Maternal knowledge on neonatal danger signs is the major contributing factor for the reduction of neonatal morbidity and mortality which requires a compressive health care . Because reducing neonatal morbidity and mortality requires immediate caregiver’s knowledge on common neonatal danger signs and visiting the nearby health facility. According to this study, the prevalence of maternal good knowledge on neonatal danger signs was 33.1%. This is lower than the study conducted in Nepal which was 35.63% , Port Harcourt Nigeria which was 45.2%  and the study done in Bangladesh 50%  but higher than the study done in Nigeria, Sudan, Kenya and Gahana which were 30.3%, 20.4%, 15.5% and 28.1% [28, 29, 30, 31] respectively.
This study good knowledge level is also higher than the study done in Woldia general hospital which was 11.67% . The discrepancy might be due to time difference in assessing maternal knowledge (previous studies assessed maternal knowledge after neonatal period which were exposed to recall bias), difference in study setting, time gap, sample size variation, difference in knowledge assessment questions and evaluation method. In addition to this, the possible explanation might be due to participant place of residence, difference in health care delivery system or difference in intervention program, difference in access to media and educational difference or information gap about neonatal danger signs. This study also reported that, majority of the mothers (72.5%) knew fever as common neonatal danger sign which is supported by Nigerian  and Kenyan studies . The possible justification for this might be this symptom is easily felt by mothers when they touch their neonates and it is an alarming sign for systemic infection and easily detected by mothers.
This study also showed that mothers’ age was statistically significant factor to maternal knowledge on neonatal danger signs. Mothers who were 25-34 and 35-44 years old had nearly three and four times respectively knowledgeable as compared to mothers who were less than 15-24 years old. This is supported by the studies done in Bangladesh  and Woldia . This might be due to in this age group mothers have experience on symptoms that occur on neonates and children. In addition to this, they are active reproductive age group and child-bearing age women; they can give attention to neonates. But this study finding is incongruent with the study done in Nigeria, Sudan and Kenya [29, 31, 32]. The possible justification for this difference might be due to the case that health care providers deliver health information or counseling about neonatal danger signs regardless of age differently in different areas.
Likewise, educational status of the mothers was statistically significant to maternal knowledge. Those mothers who had college and above educational status were two times more knowledgeable as compared to who cannot read and write. This is consistent with the study done in Gondar, Woldia and Bangladesh [24, 27, 32]. The possible justification for this could be educated mothers were more likely to made decision to look for quality health service, had better access to health service information, took their sick neonate to health institution and get additional information about neonatal danger signs and improved knowledge on neonatal danger signs. Moreover, they acquire knowledge on disease and neonatal conditions as well as child health through their academic life. But this is incongruent with the study done in Rural Uganda . The difference might be due to information gap and difference in accessibility of media. Similarly, those mothers who delivered by caesarean section were nearly four times more likely to be knowledgeable as compared to mothers who had spontaneous vaginal delivery. This is supported by the study done in Bangladesh . The possible explanation for this might be mothers who delivered by cesarean section had more health professional contact and long hospital stay; this in turn creates an opportunity to get education about neonatal danger signs from health care providers.
Moreover, PNC visit for the last child and parity were significantly associated with maternal level of knowledge. Mothers who had three and above PNC visit were nearly four times and participants who had more than three parity had five times more likely to be knowledgeable as compared to those who had less than three PNC follow up and less than five parity. This is supported by the study conducted in Gondar . The justifiable reason for this might be education during PNC visit and also may be those mothers who have high parity were exposed to neonatal danger signs knowledge at some point during their previous ANC and PNC visit and have their own experiences of neonatal danger signs from previous delivery. However, the finding of this study is in part different from the study done in Chencha .This discrepancy might be due to the fact that educational difference during PNC visit, difference in study setting and difference in maternal exposure to neonatal danger signs from previous delivery.
According to this study report, birth preparedness was statistically significant to mothers’ knowledge on neonatal danger signs. Participants who identified skilled birth attendant for the last delivery had two times more knowledge about neonatal danger signs as compared to who had no birth preparedness which is consistent with the study done in Uganda . The possible reason for this might be due to getting information about neonatal danger signs from birth attendants. Because identifying birth attendants increase contact of mothers with knowledgeable personnel and create a good opportunity to get the necessary information about neonates and young infant illness.
Source of information about neonatal danger signs was statistically significant to mothers’ knowledge. This finding is supported by the study conducted in India , Chencha  and Gondar . Mothers who got information from health professionals were 4.54 times more likely to be knowledgeable about neonatal danger signs as compared to those who did not get information. The possible explanation for this might be mothers who give birth in health institution and who had PNC follow up receives post natal counseling by health professionals on appropriate time; this increases their knowledge and they pied attention what they told. This study also showed that, mothers who had television access had two times more knowledge than their counterpart. This is supported by the study done in Gondar . The possible justification for this could be television contains a segment of airtime dedicated to teach the mother about health issue of neonates and children. Therefore, using television could also increase the memorability of the message compared to other Medias and the similarity of these two studies might be due to similar accessibility of television to mothers.
Moreover, education during PNC visit was statistically significant to maternal knowledge on neonatal danger signs. Mothers who got education during PNC visit were nearly three times more likely to be knowledgeable as compared to their counterpart. The possible explanation for this could be getting education creates awareness and make mothers more conscious for neonates’ infection indicator signs and alert to every symptom. This is also initiate mothers to take their neonates to health institution and help to get additional information.
Including NICU in the study area makes important to assess maternal knowledge on neonatal danger signs since this area is the most critical area those neonates who had danger signs were found. Collecting data within 28 days of delivery minimize recall bias and helps to identify the true maternal knowledge and data collectors were trained health professionals that contribute the quality of the data. Moreover, this study includes more than one study area (multicenter study) which increase external validity of the study and used relatively large sample size. Despite the above strength, its cross-sectional nature of the study affects the establishment of the cause and effect relationship between maternal knowledge on neonatal danger signs and the factors that were identified.