, 3). Pregnancy and its related complications remain one of the major causes of maternal morbidity and mortality worldwide, with over half a million women dying each year due to pregnancy-related causes. Almost all of these (87%) maternal deaths occur in low-income countries (3, 4). Direct obstetric factors, such as severe bleeding, pregnancy-induced hypertension, unsafe abortion, labor and delivery difficulties, and maternal infections, account for approximately 73% of all maternal deaths (3).
Developing countries experience a maternal mortality rate that is 15 times higher than that of developed countries, and the global burden of maternal mortality is concentrated in these regions, with sub-Saharan Africa accounting for 56% of all reported maternal deaths (5). Maternal mortality remains a significant public health concern in low- and middle-income countries, particularly in sub-Saharan Africa, where Ethiopia is located. One of the most effective strategies for reducing maternal mortality is the early identification and management of obstetric danger signs, which are critical indicators of potential complications during pregnancy, childbirth, and the postpartum period (6). Timely recognition of obstetric danger signs allows for prompt intervention, preventing life-threatening complications such as preeclampsia, obstructed labor, and hemorrhage (7).
The Sustainable Development Goal 3 (SDG 3) aims to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. In addition to this target, each country has the responsibility and commitment to achieve a target of no more than 140 maternal deaths per 100,000 live births (8, 9). Although the maternal mortality ratio is decreasing globally, its reduction in sub-Saharan countries is occurring at a much slower rate. According to the 2019 Ethiopia Demographic Health Survey (EDHS) mini-report, the maternal mortality and morbidity ratio in Ethiopia was 402 per 100,000 live births. Of these deaths, 30% were related to obstetrical danger signs during pregnancy (4).
Maternal mortality remains a critical health challenge in Ethiopia, particularly in rural areas where access to healthcare services is limited. One of the key factors contributing to the high maternal mortality rate is the delay in recognizing and responding to obstetric danger signs. These signs serve as early warning of potential complications during pregnancy, childbirth, and the postpartum period (10).
In the majority of developing countries, including Ethiopia, the underlying cause of maternal death during pregnancy is attributed to three crucial delays, even when ODS occur: delay in identifying danger signs and making the decision to visit the health facility, delay in reaching the health facility, and delay in receiving appropriate and adequate care at the health facility (1, 2).
The majority of women in Ethiopia have a low social status, and the decision-making power regarding access to and use of care is dominated by men. This factor can significantly contribute to adverse pregnancy outcomes (11, 12). A study conducted by Mbizvo and Say analyzed the factors that reduced maternal mortality in Bangladesh, Morocco, and Rwanda. The findings revealed that maternal mortality rates decreased by 20–50% through increased skilled birth attendance and efforts to educate husbands about obstetric danger signs (30).
Several studies conducted in various regions of Africa (including Nigeria, Tanzania, Kenya, and Ethiopia) showed that male partners had a low level of knowledge about obstetric danger signs during pregnancy and childbirth. Only 22.4 to 56.2% of them were able to identify at least two or more of the listed danger signs (2, 13–15).
When husbands fail to recognize the danger signs during pregnancy, it can affect the health of both the mother and the fetus, leading to conditions such as anemia, infections, prematurely ruptured membranes, neonatal morbidity and mortality, abortion, antepartum hemorrhage, and illness or death of the mothers (5, 16). Moreover, a lack of knowledge regarding obstetric danger signs is associated with a delay in the utilization of skilled care, which contributes to an increase in maternal mortality and morbidity (17).
Husbands, particularly in rural Ethiopia, play a key role in influencing the first two delays. As primary decision-makers in many households, they are often responsible for determining when and whether their wives should seek medical care during pregnancy and childbirth (18). If husbands lack knowledge about obstetric danger signs, such as severe vaginal bleeding, convulsions, and prolonged labor, it can lead to significant delays in recognizing complications and deciding to seek timely care, thereby contributing to poor maternal and neonatal outcomes (10).
The World Health Organization (WHO) advocates for the inclusion of men in maternal health strategies as their participation can lead to better care-seeking behaviors, timely interventions, and improved overall maternal well-being (19). Limited awareness of obstetric danger signs among husbands contributes to delays in seeking care, which is a known factor in increasing the risk of maternal mortality in rural Ethiopia. However, maternal deaths are influenced by multiple factors (10, 19).
In Ethiopian cultural practices, men are at the top of the decision-making hierarchy, including decisions regarding the healthcare of their spouses. Therefore, they become a major factor in determining where, when, why, and how many pregnant women can access antenatal care, delivery services, and postpartum care. Husbands’ knowledge of obstetric danger signs, such as severe headache, severe bleeding, convulsions, and prolonged labor, can directly impact the timeliness of seeking care. Husbands with insufficient knowledge of obstetric danger signs may fail to recognize when their wives are in need of urgent medical attention, leading to delays that could result in adverse maternal or neonatal outcomes.
Various studies have been conducted in Ethiopia on male involvement during pregnancy. Despite the acknowledged importance of male involvement in maternal health, there is limited research on husbands’ knowledge of obstetric danger signs. In addition, there is still considerable variation in the variables studied, and no research has been conducted specifically in rural districts such as Raya Kobo.
This study aimed to assess husbands’ knowledge of obstetric danger signs in the Raya Kobo district and to identify the factors associated with this knowledge. Understanding these factors can guide public health interventions aimed at improving male engagement in maternal health and help design targeted educational programs to increase husbands’ awareness of obstetric danger signs, ultimately reducing delays in care-seeking and improving maternal outcomes.
Therefore, incorporating variables, such as distance from nearby health facilities, and sources of information would help assess husbands’ knowledge of obstetric danger signs and the associated factors in the Raya Kobo district.
MethodologyStudy area
This study was conducted in the Raya Kobo district, North Wollo Zone, Amara Regional state, Ethiopia, which is 570 Km away from Addis Ababa, the capital city of Ethiopia, and 409 km from Bahir Dar, the capital of the regional state. According to the 2007 Census conducted by the Central Statistical Agency (CSA) of Ethiopia, the district had a total population of 221,958. There were 2,659 pregnant women in the district. The district consists of 37 rural and five urban kebeles. It has 1 hospital, 7 health centers, and 42 health posts. Each health post has two health extension workers (HEWs) (20).
Study design and period
A community-based cross-sectional study was conducted from 29th April to 30th May 2023.
Participants
The source population included all husbands living in the Raya Kobo district whose wives were pregnant or had given birth within the 12 months prior to the study period. The study population consisted of all husbands living in the selected 11 kebeles whose wives were pregnant or had given birth within the 12 months prior to the study period.
Eligibility criteria
Inclusion criteria: all husbands living in the Raya Kobo district for 6 months and above were included in this study.
Exclusion criteria: husbands who were critically ill and unable to participate in the interview during the data collection period were excluded from the study.
Sample size determination
The sample size was determined using a single population proportion formula based on the levels of husbands’ knowledge (p = 44%) from a previous study in the Amara region’s Andede district (35). The sample size was calculated as follows:
vn1=Za/22p.qd2=z2x1−pd2=1.962∗0.44∗0.56/0.052=379
Considering a 1.5 design effect and a 10% non-response rate, the total sample size was calculated to be 626.
The second largest sample size was calculated using EP Info V.7, with a maximum result of 189. Therefore, the overall final sample size was determined by considering the first objective, which was 379, a 1.5 design effect, and a 10% non-response rate, resulting in a total sample size of 626.
Sampling technique and procedure
A multi-stage stratified random sampling technique was used to select participants. The district was divided into urban and rural areas, with nine kebeles selected from the rural area and two kebeles from the urban area using random sampling and considering a minimum sample size of 25%. Data on husbands whose wives were pregnant or had given birth within the past 12 months were collected through a survey before the actual data collection. Husbands of mothers who were single, divorced, or widowed in the selected kebeles were excluded from the study. After determining the number of participants, the sample size for each kebele was proportionally allocated, and eligible women were selected using a systematic sampling technique. The interval was determined by dividing the total number of eligible women in the study area, which was estimated to be 1,337, by the sample size of 626, resulting in an interval of 2 (K=N/n, 1,337/626 = 2). The eligible women were initially selected using the lottery method from a list of folders, and after selecting these women, the researchers then proceeded to approach their husbands to administer the questionnaire (Figure 1).
Schematic presentation of the sampling procedure.
Data collection method
Data were collected using face-to-face interview techniques and structured questionnaires adapted from various studies (19, 21). The information collected included sociodemographic and economic characteristics (maternal age, husband’s age, residence, income, educational status of the woman/husband, and occupational status), infrastructure (availability of health facilities and distance from a health facility), obstetrical characteristics (gravidity, parity, and place of delivery), and husbands’ awareness of danger signs of obstetric complications at three stages. A total of eight female HEWs and three BSc midwifery graduates were hired as data collectors and were supervised by two MPH students.
Dependent variable: the dependent variable was the husbands’ knowledge of obstetric danger signs.
Independent variables: the independent variables included sociodemographic and socioeconomic characteristics (maternal age, husband’s age, residence, educational status of the woman/husband, occupational status of the woman/husband, and family income), obstetrical characteristics (gravidity, parity, place of delivery, previous history of danger signs, and male involvement in antenatal care (ANC) follow-up), infrastructure (availability of health facilities and distance from a health facility), and sources of information (radio, TV, decision-making by the husband, and health professionals).
Husbands’ good knowledge of obstetrical danger signs: this refers to men who responded to 26 questions about obstetric danger signs during any of the three phases (pregnancy, childbirth, or the post-partum period) and scored above or equal to the median score (20, 22).
Data processing and analysis
Each completed questionnaire was checked manually for completeness before data entry. The data were coded and entered into EpiData (V.4.6), cleaned to check for accuracy and consistency, and any errors identified were corrected. The final data were exported to SPSS (IBM-26) for further cleaning and analysis. Logistic regression was performed, and the variables with a 95% CI and a p-value of <0.05 were considered significant. The strength of the statistical association was determined by the adjusted odds ratio (AOR) and 95% CI. The assumptions of multiple logistic regression were fulfilled, and the goodness of fit was tested using the Hosmer–Lemeshow statistical test (0.12). Multicollinearity was assessed based on the maximum number of variables. The important findings’ frequencies, proportions, means, and standard deviations were summarized and presented using tables, figures, and narratives.
Data quality assurance
To maintain the data quality, a reliability test was performed using Cronbach’s α, which yielded a value of 0.787. A validity test was conducted by a senior expert, and the Pearson correlation coefficient was calculated using SPSS software. Data collectors received training to further uphold the quality of data. A pretest was conducted on 5% of the study participants from a similar population in the Guba Lafto district, located outside the study area. Based on the pretest feedback, some questions were rephrased and inappropriate skipping patterns were corrected. The questionnaires were initially prepared in English, then translated into Amharic (the national language), and subsequently translated back into English by two different language experts to ensure consistency and clarity.
ResultsSociodemographic and socioeconomic characteristics of the husbands
Data collection was planned for 626 participants, and 620 completed the interviews, resulting in a resonse rate of 99.04%. The mean age of the respondents was 34.68 (SD ± 6.46) years. A total of 270 (43.5%) respondents were between the ages of 26 and 35 years. Among the study participants, 209 (33.7%) had primary education, while only 55 (8.9%) had attended college or higher education. A total of 408 (65.8%) respondents lived in rural areas (Table 1).
Distribution of the respondents and their wives by socio-demographic and economic characteristics in the Raya Kobo district, April 2023 (n = 620).
Variable
Characteristic
Frequency
Percentage (%)
Age of the respondent
25 and below
66
10.7
26–35
270
43.5
36–45
217
35.0
46 and above
67
10.8
Age of the wife
24 and below
145
23.4
25–29
303
48.9
30–34
92
14.8
35 and above
80
12.9
Educational status of the husband
Unable to read and write
45
7.3
Able to read and write
159
25.6
Primary school
209
33.7
Secondary school
152
24.5
College and above
55
8.9
Educational status of the wife
Unable to read and write
86
13.8
Able to read and write
147
23.7
Primary school
267
43.1
Secondary school
81
13.1
Collage and above
39
6.3
Occupational status of the husband
Farmer
346
55.8
Governmental employee
155
25.0
Merchant
60
9.7
Daily labor
59
9.5
Occupational status of the wife
Housewife
412
66.5
Governmental employee
93
15.0
Merchant
107
17.2
Daily labor
8
1.3
Average family income
1,500 birr and below
145
23.4
1,501–3,000 birr
268
43.2
3,001–500 birr
102
16.5
5,001 birr and above
105
16.9
Residence
Urban
212
34.2
Rural
408
65.8
Obstetric characteristics of the respondents
The obstetric characteristics of the respondents were determined based on the condition of their wives, as reported by the husbands. Among the respondents’ wives, 492 (79.4%) were pregnant during the data collection. Regarding the number of pregnancies, 511 (82.4%) of the respondents’ wives were multigravida, and 376 (60.6%) husbands helped their wives comply with the instructions received at health institutions during ANC visits. The majority of the respondents, 600(98.6%), reported that there was a health facility available in their kebeles, but only 99 (16.0%) of them lived within 30 min of a health facility. Similarly, 108 (17.4%) of the respondents needed to walk distances greater than 90 min (Table 2).
Distribution of the respondents and their wives by obstetric characteristics in the Raya Kobo district, April 2023.
Variable
Characteristics
Frequency
Percentage (%)
Current status of their wives (n = 620)
Pregnant
492
79.4
Breastfeeding
128
20.6
Husbands’ involvement during the ANC visit (n = 620)
Yes
376
60.6
No
244
39.4
Number of gravidity (n = 620)
Primigravida
109
17.6
Multigravida
511
82.4
Place of birth of the last delivery (n = 449)
Home
91
20.27
Health facility
358
79.73
History of obstetric complication (n = 511)
Yes
155
30.33
No
356
69.67
Number of children (n = 620)
2 and below
282
45.5
3 and 4
227
36.6
5 and above
111
17.9
Infrastructure-related factors
Of the respondents, 600 (96.8%) reported that health facilities were available in their kebeles, and only 216 (36%) of the respondents reported that it took them less than 30 min to reach the nearest health facility (Table 3).
Availability of a health facility and the time it takes to reach it in the Raya Kobo district, 2023.
Variable
Character
Frequency
Percentage
Availability of a health facility (620)
Yes
600
96.8%
No
20
3.2%
The time it takes to reach the nearest health facility (600)
30 min and below
216
36%
>30 min above
384
64%
Sources of information
The findings of this study indicated that the majority of the participants, 247(39.8%), who gathered information about obstetric danger signs received it from health professionals (Figure 2).
Source of information for the husband on ODS in Raya Kobo district, April (2023).
Knowledge of obstetric danger signs
The knowledge of obstetric danger signs among the respondents was calculated for each period using the median score cut-off point of 34. It was categorized as “good knowledge” when the average score was above the median score, and it was categorized as “poor knowledge” when the average score was below the median score. Of all respondents, 46.3% (95% CI: 42.6–50.3) had good knowledge (Figure 3).
Knowledge of obstetric danger signs among husbands in the Raya Kobo District April 2023.
Knowledge of obstetric danger signs during pregnancy, delivery, and postpartum periods
When computing the phase one variable to identify those above the median score, 261 (42.1%) of the respondents, with a 95% CI of (38.1, 46.0), had good knowledge during the postpartum period. In this phase, severe vaginal bleeding after delivery was reported to be a high-scoring obstetric danger sign, mentioned by 348 (56.1%), while severe weakness was reported to be a lower-scoring obstetric danger sign, mentioned by 185 (29.8%). In another computed variable, 36.6% of the respondents had good knowledge throughout pregnancy. A total of 422(68.1%) respondents mentioned membrane rupture before labor and 411 (66.3%) respondents mentioned severe vaginal bleeding as high-scoring obstetric danger signs, while 92 (14.8%) mentioned difficulty breathing as a lower-scoring obstetric danger sign. Lastly, during delivery, 26% of the husbands mentioned in phase two had a median score. A total of 301 (48.1%) identified placenta retention (placenta not detaching before 30 min) as the highest-scoring obstetric danger sign, while 106 (17.1%) mentioned high-grade fever as a lower-scoring danger sign (Table 4).
Knowledge of obstetric danger signs during pregnancy, delivery, and postpartum periods among the husbands in the Raya Kobo district, April 2023.
Variable
Frequency (Yes)
Percentage (%)
Part 1: during pregnancy
Severe vaginal bleeding
411
66.3%
Severe headache
280
45.2%
Blurring of vision
216
34.8%
Convulsion
204
32.9%
Swelling of hand and face
153
24.7%
High-grade fever
101
16.3%
Difficulty breathing
92
14.8%
Severe weakness
100
16.1%
Severe abdominal pain
243
39.2%
Reduced fetal movement
243
39.2%
Membrane rupture
422
68.1%
Part 2: during delivery
Vaginal bleeding
205
33.1%
Severe headache
129
20.8%
Convulsion
111
17.9%
High-grade fever
106
17.1%
Labor >12 h
266
42.9%
Placenta not detached after 30 min
301
48.5%
Part 3: during postpartum
Severe vaginal bleeding
348
56.1%
Severe headache
226
36.5%
High-grade fever
187
30.2%
Offensive vaginal discharge
229
36.9%
Convulsion
203
32.7%
Severe weakness
185
29.8%
Blurring of vision
197
31.8%
Swelling of hand and face
199
32.1%
Difficulty breathing
236
38.1%
Factors associated with the husbands’ knowledge of obstetrical danger signs
To identify the factors associated with the husbands’ knowledge of obstetric danger signs, binary and multivariable logistic regression analyses were conducted with the dependent and independent variables. In the binary logistic regression, the age of the husband, the occupation of the husband, the level of education of the husband, family income, residence, the husband’s involvement in ANC visits, the wife’s history of bad obstetric signs, number of children, and the level of education of the wife were significantly associated with the husbands’ knowledge of obstetric danger signs.
The multivariable analysis was performed to identify independent predictors of the husbands’ knowledge regarding obstetrics danger signs. After controlling for possible confounders, the husband’s education, residence, number of children, and family income were identified as the independent predictors of the husbands’ knowledge of obstetrics danger signs in the Raya Kobo district. These results also showed that the husbands who had secondary school education were 4.8 times (AOR = 4.77, 95% CI, (1.42–16.04)) more likely to have good knowledge of obstetrics danger signs than those who were unable to read and write.
The husbands in families with more than five children were 85% (AOR = 0.15: 95% CI; (0.05–0.46)) less likely to have good knowledge of obstetric danger signs compared to those with fewer than two children. The husbands with an average monthly income of 3,001–5,000 birr were 3.4 times (AOR = 3.35, 95% CI = (1.58, 7.12)) more likely to have good knowledge compared to those with an average monthly income of less than 1,500 birr. The husbands living in urban areas were 3 times (AOR = 3.00, 95%CI = (1.59, 7.57)) more likely to have good knowledge than those living in rural areas (Table 5).
Multivariate and bivariate logistic regression analyses showing factors independently associated with the husbands’ knowledge of obstetrics danger signs in the Raya Kobo district, 2023.
Characteristic with Variable
Knowledge
COR (95% CI)
AOR (95% CI)
Good knowledge
Poor knowledge
Age of the respondent
25 and below
34 (51.5)%
32 (48.5)%
1
1
26–35
141 (52.2)%
129 (47.8)%
1.03 (0.60–1.67)
0.82 (0.35–1.95)
36–45
93 (42.9)%
124 (57.1)%
0.71 (0.41–1.23)
1.20 (0.44–3.29)
46 and above
19 (29.4)%
48 (71.6)%
0.34 (0.18–0.76)
1.96 (0.51–7.54)
Husbands’ education
Unable to read and write
15 (33.4%)
30 (66.6%)
1
1
Able to read and write
43 (27%)
116 (73%)
0.74 (0.36–1.51)
1.43 (0.55–3.71)
Primary school
74 (35.4%)
135 (64.6%)
1.09 (0.55–2.17)
1.79 (0.59–5.42)
Secondary school
117 (75%)
38 (25%)
6.16 (3.24–13.8)
4.77 (1.42–16.04)*
Collage and above
38 (69.1%)
17 (30.9)
4.47 (1.92–10.39)
1.65 (0.45–6.05)
Husbands’ occupation
Farmer
96 (27.7)%
250 (72.3)%
1
Government employee
109 (69.3)%
46 (29.7%)
6.17 (4.06–9.37)
1.57 (0.81 to 3.05)
Merchant
44 (73.3)%
16 (26.7)%
7.16 (3.86–13.3)
2.16 (0.9 to 5.17)
Daily labor
38 (64.4)%
21 (35.6)%
4.7 (2.63–8.44)
1.23 (0.54 to 2.8)
Residence
Urban
159 (75)%
53 (25)%
6.56 (4.51–9.54)
3.00 (1.59–5.57)**
Rural
128 (21.4)%
280 (68.6)%
1
1
Husbands’ involvement in the ANC visit
No
85 (34.8%)
159 (65.2%)
1
1
Yes
202 (53.7%)
174 (46.3%)
2.17 (01.56–3.02)
1.73 (0.81 to 3.68)
History of obstetric danger signs
No
150 (42.4%)
206 (57.6%)
1
1
Yes
78 (49.4%)
80 (50.6%)
0.78 (0.53–1.13)
1.22 (0.54 to 2.74)
Number of children
2 and below
168 (59.9)%
114 (40.2)%
1
1
3 and 4
94 (41.4)%
133 (58.6)%
0.48 (0.34–0.68)
0.79 (0.45–1.41)
5 and above
25 (22.5)%
86 (77.5)%
0.20 (0.12–0.33)
0.15 (0.05–0.46)*
Family income
1,500 birr and below
37 (24.5)%
108 (74.5)%
1
1
1,501–3,000 birr
92 (34.3)%
176 (65.7)%
1.53 (0.97–2.39)
1.15 (0.67–1.99)
3,001–500 birr
76 (74.5)%
26 (25.5)%
8.53 (4.77–15.26)
3.35 (1.58–7.12)*
5,001 birr and above
82 (78.1)%
23 (21.9)%
10.41 (5.74–18.85)
1.68 (0.66–4.26)
*significant at p value < 0.05, **significant at p value < 0.01.
Discussion
The findings of this study indicated that the magnitude of the husbands’ knowledge of obstetric danger signs in the overall combination of three phases (prenatal period, childbirth, and postnatal period) was 46.3%, with a 95% CI of 42.6 to 50.3%. This finding is lower than that in Nigeria, where research conducted in two different study areas found that 53.8 and 51.9% of men had good knowledge of obstetric danger signs in pregnancy, as well as 53.3% in Dessie (12, 21, 22). This variation may be due to socio-economical differences between the studies conducted in Nigeria and this study, where the majority of the participants lived in rural areas that had less access to sources of information about obstetric danger signs and a lower likelihood of wives attending ANC follow-up visits, which would provide opportunities for sharing knowledge on danger signs. However, this finding was higher than the findings of studies conducted in the Musoma district, Mara region, Tanzania (32%) and southern Ethiopia (42.2%) (23).
Possible reasons for the higher prevalence and the differences observed might include healthcare system disparities between the countries, especially the utilization of community mobilization on maternal health in Ethiopia by health extension workers. Additionally, the time gap between studies may have contributed, as wives’ utilization of maternal care may have improved, which in turn could have led to an increase in husbands’ knowledge of danger signs. The study found that the husbands who had completed secondary school were 4.8 times (AOR = 4.77, 95% CI, (1.42–16.04)) more likely to have good knowledge of obstetric danger signs than those who were unable to read and write. This finding is in line with a study conducted in Southwest Nigeria (24). This may be due to the fact that education is an important tool for increasing understanding and access to information about obstetric danger signs and their outcomes through various electronic media. In addition, closer collaboration between schools and local health services may enhance the delivery of reproductive health education. The place of residence was significantly associated with the husbands’ knowledge of obstetric danger signs. The husbands living in urban areas were 3 times (AOR = 3.00, 95%CI = (1.59, 7.57)) more likely to have good knowledge than those living in rural areas. This finding is similar to a study conducted in the Andede district (25). This could be because the respondents living in urban areas in the present study had greater access to information compared to those in rural areas, as most messages are transmitted through various media available in urban settings. However, this finding is in contradiction with a study conducted in the Chencha district, Gamo Gofa Zone, southern Ethiopia, which showed that husbands living in rural areas were 8.4 times more knowledgeable than those living in urban areas (11). This discrepancy may be due to the fact that the husbands living in rural areas in this study had limited sources of information and lower educational backgrounds compared to those living in urban areas.
The number of children in this study was a significant factor associated with the husbands’ awareness. The husbands in families with more than five children were 85% times (AOR = 0.15; 95% CI: 0.05–0.46) less likely to have good knowledge of obstetric danger signs compared to those with fewer than two children. The finding is consistent with a study conducted in Tanzania (26).A possible reason for this is that husbands with many children tend to prioritize income generation, leading to longer working hours and multiple sources of employment (27). This situation leaves them with limited time to attend antenatal care (ANC) visits or to recognize and respond to obstetric danger signs, such as prolonged labor, severe bleeding, or reduced fetal movement, all of which require immediate attention. However, a study conducted in Nigeria showed no significant difference in the knowledge of danger signs regarding the number of children in the family (28). The reason for this discrepancy may be the large sample size used as larger sample sizes increase the probability of detecting associations between variables.
The total average monthly income of the family was also a factor associated with the husbands’ knowledge of obstetric complications. The husbands with an average monthly income of 3,001–5,000 birr were 3.4 times (AOR = 3.35, 95% CI = (1.58, 7.12)) more likely to have good knowledge compared to those with an average monthly income of less than 1,500 birr. This finding is in line with studies conducted in South Ethiopia and Uganda, where economic status was also significantly associated with men’s awareness of danger signs of obstetric complications (28, 29). This may be because men with higher economic status are more likely to be exposed to health education provided by health institutions. In addition, they can afford radios, TVs, and other media to access more information about maternal health. Higher-income households tend to exhibit better health-seeking behaviors and greater engagement in maternal health, as they are less constrained by financial limitations. This access to information and services enables them to pay more attention to their wives’ pregnancies, increasing the likelihood of early recognition and intervention in the case of obstetric danger signs.
Strengths and limitations of this study
The study was community-based, which allowed it to reflect the experiences of the husbands during the study period. It also utilized a large sample size, making the findings more representative. However, a limitation of the study is the potential for recall bias, even though the recall period was reduced to 1 year. The husbands were asked to remember events that occurred up to 1 year before the study, and the data were collected by having them mention the obstetric danger signs they knew and the activities they had undertaken, without providing them with options to choose from.
Conclusion
The husbands’ knowledge of obstetric danger signs in the Raya Kobo district was limited. Severe vaginal bleeding was the most frequently identified obstetric danger sign during the antepartum, intrapartum, and postpartum periods. The educational status of the husband, average family income, residence, and number of children were significantly associated with the husbands’ knowledge of obstetric danger signs. These findings highlight the importance of addressing knowledge gaps through targeted educational programs aimed at improving awareness of obstetric complications. Enhancing this awareness among husbands could play a crucial role in promoting timely healthcare-seeking behaviors and improving maternal health outcomes in the study area.
Data availability statement
The data sets used or analyzed during the current study are available from the corresponding author upon reasonable request.
Ethics statement
The studies involving humans were approved by the Institutional Review Board (IRB) of Debre Berhan University, Asrat Woldeys Health Science Campus, who granted ethical approval under reference number IRB01/74/2015. The Official letter was written for Amara Public Health Institute to Raya Kobo District health offices and informed verbal consent was taken from individual participants. No form of identifier was included in the questionnaires to maintain confidentiality. Participation was voluntary and participants were informed that they could withdraw from the study at any stage if they desired, without any penalty. At the end of the interview, information was given about the danger signs of obstetric complications at three stages (during pregnancy, labor and childbirth, and the postpartum period). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.
The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. The study was fully funded by the Amhara National Regional State Health office.
First, we would like to thank all study participants for their contribution in providing the necessary information. We also thank data collectors and supervisors for their commitment to the accomplishment of this thesis work. Finally, we would like to thank the Amhara Regional State Health Bureau for their cooperativeness.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Abbreviations
ANC, Antenatal Care; AOR, Adjusted Odds Ratio; BSc, Bachelor of Science; CI, Confidence Interval; CM, Clinical Midwife; COR, Crude Odd Ratio; EDHS, Ethiopia Demographic Health Survey; HEWs, Health Extension Workers; ICPD, International Conference on Population and Development; ODS, Obstetric Danger Signs; OR, Odd Ratio; RH, Reproductive Health; SBA, Skilled Birth Attendant; SDG, Sustainable Development Goal; SPSS, Statistical Package and Services Solution; WHO, World Health Organization.
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