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

Inquiry (United States), Volume 59, Year 2022

Interpretation

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.

AI Digest

Study Justification:

– Early health care seeking for neonatal danger signs can save lives and reduce neonatal mortality.
– Understanding the factors associated with maternal health-seeking behavior is crucial for improving neonatal health outcomes.
– This study aims to assess maternal health-seeking behavior for neonatal danger signs and identify associated factors among postpartum mothers in Southeast Ethiopia.

Highlights:

– 44% of the respondents demonstrated appropriate healthcare-seeking behavior for neonatal danger signs.
– Factors associated with appropriate healthcare-seeking behavior included postnatal care follow-up, good knowledge of neonatal danger signs, decision-making power, living with a partner, and having health insurance.
– Emphasis should be placed on creating awareness of neonatal danger signs, maintaining postnatal follow-up, and encouraging immediate healthcare-seeking at healthcare institutions.

Recommendations:

– Increase awareness among mothers/caregivers about neonatal danger signs and the importance of seeking healthcare promptly.
– Strengthen postnatal care follow-up services to ensure continuous monitoring of neonates’ health.
– Promote health insurance coverage to improve access to healthcare services.
– Support decision-making power for mothers in seeking healthcare for their sick neonates.
– Collaborate with relevant stakeholders to implement strategies that address the identified factors associated with appropriate healthcare-seeking behavior.

Key Role Players:

– Ministry of Health: Responsible for policy development and implementation of maternal and neonatal health programs.
– Health Extension Workers: Provide community-based health education and support to mothers and families.
– Health Facility Staff: Including doctors, nurses, and midwives who provide healthcare services to mothers and neonates.
– Community Leaders: Engage in community mobilization and advocacy efforts to promote maternal and neonatal health.

Cost Items for Planning Recommendations:

– Awareness Campaigns: Budget for developing and disseminating educational materials, organizing community events, and conducting health education sessions.
– Postnatal Care Services: Allocate resources for staffing, training, and equipping health facilities to provide comprehensive postnatal care.
– Health Insurance: Consider the cost of expanding health insurance coverage and subsidizing premiums for vulnerable populations.
– Capacity Building: Invest in training programs for healthcare providers to enhance their knowledge and skills in neonatal care.
– Monitoring and Evaluation: Allocate funds for data collection, analysis, and reporting to assess the impact of interventions and track progress towards improving healthcare-seeking behavior.
Note: The actual costs will vary based on the specific context and resources available in Southeast Ethiopia.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is a community-based cross-sectional study, which provides valuable insights into maternal health-seeking behavior for neonatal danger signs. The sample size of 400 women is adequate for this type of study. The study utilizes a modified Anderson and Newman behavioral model to assess factors associated with health-seeking behavior. Multivariate logistic regression analysis is used to identify significant factors. However, the abstract does not provide information on the response rate or the representativeness of the sample. To improve the strength of the evidence, future studies could consider increasing the sample size and ensuring a higher response rate. Additionally, providing information on the representativeness of the sample would enhance the generalizability of the findings.

Abstract

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.

Materials

https://efashare.b-cdn.net/materials/a50ddb53b24b6956b69723cdb65079aae20129e49b48cab7dc8b6c81d9291a56/sj-docx-1-inq-10.1177_00469580221143629.docx

Innovations

Based on the findings of the study titled “Maternal Health Care Seeking Behavior for Neonatal Danger Signs and Associated Factors Among Post-Partum Mothers in Southeast Ethiopia: A Cross-Sectional Study,” the following recommendations can be developed into innovations to improve access to maternal health:

1. Emphasize postnatal care follow-up: Innovative interventions should focus on promoting and facilitating postnatal care visits for mothers, ensuring they receive necessary information and support during this critical period.

2. Increase awareness of neonatal danger signs: Innovations should aim to raise awareness among mothers and caregivers about the signs and symptoms that indicate potential health issues in newborns. This can be done through community-based education programs, mobile health applications, and targeted messaging campaigns.

3. Empower mothers in decision-making: Innovations should focus on empowering mothers to make informed decisions regarding their newborn’s health, including seeking timely medical care. This can be achieved through educational programs that promote shared decision-making between mothers and healthcare providers.

4. Strengthen health insurance coverage: Innovations should aim to improve access to health insurance for mothers, ensuring that financial barriers do not hinder their ability to seek timely and appropriate healthcare for their newborns.

5. Collaborate with partners and families: Innovations should involve partners and families in maternal health initiatives, promoting their active involvement and support in seeking healthcare for both the mother and newborn.

By implementing these recommendations as innovative interventions, access to maternal health can be improved, leading to better outcomes for both mothers and newborns.

AI Innovations Description

The study titled “Maternal Health Care Seeking Behavior for Neonatal Danger Signs and Associated Factors Among Post-Partum Mothers in Southeast Ethiopia: A Cross-Sectional Study” provides valuable insights into improving access to maternal health. Based on the findings of the study, the following recommendations can be developed into innovations to improve access to maternal health:

1. Emphasize postnatal care follow-up: The study found that postnatal care follow-up was significantly associated with appropriate healthcare-seeking behavior for neonatal danger signs. Therefore, innovative interventions should focus on promoting and facilitating postnatal care visits for mothers, ensuring they receive necessary information and support during this critical period.

2. Increase awareness of neonatal danger signs: Good knowledge of neonatal danger signs was found to be positively associated with appropriate healthcare-seeking behavior. Innovations should aim to raise awareness among mothers and caregivers about the signs and symptoms that indicate potential health issues in newborns. This can be done through community-based education programs, mobile health applications, and targeted messaging campaigns.

3. Empower mothers in decision-making: The study revealed that decision-making power for seeking healthcare was a significant factor in appropriate healthcare-seeking behavior. Innovations should focus on empowering mothers to make informed decisions regarding their newborn’s health, including seeking timely medical care. This can be achieved through educational programs that promote shared decision-making between mothers and healthcare providers.

4. Strengthen health insurance coverage: The study found that having health insurance was significantly associated with appropriate healthcare-seeking behavior. Innovations should aim to improve access to health insurance for mothers, ensuring that financial barriers do not hinder their ability to seek timely and appropriate healthcare for their newborns.

5. Collaborate with partners and families: The study found that mothers living with their partners were more likely to exhibit appropriate healthcare-seeking behavior. Innovations should involve partners and families in maternal health initiatives, promoting their active involvement and support in seeking healthcare for both the mother and newborn.

By implementing these recommendations as innovative interventions, access to maternal health can be improved, leading to better outcomes for both mothers and newborns.

AI Innovations Methodology

To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be used:

1. Emphasize postnatal care follow-up: Implement a program that promotes and facilitates postnatal care visits for mothers. This can include providing incentives for attending postnatal care appointments, such as free transportation or baby care items. Monitor the number of postnatal care visits before and after implementing the program to measure the impact on access to maternal health.

2. Increase awareness of neonatal danger signs: Develop community-based education programs that focus on raising awareness among mothers and caregivers about neonatal danger signs. This can include conducting workshops, distributing educational materials, and organizing awareness campaigns. Measure the increase in knowledge of neonatal danger signs among mothers and caregivers to assess the impact of the program.

3. Empower mothers in decision-making: Implement educational programs that promote shared decision-making between mothers and healthcare providers. This can include training healthcare providers on effective communication and involving mothers in the decision-making process. Monitor changes in decision-making power among mothers and assess the impact on healthcare-seeking behavior.

4. Strengthen health insurance coverage: Work with relevant stakeholders to improve access to health insurance for mothers. This can involve advocating for policy changes, expanding insurance coverage, and providing information and assistance to mothers in obtaining health insurance. Track the number of mothers with health insurance before and after the intervention to measure the impact on healthcare-seeking behavior.

5. Collaborate with partners and families: Develop initiatives that involve partners and families in maternal health initiatives. This can include organizing support groups, providing education and resources to partners and families, and encouraging their active involvement in maternal healthcare decisions. Monitor the level of partner and family involvement before and after the intervention to assess the impact on healthcare-seeking behavior.

To evaluate the impact of these interventions, data can be collected through surveys and interviews with postpartum mothers in the study area. The data should include information on healthcare-seeking behavior, knowledge of neonatal danger signs, decision-making power, health insurance coverage, and partner and family involvement. The data can be analyzed using statistical methods, such as logistic regression, to determine the association between the interventions and improved access to maternal health. The findings can then be used to assess the effectiveness of the recommendations and make further improvements to the interventions if necessary.

Author

Dima Health

Identifiers:

DOI: 10.1177/00469580221143629

ISSN: 00469580

Research Areas:

Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants, Workforce

Study Countries:

Ethiopia

Study Design:

Cohort Study, Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative

Participants Gender:

Female