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1 Medical Faculty of Mahajanga, University of Mahajanga, Madagascar
2 Complexe Mère Enfant, University Hospital Centre, Madagascar
Submission: October 14, 2019; Published: October 22, 2019
*Corresponding author:RANDAOHARISON PG, Complexe Mère Enfant, University Hospital Centre, Professor Zafisaona Gabriel, Mahajanga, Madagascar
How to cite this article:Ratsiambakaina D, Ramarokoto MFM, Rakotomalala NZ, Randaoharison. Correlations Between the Level of Education and
Obstetric Complications in Pregnant Women. Glob J Reprod Med. 2019; 7(2): 5556706. DOI: 10.19080/GJORM.2019.07.555706.
Introduction: According to the WHO, 1500 women die ona daily basis with complications related to pregnancy and or preterm labor. This situation of vulnerability affects mostly developing countries like Madagascar. To determine the cause of such complications with several factors, it takes multi-scopes analyses in order to tackle the root of the problem.
Aim: The aim of this study was to establish any correlation between the education level and obstetrical complications.
Methods:A descriptive and analytical study was conducted at the mother and child compound of the University Hospital of PZaGa Androva Mahajanga, for twelve months, start on January 1st 2017 to 31 December 31st 2017.The level of education (uneducated, primary, secondary, High school, University),ethnicity, gynaeco obstetrical antecedents, pregnancy follow-up, and obstetrical complications were considered. Variables factors were treated with Microsoft Excel 2013 and R software. A Chi square Pearson test was performed, with a threshold value above 0,1
Result: All along this study,263 cases of women with complications were noticed with06 deaths. The main complications found were : risk of preterm labor on 92 women (34.98%) ; hemorrhage complications on 77 women (29.27%) ;hypertensive disorder found on 75 women (28.51%) ; infectious disease and others on 19 women (7.24%) One hundred and sixty four patients (62.33%)had a level of education below T9. The Chi-square tests between the level of education (below or above ou T9) and primary obstetrical complications (Hemorrage and risk of preterm labor in one hand; infections and related in the other hand) were significant with a value of 6,63 5 (Chi-square test limit: 0,14)
Conclusion The level of education could play a role in occurrence of obstetrical complications in our study.
Keywords: Complications, Hemorrhage, Infection, Risks of preterm labor, Level of education
In this study, 263 cases of women with complications were recorded. This gives a frequency of 12,22%: 97,72% of which
were successfully recovered and 2,28% died. A similar study was conducted in Antananarivo at the University Hospital Centre of Gynecology and Obstetrics of Befelatanana in 2015 by Randriatsarafara they found 442 cases that is 16,80% of patients who presented major obstetric complications . These complications are common and become daily occurrences at reference Hospital centres as it is the cases of the two centers under the study.
More than half of patients, that is 62.3% of cases had an educational level below Grade 9. Most of similar studies did not
have regular results: the one that was performed in Antananarivo in 2015 showed 13,64% of patients with university education, 39,1% with secondary one, 34,54% with primary education, and 12,72% uneducated . In 2015, Oliveira and al. reported 43,2% of women in Brazil with secondary education . In Cameroun, Diakité and al. revealed 67,62% of patients being uneducated in 2012 . Widely above the significance, the proportion of illiterates as reported by Zouini and al. rised to 94% in 2014 . These surveys were conducted in countries with low and medium income. Custom and beliefs prevent young women from attending schools and to go far in their education.
The test of relevancy was significant with a chi-square value of 6.634. Therefore, it can be asserted that there is a relationship between the level of education of women and occurrence of
obstetric complications. It is not surprising to notice in developing
countries, where the rate of school admission of women is low,
that obstetric complications leading to maternal mortality remain
high. As being observed, obstetric complications were more
common among developing countries than in the developed
ones. Obviously, life standards, the quality of medical care’s make
the difference and many other environmental factors might as
well influence the phenomenon. In developing countries like
Madagascar, parents alone could not take charge of the household
sustenance, children must contribute to the family earnings. Girls
are forced to marry young and should leave their family. And it
occurs from one family to another, the level of education of women
will be consequently low. Moreover, in view of the situation
of unemployment in the country, freshly graduates fail to find
job or at the limit, take unsuitable one that did not match with
their education. Numbers of parents cannot afford to send their
children to school (Figure 1).
Women with low educational level would live and behave
according to traditions and custom. They would take heed to
soothsayers and birth attendant advices during pregnancies and
labors. Therefore, decision making to attend specialized reference
unit would be delayed. In Mahajanga as it is also the case for
all Madagascar, habit and beliefs play a huge role in daily life of
population. When a woman carries pregnancy, it is the least of
her priority to attend prenatal cares though these operations are
crucial in term of education and information to improve obstetric
prognosis. This educational level could be evolved into probable
etiology and cause of obstetric troubles. It is worth noting that a
poor intellectual background is almost associated with low social
and economic life standard. Thus, any measure considered to
reduce the rate of maternal death, obstetric complications, could
not be achieved without lateral approach which aims to raise the
intellectual level of the population. Indeed, an educated woman or
a person with a high intellectual standard would be more attentive
to information and recommendations and become more prone to
follow advice given by the service provider.
This study revealed that, 108 parturient women were
nulliparous (41,1%), closely followed by 63 primipara equal to
24%. These results differ from those of Moussa in Bamako in 2010:
76% of primipara, and that of Randriatsarafara in Antananarivo
in 2015 with 35% of primipara [4,8]. It is a possibility that more
nulliparous women frequently attended health center than
multiparous ones. Once having delivered in ectopic pregnancies,
these women with low education level, would consider next
deliveries to be the same; They did not see how important is to
attend health center.
A quality PNC aims to diagnose high risk pregnancies. It
allows to detect and to deal with risk bound pathologies, and thus
enables to reduce maternal morbidity. In this study, over the half
of the parturient have performed at least 4 PNC that is 63,88%.
The number of prenatal consultations did not influence the
reduction of the maternal morbidity rate. As a matter of routine,
with lack of motivation, and failing equipment’s, PNC is carried
out in a haste. Many information and examinations were neglected
and fail to meet standards. A study led by Salif in Mali in 2010 has
evidenced a lower outcome with 30% . Such rate would result
from the ignorance of health services that women should have
benefited during pregnancy. Prenatal consultations, particularly
that of PNC4 was considered to be the most effective way to detect
obstetric complications and will enable health workers to timely
refer to patients when risks factors arise Table 1.
The study has revealed pregnancies aged between 28 and 32
WA overwhelming at 54% and another batch at 32WA with an
end term of 34,2%. Pregnancies of the second quarter represent
11,4% while one woman overpasted the end term. This rate
can be explained by the fact that preterm birth was caused by
pathologies and considered as one of comorbidities commonly
found particularly in Mahajanga and overall in Madagascar.
Similar proportion was found by Koumare and al. in Mali in 2005
with 34,7% , but as for Shrestha in Rwanda in 2015 it was
Among common etiologies evoked by the study was the
threat of preterm labors representing 34,98%, to which 65,22%
had a level of education below Grade 9. Some pathologies were
also frequenting. Bleeding and high blood pressure complications
respectively 29,27% to which 57,14% with an educational level
below Grade 9, and 28,51% to which 66,66% with an educational
level below Grade 9. Threat of preterm labors was the major
etiology, closely followed by hemorrhages and high blood
pressure complications. A study conducted by Randriatsarafara in
Antananarivo showed that hemorrhages represented 30% of case
that was close to this result and for hypertensive complications
a slightly superior as of 37,27% . In 2015, Soma-Pillayand
al. in South Africa showed an identical proportion of 32,5% for
hemorrhage and 31% for pregnancy-induced hypertension .
Nonetheless, the frequencies of haemorrages and hypertension
complications change from one study to another Table 2:
a. 30,23% and 44,18%, for Shresta in 2015 (Rwanda) 
b. 34,4% and 51,6% for Almerie in 2010 (Damascus) 
c. 51% and 8,5% for Mustafa and Hashmi in 2009
This observation is quite normal since it reflects a general
aspect of obstetric complications overwhelmed by hypertension
Despite of the low frequency of the obstetric complications
and the availability of cares during pregnancy in developing
countries like Madagascar, these complications always remain
significant and worth to be considered as public health issue. This
study showed a high prevalence of major obstetric complications.
Most of these women were aged under 30 and over the half of
them had an education level below the ninth Grade. These two
variables seem to affect the occurrence of complications during
pregnancy as demonstrated in this study.