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Introduction: Globally, nearly three million children die in the neonatal period. Although there is scant information about rural mothers, the enhancement of mothers’ knowledge and skills toward essential newborn care (ENC) is a vital aspect in the reduction of newborn illness and mortality. Thus, this study aimed to assess the magnitude and determinants of mothers’ knowledge of ENC. Methods: A community-based cross-sectional study was conducted among recently delivered women using a multistage sampling method in Chole woreda. Data were collected via face-to-face interviews. A multivariate logistic regression model was used to identify the determinant factors with the level of knowledge. Odds ratios with a 95% confidence interval was used to describe association and significance was determined at a P-value < 0.05. Results: Data from 510 mothers were employed for analysis. Overall, 33.5% (95% CI: 29.4, 37.6) of the mothers had good knowledge of ENC. Antenatal care (ANC) visits [AOR: 2.42; 95% CI: (1.50, 3.88)], counseled about ENC during ANC [AOR: 5.71; 95% CI: (2.44, 13.39)], delivery at health institutions [AOR: 2.41; 95% CI: (1.30, 4.46)], religion [AOR 1.99, 95% CI: (1.25, 3.16)], and educational level [AOR = 1.64 95% CI: (1.10, 2.51)] were significantly associated with knowledge of ENC. About 74, 75, and 41% of mothers practiced appropriate cord care, breastfeeding, and thermal care, respectively. Conclusion: Three out of 10 mothers had a good level of knowledge of ENC. Knowledge gaps identified pertained to cord care, breastfeeding, and thermal care. There is opportunity to enhance maternal knowledge of ENC through improving access to ANC and institutional delivery.
This survey was studied at Chole woreda from March 1 to 30 in 2019. The administrative center for Chole woreda is Chole town. There are 4 health centers, 18 health posts, 10 private clinics, and eight pharmacy shops in the woreda. Each health center serves a population of 15,000–25,000 and health posts are attached to each health center (each health post serves 3,000–5,000 people in the woreda). Maternal and child health care services, including antenatal care (ANC), postnatal care (PNC), family planning, and immunization services, were available in the facilities free-of-fee-services. A total of 20 kebeles represented the woreda. The annual report in 2017 of the Chole health office indicated that the health coverage of the woreda attained 57.3% (14). This is a cross-sectional study conducted at the community level among postnatal mothers who delivered within 6 months before the study period. Postnatal mothers who delivered in the past 6 months at Chole woreda but were incapable to communicate because of serious illness or impaired cognition at the time of the data collection were not included in the study. The sample size was computed using a single population proportion formula by assuming a confidence level of 95% = 1.96, a margin of error (d) = 5%, design effect = 1.5, and prevalence of postnatal mothers' knowledge of ENC (P = 31%) in accordance to a study conducted in southern Ethiopia in 2017 (15). It also included a 5% non-response rate. Finally, 520 postnatal mothers were included. A multi-stage cluster sampling method was used to select postnatal mothers. Chole woreda has 20 kebeles (the smallest administrative unit; 16 rural and four urban), five and two kebeles from the rural and urban areas, respectively, were included through a simple random sampling technique. The final sample size was allocated to each kebele proportional to the number of their population. Finally, study participants were randomly recruited from the sampling frame found from records of health extension workers of the kebele. All eligible study participants were interviewed until the desired sample size was achieved. The data were collected using an interviewer-administered structured questionnaire adapted from previous studies (10, 16–18). The questionnaire included socio-demographic, obstetrics, and reproductive characteristics, knowledge about essential newborn care, and exposure to counseling during the postnatal period. Seven trained health professionals collected the data under the supervision of three health professionals. A face-to-face interview was conducted among volunteer mothers through structured and pretested questionnaires. Some of the questions on several features of newborn care included practice regarding immunization, thermal care, breastfeeding, cleanliness, and umbilical cord care. Knowledge level was assessed based on questions on various aspects of essential newborn care (e.g., knowledge about immunization, thermal care, breastfeeding, and umbilical cord care were assessed). The values were coded as 1 = Correct response and 0 = Incorrect response. Finally, based on the median score, a composite variable from these questions was generated to categorize mothers as having “Good/poor knowledge.” Those postnatal mothers who were able to answer the knowledge questions above or equal to the median (17). Those postnatal mothers who were able to answer the knowledge questions below the median (17). Essential newborn care refers to the postnatal mothers' care for newborns, which includes early breastfeeding, cord care, eye care, immunization, neonatal danger signs, and thermal care (19). Safe cord care refers to the maintenance of the umbilical cord. Particularly, ensuring that the cord clean and dry without application of any substance on the cord stump except for medically indicated medications, such as chlorhexidine (10). Optimum thermal care includes wrapping the newborn in a clean and dry cloth and the delay in bathing for 24 h to avoid hypothermia (10). Early breastfeeding is the act of immediately starting breastfeeding within the first hour of birth without pre-lacteals and feeding the child with colostrum (10). A pretest among 10% of the computed sample size was carried out to test the quality of the questionnaires. Each question under the questionnaire was checked for completeness and consistency. The questionnaire was translated into Amharic and Afan Oromo languages (language spoken by the local community). The data collectors and supervisors were trained. The collected data was double data entered into Epi Data version 3.1 software. Descriptive analysis by statistical package for social sciences (SPSS) version 20 stat calc was presented with a proportion of 95% CI. Continued variables were described using a median and interquartile range. The results were shown using frequencies, percentages, tables, and figures. A chi-square assumption was checked before fitting the model. The Hosmer-Lemeshow statistic and Omnibus tests were checked to assure the model's goodness of fit. A binary logistic regression model was utilized to detect the association between determinants and the outcome variable. All variables with P ≤ 0.25 in the bivariate analysis were exported to multivariate analysis to control all possible confounders. The degree of a statistical association between determinants and outcome variables was assessed by using an odds ratio at a 95% level of confidence. Statistical significance was stated at a P-value < 0.05. The Ethical clearance was granted by the College of Health and Medical Sciences, Institutional Health Research Ethics Review Committee (HU-IHRERC) of Haramaya University. Additionally, an official letter that allows us to conduct this study was obtained from the woreda health bureau and governmental officials. After explaining the purpose of the study and their right, informed and voluntary signed consent was obtained from each study participant.
