Research Article
Volume 2 Issue 3 - 2015
Awareness of Obstetric Danger Signs among Husbands in Outpatient Department of Obstetrics and Gynaecology at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia in September 2015. (Cross-Sectional Study)
Ayman A Bakhari1*, Ahmad MS Almrstani1, Osama S Bajouh1, Abdullah F Alahmari2, Ziyad T Alzahrani2 and Rayan M Alghamdi2
1Obstetrics and Gynaecology, King Abdulaziz University, Saudi Arabia
2Faculty of Medicine, King Abdulaziz University, Saudi Arabia
*Corresponding Author: Ayman A Bakhari, Department of Obstetrics and Gynaecology, Faculty of Medicine, King Abdulaziz University, Saudi Arabia.
Received: November 27, 2015; Published: December 02, 2015
Citation:Ayman A Bakhari., et al. “Awareness of Obstetric Danger Signs among Husbands in Outpatient Department of Obstetrics and Gynaecology at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia in September 2015 (Cross-Sectional Study)”. EC Gynaecology 2.3 (2015): 192-197.
Abstract
Objective: The aim of the study was to assess awareness of obstetric danger signs among husbands who attended outpatient department of Obstetrics and gynecology at King Abdulaziz University Hospital, Jeddah, Saudi Arabia in September 2015.
Methods: A cross sectional descriptive community survey was done at the outpatient department of Obstetrics and Gynaecology at King Abdulaziz University Hospital. Participants were husbands accompanying patients attending outpatient department of Obstetrics and Gynaecology at King Abdulaziz University Hospital. The study was conducted over a period of two weeks in September 2015.
Results: Out of the 140 husbands were asked to participate, 5 husbands refused participation. One-hundred-and-thirty-five husbands volunteered to be in the study, making the response rate 96.5%. Knowledge and perception toward obstetric danger signs: doctors were the predominant source of information to 31.9% of husbands. The awareness score was made as follows, husbands who mentioned three or more obstetric danger signs were labeled as aware whereas husbands who mentioned less than three were labeled as not aware. Sixty percent of husbands could mention three or more obstetric danger signs during pregnancy, only 31.9% during labor and 42.2% in the period of two days after giving birth.
Conclusions: Husbands’ awareness of obstetric danger signs in labor and two days after labor were low in comparison with their awareness in the pregnancy period. Thus, more effort needs to be done to educate husbands through couples’ classes, social media and to involve husbands in the antenatal care visits.
Keywords: Danger signs; Husbands’ awareness; Couples’ classes; KAUH; Antenatal care
Abbreviations: KAUH: King Abdulaziz Hospital
Introduction
Maternal mortality is a serious global health issue despite the decrease in its ratio in the last 2 decades [1]. Over the years in Saudi Arabia, it was estimated that in 1990 the maternal mortality ratio was41 and in 2013 it was 16 (per 100.000 live births) [2]. Even though the maternal mortality was declining, the target set by the Millennium Development Goal (MDG) 5, which aimed to decrease the maternal mortality ratio by three quarters by 2015, was not met yet in Western Asia, thus more effort needs to be done for the goal to be reached [3]. The dominant causes of maternal deaths are hemorrhage, hypertensive disorders and sepsis [4]. The most influential, decisive and decision-maker for a pregnant woman to seek medical attention in most societies is the husband [5]. Therefore, the role of husbands is crucial in deciding the fate of their pregnant wives and the wellbeing of their expected newborns [6]. The husband’s awareness of obstetric danger signs and his non-hesitant action towards minimizing their complications is essential [7,8]. There were no published studies in Saudi Arabia assessing the knowledge of obstetric danger signs among husbands, thus this study aimed to assess awareness of obstetric danger signs among husbands who attended outpatient department of Obstetrics and gynaecology at KAUH, Jeddah, Saudi Arabia in September 2015.
Materials and Methods
This study was carried out at the outpatient department of obstetrics and gynaecology at King Abdulaziz University Hospital (KAUH) in Jeddah, which is in the west region of Saudi Arabia. It was designed as a cross sectional descriptive community survey. Participants were husbands accompanying patients attending outpatient department of Obstetrics and Gynaecology at KAUH. The study was conducted over a period of two weeks in September 2015. These clinics ran four days per week and dealt approximately with 50 patients per day, almost more than half of them were accompanied by a male companion. Sample size was calculated using Raosoft® website to be 140. Eligibility criteria included husbands accompanying patients who attended outpatient clinic of Obstetrics and Gynaecology at KAUH and all legible husbands were recruited. Data were assembled by three medical students who were trained to interview the husbands; each interview takes from 3 to 5 minutes. An informed consent was taken after explaining to the husbands the aim of the study and that all of their information will be confidential. A pre-tested structured interviewer-administered questionnaire made by Johns Hopkins program for international education in gynaecology and obstetrics (JHPIEGO) was used to collect the data and was modified for the Saudi context [5]. The questionnaire consisted of questions about husbands’ sociodemographic characteristics, reproductive information, their general knowledge and perception toward obstetric danger signs and to name them spontaneously during pregnancy, labor and postpartum (during the first two days after giving birth). Data were collected via an electronic survey (google® form) and were analyzed by Statistical Package for the Social Sciences (SPSS) version 22. Pilot study was conducted among 10% of targeted population and some changes were done, such as: the variable type of age of husbands was changed from an interval variable to a continuous variable. The outpatient department had two waiting areas, one for females and one for males, the data were collected from the male side. The Research Ethics Committee in King Abdulaziz University gave the approval for this study.
Results
Sociodemographic and reproductive characteristics: out of the 140 husbands were asked to participate, 5 husbands refused participation. One-hundred-and-thirty-five husbands volunteered to be in the study, making the response rate 96.5%. The mean age was 39 years with standard deviation of 8.6. Two-thirds of them had bachelor’s degree. More than 95% of them had one wife while less than 5% had two. Saudis accounted for 82.2% while Non-Saudis made up 17.8% of the total number of husbands. Only 11.1% were Healthcare Employees. 52.2% earned a monthly income more than 10.000 Saudi Riyals. Results related to successful completed pregnancy were; (12.6%) having no pregnancies, (60.7%) having 1-4 successful pregnancies and (26.7%) having more than 4. Thirty eight of their wives, 28.1%, were pregnant at the time of data collection, 28.9% were pregnant in a period of two years or less, 35.6% were pregnant in more than two years while 7.4% had never been pregnant. Husbands who had accompanied their wives to the antenatal care clinic in their last pregnancy were equal to89.6%. Obstetric complications of their wives were found to be 24.4% in their last pregnancy. (Table 1)
Knowledge and perception toward obstetric danger signs: doctors were the predominant source of information to 31.9% of husbands followed by family and relatives 20%, the internet 14.8% while 24.4% reported not having enough information about the subject. Husbands who believed in the presence of pregnancy-related problems which they could endanger pregnant women’s lives were 91.1%.The awareness score was made as follows, husbands who mentioned three or more obstetric danger signs were labeled as aware whereas husbands who mentioned less than three were labeled as not aware. Sixty percent of husbands could mention three or more obstetric danger signs during pregnancy, only 31.9% during labor and 42.2% in the period of two days after giving birth. When husbands were asked about the danger signs during pregnancy, labor and two days after giving birth, 74.8%, 64.4% and 63.7% mentioned bleeding, respectively. During pregnancy, 63% mentioned severe abdominal pain and 37.8% mentioned water breaking before labor. During labor, almost 30% of husbands mentioned labor lasting more than 12 hours and placenta not delivered within 30 minutes after delivery of baby. In the two days period after giving birth 40.7% mentioned high fever and 32.6% mentioned severe weakness. (Table 2)
Characteristics Number N = 135 %
Age in years, mean (SD)a
39.1(8.6)  
Marital Status
Married
135 100.0%
Nationality
Saudi
111 82.2%
Non-Saudi
24 17.8%
Number of Wives
1
129 95.6%
2
6 4.4%
Number of Successful
Completed Pregnancy
0
17  
1-4
82  
More than 4
36  
Number of Abortions
0
80  
1- 4
55  
More than 4
15  
Wives’ Current Pregnancy Status
Currently pregnant
38 28.1%
Pregnant in a period of one year or less
24 17.8%
Pregnant in a period of less than or equal to two years and more than one year
15 11.1%
Pregnant in a period more than two years
48 35.6%
Never been pregnant
10 7.4%
Education Level
Primary education
3 2.2%
Intermediate education
8 5.9%
Secondary education
25 18.5%
Bachelor's degree
84 62.2%
Postgraduate degree
15 11.1%
Occupation
Healthcare employee
15 11.1%
Non-healthcare employee
92 68.1%
Others
28 20.7%
Residency Type
Villa
28 20.7%
Apartment
95 70.4%
Slum
10 7.4%
Others
2 1.5%
Housing Tenure
Owned
64 47.4%
Rented
71 52.6%
Monthly Income
Less than 2000
2 1.5%
2000-5000
16 11.9%
More than 5000-10.000
46 34.1%
More than 10.000-20.000
51 37.8%
More than 20.000
20 14.8%
Region Of Residence
North of Jeddah
37 27.4%
South of Jeddah
24 17.8%
East of Jeddah
26 19.3%
West of Jeddah
4 3.0%
Downtown
11 8.1%
Outside Jeddah
33 24.4%
Accompanied Wife to Antenatal Clinic in Previous Pregnancy
Yes
121 89.6%
No
4 3.0%
Never been pregnant
10 7.4%
Obstetric Complication in
Previous Pregnancy
Yes
33 24.4%
No
92 68.1%
Never been pregnant
10 7.4%
Place of Delivery in Previous Pregnancy
University hospital
17 12.6%
Governmental hospital
39 28.9%
Private hospital
58 43.0%
Private clinic
1 0.7%
Polyclinic
3 2.2%
Never gave birth
17 12.6%
Source of Information
Regarding Obstetric Danger Signs
Doctor
43 43
Family and relatives
27 20.0%
Internet
20 14.8%
Books and magazines
8 5.9%
audiovisual media
4 3.0%
No information
33 24.4%
Perception Towards Obstetric Danger Signs
Yes
123 91.1%
No
12 8.9%

Table 1: Sociodemographic and Reproductive Characteristics.

Obstetric danger sign Number N = 135 %
During Pregnancy
Bleeding
101 74.8%
Severe headache
26 19.3%
Blurred vision
24 17.8%
Convulsions
28 20.7%
High fever
35 25.9%
Loss of consciousness
40 29.6%
Difficulty breathing
42 31.1%
Severe weakness
45 33.3%
Severe abdominal pain
85 63.0%
Reduced fetal movement
42 31.1%
Water breaks without labor
51 37.8%
During Labor
Bleeding
87 64.4%
Severe headache
17 12.6%
Convulsions
28 20.7%
High fever
27 20.0%
Loss of consciousness
35 25.9%
Labor lasting > 12 hours
48 35.6%
Placenta not delivered 30 minutes after baby
37 27.4%
During Postpartum
Bleeding
86 63.7%
Severe headache
22 16.3%
Blurred vision
21 15.6%
Convulsions
19 14.1%
High fever
55 40.7%
Loss of consciousness
33 24.4%
Difficulty breathing
37 27.4%
Severe weakness
44 32.6%
Malodorous vaginal discharge
39 28.9%
Multiple responses possible.

Table 2: Husbands’ knowledge of danger signs during pregnancy, labor and postpartum.

Factors associated with awareness of obstetric danger signs: a chi square analysis of sociodemographic characteristics was put against awareness of obstetric danger signs during pregnancy, labor and two days after labor. During the pregnancy period, awareness was significantly related to nationality (P < 0.0001), wives’ current status of pregnancy (P < 0.024) and obstetric complication in previous pregnancy (P < 0.026). Furthermore, during labor, awareness was significantly related to nationality (P < 0.025), wives’ current status of pregnancy (P < 0.001) and occupation (P < 0.035). The awareness during two days after labor was significantly related to nationality (P < 0.001), wives’ current status of pregnancy (P < 0.001) and obstetric complication in previous pregnancy (P < 0.027).
Discussion
This study turned the spotlight on the level of awareness of obstetric danger signs between husbands. It showed that the awareness of husbands towards obstetric danger signs during pregnancy was significantly higher (60% of husbands) in comparison with their awareness during labor (31.9%) and two days after labor (42.2%) which could be explained by the fact that husbands whom their wives were pregnant or had been pregnant (92.5%) were more aware than those who had never been pregnant (7.5%). Furthermore, this study found that around 79% of husbands whom their wives had complications during previous pregnancies were aware. It’s known that antenatal care have a positive impact on the maternal and perinatal health [9] which is a reassuring fact since almost 90% of husbands in this study went with their wives to the antenatal care clinic in their last pregnancy, this might have had a hand in increasing the awareness of husbands about the obstetric danger signs during the pregnancy period, although this association was not statistically significant, perhaps due to the small sample size of this study. Bleeding was mentioned in this study as an obstetric danger sign in the pregnancy period by around three quarters of interviewed husbands, in contrast with two studies done in Tanzania (10.1%) and Nigeria (11.6%). [10,11] In comparison with the study published in Tanzana, the awareness of convulsions (13.9%), severe headache (4%) and loss of consciousness (1.8%) in labor were low similarly to the findings of this study [11].
Limitations
Regarding this study’s limitations, there were few worth stating. Respondents who were waiting for long hours due to the large number of patients attending the obstetrics and gynaecology clinic made them stressed and to some extent, unable to recall enough information about what was asked.
Conclusion
Husbands’ awareness of obstetric danger signs in labor and two days after labor were low in comparison with their awareness in the pregnancy period. Thus, more effort needs to be done to educate husbands through couples’ classes, social media and to involve husbands in the antenatal care visits with their wives so that they start recognizing the obstetric danger signs as soon as it occur and seek medical advice as soon as possible.
Bibliography
  1. Kassebaum NJ., et al. “Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013”. Lancet 384.9947 (2014): 980-1004.
  2. WHO, UNICEF and UNFPA. “The World Bank and the United Nations Population Division (2014) Trends in Maternal Mortality 1990– 2013”. WHO, Geneva.
  3. UN. “The Millennium Development Goal Report”.2010. United Nations, Addendum 2
  4. Say L., et al. “Global causes of maternal death: a WHO systematic analysis”. Lancet Global Health 2.6 (2014): e323-e333.
  5. JHPIEGO (2004) Monitoring Birth Preparedness and Complication Readiness: Tools and Indicators for Maternal and Newborn Health. Baltimore, MD: JHPIEGO
  6. Carter M. “Husbands and maternal health matters in rural Guatemala: wives’ reports on their spouses’ involvement in pregnancy and birth”. Social Sciences and Medicine 55.3 (2002): 437- 450.
  7. Mullany BC., et al. “The impact of including husbands in antenatal health education services on maternal health practices in urban Nepal: results from a randomized controlled trial”. Health Education Research 22.2 (2007): 166-176.
  8. Perreira KM., et al. “Increasing awareness of danger signs in pregnancy through community- and clinic-based education in Guatemala”. Maternal and Child Health Journal 6.1 (2002): 19-28.
  9. World Health Organization, UNICEF: Antenatal care in developing countries. Promises, achievements, and missed opportunities. Geneva, Switzerland: World Health Organization, (2003).
  10. August F., et al. “Men’s Knowledge of Obstetric Danger Signs, Birth Preparedness and Complication Readiness in Rural Tanzania”. PLoS One 10.5 (2015): e0125978.
  11. SekoniOO and Owoaje ET. “Male knowledge of danger signs of obstetric complications in an urban city in South west Nigeria”. Annals of Ibadan Postgraduate Medicine 12.2(2014): 89-95.
Copyright: © 2015 Ayman A Bakhari., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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