Pregnancy-related complications are the most common health problem facing women in developing countries. Around 295,000 women worldwide die each year from pregnancy-related causes, and 86% of this maternal mortality occurs in developing countries. Although significant progress has been made in all developing regions, the average annual percentage decrease in the world maternal mortality rate (MMR) was 2.9%; this means that the global MMR declined by an average of 2.9% every year between 2000 and 2017 (1). Approximately 500,000 women worldwide die each year from pregnancy complications, and unfortunately maternal aspects of maternal and child health have all too often been ranked second in the child survival revolution(2).
Developing countries account for 99% (284,000) of global maternal mortality, with most of them in sub-Saharan Africa (162,000) and southern Asia (83,000). These two regions accounted for 85% of global burden, with sub-Saharan Africa alone accounting for 56%. The average maternal mortality rate in developing countries was 240 per 100,000 births in 2010, versus 16 per 100,000 in developed countries, due to inequalities in access to health services and highlighting the gap between rich and poor. Sub-Saharan Africa had the highest maternal death rate at 500 maternal deaths per 100,000 live births. According to a systematic analysis of progress towards achieving Millennium Development Goal 5, more than 50% of all maternal mortality in 2008 occurred in just six countries (India, Nigeria, Pakistan, Afghanistan, Ethiopia and the Democratic Republic of the Congo) (1).
The situation in Ethiopia is similar to that in many developing countries. In Ethiopia, maternal mortality and morbidity are among the highest in the world, and the current MMR estimate is 412 per 100,000 live births. That means that for every 1,000 births in Ethiopia there are about 4 maternal mortality(2).
Reducing maternal and neonatal mortality and morbidity have been identified as priority areas that need urgent attention from the health sector. Maternal morbidity and mortality could be prevented and significantly minimized if women and their families recognize obstetric signs of Hazard and seek immediate medical help (3).
The most common signs of Hazard during pregnancy are heavy vaginal bleeding, swollen hands / face, and blurred vision. Major signs of Hazard during labor and delivery include heavy vaginal bleeding, prolonged labor, convulsions, and placental retention. Signs of Hazard in the postpartum period include severe postpartum bleeding, postnatal unconsciousness, and fever. Bleeding remains the leading cause of maternal mortality, accounting for around a third of deaths. Many of the complications that lead to maternal death and contribute to prenatal death are unpredictable and can be both sudden and serious. The complications that lead to the death of the mother can occur without warning at any time during pregnancy and childbirth. Low awareness of the signs and symptoms of Hazard during pregnancy, labor, childbirth, and postpartum contributes to delays in finding and getting qualified care. Awareness of the Hazard signs of obstetric complications is the critical first step in accepting an appropriate and timely referral to obstetrics and neonatal care(4).
Knowledge of obstetric hazard signs and antenatal care are strategies aimed at improving the availability of quality care for low risk births and emergency obstetric care in complicated cases in low-income countries. More knowledge and awareness is essential to reduce delays in finding medical care and reaching a healthcare facility(5).
Communities and women should be empowered not only to recognize pregnancy related risks, but they must also have the means to react quickly and effectively once such problems arise(6). The national reproductive strategy of Ethiopia has placed emphasis on maternal and newborn health in order to reduce the high maternal and newborn mortality. The strategy focuses on the need to empower women, men, families and communities to identify pregnancy-related risks and take responsibility for developing and implementing appropriate measures. One of the goals of the strategies is to ensure that 80% of families will recognize at least three signs of Hazard associated with pregnancy-related complications by 2010 in areas where the health promotion program is fully implemented (7).
Maternal mortality is the leading killer of adult women in many countries. The death of women during childbirth often means the death of the newborn, and both death and disability create emotional, social, and economic difficulties for the women's older children, their entire families, and even communities (8). Every day 810 women die from preventable causes related to pregnancy and childbirth(9). Maternal mortality is preventable, skilled care before, during, and after the birth of a child and when women with complications are able to identify and receive appropriate emergency obstetric care that makes the difference between life and death (5). Maternal mortality has both direct and indirect causes. Approximately 73% of maternal mortality worldwide is caused by direct obstetric complications. The five most important global causes of maternal death are: severe bleeding (mostly postpartum bleeding), infections (also mostly shortly after delivery), unsafe induced abortions, hypertensive disorders during pregnancy (eclampsia) and obstacles to birth. Around 73% of maternal mortality rates worldwide are due to these causes. Bleeding alone accounts for a third of all maternal deaths in Africa, but many of these deaths are preventable. Serious postpartum bleeding can kill a healthy woman in two hours if left unattended. Obstetric fistulas resulting from the inhibition of labor are a long-term complication affecting up to two million women). Indirect causes such as malaria, diabetes, hepatitis, anemia, and other cardiovascular diseases made worse by pregnancy can also lead to the death of the mother (10).
Understanding the Hazard signs of obstetric complications is the critical first step in accepting an appropriate and timely referral to obstetrics and neonatal care. Raising women's awareness of the Hazards of pregnancy, childbirth and the puerperium improves mothers' attitudes to receiving medical attention and is key to safe motherhood (11).
If mothers fail to recognize the signs of Hazard during pregnancy, negative effects can occur on the mother, the unborn child or the pregnancy itself. Side effects include: maternal illness or death; B. Heavy bleeding can lead to anemia or the death of the mother, infection of the unborn child through prematurely torn mucous membranes when amniotic fluid leaks from the vagina. Failure to do so can lead to fetal or neonatal morbidity and mortality, premature termination of pregnancy due to vaginal bleeding. Maternal high blood pressure or fever 4 can lead to an increased number of deaths in newborns or premature babies who may eventually die from inadequate care facilities(12).
The death of a mother in childbirth denies her children their natural primary caregiver and significantly increases the risk that her child will die or not reach the age of 5. Many children who survive without mothers also run the risk of being lost emotionally (13). Most maternal mortality is preventable as the health solutions to prevent or treat complications are known. All women need access to prenatal care, qualified care during childbirth and care and support in the weeks after the birth. It is especially important that all births are accompanied by qualified health care workers, as timely treatment and treatment can make the difference between life and death(13, 14).
According to the Ethiopian Demographic Health Survey 2016, only 26% of deliveries are cared for in health facilities. In a country where the maternal mortality rate is 412 per 100,000 live births and the IMR 48/1000 and NMR 29/1000 live births are the highest in the world. In Ethiopia, since the introduction of Health Extension Workers (HEWs), there has been little information about the knowledge, attitude and practice of obstetric hazard signs during pregnancy, although the national reproductive strategy aims to raise awareness in the area where HEW. to be used to 80% (2).
A study conducted in the Tsegedie district showed that women's knowledge of obstetric hazard signs was low and was influenced by the neighborhood. Therefore, identified awareness deficits should be addressed by maternal and child health services by developing appropriate strategies, including the provision of targeted information, education and communication. Despite the great potential for knowledge, attitude, and practice of obstetric hazard signs to reduce maternal and newborn mortality, their status is not well known in most of sub-Saharan Africa, including Ethiopia(15). The aim of this study is therefore to close this gap by assessing the current state of knowledge about Hazard signs in mothers in the study area