A community based cross-sectional study was conducted from September 24 to October 16, 2017 in Debre Markos Town, which is found in East Gojjam zone, Amhara Nation Regional State. Menkorer was the former name of the town which was established in 1845 E.C. the town was established at the altitude of 2420 – 2509 meters above sea level and located 300 km away from Addis Ababa, the capital city of Ethiopia and 265 km from Bahir Dar, the Amhara region capital. The town has average annual temperature of 16 0C and average annual rain of 1308 mm3. The town is organized into 07 kebeles and based on 2007 E.C census the town has total population of 101, 582 of whom 52, 827 were women and 48,755 were men all allocated with an estimated area of 600 square kilometers. In the town there are 3 health centers, 7 health posts, 17 clinics, 21 drug dispensers and 01 referral hospital.
All mothers who gave birth within the last 12 months and who were living in Debre Markos town were source populations. The Study population for this study included all mothers who gave birth within the last 12 months in the selected ‘kebeles’ who were available during the study period. And then, all mothers who gave birth within the last 12 months in the selected ‘kebeles’, at household level were considered as study units.
Mothers who lived in the study area less than 6 months, mothers who had still birth for the recent delivery and those who were mentally and physically incapable to give response during the data collection were excluded.
The sample size was calculated by using the single population proportion formula with the assumption of 95 % CI, and 18.2% proportion of mothers’ good knowledge on neonatal danger signs(11). Considering the design effect of cluster sampling (2) and possible non – response rate during the survey (10 %), the final sample size required was 504.
Cluster sampling technique was used to select the study units by considering kebeles as clusters. Out of 7 kebeles (clusters) in the town; three clusters (C2, C 4 and C 5) were selected by simple random sampling by using balloting method. Then all eligible mothers in the selected clusters (521) were included in the study. Tottery method was used to select one participant when two or more eligible mothers were available in the same household.
The independent variables were categorized into three sections: socioeconomic and demographic variables; (age, marital status, parents’ educational status, occupational status, economical status, religion and ethnicity), obstetrics related factors: (parity, Ante natal care, BPCR, SBA, place of birth, mode of delivery and PNC) and other health related: (woman’s’ autonomy on health issues, income, source of information and access to media.
The dependent variable in this study was being knowledgeable or not for neonatal danger signs. Those study participants who mentioned as many danger signs as the calculated mean value (three) and above to unprompted knowledge related list of WHO identified danger signs.
Data was collected by face to face interview using a structured and pre-tested questionnaire. The questionnaire was first prepared in English and translated to Amharic, and then back to English after minimal amendment was done. Five diploma midwives were allocated to collect data. Two BSc midwives from Debre Markos hospital were assigned to supervise the data collection process. Both the data collectors and supervisors were given one day training before the actual work regarding WHO neonatal danger signs, the aim of study, procedures and collection techniques going through the questionnaires, art of interviewing and ways of collecting the data.
After obtaining oral informed consent, trained data collectors interviewed mothers regarding newborn danger signs. Mothers with children under-1 year were asked to list signs they considered serious health issues and could potentially endanger the life of neonates. They were also requested to list any of these signs they have had personally experienced and the initial actions they took. The danger signs listed by mothers were organized and grouped into eight WHO recognized danger signs(12).
Every day after data collection, questionnaires were reviewed and checked for completeness and relevance by the supervisors and principal investigator and the necessary feedback was offered to data collectors in the next morning and before end up incomplete questions were complete using pre-coded and for controlling errors during data analysis, 10% of the questionnaire was double entered into the software and also frequency check was done.
Epi-Info 7 was used to input the raw data. Data cleaning was done. SPSS 20 was used for data analysis. Chi-square and logistic regression statistical instrument was also used to establish the relationship between knowledge of WHO recognized danger signs and other explanatory variables. Results were presented in percentages, odds ratios and 95% confidence intervals where appropriate. Statistical significance was set or considered at p-value <0.05.
Ethical clearance was obtained from Midwifery department though delegation from institutional ethical review board of university of Gondar. Formal letter of cooperation was written for Debre Markos health office and respective kebeles. Following this permission was obtained. Verbal informed consent was obtained from each study participants, each respondent was informed about the objective of the study that it would contribute to improve child health. Any involvement in the study was after complete consent obtained. Any mother who was not willing to participate in the study was not forced to participate. They were also informed that all data obtained from them would be kept confidentially by using codes instead of any personal identifiers and is meant only for the purpose of the study.