Study design and setting
We carried out a community based cross sectional study in Goba district, Bale zone Ethiopia during April, 2013. Currently, the district has 24 rural and 2 urban kebeles. The estimated total number of women of reproductive age (15-45 years) and pregnant women in the district is 16,277 and 2725, respectively. A total of 43 health institutions were available in the district: 13 in Goba town including 2 government health facilities (1 hospital and 1 health center) and 11 private health facilities (6 clinics and 5 pharmacies), and 30 outside Goba town including 28 government health facilities (3 health centers, 24 health posts and 1 clinics) and 2 private clinics .
Mothers who had been living for at least 6 months in Goba district and who had given birth within the last 12 months prior to the data collection, irrespective of birth outcome, were the source population of this study.
Sample size determination
Using the formula for single population proportions, we made the following assumptions: proportion of mothers knowing obstetric danger signs during pregnancy to be 23.8% , confidence level 95%, absolute precision +/-5%, design effect 2, and non-response rate 5%. The required sample size was thus 580.
All kebeles of Goba district were stratified into urban (n = 2) and rural ones (n = 24). Roughly 1/3 of the kebeles in each stratum, i.e. one urban and eight rural kebeles, were selected by simple random sampling. Census was carried out in the selected kebeles to identify mothers who gave birth in the last one year prior to the survey. Then, the total sample size (n = 580) was allocated proportionally on each kebele based on the number of mothers delivered during the last 12 months prior to the data collection of this study. Finally, systematic sampling was employed to select the study subjects in each kebele until the desired numbers of sample was obtained. To select the first house hold in each kebele, a starting point was identified at the centre of each kebele with the help of health extension workers (actors in an innovative community based health care delivery system to accelerate expansion of primary health care coverage program) assigned in that kebele.
Operational and term definitions
Knowledge of obstetric complication(s): Any symptom of obstetric complication(s) reported by woman which may occur in women during pregnancy, delivery or within 6 weeks after delivery.
Knowledgeable on key danger signs of pregnancy: In this research a woman was considered as knowledgeable if she can mention at least three key danger signs for pregnancy.
Knowledgeable on key danger signs of labor/childbirth: In this research a woman was considered as knowledgeable if she can mention at least three key danger signs for Labor/childbirth spontaneously or after prompting.
Knowledgeable on key danger signs of post partum: In this research a woman was considered Knowledgeable if she can mention at least the three key danger signs for post partum spontaneously or after prompting.
Data collection procedure
A safe motherhood questionnaire developed by the Maternal and Neonatal Program of JHPIEGO, an affiliate of John Hopkins University was used after adoption to actual set up . The questionnaire was translated from English to local language. The questionnaire was pre-tested on 5% of the total sample size in Robe town and a necessary adjustment was made before use for data collection. Eight diploma Nurses who were fluent in speaking local language were involved in the data collection. Two Bachelor of Science degree (BSc) holder health professionals were recruited as supervisors.
Data quality control
After pre-testing the questionnaire, Cronbatch’s Alpha was calculated by using SPSS window version 16.0 to test internal consistency (reliability) of the item and Cronbatch’s Alpha greater than 0.7 was considered as reliable. On the top of this, content validity was cross checked by another maternal and/or reproductive health expert. Data collectors and supervisors were trained for three days (including practical sessions) on the study instrument and data collection procedure. The principal investigator and the supervisors checked the collected data for completeness and corrective measures was taken accordingly.
Data processing and analysis
The data was checked for completeness and consistencies, then it was coded and entered in to computer using statistical package for social sciences (SPSS) windows version 16.0. and further clearance was made after entry using this software. The level of knowledge on key danger signs of obstetric complication during pregnancy, child birth and during post partum period was described and in this study a woman was considered knowledgeable when she mention at least three recognized danger signs for each of the aforementioned period. Additionally, binary logistic regression was determined to see the independent effect of an independent variable during pregnancy, child birth and during post partum period. Furthermore, multiple logistic regressions were carried out to examine the existence of relationship between the aforementioned outcome variables and selected determinant factors. Variables significant in the bivariate analysis were then entered into a multiple logistic regression analysis. The associations between knowledge on key danger signs of obstetric complication during the three period (pregnancy, child birth and during post partum) and each independent variable were estimated by odds ratio (OR) and 95% confidence interval (CI). A CI was considered statistically significant when the interval between the upper and lower values did not include one.
The proposal was approved by Ethical Review Committee of College of Medicine and Health sciences of Madawalabu University. Furthermore, letter of permission was obtained from Bale Zone health department and from Goba Woreda administrative and health offices. Verbal consents was obtained from the study subjects after explaining the study objectives and procedures and their right to refuse not to participate in the study any time they want was assured. For this very purpose, a one page consent letter was attached to the cover page of each questionnaire stating about the general objective of the study and issues of confidentiality which was discussed by the data collectors before proceeding with the interview.