Maternal Health Care Seeking Behavior for Neonatal Danger Signs and Associated Factors Among Post-Partum Mothers in Southeast Ethiopia: A Cross-Sectional Study

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. Therefore, this study aimed to assess maternal health-seeking behavior for neonatal danger signs and associated factors among postpartum mothers in Southeast Ethiopia. A community-based cross-sectional study was conducted on a random sample of 400 women with sick neonates from June 1st, 2020 to 27th, November. A Modified Anderson and Newman behavioral model consisting predisposing, enabling, need, and health system factors were utilized and participants were interviewed by using structured questionnaires. Multivariate logistic regression analysis was used to identify factors associated with maternal health-seeking behavior. Adjusted odds ratios (AOR) were reported with their corresponding 95% confidence interval (CI) to determine the strength of the association. The statistical significance was declared at P <.05. Slightly higher than two-fifths, (44%, 95% CI: 39.2-48.9) of the respondents’ have appropriate healthcare-seeking behavior for neonatal danger signs. Postnatal care follows-up (AOR = 3.5; 95% CI: 2.06-5.80), good knowledge of neonatal danger signs (AOR = 2.78; 95% CI: 1.63-4.73), decision-making power for taking sick neonates to health institution (AOR = 3.02, 95% CI: 1.61-5.67), mothers living with their partner (AOR = 3.00; 95% CI: 1.42-6.31), and health insurance (AOR = 1.82; 95% CI: 1.08-3.06) were significantly associated with having appropriate healthcare-seeking behavior. Healthcare-seeking behavior of the respondents’ was low and indicated by nearly 2 out of 5 respondents’ had appropriate health-seeking behavior for neonatal danger sign. Postnatal care follow-up, health insurance, good knowledge of neonatal danger signs, living with a partner, and decision-making power were predictors of appropriate healthcare-seeking behavior for neonatal danger signs. 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.

This study was conducted in Shashamane town Oromia, a regional state, which is located 251 km to the south of Addis Ababa, the capital of Ethiopia. There are 8 kebeles (the least administrative unit in Ethiopia) and 2 government hospitals (1 general and 1 comprehensive specialized hospital), 1 private hospital, 4 health centers, 71 medium private clinics, and 72 private pharmacies in the town. The total town population was 279 814 by 2020, of which 141 150 and 138 665 were males and females. Approximately, there are 12 216 total pregnant women by 2020 (Unpublished Shashamane Town health office’s data). A community-based cross-sectional study design was employed to assess maternal health-seeking behavior for neonatal danger signs among postpartum mothers in Shashamane town from June 1st, 2020 to November 27th, 2020. The sample size was 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 was the sample size of 410. A simple random sampling technique was used to identify participants. For each 8 kebeles’, the list of postpartum mothers was prepared with their addresses using health extension workers’ data. The calculated sample size was proportionally distributed for each kebeles. Six thousand and one hundred eight (6108), the average number of postpartum mothers lived in the town within the last 6 months. All post-partum mothers at Shashamane town were source population. While postpartum mothers whose neonates had history of illnesses for at least 1 times within 28 days of their life in the study area were included in the study. Postpartum mothers who were not interested/not willing to participate in the study, unable to communicate due to severe illness, and who lost their bay at birth were excluded from the study. Health care seeking behavior (HCSB) is outcome variable for this study. HCSB was measured using structured interviewer administered tools and finally categorized into—“Have appropriate healthcare-seeking behavior” when participants sought care at health institution within the day they recognize signs and symptoms of diseases on their neonates’ otherwise “Inappropriate healthcare-seeking behavior.”16 The independent variables are classified based on the Anderson and Newman Behavioral model classified into predisposing factors that consider the socio-cultural characteristics of individuals that exist before their illness. In addition, it considers social Structures like Education, marital, occupation, ethnicity, social networks, social interactions, and culture. From the health beliefs side, it includes values and knowledge of people toward the health care system. Under socio-demographic features, age and gender were included as predisposing factors; enabling Factors (the logistical aspects of obtaining care) were stated also as it includes some variables like means and knowledge of how to access health services, income, health insurance, regular source of care, travel, extent, and quality of social relationships and available health personnel and facilities, and waiting time. 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) (Figure 1, S.1. Supplemental Material).15,25 -27 Conceptual frame for healthcare-seeking behavior (modified Anderson and Newman model). 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 A pretest was done in Arsi Negelle 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. 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. 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 bivariate binary logistic regression were transferred to multivariate binary logistic regression analysis. Hosmer and Lemeshow’s model fitness test shows the data well fitted the model (P = .64). All statistical tests were two-tailed, and P < .05 used to declare the significance.

• gomora, degefa
• geta, girma
• kene, chala
• seyoum, kenbon
• tekalegn, yohannes
• desta, fikreab
• sahiledengle, biniyam
• atlaw, daniel
• ejigu, neway
• negash, wogene