Mother’s knowledge and Practice about Neonatal Danger Signs and Associated Factors in Wolkite Town, Gurage Zone, SNNPR, Ethiopia, 2017

Walellign Anmut, Bekana Fekecha* and Tigist Demeke

Jimma University, Institute of Health, College of Health Science, South West, Ethiopia

*Corresponding Author:
Fekecha B
Jimma University, Institute of Health, College of Health Science
South West, Ethiopia
Tel: 55 11 55793321
Email: [email protected]

Received date: September 25, 2017; Accepted date: October 03, 2017; Published date: October 13, 2017

Citation: Anmut W, Fekecha B, Demeke T. Mother’s knowledge and Practice About Neonatal Danger Signs and Associated Factors in Wolkite Town, Gurage Zone, SNNPR, Ethiopia, 2017. J Biomedical Sci. 2017, Vol. 6 No 4:33. doi: 10.4172/2254-609X.100077

Copyright: © 2017 Anmut W, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Background: Neonates are more prone to show subtle signs of illness. Most infants are either born at home or are discharged from the health facility early, families should be able to recognize signs of newborn illnesses and bring the newborn infant to the attention of a health worker.

Methods: Community based cross sectional study design was carried out in wolkite town from March to April, 2017. A total of 368 mothers who gave birth within 12 months prior to the study period were selected by using systematic random sampling technique. Pretested Structured questionnaire was used to collect data. Data was entered into Epi data version 3.1 and exported into statistical package for social science version 21 for analysis. Bivariate and multivariable logistic regression model was used for identifying statistically significant associations between dependent and independent variables.

Result: In this study, 31.32% of mothers have good knowledge about neonatal danger sign. From a total of mothers, 64.5% respondents’ practice for their sick neonate was unsafe. Mothers secondary and above educational level (AOR=1.21, CI 0.049, 0.677), income (AOR=0.44, CI 0.201, 0.964), place of birth (AOR=1.867, CI 1.102, 3.164) and source of information (AOR=0.173, CI 0.034, 0.875) were factors for having good knowledge. Husbands’ educational level (AOR=0.183, CI 0.049, 0.677), husbands’ occupation (AOR=0.132, CI 0.032, 0.543), place of delivery (AOR=6.45, CI 2.617, 7.185) and PNC follow up (AOR=6.19, CI 1.070, 5.626) were factors that contribute for mothers to bring their sick neonate to health institution.

Conclusion and recommendation: There was poor knowledge of mothers towards neonatal danger signs and unsafe practice. Town health office, NGOs and health workers should collaborate to create awareness about neonatal danger sign in the community.


Neonate; Neonatal Danger Sign; Knowledge; Practice


ANC - Ante Natal Care; AOR- Adjusted Odd Ratio; CI - Confidence Interval; EDHS - Ethiopian Demographic Health Survey; IMNCI - Integrated Management of Newborn and Childhood Illness; IMR - Infant Mortality Rate; IRB - Institutional Review Board; Km - Kilo Meter; MDG - Millennium Development Goal; NMR - Neonatal Mortality Rate; OR - Odd Ratio; PNC - Post Natal Care; SDG – Sustainable; Development Goal; SNNPR - South Nation Nationality Peoples Region; SPSS - Statistical Package for Social Science; UNICEF-United Nations Children Education Fund; WHO - World Health Organization.


A newborn or neonate is a child under 28 days of age. During these first 28 days of life, the child is at highest risk of dying. It is thus crucial that appropriate feeding and care are provided during this period, both to improve the child’s chances of survival and to lay the foundations for a healthy life [1].

Neonatal danger signs refer to presence of clinical signs that would indicate high risk of neonatal morbidity and mortality and need for early therapeutic intervention. Fever is an elevation of body temperature above the normal daily variation. It is one of the famous manifestations of diseases and it is the most common cause to seek health care provider and visit physicians in childhood. Convulsion, which is one of neonatal danger sign happen because of sudden, abnormal electrical activity in the brain. Lethargy and poor sucking, especially in an infant who was feeding well earlier, are very important and sensitive indicators of neonatal illness. An increased respiratory rate (more than 60 per minute when counted for at least one minute) and chest retractions indicate a serious problem. Vomiting and Jaundice are also important danger signs which require urgent treatment [2-5].

The neonatal period is the most critical time for the survival of an infant. For too many babies, their day of birth is also their day of death [6]. Every year an estimated 4 million babies die in the first 4 weeks of life and, Almost all (99%) deaths arise in lowincome and middle-income countries. The highest numbers are in south-central Asian countries and the highest rates are generally in sub-Saharan Africa [7]. In these regions, especially the sub-Saharan, preventable health conditions with access to affordable and simple interventions account for more than half of child deaths [8-10].

Childhood mortality levels are decreasing in Ethiopia. According to Ethiopian Demographic Health Survey 2016 Neonatal Mortality Rate are 29 per 1,000 live births. Infant mortality Rate (IMR) is 48 deaths per 1,000 live births and Under-five mortality was 67 deaths per 1,000 live birth [11]. Most neonatal death take place at home, this indicating that lack early recognition on the danger sign and low treatment seeking practice of mothers (care taker) towards modern health care service [12].

In Ethiopia, although significant works has been done in the implementation of IMNCI, children are still suffering from morbidities and mortalities related with danger signs. This is mainly attributed to parent’s care seeking practices. Only few studies were conducted in Ethiopia with regard to care seeking practice of mothers for their children [13-19]. So this research aimed to assess the mothers’ knowledge and practice about neonatal danger sign and what factors influence mothers to have poor knowledge and not seeking modern medical care for their sick neonates.

Materials and Methods

Community based cross sectional study design was carried out on mothers who gave birth within 12 months in Wolkite town from March 7 to April 30, 2017. Wolkite town, which is 158 km far from Addis Ababa, is the administrative center of the Gurage Zone of the Southern Nations, Nationalities and Peoples' Region (SNNPR). Its astronomical location is 07010’ 08’’ North Latitude and 370 37’50’’ East Longitude and an elevation between 1910 and 1935 meters above sea level. Based on the 2007 Census conducted by the Central Statistical Agency, this town has a total population of 28,866, of whom 15,074 are men and 13,792 women. There are 2532 under one year children in the town.

Single population proportion formula was used to calculate a sample size, by using 50% of the proportion of expected mothers ‘knowledge and practice about neonatal danger signs. Systematic random sampling technique was used for selecting study respondents. The town has 6 Kebeles; all Kebeles was included in the study. There are 2532 mothers who were eligible. The study participants in each Kebeles were proportionally allocated. Every house in each kebele which have those mothers gave birth within 12 months were coded then by using systematic random sampling technique every 7th mothers were interviewed.

Data was collected using structured interviewer administered questionnaires. The questionnaire consisted of information on socio-demographic characteristics, Obstetric characteristics, knowledge, and practice questions. The internal reliability of the item was checked by computing Cronbach's alpha (sociodemographic characteristics 0.87, Obstetric characteristics 0.75, knowledge 0.73, and practice 0.7) respectively. The gathered data was coded, cleaned, recoded and entered into Epi-data version 3.1 and finally export to SPSS version 21 for analysis. Simple descriptive summary statistics was done. Tables, statements, charts and graphs were used to present the result of the analyzed data. Associations between independent and dependent variables were analyzed first using bivariate logistic regression analysis. Variables that had p<0.25 on bivariate analysis were entered into multivariable logistic regression analysis. The statistical association between the different independent variables in relation to dependent was measured using OR, AOR, 95% CI and P-values <0.05 was considered statistically significance.

Ethical clearance was obtained from the institutional Review Board (IRB) of Jimma University, institute of Health Science. Official letter was written from school of Nursing and Midwifery for wolkite town Health office. Other necessary permissions were gained from wolkite town Health office. Verbal and written consent was obtained from each participant after thorough explanation of the purpose of the study. Participation in the study was on a voluntary base. All responses were kept confidential and anonymous.


Socio demographic characteristics of respondents

From a total of 368 mothers selected to participate, 355 mothers were completed the interview making the response rate of 97%. The mean age of the respondents was 27.7(SD ± 6.19) years. Majority of the mothers had primary 96(27.0%) as their highest educational attainment. Two hundred ten (59.2%) mothers were house wife (Table 1).

Variables Category Frequency Percent (%)
Mother's educational status No formal education 128 36.1
Primary 96 27
Secondary 61 17.2
Diploma and above 70 19.7
Husband educational status No formal education 105 29.6
Primary 98 27.6
Secondary 70 19.7
Diploma and above 82 23.1
Husband occupation Government Employee 90 25.4
Merchant 83 23.4
Daily laborer 80 22.5
Private employee 71 20
Other 31 8.7
Family monthly Income 1200 90 25.4
1200-3000 68 19.2
3000-5000 106 29.9
≥ 5000 91 25.6
Type of communication media used Television 260 73.2
Radio 95 26.8

Table 1: Socio-demographic characteristics of mothers in Wolkite town, Gurage zone, SNNPR, Ethiopia, 2017 (N=355).

Obstetrics history of the respondents

Among the interviewees, 277 (78.0%) of them attend ANC follow up for their last pregnancy. Two hundred and thirty four (65.9%) mothers were gave their last birth at health institution. Seventy one (20.0%) of mothers had PNC follow up in last delivery (Table 2).

Variables Category frequency Percent (%)
Place of last birth Health institution 234 65.9
Home 121 34.1
PNC follow up Yes 71 20
No 284 80
No of PNC follow up <3 66 91.7
≥ 3 6 8.3

Table 2: Obstetrics characteristics of mothers in Wolkite town, Gurage zone, SNNPR, Ethiopia, 2017 (n=355).

Mothers’ knowledge about neonatal danger sign

Out of the total 355 respondents, 281 (79.2%) of them had information (heard) about neonatal danger sign. The newborn danger sign for which there was high awareness among mothers was diarrhea 160 (57.3%), fever 136 (48.4%) and followed by persistent vomiting 127 (45.2%) (Table 3).

Variable Response Frequency  Percent (%)
Heard about neonatal danger sign Yes 281 79.2
No 74 20.8
list of neonatal danger sign Diarrhea 160 57.3
Fever 136 48.4
Persistent vomiting 127 45.2
Difficulty/fast breathing 71 25.3
Poor feeding or unable to suckle 55 19.6
Baby is cold 31 11.1
Convulsion 37 13.2
Lethargy/unconsciousness 10 3.6
Yellow Skin color (Jaundice) 4 1.4
Other* 20 6.5

Table 3: Distribution of mothers by their knowledge about neonatal danger sign in Wolkite town, Gurage zone, SNNPR, Ethiopia, 2017.

The overall knowledge level of study participants

68.68% of mothers found to have a good knowledge concerning neonatal danger signs. NB: Good Knowledge: those mothers listing three and above neonatal danger signs. Poor knowledge: those mothers list less than three of neonatal danger signs [20].

Practice of mothers for neonatal danger signs

Regarding place of seeking a care 78 (33.8%) of mothers preferred place of seeking a care for their sick neonate was home, 82 (32.0%) take to health institution, 56 (24.2%) take to traditional healers and 15 (6.5%) were do nothing. The home treatments mothers gave for their sick child were “damakesie”, garlic, “tenadam”, honey, a mixture of lemon and ash put on neonate’s head for tonsil, match stick for convulsion, tepid sponging for fever, exposure to sunlight for jaundice, rubbing by coconut oil for cold body.

The majority 118 (51.1%) of mothers continued breast feeding for their sick neonate while 113 (48.9%) were not (Table 4).

Variables Category Frequency Percent (%)
Persistent vomiting stop breast feeding 33 18.5
give home treatment 56 31.5
take to health institution 61 34.3
take to tradition healer 19 10.7
I don't know 9 5
Total 178 100
Diarrhea take to health institution 59 40.4
I give home treatment 43 29.5
take to traditional healer 32 21.9
do nothing 12 8.2
Total 146 100
Breathing problem take to health institution 89 44.9
take to traditional healer 67 33.8
do nothing 42 21.2
Total 198 100
Fever take to health institution 79 37.8
give home treatment 94 45
take to traditional healer 36 17.2
Total 209 100
Convulsion take to health institution 5 19.2
give home treatment 13 50
take to traditional healer 8 30.7
Total 26 100
Jaundice take to health institution 3 20
give home treatment 6 40
take to traditional healer 6 40
Total 15 100

Table 4: Actions taken by mothers for danger signs in Wolkite town, Gurage zone, SNNPR, Ethiopia, 2017.

Factors associated with maternal knowledge about neonatal danger signs

In multivariable logistic regression, mothers’ educational status, income, place of birth and source of information are factors that contribute for mothers’ knowledge towards neonatal danger sign (Table 5).

Variable knowledge level   Odds ratio and 95%CI  
Poor Good Crude Adjusted
Mothers educational status        
No formal education 55 (59.8%) 37 (40.2%) 1.692 (0.947,3.022) 0.56 (0.094, 1.852)
Primary 55 (75.3%) 18 (24.7%) 0.823 (0.422,1.605) 1.21 (0.049,0.677)a
secondary and above 83 (71.6%) 33 (28.4%) 1  
1200 56 (74.7%) 19 (25.3%) 0.497 (0.245, 1.009) 0.44 (0.201,0.964)b
1200-3000 35 (68.6%) 16 (31.4%) 0.669 (0.312, 1.434) 0.462 (0.196,1.086)
3000-5000 61 (70.9%) 25 (29.1%) 0.600 (0.307, 1.172) 0.47 (0.226,1.003)
>= 5000 41 (59.4%) 28 (40.6%) 1  
Place of birth        
Health institution 139 (73.2%) 51 (26.8%) 0.535 (0.316,.907) 1.867 (1.102, 3.164)c
Home 54 (59.3%) 37 (40.7%) 1  
Source of information        
Health professionals 51 (78.5%) 14 (21.5%) 1  
Media 117 (63.2%) 68 (36.8%) 2.117 (1.091,4.107) 1.477 (0.721, 3.029)
Other* 25 (92.6%) 2 (7.4%) 0.291 (0.061,1.383) 0.173 (0.034, 0.875)d

Table 5: Bivariate and Multivariate logistic regression for factors associated with mother’s knowledge about neonatal danger signs in Wolkite town, Gurage zone, SNNPR, Ethiopia, 2017.

Factors associated with maternal practice about neonatal danger signs

Similarly in multivariate logistic regression, husband educational status, husband occupational status, place of birth and attending PNC were the factors that significantly affect maternal practice for neonatal danger signs (Table 6).

Variables Practice category Odds Ratio and 95% CI
Unsafe Safe Crude Adjusted
>5 12 (70.6%) 5 (29.4%) 1
Husband educational status
no formal education 46 (75.4%) 15 (24.6%) 0.143 (0.053,0.382) 0.355 (0.068, 1.851)
primary 41 (70.7%) 17 (29.3%) 0.341 (0.151,0.771) 0.418 (0.094, 1.852)
secondary 38 (73.1%) 14 (26.9%) 0.203 (0.079,0.524) 0.183 (0.049,0.677)a
diploma and above 24 (40.0%) 36 (60.0%) 1
Husband occupation
Merchant 33 (58.9%) 23 (41.1%) 1
daily laborer 36 (80.0%) 9 (20.0%) 0.359 (0.145, 0.886) 0.371 (0.104, 1.323)
government employee 33 (53.2%) 29 (46.8%) 1.261 (0.608, 2.615 0.391 (0.122, 1.256)
private employee 31 (63.3%) 18 (36.7%) 0.833 (.379, 1.832) 0.132 (0.032, 0.543)b
Place of birth
health institution 83 (53.2%) 73 (46.8%) 3.906 (4.716, 6.335) 6.45 (2.617, 7.185)c
home 66 (88.0%) 9 (12.0%) 1
PNC follow up
yes 16 (31.4%) 35 (68.6%) 5.037 (2.538, 9.996) 6.19 (1.070, 5.626)d
no 133 (73.9%) 47 (26.1%) 1

Table 6: Bivariate and multivariate logistic regression for factors associated with mother’s practice about neonatal danger signs in Wolkite town, Gurage zone, SNNPR, Ethiopia, 2017.


Reducing child morbidity and mortality requires immediate caregiver’s recognition of suggestive danger signs in the child and visiting the nearby health facility. But in this study only 31.3% of mothers have good knowledge about neonatal danger sign. This knowledge level report is higher when compared to the reports of the studies conducted in North West of Ethiopia 18.2% [20], slightly lower than the study conducted in Gedeo zone SNNPR, Ethiopia which is 32.4% [21] and higher than the study done in Southwestern Rural Uganda14.8% of mothers were knowledgeable [8]. This discrepancy may be due to sample size variation, time gap, residence and socio cultural variation.

The result of this study showed that 65.1% of mothers had seen a sick neonate in their family in the past one year and only 32.0% of them take their neonate to health institution. This study varies with study conducted in Wardha, India in which 41.8% of sick neonates got medical treatment [22,23]. And 47.7% of Nigerian mothers took the child to the hospital immediately without any home intervention [24]. These variations might be explained by differences in the disease spectrum between these different study areas and knowledge level of mothers.

This study reviled that maternal educational level was significantly associated with knowledge of mothers towards neonatal danger sign. Mothers who attended secondary and above were 1.21 times more knowledgeable when compared to primary educational level. The study conducted in north west of Ethiopia showed that those mothers who attended; collage and above were knowledgeable than primary [25,26]. The possible justification for this could be educated mothers acquire knowledge through their academic life and educated mothers take their sick neonate to health institution so they gain additional information from health providers.

Monthly house hold income was found to have association with women to have knowledge of danger sign. Those women whose household income was less than 1200 ET birr monthly income were 56% less likely knowledgeable than those gain greater than or equal to 5000 ET birr. This may be due to those mothers who have financial problem are less likely access to media. An increased exposure to media also increased the knowledge of mothers on neonatal danger signs.

Women’s place of birth and source of information were significant predictors for knowledge of neonatal danger sign. Mothers who have gave birth in health institution in their last pregnancy were nearly two times knowledgeable than as compared to mothers who had given birth at home. Those mothers their source of information other than health professionals were 83% less likely knowledgeable as compare to mothers who gain information from health professionals. The study done in Kenya, showed that mothers receiving information on neonatal danger signs from care provider are increased having knowledge of neonatal danger sign [27,28]. The possible justification for this is mothers give birth in health institution receives post natal counselling by health professionals on appropriate time; this increases their awareness and they pied attention what they told.

Husband educational level is important to bring the neonate to health institution. Those mothers their husbands’ educational level secondary were 82% less likely to visit health institution as compared to diploma and above. Similarly, those respondents whose husband’s occupation private employee was 87% less likely to take their sick neonate to health institution as compared to merchants. Education of mother and father and their work status have strong effect on child survival in developing countries. Educated women tend to provide better healthcare, hygiene and are more likely to seek help when a child is ill [29]. This may due to educated husbands are more informed and can help their wives’ to take the sick neonate to health institution and merchants may gain more income so they can fulfil medical payments.

Place of birth and PNC follow up were statistically significant to bring the sick neonate to health institution. Those mothers who deliver their last child in health institution were 6.45 times bring their sick neonate to health institution as compared to mothers who had given birth at home. Similarly, mothers who had PNC follow up were 6.19 times more likely to go health institution when compared to those who did not follow PNC care. The possible reason may mothers give birth at health institution and have PNC follow up are counselled about neonatal danger sign; this increase knowledge of the mother concerning the neonatal danger signs. They become alert for those signs and this help to bring their neonate to health institution when they become sick.


The findings of this study showed that there was poor knowledge of mothers towards neonatal danger signs in the studied area. Mothers practice for neonatal danger sign was unsafe; most mothers take their sick neonate to traditional healers and give home remedies. Maternal educational level, household monthly income, place of birth and source of information are contributing factors for good knowledge of danger sign. Husbands’ educational level and occupation, place of delivery and PNC follow up were statistically significant for mothers to bring their neonate to health institution when they become sick.

Author’s Contributions

All authors participated in the design and analysis of the study. WA searched the databases, and wrote the first and second draft of the article. BF and TD reviewed proposal development activities and each drafts of the result article. All authors revised the manuscript and approved the final version.


First and for most we would like to thank the almighty God for initiating us for conducting this research thesis. We are also grateful for those all individuals for their contribution in one or another way while we are preparing this thesis. Lastly, but not least our heartfelt thanks goes for Wolkite town health office, study participants, supervisors and data collectors for their cooperation.


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