Evaluation of the Role of Nurses in Maternal Health Education Programs on Reducing Obstetric Complications in Resource-Limited Settings

Mushahida  Khatoon; Shamsa  Kanwal; Saima  Ashraf

doi:10.54112/bcsrj.v6i8.1935

Authors

Mushahida Khatoon School of Nursing at Services Hospital, Lahore, Pakistan
Shamsa Kanwal Almodawat Hospital, Muhayil, Saudi Arabia
Saima Ashraf Department of Zoology, University of Sialkot, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i8.1935

Keywords:

Maternal Health Education, Nurses, Obstetric Complications, Antenatal Care, Pakistan

Abstract

Maternal health education is a crucial strategy for reducing obstetric complications, particularly in resource-limited settings. Nurses play a central role in delivering structured education to enhance maternal knowledge, promote health-seeking behavior, and improve outcomes. Objective: To evaluate the effectiveness of a nurse-led Maternal Health Education Program (MHEP) in improving antenatal care (ANC) attendance, knowledge of obstetric danger signs, and reducing maternal complications in a Pakistani tertiary care hospital. Methods: A prospective, controlled evaluation was conducted from July to December 2024, involving 99 pregnant women (49 with MHEP, 50 controls). Participants in the intervention group received structured one-to-one and follow-up educational sessions based on WHO/UNICEF guidelines, adapted for local literacy and language needs. The primary outcome was a composite of maternal complications (hypertensive disorders, postpartum hemorrhage, maternal sepsis, prolonged/obstructed labor). Secondary outcomes included ANC process indicators, knowledge scores, and neonatal outcomes. Results: The MHEP group demonstrated significantly higher attendance at≥4 ANC visits (73.5% vs 46.0%, p = 0.005), improved iron–folate adherence (69.4% vs 38.0%, p = 0.0017), and greater birth preparedness (65.3% vs 34.0%, p = 0.0018). Mean knowledge scores on obstetric danger signs were markedly higher (14.2 ± 3.1 vs 10.7 ± 3.4, p<0.001). Composite maternal complications were reduced in the MHEP group (24.5% vs 44.0%; RR 0.56, p=0.041; NNT=5.1). A dose–response relationship was observed, indicating fewer complications with greater session attendance (p = 0.023). Multivariable analysis confirmed an independent reduction in the odds of complications associated with MHEP participation (adjusted OR, 0.41; p = 0.045). Conclusion: Nurse-led maternal health education significantly improved ANC utilization, maternal knowledge, and reduced maternal complications in a resource-limited setting. The observed dose–response effect highlights the importance of sustained, repeated educational engagement. Scaling such interventions could be an effective strategy to improve maternal health outcomes in similar contexts.

Downloads

Download data is not yet available.

References

Woldeamanuel G., Lemma G., & Zegeye B... Knowledge of obstetric danger signs and their associated factors among pregnant women in Angolela Tera District, Northern Ethiopia. BMC Research Notes 2019; 12(1). https://doi.org/10.1186/s13104-019-4639-8

Ketema D., Leshargie C., Kibret G., Assemie M., Petrucka P., & Alebel A. Effects of maternal education on birth preparedness and complication readiness among Ethiopian pregnant women: a systematic review and meta-analysis. BMC Pregnancy and Childbirth 2020; 20(1). https://doi.org/10.1186/s12884-020-2812-7

Wang H., Frasco E., Takesue R., & Tang K... Maternal education level and maternal healthcare utilization in the Democratic Republic of the Congo: an analysis of the multiple indicator cluster survey 2017/18. BMC Health Services Research 2021;21(1). https://doi.org/10.1186/s12913-021-06854-x

Kohi T., Boniphace J., & Dol J. Maternal health care decision-making process at the family level in Geita region, Tanzania: a qualitative study. 2020. https://doi.org/10.21203/rs.2.22054/v1

Oguntunde O., Nyenwa J., Yusuf F., Dauda D., Salihu A., & Sinaï I. Factors associated with knowledge of obstetric danger signs and perceptions of the need for obstetric care among married men in northern Nigeria: a cross-sectional survey. BMC Pregnancy and Childbirth 2019; 19(1). https://doi.org/10.1186/s12884-019-2271-1

Das S., Patil S., Pathak S., Chakravarthy S., Fernandez A., Pantvaidya S.et al.. Emergency obstetric referrals in public health facilities: A descriptive study from urban Maharashtra, India. Frontiers in Health Services 2023; 3. https://doi.org/10.3389/frhs.2023.1168277

Ahmed N. and Ibrahim W... Effects of educational program on maternity nurses' knowledge and practice regarding obstetric triage. Egyptian Journal of Health Care, 2022; 13(2): 1739-1754. https://doi.org/10.21608/ejhc.2022.254822

Kyei-Nimakoh M., Carolan M., Awoonor‐Williams J., & McCann T... Review of emergency obstetric care interventions in health facilities in the Upper East Region of Ghana: a questionnaire survey. BMC Health Services Research 2018; 18(1). https://doi.org/10.1186/s12913-018-2980-6

Kea A., Lindtjørn B., Gebretsadik A., & Hinderaker S... Variation in maternal mortality in Sidama National Regional State, Southern Ethiopia: a population-based cross-sectional household survey. Plos One 2023; 18(3):e0272110. https://doi.org/10.1371/journal.pone.0272110

Waseem S., Rizwan A., Uddin N., Zaman Q., Sayed T., & Ali S.. Assessment of Knowledge about Essential Obstetric Care among Pregnant Females in Punjab, Pakistan. PJMHS 2021; 15(7):2278-2281. https://doi.org/10.53350/pjmhs211572278

Nuamah G., Agyei‐Baffour P., Mensah K., Boateng D., Quansah D., Dobin D.et al.. Access and Utilization of Maternal Healthcare in a Rural District in the Forest Belt of Ghana. BMC Pregnancy and Childbirth 2019; 19(1). https://doi.org/10.1186/s12884-018-2159-5

Mohammad K., Zahura F., & Rahman M... Importance of maternal education on antenatal care visits in Bangladesh. Bangladesh Journal of Scientific Research 2018; 30(1-2):23-33. https://doi.org/10.3329/bjsr.v30i1-2.36117

Kanyesigye H., Kabakyenga J., Mulogo E., Fajardo Y., Atwine D., MacDonald N.et al.. Improved maternal–fetal outcomes among emergency obstetric referrals following phone call communication at a teaching hospital in south western Uganda: a quasi-experimental study. BMC Pregnancy and Childbirth 2022; 22(1). https://doi.org/10.1186/s12884-022-05007-0

Steinbrook E., Min M., Kajeechiwa L., Wiladphaingern J., Paw M., Pimanpanarak M.et al.. Distance Matters: Barriers to Antenatal Care and Safe Childbirth in a Migrant Population on the Thailand-Myanmar Border from 2007 to 2015, a Pregnancy Cohort Study. BMC Pregnancy and Childbirth 2021; 21(1). https://doi.org/10.1186/s12884-021-04276-5

Chutke A., Doke P., Gothankar J., Pore P., Palkar S., Patil A.et al.. Perceptions of and challenges faced by primary healthcare workers regarding preconception services in rural India: A qualitative study using focus group discussions. Frontiers in Public Health 2022;10. https://doi.org/10.3389/fpubh.2022.888708

Huda T., Chowdhury M., Arifeen S., & Dibley M... Individual and community level factors associated with health facility delivery: a cross-sectional multilevel analysis in Bangladesh. Plos One 2019; 14(2):e0211113. https://doi.org/10.1371/journal.pone.0211113

Nove A., Friberg I., Bernis L., McConville F., Moran A., Najjemba M.et al.. Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: a lives saved tool modelling study. The Lancet Global Health 2021; 9(1):e24-e32. https://doi.org/10.1016/s2214-109x(20)30397-1

Rohimi U., Syafi’i A., & Rofifah J... The impact of community-based health education on maternal health outcomes in rural Southeast Asia. Asian Journal of Healthy and Science 2024; 3(11):327-333. https://doi.org/10.58631/ajhs.v3i11.166

Hailemariam T., Atnafu A., Gezie L., & Tilahun B... Why does the maternal continuum of care remain low in northwest Ethiopia? A multilevel logistic regression analysis. Plos One 2022; 17(9):e0274729. https://doi.org/10.1371/journal.pone.0274729

Mochache V., Wanje G., Nyagah L., Lakhani A., El‐Busaidy H., Temmerman M.et al.. Religious, socio-cultural norms and gender stereotypes influence uptake and utilization of maternal health services among the Digo community in Kwale, Kenya: a qualitative study. Reproductive Health 2020; 17(1). https://doi.org/10.1186/s12978-020-00919-6

Gómez P., Nelson A., Asiedu A., Addo E., Agbodza D., Allen C., et al. Accelerating newborn survival in Ghana through a low-dose, high-frequency health worker training approach: a cluster randomized trial. BMC Pregnancy and Childbirth 2018; 18(1). https://doi.org/10.1186/s12884-018-1705-5

Diguisto C., Saucedo M., Kallianidis A., Bloemenkamp K., Bødker B., Buoncristiano M.et al.. Maternal mortality in eight European countries with enhanced surveillance systems: descriptive population-based study. BMJ 2022:e070621. https://doi.org/10.1136/bmj-2022-070621.