O.O. Sekoni and E.T. Owoaje

Department of Preventive Medicine and Primary Care (Community Medicine), College of Medicine, University of Ibadan, Ibadan, Nigeria.


Background: Knowledge of danger signs in pregnancy can be regarded as one of the ways to eliminate the first level of delay as a factor influencing maternal mortality. The role of men as decision makers cannot be overlooked in this regard. The aim of this study was to determine men’s knowledge of danger signs in pregnancy and their role in pregnancy related decision making.

Methods: A cross sectional survey was conducted among 259 men aged 15-65 years in selected communities in Ibadan, Oyo State by multistage sampling. A semi-structured pretested questionnaire was used to obtain information on socio-demographic characteristics, attitude and practices concerning antenatal care, knowledge of danger signs in pregnancy and decision to seek hospital care. Knowledge of danger signs was the main outcome measure categorized into poor and good based on a score of < 6 and > 6. Data were analyzed using descriptive statistics and bivariate analysis with level of significance set at 5%.

Results: Mean age of respondents was 40.4 ± 11.4 years. Almost half had at least secondary education (47.5%) and were mainly artisans by occupation (59.8%), while 18.1% could not mention any danger sign. Majority had poor knowledge about danger signs in pregnancy (60.6%). There was no significant difference in knowledge of respondents within different age groups, by occupation, number of children and from different educational levels.

Conclusion: Poor knowledge of obstetric danger signs was evident among these men. Programmes targeted at providing education about danger signs in pregnancy for men are recommended.

Keywords: Danger Signs in Pregnancy, Obstetric Complications, Male Knowledge


Dr. O.O. Sekoni
Dept. Preventive Medicine and Primary Care
College of Medicine,
University of Ibadan,
P.M.B. 5017, Ibadan,
Telephone No.: +234-803-357-9048


Maternal mortality in sub-Saharan Africa has been unacceptably high over the years despite the various attempts which have been made to address this.1,2 Reduction in maternal mortality by three quarters has been earmarked the target required to achieve the fifth Millennium Development Goal (MDG) by the year 2015. Between 1990 and 2008, there had been a 34% decline in maternal mortality but despite this, the average annual percentage decline in the global maternal mortality ratio was 2.3 per cent short of the 5.5 percent annual decline necessary to meet the MDG target.3 In Nigeria, maternal mortality rates have remained very high with current figures being as high as 545 per 100,000. 4

Factors responsible for maternal mortality have been identified to include direct and indirect causes as well as various levels of delay. 5 These levels of delay have considerable bearing on maternal health outcomes. The failure to recognize complications, sociocultural barriers to seeking care as well as human resource and health facility constraints play major roles in contributing to these levels of delay.

Maternal death is often as a result of an interplay of many of these factors. Pregnant women in low and middle income countries including Nigeria are particularly vulnerable as a result of their socioeconomic and cultural status in society. In addition to this, the autonomy of pregnant women to access health care is usually affected by social dynamics that determine the extent of this autonomy.6

With the preponderant patriarchal nature of the Nigerian society, the decision for a pregnant woman to access maternal care services many times rests on the shoulders of her husband; a fact that had been documented several decades ago and is still of relevance now.7,8 The implications of male gender supremacy can be far reaching and affect when, where or even whether a pregnant woman is allowed to seek care.8 Therefore, the involvement of fathers could be the difference between a healthy birth and a maternal death.9 Male partner involvement could also have a strong bearing on the timeliness of such care and the eventual outcome. The support of men in the health care seeking behaviour of their pregnant partners such as attendance at antenatal and postnatal clinics is one of the ways by which maternal deaths can be avoided.10

Antenatal care visits provide an opportunity to inform women about the danger signs and symptoms for which assistance should be sought from a health care provider without delay. Research has shown that knowledge of danger signs in pregnancy by pregnant women themselves is low resulting in a reduced tendency to seek skilled attendance at birth and referral in case of complication.11 Women and their partners need to be informed about danger signs during pregnancy and delivery and they should be counselled to seek assistance with minimum delay. The low level of knowledge of dangers signs of pregnancy identified among both men and women in developing countries can be adjudged to be a contributory factor to the first level of delay which plays a role in the high levels of maternal mortality observed in many of such countries.8, 12

A number of studies have been carried out on the role of men in reproductive health in various parts of Nigeria,8,13,14 but comparatively little research has focused on the awareness of men in southwest Nigeria about danger signs in pregnancy as well as their participation in pregnancy care by their own admission. This is particularly important in the context of the fact that these men have the highest literacy rate in any language among the six geopolitical zones of the country as well as the patriarchal nature of the nation as a whole.15

As a result of the strong influence men wield in determining women’s health seeking behavior, the documentation of this would be useful in designing effective strategies for the reduction of maternal mortality. The objective of this study therefore is to document men’s awareness of danger signs in pregnancy and their role in pregnancy related decision