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Knowledge of Neonatal Danger Signs and Associated Factors Among Open access Original research BMJ Open: first published as 10.1136/bmjopen-2020-045930 on 16 August 2021. Downloaded from Knowledge of neonatal danger signs and associated factors among husbands of mothers who gave birth in the last 6 months in Gurage Zone, Southern Ethiopia, 2020: a community- based cross- sectional study Solomon Shitu ,1 Haimanot Abebe ,1 Daniel Adane ,1 Abebaw Wassie,1 Ayenew Mose ,1 Alex Yeshaneh 2 To cite: Shitu S, Abebe H, ABSTRACT Strengths and limitations of this study Adane D, et al. Knowledge Objective To assess knowledge of neonatal danger signs of neonatal danger signs and and their associations among husbands of mothers who associated factors among ► To the best of our knowledge, this is the first study to gave birth in the last 6 months in Gurage Zone, Southern husbands of mothers who gave be carried out in the study area and in the southern Ethiopia, from 1 February to 28 February 2020. birth in the last 6 months in region of Ethiopia. Design Community- based cross- sectional study. Gurage Zone, Southern Ethiopia, ► The study employed a nationally validated assess- 2020: a community- based Setting Gurage Zone, Southern Ethiopia. ment tool. cross- sectional study. Participants The study was conducted among 633 BMJ Open ► This was a community- based survey designed to 2021;11:e045930. doi:10.1136/ participants living in Gurage Zone from 1 February to explore factors that can predict knowledge status by bmjopen-2020-045930 28 February 2020. 618 completed the questionnaire. A focusing on those who cannot visit health institu- multistage sampling technique was employed to obtain ► Prepublication history for tions due to different factors. study participants. Data were collected through face-to- this paper is available online. ► Predictors of knowledge of danger signs would To view these files, please visit face interviews conducted by 20 experienced and trained have been best addressed if the study included both http://bmjopen.bmj.com/ the journal online (http:// dx. doi. data collectors using a pretested structured questionnaire. the husband and the wife as study participants for org/ 10. 1136/ bmjopen- 2020- To assess knowledge, 10 questions were adopted from the comparison. 045930). WHO questionnaire, which is a standardised and structured questionnaire used internationally. Data were entered into Received 19 October 2020 Accepted 27 July 2021 EpiData V.3.1 and exported to SPSS (Statistical Package for Social Sciences) V.24 for analysis. Descriptive statistics wives during antenatal care and postnatal care visits, were performed and the findings were presented in text, or create a strategy to increase husbands’ participation figures and tables. Binary logistic regression was used to in access to maternal and child health service since husbands are considered decision- makers when it comes assess the association between each independent variable to healthcare-seeking in the family. The government on September 23, 2021 by guest. Protected copyright. and the outcome variable. All variables with p<0.25 in the should come up with policies that will help promote formal bivariate analysis were included in the final model and education in the community and increase their media statistical significance was declared at p<0.05. Voluntary access. consent was taken from all participants. Results A total of 618 participants were included in the study, with a response rate of 97.6%. Of the participants, © Author(s) (or their BACKGROUND employer(s)) 2021. Re- use 40.7% had good knowledge (95% CI 36.3 to 44.2). The neonatal period refers to the period from permitted under CC BY-NC. No Urban residence (adjusted OR=6.135, 95% CI 4.429 birth to 28 days and is the most critical period commercial re- use. See rights to 9.238) and a primary and above educational level of the baby’s life as many complications and and permissions. Published by (adjusted OR=4.294, 95% CI 1.875 to 9.831) were some death may occur. The major contributor to BMJ. independent predictors of husbands’ knowledge status. 1 newborn morbidity and mortality is delay in Department of Midwifery, Conclusion Knowledge of neonatal danger signs Wolkite University, Welkite, in this study was low. Urban residence, primary and recognising newborn danger signs. Common Ethiopia above educational level, the husband’s wife undergoing danger signs include poor or no sucking, 2 Midwifery, Wolkite University, instrumental delivery and accompanying the wife during lethargy or drowsiness, difficulty in breathing, Wolkite, Ethiopia antenatal care visits were independent predictors of hypothermia, hyperthermia, yellowish disc- Correspondence to knowledge. Thus, strong multisectoral collaboration olouration of the palms and soles, bleeding Mr Solomon Shitu; should target reducing the knowledge gap by improving from the umbilical cord, diarrhoea, convul- solomonsht7@ gmail. com husbands’ attitude with regard to accompanying their sion and vomiting.1–5 Shitu S, et al. BMJ Open 2021;11:e045930. doi:10.1136/bmjopen-2020-045930 1 Open access BMJ Open: first published as 10.1136/bmjopen-2020-045930 on 16 August 2021. Downloaded from Globally, neonatal mortality, accounting for an esti- It has 16 districts and 5 town administrations. The town mated four million deaths worldwide each year, consti- of Wolkite is the zone’s capital. According to the 2017 tutes 40% of under-5 mortality and approximately 57% of Ethiopian Central Statistical Agency population projec- infant mortality. Most neonatal deaths (99%) come from tion, Gurage Zone has a total population of 1 635 311, low- income and middle- income countries and approx- of these 842 065 were female and the remaining 793 246 imately half occur at home. Across countries, neonatal were male.16 There are seven hospitals (five public and mortality rates (NMRs) ranged from 46 deaths per 1000 two non- government) serving the zone’s total population. live births in Pakistan to 1 per 1000 live births in Iceland Five of the hospitals in the zone are primary hospitals, and Japan.6–8 and the remaining two are general zonal hospitals. All Childhood mortality is decreasing in Ethiopia. Approx- hospitals found in Gurage Zone provide comprehensive imately 42% of under-5 mortality in Ethiopia are attrib- emergency obstetric care services for saving the lives of utable to neonatal deaths. According to the Ethiopian women and their children. Additionally, 72 health centres Demographic and Health Survey in 2016, NMR in Ethi- provide basic emergency obstetric care services. opia and in the Southern Nations, Nationalities, and Peoples’ Region (SNNPR) has remained stable at 30 and Source population 35 deaths per 1000 live births, respectively. According to The study population was sourced from husbands in a study done in the country in 2013 by Mekonnen and Gurage Zone with children less than 6 months of age. his colleagues,9 NMR, early NMR and late NMR were 36.7, 29.2 and 7.5 per 1000 population, respectively. Most Study population neonatal deaths happen at home, indicating that lack of The study population included husbands with children early recognition of the danger signs, decision- making less than 6 months of age in randomly selected kebeles of and low treatment- seeking practices among mothers Gurage Zone. (caretakers) are significant contributors.6 9–12 Sustainable Development Goal 3 aimed to reduce Inclusion criteria neonatal mortality to at least as low as 12 per 1000 live All husbands with children less than 6 months of age and births. Early identification with prompt and appropriate who were residents of Gurage Zone for at least 6 months healthcare- seeking of the family serves as the backbone for were included in the study. reducing neonatal mortality. Trends in Ethiopian society so far recognised mothers as caretakers of the majority Exclusion criteria of neonates while husbands are responsible for decision- Husbands who were seriously ill and unable to respond at making when it comes to healthcare- seeking.13–15 the time of data collection were excluded. Some studies in Ethiopia have assessed mothers’ knowledge of neonatal danger signs and have identified http://bmjopen.bmj.com/ Sample size determination some factors that affect knowledge; however, knowledge concerning the role of men in neonatal care in Africa Separate sample size was calculated for each specific objec- is understudied despite their economic dominance and tive (to determine the magnitude of husbands’ knowl- decision- making power. In a patriarchal society like Ethi- edge of neonatal danger signs and to identify the factors opia, pregnancy and childbirth are often regarded as associated with knowledge of neonatal danger signs) by exclusively women’s affairs. Men are socially and econom- using both single and double population proportion ically dominant; they exert strong influence over their formula. The sample size for the first objective (to deter- wives in terms of access to healthcare. This makes men mine the magnitude of husbands’ knowledge of neonatal on September 23, 2021 by guest. Protected copyright. critical partners in the improvement of child healthcare danger signs) was calculated using the single population and in the reduction of neonatal mortality.10 To increase proportion formula, awareness about neonatal danger signs and to reduce (Zα/2)2P(1 P) n = 2 − mortality and morbidity, knowing the current status of d knowledge among husbands is necessary. This study with the following assumptions: n=minimum sample size aimed to assess husbands’ knowledge of neonatal danger required for the study, (Z α/2)2= standard normal distri- signs and their predictors. bution with 95% CI, P=50% men’s knowledge of danger signs (due to the absence of previous findings on men in Ethiopia), and d=a tolerable margin of error (d=0.04). METHODS The sample size for the second objective was calculated Study area, design and period by Epi Info V.7 Stat Cal using different factors.
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