Postpartum women’s knowledge on pregnancy related danger signs, uterotonics and their perceptions on respectful maternity care in 10 selected counties, Kenya

Abstract

Abstract Post-partum Hemorrhage is the leading cause of maternal mortality worldwide with 94% of deaths occurring in low resource settings. Awareness on danger signs and expected care may help mothers take early preventive actions during pregnancy. Disrespect and Abuse (D&A) during childbirth is known to contribute to the three delays in maternity care. To create awareness on PPH and danger signs among women, Smiles for Mothers project implemented a package of interventions including dissemination and utilization of client literacy materials, training of community health promoters and strengthening facility health talks. A study to assess postpartum women’s knowledge on pregnancy related danger signs, uterotonics before and after intervention was implemented in 39 health facilities from 10 counties; from July 2021 up to November 2022. For quantitative survey, we interviewed 191 women at baseline and end line; at end line we conducted 20 qualitative interviews. Post-partum women were asked whether they were aware of uterotonics given immediately after delivery; 92 (48.2%) at baseline reported that they were aware compared to 154 (80.6%) (p < 0.001) at end line. The main source of information about uterotonics was healthcare provider during health talk (70.1%) and one on one session (29.9%). At end line, more postpartum women 131 (68.6%), reported that health care provider educated them on how to identify excessive bleeding both at ANC and after delivery compared to baseline 54 (28.3%). The odds of good knowledge of PPH danger signs were four times (AOR = 3.55; 95% CI: 1.76, 7.14) and 13 times (AOR = 12.59; 95% CI: 2.78, 57.04) higher among women aged 26–35 years and 36–46 years respectively, compared to those aged 15–25 years. Awareness on uterotonics among postpartum women at baseline was low. Health care providers are a trusted source of health information among women; there is need to provide them with accurate information. Older women had higher odds of good knowledge; therefore, we recommend age specific considerations during health education. Postpartum women who had attended at least 4 ANC visits had higher odds on knowledge of uterotonics. A small proportion of women reported disrespect and abuse. There is need to eliminate D&A.