Awareness of Danger Signs during Pregnancy and Post-Delivery Period among Women of Reproductive Age in Unguja Island, Zanzibar: A Qualitative Study

Rukia R. Bakar, Blandina T. Mmbaga, Birgitte B. Nielsen, Rachel N. Manongi


Zanzibar is part of the United Republic of Tanzania with high levels of maternal mortality due to obstetric complications. Women's awareness on obstetric danger signs and early seeking of medical care is the first intervention in reduction of maternal deaths. This study explored awareness of danger signs among women of reproductive age in Unguja Island, Zanzibar. A community-based qualitative study using focus group discussions among women of reproductive age was conducted to explore awareness of danger signs between March and April 2016. Data was analyzed using thematic analysis. The study found that women were aware of danger signs during pregnancy but not during the post-delivery period. The mentioned danger signs during pregnancy included vaginal bleeding, fits, swelling of the legs and leaking of vagina fluid. Some women still believed that danger signs during pregnancy and post-delivery period were due to witchcraft leading to consultations with traditional healers and hence delays in seeking skilled medical care. In this context of misconceptions and cultural beliefs there should be investment in health education on danger signs to the community in general with involvement of traditional birth attendants and traditional healers who might play a role in advising and referring women with danger signs to the health facilities for care. (Afr J Reprod Health 2019; 23[1]: 27-36).

Full Text:



Demissie E, Dessie F, Michael FW and Tadele N. Level

of Awareness on Danger Signs of Pregnancy among Pregnant Women Attending Antenatal Care in Mizan Aman General Hospital, Southwest, Ethiopia: Institution Based Cross-sectional Study. J Women’s Health Care. 2015;4(8):8–11.

WHO. Managing complications in pregnancy and

childbirth. 2007.

Ronsmans C. Maternal Survival 1 Maternal mortality :

who , when , where , and why. The Lancet. 2006;368: 1189–200.

WHO. Trends in Maternal Mortality : 1990 to 2015.

WHO. The Global Strategy for Women’s, Children’s and

Adolescents’ Health (2016-2030): Survive, Thrive, Transform. United Nations. 2015;1:1–108.

National Bureau of Statistics. Population and Housing

Census, Mortality and Health. 2012.

Herklots T, Acht L Van, Meguid T, Franx A and Jacod B.

Severe maternal morbidity in Zanzibar ’ s referral hospital : Measuring the impact of in- hospital care. PLoS One. 2017;1–11.

WHO. Reducing maternal and child mortality in

Zanzibar : Wired Mothers. 2014.

Alkema L, Chou D, Hogan D, Zhang S, Moller A,

Gemmill A, Fat D, Boerma T, Temmerman M, Mathers C and Say L. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015 , with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group The Lancet. 2016;387462–74.

Okour A, Alkhateeb M and Amarin Z. Awareness of

danger signs and symptoms of pregnancy complication among women in Jordan. Int J Gynecol Obstetr.; 2012; 118 (2012): 11–14

JHPIEGO. Monitoring birth preparedness and

complication readiness. Tools and indicators for maternal and newborn health. Matern Neonat Health. 2004.

Tilahun T and Sinaga M. Knowledge of obstetric danger

signs and birth preparedness practices among pregnant women in rural communities of Eastern Ethiopia. Int J Nurs Midwifery. 2016;8(1):1–11.

Nambala BS and Ngoma C. Knowledge and perception of

women towards danger signs in pregnancy in Choma rural District, Zambia. Med J Zambia. 2013;40(2):43–7.

Salem A, Lacour O, Scaringella S, Herinianasolo J,

Benski AC, Stancanelli G, Vassilakos P, Petignat P and Schmidt NC. Cross-sectional survey of knowledge of obstetric danger signs among women in rural Madagascar. BMC Pregnancy and Childbirth; 2018;18(1):1–9.

Nikiéma B, Beninguisse G and Haggerty JL. Providing

information on pregnancy complications during antenatal visits: Unmet educational needs in sub-Saharan Africa. Health Policy Plan. 2009;24(5):367–76.

Bililign N and Mulatu T. Knowledge of obstetric danger

signs and associated factors among reproductive age women in Raya Kobo district of Ethiopia : A community based cross-sectional study. BMC Pregnancy and Childbirth; 2017;1–7.

Duysburgh E, Ye M, Williams A, Massawe S, Sié A,

Williams J, Mpembeni R, Loukanova S and Temmerman M. Counselling on and women’s awareness of pregnancy danger signs in selected rural health facilities in Burkina Faso, Ghana and Tanzania. Trop Med Int Heal. 2013;18(12):1498–509.

Maseresha N, Woldemichael K and Dube L. Knowledge

of obstetric danger signs and associated factors among pregnant women in Erer district, Somali region, Ethiopia. BMC Women’s Health; 2016;16(1):30.

Hailu M, Gebremariam A and Alemseged F. Knowledge

about obstetric danger signs among pregnant women in Aleta Wondo District, Sidama Zone, Southern Ethiopia. Ethiop J Health Sci. 2010;20(1): 25–32.

Dessu S, Gedamu G and Tamiso A. Assessment of

Knowledge on Danger Sign of Pregnancy and Associated Factors among ANC Attendant Pregnant Women in Arbaminch Town Governmental Institutions , Southern Ethiopia. Ann Med Health Sci Res. 2018;8(1): 64–9.

Solomon AA, Amanta NW, Chirkose EA and Badi MB.

Knowledge About Danger Signs of Pregnancy and Associated Factors Among Pregnant Women in Debra Birhan Town, Central Ethiopia. Sci J Public Heal. 2015;3(2): 269–273.

National Bureau of Statistics. Tanzania Demographic and

Health Survey. 2010.

Ministry of Health & Social Welfare, Zanzibar. Health

Management Information System Unit. Health information Bulletin, 2008. 2009.

Revolutionary Government of Zanzibar, Zanzibar

Ministry of Health. Zanzibar health sector strategic plan iii 2013/14-2018/19. 2018

Ministry of Health. The Zanzibar Annual Health Bulletin.

Revolutionary Government of Zanzibar. Zanzibar

Country Analysis Report. 2003.

Zanzibar Regional Administration Act, 2014;(1):1–23. accessed 23Aug. 2018

National Bureau of Statistics. The Population and

Housing Census, Population Distribution by Age and Sex. 2012.

Ministry of Health. The Zanzibar Annual Health Bulletin.


Pembe AB, Lindmark G, Lindmark G, Nyström L and

Darj E. Rural Tanzanian women’s awareness of danger signs of obstetric complications. BMC Pregnancy Childbirth. 2009;9(12).

Ministry of Health and Social welfare (MoHSW). Road

Map to Accelerate the reduction of Maternal, Newborn and Child Mortality in Zanzibar (2008 - 2015). Zanzibar; 2008.

Amenu G, Mulaw Z, Seyoum T and Bayu H. Knowledge

about Danger Signs of Obstetric Complications and Associated Factors among Postnatal Mothers of Mechekel District Health Centers, East Gojjam Zone, Northwest Ethiopia 2014. Scientifica (Cairo). 2016:2016: 3495416.

Nurgi S, Tachbele E, Dibekulu W and Wondim MA.

Knowledge, Attitude and Practice of Obstetric Danger Signs during Pregnancy in Debre Berhan, Ethiopia. Health Sci J. 2017;11(6):533.

Oiyemhonlan B, Udofia E and Punguyire D. Identifying

Obstetrical Emergencies at Kintampo Municipal Hospital: a perspective from Pregnant Women and Nursing Midwives. 2013;17:129–40.

Aborigo RA, Moyer CA, Gupta M, Adongo PB, Williams

J, Hodgson A, Allote P. and Engmann CM. Obstetric Danger Signs and Factors Affecting Health Seeking Behaviour among the Kassena-Nankani of Northern Ghana: A Qualitative Study. AfrJ Reprod Health. 2014;18(3):78–86

Matsuyama A and Moji K. Perception of bleeding as a

danger sign during pregnancy, delivery, and the postpartum period in Rural Nepal. Qual Health Res. 2008;18(2):196–208.

Dako-Gyeke P, Aikins M, Aryeetey R, Mccough L and

Adongo PB. The influence of socio-cultural interpretations of pregnancy threats on health-seeking behavior among pregnant women in urban Accra, Ghana. BMC Pregnancy Childbirth. 2013;13(211).

Morris JL, Short S, Robson L and Andriatsihosena MS.

Maternal health practices, beliefs and traditions in southeast Madagascar. Afr J Reprod Health. 2014;18(3):101–17.

Withers M, Kharazmi N and Lim E. Traditional beliefs

and practices in pregnancy, childbirth and postpartum: A review of the evidence from Asian countries. Midwifery. 2017;56(2018):158–70.


  • There are currently no refbacks.