The knowledge of mothers on neonatal danger signs was found to be 50.2% (95%CI: 46.3, 54.3) (able to mention three or more WHO identified neonatal danger signs). Factors that significantly associated to women knowledge of neonatal danger signs were mother’s educational level, husband’s educational level, place of residence, number ANC visits, counseling during ANC and knowledge about essential newborn care.
The knowledge of neonatal danger signs in this study was consistent with studies done in Southern Ethiopia (Abera ,et al., 2017) which was 50.3% and Tigray region, Ethiopia (Nuredin ,et al., 2017) which was 50.6%. But higher than studies conducted in Kenya (Kibaru and Otara, 2016), Eastern Ethiopia(Tesfaye, 2018) and Gondar, Ethiopia(Solomon ,et al., 2015) which was (15.5%), (9.38%) and (18.2%) respectively. This difference might be due to study period difference, a slight difference in the data collection tools, number of neonatal danger signs included in this study were higher than those studies and in this study exposure to ANC and percentage of institutional delivery (mothers who delivered at health institutions had better exposure to post- natal counseling) were found to be higher. In another ways, previous studies included mothers who gave birth two years back which might lead to mothers fail to recall and loose caring responsibility. Meanwhile, this study is lower than studies conducted in Baghdad (Abdulrida ,et al., 2018) (81%), Sri Lanka (Senarath ,et al., 2011), (80%), Nigeria (Ekwochi ,et al., 2015) (78.7%), and Wolkite, Ethiopia (Walellign ,et al., 2017) (68.68%). This might be due to involvement of rural women in this study and study area difference that, this study was community-based study. In this study, a low level of mothers’ knowledge of the neonatal danger signs was observed even though the majority of the women had attended more than 3 visits of antenatal care; this led to an idea that the antenatal care providers may not have proper resources and facilities to educate mothers about the neonatal danger signs. Poor knowledge of mothers on neonatal danger signs will have negative impact on Integrated Management of Childhood Illnesses (IMCI) Program in Ethiopia, because the program is based on early identification of newborn danger Signs by caregivers and appropriate referral aiming at reduction in neonatal mortality.
The most frequently mentioned danger signs were fever, vomiting and lethargy which is consistent with study conducted in Kenya (Kibaru and Otara, 2016) and Ethiopia (Abera ,et al., 2017). This might be due to these signs were commonly affect the health of neonates and were relatively easily detected by caregivers. And incongruent with studies conducted in Nigeria (Ekwochi ,et al., 2015) and Ethiopia (Mekdes ,et al., 2018; Solomon ,et al., 2015). This might be due to the difference in extensive HEWs counseling in the community and socio-cultural variation between the study participants. Overall, this implies Poor recognition of danger signs is the main barrier in order not to seek care even if they are manifesting those signs and also caregivers do not seek medical care if they do not recognize it as severe (because only 61.2% of mothers in this study perceived the recognized signs as severe).
In this study, mothers having secondary and above educational level were about two times more likely to know about neonatal danger signs as compared to those mothers with primary or below educational level. This is nearly consistent with study conducted in Gondar town (Solomon ,et al., 2015). The possible justification could be educated mothers acquire knowledge about disease and human health through their academic life and education increase to get health service and increase tendency to read and understand materials related to newborn health.
Similarly, husband educational level was significantly associated with mothers’ good knowledge about neonatal danger signs. The odds of being having knowledge about neonatal danger signs was two times among mothers whose husbands achieved secondary and above educational level. This is consistent with the study conducted in Wolkite and Gondar, Ethiopia (Walellign ,et al., 2017; Solomon ,et al., 2015). This could be explained as educated husbands are more informed and help the mother in recognition of neonatal danger signs and this might positively affect the knowledge of the mothers.
The study showed that mothers who live in urban were 5.83 times more likely knowledgeable as compared to mothers who lived in rural area. This is congruent with the study conducted in Southern Ethiopia (Abera ,et al., 2017) and Woldia, Ethiopia (Mekdes ,et al., 2018) where living in rural increase the odds of good knowledge of neonatal danger signs. This might be due to mothers who live in urban were more likely to seek health care and health information from different sources as compared to mothers who living in rural parts. This study showed that 82% of home delivery was conducted at rural area and this leads to less chance to contact with health professionals. This leads to an idea that, mothers who live in rural area had tendency to deliver at home and had less chance to get immediate PNC counseling on neonatal danger signs and remain uninformed.
ANC visit was significantly associated with mother’s knowledge about neonatal danger signs. In line with that, mother who got counseling during ANC follow up were 5.71 times more knowledgeable as compared to mothers who did not get counseled during ANC. This is consistent with study conducted in Ghana (Okawa ,et al., 2015), Eastern Ethiopia (Tesfaye, 2018), Jimma, Ethiopia (Melkamu ,et al., 2016) and in Gondar (Solomon ,et al., 2015). This might be due to exposure to ANC follow up repeatedly might increase the chance to get more information related to neonatal danger signs from health professionals. These might indicate the need to improve the counseling given to mothers during ANC and PNC giving due emphasis to these signs and symptoms of serious newborn illness, given the fact that the majority of the mothers were having ANC/PNC follow-up and delivered at health facilities.
Mothers who had knowledge about essential newborn care had significant association with knowledge about neonatal danger signs. This is consistent with study conducted in Ethiopia (Abera ,et al., 2017). This might be due to the case that recognition of neonatal danger signs is one of the components of essential newborn care. So, those mothers who have knowledge on essential newborn care practices are more likely knowledgeable about neonatal signs of illness. Meanwhile, there was high institutional delivery in this study (73.7%), which probably allow the chance to get contact with health professionals at health facility and get counseled on neonatal danger signs on appropriate time.
The study might not show cause and effect relationship because of the nature of the study design (cross-sectional). It might be affected by recall bias because it allowed mothers who gave birth in the past 6 months, while neonatal danger signs occurred during the first one month of life.