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Health Care Seeking Behavior Towards Neonatal Danger Signs and Associated
Factors Among Mothers in Kamba Zuria District, South Ethiopia

Article in American Journal of Biomedical Science & Research · October 2023

DOI: 10.34297/AJBSR.2023.20.002694

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Research Article Copyright © Elias Ezo

Health Care Seeking Behavior Towards Neonatal Danger

Signs and Associated Factors Among Mothers in Kamba
Zuria District, South Ethiopia
Elias Ezo1*, Genet Degu2, Tinsae Kassa2 and Wubishet Gezimu3
1
Department of Nursing, Wachemo University, Ethiopia
2
Department of midwifery, Debre Markos University, Ethiopia
3
Department of Nursing, Mettu University, Ethiopia

*Corresponding author: Elias Ezo, Department of Comprehensive Nursing, College of Medicine and Health Science, Wachemo University, Hosanna,
Ethiopia.

To Cite This Article: Elias Ezo*, Genet Degu, Tinsae Kassa and Wubishet Gezimu. Health Care Seeking Behavior Towards Neonatal Danger
Signs and Associated Factors Among Mothers in Kamba Zuria District, South Ethiopia. Am J Biomed Sci & Res. 2023 20(2) AJBSR.MS.ID.002694,

DOI: 10.34297/AJBSR.2023.20.002694

Received: October 04, 2023; Published: October 11, 2023

Abstract
Introduction: Health care seeking behavior is any measure action taken when an individual perceives ill. Delayed health care
seeking behaviors for ill neonates contribute to high neonatal and infant mortality rates. Early identification of neonatal danger
signs and encouraging giving birth in health facility improve health care seeking behavior of mother for neonatal danger signs.
Objective: To assess health care seeking behavior towards neonatal danger signs and associated factors among mothers in Kamba
Zuria District, South Ethiopia, 2020.
Method: A community based cross sectional study design was conducted from February 1 to 30/2020. A total of 588 mothers were
selected by using simple random sampling. Epi Data version 3.1 for data entry and SPSS version 24 for data analysis was used.
Logistic regression analysis was done. Significant independent variables were interpreted at a p-value of less than 0.05 with 95% CI.
Result: Appropriate health care seeking behavior was 52.2% with [95%CI: 47.0-57.1%]. Mothers who had a number of children
from 1-3 were 1.87 times more likely to seek appropriate health care [AOR: 1.87, 95%CI: 1.16, 3.01]. Mothers who had higher
decision-making ability were 1.53 times more likely to seek appropriate health care [AOR: 1.53, 95%CI: 1.01, 2.32].
Conclusion: The appropriate health care seeking behavior of the mothers for neonatal danger signs was low. The number of children
in the family and decision-making ability of mothers were independent variables that showed significant association. Therefore,
health education should be provided concerning early seeking health care from health facility.
Keywords: Health care seeking behavior, Mothers, Neonatal danger sign, Kamba Zuria district
Abbreviations: ANC: Antenatal Care; AOR: Adjusted Odds Ratio; bpm: Breath Per Minute; CI: Confidence Interval; COR: Crud Odds
Ratio; EDHS: Ethiopian Demographic and Health Survey; HEWs: Health Extension Workers; MOH: Ministry of Health; PNC: Post
Natal Care; SD: Standard Deviation; SPSS: Stastical Package for Social Science; SVD: Spontaneous Vaginal Delivery; UNICEF: United
Nations International Children’s Emergency Fund; WHO: World Health Organization

This work is licensed under Creative Commons Attribution 4.0 License AJBSR.MS.ID.002694
217
Am J Biomed Sci & Res Copyright© Elias Ezo

Introduction
Sample Size Determination
Health care seeking behavior is a functional motivation and
ability of individuals to seek treatment from available health care The sample size was determined using a single population pro-
facilities and other sources [1,2]. Health care seeking behavior for portion formula. The assumptions used to calculate the sample size
neonatal danger signs is not only treatment of the disease, but per- was population proportion 0.413 that was taken from study done in
ceived seriousness, duration, cultural practices and socio- econom- Tenta district of Amhara Region [16] with 95% confidence level and
ic status of mothers [3]. Neonatal period is the most critical period margin of error 5% as follows.
for the newborn to survive its life [4]. Neonatal danger signs are
áz 2 p (1-p ) ( 0.413)( 0.587 )
(1.96 )
2
those danger signs that occur in the first four weeks of life since =n ( ) = = 372.5 ≈ 373
( )
2
birth [5,6]. About 2.6 million newborns die within the first four 2 d2 0.05
weeks of life [7]. Delayed health care seeking behavior for ill neo-
nates contributes to high neonatal and infant mortality rates [8,9]. With non-response rate of 5%and design effect of 1.5, the total
However, appropriate health care seeking behavior of mothers for sample size was 588.
neonatal danger signs is backbone in decreasing neonatal mortality Sampling Procedure
[10]. In Ethiopia, traditional beliefs have greater influence over the
prevailing attitudes and practices of governmental policies. Nearly Seven rural kebeles and one semi-urban were included in the
half of all deaths in under-five childhood occur in the neonatal pe- study by stratified sampling. Each Kebele was selected by simple
riod, within the first four weeks of life [11]. According to the 2019 random sampling technique. Mothers were identified by propor-
Mini EDHS, neonatal mortality rate is 30 deaths per 1,000 live births tional allocation considering list of mothers in health post as a
[12]. However, it was 29 deaths per 1,000 live births in 2016 EDHS sampling frame. Finally, the data collectors visited the home of each
report which needs improvement in health care seeking behavior mother to interview with the guidance of HEWs.
[13]. Ethiopia has already made great initiatives to empower com-
Terms and Operational Definitions
munities to improve maternal and child health through the Health
Extension Workers (HEW) and Health Development Army (HAD) Neonatal Danger Signs
platforms. The Ministry of Health (MOH) of Ethiopia prepared an
Danger signs that occur in the first four weeks of life since birth
illustrated booklet called Family Health Card (FHC) through its
[6]. Included: unable to feed since birth or stopped later, convulsion,
flagship health extension program. The FHC includes recommend-
fast breathing or respiratory rate greater than or equal to 60 bpm,
ed action points and important health messages on maternal, new-
severe chest in-drowning or difficulty breathing, body temperature
born and child health. In it, there are messages on neonatal danger
greater than or equal to 37.5C0 or fever, body temperature less than
signs to help families to recognize neonatal danger signs and seek
or equal to 35.5C0 or hypothermia, absence of movement even with
prompt treatment [14]. Therefore, this study assessed health care
stimulation or weakness and lethargy, yellow skin or jaundice and
seeking behavior of mothers towards their neonates.
sign of local infections such as reddened eye or pus draining from
Methods and Materials umbilicus [7].

Study Area and Period Health Care Seeking Behavior

The study was done in Kamba Zuria district of Gamo Zone, Seeking health care for neonatal danger sign that faced neo-
South Nation Nationalities and Peoples’ Regional State. Kamba Zu- nates. It was measured by calculating all individual responses of
ria district is located 559 Km away from Addis Ababa, 390 Km from question, from where you sought care for danger sign faced and
Hawassa, the capital city of South Nation Nationalities and Peoples then categorized as appropriate (if mothers visited health facility
Regional State and 105 Km away from Arba Minch, the capital city within 24 hours since onset of the sign) or inappropriate (if moth-
of Gamo Zone. It has a primary Hospital, five health centers, one ers visited health facility after 24hours or visited out of health facil-
clinic, six private clinics and four drug stores. The total population ity for neonatal danger sign) [17].
of the district is 137,500 from which 3.46% (4,758) are reproduc- Decision Making Ability
tive age group mothers [15]. The study was conducted from Febru-
Is the way a mother reaches a decision by herself or somebody
ary 1 to 30/2020.
else to seek health care for her sick neonate. It was measured by
Study Design and Population calculating individual answers to decision-making questions and
A community based cross sectional study design was carried then categorized as higher (if mother made decision by herself) or
out. All mothers who had infants less than six months of age in the lower (if the decision was made by husband or others) [16].
district were included. Severely ill mothers who could not respond Data Collection Procedure and Quality Assurance
during the data collection period were excluded.
Tool contained semi-structured questionnaires and data was

American Journal of Biomedical Science & Research 218

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Am J Biomed Sci & Res Copyright© Elias Ezo

collected through face-to-face interview of mothers. Five data col- ed to SPSS version 24 statistical package for analysis. Data clean-
lectors (graduated diploma nurses) and four supervisors (experi- ing was performed to check for missed values and then descrip-
enced public health officers) were recruited. Pre-test was made on tive analysis such as proportions, percentages, median, tables and
5% of the total sample size in non-selected Kebele before actual graphs were used. Multi-collinearity was checked, and logistic re-
data collection. Training was given to data collectors. The question- gression analysis was done using Hosmer-Lemeshow model good-
naire was translated from English to Amharic and then to Gamogna ness fit test. Variables significant in bivariate analysis were entered
(local language) before and back to English after data collection by in multivariate analysis to identify the independent association of
language expert to assure consistency. variables with health care seeking behavior of mothers towards
neonatal danger signs. Finally, significant independent association
Data Management and Data Analysis
was interpreted at P-value of less than 0.05 with 95%confidence
Data were entered into Epi Data version 3.1 and then export- interval (Tables 1-6).

Table 1: Socio-demographic characteristics of health care seeking behavior of mothers towards neonatal danger signs, Kamba Zuria
District, South Ethiopia, 2020.

Variables (n=570) Categories Frequencies Percentages

< 24 27 4.7
25-30 186 32.6
Age in years
31-35 256 44.9
>36 101 17.7
Rural 487 85.4
Residence
Semi-urban 83 14.6
Orthodox 173 30.4
Muslim 9 1.6
Religion Protestant 316 55.4
Traditional 22 3.9
Catholic 50 8.8
Married 548 96.1
Single 7 1.2
Marital status
Widowed 9 1.6
Divorced 5 1.1
Cannot read and write 183 32.1
Primary school 186 32.6
Educational status of mothers
Secondary school 177 31.1
Above secondary 24 4.2
Cannot read and write 118 21.5

Educational status of husbands Primary school 110 20.1

(n=548) Secondary school 290 52.9
Above secondary 30 5.5
Housewife 452 79.3
Government employee 24 4.2
Occupation of mothers
Student 18 3.2
Merchant 76 13.3
Farmer 285 52
Government employee 34 6.2
Occupation of husbands (n=548)
Student 22 4
Merchant 207 37.8

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Table 2: Neonatal factors of health care seeking behavior of mothers towards neonatal danger signs, Kamba Zuria District, South
Ethiopia, 2020.

Variables (n=570) Categories Frequencies Percentages

Male 286 50.2
Sex of neonate
Female 284 49.8
1-Feb 198 34.7
Current age of neonate in month
3-May 372 65.3
Single 566 99.3
Type of pregnancy
Multiple 4 0.7

Table 3: Obstetric factors of health care seeking behavior of mothers towards neonatal danger signs, Kamba Zuria District, South
Ethiopia, 2020.

Variables (n=570) Categories Frequencies Percentages

Yes 73 12.8
PNC visit
No 497 87.2

Information about neonatal danger Yes 51 69.9

signs during PNC visit(n= 73) No 22 30.1
Pre term 10 1.8
Gestational age at delivery
Term 560 98.2
Health facility 221 38.8
Place of delivery
Home 349 61.2
Spontaneous vaginal 563 98.8
Type of delivery Instrumental 3 0.5
Cesarean section 4 0.7
Yes 359 63
ANC visit
No 211 27
One 44 12.3
Number of ANC visit (n= 359) Two 104 29
Three or above 211 58.8

Table 4: Neonatal danger signs and the mothers’ health care seeking behavior towards neonatal danger signs, Kamba Zuria District,
South Ethiopia, 2020.

Variables (n=570) Categories Frequencies Percentages

Yes 406 71.2
Faced neonatal danger signs
No 164 28.8
Unable to feed since birth/stopped
36 8.9
after
Convulsion/ abnormal body
36 8.9
movement
Fast breathing 31 7.6
Fever/ hot to touch 97 23.9
Type of neonatal danger sign
Baby is cold /Cold to touch 24 5.9
(n=406)
Severe chest indrawing/difficulty
39 9.6
breathing
Unconsciousness/ lost itself 39 9.6
Yellow skin color 33 8.1
Signs of local infection (Pus
71 17.9
discharge from umbilicus, red eyed)

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Sought care from health facility

212 52.2
within 24 hrs
Sought care from health facility
100 24.6
after 24 hrs
Place care sought(n=406) Gave home remedies 42 10.3
Sought traditional care 24 5.9
Called priest/pastor to pry 19 4.7
Sought from drug seller 9 2.2
Did not know that it is a danger sign 35 35
Reason for after 24 hour to seek Wanted to try home remedies first
60 60
from health facility (n=100) and see the improvement
Took to traditional healers 5 5

Table 5: Health system and Cultural factors of health care seeking behavior of mothers towards neonatal danger signs, Kamba Zuria
District, South Ethiopia, 2020.

Variables (n=570) Categories Frequencies Percentages

Long distance to go health facility 2 2.1
Cost for care in the health facility
5 5.3
is high
Reason to sought care out of health
facility (n=94) Neonate should not be taken
3 3.2
outside of home
Illness is not suitable for medical
45 47.9
care
Traditional herbs are more effective 39 41.5

Distance from home to health 1-2 hour 502 88.1

facility 3- 4 hour 68 11.9

Table 6: Individual factors of health care seeking behavior of mothers towards neonatal danger signs, Kamba Zuria District, South
Ethiopia, 2020.

Variables (n=570) Categories Frequencies Percentages

1-Mar 284 49.8
Number of children
4-Jul 286 50.2

Decision making ability of mothers Higher 255 62.8

(n=406) Lower 151 37.2

Results
Socio Demographic Characteristics
Table 7: Bi-variable and multi-variable analysis of factors associated with health care seeking behavior of mothers towards neonatal
danger signs, Kamba Zuria District, South Ethiopia, 2020.

Health care seeking behavior

Variables (n=406) Category COR (95%CI) AOR (95%CI) P- value
Appropriate Inappropriate
<=24 15(7.1%) 6(3.1%) 3.19(1.13, 9.06) 1.86(0.42, 5.65) 0.27

Age of mothers in 25-30 67(31.6%) 66(3%) 1.29(0.75, 2.26) 0.82(0.43, 1.55) 0.54
years 31-35 94(44.3%) 76(39.2%) 1.58(0.93, 2.69) 1.39(0.81, 2.38) 0.24
>=36 36(17%) 46(23.7%) 1 1
1-Mar 116(58.3%) 83(41.7%) 1.62(1.09, 2.39) 1.87(1.16, 3.01)* 0.01
Number of children
4-Jul 96(46.4%) 111(53.6%) 1 1
Higher 143(56.1%) 112(43.9%) 1.52(1.01, 2.27) 1.53(1.01, 2.32)* 0.04
Decision making
Lower 69(45.7%) 82(54.3%) 1 1

Note*: Hint: “*” =p<0.05: statistically associated; “1” = reference group

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Am J Biomed Sci & Res Copyright© Elias Ezo

Figure 1: Health care seeking behavior of mothers towards neonatal danger signs, Kamba Zuria District, South Ethiopia, 2020 (n = 406).

Five hundred seventy mothers gave response that made over-all the family [AOR: 1.87, 95%CI: 1.16, 3.01].This was almost the same
response rate 96.9%. Median age of mothers was 32 with SD±4.012 as a facility based cross sectional study conducted in Addis Aba-
(Table 7, Figure 1). ba, Ethiopia, in which mothers who have number of children less
than or equal to three were four times more likely to seek health
Discussion care than those having more than three children with 95% CI [23].
In this study, the magnitude of appropriate health care seeking Again, it was in agreement with previous study that described num-
behavior for the neonatal danger signs was 52.2% [95%CI: 47.0- ber of children born for the family affects the health care seeking
57.1%]. This finding was in line with a previous study done in Ye- behavior of mothers towards neonatal danger signs [25].
men (51.4%) [2], a study done in Enugu state, Nigeria (47.7%) [18]. Mothers who had higher decision-making ability were 1.53
However, it was higher than a study conducted in Edo state, Nige- times more likely to seek appropriate health care than mothers
ria (35.9%) [19]and Tenta district, Amhara region (41.3%) [16]. In who had lower decision-making ability [AOR: 1.53, 95%CI: 1.01,
contrast, it was lower than a study conducted in Pakistan (81.1%) 2.32]. This was in agreement with previous study done in Tenta Dis-
[20], Bahir Dar (72.7%) [21] and facility based study conducted in trict, Amhara Region of Ethiopia, in which mothers who had higher
Ambo town, Central Ethiopia, (60.5%) [22]. These discrepancies decision-making ability were 11.28 times more likely to seek med-
might be due to social environment that does not encourage health ical care than mothers who had lower decision-making ability [16].
care seeking behavior towards neonatal danger signs, difference in
accessibility of health facilities and the time duration in this study Conclusion
was limited to twenty-four hours since the onset of neonatal danger
This study justified that appropriate health care seeking behav-
sign. In the same time circumference, in study done in Addis Ababa,
ior of the mothers for neonatal danger signs was low in the study
Ethiopia, 26.5% of mothers whose neonate faced neonatal danger
area. Independent variables that showed significant association in
sign sought health care within first day, [23] which was about half
this study were number of children in the family and decision-mak-
lower than this study. This difference might be a result of improve-
ing ability of mothers.
ment in health care seeking behavior and incensed of infra statures
from time to time. Acknowledgement
Health care seeking behavior of mothers towards neonatal The authors are thankful for Debre Markos University funding.
danger signs out of health facility within 24 was 24.6% sought care Also like to thank mothers for their willingness of participation,
from health facility after 24 hrs,10.3% gave home remedies, 5.9% kindly provision of necessary information and scarification of their
sought traditional care, 4.7% called priest/pastor to pry and 2.2% valuable time.
sought from drug seller which was lower than a community based
study done in Wolkite town, South Nation Nationalities and Peoples Ethical Consideration
Regional State, Ethiopia that justified 33.8% mothers gave home A permission letter was provided from Debre Markos Universi-
remedies and 24.2% sought from traditional healer [24]. This vari- ty Ethical Review Committee. Again, another permission letter was
ation might be due to improvement of health care seeking behavior obtained from Kamba Zuria district Health Office to each selected
from health facility from time to time. Mothers who had number of health posts. Data collectors gave verbal informed consent, asked
children from 1-3 were 1.87 times more likely to seek appropriate openness and explained the necessity including the aim and pur-
health care than mothers who had number of children from 4-7 in

American Journal of Biomedical Science & Research 222

Am J Biomed Sci & Res Copyright© Elias Ezo

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