Menu
Menu
Menu
Menu
Introduction: Reducing neonatal mortality is an essential part of the third Sustainable Development Goal, to end preventable child deaths. Neonatal danger signs are the most common cause of neonatal mortality and morbidity. In Ethiopia, most babies are born at home or are discharged from the health institutions in the first 24 h, as a result enhancing women’s knowledge towards neonatal danger signs and its complication might reduce neonatal morbidity and mortality. Therefore, this systematic review and meta-analysis aimed to assess the women knowledge towards neonatal danger signs in Ethiopia. Method: MEDLINE/PubMed, Scopus, Hinari, Google scholar, web of science electronic databases and grey literature from repository were searched for all the available studies. Fourteen cross sectional studies were included in this systematic review and meta-analysis. Subgroup analysis was conducted for the evidence of heterogeneity. Cochrane I2 statistics were used to check the heterogeneity of the studies. Egger test with funnel plot were used to investigate publication bias. Result: Fourteen cross-sectional studies with a total of 6617 study participants were included for this study. The overall pooled prevalence of women’s knowledge towards neonatal danger sign was 40.7% (95%CI, 25.72, 55.67). Having higher educational status of the women (AOR = 3.86, 95%CI: 2.3-6.5), having higher educational status of the husband (AOR = 4.57, 95%CI: 3.29-6.35), access to mass media (AOR = 1.69, 95%CI: 1.17-2.23), having antenatal care visits (AOR = 2.63, 95%CI: 1.13-4.67), having postnatal care follow up (AOR = 2.55, 95%CI; 1.72-3.79) and giving birth at health institutions (AOR = 2.51, 95%CI:1.68-3.74) were factors associated with knowledge of the women towards danger sign of the neonate. Conclusion: In this systematic review and meta-analysis the pooled prevalence of maternal knowledge towards neonatal danger sign was low. Educational status of the mother, educational status of the husband, access to mass media, antenatal care follow-up, postnatal care follow-up and place of delivery were factors associated with knowledge of the mother towards danger sign of the newborn. Promoting antenatal care, postnatal care follow-up and community-based health information dissemination about neonatal danger signs should be strengthened. Systematic review registration: PROSPERO CRD42019132179.
Ethiopia is one of low-income countries located in Eastern Africa with a total fertility rate of 4.6. This systematic review and meta-analysis were conducted to estimate the pooled prevalence of women’s knowledge towards neonatal danger signs and its associated factors in Ethiopia. Studies were searched from online databases including MEDLINE/PubMed, Scopus, Web of Science, Maternity and Infant Care and Wiley Online Library. Additionally, bibliographies of identified articles and grey literature, including Google scholar, MEDNAR, and World Wide Science were searched. Moreover, missing data were handled by contacting corresponding authors. Search terms were formulating using PICO guidelines through the online databases and comprehensive search strategy had been developed using different Boolean operators. The following search terms were used: Knowledge OR Awareness OR Understanding AND “Neonatal danger signs” OR “newborn danger signs” OR “Warning signs of newborn” OR “Neonatal warning signs” OR “Unable to breastfeeding” OR “Convulsion” OR “Lethargy” OR “Difficulty in breathing” OR “Jaundice” OR “Hypothermia” OR “Hyperthermia” OR “Pus discharge” OR “Repeated Vomiting” AND “Mother’s” OR “Women” AND “Associated factors” AND Ethiopia and related terms. Systematic review with narrative synthesis was used to summarize the findings of articles in Ethiopia. Antenatal and postnatal women were included. Observational studies (cross-sectional, case-control, and retrospective and prospective cohort studies and national survey and surveillance reports) were included. only studies conducted in Ethiopia without time limiting and reported the magnitude or at least one least adjusted associated factor of knowledge of neonatal danger signs among mother was included. Both published and unpublished reported articles in English language only were considered. Studies published till September 2/2019 were included. Citations without abstracts and/or full-text, commentaries, anonymous reports, letters, editorials and articles not reporting the outcome of the study were excluded after reviewing the full texts. This systematic review and meta-analysis had two essential outcomes. These were: The level of knowledge of women’s towards neonatal danger signs. Factors affecting knowledge of women’s towards neonatal danger signs which were measured by higher level of maternal educational status (yes/no), higher educational level of the husband (yes/no), access to mass media (yes/no), attending antenatal care visits (yes/no), attending postnatal care follow up (yes/no), place of delivery (health facility/home) were the main contributing factors for neonatal danger signs. First, all studies obtained from all databases were exported to Endnote version X8 software to remove duplicates. Then after, all studies were exported to Microsoft Excel spreadsheet. Two authors (AD and GG) independently extracted all the important data using a standardized data extraction form which was adapted from the JBI data extraction format. Substantial agreement between reviewers i.e. Cohen’s kappa coefficient > 0.60 was accepted and resolved through discussion and consensus. For the first outcome (prevalence) the data extraction format included (primary author, year of publication, regions, study area, sample size, and prevalence with 95%CI). For the second outcome (associated factors) data were extracted with 2 by 2 table format and then the log odds ratio for each factor was calculated. Two authors (AD&GG) independently assessed the quality of each studies using Newcastle-Ottawa-scale (NOS) for cross-sectional studies [13]. All Articles underwent systematic review and meta-analysis was cross-sectional studies. The methodological quality, comparability and the outcome and statistical analysis of the study were the three major assessment tools used to declare the quality of the study. Lastly, studies scored a scale of ≥7 out of 10 was considered as achieving high quality. During quality appraisal of the articles, any discrepancies between the two authors were resolved by taking the second group authors (AW, AG and BA). All of the studies were included based on the Newcastle –Ottawa Scale quality assessment criteria. Random effect model was applied to estimate the pooled prevalence of having good knowledge of neonatal danger signs among postnatal women. After extraction of the articles in Microsoft Excel spreadsheet format, the analysis was carried out using STATA version 11 statistical software. Cochrane Q-test and I2statistics were computed to assess heterogeneity among studies [14]. After computing the statistics, results showed there is significant heterogeneity among studies (I2 = 99.6%, p < 0.001). To estimate the overall prevalence of having good knowledge of the women, via back-transform of the weighted mean of the transformed proportions arcsine variance weights and Dersimonian-Laird weights for fixed-effects model and random effect model respectively [15]. Publication bias was assessed using egger’s test. Subgroup analysis was done based on study setting (facility vs community based), sample size and women’s spontaneous response to minimize the random variations between the point estimates of the primary study. Forest plot format was used to present the pooled point prevalence with 95%Cl. For associations, a log odds ratio was used to decide the association between associated factors and having good knowledge among mothers towards neonatal danger signs in the included studies.
N/A
