Knowledge of Neonatal Danger Signs and Associated Factors Among Mothers in Fafan Zone, Somali Region, Ethiopia (2021)

doi:10.21203/rs.3.rs-4362447/v1

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Research Article

Knowledge of Neonatal Danger Signs and Associated Factors Among Mothers in Fafan Zone, Somali Region, Ethiopia (2021)

https://doi.org/10.21203/rs.3.rs-4362447/v1

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Introduction: there are different strategies to improve newborn health which was launch by the federal ministry of health in Ethiopia (FMOH). But the problem is high in Ethiopia 2019, 54.54% of under-five death is in the neonatal period. Due to different reasons the mothers’ practices about neonatal danger sign were not investigated in Somali region. So, if mothers have good knowledge and practices on their sick neonate they will save two-third of the neonate from preventable causes of neonatal death trough child survival strategies.

Objective: To assess mothers’ knowledge about neonatal danger signs and its associated factors in Fafan Zone, Somali Region 2021.

Methods: A community-based cross-sectional study was conducted among 505 respondents. Pre-tested structured Interviewer-administered data collection was applied. Systematic sampling technique was used. For analysis data was entered into EPI data 3.1 and exported to SPSS software version 23. Descriptive statistics was computed for selected variables and multivariable Binary logistic regressions was done and having P- value <0.05 at 95% CI is a significant variable. Results was presented in descriptive and inferential statistics.

Result: In this study, Mother’s knowledge of neonatal danger sign was low 100 (19.5%) and 37(61.7%) of mother’s only sought appropriate healthcare practices for their neonate who had danger signs.Accordingly, Maternal education (Formal education) [AOR =7.45, 95%CI:(3.89-14.25)], radio or tv presence in home[AOR=3.50, 95%CI: (1.07-11.49)] & having postnatal care [AOR=2.47, 95%CI: (1.11-5.2)], Neonate started vaccine) [AOR=3.5, 95%CI:(1.07-11.49)] and Exclusive breastfeeding [AOR=2.34, 95%CI:(1.19-4.58)] were factors showing significant association with knowledge of the mother on neonatal danger signs at P-value≤0.05

Conclusion & recommendation: In this study, Mother’s knowledge of neonatal danger sign was low 100 (19.5%) and 37(61.7%) of mother’s only sought appropriate healthcare practices for their neonate who had danger signs. Maternal education (Formal education), radio or tv presence in home,having postnatal care, neonate started vaccine and exclusive breastfeeding were factors showing significant association with knowledge of the mother on neonatal danger signs at P-value≤0.05. To increase their understanding and health-seeking behavior, health care provide has to provide health education and counseling (including NDSs, immunization and exclusive breastfeeding) to mothers after birth and during ANC follow-up.

Neonatal danger signs are nonspecific signs were a neonate manifest when they are sick on their neonatal period up to 28 days following delivery or four weeks of life (1).

Neonatal death is the death of babies within 28 days following delivery. The main causes of neonatal death were infection (sepsis/pneumonia, tetanus, and diarrhea), preterm and birth asphyxia and it varies in the early and late neonatal periods (2)

The first 28 days of life (the neonatal period )is the most vulnerable time for a child’s survival Globally, 2.5 million neonates die in 2018 among these 7,000 neonatal deaths every day – most of which close to 75% die in the first day after birth and its contribution for child death is increasing thorough out the times (3).

Globally, 5.4 million children under five years of age died of which 2.5 million were neonates. The age distribution of the mortality of children shows that the highest risk of death is during the neonatal period (4). A child born in sub-Saharan Africa or in Southern Asia is ten times more likely to die in the first month than a child born in a high-income country and the contribution of neonatal death was highly increased for child mortalities (5).

In Ethiopia child deaths achieve its MDG in 2012 ahead of three yeas 2015; even though neonatal death is reduced but not satisfactory as under five mortality and it accounts almost 44% of child death (6). According to the 2019 MEDHS report, the neonatal mortality rate was 30 deaths per 1,000 live births (7).

In Ethiopia neonatal mortality was high in rural and less educated population with low monthly income especially Somali region share the higher amount of neonatal death 41 per 1000 live birth next to Amhara accounts the highest 47 per 1000 live birth(8).

Neonates cannot explain their health status. Therefore mother’s knowledge about neonatal danger signs are used to reduce neonatal death by 60% - 75% through using FMOH neonatal and child health survival strategies.(6). A study conducted in rural Bangalore revealed that mother’s knowledge to give appropriate care for their neonate at home were very essential. Even though it was highly affected by Mother’s educational level, occupation, and source of information (9).The mothers’ knowledge of neonatal danger signs in sub-Saharan Africa was low. Due to this their health services utilization reduced and increase neonatal death (6, 10).

The mothers' knowledge about neonatal danger signs in Ethiopia was inconsistent from 11.5%-83% even though those amount of mothers know about neonatal danger signs; their practices (action) following the experiences were scantly investigated in Fafan zone,Somali regional state (6, 11, 12).

A newborn practice which was done by mothers/caregivers in Ethiopia was contrary to WHO recommendations that were reported from recently delivered mothers such as bathing for fever application of butter and other substances for cord discharge (13).

The survival neonatal strategies for ANC, Deliver, PNC, by 2020 was planned to address 95%, 95%, 50% respectively. Even though most services do not reach its goal ANC 74%, delivery 50%, and PNC is 34% if the mothers' knowledge become good their health service utilization will achieve its national survival strategies goal to achieve sustainable development goal three target two and four (6, 7).

Therefore this study assesses the mother’s knowledge about neonatal danger signs and its associated factors in Fafan Zone, Somali regional state.

Objectives

General objectives

To assess knowledge about neonatal danger sign and its associated factors among mothers who have children less than one year’s age in Fafan Zone, Somali Region; 2021.

Specific objectives

1. To determine the magnitude of Knowledge about neonatal danger sign among mothers who have less than one year’s age.

2. To identify factors associated with knowledge about neonatal danger signs among mothers who have infant

Study area and period

The Fafan zone, which contains the capital of the Somali Regional state (Jigjiga), is a semi pastoralist community located at the Eastern border of the country. Located in the Somali Regional State, Fafen Zone is roughly 628 kilometers away from Addis Ababa, Ethiopia's capital city. The zone encompasses 16 health centers and 2 hospitals(14). This zone has a total population of 967,652, of which 526,398 are men and 441,254 women. About 12% of the 203,588 urban inhabitants were pastoralists(15). The study was conducted from January 1–30, 2021.

Study design

A community-based cross-sectional study was employed.

Source population

All mothers who have children less than one year’s age in Fafan Zone, Somali Regional State; 2021.

Study population

Randomly selected women who have a child aged less than 1 year residing in the selected kebeles of Fafan Zone, Somali Regional State

Eligibility Criteria

Inclusion criteria

All mothers who have infant and lives in Fafan zone for more than six months.

Exclusion criteria

The mothers who could not communicate due to illness and who are not available at home during data the collection period after three visits

Sample size determination and sampling procedure

Sample size determination

As this study has four specific objectives then the sample size was calculated as follows for each specific objective accordingly.

Sample size for Knowledge: Sample size is determined by using one population proportion formula by considering the following assumptions: Confidence interval 95%, non-response rate 10% and the margin of error (d = 0.05) the similar cross-sectional study conducted on mothers knowledge in Harar district was p = 50.3% (16)

N\(= \frac{\left(\frac{Za}{2}\right)2*p(1-p)}{d2}\) Where n = minimum sample size required for the study

Z = standard normal distribution at two tailed (Z = 1.96) with confidence interval of 95% and d = 0.05(tolerable margin of error).

P = 0.503 and Q = 1-P = 0.497

N= \(\frac{\left(1.96\right)2\varvec{*} 0.503\left(0.497\right)}{\left(0.05\right)2}\)= 385 by adding 10% non-response rate with 1.5 design effect = 636

Sample size calculation f is determined by using single population proportion formulas by considering the following assumptions: Confidence interval 95%, at α = 0.05 non-response rate 10% with 1.5 design effect a similar studies conducted on mothers knowledge about neonatal danger sign in Harer were reported 32.9% of mothers have favorable practices about NDS p = 32.9% which is 0.329 and Q = 1-p = 0.671(6).

N=\(\frac{\left(\frac{Z\alpha }{2}\right)2*P(1-P)}{D2}\) Where n = minimum sample size required for the study Z = standard normal distribution with two tailed (Z = 1.96) with confidence interval of 95% and α = 0.05(tolerable margin of error).

N= (1.96)²*0.329 (0.671) = 339 with 10% non-responses rates and 1.5 design effect 559.

(0.05)²

Sample size determination by using factors (Table 1)

Table 1

Sample size determination for factors associated with mother’s knowledge among mothers who have children less than one year. The factors are taken from previous study conducted in Harar, Mekedella and Wolikate (6, 17, 18).
No	Factors	Assumptions
No	Factors	Ratio	Power	CI	Proportion of knowledge among exposed in (%)	Proportion of knowledge among unexposed in (%)	AOR	Sample size with 10% non-response rate and 1.5 design effect
1m	ANC follow up 2–3	1:1	80	95	40.5	24	2.38	190
2H	Counseled about NDS	1:1	80	95	62.8	25.75	4.87	96
3w	Home delivery.	1:1	80	95	56.2	40.7	1.867	350

Therefore, a maximum sample size of 559 was chosen for this study.

Sampling technique and procedure

A multistage stratified sampling technique was applied to select the study participants. There are 7 districts (Jigjiga, Bablie, Kebribeya,Harshin ,awbarie, gursum,Degehalie) in Fafan zone. Three districts (Kebribeya,Awbarie and degehali) selected using .simple random sampling technique. In each district one urban center (town); and 2 rural centers selected randomly since there is heterogeneity. Then, sampling frame prepared for urban and rural center separately. Sample size allocated for rural and urban centers proportionally. Finally, simple random sampling technique applied to select the study participants.

Variables of the study

Dependent variables

Mothers Knowledge on neonatal danger signs

Independent variable

Socio-demographic and socio- economic variables:

Mothers age, marital status, mother’s education, mother’s occupation, mother’s religion, mother’s residences & house hold monthly income.

Social or family related factors

Presence of media,
Media exposure (Radio/TV),
Sources of information,
husband education,
husband occupation,
husband involvement

Obstetric related factors

Having ANC, having PNC, number of ANC, number PNC
Parity, place of delivery, family size

Neonatal related factors

Previous exposure to NDS
Distance to health facilities
Cultural and traditional factors.

Operational definition and definition of terms.

Neonatal Period

Refers to the first 28 days of life (divided into early neonatal period (the first 7 days) and late neonatal period (from 8–28) following delivery(19).

Antenatal care

the systemic supervision of women during pregnancy to monitor the progress of fetal growth and to ascertain wellbeing of the mother and fetus (20).

Postnatal care

is the care given to the mother and her baby immediately after the birth and for the first six months of life following delivery(20).

Neonatal danger sign: a sign in which the newborns/neonates experiencing the following WHO recognized danger sign: i) unable to breast feed, ii) Convulsion, iii) fast breathing (Respiratory rate > 60 Bpm), iv) Severe chest in-drawing (difficulty in breathing), v) High grade fever (Hot to touch); vi) Cold to touch (hypothermia), vii) (weakness or lethargy); ix) Umbilicus redness or draining pus, x) (redness of eye/ discharge) (21).

Good knowledgeable

A mother is considerable as “good knowledgeable on neonatal danger signs” if she was spontaneously mentions at least three from ten WHO recognized neonatal danger signs (6, 11, 18, 22, 23).

Poor Knowledgeable

Those who answer less than three WHO, NDS knowledge questions.

Data collection instrument and procedure

A pretested structured, interviewer administered data collection tool used which is adapted and modified from previous similar literatures to assess the mother’s knowledge on neonatal danger sign (6, 11, 12, 22, 24, 25).The questioner was prepared by English version and translated to Somali version to the local language of the mothers and finally translated to English version to check its consistency. The questioner was grouped in to four sub-sections such as: Socio- demographic questions, obstetrics related questions, knowledge measuring, and practices related questions about NDS were asked.

Data quality control

Eighteen diploma Nurse and two-degree Midwives recruited for data collection and supervisor respectively. Training focusing on understanding the research question, sampling technique, data handling, ethical conduct, and quality of data collection delivered for two day for data collectors and supervisors intensively understanding on the tool step by step for each question. The tool validated from 5% (32) individuals prior to data collection to reduce ambiguity and increase the clarity of the tool. The collected data was reviewed daily by the supervisors and the principal investigators to check for its completeness.

Data processing, analysis and interpretation

The collected data entered, edited and cleaned using EPI data (epidemiological data software version 3.1), then exported to SPSS version 23 for analysis. Descriptive analysis conducted for selected variables to summarize the data and the final result of the study interpreted in the form of text, figures, and tables. Bivariable binary logistic regression analysis executed to see the association between independent and dependent variables. All explanatory variables with p < 0.25 in bivariable logistic regression included in multivariable logistic regression analysis and the significant association identified based on P-value p < 0.05 and with 95% CI in multivariable logistic regression was used. The final model fitness checked using the Hosmer-Lemeshow Goodness of Fit test.

Ethical clearance

The study received ethical approval from the Jigjiga University Ethics Research Review Committee. Additionally, approval was obtained from the Fafan Zone Health Office. The purpose of the study was explained briefly to participants, and verbal informed consent was obtained from each mother. They were informed that all information collected would be kept anonymous and confidential. Participation was voluntary, and mothers had the right to withdraw from the study at any time.

Sociodemographic characteristics

Out of 539 samples a total of 505 mothers were interviewed making a response rate of 93.7%. The mean age of the mother participated in this study was 28.5(± 6.275). Two hundred one (39.8%) of the respondent were found between 18–24 years. More than half (50.9%) of the mothers had male neonate. More than three-fourth (79.8%) of the respondents are urban resident. Each household has average 6.59 (± 2.78) persons in their family. Four hundred ninety-three (97.6%) of the respondents are Muslim in religion. Majority of respondents (60.2%) can’t read and write. Regarding maternal occupational status,473(93.7%) were house wife,13(2.6%) employed and 19(3.8%) were merchant. Most of the respondent 462 (91.5%) were married and 18(3.6%) were widowed. Concerning husband occupational status,360(77.3%) were private employee. Less than quarter of respondents 89(17.6%) were primipara,305(60.4%) were multipara and 111(22.0%) were grand multipara. Regarding to family size 238(47.1%) of the respondents had more than seven family members. Moreover, three hundred fifty-six (70.5%) don’t have radio and television. Majority of them 142(95.3%) watch mass media (Radio and television) two times per week (Table 2).

Table 2

Socio demographic characteristics of the mother who have children less than one year in Fafan zone, Somali Regional State(n = 505)
Characteristics		Frequency (n = 505)	Percentage
Age of the mother (year)	18–24 Years	201	39.8
	25–34 Years	196	38.8
	≥ 35 Years	108	21.4
Sex of neonate	Male	257	50.9
Sex of neonate	Female	248	49.1
Residence	Rural	102	20.2
Residence	Urban	403	79.8
Religion	Muslim	493	97.6
Religion	Christian	12	2.4
Maternal Education	Can’t read and write	304	60.2
	Can read and write	123	24.4
	Primary School	40	7.9
	Secondary school and above	38	7.5
Maternal occupation	Employed	13	2.6
	Housewife	473	93.7
	Merchant	19	3.8
Mother’s marital status	Married	462	91.5
	Single	2	0.4
	Divorced	23	4.6
	Widowed	18	3.6
Husband Education	Can’t read & write	102	21.9
	Can read & write	91	19.5
	Primary School	138	29.6
	Secondary school & above	135	29.0
Husband’s occupation	Private Employee	360	77.3
Husband’s occupation	Government Employee	106	22.7
Parity	1 (Primipara)	89	17.6
	1–5 (Multipara)	305	60.4
	≥ 5 (Grand Multipara)	111	22.0
Family Size	1–3	56	11.1
	4–6	211	41.8
	≥ 7	238	47.1
Radio/Tv in your home	Yes	149	29.5
Radio/Tv in your home	No	356	70.5
Days you watch radio/TV	1	4	2.7
	2	142	95.3
	3	3	2.0

Obstetrics characteristics

Around two third of respondents had history of antenatal care. Of the total mothers who had history of antenatal care 123(35.9%) had four and more ANC visit,118(34.4%) had 3rd visit,73(21.3%) had 2nd visit and 29(8.5%) had 1st visit. More than half 177(51.3%) of mothers had counselling about NDS during antenatal care. About 397(78.6%) of the respondent gave birth in the health institution. Most of the mother 481(95.2%) had spontaneous vaginal delivery and assisted by 399(79%) health professionals. Few 51(10.1%) mothers had postal care. Of the total mother who had postnatal care 15(29.4%) had 1st PNC visit,21(41.2%) had 2nd PNC visit,7(13.7%) had 3rd PNC visit and 8(15.7%) had four PNC visit. In addition, Majority 37(72.5%) of mothers had counselling about NDS during postnatal care. Three hundred seventy-eight (74.9%) of neonates started vaccine as well 92(18.2%) of husbands involved in maternal and child health service. Mothers were asked about time to reach health facility,157(31.1%) of them said that it took less than 30 minute and 217(43%) also replied 30 minutes up to 1 hour (Table 3).

Table 3

Obstetrics characteristics of the mother who have children less than one year in Fafan Zone, Somali regional State(n = 505)
Characteristics	Category	Frequency	Percentage
History of ANC	Yes	338	66.9
History of ANC	No	167	33.1
Number of ANC visit	1st visit	29	8.5
	2nd visit	73	21.3
	3rd visit	118	34.4
	Four and more visit	123	35.9
Counselling about NDS during ANC	Yes	177	51.3
Counselling about NDS during ANC	No	168	48.7
Place of delivery	Health Institution	397	78.6
Place of delivery	Home	108	21.4
Mode of delivery	Spontaneous vaginal delivery	481	95..2
	Assisted vaginal delivery	18	3.6
	Caesarean Section	6	1.2
Delivery attendant	Health Professionals	399	79.0
	Traditional Birth Attendants	102	20.2
	Family	4	0.8
Post-natal care	Yes	51	10.1
Post-natal care	No	454	89.9
Number of Post-natal care Visit	One	15	29.4
	Two	21	41.2
	Three	7	13.7
	Four	8	15.7
Counselling about NDS about PNC	Yes	37	72.5
Counselling about NDS about PNC	No	14	27.5
Neonate started vaccine	Yes	378	74.9
Neonate started vaccine	No	127	25.1
Husband involved in MCH service	Yes	92	18.2
Husband involved in MCH service	No	413	81.8
Time to reach health facility	< 30 Minutes	157	31.1
	30 Minutes to 1 Hour	217	43.0
	1–2 Hours	102	20.2
	≥ 2 Hours	29	5.7

Mother’s Knowledge of Neonatal Danger Signs and Health-Seeking Practices

Mothers who have good knowledge of neonatal danger sign was 100 (19.5%). High grade fever (Hotness) (85%), diarrhea (85%), vomiting everything (51%) and poor feeding or unable to suck were the commonly mentioned danger signs by the study participants(Fig. 1). Source of information about neonatal danger sign for majority of the mother were health professional 94(94%). Concerning question raised on believes of neonatal danger signs most of them mother mentioned lack of cleanness 52(53.6%) and wind 20(20.6%). Neonate experience NDS were 60(11.9%)(Fig. 2). Among the study participants whose neonate developed danger signs, 37(61.7%) sought appropriate healthcare practices and 19(31.7%) home treatment.

Regarding reasons not to take health institution while a neonate had NDS, many mothers 39.1% replied long distance to reach a health facility and 21.7% lack of knowledge. Most of the mother 454(90.3%) increase breastfeeding while they experience neonatal danger signs. Near to two third mothers 325(64.4%) decide by them self to seek care while their neonate experience danger signs.

In addition, three hundred twenty-five (64.4%) replied that they seek treatment within 24 hours while their child experience neonatal danger signs. Of these who want to take after 24 hours while their child experience NDS,70(53.8%) said baby would be better by itself,38(30%) said lack of knowledge and 10(7.7%) said it is not sever.

Then again, for question raised on mother’s intention while a neonate experience NDS 460(91.1%) replied take to health institution (Table 4).

Table 4

Mother’s Knowledge of Neonatal Danger Signs and Health-Seeking Practices related characteristics among mother’s who have children less than one year in Fafan Zone, Somali Regional State;2022
Characteristics	Category	Frequency	Percentage
Knowledge about NDS	Good	100	19.8
Knowledge about NDS	Poor	405	80.2
Source of information about danger signs	Health professional	94	94
Source of information about danger signs	Others	6	6
Believes on cause of NDS	Lack of cleanness	52	53.6
	Hunger	3	3.1
	Wind	20	20.6
	Evil sprit	5	5.2
	I don’t know	17	17.5
Neonate experience NDS	Yes	60	11.9
Neonate experience NDS	No	445	88.1
Action taken by a mother while a neonate had NDS	Take to health institution	37	61.7
	Home treatment	19	31.7
	Traditional treatment	3	5.0
	Spiritual/Religion	1	1.7
Reason not to take health institution while a neonate had NDS	Lack of money	3	13.0
	Long distance to reach health facility	9	39.1
	I have no autonomy to decide	3	13.0
	Lack of knowledge	5	21.7
	Neonate are not treatable	3	13.0
Increase breastfeeding during NDS	Yes	454	90.3
Increase breastfeeding during NDS	No	49	9.7
Decision made while neonate experience NDS	Husband	139	27.5
	Mothers (self)	325	64.4
	Mother-in-law	33	6.5
	Others	8	1.6
When you take while you experience neonatal danger signs	Within 24 hours	375	74.3
	After 24 hours	130	25.7
Reasons for not to take to health institution within 24 hours	Baby would be better by itself	70	53.8
	Medication is not given to the neonate	7	5.4
	To start with home treatment	4	3.1
	It is not severe	10	7.7
	Lack of knowledge	38	30.0
Mother’s intention while a neonate experience NDS	Take to the health institution	460	91.1
	Home treatment	20	4.0
	Traditional treatment	15	3.0
	Spiritual /religious treatment	10	2.0
Colostrum provided immediately after delivery	Yes	466	92.3
Colostrum provided immediately after delivery	No	39	7.7
Initiation of breastfeeding within one hour	Yes	459	90.9
Initiation of breastfeeding within one hour	No	46	9.1
Exclusive breastfeeding	Yes	306	60.6
Exclusive breastfeeding	No	199	39.4
Child Bathing	Less than 24 hours	223	44.2
Child Bathing	More than 24 hours	282	55.8

Breast feeding and child bathing related characteristics

Four hundred sixty- six (92.3%) of mothers gave the first milk (colostrum) immediately after delivery and also four hundred fifty-nine (90.9%) had initiate breastfeeding within one hour. Moreover,306(60.6%) of them fed breast milk exclusively. More than half (55.8%) of the mother started child bathing more than 24 hours after birth (Table 5).

Table 5

Breast feeding and child bathing related characteristics among mother’s who have children less than one year in Fafan Zone, Somali Regional State;2022
Characteristics	Category	Frequency	Percentage
Colostrum provided immediately after delivery	Yes	466	92.3
Colostrum provided immediately after delivery	No	39	7.7
Initiation of breastfeeding within one hour	Yes	459	90.9
Initiation of breastfeeding within one hour	No	46	9.1
Exclusive breastfeeding	Yes	306	60.6
Exclusive breastfeeding	No	199	39.4
Child Bathing	Less than 24 hours	223	44.2
Child Bathing	More than 24 hours	282	55.8

Correlation of sociodemographic and knowledge of mothers on neonatal danger sign

Crude analysis of socio-demographic factors through bivariate logistic regression showed that maternal education (Formal education) (COR = 14.57, 95% CI = 8.38–25.34), Maternal occupation (Employed) (COR = 10.57, 95% CI = 3.18–35.15) & Merchant (COR = 3.42, 95% CI = 1.33–8.76), parity (Primipara) (COR = 2.4, 95% CI = 1.2–4.8) and multipara (COR = 1.2, 95% CI = 0.7–2.2), Family size(> 7)(COR = 0.369, 95% CI = 0.187–0.727) and having radio/TV (COR = 5.04, 95% CI = 3.17–7.99) are candidate variable for multivariate analysis with P value < 0.25(Table 6).

Table 6

Correlation of sociodemographic and knowledge of mothers on neonatal danger sign among mother who have children less than one year in Fafan Zone, Somali Regional State;2022
Characteristics		Knowledge of mothers on neonatal danger sign		COR (95% CI)	P value
Characteristics		Yes	No	COR (95% CI)	P value
Age of the mother (year)	18–24 Years	43(43%)	158(39.0%)	1.064(0.597–1.894)	0.833
	25–34 Years	35(35%)	161(39.8%)	0.850(0.469–1.539)	0.591
	≥ 35 Years	22(22%)	86(21.2%)	1
Sex of neonate	Male	52(20.2%)	205(79.8%)	0.946(0.611–1.466)	0.804
Sex of neonate	Female	48(19.4%)	200(80.6%)	1
Maternal Education	No formal Education	49(11.5%)	378(88.5%)	1
Maternal Education	Formal Education	51(65.4%)	27(34.6%)	14.57(8.38–25.34)	0.000
Maternal occupation	Housewife	83(17.5%)	390(82.5%)	1
	Employed	9(69.2%)	4(30.8%)	10.57(3.18–35.15)	0.000
	Merchant	8(42.1%)	11(57.9%)	3.42(1.33–8.76)	0.010
Mother’s marital status	In Union	91(19.7%)	371(80.3%)	0.927(0.429–2.001)	0.846
Mother’s marital status	Not in union	9(20.9%)	34(79.1%)
Parity	1 (Primipara)	27(30.3%)	62(69.7%)	2.408(1.212–4.783)	0.012
	1–5 (Multipara)	56(18.4%)	249(81.6%)	1.244(0.688–2.249)	0.471
	≥ 5 (Grand Multipara)	17(15.3%)	94(84.7%)	1
Family Size	1–3	91(19.7%)	371(80.3%)	1
	4–6	9(20.9%)	34(79.1%)	0.712(0.371–1.368)	0.308
	≥ 7	100(19.8%)	405(80.2%)	0.369(0.187–0.727)	0.004
Radio/Tv in your home	Yes	59(39.6%)	90(60.4%)	5.037(3.172–7.996)	0.000
Radio/Tv in your home	No	41(11.5%)	315(88.5%)	1

Correlation of obstetrics and breast-feeding related factors with knowledge of the mother on neonatal danger signs

Crude analysis of obstetrics related factors through bivariate logistic regression showed that History of ANC (Yes) (COR = 5.07, 95% CI = 2.63–9.78), place of delivery (Health institution) (COR = 11.32, 95% CI = 3.51–36.47), postnatal care(Yes) (COR = 5.34, 95% CI = 2.92–9.76), neonate started vaccine(Yes) (COR = 8.19, 95% CI = 3.25–20.64) ,husband involved in MCH service(Yes) (COR = 1.57, 95% CI = 0.92–2.65) ,time to reach health facility(< 30 minute) (COR = 3.51, 95% CI = 1.86–6.62),timely initiation of breastfeeding (COR = 2.14, 95% CI = 0.82–5.56),exclusive breast feeding (COR = 3.68, 95% CI = 2.13–6.36) and child bathing (COR = 2.39, 95% CI = 1.48–3.85) are candidate variable for multivariate analysis with P value < 0.25(Table 7).

Table 7

Correlation of obstetrics and breast-feeding related factors with knowledge of the mother on neonatal danger signs among mothers who have children less than one year in Fafan Zone, Somali regional State;2022
Characteristics	Category	Knowledge of mother on neonatal danger signs		COR (95% CI)	P value
Characteristics	Category	Yes	No	COR (95% CI)	P value
History of ANC	Yes	89(26.3%)	249(73.7%)	5.069(2.626–9.784)	0.000
History of ANC	No	11(6.6%)	156(93.4%)	1
Place of delivery	Health Institution	97(24.4%)	300(75.6%)	11.317(3.511–36.471)	0.000
Place of delivery	Home	3(2.8%)	105(97.2%)	1
Mode of delivery	Spontaneous vaginal delivery	91(18.9%)	390(81.1%)	0.467(0.084–2.587)	0.383
	Assisted vaginal delivery	7(38.9%)	11(61.1%)	1.273(0.182–8.892)	0.808
	Caesarean Section	2(33.3%)	4(66.7%)	1
Post-natal care	Yes	26(51%)	25(49%)	5.341(2.923–9.759)	0.000
Post-natal care	No	74(16.3%)	380(83.7%)	1
Neonate started vaccine	Yes	95(25.1%)	283(74.9%)	8.191(3.251–20.636)	0.000
Neonate started vaccine	No	5(3.9%)	122(96.1%)	1
Husband involved in MCH service	Yes	24(26.1%)	76(18.4%)	1.565(0.923–2.653)	0.096
Husband involved in MCH service	No	68(73.9%)	337(81.6%)	1
Time to reach health facility	< 30 Minutes	49(31.2%)	108(68.8%)	3.509(1.859–6.621)	0.000
	30 Minutes to 1 Hour	36(16.6%)	181(83.4%)	1.538(0.806–2.934)	0.191
	≥ 1 Hours	15(11.5%)	116(88.5%)	1
Colostrum provided immediately after delivery	Yes	95(20.4%)	371(79.6%)	1.74(0.66–4.57)	0.260
Colostrum provided immediately after delivery	No	5(12.8%)	34(87.2%)	1
Initiation of breastfeeding within one hour	Yes	95(20.7%)	364(79.3%)	2.14(0.82–5.56)	0.119
Initiation of breastfeeding within one hour	No	5(10.9%)	41(89.1%)
Exclusive breastfeeding	Yes	82(26.8%)	224(73.2%)	3.68(2.13–6.36)	0.000
Exclusive breastfeeding	No	18(9%)	181(91%)
Child Bathing	Less than 24 hours	28(12.6%)	195(87.4%)	2.39(1.48–3.85)	0.000
Child Bathing	More than 24 hours	72(25.5%)	210(74.5%)	1

Factors associated with mother’s knowledge on neonatal danger signs

Multivariable logistic regression was performed for the purpose of controlling the confounding effect of variables. Accordingly, Maternal education (Formal education) [AOR = 7.45, 95%CI:(3.89–14.25)], radio or tv presence in home [AOR = 3.50, 95%CI: (1.07–11.49)] & having postnatal care [AOR = 2.47, 95%CI: (1.11–5.2)], Neonate started vaccine) [AOR = 3.5, 95%CI:(1.07–11.49)] and Exclusive breastfeeding [AOR = 2.34, 95%CI:(1.19–4.58)] were factors showing significant association with knowledge of the mother on neonatal danger signs at P-value ≤ 0.05. The odds of knowledge of the mother on neonatal danger sign on those who had formal education 7.5 time [AOR = 7.45, 95%CI:(3.89–14.25)] higher than those who had no formal education. The odds of knowledge of the mother on neonatal danger sign on those had radio or tv in their home 3.5 times [AOR = 3.50, 95%CI: (1.07–11.49)] [AOR = 3.50, 95%CI: (1.07–11.49)] higher than these who haven’t. The odds of knowledge of the mother on neonatal danger signs 2.34 times [AOR = 2.34, 95%CI:(1.19–4.58)] increase among mother who had exclusive breast feeding(Table 8).

Table 8

Factors associated with knowledge on neonatal danger signs among mothers in Fafan Zone, Somali Regional State;2022
Variables	Knowledge of mothers on neonatal danger sign		COR (95% CI)	AOR (95% CI)	P -value
Variables	Yes	No	COR (95% CI)	AOR (95% CI)	P -value
Maternal Education
No formal Education	49(11.5%)	378(88.5%)	1	1
Formal Education	51(65.4%)	27(34.6%)	14.57(8.38–25.34)	7.45(3.89–14.25)	0.000
Maternal occupation
Housewife	83(17.5%)	390(82.5%)	1	1
Employed	9(69.2%)	4(30.8%)	10.57(3.18–35.15)	3.81(0.83–17.58)	0.086
Merchant	8(42.1%)	11(57.9%)	3.42(1.33–8.76)	2.93(0.71–12.13)	0.138
Parity
1 (Primipara)	27(30.3%)	62(69.7%)	2.408(1.212–4.783)	1.22(0.34–4.37)	0.759
1–5 (Multipara)	56(18.4%)	249(81.6%)	1.244(0.688–2.249)	0.67(0.26–1.68)	0.390
≥ 5 (Grand Multipara)	17(15.3%)	94(84.7%)	1	1
Family Size
1–3	91(19.7%)	371(80.3%)	1
4–6	9(20.9%)	34(79.1%)	0.712(0.371–1.368)	1.73(0.64–4.73)	0.283
≥ 7	100(19.8%)	405(80.2%)	0.369(0.187–0.727)	1.74(0.50–5.99)	0.383
Radio/Tv in your home
Yes	59(39.6%)	90(60.4%)	5.037(3.172–7.996)	3.50(1.07–11.49)	0.039
No	41(11.5%)	315(88.5%)	1

Table 8

Factors associated with knowledge on neonatal danger signs among mothers in Fafan Zone, Somali Regional State;2022(Continued)
Variables	Knowledge of mothers on neonatal danger sign		COR (95% CI)	AOR (95% CI)	P-value
Variables	Yes	No	COR (95% CI)	AOR (95% CI)	P-value
History of ANC
Yes	89(26.3%)	249(73.7%)	5.069(2.626–9.784)	1.55(0.67–3.56)	0.306
No	11(6.6%)	156(93.4%)	1	1
Place of delivery
Health Institution	97(24.4%)	300(75.6%)	11.317(3.511–36.471)	1.51(0.34–6.59)	0.587
Home	3(2.8%)	105(97.2%)	1	1
Post-natal care
Yes	26(51%)	25(49%)	5.341(2.923–9.759)	2.47(1.11–5.52)	0.027
No	74(16.3%)	380(83.7%)	1	1
Neonate started vaccine
Yes	95(25.1%)	283(74.9%)	8.191(3.251–20.636)	3.50(1.07–11.49)	0.039
No	5(3.9%)	122(96.1%)	1	1
Time to reach health facility
< 30 Minutes	49(31.2%)	108(68.8%)	3.509(1.859–6.621)	1.41(0.63–3.14)	0.399
30 Minutes to 1 Hour	36(16.6%)	181(83.4%)	1.538(0.806–2.934)	0.74(0.33–1.665)	0.456
≥ 1 Hours	15(11.5%)	116(88.5%)	1	1
Initiation of breastfeeding within one hour
Yes	95(20.7%)	364(79.3%)	2.14(0.82–5.56)	2.18(0.46–10.33)	0.326
No	5(10.9%)	41(89.1%)	1	1
Exclusive breastfeeding
Yes	82(26.8%)	224(73.2%)	3.68(2.13–6.36)	2.34(1.19–4.58)	0.014
No	18(9%)	181(91%)	1	1
Child Bathing
Less than 24 hours	28(12.6%)	195(87.4%)	2.39(1.48–3.85)	0.62(0.33–1.17)	0.143
More than 24 hours	72(25.5%)	210(74.5%)	1	1

In this study, Mothers who have good knowledge of neonatal danger sign was 100 (19.5%). The finding is lower than the study done in rural Bangladesh, Nepal, and Iraq shows that the mother’s knowledge about neonatal danger sign was within the ranges of 37%-81% (21, 26, 27). But it is consistent with study conducted in Sab-Saharan Africa revealed that mothers who are knowledgeable about NDS were between this ranges [14.8%-78.7%] (6, 10, 28, 29).Moreover, magnitude of mother’s knowledge on NDS was between this Ranges [11.5%- 47.8%] in Ethiopia (6, 11, 12, 16, 17, 18, 23).

This study showed that high grade fever (Hotness) (85%), diarrhea (85%), vomiting everything (51%) and poor feeding or unable to suck were the commonly mentioned danger signs by the study participants. This is consistent with a study done at Wolida (30)[, Kenya(31) and Baghdad Iraq (32).

According to this study participants whose neonate developed danger signs, 37(61.7%) sought appropriate healthcare practices and 19(31.7%) home treatment which was higher than reports from Nigeria,(33) and Baghdad in Iraq(34).

According to this study finding, regarding reasons not to take health institution while a neonate had NDS, many mothers 39.1% replied long distance to reach a health facility and 21.7% lack of knowledge. Most of the mother 454(90.3%) increase breastfeeding while they experience neonatal danger signs. Near to two third mothers 325(64.4%) decide by them self to seek care while their neonate experience danger signs. Similarly, A study conducted in India to assess mothers’ practices revealed as 95% of the mothers have followed(traditional) oil massage for the baby before bath. 53% of the mothers have provided home remedies for their sick neonate (87). A significant portion (55%) of mothers followed traditional practices, such as applying ashes, soot, powder, or dry cow dung to their babies. Additionally, 73% of mothers exposed their babies to sunlight when their skin appeared yellowish, and 82% applied "Kajal" to their babies' faces to ward off evil (35).

Correspondingly, a study conducted in Saudi Arabia mothers’ and caregivers shows that about (44.5%) of the mothers/caregivers had good practices about NDS (36).A cross-sectional study conducted at South-East Nigeria revealed as (47.7%) took the child to the hospital immediately without any home intervention. whereas the remaining applied home remedies or self-medication(28). A community based cross-sectional study in Wolkite town, Ethiopia, shows that, 35.5%of mothers have good practice. Most specific actions done by mothers after they recognize neonatal danger signs was (32.0%) take to health institution, (24.2%) take to traditional healers and (6.5%) were do nothing even though the babies faces NDS (6).

The odds of knowledge of the mother on neonatal danger sign on those who had formal education 7.5 time higher than those who had no formal education. Likewise, a study conducted in Iraq, Ambo, North Ethiopia, Arba Minch, wolida hospital, Harare town, and Wolkite show us educational status of the mother (having primary education and above) have positive association with mothers’ knowledge on NDS(6, 18, 21, 22, 23, 24, 37). Another study in Fogera do not show association on the educational status of the mother with their knowledge (11). This is due to the fact that educated mothers are more likely than others to use maternal and neonatal healthcare services, are financially capable (thus able to use broadcasting technologies such as television, radio, and magazines), and use maternal and neonatal health information.

The odds of knowledge of the mother on neonatal danger sign on those had radio or tv in their home 3.5 times higher than these who haven’t. Another study conducted in northern Ethiopia. Fogera district, Mekelle City, in Wolkite and Harare town access for media (radio /TV) shows positive association on mother’s knowledge about NDS (6, 11, 18, 38).The possible reason might be mass media can work through direct and indirect pathways to change the knowledge, attitude and practice of the mother toward neonatal danger signs. By informing and educating, the Media play a main role in increasing the health literacy of the community.

The odds of knowledge of the mother on neonatal danger signs 2.34 times increase among mother who had exclusive breast feeding. The possible reason might be mother’s who practiced exclusive breastfeeding had good health seeking practice and get information about neonatal danger signs

In this study, Mothers who have good knowledge of neonatal danger sign was low 100 (19.5%) and 37(61.7%) of mother’s only sought appropriate healthcare practices for their neonate who had danger signs. Maternal education (Formal education), radio or tv presence in home, having postnatal care, neonate started vaccine and exclusive breastfeeding were factors showing significant association with knowledge of the mother on neonatal danger signs at P-value ≤ 0.05.

Health care provider

To increase their understanding and health-seeking behavior, they must provide health education and counseling (including NDSs, immunization and exclusive breastfeeding) to mothers after birth and during ANC follow-up.

Government

Women's education must be prioritized by the government. Education empowers women, giving them more control over their children's health care information and decisions.

Researcher’s:

Future qualitative studies should focus on mother’s intention while their child experience neonatal danger signs.

Stakeholder’s

To increase mothers' understanding and practice of neonatal danger signs, a public health message should be broadcast by mass media (radio and television) to mothers with children under the age of one year.

ANC

Antenatal Care

AOR

Adjusted Odd Ratio

COR

Crude Odd Ratio

MDG

Millennium Development Goal

MCH

Maternal and Child Health

NDS

Neonatal Danger Signs

PNC

Post Natal Care

MEDHS

Mini Ethiopian Demographic Health Survey

SPSS

Statistical Packages for Social Sciences

WHO

World Health Organization

Acknowledgment

We would like to thank Jigjiga University for supporting this research. We forward appreciation to Somali regional health office for their provision of information related to our research topic. Our gratitude also goes to our colleagues for their encouragement and meticulous support while conducting this research. Finally, I would like to thank the data collectors, supervisors and all research participants who took part in the study

Authors’ contributions

LM designed the research, analyzed the data, interpreted the findings, and drafted the manuscript. SH, AR & AM are also involved in all the processes of this research. All authors read and approved the final manuscript for publication.

Funding
Not applicable.

Availability of data and materials

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

Consent for publication

Not applicable.
Competing interests

There is no competing interest among the authors.

Author details

¹Department of Public Health, College of Medicine and Health sciences, Jigjiga University, Jigjiga, Ethiopia.

²Department of Neonatal Nursing, College of Medicine and Health sciences, Jigjiga University, Jigjiga, Ethiopia.

³Department of Midwifery, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia

WHO,hospital care for children, Danger signs in newborns and young infants 2016.
Mengesha HG, Sahle BW. Cause of neonatal deaths in Northern Ethiopia: a prospective cohort study. BMC public health. 2017;17(1):62.
Dee TS. Are there civic returns to education? Journal of public economics. 2004;88(9-10):1697-720.
UNICEF. Levels and trends in child mortality: report 2019. Estimates developed by the UN Inter-agency Group for child mortality estimation. 2015.
Kretschmer A, Spinler S, Van Wassenhove LN. A school feeding supply chain framework: Critical factors for sustainable program design. Production and Operations Management. 2014;23(6):990-1001.
Shariff ZM, Bond JT, Johnson NE. Nutrition and educational achievement of urban primary schoolchildren in Malaysia. Asia Pacific Journal of Clinical Nutrition. 2000;9(4):264-73.
Bryce J, Coitinho D, Darnton-Hill I, Pelletier D, Pinstrup-Andersen P, Maternal, et al. Maternal and child undernutrition: effective action at national level. The Lancet. 2008;371(9611):510-26.
Bundy D. Rethinking school health: a key component of education for all: The World Bank; 2011.
Gibson RS, Abebe Y, Hambidge KM, Arbide I, Teshome A, Stoecker BJ. Inadequate feeding practices and impaired growth among children from subsistence farming households in Sidama, Southern Ethiopia. Maternal & child nutrition. 2009;5(3):260-75.
Glewwe P, Miguel EA. The impact of child health and nutrition on education in less developed countries. Handbook of development economics. 2007;4:3561-606.
UNICEF. Progress for children: a world fit for children statistical review: Unicef; 2007.
Matanda DJ, Mittelmark MB, Kigaru DMD. Child undernutrition in Kenya: trend analyses from 1993 to 2008–09. BMC pediatrics. 2014;14(1):5.
Callaghan-Koru JA, Seifu A, Tholandi M, de Graft-Johnson J, Daniel E, Rawlins B, Worku B, Baqui AH. Newborn care practices at home and in health facilities in 4 regions of Ethiopia. BMC pediatrics. 2013 Dec 1;13(1).
Jibril MK, Yimam AA, Abdu NR, Ali SY. Psychological impact and associated factors of the COVID-19 pandemic among pregnant women in Fafan Zone health institutions, Somali Region, Eastern Ethiopia, 2021. BMC Women's Health. 2024;24(1):270.
Gina TG, Tadesse BA, Jigjiga E. The role of working animals toward livelihoods and food security in selected districts of Fafan Zone, Somali Region, Ethiopia. transport. 2015;33.
Woday A, Menber Y, Tsegaye D. Prevalence of and associated factors of stunting among adolescents in Tehuledere District, North East Ethiopia, 2017. J Clin Cell Immunol. 2018;9(2):546.
Haile D, Nigatu D, Gashaw K, Demelash H. Height for age z score and cognitive function are associated with Academic performance among school children aged 8–11 years old. Archives of Public Health. 2016;74(1):17.
Yisak H, Gobena T, Mesfin F. Prevalence and risk factors for under nutrition among children under five at Haramaya district, Eastern Ethiopia. BMC pediatrics. 2015;15(1):212.
Faught EL, Williams PL, Willows ND, Asbridge M, Veugelers PJ. The association between food insecurity and academic achievement in Canadian school-aged children. Public health nutrition. 2017;20(15):2778-85.
Federal Democratic Republic of Ethiopia Ministry of Health, Management protocol on selected obstetrics topics January, 2010.
Gashu D, Stoecker BJ, Bougma K, Adish A, Haki GD, Marquis GS. Stunting, selenium deficiency and anemia are associated with poor cognitive performance in preschool children from rural Ethiopia. Nutrition journal. 2015;15(1):38.
Wassie MM, Gete AA, Yesuf ME, Alene GD, Belay A, Moges T. Predictors of nutritional status of Ethiopian adolescent girls: a community based cross sectional study. BMC Nutrition. 2015;1(1):20.
Weres Z, Yebyo H, Miruts K, Gesesew H, Woldehymanot T. Assessment of Adolescents’ under nutrition level among school students in eastern Tigray, Ethiopia: a cross-sectional study. J Nutr Food Sci. 2015;5(5):1.
Getahun Z, Urga K, Ganebo T, Nigatu A. Review of the status of malnutrition and trends in Ethiopia. The Ethiopian Journal of Health Development (EJHD). 2001;15(2).
Information UNDoP. Millennium Development Goals Report 2009 (Includes the 2009 Progress Chart): United Nations Publications; 2009.
Ahmed T, Mahfuz M, Ireen S, Ahmed AS, Rahman S, Islam MM, et al. Nutrition of children and women in Bangladesh: trends and directions for the future. Journal of health, population, and nutrition. 2012;30(1):1.
Akombi BJ, Agho KE, Hall JJ, Wali N, Renzaho A, Merom D. Stunting, wasting and underweight in sub-Saharan Africa: a systematic review. International journal of environmental research and public health. 2017;14(8):863.
Herrador Z, Sordo L, Gadisa E, Moreno J, Nieto J, Benito A, et al. Cross-sectional study of malnutrition and associated factors among school aged children in rural and urban settings of Fogera and Libo Kemkem districts, Ethiopia. PLoS One. 2014;9(9):e105880.
Meerman J, Carisma B, Thompson B. Global, regional and subregional trends in undernourishment and malnutrition. SOFA FOA. 2012;1:1-33.
Jemberia MM, Berhe ET, Mirkena HB, Gishen DM, Tegegne AE, Reta MA. Low level of knowledge about neonatal danger signs and its associated factors among postnatal mothers attending at Woldia general hospital, Ethiopia. Maternal health, neonatology and perinatology. 2018;4:5.
Kibaru EG, Otara AM. Knowledge of neonatal danger signs among mothers attending well baby clinic in Nakuru Central District, Kenya: cross sectional descriptive study. BMC research notes. 2016;9(1):481.
Abdulrida HN, Hassan RJ, Sabri MM. Knowledge and health-seeking practices of mothers attending primary health-care centers in Baghdad Al-Karkh sector about danger signs in newborns. Mustansiriya Medical Journal. 2018;17(1):29.
Ekwochi U, Ndu IK, Osuorah CDI, Amadi OF, Okeke IB, Obuoha E, et al. Knowledge of danger signs in newborns and health seeking practices of mothers and care givers in Enugu state, South-East Nigeria. Italian Journal of Pediatrics. 2015;41(1):18.
Abdulrida H, Hassan R, Sabri M. Knowledge and health-seeking practices of mothers attending primary health-care centers in Baghdad Al-Karkh sector about danger signs in newborns. Mustansiriya Medical Journal. 2018;17(1):29-35.
Mesfin F, Berhane Y, Worku A. Prevalence and associated factors of stunting among primary school children in Eastern Ethiopia. Nutr Diet Suppl. 2015;7:61-8.
Wolde T, Belachew T. Chronic undernutrition (stunting) is detrimental to academic performance among primary schools of adolescent children: a randomized cross sectional survey in Southern Ethiopia. BMC research notes. 2019;12(1):142.
Asmare B, Taddele M, Berihun S, Wagnew F. Nutritional status and correlation with academic performance among primary school children, northwest Ethiopia. BMC research notes. 2018;11(1):805.
Behrman JR. The impact of health and nutrition on education. The World Bank Research Observer. 1996;11(1):23-37.

No competing interests reported.

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Knowledge of Neonatal Danger Signs and Associated Factors Among Mothers in Fafan Zone, Somali Region, Ethiopia (2021)

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Abstract

Figures

Introduction

General objectives

Specific objectives

Methods and materials

Study area and period

Study design

Source population

Study population

Eligibility Criteria

Inclusion criteria

Exclusion criteria

Sample size determination and sampling procedure

Sample size determination

Sampling technique and procedure

Variables of the study

Dependent variables

Independent variable

Socio-demographic and socio- economic variables:

Social or family related factors

Obstetric related factors

Neonatal related factors

Data collection instrument and procedure

Data quality control

Data processing, analysis and interpretation

Ethical clearance

Result

Sociodemographic characteristics

Obstetrics characteristics

Mother’s Knowledge of Neonatal Danger Signs and Health-Seeking Practices

Breast feeding and child bathing related characteristics

Correlation of sociodemographic and knowledge of mothers on neonatal danger sign

Factors associated with mother’s knowledge on neonatal danger signs

Discussion

CONCLUSION

Recommendation

Researcher’s:

Abbreviations

Declarations

References

Additional Declarations

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