Wassihun et al.

Reproductive Health (2020) 17:4

https://doi.org/10.1186/s12978-020-0853-z

RESEARCH Open Access

Knowledge of obstetric danger signs and

associated factors: a study among mothers
in Shashamane town, Oromia region,
Ethiopia
Biresaw Wassihun1*, Berhanu Negese1, Hunduman Bedada1, Solomon Bekele1, Agegnehu Bante1, Tomas Yeheyis1,
Agere Abebe1, Duro uli1, Merima Mohammed1, Salasebish Gashawbez1 and Emebet Hussen2

Abstract
Background: Child birth which is a special moment for parents, families and communities is also a time of intense
vulnerability. In many developing countries including Ethiopia, maternal morbidity and mortality still pose a
substantial burden. Raising awareness of women about the danger signs of pregnancy and childbirth is the first
essential step in appropriate and timely obstetric care.
Objective: To assess the knowledge of obstetric danger signs among mothers and associated factors in
Shashamane town, oromia region, Ethiopia.
Methods: A community based cross sectional study design was employed. All kebeles were included in study; the
number of households was determined using proportionate-to-population size then systematic random sampling
technique to select 422 women who gave birth in Shashamane town between April and May 2018. A structured
questionnaire was used to collect data. Data was checked and entered into Epi data version 3.1 then exported to
Statistical Package for Social Science version 23 for analysis. Univariate, bivariate and multivariable analysis with 95%
CI was carried out. Women who spontaneously mentioned at least two danger signs of pregnancy from eight
items were considered to have good knowledge of the obstetric danger signs.
Result: A total of 422 mothers were involved in the study. The mean age of the respondent was 25 with a
standard deviation of 4.3 year. 59.5% of the respondents were found to have poor knowledge of obstetric danger
signs. Majority of respondents mentioned vaginal bleeding (64.7%) as a danger sign of pregnancy. According to the
result of the multivariable analysis, antenatal care was significantly associated with the knowledge of obstetric
danger sign. Respondents who attended antenatal care were 1.26 times more likely to have good knowledge of
obstetric danger signs than those who had no antenatal care [AOR = 1.26, 95%CI (1.08–1.85)]. Respondents who
gave birth at health center were 3.57 time more likely to have good knowledge of obstetric danger signs than
those who gave birth at home [AOR = 3.57, 95%CI (1.23–10.39)].
Conclusion: According to this study, the knowledge of obstetric danger signs was poor. Some of the factors
associated with this knowledge were antenatal care attendance and place of delivery; therefore, it is recommended
that mothers should have at least four antenatal visits; this may create good relationship with the providers and
enhance their knowledge. In addition to this providing compassionate and respectful maternity care in health
facility is also crucial steps to attract more women to health facilities, and to reduce home deliveries.
Keywords: Knowledge, Obstetric, Danger sign, Ethiopia

* Correspondence: [email protected]
1
Colleges of Medicine and Health Sciences, Arba Minch University, Arba
Minch, Ethiopia
Full list of author information is available at the end of the article

© The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Wassihun et al. Reproductive Health (2020) 17:4 Page 2 of 8

Plain English summary recognize pregnancy related risks, and to take responsi-
Worldwide, a projected half million women die as a re- bility for developing and implementing appropriate re-
sult of pregnancy and childbirth related complications. sponse to them [9]. In many low resources countries,
In Ethiopia, only one-third of mothers gives birth at a home delivery is prevalent. Therefore, it is important
health institution and the maternal mortality ratio is that people are trained to recognize danger signs and de-
410/100,000 live births. One of the contributing factors velop plans for emergencies [9]. Maternal deaths during
to maternal deaths was a lack of knowledge of child birth has profoundly bad consequences for her
pregnancy-related danger signs. Therefore, this study family, particularly for children left without care taker
aimed to investigate the knowledge of obstetric danger and have a negative impact on the society and econ-
signs among recently-delivered women and associated omies of their nations at large [10]. Majority of maternal
factors in Shashamane town, oromia region, Ethiopia. A deaths are avoidable, if women with complications are
community based cross-sectional study design was able to identify and seek appropriate emergency obstet-
employed on 422 mothers who gave birth in Shasha- ric care [9]. Maternal deaths have both direct and indir-
mane town between April and May 2018. The data was ect causes. Around 85% of maternal deaths worldwide
collected using a face to face interview and question- are due to direct obstetric complications such as severe
naire. A total of 422 women responded fully for the postpartum bleeding, infections after delivery, unsafe in-
questions asked. The result of the response was analyzed duced abortion, hypertensive disorders in pregnancy and
using statistical software to identify which variables were obstructed labour [11]. Direct cause of maternal mortal-
associated with knowledge of obstetric danger signs. ity was easily avoidable if the mother and family
Women attending antenatal care, and giving birth in recognize sign and seeking immediate care, health facil-
health facility had better knowledge of obstetric danger ity provides quality care and transportation were easily
sign. available [12]. High levels of maternal mortality can be
reduced by providing quality maternity service and
Background empowering women with knowledge of the danger signs
The burden of pregnancy complications is higher in de- of pregnancy and promote appropriate health seeking
veloping countries [1]. In 2015, a total of 303,000 perceptions. In Ethiopia; however, few studies have been
women have lost their life due to easily preventable conducted with regarding the knowledge of obstetric
pregnancy and childbirth related complications, 99% of danger sign during pregnancy, childbirth and associated
which were contributed by low income countries [2]. factors and we could not find any published research
Knowledge of danger signs during pregnancy, labour that is conducted in this study area. This study was
and delivery is crucial for safe motherhood [3]. Preg- therefore, aimed at assessing the current status of know-
nancy danger signs are those symptoms that may signal ledge of obstetric danger signs and associated factors
danger to a pregnant woman or her fetus and therefore among mothers in Shashamane town, oromia region,
require immediate medical attention. The most common Ethiopia.
danger signs during pregnancy are severe vaginal bleed-
ing, swollen face/hand, and blurred vision: danger signs Methods
during labor and childbirth include severe vaginal bleed- Study area
ing, prolonged labor, and convulsions; Danger signs dur- The study was conducted in Shashamane town, located
ing the postpartum period include severe bleeding in central part of Oromia region, 130 km from Adama,
following childbirth, loss of consciousness after child- the capital city of the region and 248 km from Addis
birth, and fever [4]. Many of the complications that re- Ababa, the capital city of Ethiopia. The town was estab-
sult in maternal deaths contributing to prenatal deaths lished in 1903 e. c. Based on the 2007 Census the town
are unpredictable, and their onset can be both sudden has a total population of 218,335 where, about 48.9% are
and severe [5, 6]. In low income countries maternal females. It consists of peoples with different languages,
mortality due to childbirth related complication could more than 18 ethnic groups and foreigners like the Ras
be prevented if pregnant women recognize danger signs Teferian community. There are 74 health institutions in
and seek immediate obstetric care [7]. Poor knowledge the town. Among this there are two public hospitals
of danger sign is one of the most common causes of fail- which serve the district and referral levels 30 pharmacies
ure to recognize the complication when it occurs and six health centers, 28 private clinics, one private hospital
delaying the decision to seek care [8]. The national re- and five health posts.
productive strategy of Ethiopia has emphasis on mater-
nal and newborn health to reduce high maternal and Study design and period
neonatal death [8]. The strategy focuses on the need to A community based cross sectional study was conducted
empower women, men, families and communities to in Shashamane town between April and May 2018.
Wassihun et al. Reproductive Health (2020) 17:4 Page 3 of 8

Population Data collection tool and procedure

Source population Data were collected by face to face interview using a
All mothers who gave birth in the last 1 year at Shasha- structured questionnaire adapted from the survey tools
mane town. developed by JHPIEGO’s Maternal Neonatal Health Pro-
gram. The questionnaire was used to assess the know-
Study population
ledge of mothers regarding the pregnancy danger signs.
All mothers who gave birth within the last 1 year from The data collection tool was pre-tested on women with
selected four kebeles of Shashamane town and fulfill in- similar characteristics living out of the study area on
clusion criteria. 10% of sample size. After pre-testing further adjustments
to the data collection tool were made to improve clarity.
All of the questionnaires were checked for completeness
Inclusion criteria and accuracy before, during and after the period of data
All mothers who gave birth in the last year in Shasha- collection. Five diploma midwives who were fluent in
mane town. the local language were involved in the data collection.
Women who were resident of the area for the past 6 Two Bachelor of Science degree (BSc) holder health pro-
months. fessionals were recruited as supervisors.

Exclusion criteria Data quality control

Mothers who were critically ill and unable to communi- After pre-testing the questionnaire, Chronbach Alpha
cate at the time of data collection. was calculated by using SPSS window version 23.0 to
test internal consistency (reliability) of the item and
Chronbach Alpha greater than 0.7 was considered as re-
Sample size determination
liable. On the top of this, content validity was cross
The single population proportion formula was used to checked by another maternal and reproductive health
calculate the sample size by hypothesizing that the pro- expert at Arba Minch University. Data collectors and su-
portion of mothers who had good knowledge of danger pervisors were trained for 2 days on the study instru-
sign would be 50%, adding a non-response rate of 10%, ment and data collection procedure. The principal
and using the assumptions of a 95% confidence level and investigator and the supervisors checked the data for
a 5% margin of error. The resulting sample size was 422 completeness and corrective measures was taken
mothers. accordingly.

Sampling procedure Data processing and analysis

Systematic random sampling was used to select study The collected data were checked manually for com-
participant from 10 kebeles of Shashamane town admin- pletion and any incomplete or misfiled questions,
istration. All kebeles were included in the study and the cleaned and stored for consistency, entered into Epi-
number of households was determined using Data version 3.1 (EpiData Association, Odense,
proportionate-to-population size. Denmark), and then exported to SPSS version 23.0
To select the first household the data collectors used (IBM Corp., Armonk, NY, USA) for analysis. Descrip-
the kebeles administration office and church as a start- tive statistics were calculated and presented using ta-
ing point. The data collectors used spinning techniques bles and figures. Multivariable logistic regression
to select the first house hold by rotating a pen and select analysis was performed to adjust for possible con-
the house which is found to the direction of the pen. founding variables. Variables that were significant in
Then went to the right direction of the first household. the bivariate logistic regression were entered into the
From this onwards data was collected in every 12th multiple regression analysis. The p < 0.05 or 95% con-
interval until the desired sample was achieved in each fidence intervals (CIs) not including 1.0 were consid-
kebeles. ered to indicate statistical significance.
A mother in the selected household was inter-
viewed. For household with more than one individual, Measurement
only one person was selected using a lottery. For Danger signs are indications of potential obstetric com-
those selected household which was unavailable dur- plications. Knowledge of women about obstetric danger
ing data collection, data collectors revisited three signs were measured by the total number of correct
times at different time intervals, and if interviewers spontaneous answers to eight items on knowledge of
still failed to get an individual in the house hold, it pregnancy danger signs and eight items on knowledge of
was considered as non-response. labor and childbirth danger signs with a minimum score
Wassihun et al. Reproductive Health (2020) 17:4 Page 4 of 8

of zero and maximum of eight. Spontaneous knowledge Table 1 Socio demographic characteristics of mother in
refers to the respondent’s naming a sign without being Shashamane town, April, 2018
asked about that sign by name. Only true obstetric com- Variable Frequency(n = 422) Percent (%)
plications spontaneously mentioned by individual re- Age in year
spondents were included. Accordingly, two categories 16–19 19 4.5
were developed for each pregnancy and childbirth dan-
20–24 164 38.9
ger signs. Good knowledge about pregnancy danger
25–29 163 38.8
signs: women who spontaneously mentioned at least two
danger signs of pregnancy. Poor knowledge about preg- 30 and above 76 18.0
nancy danger signs: women who did not spontaneously Marital status
mention two danger signs of pregnancy. Good know- Single 16 3.8
ledge about the danger signs of labor and childbirth: Married 394 93.4
women who spontaneously mentioned at least two dan-
Divorced 11 2.6
ger signs of labor and childbirth. Poor knowledge about
Widowed 1 0.2
the danger signs of labor and delivery: women who did
not spontaneously mention two danger signs of labor Ethnicity
and childbirth. Oromo 266 63
Amara 62 14.5
Wolayita 39 9.2
Result Sidama 16 3.8
Socio demographic characteristics
Tigre 13 3.1
A total of 422 mothers were involved in the study.
a
The mean age of respondents was 25 with a standard Other 27 6.4
deviation of 4.3 years. The minimum and maximum Religion
age of respondent was 16 and 39 respectively. Around Muslim 154 36.5
154 (36.5%) of the participants were Muslim and 266 Orthodox 139 32.9
(63%) were Oromo in ethnicity. Majority 394 (93.4%)
Protestant 124 29.4
of the women were married and majority 275(65.2%)
Catholic 5 1.2
of the respondents were housewives. 162 (38.4%) had
completed primary school and 57(13.5%) had com- Occupation
pleted college or greater. Majority 243 (57.6%) of the Unemployed 275 65.2
respondents had a monthly family income < 4000 Employer 43 10.2
Ethiopian birr (Table 1). Merchant 60 14.2
Private employer 26 6.2
Obstetric history related characteristics
Farmer 1 0.2
Out of 422 respondents, 244 (57.8%) were multi para
while other 164 (38.9%) were grand multi para. Majority Othersb 17 4
of the respondents, 368 (87.2%) gave birth at a health Educational status
center. From the total respondents, 334 (79.5%) had a No formal education 69 16.4
spontaneous vaginal delivery, while 86 (20.4%) had an Primary school 162 38.4
instrumental delivery. Almost all 323 (76.5%) of the re-
Secondary and preparatory 134 31.8
spondents decided where they gave birth by themselves
Collage and above 57 13.5
and 86 (20.4%) respondents had the decision made by
their husband, only 13 (3.1%) were decided by their rela- Monthly income
tives (Table 2). Below 4000 243 57.6
Above 4000 179 42.4
Knowledge about obstetric danger signs Median 4000
Knowledge of obstetric complications was assessed by In ethnicity a = Guraga, Gamo, Gofa. In occupation b
= students, Daly workers
questions of danger signs related to pregnancy and
childbirth. The most commonly mentioned danger sign
of pregnancy was vaginal bleeding (64.7%), followed by decrease fetal movements (28.4%). In addition, a com-
absent or decreased fetal movements (38.6%). Similarly, monly mentioned danger sign during post-partum was
the most commonly mentioned danger sign during postnatal bleeding (63.3%), followed by postnatal fever.
childbirth was bleeding (60%), followed by absent or 251(59.5%) of the respondents were found to have poor
Wassihun et al. Reproductive Health (2020) 17:4 Page 5 of 8

Table 2 Obstetric characteristics of mothers in Shashamane danger signs than housewives [COR = 1.36 (95%CI
town, April, 2018 1.853–2.17)]. In multivariate logistic regression on both
Variables Frequency (n = 422) Percent (%) socio-demographic and obstetric history of respondents,
Age of first pregnancy in year number of antenatal care (ANC) visits and place of de-
< 20 134 31.8 livery were found to be significantly associated with
knowledge of obstetric danger signs at P-value of < 0.05.
20–24 275 65.2
Respondents who attended ANC were 1.26 times more
25–29 12 2.8
likely to have good knowledge of obstetric danger signs
30–34 1 0.2 than respondent with no ANC [AOR = 1.26 (95%CI
Total number of pregnancy 1.07–2.85)]. Respondents who gave birth in the health
1 178 42.2 center had 3.57 time more likely to have good know-
2–5 209 49.5 ledge of obstetric danger signs than those respondents
who gave birth at home [AOR = 3.57 (95%CI1.23–
>6 35 8.9
10.39)] (Table 4).
Pregnancy resulted alive
0 18 4.3 Discussion
1 193 45.7 The findings of this study revealed that the good know-
>1 211 50 ledge of respondents regarding obstetric danger sign was
Total number of children 40% which is higher than other studies conducted in
Egypt 26.0% [12], Jordan 15.2% [13], and Uganda 19%
1 14 3.3
[14]. However, it was lower than the findings of South Af-
2–4 376 89.1
rica 52% [15]. This difference might be due to socio-
>5 32 7.6 cultural differences and differences in implementation of
ANC follow up health programs. The finding of this study is also consist-
Yes 367 87.0 ent with study conducted in another part of the Ethiopia
No 55 13.0 in Debra Berhan public health institution, 38.6% [16].
The most common danger sign mentioned during preg-
Number of ANC follow up
nancy was vaginal bleeding at 64.7%. This is greater than
One 5 1.3
in Tsegedie district, Tigray 51.2% [17]. The difference may
Two 22 5.9 be due to study period difference and increasing the num-
Three 107 29.1 ber of staffs which providing counseling on danger signs
Four and above 233 63.4 during antenatal, childbirth and postnatal period. The
Key: ANC Antenatal care finding of this study was comparable with the same study
conducted in Debre berhan city administration 61.1%
[18]. Vaginal bleeding during childbirth was also men-
knowledge; however, 171(40.5%) had good knowledge of tioned by about 60% of the respondents, while persistent
obstetric danger sign (Table 3), (Fig. 1). headache and blurred vision was mentioned by 24.9%,
which was higher than study conducted in aleta wendo
Factors affecting knowledge of obstetric danger signs district, sidama zone 55 and 7%. The discrepancy may be
According to the bivariate analysis, knowledge was sig- due to improvement of service provision in maternity care
nificantly associated with educational status of mothers. [19]. In this study respondents who had a history of ANC
Respondents who had a formal education were 6.01 were 1.26 times more knowledgeable than those who had
times more likely to have good knowledge of obstetric no ANC visits. This finding is consistent with study done
danger signs than respondents did not have formal edu- in other part of Ethiopia [17, 19]. Simlarly in this study re-
cation [COR = 6.01 (95% CI 2.26–2.60)]. Place of delivery spondents who gave birth in health faclity was 3.57 times
was significantly associated with knowledge of obstetrics more likely to have good knowledge than those who gave
danger signs, respondents who gave birth at a health in- birth at home.
stitution were 5.7 times more likely to have good know-
ledge of obstetric danger signs than those who gave Conclusions
birth at home [COR = 5.7 (95%CI 2.98–11.17)]. Occupa- This study’s findings revealed that knowledge about obstet-
tion of respondent was also significantly associated with ric danger signs of pregnancy overall was poor. The most
knowledge of obstetric danger signs. Respondents who commonly mentioned danger signs during pregnancy, and
were working for a governmental employer were 1.36 childbirth was severe vaginal bleeding followed by absence
times more likely to have good knowledge of obstetric of fetal movements. From this study it can be concluded
Wassihun et al. Reproductive Health (2020) 17:4 Page 6 of 8

Table 3 knowledge of obstetric danger signs during pregnancy, Table 3 knowledge of obstetric danger signs during pregnancy,
child birth and postnatal among mothers in Shashamane town, child birth and postnatal among mothers in Shashamane town,
April 2018 April 2018 (Continued)
Variables Frequency (n = 422) Percent (%) Variables Frequency (n = 422) Percent (%)
Danger sign during pregnancy Yes 82 19.4
Vaginal bleeding No 340 80.6
Yes 273 64.7 Mal-presentation/position
No 149 35.3 Yes 54 12.8
Persistent nausea and vomiting No 368 87.2
Yes 121 28.9 Severe continuous abdominal pain
No 301 71.1 Yes 120 28.4
Swelling of body No 302 71.6
Yes 124 29.4 Danger sign during post-partum
No 298 70.6 Post Natal Bleeding
Persistent headache and blurred vision Yes 267 63.3
Yes 164 38.9 No 155 36.7
No 258 61.1 Persistent headache &blurred vision
Absent or decreased fetal movement Yes 106 25.1
Yes 163 38.6 No 316 74.9
No 259 61.4 Swelling hand, face
Severe abdominal cramps Yes 99 23.5
Yes 121 28.9 No 325 76.5
No 301 71.1 Postnatal Fever
Leakage of amniotic fluid without lab Yes 168 38.9
Yes 119 28.1 No 254 60.2
No 303 71.9 Unconscious
High fever Yes 90 21.3
Yes 98 23.2 No 332 78.7
No 324 76.8
Danger sign during child birth
Bleeding through birth canal
Yes 253 60
No 169 40
Persistent headache &blurred vision
Yes 105 24.9
No 317 75.1
Swelling of hand, face etc.
Yes 54 12.8
No 368 87.2
Absent or decrease fetal movement
Yes 120 28.4
No 302 71.6
Increased blood pressure
Yes 74 17.5
No 348 82.5
Retained Placenta (> 1 h.) Fig. 1 Knowledge of obstetric danger sign among mothers in
Shashamane town, April, 2018
Wassihun et al. Reproductive Health (2020) 17:4 Page 7 of 8

Table 4 Factors associated with knowledge of key obstetric danger sign during pregnancy, child birth and postnatal period among
mothers in Shashamane town, April 2018
Types of variable Good knowledge Poor knowledge COR (95% C.I) AOR (95% C.I)
Age of respondent
15–19 10 9 1 1
20–24 56 108 1.11 (0.41–3.04) 1.46 (0.24–8.98)
25–29 67 96 0.52 (0.29–0.90) 0.84 (0.26–2.67)
≥ 30 38 38 0.69 (0.04–1.21) 1.28 (0.46–3.51)
Occupation
House wife 118 157 1 1
Governmental employed 18 27 1.36 (1.85–2.17)a 2.05 (0.97–4.32)
Self-employed 37 67 1.07 (0.51–2.24) 1.74 (0.55–5.51)
Number of pregnancy
1 70 108 1 1
2–5 83 126 0.61 (0.29–1.27) 1.77 (0.37–6.68)
≥6 18 17 0.62 (0.30–1.27) 0.98 (0.27–3.62)
ANC follow up
No 51 4 1 1
Yes 120 247 0.67 (0.45–1.54) 1.26 (1.07–1.85)a
Place of delivery
Home 41 13 1
Health center 130 238 5.74 (2.98_11.16)a 3.57 (1.23–10.39)a
Source of information
Health personal 32 204 1 1
Relative 5 8 0.03 (0.02–0.06) 0.03 (0.02–0.06)
Friends 2 10 0.14 (0.04–0.45) 0.28 (0.05–0.17)
Media 123 29 0.04 (0.09–0.21) 0.05 (0.01–0.31)
Educational status
Informal education 16 7 1 1
a
Formal education 126 167 6.07 (2.26–16.26) 3.91 (0.84–18.12)
Collage and above 29 77 2.03 (1.23–3.25)a 1.96 (0.95–4.05)
Income
< 4000 106 135 1 1
a
> 4000 65 114 1.35 (1.91–2.02) 1.11 (0.60–2.06)

that women’s knowledge of danger signs during pregnancy Abbreviations

and childbirth was increased by their educational level, ANC: Antenatal care; AOR: Adjusted odds ratio; CI: Confidence interval;
COR: Crude Odds ratio
number of ANC visits and having an institutional delivery.
We recommended mobilizing communities to increase Acknowledgements
knowledge on obstetric danger sign during pregnancy. We would like to express our deepest heartfelt thanks to Arba Minch
University for allowing the conduct of this study. Our especial thanks also
Similarly encouraging pregnant women to attend extended to data collectors and study participants.
antenatal clinics and providing health information dis-
semination related to pregnancy danger sign and Authors’ contributions
BW, AB, EH, HB, MM, BN, TY and SB was involved in the conception, design,
seeking behavior is also vital. Finally, we recommend analysis, interpretation, report and manuscript writing. SG, AB, AA, DU and
further research to be conducted using both qualita- BW were involved in the design, analysis, interpretation and report writing.
tive and quantitative methods to address the behavior All authors read and approved the final manuscript.
and attitude of health care providers and maternity Funding
users regarding obstetric danger sign. Not applicable.
Wassihun et al. Reproductive Health (2020) 17:4 Page 8 of 8

Availability of data and materials 16. Solomon AA, Amanta A, Chirkose E, Badi MB. Knowledge about danger
The datasets used and/or analyzed during the current study available from signs of pregnancy and associated factors among pregnant women in
the corresponding author on reasonable request. Debra Birhan Town, Central Ethiopia. Sci J Public Health. 2015;3(2):269–73.
17. Hailu D, Berhe H. Knowledge about obstetric danger signs and associated
Ethics approval and consent to participate factors among mothers in Tsegedie District, Tigray Region, Ethiopia; 2014.
Ethical approval was obtained from the ethics committee of the Department 18. Nurgi S. Knowledge attitude and practice of obstetrics danger sign during
of Midwifery, College of medicine Health Science, Arba Minch University. A pregnancy in Debre Berhan Administration, Ethiopia; 2014.
letter from the research ethics committee was then submitted to the oromia 19. Mesay H, et al. Knowledge about obstetric danger signs among pregnant
Regional Health Bureau and the selected kebeles. After explaining the women in Aleta Wondo District, Sidama Zone, Southern Ethiopia. Ethiop J
objectives of the study in detail, informed verbal consent was obtained from Health Dev. 2007;20(1):25–32.
all study participants. All the participants were reassured of anonymity, as no
personal identifiers were used. Then, after obtaining informed consent from Publisher’s Note
every participant, the data collectors continued to show due respect to the Springer Nature remains neutral with regard to jurisdictional claims in
norms, values, beliefs, and culture of the participants, and the confidentiality published maps and institutional affiliations.
of the data was ensured.

Consent for publication

Not applicable.

Competing interests
The authors declare that they have no competing interests.

Author details
1
Colleges of Medicine and Health Sciences, Arba Minch University, Arba
Minch, Ethiopia. 2Ethiopian Midwifery Association, Addis Ababa, Ethiopia.

Received: 19 October 2018 Accepted: 6 January 2020

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