This interventional study assessed knowledge of danger signs in newborns among women mainly of the reproductive age group, low and middle socioeconomic class, and those who had also achieved some level of formal education.
Even though statistical significance was not attained probably due sample size, our study showed that increasing maternal educational attainment was associated with better knowledge of danger sign in newborn. Maternal education has been shown to improve child health and earlier preventive care initiatives.12 Maternal education is also a signal of trainability because it enables appreciation of the benefits that can be gained from complying with recommended health practices and can improve their uptake.13, 14 Thus, the subjects were expected to be in good standing to maximally benefit from whatever knowledge or skills provided by the training. This is consistent with the findings of similar studies, 14, 15 and it has been suggested that these mothers with less education were more likely to rely on assistance from relatives with similar educational status than mothers with higher levels of education14 On the other hand, a cross-sectional study in a Neonatal Intensive Care Unit (NICU), North Central Ethiopia, documented that Secondary and above levels of education were among the factors reported as significant determinants of knowledge of neonatal danger signs among postnatal mothers.16
Our study also revealed that the number of newborns previously nursed by the respondents stood out as a significant determinant of their knowledge of danger signs in the sick newborn. Similarly, a cross-sectional survey of women's knowledge and reported practices on maternal and child health in rural Sierra Leone revealed that the number of children significantly influenced health knowledge scores.17 This finding is consistent with the age-long adage that ‘experience is the best teacher”. It stands to reason that they have gained such knowledge from caring for their newborns over the years. Some caregivers, possibly, got the correct information after counseling following the death of their newborn due to their failure to detect the signs early enough. It is also noteworthy that the other maternal socio-demographic variables had been shown not to be significant determinants of knowledge of danger signs in the first phase of this study in the same communities about six (6) years ago. 10
Our study documented a strong influence of training in enhancing the knowledge of danger signs in sick newborns among mothers. Of the nine (9) WHO recognized danger signs in the sick newborn (refusal to feed/ stop feeding, convulsion, fast breathing, fever, hypothermia, weakness/lethargy, jaundice, difficulty in breathing, and local infections)4 there was a significant improvement in the knowledge of seven namely refusal to feed/ stop feeding, fever, hypothermia, weakness/lethargy, jaundice, difficulty in breathing and local infections in the post- training phase. A similar study on the impact of training on knowledge and care-seeking behavior of caregivers has documented that trained traditional birth attendants (TBAs) were more knowledgeable about danger signs during pregnancy and childbirth and were more likely to refer women with complications to a health facility, compared to untrained TBAs.18 There is a saying that “Training gives everyone a great understanding of their responsibilities and the knowledge and skills they need to do that job. This will enhance their confidence which can also improve their overall performance”.19 It is the authors' view that our participants formal educational background has primed them to comprehend the content of the training.
Early recognition of these signs will enhance care and survival of the newborn because many newborn deaths are related to late recognition of neonatal illness and subsequent late intervention at the time of presentation to the hospital. 20 Authors strongly believe that with further trainings and re-trainings a significant improvement in the knowledge of the whole nine signs is achievable.
Another remarkable finding of this study is that the post-interventional phase recorded a significant improvement in the ability to seek care in a health facility for each of the newborn danger signs. The study documented significant improvement in seeking health care in a health facility for all the newborn danger signs. This is a welcome development and a landmark achievement. The symptoms of serious illness in newborns can be subtle. 21 Therefore, they may elude the recognition of mothers and caregivers at home. Hence, the observed significant improvement in their ability to seek care at a health facility where healthcare workers and professionals can quickly identify these signs and institute care early enough is a welcome development that will enhance survival of the sick newborn.
The most important aspect of this care seeking is that the training has also achieved a significant improvement in the time from observing the danger signs to seeking care at a health facility. Most of the subjects now sought care at a health facility less than 24 hours after observing any danger sign in their newborn. This development will shorten level one delay (delay at household), which has been documented as a significant cause of delay in health care delivery to sick newborns and a strong contributor to neonatal mortality. 22, 23