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MATTU UNIVERSITY
COLEGE OF HEALTH SCIENCES

DEPARTMENT OF MIDWIFERY
MATERNAL HEAITH CARE SEEKING BEHAVIOR FOR NEONATAL DANGER

SINGS AD ASSOCIATED FACTORS AMONG POST PARTUM MOTHERS IN MATTU
KARL SPECIALIZED HOSPITAL
RESEARCH THESIS SUBMITTED TO MATTU UNIVERSITY COLLAGE OF

HEALTH SCIENCE DEPARTMENT OF MIDWIFERY IN PARTIAL FULFULMENT
OF THE DEGREE OF BACHELOR SCIENCE IN MIDWIFERY
PREPARED BY EYASU LAGIDE

ID NUMBER RU 4520/12
ADVISOR Mr. SAMUEL.E (MSC)
November 2023
MATTU, ETHIOPIA
ACKNOWLEDGEMENT
First I would like to give my deepest gratitude to Mattu University collage of health science,
department of midwifery for giving me the academic qualification to develop and conduct. Next
i would like to thanks for his unreserved guidance and constructive advice in a various aspects
that make me come up with research paper and my respected acknowledge is forward to Nicu
staff and mattu karl specialist hospital medical director that helped me a lot in searching for the
development of this proposal paper.
Finally I would like to express my very great appreciation to my friends and classmates who has
provided personal computer to perform this paper.
Mattu University, COHS, Department of Midwifery Page I

Abstract
Early health care seeking could save neonates’ lives and have a significant role in decreasing
neonatal death, while delayed health care seeking has many contributions to neonatal mortality.
Neonatal dangers are became a substantial problem in many developing countries like Ethiopia.
More specifically, neonatal rates in Ethiopia are among the highest in the world. In this regard,
health-seeking behavior of mothers for neonatal care highly relies on their knowledge about
neonatal danger sign, and it has been hardly investigated. Therefore, mothers’ knowledge is
needed to reduce maternal health care seeking behavior for neonatal danger sings and associated
factors among post-partum mother.
The aim of this study was to assess the knowledge on neonatal danger sign and associated factors
among post natal mothers in mattu karl specialized hospital.
Institutional-based cross-sectional study design was conducted from September 25th to

November 2 2023, among 410 mothers attending mattu karl specialist hospital. A structured, per-
tested, and interview-administered questionnaire comprehending 13 neonatal danger signs will
be employed to collect the data. Data will be entered into EPI-Info 3.1 and it will be analyzed by
SPSS version 26. Multivariate logistic regression model will be used to identify associated
factors. Odds ratio with 95% CI will be computed to assess the strength and significant level of
the association.
From total sample size of 410, four hundred participants were successfully interviewed in this
study giving a response rate of 97.6%. Among the study participants, 160 (40%) were in the age
group of 25 to 29years and the mean (±SD) age was 27.45±5.02years while the mean age (±SD)
of the neonates was 17.9±5.7 days.
Maternal health care seeking of the respondents was low; Emphasis should be given to creating
awareness of neonatal danger signs, maintaining postnatal follow-up, and encouraging
mothers/caregivers to make immediate decisions for seeking healthcare at healthcare institutions.
Keywords: - Health-care-seeking behavior, Postpartum, Mothers, Neonatal dangers sign,

Ethiopia.
Mattu University, COHS, Department of Midwifery Page II

ACRONYMS/ABBREVIATIONS
ANC Antenatal Care
AOR Adjusted Odd Ratio
CD Cesarean Delivery
CI Confidential Interval
COR Crude Odds Ratio
EMDHS Ethiopian Min Demographic and Health Survey
ENC Essential Newborn Care
EPI Expanded Program of Immunization
EHSTP Ethiopian Health Sector Transformation Plan
HI Health Institution
IMNCI Integrated Management of Newborn and Childhood Illnesses
IMR Infant Mortality Rate
NDSs Neonatal Danger Signs
NGO Non-Governmental Organization
NMR Neonatal Mortality Rate
PMTCT Prevention of Mother to Child Transmission
PNC Postnatal Care
SDG Sustainable Developmental Goal
SPSS Statistical Packaged for Social Science
SVD Spontaneous Vaginal Delivery
UNICEF United Nations Children’s Fund
WHO World Health Organization
Mattu University, COHS, Department of Midwifery Page III

Table of Contents
ACKNOWLEDGEMENT................................................................................................................I
Abstract...........................................................................................................................................II
ACRONYMS/ABBREVIATIONS...............................................................................................III
CHAPTER ONE..............................................................................................................................1
INTRODUCTION...........................................................................................................................1
1.1. Background...........................................................................................................................1
1.2. Statement of Problem...........................................................................................................2
1.3. Significance of the study......................................................................................................4
CHAPTER TWO.............................................................................................................................6
LITERATURE REVIEW................................................................................................................6
2.1. Newborn Danger Signs.........................................................................................................6
2.2. Maternal Health Care seeking for neonatal danger signs.....................................................7
2.3. Mothers Knowledge on Neonatal Danger Signs..................................................................9
2.4. Factors Associated With Health Care Seeking Behavior for Neonatal Danger Signs.......10
2.4.1. Socio-demographic characteristics of the mother........................................................11
2.4.2. Maternal health service exposure and obstetric factors................................................12
2.4.3. Source of Information about Neonatal Danger Signs..................................................12
CHAPTER THREE.......................................................................................................................15
OBJECTIVE..................................................................................................................................15
3.1. General Objective...............................................................................................................15
3.2. Specific Objectives.............................................................................................................15
CHAPTER FOUR.........................................................................................................................16
METHOD AND MATERIALS.....................................................................................................16
4.1. Study Area..........................................................................................................................16
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4.2. Study Period........................................................................................................................16
4.3. Study design........................................................................................................................16
4.4. Population...........................................................................................................................16
4.4.1. Source of Population....................................................................................................16
4.4.2. Study Population..........................................................................................................16
4.5. Inclusion and exclusion criteria..........................................................................................16
4.5.1. Inclusion criteria...........................................................................................................16
4.5.2 Exclusion criteria...........................................................................................................17
4.6 Sample size and sampling techniques..................................................................................17
4.6.1 Sample size determination.............................................................................................17
4.6.2 Sampling Techniques....................................................................................................18
4.7. Variables in the study.........................................................................................................18
4.7.1. Dependent variables.....................................................................................................18
4.7.2 Independent variable.....................................................................................................18
4.8. Operational Definition........................................................................................................19
4.9. Data Collection...................................................................................................................19
4.10. Quality control measures..................................................................................................19
4.11. Pre-test..............................................................................................................................20
4.12. Data Analysis....................................................................................................................20
4.13. Ethical Consideration........................................................................................................20
4.14. Dissemination of result..................................................................................................20
CHAPTER FIVE...........................................................................................................................21
RESULT........................................................................................................................................21
Mattu University, COHS, Department of Midwifery Page V

5.1. Socio Demographic Characteristics of the Participants......................................................21
5.2. Health Service Uptake of the Study Participants................................................................22
5.4. Health Care Seeking Behavior for Neonatal Danger Signs.............................................................24
5.5. Factors Associated With Health Care Seeking Behavior for Neonatal Danger Signs.......28
CHAPTER SIX..............................................................................................................................31
DISCUSSION................................................................................................................................31
6.1. Discussion...........................................................................................................................31
6.2. Strength and limitation of study.........................................................................................33
6.2.1 Strength of study........................................................................................................33
6.2.2 Limitation of the study..................................................................................................34
CHAPTER SEVEN.......................................................................................................................35
CONCLUSION..............................................................................................................................35
CHAPTER EIGHT........................................................................................................................36
RECOMMENDATION.................................................................................................................36
REFERENCES..............................................................................................................................37
QUESTIONNAIRE.......................................................................................................................43
Mattu University, COHS, Department of Midwifery Page VI

List of table
Table 1:- Project plan................................................................................................................................21
Table 2:- Proposal budget plan..................................................................................................................23
List of figure
Figure 1:- The conceptual frame work for this study by reviewing different literatures in selected mattu
karl specialist hospital 2023.......................................................................................................................14
Mattu University, COHS, Department of Midwifery Page VII

CHAPTER ONE
INTRODUCTION
1.1. Background
The neonatal period (the first 28 days of life) is the most vulnerable time for the child's survival.
Health care-seeking behavior is defined as any action under taken by individuals who perceive
them to have a health problem or to be ill to find an appropriate remedy [1]. Globally, the
neonatal mortality rate is 17 deaths per 1000live births or approximately 6700 deaths per year,
while about 47% of all under-five deaths occurred in neonatal periods in 2019. Furthermore, the
neonatal mortality rate was the highest in Sub-Saharan Africa (27 deaths per 1000 live births)[2].
One of the third Sustainable development goal (SDG) aims was to end preventable deaths of
newborns by2030 [3]. Also, all countries were aiming to reduce neonatal mortality to at least as
low as 12 deaths per 1000 live births in 2030, but in Ethiopia, the neonatal mortality rate shows
as light increase from 29 death per 1000 live birth in 2016 to 30 deaths per live births in
2019[3,4].
Delayed healthcare seeking contributes much for neonatal mortality. Because the majority of
neonatal deaths occur at home, where a few families sought medical care for signs of neonatal
illness, and nearly no neonates were taken to health facilities when they were sick.[5] Therefore,
a family understanding of health care seeking is essential to minimize potential delays that
contribute to neonatal mortality and effectively improve neonatal health.[6] Healthcare-seeking
behavior for neonatal danger signs is essential in managing illness and preventing mortality in
neonates.[7] Mothers’ and caregivers’ recognition of newborn disease (neonatal danger signs) at
home was poor; and/or delayed due to different traditional beliefs or cultural beliefs related to
ideas of what causes neonatal illness. [5,6,8-14] The proportion of mothers who sought care at
the health facility for neonatal danger signs varied across the globe. For example, in Asia from
11.3% to 79.23% from 2006 to 2019.[15,16] While 47.7% to 35.9% in Africa in 2015.[17,18]
and 27% to 97.7% from 2017 to 2020 in Ethiopia.[14,19-24] In a developing country like
Ethiopia, the absence of health care seeking behavior among Ethiopian women causes a lack of
early recognition of neonatal danger signs, and hence neonatal death occurs at home[5]. Besides
this, different studies reported that urban residence, maternal secondary education, the practice of
optimal thermal care, place of delivery (institutional delivery) and postnatal care follow-up
Mattu University, COHS, Department of Midwifery Page 1

(having postnatal care follow-up), knowledge of neonatal illness, or danger signs were factors
that significantly associated with health care seeking behavior[14, 17, 22, 23]. Recognition of
why families were choosing to or not choose to seek health care was key.
A child born in sub Saharan Africa was ten times more likely to die in the first month than a
child born in high income country. Likewise, Ethiopia is among the top four countries with the
highest burden of newborn deaths (99,000 deaths in 2019). Neonates and infants often present
with nonspecific symptoms and signs of severe illness [3]. Neonatal danger signs are clinical
signs that indicate a high risk of neonatal morbidity and mortality and require immediate
therapeutic intervention [2, 3]. The world health organization (WHO) described nine neonatal
danger signs, which includes; not able feed, convulsion, fever (>37.5`C), hypothermia (<35.4`C),
yellow soles, movement only when stimulated or no movement, and sign of local infection
(umbilicus red or draining pus, skin boils, or eyes draining pus) [2, 4, 8]. The majority of
neonatal deaths in developing countries occur at home due to late recognition of the signs of
serious illness by parents or care givers [5].As a result maternal health care seeking of newborn
danger signs has a significant impact on new born health [14,17,22]. Additionally, various
factors that had a significant association with maternal health care of neonatal danger signs were
also identified. Of these, age, maternal level of education, fathers education level, Variables like
knowledge of NDSs, health insurance, ANC follow-up for the last pregnancy, post-natal care
follow-up, decision-making power, marital status, mother occupational status, average self-
responded monthly income, last neonates place of delivery, last neonate birth order, educational
status of mothers were included in the multi-variable logistic regression model. However, having
postnatal care follow-up, good knowledge of neonatal danger signs, decision-making power,
living with a partner, and having health insurance were significantly associated with having
appropriate health care seeking behavior [12, 20, 21]. Therefore this study will be aimed to
maternal knowledge and health care seeking behavior of neonatal danger signs and associated
factors among post-partum mothers in mattu karl specialist hospital, Ethiopia.
1.2. Statement of Problem

Neonatal danger signs refer to the presence of clinical features that would indicate high risk of
neonatal mortality and morbidity cause [39, 40]. Worldwide the average neonatal mortality is
estimated to be 33 per 1000 live births. It is estimated that each year four million neonatal deaths

occur, and almost exclusively in low income countries [3, 8]. Three quarters of neonatal deaths
occur in the first week of life, suggesting the need for early care [41].
Over the past several decades, the global incidence of child mortality has steadily decreased.
More than 40% of under-five deaths now occur in the first month of life—the neonatal period;
thus, achievement of sustainable Development Goal-3 (SDG) for child survival depends on more
effectively addressing neonatal deaths, particularly early deaths in the first week of life.
Despite the progress made worldwide in newborn survival, the speed is low in developing
countries where the burden of neonatal death accounted for 99% of all deaths [3,].
Neonatal morbidity and mortality rates in Ethiopia are among the highest in the world and stem
from a range of socioeconomic, political and demographic factors. Many of these deaths are
preventable. Newborns die every year and the neonatal mortality rate is 30 per 1000 live births
[3,4].Childhood mortality levels are decreasing in Ethiopia. According to Ethiopian
Demographic Health Survey (EDHS 2011), Neonatal Mortality Rate (NMR) is rate 37 per 1,000
live births. Infant mortality Rate (IMR) is 59 deaths per 1,000 live births for the five-year before
the survey compared with 77 deaths per 1,000 live births in 2005. Under-five mortality levels
have also decreased from 123 deaths per 1,000 live births in 2005 to the current level of 88
deaths per 1,000 live births [16, 20].
Mini EDHS 2014 states that a large proportion of maternal and neonatal deaths occur during the
48 hours after delivery, and these first two days following delivery are critical for monitoring
complications arising from the delivery. The level of postnatal care coverage is extremely low in
Ethiopia. Only 13 percent of women received postnatal care within two days, as recommended
[4,]. So, improving knowledge and health seeking behavior of mothers are one crucial factor for
essential post natal coverage and child health.
The newborn cannot explain or express their discomfort and therefore identification and
diagnosis of illness may be delayed if parents are not intelligent, observant, and concerned [44].
Mothers are the primary caregivers of the newborn. Thus the knowledge of the mothers
regarding newborn danger signs has a great influence on the health of the newborn [7].

Integrated Management of Newborn and Childhood Illnesses emphasize on mothers, community
leaders and health workers to identify danger signs among newborns for early referral to
appropriate health care provider/ facility. Early identification with prompt and appropriate
referral serves as backbone of the programs aiming at reduction in neonatal mortality [3, 6].
Absence of health care seeking and late seeking are associated with numerous infant deaths in
developing countries. In these countries, easily treatable diseases like pneumonia and diarrhea
are still the principal causes of illness and death among children under one year of age [45].
Some studies have shown that perceived illness severity, maternal recognition of certain signs
and symptoms of childhood illness were critical factors determining health care-seeking behavior
[9, 11, 15].
In order to achieve sustainable Development Goal-3 (SDG) of Ensure health lives and promote
well-being for all at all ages and end preventable deaths of new born and under five children it is
important to study distribution of neonatal illnesses, Care-seeking behavior, and direct enabling
and disabling factors related to health systems which affect neonatal health [3,26].
Various studies from developing countries have reported that delay in seeking appropriate care
and not seeking any care contributes to the large number of child deaths. Mothers need to know
the danger signs of sick newborn. They can explain these signs to others or family member in a
simple language so as to enable them to identify the danger signs and to seek early and prompt
medical help. Hence, this study will be carried out to assess mothers’ knowledge and health care
seeking behavior about neonatal danger signs [14, 31, 33].
1.3. Significance of the study

Improving newborn survival is one part of Sustainable Development Goal. The greatest gap in
New born care is often during the critical first week of life when most neonatal deaths often
occur at home and without any contact with the formal health sector. These conditions can be
managed if mothers are aware of newborn danger signs and develop experience of early
recognition and healthcare seeking behavior for newborn illness [9, 10, 11]. This study will be
assessing knowledge of mothers about newborn danger signs and their health care seeking
behavior. The results of the study will be used as baseline information to design appropriate
policies, strategies, and intervention, which can improve mothers’ early recognition of newborn

danger signs and their health care seeking behavior and support the maternal and child health
service improvement. The results of the study will also add the evidence about mother’s
recognition of newborn danger signs and give background information for further studies in
neonatal health and newborn survival. hygienic umbilical cord and skin care; early and exclusive
breast feeding; assessment for signs of serious health problems or need of additional care those
that are low birth weight, sick or have an HIV infected mother [21].

CHAPTER TWO
LITERATURE REVIEW
2.1. Newborn Danger Signs

Newborn danger signs refer to presence of clinical signs that would indicate high risk of neonatal
morbidity and mortality and the need for early therapeutic intervention. Nowadays mortality
among sick neonates is very high and facilities for appropriate care of very sick neonates are
less. It may take a long time for a sick neonate to reach a hospital. It is therefore important that
they are identified early and referred for appropriate treatment. Early identification of a sick
newborn however, has some problems. The clinical features are nonspecific e.g. whether the
illness is of infective or metabolic origin; the signs do not help us in differentiating the cause.
Moreover, the distinction between variation of normal behavior and early signs of illness
becomes more difficult in low birth weight and preterm infants [46]. In a full-term baby, lethargy
and poor sucking, especially in an infant who was feeding well earlier, are very important and
sensitive indicators of neonatal illness. Most of the mothers shall be able to give this history and
most of the times mothers are rightly concerned. In a preterm baby, however, poor feeding
and/or lethargy may at times be normal. Such infants must be carefully assessed for referral, as
even these babies often need better health care facilities available in some hospitals only [47].
Temperature instability is a very important danger signs in neonates. Hypothermia (temperature
below 36.5 degrees centigrade) is a common signs in sick neonates especially in low birth weight
babies. Auxiliary temperature recorded for at least three minutes will indicate the extent of
hypothermia in a baby who is “cold to touch” Unlike adults, neonates often manifest
hypothermia assignor. Fever (temperature above 37.5 degrees centigrade) is a sign of infection
usually in term neonates [47]. Convulsions happen because of sudden, abnormal electrical
activity in the brain. Febrile convulsions are seizures that occur because of fever, which is a
temperature higher than 38°C. High fevers might come with an infection. We don’t know why,
but in these cases, the rapid rise in temperature causes an abnormal electrical discharge in the
brain. Febrile convulsions are pretty common, occurring in about 4% of children between the
ages of six months and five years. Two-thirds of these children will only ever have one fit [46].
Most will occur while the child is younger than three years old. Children who have their first
febrile convulsion before the age of one year have a higher risk of having recurrent febrile

convulsions. This type of convulsion tends to run in families, and affects boys more often than
girls [47].
Breathing difficulties indicate serious illness in the newborn. An increased respiratory rate (more
than 60 per minute when counted for at least one minute) and chest retractions indicate a serious
problem. It could be due to pneumonia, hyaline membrane disease, heart failure or malformation.
Since neonates, especially preterm babies, have a very soft chest wall and their breathing is
mainly diaphragmatic, one needs to count the rise of abdomen in a minute for counting
respiration (inspiration). The normal breathing pattern in the newborn is characterized by brief
periods of cessation of breathing called periodic breathing. The common causes of apnea in a
neonate can be (any one or in combination): hypo -or hyperthermia, hypoglycemia, septicemia,
anemia, meningitis, intracranial hemorrhage or apnea of prematurity [47]. Regurgitation or
vomiting soon after feeds is often due to faulty feeding technique or autophagy. In case of
persistent, projectile or bile stained vomiting in association with failure to pass me conium
during the first 24 hours and or abdominal distension, the baby should be investigated for
intestinal obstruction. Such neonates must reach the hospital before becoming dehydrated or
worse due to electrolyte imbalance [47]. Change in established bowel pattern towards greater
frequency and looseness should be taken seriously. Many infants pass stools while being fed but
otherwise remain alright and keep on gaining weight. Breast fed babies pass more frequent stools
than formula fed babies. Maternal ingestion of drugs (ampicillin, laxatives) and certain fruits like
mango may result in loose stool in breast fed babies; it does not need any specific treatment [47].
2.2. Maternal Health Care seeking for neonatal danger signs

A study conducted in Uttar Pradesh, India on gender differences in perception and care-seeking
for illness of newborns. Perception of illness was significantly lower in incidence among
households with female versus male newborns. These results suggest that, during the neonatal
period, care-seeking for girls is neglected compared to boys, laying a foundation for programs
and further research to address gender differences in neonatal health in India [50].
A study conducted in rural Ghana on recognizing childhood illnesses and exploring options for
care-seeking interventions reported that symptom recognition was a care-seeking barrier, and
interventions must move away from a narrow symptom recognition focus because there are other
significant barriers to care-seeking; symptom recognition is not always necessary for care-

seeking; not all recognition problems can be addressed; and little is known about which
symptoms or symptom combinations trigger action .The study also showed that financial access
was a major barrier to appropriate care-seeking. Although interventions to improve care-seeking
must consider logistic factors as important influencers on the care-seeking process, we found that
poor physical access resulted in delayed care-seeking rather than no care-seeking. Poor access
does not reduce the importance of care-seeking interventions, in fact, where access is poor
caregivers would benefit greatly from being able to discern which episodes really need to be
taken to a health facility [48].
Another study conducted in Southern Tanzania on understanding home-based neonatal care

practice reported that majority of mothers reported that they knew what action to take when the
baby became sick, but accessibility, lack of money, lack of drugs and abusive language by health
personnel were mentioned as barriers to neonatal care-seeking. Mothers discuss issues related to
childcare with their female friends, husbands, aunts and other close female relatives [49]. Mini
EDHS 2014 states that a large proportion of maternal and neonatal deaths occur during the 48
hours after delivery, and these first two days following delivery are critical for monitoring
complications arising from the delivery. The level of postnatal care coverage is extremely low in
Ethiopia. Only 13 percent of women received postnatal care within two days, as recommended.
Nevertheless, this is an improvement from fifteen years ago when only 2 percent received
postnatal care during the first two days of delivery. The great majority of women (82 percent)
with a live birth in the preceding five years did not receive a postnatal checkup at all [43]. Study
conducted in Jimma zone shows that from a total of 4463 live-births, 2077 died before 28 days of
birth making weighted neonatal mortality rate of 60%. Individual-level variables such as birth
order, frequency of antenatal care use, delivery place, gestation age at birth, premature rupture of
membrane, complication during labor, twin births, size of neonate at birth and neonatal care
practice were identified as determinants of neonatal mortality. Birth asphyxia (47.5%), neonatal
infections (34.3%) and prematurity (11.1%) were the three leading causes of neonatal mortality
accounting for 93 %.so, assessment of knowledge and health seeking behavior is one crucial
factor to prevent neonatal morbidity and mortality [51]. Generally neonates and young infants
often present with nonspecific symptoms and Signs that indicate severe illness. These signs
might be present at or after delivery or in a newborn presenting to hospital or develop during
hospital stay. Because most babies are born at home or are discharged from the hospital in the

first 24 hours, increasing community awareness of the danger signs of newborn and improving
care seeking of newborn care is of critical importance for improving newborn survival [47].
2.3. Mothers Knowledge on Neonatal Danger Signs

Reducing neonatal morbidity and mortality needs immediate caregiver’s recognition of
suggestive danger signs. Mothers‟ knowledge on neonatal danger signs is crucial to influence
their decisions to seek immediate health care for their sick neonate. Failure to seek professional
help and visiting the nearby clinic for early treatment is highly related to lack of knowledge on
neonatal danger signs [7].
According to cross-sectional studies conducted in Bangladesh and Nepal the overall prevalence
of mothers‟ knowledge on neonatal danger sign was 35.63 and 50% respectively (25, 26). A
similar study conducted in Enugu state in Nigeria using cross sectional study design indicated
that only 30.3% of mothers had knowledge on more than three of the WHO recognized danger
sign but majority of the mothers around 95.2% had knowledge on only fever while only 2.9%
and 0.3% correctly listed up to six and seven danger sign respectively. Whereas, about 4.8% of
mothers couldn’t able to list even one danger signs [17].
Another cross-sectional study done in University of Port Harcourt in Nigeria using cross-
sectional study design on 146 post natal mothers revealed that almost 50% of mothers had poor
knowledge regarding to neonatal danger sign whereas, 45.2% of mothers had good knowledge
only on fast breathing (28). Likewise, an institution based cross sectional study conducted in
South Sudan revealed that the prevalence of maternal knowledge was only 20.4% those who able
to identify four or more danger signs whereas 47.8% of mothers had no any knowledge on any of
the neonatal danger signs [53].
An institution based cross-sectional study conducted in Kenya showed that the prevalence of
good knowledge among mothers was only 15.5%. Despite about 84.5% of mothers had poor
level of knowledge, 74.9% of postnatal mothers recognized hotness of the body (fever) as
common danger signs Moreover, poor feeding and lethargy/unconsciousness were identified as
new born danger signs by 40.1% and 5.8% of mothers respectively. Whereas only 11.1% and
9.7% of mothers had knowledge on convulsion and hypothermia sequentially [28].

According to the study done in West African country in Ghana using cross-sectional study
design the total prevalence of maternal knowledge was only 28.1% whereas, 71.9%, and 28% of
mothers mentioned greater than two and three neonatal danger signs respectively.
Overall, 93.6%, 94.3%, 95.1% and 92.3% of mothers did not know that Yellow palms, baby too
small, redness of umbilical stump, and unconsciousness were neonatal danger signs respectively
[37]. Similarly, a study conducted in 4 regions of Ethiopia (Oromia, Tigray, Amhara and
Southern Nations) on newborn care practice at home and in health facilities revealed that only
29.3% of mothers had good knowledge towards newborn danger signs who could mention 3 or
more danger signs out of a list of 11. Based on this study, 83.6% had good awareness on fever as
major neonatal danger signs. To a lesser extent, 39.5%, 21.1%, 17.3%, 12.7%, 10.3% of mothers
had knowledge towards poor feeding/suckling, difficult/fast breathing, lack of consciousness,
convulsions and redness of the eye respectively and only 8.5%, 3.5%, and 1.7% of mothers had
knowledge on cold temperature, lethargy and yellow palms, eyes, or soles and only 46.2% of
neonates were taken to health facilities [52].
According to a community based cross- sectional studies done in Tenta District, Northeast
Ethiopia and Woldia, 76.7% of mothers noticed one or more of their newborn danger signs and
overall prevalence of maternal knowledge on neonatal danger signs was only 11.67%
respectively [14].
2.4. Factors Associated With Health Care Seeking Behavior for Neonatal Danger
Signs
Variables like knowledge of NDSs, age, high educational level of both mother and husband,
family income, health insurance, ANC follow-up, post-natal care follow-up, and birth
preparedness decision-making power, both occupational status, are the major contributing
factors affecting maternal health care seeking for neonatal danger signs whereas, religion, parity,
delivery assistant, marital status are less contributing factors. However, having postnatal care
follow-up, good knowledge of neonatal danger signs, decision-making power, living with a
partner, and having health insurance were significantly associated with having appropriate health
care seeking behavior [7, 14].

2.4.1. Socio-demographic characteristics of the mother
Regarding to age of the mother studies conducted in Bangladesh showed that those mothers who
had middle age were 1.67 times more knowledgeable [38]. On the other hand, cross-sectional
studies conducted in Nigeria, Sudan and Kenya revealed that the age of the mothers had no any
Significant association with mothers‟ knowledge on neonatal danger signs [17, 28, 53]. In
contrast, another institution based cross-sectional study conducted in Debretabor general hospital
indicated that those mothers whose age 18-35 years were 1.33 more likely to be knowledgeable
as compared to mothers who were < 18 years old [35].
Studies conducted in Nigeria and Kenya indicated that maternal marital status had no significant
association with knowledge on neonatal danger signs [17, 28]. On the other hand, a study done in
Woldia showed that, marital status 2.50 had positive association with maternal level of
knowledge to identify different neonatal danger signs. Those mothers who are widowed had
three times less likely to identify at least six neonatal danger signs [35]. A study done in India
indicated that there is a significant association between levels of knowledge on selected neonatal
danger signs among prim mothers with religion. On the other hand, a study done in Nigeria
reported that there was no significant association between maternal religion and maternal
knowledge [17]. In income consideration, according to a study done in Indian family income was
not significantly associated with mothers‟ knowledge [17]. On the other hand a study conducted
in Mekelle city revealed that those mothers who had a household income of 501 to 1000
Ethiopian Birr (ETB) was 2.2 times more likely to be aware of neonatal danger signs and those
who had more than 1000 Ethiopian Birr monthly incomes were also 2.9 times more likely to be
aware of the defined neonatal danger signs [54]. Regarding family size or number of children
studies conducted in India, Nigeria and revealed that there was no any significant association
between number of children or family size and maternal knowledge on neonatal danger signs
[17]. Regarding place of residence a cross-sectional studies done in Bangladesh and Baghdad
revealed that there was no significant association between the knowledge levels of danger signs
with place of living. In contrast, a study conducted in Woldia and Mekelle showed that mothers
who lived in the urban area were 22% and 4.1 times more likely to have knowledge about
neonatal danger signs as compared to those living in rural area respectively [17]. Regarding
occupation studies conducted in Bangladesh, and Baghdad showed that there was significant

association between mothers’ knowledge on neonatal danger signs and occupation [38]. On the
other hand, a study done in Nigeria indicated that maternal and husband occupation was no
associated with mothers‟ knowledge on neonatal danger signs [17].
2.4.2. Maternal health service exposure and obstetric factors

A study done in Baghdad showed that mothers who had history of ANC attendance and more
than 4 visits were significantly associated with mothers level of knowledge on neonatal danger
signs more than those who did not have a history of ANC attendance [55]. According to a facility
based cross-sectional study done in Rural Bangladesh on 142 mothers, postnatal care and
increased ANC follow up were associated with knowledge of at least one neonatal danger sign
among post natal mothers. Likewise, high parity was associated with an increased maternal
knowledge of newborn danger signs but there was no significant association between maternal
knowledge and delivery assistant as well as mode of delivery [38]. A cross- sectional study
conducted in Urban Slums revealed that, those mothers who had delivered at home had 30%
lesser awareness as compared to those who went for institutional delivery [56]. According to a
study done in Sub-district hospitals of Bangladesh, mothers who had increased parity and
hospital delivery were two times knowledgeable than their counter part. Similarly, mode of
delivery had an effect on maternal knowledge regarding neonatal danger sign [38]. A study done
in Gonder also showed that those mothers who had PNC visit were 2 times more knowledgeable
than who had not [35]. Another study done in Wolkite Town showed that mothers who gave
birth in health institution in their last pregnancy were nearly two times knowledgeable as
compared to those who gave birth at home [23].
2.4.3. Source of Information about Neonatal Danger Signs

As stated by different studies, information regarding neonatal danger sign had a crucial role for
improving mothers‟ knowledge on neonatal danger signs [38, 55]. With regard to this, a study
conducted in India indicated that there was significant association between sources of
information with level of knowledge regarding home care for selected newborn illness among
mothers [10].

According to the study done in Chencha District, Southern Ethiopia, those mothers who had
radio in the household were 67% times more likely be knowledgeable about neonatal danger
signs or 1.67 times more knowledgeable than who had not. But the study did not indicate any
relation between mothers‟ knowledge and source of information from health professionals
(Doctors, Midwifery Nurses and public health officers) and health extension works [57].
Likewise, a study done in Gondar University revealed that, mothers‟ access to television
increased their knowledge about neonatal danger signs by 3.5 times as compared to those
mothers who had no television access (38). In line with this study, the study conducted in Woldia
indicated that those mothers who had gotten information about neonatal danger signs increased
their knowledge by 3 times as compared to those did not get any information [14]. Similarly
another study done in Wolkitie Town showed that, source of information was significant
predictors for knowledge of neonatal danger sign. Based on this study, those mothers whose
source of information other than health professionals were 83% less likely knowledgeable as
compare to those who gained from health professionals including health extension workers [23].

2.4. Conceptual Frame Work
Figure 1:- The conceptual frame work for this study by reviewing different literatures in selected
mattu karl specialist hospital 2023

CHAPTER THREE
OBJECTIVE
3.1. General Objective

To determine maternal health care seeking behavior for neonatal danger signs and associated
factors among post-partum mothers in mattu karl specialized hospital, Oromia, South-west
Ethiopia, 2023.
3.2. Specific Objectives

To assess maternal health care seeking behavior for neonatal danger signs among post-partum
mothers in mattu karl specialized hospital, Oromia, South-west Ethiopia, 2023.
To assess the factors associated with maternal health care seeking behavior for neonatal danger
signs among post-partum mothers in mattu karl specialized hospital, Oromia South-west
Ethiopia, 2023.

CHAPTER FOUR
METHOD AND MATERIALS
4.1. Study Area
This study was conducted in mattu town Oromia, a regional state, which is located 541.5 km to
the south-western of Addis Ababa, the capital of Ethiopia. Located in the illubabor zone of the
Oromia along the Sor River, this town has a latitude and longitude of 8*18`N 35*35`E and an
altitude of 1605 meters. There are 4 kebeles and 1 comprehensive specialized hospital, 4 health
centers, 71 medium private clinics, and 72 private pharmacies in the town. The total town
population was 59,706 by 2022, of which 29,569 and 30,137 were males and females
(Unpublished mattu Town health office’s data).
4.2. Study Period

The study will be conducted in mattu Genera Hospital from May, 2023 to September, 2023EC.
4.3. Study design

Institutional based cross sectional study design.
4.4. Population
4.4.1. Source of Population

All post-partum mothers at mattu town are source population.
4.4.2. Study Population

The study population will be all postpartum mothers whose neonates will be history of illness
with in 28days of life from May 2023EC.
4.5. Inclusion and exclusion criteria
4.5.1. Inclusion criteria

While postpartum mothers whose neonates will be the history of illnesses for at least 1 times
within 28 days of their life in the study area will be included in the study.

4.5.2 Exclusion criteria
Postpartum mothers who will be not interested/not willing to participate in the study, unable to
communicate due to severe illness, and who lost their bay at birth will be excluded from the
study.
4.6 Sample size and sampling techniques
4.6.1 Sample size determination

The sample size will be determined based on single population proportion formula by
considering 41.3% the prevalence of healthcare-seeking behavior of postpartum mothers at Tenta
district in 2015,[13] at 95% confidence level, 5% marginal error (d), and 10% non-response rate;
the result will be the sample size of 410. A simple random sampling technique will be used to
identify participants.
Accordingly, the value will be substituted in the following single population proportion formula:
n = (Z α/2)2 × P (1-P)/d2
Where n = minimum sample size required
Z = critical value for normal distribution at 95% confidence level which equals to 1.96 (z value
at α = 0.05)
P = proportion of mothers‟ Health care seeking behavior for neonatal danger signs”
d = Margin of error (precision) which is 5%. With 10% non-response rate.
P = 41.3% = 0.413
(Zα/2) = 1.96
d = 5% = 0.05
no = initial sample size
no = (Zα/2)2 x p(1-p)/d2
No = ((1.96)2 x 0.413x (1-0. 413))/(0.05x0. 05) =372

4.6.2 Sampling Techniques:
Simple random sampling technique will be used of postpartum mothers until sample size will be
met.
4.7. Variables in the study
4.7.1. Dependent variables

Health care seeking behavior (HCSB),
Knowledge about neonatal danger signs
4.7.2 Independent variable

 Age of mother
 Age of child
 Marital status
 Occupation
 Ethnicity
 Mother educational level
 Father educational level
 Income
 Number of children
 Decision making ability
 Religion
Need factors are another factor that states perceived need was better to help to understand care
seeking and adherence to a medical regime that includes perceived illness/self-reported illness
(status and severity of diseases. In addition, health system factors (Distance of health facility,
Perceived quality of services, Type of healthcare services).

4.8. Operational Definition
Health care seeking behavior: Seeking care at health institution (from trained health professional)
or (seek care from a traditional healer, spiritual healers and doesn’t took any were) in response to
neonatal danger signs to reduce severity and complication after recognizing/identifying the
danger signs and perceived nature of the illness [14]. In this study, if participants sought care at
health institution within the day they recognize signs and symptoms of diseases on their neonate
considered as “Have appropriate healthcare-seeking behavior,” otherwise “Inappropriate
healthcare-seeking behavior” [16].
Have decision-making power: (if participants make decision by herself and/or with her husband
to get medical care and to select treatment place for their ill neonate).
Have not decision-making power: (if participants do not make decision by herself and/or with
her husband to get medical care and to select treatment place for their ill infant) [14].
Good knowledge of neonatal danger sings: (if mothers were able to list more than 3 out of 9
WHO outlined neonatal danger signs).
Poor knowledge of neonatal danger sings: (if mothers were able to list at most 3 out of 9 WHO
outlined (none of and/or ≤3) neonatal danger signs) [17, 28].

4.9. Data Collection
The questionnaire was prepared in English language and translated into the local language (Afan
Oromo) and back to English languages to check the consistency. A structured interviewer-
administered questionnaire adapted from different literature was used to collect the
data.14,15,23,26,27 One MSc holder in clinical midwifery and researcher supervisor and 4 BSc
midwives participated in the data collection process.
4.10. Quality control measures
A pretest was done in mattu town on 5% (21) of the participants after the questionnaire was
translated into the Afan Oromo language. According to the results of the pretest, further
modification (reordering, rewriting, and regrouping) of the questionnaire was done before the
actual data collection. Orientation was given to data collectors and supervisors. Collected data
was reviewed and checked for completeness and relevance by supervisors on a daily base.
4.11. Pre-test
Before actual data collection, pre-test will be done at in order to check whether the questionnaire
is a problem or not and to ensure reliability and validity of the instrument.

4.12. Data Analysis
The data were checked for completeness, consistencies, and missing values and then coded, and
entered using Epi Data version 3.1. Then cleaned and exported to and analyzed using Statistical
Package for Social Science (SPSS) version 26.29 Descriptive statistics were computed to
determine frequencies and summary statistics (mean, median, standard deviation, and
percentage) to describe the study population concerning socio-demographic and other relevant
variables. Data were presented using tables, graphs, and figures. Both binary and multivariate
logistic regression was executed to see the association between independent and dependent
variables. All explanatory variables with p<.25 in binary logistic regression were transferred to
multivariate binary logistic regression analysis.
4.13. Ethical Consideration

Formal letter of ethical clearance of permission will be obtained from Mattu university collage of
health science department of midwifery to mattu karl specialist hospital in order to conduct the
study in this hospital and the objective of the study will be discussed with the hospital leaders to
obtain desired cooperation.
4.14. Dissemination of result

At the end of the study, the result will be presented to Mattu university collage of health science
Department of midwifery, health library and other Concerns body like mattu karl specialist
hospital

CHAPTER FIVE
RESULT
5.1. Socio Demographic Characteristics of the Participants
From total sample size of 410, four hundred participants were successfully interviewed in this
study giving a response rate of 97.6%. Among the study participants, 160 (40%) were in the age
group of 25 to 29years and the mean (±SD) age was 27.45±5.02years while the mean age (±SD)
of the neonates was 17.9±5.7 days. About 326 (81.5%) of participants were living with their
partner while 156 (39%) of study participants had secondary and above level of education. Two
hundred seventy three (68.8%) of study participants were unemployed (Table 1).
Table 1. Socio-Demographic Characteristics of Postpartum Mothers in Mattu Town, Oromia, Ethiopia,

2020 (N = 400).
Variables Categories Frequencies Percent
Mothers age in 15-19 27 6.8

years
20-24 81 20.3
25-29 160 40.0
30-34 95 23.8
≥35 37 9.3
Neonate age in days <7 days 4 1.0
7-28 days 396 99.0
Sex of neonate Male 253 63.2
Female 147 36.8
Marital status Live with partner/in marriage 326 81.5
Out of marriage/live without partner 74 18.5
Educational status No formal education 162 40.5

of

Mothers Elementary/primary 82 20.5
Secondary and above 156 39.0
Mothers Unemployed 275 68.8

occupational
Status Self-employed/merchant 75 18.8
Gov’t/NGO employed 50 12.5
Family size in <5 221 55.3

number
≥5 179 44.8
Average self- <Median 197 49.3

reported
monthly income ≥Median 203 50.7
Health insurance No 164 41.0
Yes 236 59.0
Last neonate birth 1-2 218 54.5
Order ≥3 182 45.5
a Includes mothers who were divorced, single, and widowed.
b Includes mothers who were students, homemaker/house wife, farmer, and labor worker.
5.2. Health Service Uptake of the Study Participants
Nearly two third, 262 (65.5%) of study participants had antenatal care follow up for their last
pregnancy. Spontaneous vaginal delivery (SVD) was the most 348 (87%) reported mode delivery
by the study participants. One hundred eighty three (45.8%) of the study participants had history
of postnatal follow up after the birth of their last neonates (Table 2).
Table 2. Health Service Uptake of Postpartum Mothers in Mattu Town, Oromia, Ethiopia, 2020
Variables Categories Frequencies Percent

Had ANC follow up for the last No 138 34.5
pregnancy (N = 400) Yes 262 65.5

Number of ANC visits (N = 262) 1 times 43 16.4
2 times 21 8.0
3 times 90 34.4
4+ times 108 41.2
ANC counseling services No 66 25.2
(N = 262) Yes 196 74.8
Last neonates place of delivery Home 85 21.3
(N = 400) Health institution 315 78.8
Mode of delivery (N = 400) SVD 348 87.0
Cesarean section 52 13.0
History of post-natal attendance No 217 54.3
for their last neonate (N = 400) Yes 183 45.8
5.3. Knowledge/Recognition of Neonatal Danger Signs by Respondents

From total study participants; nearly half 205 (51.3%) of par- participants have good knowledge
of neonatal danger signs (able to mention more than 3 out of 9 WHO neonatal danger signs).
About 222 (77.1%) neonatal danger sign mentioned by participants was unable/stop
feeding/poor feeding (Table 3).
Table 3. Knowledge and Types of Neonatal Danger Signs Mentioned by Postpartum Mothers
about NDSs in Mattu Town, Oromia, Ethiopia, 2020.
Variables Category Frequencies Percent

Knowledge of neonatal Poor knowledge of 195 48.8
Danger signs (NDSs) NDSs
(N = 400)
Good knowledge of 205 51.3

NDSs
Have you ever heard NO 112 28
about NDSs (N =
400)
YES 288 72
Types of NDSs Unable to feeding/poor 222 77.1

mentioned by feeding
mothers (N = 288)
Convulsion/lethargy 177 61.5
Fast breathing 194 67.4
Cold to 175 60.8
touch/hypothermia
Hot to touch/fever 144 50
Umbilicus redness or 109 37.9
draining pus, skin boils,
or eyes draining pus
(sign of local infection)
Only moves when 116 40.3
stimulated or not even
when stimulated
(weakness or lethargy)
Yellow soles (sign of 82 28.5

jaundice)
Severe chest in drawing 84 29.2
(difficulty in breathing)
Source of information Health care providers 255 88.5
(N = 288)
Medias:- TV 209 72.6
Radio 53 18.4
Others 26 9
Families 86 29.9
Neighbors’ 16 5.6
5.4. Health Care Seeking Behavior for Neonatal Danger Signs

From total 400 mothers whose neonates have got illnesses for at least once since their birth to
28 days of life; about 176 (44%, 95% CI: 39.2-48.9) of them have appropriate health care
seeking behavior (sought care at health institution within a day they have seen symptoms on
neonates). However, regarding place of care sought about 153 (38.5%) of the respondents were
sought care at public or private hospitals while about 137 (34.3%) of them took their sick
neonates to health center; but 32 (8%) of them sought care from private clinic regardless of time
they sought care (Table 4).
Table 4. Health Care Seeking Behavior among Postpartum Mothers in mattu Town, Oromia,
Ethiopia, 2023 (N = 400).
Variables Category Frequency Percent

Frequency of illness occurrence on 1 times 231 57.8
their last neonates
>1 times 169 42.3
Degree of neonatal illnesses Mild 142 35.5
Moderate 144 36.0
Very severe 114 28.5
Usual mode of transport On foot 96 24
By vehicle 304 76
How much time it takes from your Less than half an hour 316 79
home to nearby HI
Half an hour-1 h 84 21
Where did you take your sick neonate Public/private hospital 153 38.3
for treatment?
Health center 137 34.3
Private clinic 32 8.0
Traditional healers 35 8.8
Spiritual healers 31 7.8
Doesn’t took any where 12 3.0
When you took your sick neonates for Within a day of sign and symptoms 218 54.5
neonates? recognition
After 1 days of sign and symptoms 182 45.6
recognition
When did you took Non-health Within a day of sign and symptoms 42 53.8
institution (N=78) recognition
sick neonate for After 1 days of sign and symptoms 36 46.2

recognition
treatment Health institution Within a day of sign and symptoms 176 54.7
recognition

(N = 322) After 1 days of sign and symptoms 146 45.3
recognition
Usual waiting time in a place you ≤30 min 135 33.8

sought care.
>30 min 265 66.3
How did you rate the quality of service Very good 118 29.5
given
for your baby Good 238 59.5
Bad 42 10.5
Very bad 2 0.5
Health care seeking behavior (HCSB) Have inappropriate HCSB 224 56.0
Have appropriate HCSB 176 44.0
Reason for delay care seeking/not seek Lack of money 89 39.7

care
at health institution within a day of s/s Believe it will be improved by itself 213 95.1
recognition.c Believe it will not be improved by 206 92.0

treatment
Believe it will be improved by traditional 144 64.3

treatment
Long distance from health institution 9 4.0
Lack of transport access 4 1.8
Lack of transport cost 13 5.8
Work load 15 6.7

Long waiting time in HI 4 1.8
Lack of self-decision making ability 83 37.1
Lack of money 89 39.7
Believe it will be improved by itself 213 95.1
Believe it will not be improved by 206 92.0

treatment
About 303 (75.8%) of the respondents have decision- making power, however the major decision
maker for health care seeking of their seek neonates were both mothers and fathers 223 (55.8%)
(Figure 2).
Figure 2. Decision makers for seeking care for their sick neonate among postpartum mothers in mattu
Town, Oromia Region, 2020 (N = 400).

5.5. Factors Associated With Health Care Seeking Behavior for Neonatal Danger
Signs
Variables like knowledge of NDSs, health insurance, ANC follow-up for the last pregnancy,
post-natal care follow-up, decision-making power, marital status, mother occupational status,
average self-responded monthly income, last neonates place of delivery, last neonate birth order,
educational status of mothers were included in the multivariable logistic regression model.
However, having postnatal care follow-up, good knowledge of neonatal danger signs, decision-
making power, living with a partner, and having health insurance were significantly associated
with having appropriate healthcareseeking behavior. Given that, postpartum mothers who have
postnatal care follow-up were 3.5 times higher odds of having appropriate healthcare-seeking
behavior than those who have no postnatal care follow-up (AOR=3.5; 95% CI: 2.06-5.80).
Similarly, postpartum mothers who have good knowledge of neonatal danger signs were 2.8
times more likely to have appropriate health care seeking behavior than those who have poor
knowledge of neonatal danger signs (AOR=2.78; 95% CI: 1.63-4.73). Also postpartum mothers
who have decision making power had 3.02 times higher odds of appropriate health care seeking
behavior than those who have no decision making power (AOR=3.02, 95% CI: 1.61-5.67).
Moreover, postpartumtum mothers who were in marriage or ever live with their partner were 3
times higher odds of having appropriate health care seeking behavior than those who were out of
marriage or live without their partner (AOR=3.00; 95% CI: 1.42-6.31). Besides, postpartum
mothers who have health insurance were 1.8 times higher odds of having appropriate health care
seeking behavior than those who have no health insurance (AOR=1.82; 95% CI: 1.08-3.06)
(Table 5).
Table 5. Factors Associated With Health Care Seeking Behavior of Postpartum Mothers for Neonatal
Danger Signs at Mattu Town, Oromia, Ethiopia, 2023.
Health care seeking behavior (HCSB)
Variable Category Have Have

inappropriate appropriate COR (95% AOR (95% CI)
HCSB (%) HCSB (%) CI)
Knowledge of NDSs Poor knowledge of 147 (65.6) 48 (27.3) 1 1
NDSs
Good Knowledge of 77 (34.4) 128 (72.7) 5.09 (3.31- 2.78 (1.63-
NDSs 7.84) 4.73)*

Health insurance No 110 (49.1) 54 (30.7) 1 1
Yes 114 (50.9) 122 (69.3) 2.18 (1.44- 1.82 (1.08-
3.30) 3.06)**
Have ANC follow up No 94 (42) 44 (25) 1 1
for
the last pregnancy
Yes 130 (58) 132 (75) 2.17 (1.41- 1.16 (0.66-
3.34) 2.02)
Post natal care No 159 (71) 58 (33) 1 1
follow up
Yes 65 (29) 118 (67) 4.98 (3.25- 3.5 (2.06-
7.63) 5.80)*
Decision making Have no decision 73 (32.6) 24 (13.6) 1 1
power making power
Have decision 151 (67.4) 152 (86.4) 3.06 (1.83- 3.02 (1.61-
making power 5.12) 5.67)*
Marital status In marriage/ live 59 (26.3) 15 (8.5) 3.84 (2.09- 3.00 (1.42-
with partner 7.04) 6.31)**
Out of marriage 165 (73.7) 161 (91.5) 1 1
Mothers Unemployed 163 (72.8) 112 (63.6) 1 1
occupational status
Self-employed/ 46 (20.5) 29 (16.5) 0.92 (0.54- 1.13 (0.53-
merchant 1.55) 2.43)
Gov`t/ NGO 15 (6.7) 35 (19.9) 3.40 (1.77- 1.19 (0.51-
employed 6.51) 2.81)
Average self- <Median 128 (57.1) 69 (39.2) 1 1
responded monthly
income
≥Median 96 (42.9) 107 (60.8) 2.07 (1.38- 1.1 (0.59-
3.09) 1.90)
Last neonates place Home 62 (27.7) 23 (13.1) 1 1
of delivery
Health institution 162 (72.3) 153 (86.9) 2.55 (1.50- 0.88 (0.44-
4.31) 1.75)
Last neonate birth 1-2 122 (54.5) 60 (34.1) 2.31 (1.54- 1.61 (0.93-
order 3.48) 2.79)
≥3 102 (45.5) 116 (65.9) 1 1
Educational status No formal 117 (52.2) 45 (25.6) 1 1
of mother education
Elementary/ 47 (21) 35 (19.9) 194 (1.11- 1.44 (0.68-

primary 3.38) 3.06)
Secondary and 60 (26.8) 96 (54.5) 4.16 (2.60- 1.90 (0.94-
above 6.67) 3.84)
a Mothers who were divorced, widowed/not live with their partner.
b Includes mothers who were students, homemaker/house wife, farmer, and labor worker.
*P-value ≤.001. **P-value
CHAPTER SIX
DISCUSSION
6.1. Discussion
Maternal healthcare-seeking behavior for neonatal danger signs is essential in managing illness
and preventing mortality in neonates since the majority of the mothers were caregivers of the
neonate and/or newborn.7 Mothers’ recognition of newborn, and/or neonatal danger signs at
home was poor; and/or delayed due to low maternal educational level, knowledge of neonatal
danger signs, different traditional beliefs or cultural beliefs related to ideas of what causes
neonatal illness.5,6,8-14 Therefore, this study assessed the maternal healthcare-seeking
behavior for neonatal danger signs and associated factors among postpartum mothers in South
East Ethiopia. It showed that 44% (95% CI: 39.2- 48.9) of postpartum mothers had appropriate
healthcareseeking behavior.
This finding is consistent with the studies done in parts of Ethiopia 41.3%,14 43.2%,22 Nigeria
(47.7%),17 and India (41.8%).10 However, it is higher than the other studies conducted in
Ethiopia (27%,19 32.0%23), India (23%),30 Nigeria (35.9%),18 and Nepal (11.3%).15 The
possible reason for these differences in appropriate healthcare-seeking behavior might be due to
the higher sample size in this study than the study done in Northern India and Western Nepal.
Despite this; differences in postnatal care follow-up might be the reason; that is in the study
done in Wolkite town majority (80%) of the respondents have no postnatal care follow-up for
their last neonates; which restrains their chance of getting counseling on neonatal danger
signs.21,23
The other possible difference might be the difference in the educational level of the study
participants; which is the majority (86.8%) of study participants have no formal education in the
study done in Anedid district.19 This might be due to that the mothers who had formal education
had more knowledge about neonatal danger signs, and where to seek care and when to seek care
than those who had no formal education.21 Besides, having good knowledge about neonatal
danger signs were related to having appropriate health care seeking behavior.23 Additionally,
some socio-demographic factors like place of residence; in the previous studies except study in
Wolkite town (include only town)23; others include the rural part in which there is a constraint
of health care seeking and the probability of utilizing and believing traditional health is higher
than an urban community.5

The current finding was lower than the study finding done in other parts of Ethiopia (83%,31
72.7%,32 81.2%,33 52.3%,34 97.1%20) and Odisha (79.23%).16 The possible differences might
be due to differences in study setting (communitybased vs health facility based); educational
level; higher educational level/more than half of participants had secondary and above the
educational level in the study done in Debre Markos; which is not in this study. However, in the
study done in the urban slum of Bhubaneswar, Odisha; all participants were literate. Given that, a
higher educational level is related to good knowledge of neonatal danger signs and health care
seeking on time.21. The other possible difference might be the difference in outcome variable
definitions.
Another possible reason might be the difference in post-natal care follow-up (89%) of
participants in the study done in Tiro Afeta while about 45.8% in this study) which in turn helped
the participants to have a chance of counseling about neonatal danger signs and health care
seeking. Similarly, the difference in antenatal care follow-up might be the possible reason.
Supported, the Majority (more than 88%) of the study participants in the study done in Bahir Dar
and Fiche town had antenatal care follow up. This might give them a high possibility of getting
counseling on neonatal danger signs, and having antenatal care follow-up was related to having
good knowledge of neonatal danger signs.23,34.
The other possible reason might be due to the higher sample size noted in the study done in Dire
Dawa and the difference in the outcome variable definition. This study also found that having
postnatal care followup was a strong predictor of having appropriate healthcareseeking behavior.
This might be due to the opportunity of postnatal counseling on newborn illness (neonatal danger
signs) that can improve the mother’s knowledge and attitude on the neonatal danger signs, in
which knowledge of neonatal danger signs is the entry point for healthcareseeking behavior.
Similar to this study finding, a study in Wolkite town and Fiche town found that having postnatal
attendance showed a significant association with having appropriate healthcare-seeking behavior
for neonatal danger signs.23,34.
Besides this, in the current study, having good knowledge of neonatal danger signs was
significantly associated with having appropriate healthcare-seeking behavior. Similarly, studies
in Ethiopia and Nigeria showed that knowledge of neonatal danger signs indicates a strong
association with having appropriate healthcare-seeking behavior.17,22 This might be because
having good knowledge of neonatal danger signs helps mothers to decide where to seek care and

when to seek healthcare.35 This study also revealed that postpartum mothers who have decision-
making power were more likely to have appropriate healthcare-seeking behavior than their
counterparts were. Similarly, a study in Debretabor and Tenta district found that maternal
autonomy to decide on health care seeking was associated with health care seeking
behavior.14,35 This is supported, with that, autonomous mothers were more likely to have good
knowledge of neonatal danger signs, and autonomous mothers, were expected to influence their
husbands to seek care early.35.
This study also showed that having health insurance indicates an association with having
appropriate healthcareseeking behavior. This might give them the chance to get counseling on
neonatal danger signs that help them in health care-seeking neonates.36 Furthermore; this might
be because mothers who have health insurance were more likely to utilize maternal and child
health services.37.
Besides, living in marriage/living with their partner was also significantly associated with having
appropriate healthcare-seeking behavior. The possible reason for this association might be due to
partners actively involved in maternal antenatal care follow-up, facility delivery, and postnatal
follow-up associated with maternal knowledge of neonatal danger signs, in which knowledge of
neonatal danger signs is the critical point for having healthcare-seeking behavior.38
6.2. Strength and limitation of study
6.2.1 Strength of study

This study has the following strength. 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. In addition to this, collecting data within 28 days of
delivery minimize recall bias and helps to identify the true maternal knowledge and all 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.

6.2.2 Limitation of the study
Despite the above strength, the potential limitation of this study is; 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.

CHAPTER SEVEN
CONCLUSION
The overall health care seeking behavior in this study was low. Having postnatal care follow up,
having health insurance, living with partner/in marriage, having decision making power about
where, when, and how to seeking care for their sick neonates, and good knowledge of neonatal
danger signs were factors having a statistically significant association with having good health
care seeking behavior.
Emphasis should be given in creating awareness toward neonatal danger signs, maintaining
postnatal follow-up, and immediate decision making for seeking health-care at health
institutions, encourage partner accompanies and health care providers on counseling more on the
importance of postnatal follow-up and health care seeking at health institutions was
recommended in general. Creating women’s/families’ awareness through religious leader (whom
they trust more), women campaigns, increasing counseling at ANC, family planning, and labor
and post-natal wards for women there for the services at each wards. Similarly counseling or
creating awareness about neonatal danger signs should be considered before, during, and after
pregnancy time. In addition to this, further study (qualitative) that will study maternal perception,
believes toward neonatal danger signs, and attitude recommended.

CHAPTER EIGHT
RECOMMENDATION
1. For Mattu Town governmental and non-Governmental health organizations
These organizations should strengthen and sustain the existing newborn care strategies; promote
education of mothers for further improvement of knowledge of the mother towards neonatal
danger signs through planning the necessary training program for health care providers who
work in NICU and postnatal unit.
2. For health professionals working at NICU, post natal unit and who give antenatal care in
Mattu Karl Specialized Hospital.
The health care providers should work on awareness creation through educational programs at
health facilities focusing on increase mothers' knowledge level on different neonatal danger signs
by strengthening the provision of education during institutional delivery, ANC and PNC visit.
They should encourage mothers to actively consume mother and child health (MCH) services
and do on behavioral change communication at facility level.
3. For health extension workers working in Mattu town

It is also recommended if the health extension workers (HEW) provide health education
regarding neonatal danger signs at community level to increase maternal knowledge on neonatal
danger signs. It is also recommended that they should encourage mothers to use media as source
of information and do on behavioral change communication at community level.
4. For researchers
Further studies that mainly address all areas of associated factors that may significantly affect the
knowledge level of mothers towards neonatal danger signs are needed. Therefore, further
investigations to identify other important factors by using different tools, study design and study
area is needed.

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QUESTIONNAIRE
MATTU UNIVERSITY
COLLAGE OF HEALTH SCIENCE DEPARTMENT OF MIDWIFERY
CONSENT FORM AND QUESTIONNAIRE
My name is Eyasu, I am currently undergraduate a student at Mattu University Department of
midwifery. I would like to interview you few questions related to your new born care and health.
The objective of this study is to health care seeking behavior of mothers (care givers) and
knowledge on neonatal danger sign which is important for reduction of neonatal morbidity and
mortality. I request you to participate honestly. Your participation in filling the prepared
questionnaire and every aspect of the study are voluntary. You may also ask me to clarify
question if you don't understand them or can stop the interview any time. Finally, all the
information that you will provide for the study is kept completely confidential.
Instruction for data collectors; please circle correct information and write others on space
provided
PART I, SOCIO-DEMOGRAPHIC INFORMATION
1.1. Age of mother [yrs.]? -------------------
1.2. Age of child {wks.}? ----------------------
2. What is your religion? A. Muslim B. Orthodox C. Protestant D. Catholic E. other

[specify]……
3. What is your Ethnicity? A. Oromo B. Amhara C. Tigre D. Gurage E. other

{specify} -----
4. What is your level of education?
A. No formal education B. Primary (1-8) C. 9-12 D. Tertiary (>12)
5. What is your husband's’ level of education?
A. No formal education B. Primary (1-8) C. 9-12 D. Tertiary (>12)
6. What is your occupation?

A. Employed B. Student C. Merchant D. Farmer E. Housewife F. Other (specify) -----
7. What is your marital status now?
A. Not married B. Married C. Separated D. Divorced E. Widowed
8. How many money you can earn per month Ethiopian birr? ---------------------
9. Family size: how many children do you have-----------------------------.
PART II NEONATAL HEALTH CARE-SEEKING BEHAVIOR
10. Did you attend ANC during pregnancy? A. Yes B. No
11. Where you deliver your infants? A. home B. Health institution
12. Did you attend postnatal care after delivery? A. Yes B. No
13. Have you seen sick neonate in your own family in the past 1 year? A. Yes B. No
14. If yes Q27, What type of manifestation seen by them?
A. Fever C. Diarrhea/loose stools E. Abdominal distention/stomach pain
B. Continuous crying D. Cough/breathing problem F. Irritability G. Other

(specify)
15. If your newborn has any of manifestations of illness what did you do?
A. Take to Health institution B. Take to Traditional healer C. I will give Home treatment D.
other (specify)--
16. Where do you seek medical care for your neonates?
A. Government health institution B. Pharmacy C. Private Clinic D. Other (specify) ---
17. If you identify /recognize any sickness to your baby how many hours /days you take to show
to the health care provider/Doctor?
A. 1-4hrs B. 5-8 hrs. C. One day D. Two day E. More than two days

18. If you come HC more than one day, Reason for delayed health care?
A. Did not know that it is a danger sign C. Health Center is far E. Wanted to try
home remedies first
B. Lacked money D. Thought the child would get better F. other (specify)
19. How do you explain the ability of primary care providers in the health centers?
A. Excellent B. Very good C. Good D. Fair
PART III, KNOWLEDGE ABOUT NEONATAL DANGER SIGNS
20. Do know any neonatal danger signs and conditions of a newborn that need medical care?
A. Yes B. No
21. If yes question number 10, Can you mention neonatal danger signs? More than one answer is
possible;
A. Diarrhea D. Discharge from umbilicus G. Continue cry
B. Unable to feed breast or poor feeding E. Convulsion H. Fever
C. Lethargy/unconsciousness’, vomiting everything I. Skin rash, other (specify)
22. If yes to [Q10] from whom did you get the information?
A. Health professional C. Neighbors E. Reading books
B. Media D. Friends F. Other (specify) -------
23, Do you know what causes neonatal illnesses [problems]?
A. Poor Hygiene. C. Poor feeding E. I don’t know
B. Exposure to cold/wind's D. Evil spirit (eye) F. other [specify]................
24. What sign of unable to breastfeed you know?

A. Unable to suck B. Breast engorgement C. Unable to swallow D. Crying, other (specify)
25. What sign of lethargic or unconscious newborn you know?
A. No energy. B. Sleep long time C. Weakness D. unable to awake for feeding
26. How did you check of fever?
A. Hot to touch forehead B. Sweating C. Hot to touch body D. Weakness/lethargy E. Other

(specify)
27. If a newborn have diarrhea what you will do?
A. Increase breastfeeding B. Take to health institution C. Give LEMLEM/ORS D. I don’t

know E. Other (specify)
28. How did you identify sign of unable to pass stool?
A. Pain during defecation B. Dry stool C. Hard abdomen D. I don’t know E. Other
(specify)
29. If a newborn have persistent vomiting what you will do?
A. Stop breast feeding B. Take to health institution C. Continue breast feeding D. I don’t
know E. Other
30. If a newborn is sick do you continue breast feeding? A. Yes B. No
31. If no Q20, Reason for not continuing breastfeeding?
A. Cause vomiting B. Cause chocking C. cause diarrhea D. Other (specify)
32. Do you give colostrum for newborn? A. Yes B. No
33. If no Q22, Reason for not giving colostrum?
A. It is harmful for a baby B. Due to ignorance of advantage C. Prohibited by elderly

D. don’t know E. Other

GAAFFII
YUNIVARSIITII MATTU
KOOLLEEJII SAAYINSII FAYYAA KUTAALEE DESSITUU
UNKA FI GAAFFIILEE EEYYAMA
Maqaan koo Eyasuu jedhama, yeroo ammaa Yuunivarsiitii Mattuu Kutaa deessiftuu keessatti
barataa digirii jalqabaati. Gaaffiiwwan muraasa kunuunsaa fi fayyaa daa’imman reefuu dhalatan
keessan waliin walqabatan isin gaafachuu barbaada. Kaayyoon qorannoo kanaa amala kunuunsa
fayyaa barbaaduu haadholii (kunuunsitoota) fi beekumsa mallattoo balaa daa’immanii irratti kan
dhukkubbii fi du’a daa’immanii hir’isuuf barbaachisaadha. Amanamummaan akka hirmaattan
isin gaafadha. Hirmaannaan keessan gaaffilee qophaa’e guutuu fi gama qorannichaa hundaan
tola ooltummaadha. Akkasumas gaaffii qulqulleessuuf na gaafachuu dandeessu yoo isaan hin
galle ykn yeroo barbaaddanitti interview dhaabuu dandeessu. Dhumarratti, odeeffannoon
qorannichaaf kennitu hundi guutummaatti iccitii ta’ee eegama.
Qajeelfama namoota odeeffannoo walitti qaban; mee odeeffannoo sirrii geengoo godhaa bakka
kenname irratti kanneen biroo barreessi
KUTAA I, ODEEFFANNOO HAWAASII-DIMOGRAAFII

1.1. Umrii haadha [waggoota]?
1.2. Umurii daa'imaa [turban]?
2. Amantiin keessan maali? A. Muslima B. Ortodoksii C. Pirootestaantii D. Kaatolikii

E. Kan biroo[ibsi].
3. Sabummaan keessan maali? A. Oromoo B. Amaaraa C. Tigre D. Gurage E. Kan

biroo{specify}
4. Sadarkaan barnootaa keessan maali? A. Barnoota idilee hin qabu B. Sadarkaa tokkoffaa (1-8)
C. 9-12 D. Sadarkaa olaanaa (>12).
5. Sadarkaan barnootaa abbaan warraa keetii maali?

A. Barnoota idilee hin qabu B. Badarkaa tokkoffaa (1-8) C. 9-12 D. Sadarkaa olaanaa (>12).
6. Hojiin kee maali?
A. Qacarame B. Barataa C. Daldalaa D. Qonnaan bulaa E. Haadha manaa F. kan biroo (ibsi)
7. Amma haalli gaa'ela keessanii maali? A. Hin fuudhin B. Heerumte C. Gargar ba'e D.
Hiikkame E. Dubartii abbaan manaa irraa du'e
8. Ji'atti birrii Itoophiyaa meeqa argachuu dandeessa?
9. Baay'ina maatii: ijoollee meeqa qabda
KUTAA II AMALOOTA EEGUMSA FAYYAA DAA’IMMANII

10. Yeroo ulfaa ANC barattee? A. Eeyyee B. Lakki
11. Daa'imman keessan bakka itti deesse? A. Mana B. Dhaabbata fayyaa
12. Erga da’umsa booda kunuunsa dahumsa boodaa irratti argamteettaa? A. Eeyyee B. Lakki
13. Waggaa 1 darbe keessa maatii ofii keessatti daa'ima da'umsaa dhukkubsate argiteettaa?
A. Eeyyee B. Lakki
14. Yoo eeyyee ta’e G27, Mul’annoo gosa akkamii isaan argan? A. Ho’a qaamaa C.
Garaachaa/sagaraa laaftuu E. Garaan bal’achuu/dhukkubbii garaa B. Itti fufiinsaan boo’uu
D. Qufaa/rakkoo hafuura baafachuu F. Aarsuu G. Kan biroo (ibsi) .
15. Daa'imni kee reefuu dhalate mul'annoo dhukkubaa tokko yoo qabaate maal goote?
A. Dhaabbata Fayyaa geessu B. Fayyisaa Aadaa geessu C. Wal'aansa Manaa nan kenna
D. kan biroo (ibsi).
16.Daa’imman reefuu dhalataniif kunuunsa fayyaa eessa barbaadda?
A. Dhaabbata fayyaa mootummaa B. mana qorichaa C. Kilinika dhuunfaa D. Kan biroo (ibsi).
17.Yoo daa’ima keessaniif dhukkuba kamiyyuu adda baaftan /barbaattan sa’aatii /guyyaa meeqa
fudhattanii ogeessa eegumsa fayyaa/Doktora agarsiisuuf? A. Sa’aatii 1-4 B. Sa’aatii 5-8
C. Guyyaa tokko D. Guyyaa lama E. Guyyaa lamaa ol

18.Yoo guyyaa tokkoo ol HC dhufte, Sababni kunuunsa fayyaa harkifate?
A. Mallattoo balaa ta'uu hin beeku C. Buufata Fayyaa fagoo E. Dursee qoricha manaa yaaluun
barbaade
B. Qarshii dhabe D. Mucaan ni fooyya'a jedhee yaade F. Kan biroo (ibsi).
19. Dandeettii kennitoota kunuunsa sadarkaa duraa buufataalee fayyaa keessatti qaban akkamitti
ibsitu?
A. Baay'ee gaarii B. Baayyee gaarii C. Gaarii D. Haqa qabeessa
KUTAA III, BEEKUMSA WAA'EE MALLATTOO BALAA DA'I

20. Mallattoolee fi haala balaa daa’ima reefuu dhalatee kunuunsa fayyaa barbaadu beektaa?
A. Eeyyee B. Lakki
21. Yoo eeyyee ta’e gaaffii lakkoofsa 10, Mallattoolee balaa daa’immanii kaasuun ni
danda’amaa? Deebiin tokkoo ol ni danda’ama;
A. Garaachaa D. Dhangala’aan umbilicus irraa bahu E. Boo’icha itti fufuu
B. Harma nyaachisuu dadhabuu ykn nyaata gaarii hin qabne
C. Waan hunda garaa kaasuu F. Gogaa irratti dhangala’uu, G. Kan biroo (ibsi).
22. Yoo eeyyee ta’e [G10] eenyu irraa odeeffannoo argatte?
A. Ogeessa fayyaa C. Ollaa E. Kitaaba dubbisuu
B. Miidiyaa D. Hiriyyoota F. Kanneen biroo (ibsi).
23. Dhukkuba [rakkina] daa’imman da’umsa booda maaltu akka fidu beektuu?
A. Qulqullina Gadhee. C. Nyaata gadhee E. Hin beeku
B. Qorqorroo/bubbeedhaaf saaxilamuu D. Hafuura hamaa (ija) F. Kan biroo [ibsi].
24. Mallattoo harma hoosisuu dadhabuu akkamii beekta?

A. Xuuxuu dadhabuu B. Harma dhiphachuu C. Liqimsuu dadhabuu D. Boo’uu, kern biroo
(ibsi)
25. Mallattoo daa’ima reefuu dadhabe ykn of wallaalee akkamii beekta?
A. Humna hin qabu. B. Yeroo dheeraa rafuu C. Dadhabina D. Nyaata nyaachuuf dammaquu
dadhabuu
26. Ho'a qaamaa akkamitti sakatta'e?
A. Morma tuquuf ho'aa B. Daftuu C. Qaama tuquuf ho'aa D. Dadhabbii/dadhabbii E. Kan

biroo (ibsi) .
27. Daa'imni reefuu dhalate yoo dhukkuba garaachaa qabaate maal goota? A. Harma hoosisuu
dabaluu B. Dhaabbata fayyaa geessu C. LEMLEM/ORS kennuu D. Hin beeku
E. Kan biroo (ibsi).
28. Mallattoo sagaraa darbuu dadhabuu akkamitti adda baafte? A. Dhukkubbii yeroo manca’aa
B. Sagaraa goguu C. Garaa jabaa D. Hin beeku E. kan biroo (ibsi).
29. Daa'imni reefuu dhalate yoo garaa kaasaa itti fufiinsa qabu qabaate maal goota?
A. Harma hoosisuu dhaabuu B. Dhaabbata fayyaa geessu C. Harma hoosisuu itti fufuu
D. Hin beeku E. Kan biraa
30. Daa'imni reefuu dhalate yoo dhukkubsate harma hoosisuu itti fuftaa? A. Eeyyee B. Lakki
31. Yoo hin jiraanne G20, Sababni harma hoosisuu itti fufuu dhabuu?
A. Sababa garaa kaasaa B. Sababa chocking C. Fiduu garaachaa D. Kan biroo (ibsi).
32. Daa’imman reefuu dhalataniif colostrum’s ni kennituu? A. Eeyyee B. Lakki
33. Yoo hin jiru ta’e G22, Sababni colostrum’s hin kennineef?
A. Daa’imaaf miidhaa qaba B. Faayidaa wallaaluu irraa kan ka’e C. Maanguddoota D. Hin
beeku E. Kan biro
GALATOOMAA!!!


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MATTU UNIVERSITY

COLEGE OF HEALTH SCIENCES

MATERNAL HEAITH CARE SEEKING BEHAVIOR FOR NEONATAL DANGER

RESEARCH THESIS SUBMITTED TO MATTU UNIVERSITY COLLAGE OF

PREPARED BY EYASU LAGIDE

Mattu University, COHS, Department of Midwifery Page I

Institutional-based cross-sectional study design was conducted from September 25th to

Keywords: - Health-care-seeking behavior, Postpartum, Mothers, Neonatal dangers sign,

Mattu University, COHS, Department of Midwifery Page II

AOR Adjusted Odd Ratio

COR Crude Odds Ratio

EMDHS Ethiopian Min Demographic and Health Survey

ENC Essential Newborn Care

EPI Expanded Program of Immunization

EHSTP Ethiopian Health Sector Transformation Plan

IMNCI Integrated Management of Newborn and Childhood Illnesses

IMR Infant Mortality Rate

NDSs Neonatal Danger Signs

NGO Non-Governmental Organization

NMR Neonatal Mortality Rate

PMTCT Prevention of Mother to Child Transmission

PNC Postnatal Care

SDG Sustainable Developmental Goal

SPSS Statistical Packaged for Social Science

SVD Spontaneous Vaginal Delivery

UNICEF United Nations Children’s Fund

WHO World Health Organization

Mattu University, COHS, Department of Midwifery Page III

1.2. Statement of Problem...........................................................................................................2

1.3. Significance of the study......................................................................................................4

2.1. Newborn Danger Signs.........................................................................................................6

2.2. Maternal Health Care seeking for neonatal danger signs.....................................................7

2.3. Mothers Knowledge on Neonatal Danger Signs..................................................................9

2.4.1. Socio-demographic characteristics of the mother........................................................11

2.4.2. Maternal health service exposure and obstetric factors................................................12

2.4.3. Source of Information about Neonatal Danger Signs..................................................12

3.1. General Objective...............................................................................................................15

3.2. Specific Objectives.............................................................................................................15

METHOD AND MATERIALS.....................................................................................................16

4.1. Study Area..........................................................................................................................16

Mattu University, COHS, Department of Midwifery Page IV

4.3. Study design........................................................................................................................16

4.4.1. Source of Population....................................................................................................16

4.4.2. Study Population..........................................................................................................16

4.5. Inclusion and exclusion criteria..........................................................................................16

4.5.1. Inclusion criteria...........................................................................................................16

4.5.2 Exclusion criteria...........................................................................................................17

4.6 Sample size and sampling techniques..................................................................................17

4.6.1 Sample size determination.............................................................................................17

4.6.2 Sampling Techniques....................................................................................................18

4.7. Variables in the study.........................................................................................................18

4.7.1. Dependent variables.....................................................................................................18

4.7.2 Independent variable.....................................................................................................18

4.8. Operational Definition........................................................................................................19

4.9. Data Collection...................................................................................................................19

4.10. Quality control measures..................................................................................................19

4.12. Data Analysis....................................................................................................................20

4.13. Ethical Consideration........................................................................................................20