Assessing The Knowledge And Reported Practices Of Women On Maternal And Child Health In Northern Rural Sierra Leone:a Cross-sectional Survey

Globally Sierra Leone is ranked among the countries with the worst maternal and child health indicators. The2008Sierra Leone Demographic and health survey reported high maternal mortality at857maternal deaths for every100,000live births (SLDHS2008); and also estimated that women face a one in six life-time risk of dying from pregnancy and childbirth related complications and that another15-30women will face long term health complications (uterine rupture, uterine prolapse, obstetric fistula, or infertility) for every woman who dies. Under-five mortality rate remains high at140deaths per1,000live births; infant mortality rate is89deaths per1,000live births; newborn deaths account for40%of all infant deaths (the neonatal mortality rate is36per1,000live births) and25%of all under-five deaths (SLDHS2008). There are high poverty levels, illiteracy, fertility rates, and teenage child bearing, and low uptake of family planning. These deaths can be prevented or minimized by using simple cost-effective community-based interventions. However, prior to the formulation of these interventions and during implementation, it is important to assess the health knowledge of the target population.Objective The aim of this present study was to understand women’s levels of knowledge on maternal and child health, and treatment-seeking and preventative behaviours in the Bombali district in northern Sierra Leone and offer appropriate suggestions for policy makers. Also, the study aimed to assess the effect of husbands’ contributions on health knowledge and practices of women in rural Sierra Leone. Also, factors influencing health knowledge of women in rural Sierra Leone, and how certain knowledge variables are related to participants’behaviours were investigated.Methods Women with at least a child five years or below were interviewed in their households (at home) using a structured questionnaire. Characteristics of the households and of the respondents were tabulated and the number of correct answers given to the health knowledge and practice questions and their percentage distribution were tabulated and an overall health knowledge score was derived. The derived health knowledge score was then used as dependent variable in a regression analysis to investigate factors influencing health knowledge. A canonical correlation analysis was also done to investigate how certain knowledge variables are related with certain behavioural patterns of the participants.Results The derived overall health knowledge revealed a mean score of61.62%(maximum of91%and a minimum of18%) with a standard deviation of14.683%and a median of63.27%.The result of the multivariable analyses revealed that education and number of pregnancies are associated with knowledge score. For each level increase in education there is a3.815%in score, and a1.239%increase in score for each increase in the number of children. There were some inappropriate practices in hygiene and sanitation. However, vaccination coverage was high with almost100%coverage for BCG. Health knowledge scores amongst those who have accessed higher education improve significantly. Also investigated was the linear regression relationship between the husband’s roles scores and the health knowledge score of the respondents but this was found to be statistically insignificant in both the simple and multiple regression models. The canonical correlation in this study is0.40136, which is significantly different than zero at the0.05level. The Canonical R2of0.16109shows that16.1%of the overall variability in the behavioural variables (dependent variate) was accounted for by the variability in the knowledge variables (independent variate) for the first canonical function, with a p-value of0.00. However, the redundancy index for the first canonical function indicates that that6.7%of the variance in the dependent variable is accounted for by the variability in the knowledge items. Conversely,5.1%of the variation in the educational items (the independent set) is accounted for by the variability in the behavioural set of variables (dependent set). Thus, participants’behaviour and health knowledge are significantly related in a positive manner.Conclusions Based on the findings of this study, health promotion activities focusing on diarrhoea, malaria, pneumonia, pregnancy, delivery, neonatal care and environmental sanitation could prove invaluable in improving women’s knowledge on maternal and child health issues-areas where knowledge and practices were found to be inadequate. Also the strong positive relationship between knowledge score and certain behavioural patterns of women, as revealed in this study, indicates that improved health knowledge can have a huge impact in influencing the decisions of women in certain health issues, which in turn can positively influence the outcomes of maternal and child health.