This document provides a synopsis for a research project assessing the knowledge and practices of pregnant women regarding danger signs of pregnancy at tertiary care hospitals in Karachi, Pakistan. It includes a title page listing the 9 student researchers and their supervisor, Sher Alam. It then includes letters requesting approval from the supervisor and principle for the research topic. The synopsis also includes an introductory chapter outlining the background and significance of the study, research objectives and operational definitions. It concludes with an outline of the proposed research methodology, which will employ a descriptive cross-sectional design to study knowledge and practices regarding WHO-recommended danger signs of pregnancy.
1. Assessment of Knowledge and Practices of Pregnant Women towards
Danger Signs of Pregnancy at Tertiary Care Hospitals Karachi, Pakistan.
SYNOPSIS
Of
EVIDENCE BASED RESEARCH PROJECT
POST RN BSN, YEAR II, SEMESTER IV, SESSION 2019-21
Supervisor: Sher Alam
Submitted by
1. Noureen
2. Quratulain
3. Ayesha
4. Ume Farwa
5. Hanif
6. Shahzad
7. Rahat shah
8. Sadam
9. Deedar
Date of Submission: September 11, 2021
SCHOOL OF NURSING KARACHI, KHARADAR GENERAL
HOSPITAL
2.
3. i
To,
The Sher Alam,
School of Nursing
Kharadar General Hospital.
Subject: Application for Mentorship
Respected Sir,
We are a student of the Post RN BSN. Year II, Semester IV at School of Nursing, Kharadar
General Hospital Karachi, aiming to conduct our research based project to fulfill the mandatory
requirement of ,School of Nursing Karachi, Kharadar General Hospital academia to be awarded
our degree.
As a part of the research protocol, we would be requiring immense guidance and regular
consultations by a credible research faculty to help us in this accomplishment. We shall be
highly obliged if you accept us in your Mentorship and master our research based project. On
completion of all the orientations and introductory discussions on final research project with
our School Management, here is our selected topic.
“Assessment of Knowledge and Practices of Pregnant Women towards Danger Signs of
Pregnancy at Tertiary Care hospital; Karachi, Pakistan”
We would be deeply honored to work under your wing.
Thanking you in advance.
Sincere regards,
1. Noureen____________
2. Quratulain __________
3. Ayesha ____________
4. Ume Farwa _________
5. Hanif ______________
6. Shahzad ____________
7. Rahat shah __________
8. Sadam _____________
9. Deedar _____________
4. ii
To,
Miss Talat Parveen Shah,
Principle of School of Nursing,
Kharadar General Hospital,
Karachi, Pakistan.
Subject: Request for approval of Synopsis
Dear Madam,
The Evidence Based Research Project synopsis entitled “Assessment of Knowledge and
Practices of Pregnant Women towards Danger Signs of Pregnancy at Tertiary Care hospital,
Karachi, Pakistan” has been submitted by Post RN BSN Year, II, Semester IV, students
(Research group D). As per review and evaluation by the research evaluation representatives
and our endorsement of the review given from our competent expertise, this synopsis fulfills
the requirements of the Research Based Project and is capable of being worked upon to be
reported and presented as part of the project requirement.
Your approval shall be appreciated.
Kind regards,
__________________
Sher Alam
Research Supervisor
School of Nursing
Kharadar General Hospital
Karachi.
5. iii
Supervisor Approval letter
To,
1. Noreen
2. Quratulain
3. Ayesha
4. Ume Farwa
5. Hanif
6. Shahzad
7. Rahat shah
8. Sadam
9. Deedar
Topic: “Assessment of Knowledge and Practices of Pregnant Women towards
Danger Signs of Pregnancy at Tertiary Care hospital; Karachi, Pakistan”
Department : School of Nursing, Kharadar General Hospital
Year : Post Rn BSN Year II, Semester IV, Session 2019-21
This is to certify that I have agreed to be the Supervisor of these students. I accept the research
Based Project synopsis’ topic and have read, reviewed and approved. After due approval from
the competent authority of the Kharadar General Hospital, School of Nursing Karachi.
Students are hereby directed to carry on with the data collection and analysis of the above
mentioned topic to be completed as part of her research based project synopsis.
Name of supervisor: Sher Alam
Signature: ________________
Date: ________________
6. iv
CONTENTS
CHAPTER 1_______________________________________________________________1
INTRODUCTION ___________________________________________ Error! Bookmark not defined.
1.0 INTRODUCTION AND BACKGROUND __________________________________________________1
1.1 OBJECTIVE OF THE STUDY__________________________________________________ 3
1.2 RATIONALE OF THE STUDY _________________________________________________ 3
1.3 SIGNIFICANCE OF THE STUDY_______________________________________________ 3
1.6 OPERATIONAL DEFINITIONS ________________________________________________ 4
CHAPTER 2_______________________________________________________________5
LITERATURE REVIEW _________________________________________________________ 5
CHAPTER 3_______________________________________________________________8
RESEARCH METHODOLOGY ___________________________________________________ 8
3.1 STUDY DESIGN________________________________________________________________________8
3.2 STUDY SETTING ______________________________________________________________________8
3.3 STUDY DURATION ____________________________________________________________________8
3.4 SAMPLING TECHNIQUE _______________________________________________________________8
3.5 SAMPLE SIZE _________________________________________________________________________8
3.6 INCLUSION CRITERIA_________________________________________________________________8
3.7 EXCLUSION CRITERIA ________________________________________________________________8
3.8 ETHICAL CONSIDERATION____________________________________________________________8
3.9 DATA COLLECTION TOOL AND MEASUREMENT_______________________________________9
REFERENCES ___________________________________________________________10
ANNEXURE A____________________________________________________________13
QUESTIONNAIRE ________________________________________________________13
Demographic Data_________________________________________________________13
ANNEXURE B______________________________________________________________18
INFORMED CONSENT____________________________________________________18
7. 1
CHAPTER 1
1.0 INTRODUCTION AND BACKGROUND
World Health Organization (WHO) estimates that about 300 million women in the
developing countries suffer from short and long-term illnesses due to complications related to
pregnancy and childbirth (Dasanayake et al., 2018). An estimated 15% of pregnant women
in developing countries experience pregnancy related complications (WHO, 2005 & WHO
2004). About 529,000 mothers die each year from maternal causes, out of which 99% of
deaths being from the developing world (Dasanayake et al., 2018).
In 2005, 535,900 women died from causes related to pregnancy and childbirth; half of
these deaths occurred in sub-Saharan Africa (Hill, 2007). In Ethiopia, the levels of maternal
mortality and morbidity are among the highest in the world and the current estimate of MMR
(Maternal mortality Rate) is 673 per 100, 000 live births and it is reported that Maternal
deaths accounted for 21% of all deaths (WHO, 2015).
In Ethiopia, the levels of maternal mortality and morbidity are among the highest in the
world and the current estimate of MMR (Maternal Mortality Rate) is 673 per 100, 000 live
births and it is reported that Maternal deaths accounted for 21% of all deaths (CSA, 2011).
Pregnancy is a very exciting event and it is the period every woman wants to treasure
throughout her lifetime. So, significant attention and care from the family, society and
medical system should also be provided to pregnant women (Yibalih, Dugassa &Alemu,
2019).
Providing timely and appropriate treatment that reduces maternal mortality and
morbidity ensures taking the right health care action. As a result, when attending an antenatal
care clinic, women should receive health education about pregnancy including outcomes,
danger signs of pregnancy as well as other services (Ketema, et al., 2020; Yibalih, Dugassa
and Alemu, 2019).
8. 2
A pregnant woman is a unit of two individuals that consists of the mother and the fetus
which starts after conception and continues through all the phases of pregnancy and after
delivery.
Women's knowledge of the danger signs of pregnancy is highly necessary in order to
increase the use of skilled care during pregnancy and childbirth and to obtain timely
emergency obstetric services (Bintabara, 2017). It is also necessary to minimize delays in
obtaining medical attention and in reaching a health facility. Lack of awareness on these
warning signs disserves the willingness of women to engage in healthy motherhood
initiatives (El-Nagar, Ahmed and Belal, 2017).
Knowledge of danger signs among pregnant women is the first essential step in accepting
appropriate and timely referral. Also, it is important in improving maternal and fetal health
outcomes (Nurgi, Tachbele, Dibekulu& Wondim, 2017). The present study aimed to assess
knowledge and practices of pregnant women toward danger signs of pregnancy.
WHO recommended Danger Signs of Pregnancy are,
1. Excessive vomiting,
2. Excessive abdominal pain,
3. Vaginal bleeding during pregnancy,
4. Swelling of the face, Fingers and feet,
5. Blurred vision,
6. Pregnancy fits,
7. Extreme frequent frontal headache,
8. Elevated grade fever,
9. Marked changes in fetal movement,
10. Elevated blood pressure.
9. 3
1.1 OBJECTIVE OF THE STUDY
To assess knowledge and practices of pregnant women towards danger signs of
pregnancy.
1.2 RATIONALE OF THE STUDY
Significant number of mothers had no information on danger signs of pregnancy.
Negligence was the main reason for not having good awareness of danger sign of
pregnancy.
1.3 SIGNIFICANCE OF THE STUDY
Knowledge of these signs will encourage women to make the right choices and take
timely steps to access health care, while obtaining prompt and adequate care to reduce
maternal mortality and morbidity (Ketema, et al., 2020; Yibalih, Dugassa and Alemu,
2019).
Moreover, practices toward danger signs of pregnancy will save lives of women from
preventable diseases and maternal death and reduce maternal mortality and morbidity.
Maternal morbidly and mortality could be prevented significantly if women and their
families recognize obstetric danger signs and promptly seek health care (Bintabara,
2017).
The knowledge will ultimately empower them and their families to make prompt
decisions to seek care from skilled birth attendants (Nurgi, Tachbele, Dibekulu&
Wondim, 2017).
10. 4
1.4 NULL HYPOTHESIS
There is no significant knowledge and practices of pregnant women toward danger signs of
pregnancy.
1.5 ALTERNATE HYPOTHESIS
There is a significant knowledge and practices of pregnant women toward danger signs of
pregnancy.
1.6 OPERATIONAL DEFINITIONS
1. KNOWLEDGE
The knowledge is to learn about something on specific area through observation, experience
or Practice.
2. PRACTICE
The actual application or use of an idea, belief, or method, as opposed to theories relating to it.
3. MOTHER
Health care of mother during pregnancy.
4. DANGER
The possibility of something unwelcome or unpleasant happening.
5. SIGN
Any objective evidence of disease, as opposed to a symptom, which is, by nature, subjective.
11. 5
CHAPTER 2
LITERATURE REVIEW
One of the main public health concerns worldwide is maternal health that lays a
strong foundation to the health of the nation in general. Around 80% of maternal deaths
worldwide are due to direct complications during pregnancy such as extreme bleeding,
obstructed labor, infections, hypertension induced pregnancy and/or unsafe induced abortion.
Maternal death are also thought to occur due to three delays, delay in deciding to seek
appropriate care, delay in reaching appropriate health facility and delay in receiving adequate
emergency care (GCMD, 2014).
Delays in the search for effective health care due to lack of understanding can be
decreased by enhancing access to health care services and education through the adoption of
community outreach services that actually provide information on child-bearing issues that
are especially serious indicators of pregnancy and practice guidelines for women. In order to
facilitate their cooperation when care is needed, individual women and their families should
be given such information (Wassihun et al., 2020).
One of the eight-millennium developmental goals (MDGs) is to enhance maternal
health. The aim of the MDG 5 was to reduce the (MMR between 1990 and 2015) by 75 %
(UNMP, 2017).
In the Sustainable Development Goals, the reduction of maternal mortality to 70 by
2030 is set as goal 3(UNMP, 2017). Maternal mortality is a major public health issue
worldwide, with 800 women dying every day due to health care services and education
through the adoption of community outreach services that actually provide information on
child-bearing issues that are especially serious indicators of pregnancy and practice
guidelines for women. In order to facilitate their cooperation when care is needed, individual
women and their families should be given such information (UNMP, 2017).
12. 6
One of the eight-millennium developmental goals (MDGs) is to enhance maternal
health. The aim of the MDG 5 was to reduce the MMR between 1990 and 2015 by 75 %. In
the Sustainable Development Goals, the reduction of maternal mortality to 70 by 2030 is set
as goal 3. Maternal mortality is a major public health issue worldwide, with 800 women
dying every day due to pregnancy or childbirth complications (UNMP, 2017). The maternal
mortality ratio is still high in Egypt, with 1400 women and 50 percent of their newborns
dying yearly due to pregnancy and childbirth complications.
There are a variety of practices that women may perform to overcome their danger
signs during pregnancy. Some women visit a health facility while others contact with health
personnel, consult a friend or relative, make self-care, consult traditional healer or do nothing
during such conditions. This disparity may be attributable to the difference in understanding
the seriousness of pregnancy danger signs among women, the level of awareness or the
difference in cultural context that might influence their practices (Mwilike, 2018).
Providing timely and appropriate treatment that reduces maternal mortality and
morbidity ensures taking the right health care action. As a result, when attending an antenatal
care clinic, women should receive health education about pregnancy including outcomes,
danger signs of pregnancy as well as other services (Ketema, et al., 2020; Yibalih, Dugassa
and Alemu, 2019).
Each woman should be able to identify danger signs that occur during pregnancy,
because these signs typically mean the existence of complications that occur during
pregnancy at any time.
13. 7
LITERATURE REVIEW
PRINCIPAL
INVESTIGATOR
STUDY Country RESULTS
Woldeamanuel, G. W.,
Lemma, G., Zegeye, B.,
(2019).
Knowledge of obstetric
danger signs and its
associated factors among
pregnant women in Angolela
Tera District, Northern
Ethiopia
Ethiopia A total of 563 pregnant women
were included in the study.
About 211 (37.5%) women
were knowledgeable about
obstetric danger signs.
Zaki, E.S.A., Fouad, S.,
Khedr, H.F.N., (2021)
Assessment of knowledge and
practices of pregnant women
toward danger signs of
pregnancy
Ethiopia 242 pregnant women chosen
for this study. Pregnant women
total knowledge score of
danger signs was poor in
57.9% whereas More than two
thirds (65.3%) of pregnant
women had inadequate
practices regarding danger
signs of pregnancy.
Bolanko, A., et al., (2021) Knowledge of obstetric
danger signs and associated
factors among pregnan
women in Wolaita Sodo town,
South Ethiopia: A
community-based cross-
sectional study.
Egypt A total of 740 pregnant women
participated in the study with
the response rate of 97.5%.
One hundred twenty our
(16.8%) of the respondents
were knowledgeable about
obstetric danger signs.
Tesfaye, B., Jawed, A.,
(2021)
Assessment of knowledge
and practices of pregnant
women toward danger signs
of pregnancy.
Ethiopia A total of 280 study subjects
were included. This study
found that 80 (38.5%) were
heard about obstetric danger
signs. The study showed that
More than two fourth of the
study participants had good
knowledge about danger signs
14. 8
CHAPTER 3
RESEARCH METHODOLOGY
3.1 STUDY DESIGN
Descriptive Cross sectional study design will be conducted.
3.2 STUDY SETTING
The study will be performed at Tertiary Care Hospitals Karachi, Pakistan.
3.3 STUDY DURATION
The duration will be from 1st
August to 30th
Oct 2021.
3.4 SAMPLING TECHNIQUE
Convenient sampling type will be applied.
3.5 SAMPLE SIZE
Sample size will be calculated through standard method, by using openepi.com by using the
prevalence of parent’s knowledge related to danger signs.
3.6 INCLUSION CRITERIA
All pregnant women who will agree to participate in the study will be included.
3.7 EXCLUSION CRITERIA
Women in the pilot study and who did not sign consent form will be excluded from the study.
3.8 ETHICAL CONSIDERATION
Ethical approval will be obtained from Research Ethics Committee of the – Kharadar
General Hospital.
Participants will be informed about the purpose of the Study and written informed
consent will be taken.
They will be also informed that each participant has the right to withdraw from the
study at any time without any consequences.
15. 9
Anonymity, privacy, safety and confidentiality will absolutely be assured throughout
the study.
3.9 DATA COLLECTION TOOL AND MEASUREMENT
Data will be collected through structure questionnaire and interview by visiting the
selected Hospitals and formal permission will be taken through official correspondence.
3.10 DATA ANALYSIS
The collected data will be coded, tabulated and analyzed using Statistical Package of
Social Science (SPSS).
The data will be analyzed on SPSS licensed V-16 software. Percentages and
Frequencies will be used to describe sociodemographic characteristics. The qualitative
variables results will be shown by pie-chart and bar graph. The Mean, Median and Standard
Deviation will be calculated for quantitative variables. The results will be shown by using
Charts, Graphs and Frequency tables.
3.11 PILOT STUDY
The study tools will be applied on 10% (25 pregnant women) of the total study sample
to test the objectivity and applicability of the study tools and the feasibility of the research
process as well as to estimate the time needed to answer them.
3.12 VALIDITY AND RELIABILITY
Validity and Reliability of the tools will be checked through the IRB of the Kharadar
General Hospital and a panel of three experts in maternity nursing specialty will analyzed the
content validity of the tools before using it to ensure that all questions will consistently convey
and carry the anticipated meaning that they prepared.
16. 10
REFERENCES
Bolanko, A., et al., (2021). Knowledge of obstetric danger signs and associated factors among
pregnant women in Wolaita Sodo town, South Ethiopia: A community-based cross-sectional
study. SAGE Open Medicine. 9, 1-9.
Bintabara, D., Mpembeni, R.N.M., Mohamed, A.A., (2017).Knowledge of obstetric danger
signs among recently-delivered women in Chamwino district, Tanzania: A cross-sectional
study. pp. 1–10. [PMC free article] [PubMed] [Google Scholar]
CSA. (2011). Ethiopia Demographic and Health Survey 2011 Addis Ababa, Ethiopia and
Calverton, Maryland, USA.
Dasanayake, D., Ganewatta, S., Rathnayaka, N. (2018). Knowledge and practices on birth
preparedness and complication readiness among antenatal mothers: A study from southern
provinc. Sri Lanka Journal of Obstetrics and Gynecology. 40(1).
El-Nagar, A. E., Ahmed, M., & Belal, G. (2017). Knowledge and Practices of Pregnant Women
Regarding Danger Signs of Obstetric Complications. IOSR Journal of Nursing and Health
Science, 6, 30-41.
Hill, K., Thomas, K., Abou, Z. C., Walker, N., Say, L., Inoue, M., et al. (2007): Estimates of
maternal mortality worldwide between 1990 and 2005: An assessment of available data. Lancet
2007, 370(9595):1311-9.
Ketema, D. B., Leshargie, C. T., Kibret, G. D., Assemie, M. A., Petrucka, P., & Alebel, A.
(2020). Effects of maternal education on birth preparedness and complication readiness among
Ethiopian pregnant women: A systematic review and meta-analysis. BMC Pregnancy and
Childbirth, 20(1), 1-9.
17. 11
Mwilike, B., Nalwadda, G., Kagawa, M., Malima, K., Mselle, L., & Horiuchi, S. (2018).
Knowledge of danger signs during pregnancy and subsequent healthcare seeking actions
among women in Urban Tanzania: A cross-sectional study. BMC pregnancy and childbirth,
18(1), 4.
Nurgi, S., Tachbele, E., Dibekulu, W., & Wondim, M. A. (2017). Knowledge, Attitude and
Practice of Obstetric Danger Signs during Pregnancy in Debre Berhan, Ethiopia. Health
Science Journal, 11(6), 1-7.
Say, L., Chou, D., Gemmill, A., Tunçalp, O., Moller, A.B., Daniels, J.D., et al. (2018). Global
Causes of Maternal Death: A WHO Systematic Analysis. Lancet Global Health. 2(6): e323-
e333.
Tesfaye, B., Jawed, A., (2021). Knowledge, Attitude and Practice of Danger Signs during
Pregnancy among Mothers Attending Antenatal Care at Melka Oda Hospital, Southeast
Ethiopia. 29 (3), 41-46.
UNFPA. (2017). World population dashboard—Papua New Guinea Retrieved 3rd Sept, 2018,
from: ttps://www.unfpa.org/data/worldpopulation/PG
WHO. (2005). the world health report 2005— make every mother and child count, Tech. Rep.,
WHO, Geneva, Switzerland.
WHO. (2004). Maternal mortality in 2000: estimates developed by WHO, UNICEF and
UNFFA, Tech. Rep., WHO, Geneva, Switzerland, 2004.
WHO. (2015). Trends in Maternal Mortality: 1990 to 2015 Estimates by WHO, UNICEF,
UNFPA, World Bank Group and the United Nations Population Division Excutive summary.
18. 12
Wassihun, B., Negese, B., Bedada, H., Bekele, S., Bante, A., Yeheyis, T., & Hussen, E. (2020).
Knowledge of obstetric danger signs and associated factors: A study among mothers in
Shashamane town, Oromia region, Ethiopia. Reproductive Health, 17(1), 18.
Woldeamanuel, G. W., Lemma, G., Zegeye, B., (2019). Knowledge of obstetric danger signs
and its associated factors among pregnant women in Angolela Tera District, Northern Ethiopia.
BMC Research Notes, 12(606), 6.
Yibalih, N. K., Dugassa, W., & Alemu, A. (2019). Awareness of obstetric danger signs and
associated factors among Pregnant Women Who Attend Antenatal Care in Public Health
Institutions of Adama City, Oromia, Ethiopia. International Medical Science Research
Journal, 1(3), 79-92
Zaki, E.S.A., Fouad, S., Khedr, H.F.N., (2021). Assessment of knowledge and practices of
pregnant women toward danger signs of pregnancy. Mansoura Nursing Journal. 8, 1-202
19. 13
ANNEXURE A
QUESTIONNAIRE
Serial No: ___________
Demographic Data
1. Name (optional) ____________
2. Age at first pregnancy
a. Less than 20 years
b. 20 – 29 Years
c. 30 – 39 Years
d. Greater than 40 Years
3. Gestational age of current pregnancy
a. Ist Trimester
b. 2nd
Trimester
c. Last Trimester
4. Gravida
a. 1
b. 2
c. 3
d. Greater than 3
5. Maternal education
a. Illiterate
b. Primary
c. Middle
d. Matriculation
e. Intermediate
f. Graduation
g. Other_________
6. Maternal occupation
a. Hose wife b. Working lady
7. Religious
a. Muslim
b. Christian
c. Hindu
d. Other ____________
8. Ethnicity
a. Baloch
b. Punjabi
c. Pakhtoon
d. Urdu Speaker
e. Other ___________
9. Family monthly income in PKR
a. Less than 20, 000
b. 20,000 – 29000
c. 30,000 – 39,000
d. Greater than 40,000
K.1. among following danger signs please tick those which you know or heard about
1. Excessive vomiting
2. Excessive abdominal pain
3. Vaginal bleeding during pregnancy
4. Swelling of the face Fingers and feet
5. Blurred vision
6. Pregnancy fits
7. Extreme frequent frontal headache
20. 14
8. High grade fever
9. Marked changes in fetal movement
10. Elevated blood pressure.
P.1. What did you do when you had developed any danger sign of the following?
S.NO Tick (√) the below mention signs and your response) Responses
1. High grade fever Take Panadol
Went to hospital
Do nothing
2. Excessive vomiting Went to hospital
Do nothing
3. Excessive abdominal pain Home treatment
Went to hospital
Do nothing
4. Vaginal bleeding during pregnancy Home treatment
Went to hospital
Do nothing
5. Swelling of the face, finger and feet Home treatment
Went to hospital
Do nothing
6. Blurred vision Home treatment
Went to hospital
Do nothing
7. Pregnancy fits Home treatment
Went to hospital
Do nothing
8. Extreme frequent frontal headache Home treatment
Went to hospital
Do nothing
9. Marked changes in fetal movement Went to hospital
Do nothing
10. Elevated blood pressure. Home treatment
Went to hospital
Do nothing
21. 15
P.II Reason for not taking to health facility? 1. Illness was not serious
2. Had no enough money
3. Long distance to
health facility
4. Busy / No time
25. 18
ANNEXURE B
INFORMED CONSENT
I have read the invitation letter from ______________ and understood the nature of his/her propose
study titled: “Assessment of Knowledge and Practices of Pregnant Women towards Danger
Signs of Pregnancy at Tertiary Care Hospital Karachi, Pakistan”
I consent to participate in the study. I understand my participation in this research would be voluntary and I
can withdraw from the study if I wish so or I can also withhold any information if I want so. I understand
that I will be required to fill up a questionnaire. I also understand that all information that I will share with
the researchers through questionnaire and interviews will be kept confidential. Furthermore, this
information will be only used for academic purposes. I understand that my participation in this study will
not lead to any financial benefits.
Participant’s Signature: ________________________________
Signature of person obtaining consent: ____________________
Date: _______________________________________________
