Mothers treatment seeking intention for neonatal danger signs in northwest Ethiopia: A structural equation modeling

Bogale, Tariku Nigatu; Worku, Abebaw Gebeyehu; Yalew, Alemayehu Worku; Bikis, Gashaw Andargie; Kebede, Zemene Tigabu

doi:10.1371/journal.pone.0209959

Cited by 6 publications

(6 citation statements)

References 30 publications

(31 reference statements)

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“…sunlight), newborn isolation from strangers until the newborn has been religiously blessed and ambiguous newborn personhood [7,14,17]. However, only three known studies assess the determinants of care for sick newborns in Amhara [6,18,19] with no known studies assessing household care seeking for neonatal PSBI in the region. Although findings are specific to the woredas sampled in this study, recommendations may be transferable by local and regional contexts.…”

Section: Introductionmentioning

confidence: 99%

Neonatal care and community-level treatment seeking for possible severe bacterial infection (PSBI) in Amhara, Ethiopia

Asfaha

Comeau

Spangler

et al. 2020

BMC Health Serv Res

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Background: In Ethiopia, neonatal mortality accounts for approximately 54% of under-five deaths with the majority of these deaths driven by infections. Possible Severe Bacterial Infection (PSBI) in neonates is a syndromic diagnosis that non-clinical health care providers use to identify and treat newborns with signs of sepsis. In low-and middleincome countries, referral to a hospital may not be feasible due to transportation, distance or finances. Growing evidence suggests health extension workers (HEWs) can identify and manage PSBI at the community level when referral to a hospital is not possible. However, community-based PSBI care strategies have not been widely scaledup. This study aims to understand general determinants of household-level care as well as household care seeking and decision-making strategies for neonatal PSBI symptoms. Methods: We conducted eleven focus group discussions (FGDs) to explore illness recognition and care seeking intentions from four rural kebeles in Amhara, Ethiopia. FGDs were conducted among mothers, fathers and households with recruitment stratified among households that have had a newborn with at least one symptom of PSBI (Symptomatic Group), and households that have had a newborn regardless of the child's health status (Community Group). Data were thematically analyzed using MAXQDA software. Results: Mothers were described as primary caretakers of the newborn and were often appreciated for making decisions for treatment, even when the father was not present. Type of care accessed was often dependent on conceptualization of the illness as simple or complex. When symptoms were not relieved with clinical care, or treatments at facilities were perceived as ineffective, alternative methods were sought. Most participants identified the health center as a reliable facility. While designed to be the first point of access for primary care, health posts were not mentioned as locations where families seek clinical treatment.

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Section: Introductionmentioning

confidence: 99%

Neonatal care and community-level treatment seeking for possible severe bacterial infection (PSBI) in Amhara, Ethiopia

Asfaha

Comeau

Spangler

et al. 2020

BMC Health Serv Res

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“…Neonatal mortality contributes to nearly half of the under-five mortality in Ethiopia [7]. Neonatal mortality declined from 49 deaths per 1,000 live births in 2000 to 29 deaths per 1,000 births in 2016, a reduction of 41% over the past 16 years [8].…”

Section: Introductionmentioning

confidence: 99%

Knowledge of Neonatal Danger Signs and Its Associated Factors among Mothers Attending Child Vaccination Centers at Sheko District in Southwest Ethiopia

Yosef

Nigussie

Asefa

2020

International Journal of Pediatrics

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Background. Even though a great improvement in the last twenty years, the problem of newborn deaths is still remaining. In 2017 alone, an estimated 2.5 million neonatal deaths occurred worldwide, around 39 percent of all deaths in sub-Saharan Africa. Early detection of neonatal illness is an important step towards improving newborn survival. If mothers know the appropriate manifestations of the causes of death in newborns (neonatal danger signs), it is possible to avert related mortality, because of the health-seeking behavior of mothers highly relies on their knowledge of neonatal danger signs. Objective. To assess knowledge of neonatal danger signs and its associated factors among mothers attending child vaccination centers at Sheko District in Southwest Ethiopia. Methods. A facility-based cross-sectional study was conducted among 351 mothers who attended health centers for child vaccination in Sheko District from March 17 to April 30, 2018. A consecutive sampling method was used to select study participants. Data were collected by using structured questionnaires through face-to-face interviews. Data were entered using EPI-DATA version 3.1 and analysed using SPSS version 21. Results. Of the 351 mothers interviewed, 39% (137) had good knowledge of neonatal danger signs. The study also found that mothers aged 29-40 years (AOR=2.37, 95% CI [1.35-4.17], P=0.003), educational status of primary and above (AOR=2.68, 95% CI [1.48-4.88], P=0.001), attending ≥ 4 antenatal care visits during pregnancy (AOR=3.57, 95% CI [2.10-6.06], P<0.001), and history of postnatal attendance after birth (AOR=2.33, 95% CI [1.16-4.65], P=0.017) were significantly associated with good knowledge of neonatal danger signs. Conclusion. The proportion of mothers with good knowledge of neonatal danger signs was remarkably low. Since the problem is a public health importance in developing countries, particularly in Ethiopia, which determines future generations. Great efforts are needed to create awareness for mothers on the importance of the early identifying neonatal danger signs plus to avert the high magnitude of neonatal mortality.

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“…In our conceptual model, neonatal danger sign knowledge was the most proximal factor to neonatal care-seeking; having only a direct effect on care-seeking (75)(76)(77)(78) and serving as a mediating channel for most factors to affect neonatal careseeking for illness episodes. Our study results showed low knowledge levels among women about danger signs.…”

Section: Discussionmentioning

confidence: 99%

“…This evidence deems the importance of raising maternal awareness about newborn danger signs, most importantly, raising awareness regarding the severity and subsequent qualified care-seeking options. Counseling and health education should be strengthened at the available contact points during the antenatal, delivery, and postnatal periods at the facility and in the community ( 75 , 78 ).…”

Section: Discussionmentioning

confidence: 99%

Mother's care-seeking behavior for neonatal danger signs from qualified providers in rural Bangladesh: A generalized structural equation modeling and mediation analysis

et al. 2023

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BackgroundNeonatal deaths contribute to nearly half (47%) of under-five mortality globally and 67% in Bangladesh. Despite high neonatal mortality, care-seeking from qualified providers for newborn danger signs remains low. Identification of direct and indirect factors and their pathways affecting care-seeking will help to design a well-targeted intervention. This study assessed the direct, indirect, and total effect of the predictive factors on neonatal care-seeking in Bangladesh.Materials and methodsThis was a cross-sectional baseline household survey conducted in 14 districts of Bangladesh in 2019 with 17,251 recently delivered women (RDW) with a live birth outcome in the preceding 15 months. We used a two-stage stratified cluster sampling process to select the samples from 14 districts. We investigated the inter-relationship of maternal background characteristics, maternal health utilizations, child/neonate factors, health service delivery-related factors and newborn danger sign knowledge with newborn care-seeking practices and estimated the direct, indirect, and total effects using Generalized Structural Equation Modeling (GSEM) and mediation analysis. p-value = 0.05 was considered statistically significant. The result of the mediation analysis was reported in Log Odds (LOD). The positive LOD (LOD > 0) implies a positive association.ResultsHalf of the mothers (50.8%) reported a neonatal illness and among them, only 36.5% mothers of sick neonates sought care from qualified providers. Our mediation analysis showed that maternal health utilization factors, i.e., 4 + antenatal care visits (ANC) from a qualified provider (LOD: 0.63, 95% CI: 0.49, 0.78), facility delivery (LOD: 0.74, 95% CI: 0.30, 1.17) and postnatal care (PNC) from a qualified provider (LOD: 0.50, 95% CI: 0.21, 0.78) showed the highest total effect over other factors domains, and therefore, were the most important modifiable predictors for qualified neonatal care-seeking. Other important factors that directly and/or indirectly increased the chance of newborn care-seeking from qualified providers were household wealth (LOD: 0.86, 95% CI: 0.70, 1.02), maternal education (LOD: 0.48, 95% CI: 0.32, 0.63), distance to nearest health facility (LOD: 0.20, 95% CI: 0.10, 0.30), community health worker's (CHWs) home visits during ANC (LOD: 0.24, 95% CI: 0.13, 0.36), neonatal danger sign counseling after delivery (LOD: 0.20, 95% CI: 0.06, 0.34) and women's knowledge of neonatal danger signs (LOD: 0.37, 95% CI: 0.09, 0.64).ConclusionThe inter-relationship and highest summative effect of ANC, facility delivery, and PNC on newborn care-seeking suggested the maternal care continuum altogether from ANC to facility delivery and PNC to improve care-seeking for the sick newborn. Additionally, referral training for unqualified providers, targeted intervention for poorer households, increasing CHWs home visits and neonatal danger sign counseling at the facility and community should also be considered.

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Mothers treatment seeking intention for neonatal danger signs in northwest Ethiopia: A structural equation modeling

Cited by 6 publications

References 30 publications

Neonatal care and community-level treatment seeking for possible severe bacterial infection (PSBI) in Amhara, Ethiopia

Neonatal care and community-level treatment seeking for possible severe bacterial infection (PSBI) in Amhara, Ethiopia

Knowledge of Neonatal Danger Signs and Its Associated Factors among Mothers Attending Child Vaccination Centers at Sheko District in Southwest Ethiopia

Mother's care-seeking behavior for neonatal danger signs from qualified providers in rural Bangladesh: A generalized structural equation modeling and mediation analysis

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