Men’s and women’s knowledge of danger signs relevant to postnatal and neonatal careseeking: A cross sectional study from Bungoma County, Kenya

Background Neonatal and maternal mortality rates remain high in Kenya. Knowledge of neonatal danger signs may reduce delay in deciding to seek care. Evidence is emerging on the influential role of male partners in improving maternal and newborn health. This study analysed the factors that determine men’s and women’s knowledge and practices in postnatal and neonatal care-seeking, in order to inform design of future interventions. Methods A quantitative, cross-sectional study was undertaken in Bungoma County, Kenya. Women who had recently given birth (n = 348) and men whose wives had recently given birth (n = 82) completed questionnaires on knowledge and care-seeking practices relating to the postnatal period. Univariate and multivariate logistic regression analyses were performed to investigate associations with key maternal and newborn health outcomes. Results 51.2% of women and 50.0% of men knew at least one neonatal danger sign, however women knew more individual danger signs than men. In the univariate model, women’s knowledge of a least one neonatal danger sign was associated with attending antenatal care ≥4 times (OR 4.46, 95%CI 2.73-7.29, p<0.001), facility birth (OR 3.26, 95%CI 1.89- 5.72, p<0.001), and having a male partner accompany them to antenatal care (OR 3.34, 95%CI 1.35-8.27, p = 0.009). Higher monthly household income (≥10,000KSh, approximately US$100) was associated with facility delivery (AOR 11.99, 95%CI 1.59-90.40, p = 0.009). Conclusion Knowledge of neonatal danger signs was low, however there was an association between knowledge of danger signs and increased healthcare service use, including male partner involvement in antenatal care. Future interventions should consider the extra costs of facility delivery and the barriers to men participating in antenatal and postnatal care. This is a descriptive cross-sectional survey of women and men involved in the ‘Collaborative Newborn Support Project’, Kenya [31]. The study was undertaken in Bungoma County, Kenya. Bungoma County is located in Western Kenya, bordering Uganda, and has a population of 1.67 million people [32], mostly subsistence farmers [31], with only 11.3% of the population live in urban areas (2019 census) [33]. The project team believed it important to assess knowledge attitudes and practices of rural populations who were potential users of the hospitals in the broader project. Women and men from the same geographic area were recruited independently, meaning that the responses to each questionnaire are not linked as mother-father dyads. In total, 82 men and 348 women participated in the study, based on the data collection resources available to the project team. Men whose female partners had delivered within the previous one year (between April 2016 and April 2017) were recruited through convenience sampling, from those accompanying their female partners to healthcare clinics, and from men in market centres that fell within the regular catchment area of the facilities involved in the ‘Collaborative Newborn Support Project’, Kenya [31]. Women who had recently delivered were recruited at antenatal and postnatal reproductive care units, and in maternal and child health clinics at two health facilities: Bungoma and Webuye hospitals. These facilities were purposively sampled, based on the fact that they are County and Sub-County referral hospitals respectively, and involved in the broader project intervention. Two questionnaires were administered, one to the women’s sample and the other to the men’s sample. These were adapted and abridged from the JHPIEGO birth preparedness and complication readiness tool sample questionnaires [9]. Both questionnaires covered basic socio-demographic factors and asked similar questions about knowledge, attitudes and practices relating to maternal and newborn health; however, these weren’t identical between the two surveys. Specific questions on danger signs in the postnatal period for woman or newborn classified these as Vaginal bleeding, Neo-natal sepsis, Jaundice, Convulsions, Asphyxia, High fever, Congenital problems, Difficulty breathing, Severe weakness, Changed activity, Bleeding umbilical cord, Poor breastfeeding, and free-text fields for other options. Data were collected by research assistants over a three-month period in 2017. The questionnaires were in English and Kiswahili. Research assistants translated the questions into local dialect whenever necessary. Following collection, the data were transferred to an Access database and archived in Mount Kenya University servers within the Directorate of Research and Innovation. The data were cleaned and analysed using Stata 13 [34] to find summary statistics and to undertake univariate and multivariate logistic regression analyses. Complete case analysis was used in regression analyses. Some variables were grouped to dichotomous responses, based on analysis team consensus, to ensure no group was too small for regression analysis. The common approach of interpreting a p-value of less than 0.05 as indicating statistical significance was taken. Although questions were not completely uniform across the two questionnaires, where possible we used similar variables across both data sets in the analysis to allow the contrast of women’s and men’s knowledge and practices. Outcome variables examined in the logistic regression analysis covered both knowledge and practices. There was insufficient variability in the data to include attitudes in the final analysis. Univariate associations were tested between outcome variables and hypothesised factors of association, as determined by similar studies and the availability of data from the questionnaires. These were then included in a multivariate model to control for the effects of confounding. Potential confounding factors included in the women’s multivariate model were women’s and men’s age and education levels, monthly household income, time to healthcare facility, gravidity, age at first pregnancy and shared decision making for health service seeking between woman and male partner. Potential confounding factors included in the men’s multivariate model were women’s and men’s age and education level, and monthly household income. Outcomes considered to be on the causal pathway between exposure and outcome were included in univariate models, but not in multivariate models. This study was approved by the Mount Kenya University Ethics Review Committee (MKU/ERC/0096). Participants signed informed consent forms after the aims and research process were explained to them, prior to undertaking the questionnaire.