Knowledge of neonatal danger signs and associated factors among husbands of mothers who gave birth in the last 6 months in Gurage Zone, Southern Ethiopia, 2020: A community-based cross-sectional study

BMJ Open, Volume 11, No. 8, Year 2021

Interpretation

Objective To assess knowledge of neonatal danger signs and their associations among husbands of mothers who gave birth in the last 6 months in Gurage Zone, Southern Ethiopia, from 1 February to 28 February 2020. Design Community-based cross-sectional study. Setting Gurage Zone, Southern Ethiopia. Participants The study was conducted among 633 participants living in Gurage Zone from 1 February to 28 February 2020. 618 completed the questionnaire. A multistage sampling technique was employed to obtain study participants. Data were collected through face-To-face interviews conducted by 20 experienced and trained data collectors using a pretested structured questionnaire. To assess knowledge, 10 questions were adopted from the WHO questionnaire, which is a standardised and structured questionnaire used internationally. Data were entered into EpiData V.3.1 and exported to SPSS (Statistical Package for Social Sciences) V.24 for analysis. Descriptive statistics were performed and the findings were presented in text, figures and tables. Binary logistic regression was used to assess the association between each independent variable and the outcome variable. All variables with p<0.25 in the bivariate analysis were included in the final model and statistical significance was declared at p<0.05. Voluntary consent was taken from all participants. Results A total of 618 participants were included in the study, with a response rate of 97.6%. Of the participants, 40.7% had good knowledge (95% CI 36.3 to 44.2). Urban residence (adjusted OR=6.135, 95% CI 4.429 to 9.238) and a primary and above educational level (adjusted OR=4.294, 95% CI 1.875 to 9.831) were some independent predictors of husbands' knowledge status. Conclusion Knowledge of neonatal danger signs in this study was low. Urban residence, primary and above educational level, the husband's wife undergoing instrumental delivery and accompanying the wife during antenatal care visits were independent predictors of knowledge. Thus, strong multisectoral collaboration should target reducing the knowledge gap by improving husbands' attitude with regard to accompanying their wives during antenatal care and postnatal care visits, or create a strategy to increase husbands' participation in access to maternal and child health service since husbands are considered decision-makers when it comes to healthcare-seeking in the family. The government should come up with policies that will help promote formal education in the community and increase their media access. A community-based cross-sectional study was conducted in Gurage Zone from 1 February to 28 February 2020. The study was conducted in the selected woreda of Gurage Zone in Southern Ethiopia. According to the data obtained from the zonal administration, Gurage Zone is one of the administrative zones in SNNPR in Ethiopia. It has 16 districts and 5 town administrations. The town of Wolkite is the zone’s capital. According to the 2017 Ethiopian Central Statistical Agency population projection, Gurage Zone has a total population of 1 635 311, of these 842 065 were female and the remaining 793 246 were male.16 There are seven hospitals (five public and two non-government) serving the zone’s total population. Five of the hospitals in the zone are primary hospitals, and the remaining two are general zonal hospitals. All hospitals found in Gurage Zone provide comprehensive emergency obstetric care services for saving the lives of women and their children. Additionally, 72 health centres provide basic emergency obstetric care services. The study population was sourced from husbands in Gurage Zone with children less than 6 months of age. The study population included husbands with children less than 6 months of age in randomly selected kebeles of Gurage Zone. All husbands with children less than 6 months of age and who were residents of Gurage Zone for at least 6 months were included in the study. Husbands who were seriously ill and unable to respond at the time of data collection were excluded. Separate sample size was calculated for each specific objective (to determine the magnitude of husbands’ knowledge of neonatal danger signs and to identify the factors associated with knowledge of neonatal danger signs) by using both single and double population proportion formula. The sample size for the first objective (to determine the magnitude of husbands’ knowledge of neonatal danger signs) was calculated using the single population proportion formula, with the following assumptions: n=minimum sample size required for the study, (Z α/2)2= standard normal distribution with 95% CI, P=50% men’s knowledge of danger signs (due to the absence of previous findings on men in Ethiopia), and d=a tolerable margin of error (d=0.04). The sample size for the second objective was calculated by Epi Info V.7 Stat Cal using different factors. The sample size for the first objective was greater than that of the second objective. The final sample size was derived by adding a non-response rate of 10%. A design effect of 1.5 was used because the sampling procedure was a population-based, one-stage cluster sampling. The calculated sample size for this study was 633. A multistage cluster sampling method was used to draw the final sample size. Gurage Zone has 16 districts and 5 town administrations. From these districts and town administrations, we selected five districts and two town administrations by simple random sampling technique using lottery method. For the districts, Cheha, Muhur Aklil, Mesqan, Mareqo and Abeshge were selected, and for town administrations Emdebir and Butajira Town were selected. Three kebeles from each selected district were chosen randomly. Households with husbands with children less than 6 months of age within the selected kebeles were listed from the family folder of the health extension workers. The total sample size was allocated proportionally to the selected kebeles and towns based on the number of husbands in their respective kebeles and all husbands who participated. No patients were involved. The dependent variable is husbands’ knowledge of neonatal danger signs. To assess husbands’ level of knowledge of neonatal danger signs, a total of 10 yes/no answer questions were asked: is difficulty/fast breathing a danger sign, is lethargy/unconsciousness a danger sign, is convulsion a danger sign, is a baby who did not cry a danger sign, is fever a danger sign, is coldness a danger sign, is pus discharge from the umbilicus a danger sign, is poor feeding or unable to suckle a danger sign, is persistent vomiting a danger sign, and is diarrhoea a danger sign? The total knowledge score ranges between 0 and 10. Those who scored equal or more than the mean were classified as having good knowledge and those who scored below the mean were classified as having poor knowledge. The independent variables were sociodemographic factors (age, age of the child, residence, income, educational status of wife and husband, occupation of husband and wife, marital status, age at marriage, religion, family size), history of infant illness, place of seeking care, decision-maker during care-seeking, number of children (birth order), index baby’s place of birth and mode of delivery, wife’s antenatal care (ANC) visit and frequency, husband accompanied the wife during maternal and child health (MCH) service visit, and source of information about neonatal danger signs. After reviewing relevant literature from previous related studies and other materials, the questionnaire was prepared in English5 11 18–21 and translated to Amharic (the local language spoken in the area) by experts, and then back-translated to English to check for consistency. The questionnaire was administered with the Amharic version to facilitate understanding. The questionnaire used to assess knowledge was adopted from the WHO questionnaire, which is a standardised and structured questionnaire used internationally.15 The Amharic version of the questionnaire has been validated in mothers as a screening tool in Addis Ababa, Ethiopia, with a sensitivity and a specificity of 78.9 and 75.3, respectively. Two days of training were provided to the data collectors and supervisors, and the questionnaire was pretested a week before the actual survey in a comparable setting in the town of Agena on 5% of the calculated sample size, after which the necessary corrections and modifications were made accordingly. Data were collected by 20 experienced and trained data collectors, who are bachelor’s degree holders, through a face-to-face interview using a structured questionnaire during household visits. Two experienced supervisors supervised the data collection process. Before the interview, the data collectors provided information about the aim of the study, the purpose, possible risks and benefits, participants’ rights to refuse participation in the study, and confidentiality issues. Husbands who were willing to participate and signed the voluntary consent were then interviewed. Data collection was done for 28 consecutive days. The data collectors visit up to three times if they did not see the participant at the first home visit, and participants who were not available after three visits were included as non-respondents. Completed questionnaires were checked daily for completeness and internal consistency. The collected data were checked and reviewed for completeness, coded, cleaned, edited and entered into EpiData V.3.1, and exported to SPSS V.24 for analysis. Descriptive statistics were used to determine the frequency of different variables. The data were then presented using simple frequencies, tables and figures. The associations between the dependent and independent variables were examined using bivariable and multivariable logistic regression models. Variables (p<0.25)18 in the bivariate analysis were included in the final model of multivariate analysis controlling for all possible confounders. Multicollinearity was checked to see the linear correlation among the independent variables by using SE. Variables with an SE of >2 were dropped from the multivariable analysis. Model fitness was checked using the Hosmer-Lemeshow test. The direction and strength of statistical association were measured by OR with 95 % CI using multivariable logistic regression analysis. Adjusted OR (AOR) along with 95% CI was estimated to identify the factors associated with knowledge status. In this study a p value <0.05 was considered to indicate statistically significant results.

AI Digest

Study Justification:

The study aimed to assess the knowledge of neonatal danger signs among husbands of mothers who gave birth in the last 6 months in Gurage Zone, Southern Ethiopia. This study is important because husbands play a crucial role in decision-making regarding healthcare-seeking for their families. Understanding their knowledge of neonatal danger signs can help identify gaps and develop targeted interventions to improve maternal and child health outcomes.

Highlights:

– The study included 618 participants, with a response rate of 97.6%.
– 40.7% of the participants had good knowledge of neonatal danger signs.
– Urban residence and a primary and above educational level were identified as independent predictors of husbands’ knowledge status.
– The study highlights the low knowledge of neonatal danger signs among husbands in Gurage Zone.
– The findings emphasize the importance of improving husbands’ attitudes towards accompanying their wives during antenatal and postnatal care visits.
– Multisectoral collaboration is recommended to reduce the knowledge gap and increase husbands’ participation in maternal and child health services.
– The government should consider policies to promote formal education in the community and increase access to media for health education.

Recommendations:

– Develop targeted interventions to improve husbands’ knowledge of neonatal danger signs.
– Implement strategies to encourage husbands to accompany their wives during antenatal and postnatal care visits.
– Strengthen multisectoral collaboration to address the knowledge gap and improve maternal and child health outcomes.
– Formulate policies that promote formal education in the community and increase media access for health education.

Key Role Players:

– Ministry of Health: Responsible for developing and implementing policies related to maternal and child health.
– Local Health Authorities: Involved in coordinating and implementing interventions at the community level.
– Non-Governmental Organizations (NGOs): Can provide support in implementing health education programs and interventions.
– Health Extension Workers: Play a crucial role in delivering health education and promoting behavior change at the community level.
– Community Leaders: Can help in mobilizing communities and promoting the importance of husbands’ involvement in maternal and child health.

Cost Items for Planning Recommendations:

– Training and Capacity Building: Budget for training data collectors, supervisors, and health extension workers on neonatal danger signs and health education.
– Health Education Materials: Allocate funds for developing and distributing educational materials on neonatal danger signs targeted at husbands.
– Community Mobilization: Set aside resources for community engagement activities, such as awareness campaigns and community meetings.
– Monitoring and Evaluation: Include a budget for monitoring and evaluating the implementation and impact of interventions.
– Research and Documentation: Allocate funds for further research and documentation to assess the effectiveness of interventions and identify areas for improvement.
Please note that the cost items provided are general suggestions and may vary based on the specific context and resources available.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a community-based cross-sectional study conducted in Gurage Zone, Southern Ethiopia. The study had a large sample size of 618 participants and employed a multistage sampling technique. Data were collected through face-to-face interviews using a pretested structured questionnaire. Descriptive statistics and binary logistic regression were used for analysis. The study provides specific findings on the knowledge of neonatal danger signs among husbands and identifies factors associated with knowledge. The conclusion suggests actionable steps to improve knowledge, such as promoting husbands’ participation in maternal and child health services and increasing access to formal education. However, the abstract lacks information on the limitations of the study and the generalizability of the findings.

Abstract

A community-based cross-sectional study was conducted in Gurage Zone from 1 February to 28 February 2020. The study was conducted in the selected woreda of Gurage Zone in Southern Ethiopia. According to the data obtained from the zonal administration, Gurage Zone is one of the administrative zones in SNNPR in Ethiopia. It has 16 districts and 5 town administrations. The town of Wolkite is the zone’s capital. According to the 2017 Ethiopian Central Statistical Agency population projection, Gurage Zone has a total population of 1 635 311, of these 842 065 were female and the remaining 793 246 were male.16 There are seven hospitals (five public and two non-government) serving the zone’s total population. Five of the hospitals in the zone are primary hospitals, and the remaining two are general zonal hospitals. All hospitals found in Gurage Zone provide comprehensive emergency obstetric care services for saving the lives of women and their children. Additionally, 72 health centres provide basic emergency obstetric care services. The study population was sourced from husbands in Gurage Zone with children less than 6 months of age. The study population included husbands with children less than 6 months of age in randomly selected kebeles of Gurage Zone. All husbands with children less than 6 months of age and who were residents of Gurage Zone for at least 6 months were included in the study. Husbands who were seriously ill and unable to respond at the time of data collection were excluded. Separate sample size was calculated for each specific objective (to determine the magnitude of husbands’ knowledge of neonatal danger signs and to identify the factors associated with knowledge of neonatal danger signs) by using both single and double population proportion formula. The sample size for the first objective (to determine the magnitude of husbands’ knowledge of neonatal danger signs) was calculated using the single population proportion formula, with the following assumptions: n=minimum sample size required for the study, (Z α/2)2= standard normal distribution with 95% CI, P=50% men’s knowledge of danger signs (due to the absence of previous findings on men in Ethiopia), and d=a tolerable margin of error (d=0.04). The sample size for the second objective was calculated by Epi Info V.7 Stat Cal using different factors. The sample size for the first objective was greater than that of the second objective. The final sample size was derived by adding a non-response rate of 10%. A design effect of 1.5 was used because the sampling procedure was a population-based, one-stage cluster sampling. The calculated sample size for this study was 633. A multistage cluster sampling method was used to draw the final sample size. Gurage Zone has 16 districts and 5 town administrations. From these districts and town administrations, we selected five districts and two town administrations by simple random sampling technique using lottery method. For the districts, Cheha, Muhur Aklil, Mesqan, Mareqo and Abeshge were selected, and for town administrations Emdebir and Butajira Town were selected. Three kebeles from each selected district were chosen randomly. Households with husbands with children less than 6 months of age within the selected kebeles were listed from the family folder of the health extension workers. The total sample size was allocated proportionally to the selected kebeles and towns based on the number of husbands in their respective kebeles and all husbands who participated. No patients were involved. The dependent variable is husbands’ knowledge of neonatal danger signs. To assess husbands’ level of knowledge of neonatal danger signs, a total of 10 yes/no answer questions were asked: is difficulty/fast breathing a danger sign, is lethargy/unconsciousness a danger sign, is convulsion a danger sign, is a baby who did not cry a danger sign, is fever a danger sign, is coldness a danger sign, is pus discharge from the umbilicus a danger sign, is poor feeding or unable to suckle a danger sign, is persistent vomiting a danger sign, and is diarrhoea a danger sign? The total knowledge score ranges between 0 and 10. Those who scored equal or more than the mean were classified as having good knowledge and those who scored below the mean were classified as having poor knowledge. The independent variables were sociodemographic factors (age, age of the child, residence, income, educational status of wife and husband, occupation of husband and wife, marital status, age at marriage, religion, family size), history of infant illness, place of seeking care, decision-maker during care-seeking, number of children (birth order), index baby’s place of birth and mode of delivery, wife’s antenatal care (ANC) visit and frequency, husband accompanied the wife during maternal and child health (MCH) service visit, and source of information about neonatal danger signs. After reviewing relevant literature from previous related studies and other materials, the questionnaire was prepared in English5 11 18–21 and translated to Amharic (the local language spoken in the area) by experts, and then back-translated to English to check for consistency. The questionnaire was administered with the Amharic version to facilitate understanding. The questionnaire used to assess knowledge was adopted from the WHO questionnaire, which is a standardised and structured questionnaire used internationally.15 The Amharic version of the questionnaire has been validated in mothers as a screening tool in Addis Ababa, Ethiopia, with a sensitivity and a specificity of 78.9 and 75.3, respectively. Two days of training were provided to the data collectors and supervisors, and the questionnaire was pretested a week before the actual survey in a comparable setting in the town of Agena on 5% of the calculated sample size, after which the necessary corrections and modifications were made accordingly. Data were collected by 20 experienced and trained data collectors, who are bachelor’s degree holders, through a face-to-face interview using a structured questionnaire during household visits. Two experienced supervisors supervised the data collection process. Before the interview, the data collectors provided information about the aim of the study, the purpose, possible risks and benefits, participants’ rights to refuse participation in the study, and confidentiality issues. Husbands who were willing to participate and signed the voluntary consent were then interviewed. Data collection was done for 28 consecutive days. The data collectors visit up to three times if they did not see the participant at the first home visit, and participants who were not available after three visits were included as non-respondents. Completed questionnaires were checked daily for completeness and internal consistency. The collected data were checked and reviewed for completeness, coded, cleaned, edited and entered into EpiData V.3.1, and exported to SPSS V.24 for analysis. Descriptive statistics were used to determine the frequency of different variables. The data were then presented using simple frequencies, tables and figures. The associations between the dependent and independent variables were examined using bivariable and multivariable logistic regression models. Variables (p2 were dropped from the multivariable analysis. Model fitness was checked using the Hosmer-Lemeshow test. The direction and strength of statistical association were measured by OR with 95 % CI using multivariable logistic regression analysis. Adjusted OR (AOR) along with 95% CI was estimated to identify the factors associated with knowledge status. In this study a p value <0.05 was considered to indicate statistically significant results.

Materials

Innovations

The study titled “Knowledge of neonatal danger signs and associated factors among husbands of mothers who gave birth in the last 6 months in Gurage Zone, Southern Ethiopia, 2020: A community-based cross-sectional study” aimed to assess the knowledge of neonatal danger signs among husbands in Gurage Zone and identify associated factors.

The study was conducted from 1 February to 28 February 2020 and included 618 participants. Data was collected through face-to-face interviews using a pretested structured questionnaire. The questionnaire included 10 yes/no questions adopted from the WHO questionnaire to assess knowledge of neonatal danger signs.

The findings of the study revealed that 40.7% of the participants had good knowledge of neonatal danger signs. Urban residence and a primary and above educational level were identified as independent predictors of husbands’ knowledge status.

The study concluded that knowledge of neonatal danger signs among husbands in Gurage Zone was low. It suggested that strong multisectoral collaboration should target reducing the knowledge gap by improving husbands’ attitude towards accompanying their wives during antenatal care and postnatal care visits. Additionally, strategies to increase husbands’ participation in access to maternal and child health services should be developed, as husbands are considered decision-makers in healthcare-seeking for the family. The study also recommended that the government should implement policies to promote formal education in the community and increase media access.

AI Innovations Description

The study titled “Knowledge of neonatal danger signs and associated factors among husbands of mothers who gave birth in the last 6 months in Gurage Zone, Southern Ethiopia, 2020: A community-based cross-sectional study” aimed to assess the knowledge of neonatal danger signs among husbands and identify associated factors in Gurage Zone, Southern Ethiopia.

The study was conducted from 1 February to 28 February 2020 and included 618 participants. Data was collected through face-to-face interviews using a pretested structured questionnaire. The questionnaire consisted of 10 yes/no questions adopted from the WHO questionnaire. The knowledge score ranged from 0 to 10, with a score equal to or above the mean indicating good knowledge.

The results showed that 40.7% of the participants had good knowledge of neonatal danger signs. Urban residence and a primary and above educational level were identified as independent predictors of husbands’ knowledge status. The study also found that husbands’ knowledge was associated with factors such as the wife undergoing instrumental delivery, accompanying the wife during antenatal care visits, and being the decision-maker for healthcare-seeking in the family.

Based on these findings, the study recommends strong multisectoral collaboration to reduce the knowledge gap by improving husbands’ attitude towards accompanying their wives during antenatal care and postnatal care visits. It also suggests creating strategies to increase husbands’ participation in accessing maternal and child health services, as they are considered decision-makers in healthcare-seeking. Additionally, the government is advised to implement policies that promote formal education in the community and increase media access to improve knowledge on neonatal danger signs.

Overall, the study highlights the importance of involving husbands in maternal health and emphasizes the need for targeted interventions to improve access to maternal health services and enhance knowledge of neonatal danger signs among husbands in Gurage Zone, Southern Ethiopia.

AI Innovations Methodology

Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Increase awareness and knowledge: Develop and implement educational programs targeting husbands and other family members to increase their knowledge of neonatal danger signs and the importance of maternal health. This can be done through community workshops, health campaigns, and the use of media platforms.

2. Promote male involvement: Encourage husbands to actively participate in antenatal care and postnatal care visits. This can be achieved by creating a supportive environment that welcomes and encourages male involvement, providing education on the benefits of male participation, and addressing any cultural or social barriers that may prevent husbands from accompanying their wives to healthcare visits.

3. Strengthen healthcare services: Improve the availability and quality of maternal and child health services in the community. This can include increasing the number of healthcare facilities, ensuring access to skilled healthcare providers, and providing comprehensive emergency obstetric care services.

4. Enhance communication and information dissemination: Develop effective communication strategies to reach husbands and other family members with important maternal health information. This can involve using various channels such as radio, television, social media, and community health workers to disseminate information on neonatal danger signs, healthcare services, and the importance of timely care-seeking.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Baseline data collection: Collect data on the current knowledge and behavior of husbands regarding neonatal danger signs and their involvement in maternal health. This can be done through surveys, interviews, or focus group discussions.

2. Intervention implementation: Implement the recommended interventions, such as educational programs, male involvement initiatives, and improvements in healthcare services. Ensure that these interventions are properly designed and implemented in collaboration with relevant stakeholders.

3. Post-intervention data collection: After a certain period of time, collect data again to assess the impact of the interventions. Measure changes in knowledge, behavior, and access to maternal health services among husbands and other family members.

4. Data analysis: Analyze the collected data to determine the effectiveness of the interventions. Compare the pre- and post-intervention data to identify any significant changes and trends. Use statistical methods, such as logistic regression, to assess the association between the interventions and the outcomes.

5. Evaluation and recommendations: Evaluate the overall impact of the interventions and identify areas for improvement. Based on the findings, make recommendations for further interventions or modifications to existing strategies to continue improving access to maternal health.

It is important to note that this is a general methodology and may need to be adapted based on the specific context and resources available for the study.

Author

Dima Health

Statistics:

Citations: 2

Identifiers:

DOI: 10.1136/bmjopen-2020-045930

Research Areas:

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

Study Countries:

Ethiopia

Study Design:

Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative

Participants Gender:

Male & Female