Hindawi

Advances in Public Health

Volume 2022, Article ID 7592832, 11 pages
https://doi.org/10.1155/2022/7592832

Research Article
Healthcare-Seeking Behavior and Associated Factors for Newborn
Danger Signs among Mothers Who Gave Birth in the Last
12 Months in Anlemo District

Zeyene Abute Idris,1 Garumma Tolu Feyissa,2 Legesse Tesfaye Elilo ,3

Markos Selamu Jifar ,3 and Aregash Mecha3
1
Hadiya Zone Health Department, Hossana, Ethiopia
2
Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia
3
College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia

Correspondence should be addressed to Markos Selamu Jifar; marksena15@gmail.com

Received 10 May 2022; Revised 3 October 2022; Accepted 20 October 2022; Published 19 November 2022

Academic Editor: Carol J. Burns

Copyright © 2022 Zeyene Abute Idris et al. Tis is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
Background. Healthcare-seeking behavior is referred to as any action taken by individuals who believe they have a health problem
or are ill in order to fnd an appropriate remedy. Te aim of this is to assess healthcare-seeking behavior on newborn danger signs
and associated factors among mothers who gave birth in the last 12 months in the Anlemo district. Methods. A community-based
cross-sectional study was conducted in the Anlemo district from June 15th, 2019 to July 16th, 2019. Data were collected from 421
randomly selected mothers through a face-to-face interview. Data were cleaned and entered into Epi-Data version 3.1, and then,
exported to SPSS version 22.0 for analysis. Binary logistic regression with p values less than 0.25 was entered into a multivariable
logistic regression for analysis. Finally, adjusted odds ratios (AOR) with 95% confdence intervals at a p value of <0.05 were
considered as a statistically signifcant association with the outcome variable. Results. Among mothers whose newborns faced
newborn danger signs, 34.5% (95% CI: 28.7, 40.5%) sought medical attention for newborn danger signs. When mothers were faced
with neonatal danger signs, the multivariable logistic regression model identifed three independent variables that were associated
with their healthcare-seeking behavior. Mothers who had a college degree or above were 6.34 times more likely than mothers who
could not read or write to seek medical care (AOR � 6.34, 95% CI: 1.23–32.69). Mothers or healthcare seekers who did not travel
a long distance (less than 5 kilometers) to acquire healthcare were 2.53 times more likely than mothers who traveled a long
distance (AOR � 2.53, 95% CI: 1.05–6.08), which had a signifcant association with the dependent variable. Conclusions. In this
study, the proportion of mothers seeking care for newborn danger signs was low, and the mothers’ education, time to reach the
nearest health facility, and place of delivery were factors of statistical signifcance with the dependent variable.

1. Introduction convulsions, a respiratory rate of 60 breaths per minute or

more, severe chest in-drawing, temperature >37.50°C,
A newborn is an infant that was born within the frst few temperature 35.50°C, movement only when stimulated or
minutes to hours after birth and will live for up to 28 days movement even when not stimulated, yellow soles (a sign of
[1]. Te symptoms of a dangerously ill infant that necessitate jaundice), a reddened or pus draining umbilicus, and
rapid care or, if possible, hospitalization are known as a reddened or pus draining eye [2].
newborn danger signals [2]. Ten newborn danger indicators According to a World Health Organization (WHO) data
have been identifed by the World Health Organization sheet, 5.3 million children under the age of fve died
(WHO) and the United Nations International Child Edu- worldwide in 2018, with over half of those dying in the frst
cation Fund (UNICEF) as endangering neonatal survival: 28 days of life, resulting in 7000 neonatal deaths every day,
2 Advances in Public Health

with sub-Saharan Africa accounting for 40% of neonatal mothers to postpone seeking care, resulting in increased
deaths. Ethiopia, together with India, Nigeria, Pakistan, and newborn mortality, a critical entry point for improving
the Democratic Republic of the Congo, was responsible for neonatal health. Tis could lead to a rise in the child’s
half of all child deaths under the age of fve. As a result, morbidity and mortality rates [13]. NBDS have been linked
successful interventions in developing countries to enhance to better newborn outcomes and lower mortality rates when
newborn survival involve a thorough understanding of the detected early [14]. Given the high rate of home births and
patterns and determinants of newborn-care seeking be- early hospital discharges, parents should be able to recognize
havior among mothers, relatives, and other newborn signs of newborn disease and bring their babies to the
caregivers [3]. hospital as soon as possible. However, there have been few
Low- and middle-income countries account for the great studies in this area. As a result, the aim of this study was to
majority of neonatal fatalities. Two-thirds of all newborn assess the proportion of healthcare-seeking behavior and
mortality occurs in twelve countries, six of which are in sub- factors associated with healthcare utilization among mothers
Saharan Africa. In 2013, 60 percent of all newborn fatalities who gave birth in the previous 12 months in the Anlemo
occurred in countries with a death rate of 30 or more per district.
1000 live births [4]. Healthcare usage for newborn diseases is
low in low- and middle-income developing countries. De- 2. Materials and Methods
spite the fact that various actions were carried out to increase
healthcare-seeking and utilization, education level, postnatal 2.1. Study Area and Period. Te research was carried out
(PNC) accompaniment by mothers, danger sign commu- among mothers who had given birth in the previous
nication to mothers, and site of living were the most de- 12 months in Anlemo district, Hadiya Zone, southern
termining factors [5]. Ethiopia, which is located 198 kilometers west of Hawassa,
Improving families’ care-seeking behavior is one of the the capital city of the Southern Nation Nationalities People
most important ways to reduce child mortality in un- Region (SNNPR’s) capital city, and 214 kilometers south of
derdeveloped countries. According to the World Health Addis Ababa, Ethiopia’s capital city. In the district, there
Organization, receiving prompt and appropriate medical were two urban and twenty-seven rural kebeles. According
attention can reduce infant mortality from acute respiratory to 2017 population projections, the district’s total population
infections by 20% [6]. To reduce newborn death, early de- was estimated to be 91, 464 people, with a male to female
tection of newborn danger signs (NBDS) and the provision ratio of 1 : 1. Te district had 38,293, 3,164, 2,918, and 14,277
of high-quality curative health services for sick neonates are households, expected deliveries per year, surviving infants,
critical [7]. and children under the age of fve, respectively. According to
Te frst four weeks of life are when newborns are most the Anlemo district health ofce report, the district had fve
vulnerable to death. Appropriate food and care must be health centers, twenty-seven health posts, eight private
provided at this time, both to improve the child’s chances of primary clinics, one private medium clinic, and four private
survival and to lay the foundation for a healthy future [8]. drug stores. In the 12 months leading up to June 29th, 2019,
Newborn danger signs are one of the most common causes there were 2724 mothers who gave birth (Anlemo district
of neonatal mortality in impoverished countries. Some say health ofce annual plan and performance evaluation report,
that current eforts to reduce newborn mortality are com- unpublished). Te study was conducted from June 15th,
plicated by a lack of understanding of social determinants of 2019 to July 16th, 2019.
health as well as neonatal danger signs and devising ap-
propriate mitigation techniques [9]. Te highest rate of 2.2. Study Design and Participants. A community-based
neonatal mortality occurs at home, where only a few cross-sectional study was conducted among randomly se-
mothers seek medical help for indications of neonatal illness lected mothers in the Anlemo district who had given birth
and where practically no babies are taken to hospitals when within the previous 12 months. Mothers who had given birth
they are sick. Delays in seeking medical help can increase the within the previous 12 months and who were residing in
chances of an infant dying [10]. Understanding how people selected kebeles, regardless of marital status, and who had an
seek medical treatment helps to avoid unnecessary delays infant alive during the study period were included in the
and improves neonatal health [11]. study. Tose who were unable to respond or were extremely
Every year, 2.4 million children are born in Ethiopia, but ill were, however, excluded.
the death rate is exceedingly high: 1500 children under the
age of fve die every day, 210,000 infants per year, and
350,000 children die before they turn fve [12]. 2.3. Sample Size Determination. Te required sample size
Millions of mothers and their newborns around the was determined using the following formula based on
world live in a societal environment that discourages them a single population proportion:
from seeking medical help. As a result, many mothers do not (Zα/2)2 P(1 − p)
seek ofcial healthcare during the postpartum period, which n� , (1)
d2
has a signifcant impact on both the mothers’ healthcare and
the survival of their newborns [5]. where n � required sample size, Z2 � critical values at a 95
According to Ethiopian studies, inadequate healthcare- percent confdence level of certainty � 1.96 (two-sided test),
seeking behavior and associated NBDS cause over 80% of design efect (d) � 2, P � 83 percent (P from another similar
Advances in Public Health 3

study conducted in Tiro Afeta district in southwest Ethiopia) previous 12 months to identify any ambiguity, inconsistency,
[15], q � 1 − P, d � margin error � 5%, and adjustment for validity, completeness, skip patterns, and acceptability of the
nonresponse 10%. Taking these assumptions into account, questionnaire, and necessary corrections were made before the
the formula produces 217 sample populations. Because the actual data collection. Data were collected by three diploma
number of mothers who gave birth in Anlemo district in the nurses and one supervisor BSc holder (public health ofcer)
previous 12 months was 2724 (less than 10,000), the fol- who were recruited from outside the study area. Data col-
lowing correction formula was used: nf � n/(1 + n/N) � lectors were trained, and data collection tools were thoroughly
nf � 217/(1 + 217/2724) � 201. With a 10% nonresponse rate reviewed to ensure that all members had a common un-
and a design efect of 2, the total sample size required derstanding. Each night on the same day, all of the ques-
was 442. tionnaires were checked for incompleteness.
For the second objective, the required sample size was
calculated using Epi-Info software version 7.0. Te variables
2.6. Measurement and Defnitions
associated with healthcare-seeking behavior are as follows:
mother’s educational status (20.4%), place of delivery of last 2.6.1. Dependent Variable. Healthcare-seeking behavior
child (26.2%), optimal thermal care (29.7%), decision- (yes/no) and independent variables: age, family size, religion,
making ability to seek neonatal healthcare (12.5%) with ethnicity, marital status, residence, occupation, education,
confdence level (95%, power 80% assumption), and ratio sex of the newborn, household income, decision-making
(no. of outcomes in unexposed: no. of outcomes exposed). ability, ANC, delivery, PNC service utilization, traditional
Sample size was calculated for the second objective from practice and presence of home remedy, accessibility, source
a previous study from Tenta District, northeast Ethiopia [16] of information, and perception of mothers towards
(Table 1). healthcare providers and knowledge.
Te second objectively calculated sample size was 111,
116, 188, and 38, respectively, but the maximum sample size
of 442 was taken. 2.6.2. Neonatal Danger Signs. Symptoms indicate that
a newborn is critically ill and requires immediate treatment
or, if possible, hospitalization [2].
2.4. Sampling Procedures. Te study subjects were chosen
using a multistage sampling technique. Tere were 29
kebeles in Anlemo district, which were divided into two 2.6.3. Postnatal Care. Care was provided to a mother for six
urban and twenty-seven rural kebeles. One urban and eight weeks following delivery.
rural kebeles were chosen using a simple random sampling
technique to increase representativeness. Te sample was 2.6.4. Healthcare-Seeking. A response to neonatal danger
drawn from these kebeles using a proportional allocation of signs in order to reduce severity and complications after
sample size based on the number of delivered mothers in the recognizing the danger signs and perceived nature of
previous 12 months in the selected kebeles. If a household illness [6].
had more than one mother who had given birth within the
previous 12 months, one was chosen at random using the
2.6.5. Mother’s Knowledge on Newborn Danger Signs. In this
lottery method. If the mothers in the chosen households did
study, danger signs during childbirth were assessed using
not have infants, the next household was visited. Te re-
fve items, with a correct answer receiving a score of “1” and
quired number of mothers with infants under one-year-old
an incorrect answer receiving a score of “0.” Tis ques-
was obtained using a systematic sampling procedure that
tionnaire is graded by calculating a percentage of the median
calculated the Kth value by dividing the total number of
and above score, which is categorizing as adequate or in-
women who gave birth prior to the data collection period by
adequate knowledge. Adequate knowledge was associated
the total number of sample size, and the frst interviewing
with mothers who answered more than or equal to 75% of
mother was identifed using a lottery method among the
the knowledge questions correctly, whereas inadequate
mothers in the frst sampling interval “K1.” Te proportional
knowledge was associated with mothers who answered less
allocation technique was used to determine the sample size
than 75% of the knowledge questions correctly [17–19].
for each kebele (Figure 1).

2.6.6. Mother’s Knowledge on Neonatal Danger Signs. If

2.5. Data Collection Tolls and Quality Assurance.
a mother can spontaneously mention at least three of the ten
Researchers adapted a structured interviewer-administered
WHO recognized neonatal danger signs (good knowledge)
questionnaire after reviewing various literatures on similar
and poor if they fail to mention three neonatal danger
studies that had previously been done. Te questionnaire was
signs [20].
written in English, translated into the local language
(Hadiyisa), and then, independently re-translated back into
English to check to ensure consistency. Structured question- 2.6.7. Good Healthcare-Seeking Behavior. If a mother seeks
naires were used to collect data on dependent and independent medical care when their neonate experiences newborn
study variables. A 5% sample pretest was conducted outside of danger signs, the WHO provides it in between her postnatal
the study setting on mothers who had given birth within the visits, regardless of its severity and cost.
4 Advances in Public Health

Table 1: Te second objective the required sample size was calculated by using Epi-Info software version 7.0, to identify independent
variable and compare for the largest sample size.
% of
Ratio (unexposed:
Variables outcome in Power OR Sample size
Exposed)
unexposed
Mother educational status 20.4 3.87 80 4.46 111
Place of delivery of last child 26.2 1.85 80 3.35 116
Optimal thermal care 29.7 1.78 80 2.52 188
Decision-making ability to seek neonatal healthcare 12.5 0.65 80 11.28 38

Anlemo District (29)

Two urban
kebeles Twenty seven rural kebeles

SIMPLE RANDOM SAMPLING

L/Fonko Mento/
Fonko E/laftolenka Mis/Fonko Shasha Ana-tigo B/kombota T/kebecho
akabala

MOTHERS WHO GIVEN BIRTH LAST 12 MONTHS IN SELECTED KEBELES

120 106 126 86 89 93 104 94 105

PROPORTIONAL SAMPLE ALLOCATION

57 51 60 41 43 45 50 45 50

Systematic
442 sampling was used

Figure 1: Schematic presentation of sampling procedure.

2.6.8. Poor Healthcare-Seeking Behavior. We refer to those 2.7. Data Processing and Analysis. Data were cleaned and
mothers who seek traditional, spiritual, and homemade entered into Epi-Data version 3.1 software and then
treatments for their newborn after experiencing neonatal exported to SPSS version 22.0 for analysis. For categorical
danger signs. variables, descriptive statistics were presented as frequencies,
Accessibility to health facilities: we refer to the distance percentages, means, and standard deviations, and means and
from the client’s residence to the health facility that took less standard deviations were present for continuous variables.
than 5 kilometers or 30 minutes to walk, and more than 5 All independent variables with a p value of 0.25 in the bi-
kilometers or 30 minutes was considered inaccessible [21]. variate logistic regression analysis were included in the
Advances in Public Health 5

multivariable logistic regression analysis to identify in- 3.3. Knowledge Level of Mothers Regarding Newborn Danger
dependent factors. Statistical signifcance was determined Signs. About 318 (75.5%) of the mothers who responded
using a 95% confdence interval (CI) and a p value of 0.05 to had heard about WHO-recognized newborn danger signs.
ensure that the necessary assumptions for multivariable When we tried to calculate percentage median to categorize
logistic regressions were met. Te Hosmer and Lemeshow maternal/caretaker knowledge into adequate and in-
goodness-of-ft test was used to assess whether the necessary adequate, we noticed that about one-sixth (16.7%) of the
assumptions were fulflled. mothers/caretakers could mention more than three symp-
toms and (83.3%) less than or equal to three symptoms
among the newborn danger indicators identifed by the
2.8. Ethics Approval and Consent to Participation. Te study
World Health Organization (WHO) and the United Nations
was conducted in accordance with the guidelines of the
International Child Education Fund (UNICEF). HEWs,
Hindawi journal after receiving ethical approval from the
HPs, radio, and television provided information to 133
Wachemo University’s Ethical Review Committee (refer-
(41.8%), 107 (33.6%), 52 (16.4%), and 26 (8.2%) of the
ence no. WCU/SGS/538/2011E.C). An ofcial letter was
mothers, respectively. Regarding common newborn illness,
submitted to the concerned administrative ofce in the
vomiting, poor/unable to suck, high fever (>37.5), fast
district to get permission for the study, and verbal consent
breathing (>60 minutes), difcult to breathe, altered con-
was taken from each participant who participated in the
sciousness, umbilical discharge/redness, and yellowish dis-
study following an explanation of the purpose and the
coloration of the body were the most commonly cited WHO
importance of the study in their local languages. Te con-
recognized newborn danger signs by questioning mothers,
fdentiality of study participants was maintained by using
with 75 (23.6%), 58 (18.2%), 45 (14.2%), 43 (13.5%), 37
codes instead of identifying them with their name. Te
(11.6%), 25 (7.8%), 20 (6.3%), and 15 (4.7%), respectively.
participants agreed to participate voluntarily and were in-
Respondents with adequate or inadequate knowledge of
formed of their right to withdraw from the study at any time.
newborn illnesses or danger signs were 267 (63.4%) and 154
(36.6%), respectively (Table 4).
3. Results
3.1. Sociodemographic Characteristics of the Respondents.
Te study included 421 mothers, with a response rate of 3.4. Mother’s Healthcare-Seeking Behavior. Te proportion
95.2%. Te mean age of respondents was 30 years of healthcare-seeking behavior among newborns with
(SD ± 6.07); around 118 (28.0%) were between the ages of 30 danger signs in Anlemo district was 34.5% (95% CI: 28.7% to
and 34, followed by 116 (27.6%) who were over 35; and the 40.5%). From those who faced newborn danger signs, 275
majority of 356 (84.6%) lived in rural areas. In terms of (86.5%) of them observed at least one of the NBDSs with
religion, Protestants, Muslims, and Orthodox accounted for their infant. Of these, 95 (34.6%) of the respondents seek
over half of the mothers, with 203 (48.2%), 175 (41.6%), and healthcare services at a health facility, and 180 (65.4%) did
36 (8.6%), respectively. Concerning the occupational status not seek healthcare services at a health facility. Among those
of respondents, housewives, laborers, merchants, and others places of the medical care was sought, governmental health
were 275 (65.3%), 94 (22.3%), 34 (8.1%), and 18 (4.3%), center, government hospitals, health posts, and private HFS
respectively. Regarding education of respondents, those were 51 (53.7%), 23 (24.2%), 12 (12.6%), and 9 (9.5%), re-
unable to read and write, elementary, secondary, and college spectively (Table 5).
level and above were 193 (45.8%), 165 (39.2%), 39 (9.3%),
and 24 (5.7%), respectively. In terms of the total number of 3.5. Factors Associated with Healthcare-Seeking Behavior on
families living in the house, about 247 (58.7%) had less than Neonatal Illness. When mothers were faced with neonatal
fve and 174 (41.3%) more than fve family members; nearly danger signs, the multivariable logistic regression model
two-thirds of 259 (61.5%) families had more than three identifed three independent variables that were associated
children (Table 2). with their healthcare seeking behavior. Mothers who had
a college degree or above were 6.34 times more likely than
3.2. Healthcare Service Utilization Characteristics. Nearly mothers who could not read or write to seek medical care
half of the 217 participants (51.5%) came from a long dis- (AOR � 6.34, 95% CI: 1.23–32.69). Mothers or healthcare
tance away; caretakers/clients had to travel more than thirty seekers who did not travel a long distance (less than 5 ki-
minutes from their residence to reach the nearest health lometers) to acquire healthcare were 2.53 times more likely
institution. Approximately 296 (70.3%) of responders had than mothers who traveled a long distance (AOR � 2.53, 95%
ANC follow-up during their pregnancy. Among these CI: 1.05–6.08). Mothers who delivered at home were
mothers who had ANC follow-up, all got ANC counseling 0.34 times less likely to receive healthcare delivery service
services while counseled/advised about newborn danger when compared to mothers who delivered in health in-
signs, nutrition, breastfeeding, low birth weight, and family stitutions (AOR � 0.34, 95% CI: 0.12–0.96), which had
planning were 86 (29.1%), 69 (23.3%), 67 (22.5%), 49 a signifcant association with the dependent variables
(16.6%), and 25 (8.5%), respectively (Table 3). (Table 6).
6 Advances in Public Health

Table 2: Sociodemographic variables of mothers in Anlemo district, southern Ethiopia, 2019.

Variables (n � 421) Category No (percent)
20–24 83 (19.7)
25–29 104 (24.7)
Age in years
30–34 118 (28.0)
≥35 116 (27.6)
Protestant 203(48.2)
Muslim 175 (41.6)
Religion
Orthodox 36 (8.5)
Others 7 (1.7)
Housewives 275 (65.3)
Laborer 94 (22.3)
Occupation of respondent (mother)
Merchant 34 (8.1)
Others 18 (4.3)
Unable to read & write 193 (45.8)
Elementary 165 (39.2)
Educational status mother
Secondary 39 (9.3)
College and above 24 (5.7)
Urban 65 (15.4)
Residence
Rural 356 (84.6)
≤5 247 (58.7)
Total family size
>5 174 (41.3)
≤3 162 (38.5)
Total number of children
>3 259 (61.5)
0–28 days 61 (14.5)
Age of the baby
>28 days 360 (86.5)
Male 196 (46.6)
Sex of recent birth
Female 225 (53.4)
≤12 dollars 202 (48.0)
Average monthly income of households (12–34) dollars 181 (43.0)
≥35 dollars 38 (9.0)

4. Discussion utilization (ANC, PNC follow-up and place of delivery),

mother’s decision-making at home may also infuence
Healthcare-seeking from a health facility for common mother’s healthcare-seeking behavior if she is diagnosed
newborn illnesses has a high potential to reduce neonatal with NBDS.
mortality. Tere was evidence of a link between seeking Mothers’ knowledge of signs of newborn illnesses, which
healthcare and a reduction in neonatal mortality [22]. is one of the most important factors infuencing mothers’
According to the fndings of this study, 95 (34.5%) of the care-seeking behavior, has been shown to be low in this
mothers who seek healthcare for their neonates, which is study, as demonstrated by the operational defnition 63.4%
nearly in line with studies conducted in peri-urban Wardha of mothers were aware of newborn illnesses [18]. Tis is
Sewagram, India (37.5%), fourteen rural subdistricts of nearly similar to the report of Awasthi et al. [26] who found
Bangladesh (29.4%), Uganda (30.0%), Wolkite Town, low awareness of danger signs among mothers in India.
Gurage Zone, SNNPR, Ethiopia (32.0%), and Tenta district, However, it difers from the high level of awareness of
northeast Ethiopia (41.3%) [16, 20, 23, 24]. However, it is newborn danger signs in Niger reported by Alex Hurt [28].
higher than the similar study conducted in Uttar Pradesh, Te study found that the mother’s educational status,
North India (23.0%), Ambo town (20.3%) [25] but much time to reach the nearest health facility, PNC follow-up, and
lower than the fnding of a study conducted in rural Wardha place of delivery were the key factors infuencing mothers’
of India (91.0%), Yenagoa Metropolis, Bayelsa State, Nigeria knowledge of newborn sickness. Tis fnding is partly
(56.0%), and Tiro Afeta district, southwest Ethiopia (83.0%) consistent with a study done in the Tiro Afeta district in
[15, 26–28]. southwest Ethiopia, which found that mothers’ awareness of
Tese disparities could be attributed to the social en- danger signs and health-seeking behavior in newborn
vironment (cultures, values, and beliefs) that encourages or sickness [15].
discourages healthcare-seeking behavior in response to In a study conducted in fourteen rural districts of
neonatal danger signs, geographical variation, socioeco- Bangladesh, mothers’ education was signifcantly associ-
nomic diferences, the type of study design used, sample size ated with seeking care from trained providers when
sufciency, the fear of high cost of treatment at health fa- compared to illiterate mothers [23]. In Wolkite Town,
cilities, the unavailability of qualifed health providers, the educated mothers were more likely to seek care for their
timing of the study, educational levels, and health service sick newborn at a health facility [20]. In Tenta District,
Advances in Public Health 7

Table 3: Healthcare service utilization of mothers in Anlemo district, southern Ethiopia, 2019.
Variables Categories No (percent)
≤30 204 (48.5)
Time to reach nearest HF (n � 421) (in minutes)
>30 217 (51.5)
Yes 296 (70.3)
ANC follow-up (n � 421)
No 125 (29.7)
Yes 296 (100)
ANC counseling receiving (n � 296)
No 0 (0)
Nutrition 69 (23.3)
Breast feeding 67 (22.5)
Type of ANC counseling (n � 296) (the topics clients counseled) Low birth weight 49 (16.6)
Family planning 25 (8.5)
Newborn danger signs 86 (29.1)
Health institutions 169 (57.1)
Place of delivery (n � 296)
Home 127 (42.9)
Yes 102 (60.4)
PNC follow up (n � 169)
No 67 (39.6)
Breast feeding 42 (41.2)
Nutrition 11 (10.8)
Type of counseling during PNC (n � 102) Newborn danger signs 18 (17.6)
Kangaroo mother care 9 (8.8)
Personal hygiene 22 (21.6)

Table 4: Knowledge level of mothers regarding NBDS in Anlemo district, southern Ethiopia, 2019.
Variables Categories No (percent)
Yes 318 (75.5)
Did you hear newborn illness? (n � 421)
No 103 (24.5)
≤3 265 (83.3)
How many of the newborn illness did you know? (n � 318)
>3 53 (16.7)
Health extension workers 133 (41.8)
Health professionals 107 (33.6)
Where did you get this information? (n � 318)
Radio 52 (16.4)
Television 26 (8.2)
High fever 45 (14.2)
Fast breathing 43 (13.5)
Poor sucking 58 (18.2)
Difcult to breath 37 (11.6)
Common newborn illness do you know (n � 318) (from WHO defned lists)
Vomiting 75 (23.6)
Yellowish discoloration of the body 15 (4.7)
Umbilical discharge/redness 20 (6.3)
Altered consciousness 25 (7.8)
Infection 117 (36.8)
Exposed to heat 48 (15.1)
Mothers’ perceived cause for newborn illness (n � 318)
Exposed to cold 30 (9.4)
Poor sucking 123 (38.7)
Yes 267 (63.4%)
Mother’s knowledge of newborn illness
No 154 (36.6%)

Northeast Ethiopia, educated mothers are more likely than In Bangladesh, mothers who gave birth in healthcare
illiterate mothers to seek care in a health institution for facilities were signifcantly more likely than mothers who
their sick neonates [16]. gave birth at home to seek care from trained providers [23].
Te mothers’ educational level may increase early rec- Te results of a study conducted in Tiro Afeta district
ognition of newborn danger signs, making them more likely revealed that the place of delivery had a signifcant associ-
to seek care at a health facility. Te place of delivery had ation with the care-seeking behavior of mothers who had
a signifcant association with mothers’ healthcare-seeking NBDS [15]. Te results of a study conducted in the Wolkite
behavior regarding newborn illness during the neonatal Town of birth had a signifcant impact on maternal care-
period [28]. seeking practice for newborn danger signs [20].
8 Advances in Public Health

Table 5: Mothers healthcare-seeking behavior in Anlemo district, southern Ethiopia, 2019.

Variables Categories No (percent)
Yes 275 (86.5)
Mothers who have faced newborn illness (n � 318)
No 43 (13.5)
Yes 95 (34.5)
Healthcare-seeking behavior (n � 275)
No 180 (65.5)
Health post 12 (12.6)
Health center 51 (53.7)
Place of medical healthcare-seeking (n � 95)
Gov’t hospital 23 (24.2)
Private health facility 9 (9.5)
Traditional 98 (54.4)
Home remedy 38 (21.1)
Sought to nonmedical care (n � 180) Sought spiritual 24 (13.3)
Nothing 12 (6.7)
Others 8 (4.4)
Herbal treatment best 79 (43.9)
Long distance 23 (12.8)
Negligent health workers 21 (11.7)
Reason for not seeking care at HF (n � 180)
Case not series 27 (15.0)
Work over load 18 (10.0)
Evil spirit case 12 (6.7)
Father alone 86 (29.0)
Decision-making NBDS (n � 296) Mother alone 73 (24.7)
Both 137 (46.3)

Mothers with a college degree or above were 6.34 times entry point for improving neonatal health, was found to be
more likely to seek medical care than mothers who could low in this study, despite the high healthcare seeking be-
not read or write. Te explanation for this could be that havior for newborn illness. It was especially low for some
government-employed mothers are well-educated and critical illnesses in newborns, such as jaundice. Tus, in-
seek healthcare more frequently, and they may use a dif- tervention modalities focusing on maternal counseling on
ferent source of health-related information. Mothers who the most common symptoms of illness have been identifed
delivered at home were 0.34 times less likely to receive by the WHO in the newborn, particularly during ANC/PNC
healthcare delivery services when compared to mothers follow-up as well as during institutional delivery, are very
who delivered in healthcare institutions. Tis fnding is important in order to increase mothers’ knowledge of illness
congruent with the studies conducted in Ambo Town [25]. recognition and thus improve mothers’ care-seeking
Te possible explanation was that increasing mothers’ behavior.
utilization of health services delivered at the institutional One of the study’s strengths is that participants were
level hierarchy increases mothers’ care seeking of sick selected using the probability sampling method to assure the
neonates, leads to positive care seeking behaviors, in- study’s representativeness, and several approaches were
creases mothers’ trust in health facility services, and utilized to preserve data quality. Te limitations of this study
mothers had a higher likelihood of receiving health in- are the same as those of a cross-sectional study. Further-
formation directly from skilled health professionals and more, the use of a qualitative method was not used in this
possibly gained a better understanding of the conse- study. As a result, precise reasons for not seeking healthcare
quences of NBDS. from diverse perspectives were not able to be demonstrated.
Despite Ethiopia’s endeavors to empower the commu- Furthermore, recall bias cannot be ruled out for events that
nity to improve neonatal health services at the grassroots occurred after the data collection period; social desirability
level, mothers’ knowledge of newborn illness, which is a key bias may also be a factor.
 Advances in Public Health

Table 6: Multivariable analysis of healthcare-seeking behavior of mothers on neonatal danger signs in Anlemo district, southern Ethiopia, 2019.
Healthcare-seeking behavior
Variables Sought Sought COR (95% CI) AOR (95% CI) p value
nonmedical care (%) medical care (%)
Unable to read and write 93 (51.7) 37 (38.9) 1 1 1
Elementary 62 (34.4) 42 (44.2) 1.70 (0.98, 2.94) 1.68 (0.64, 4.40) 0.288
Educational status of respondent
Secondary 19 (10.6) 7 (7.4) 0.93 (0.36, 2.38) 0.54 (0.09, 2.96) 0.476
College and above 6 (3.3) 9 (9.5) 3.77 (1.25, 11.34) 6.34 (1.23, 32.69) 0.027∗∗
≤30 75 (41.7) 56 (58.9) 2.01 (1.21, 3.33) 2.53 (1.05, 6.08) 0.038∗∗
Time to reach nearest HF
>30 105 (58.3) 39 (41.1) 1 1 1
Yes 116 (64.4) 82 (86.3) 1 1 1
PNC follow-up
No 64 (35.6) 13 (13.7) 2.82 (1.26, 6.32) 1.29 (0.32, 5.26) 0.715
Health institutions 58 (50.0) 57 (69.5) 1 1 1
Place of delivery
Home 58 (50.0) 25 (30.5) 0.44 (0.24, 0.79) 0.34 (0.12, 0.96) 0.042∗∗
∗∗
1, reference; , signifcantly associated with the dependent variable.
9
10 Advances in Public Health

5. Conclusion Abute Idris analyzed the data, interpreted the fndings, and
approved and suggested that the study should be published.
Te fndings of this study revealed that, in the studied area, there Garumma Tolu Feyissa approved and recommended pub-
was a low prevalence of mothers seeking health care for NBDS, and lication of the study. Aregash Mecha analyzed the data,
that mothers’ educational level, time to reach the nearest health interpreted the fndings, and approved and recommended
facility, and place of delivery were statistically signifcant associate’s publication of the study. Legesse Tesfaye analyzed the data,
to mothers seeking healthcare for newborn danger signs. interpreted the fndings, and approved and recommended
It is recommended that mothers’ education be improved, publication of the study. Zeyene Abute Idris, Garumma Tolu
that employment be made more available to information, Feyissa, Legesse Tesfaye Elilo, and Aregash Mecha are co-
and that healthcare providers educate mothers on NBDS authors.
during their hospital visits.

Abbreviations Acknowledgments

ANC: Antenatal care Te authors would like to thank the Wachemo University
CBNC: Community-based newborn care College of Health Sciences and Medicine Department of
CRC: Compassionated, respectful, and caring Public Health, as well as the academic staf, for their as-
EDHS: Ethiopian demographic and health survey sistance with the study. Te authors would also like to ex-
ENC: Essential newborn care press heartfelt gratitude to the Anlemo woreda
FHC: Family health card administration ofce, health ofce, health facility supervi-
HAD: Health development army sors, data collectors, and study participants for their un-
ICCM: Integrated community case management wavering support.
IMNCI: Integrated management of newborn and
childhood illnesses Supplementary Materials
HEP: Health extension program
HF: Health facility Data collection tools. (Supplementary Materials)
HEW: Health extension worker
HIV: Human immune virus References
HMIS: Health management information system
HSTP: Health sector transformation plan [1] S. Sinha, L. Miall, and L. Jardine, Essential Neonatal Medicine,
LBW: Low birth weight John Wiley & Sons, Hoboken, NJ, USA, 2017.
MDG: Millennium development goal [2] J. Haver, W. Brieger, J. Zoungrana, N. Ansari, and J. Kagoma,
MCH: Maternal child health “Experiences engaging community health workers to provide
MOH: Ministry of Health maternal and newborn health services: implementation of
NBDS: Newborn danger signs four programs,” International Journal of Gynecology & Ob-
stetrics, vol. 130, pp. S32–S39, 2015.
NMR: Neonatal mortality rate
[3] U. Syed, N. Khadka, A. Khan, and S. Wall, “Care-seeking
PNC: Postnatal care practices in south Asia: using formative research to design
PI: Principal investigator program interventions to save newborn lives,” Journal of
PPBHCP: Perceived positive behavior healthcare providers Perinatology, vol. 28, no. S2, pp. S9–S13, 2008.
SBA: Skilled birth attendant [4] A. M. Starrs, “Survival convergence: bringing maternal and
SNNPR: Southern Nation Nationalities People Region newborn health together for 2015 and beyond,” Te Lancet,
SPSS: Statistical Package for Social Science vol. 384, no. 9939, pp. 211–213, 2014.
TBA: Traditional birth attendant [5] H. K. Herbert, A. C. Lee, A. Chandran, I. Rudan, and
UNICEF: United Nations International Children A. H. Baqui, “Care seeking for neonatal illness in low-and
Education Fund middle-income countries: a systematic review,” PLoS Medi-
WHO: World Health Organization. cine, vol. 9, no. 3, Article ID e1001183, 2012.
[6] World Health Organization, Technical Bases for the WHO
Recommendations on the Management of Pneumonia in
Data Availability Children at First-Level Health Facilities, World Health Or-
ganization, Geneva, Switzerland, 1991.
Te data supporting the current study are available within [7] N. Mathur, “Status of newborns in India,” Journal of Neo-
the article. natology, vol. 19, no. 1, 2005.
[8] M. F. Graves, Te Vocabulary Book: Learning and Instruction,
Conflicts of Interest Teachers College Press, New York, NY, USA, 2016.
[9] M. M. Hoque, M. F. H. Khan, J. A. Begum, M. A. Chowdhury,
Te authors declare that they have no conficts of interest. and L. A. Persson, “Newborn care practices by the mother/
care givers and their knowledge about signs of sickness of
Authors’ Contributions neonates,” Bangladesh Journal of Child Health, vol. 35, no. 3,
pp. 90–96, 2012.
Markos Selamu Jifar designed the study, analyzed the data, [10] F. C. Anyanwu and S. R. Okeke, “Health care, care provider,
interpreted the results, and wrote the manuscript. Zeyene and client satisfaction: transforming health care delivery
Advances in Public Health 11

system for improved health care seeking behaviour,” Journal public health facilities in Ambo town, central Ethiopia,” BMC
of Modern Education Review, vol. 4, no. 10, pp. 846–853, 2014. Research Notes, vol. 12, no. 1, pp. 549–557, 2019.
[11] M. Mrisho, D. Schellenberg, F. Manzi et al., “Neonatal deaths [26] S. Awasthi, T. Verma, and M. Agarwal, “Danger signs of
in rural southern Tanzania: care-seeking and causes of death,” neonatal illnesses: perceptions of caregivers and health
ISRN Pediatrics, vol. 2012, Article ID 953401, 8 pages, 2012. workers in northern India,” Bulletin of the World Health
[12] M. Addisse, “Maternal and child health care,” Lecture Notes Organization, vol. 84, no. 10, pp. 819–826, 2006.
for Health Science Students Ethiopian Public Health Training [27] F. Mahejabin, S. Parveen, and M. Ibrahim, “Mothers/care
Initiative, 2003. giver s health seeking behaviour during childhood illness in an
[13] S. G. Nigatu, A. G. Worku, and A. F. Dadi, “Level of mother’s urban slum of Dhaka city,” Pulse, vol. 7, no. 1, pp. 5–15, 2015.
knowledge about neonatal danger signs and associated factors [28] B. Alex-Hart, D. Dotimi, and P. Opara, “Mothers’ recognition
in north west of Ethiopia: a community based study,” BMC of newborn danger signs and health seeking behaviour,”
Research Notes, vol. 8, no. 1, pp. 309–316, 2015. Nigerian Journal of Paediatrics, vol. 41, no. 3, pp. 199–203,
[14] A. Gathoni, Mother’S Knowledge, Attitude and Practice Re- 2014.
garding Neonatal Illness and Assessment of, M.Sc. thesis,
University of Nairobi, Nairobi, Kenya, 2014.
[15] M. Berhane, H. Yimam, N. Jibat, and M. Zewdu, “Parents’
knowledge of danger signs and health seeking behavior in
newborn and young infant illness in Tiro Afeta district,
southwest Ethiopia: a community-based study,” Ethiopian
Journal of Health Sciences, vol. 28, no. 4, pp. 473–482, 2018.
[16] M. Gebeyaw, G. Alemayehu, B. Tefera, and A. Bitiya, “Health
care seeking behaviour on neonatal danger signs among
mothers in Tenta district, northeast Ethiopia: community
based cross-sectional study,” International Journal of Nursing
and Midwifery, vol. 9, no. 7, pp. 85–93, 2017.
[17] A. Wolelie, M. Aychiluhm, and W. Awoke, “Institutional
delivery service utilization and associated factors in Banja
district, Awie zone, Amhara regional sate, Ethiopia,” Open
Journal of Epidemiology, vol. 4, no. 1, pp. 30–35, 2014.
[18] S. Weldemariam, A. Kiros, and M. Welday, “Utilization of
institutional delivery service and associated factors among
mothers in north west Ethiopian,” BMC Research Notes,
vol. 11, no. 1, pp. 194–196, 2018.
[19] D. Anshebo, B. Geda, A. Mecha, A. Liru, and R. Ahmed,
“Utilization of institutional delivery and associated factors
among mothers in Hosanna town, Hadiya zone, southern
Ethiopia: a community-based cross-sectional study,” PLoS
One, vol. 15, no. 12, Article ID e0243350, 2020.
[20] W. Anmut, B. Fekecha, and T. Demeke, “Mothers’ knowledge
and practice about neonatal danger signs and associated
factors in Wolkite town, Gurage zone, Snnpr, Ethiopia 2017,”
Journal of Biomedical Sciences, vol. 6, 2017.
[21] S. Z. Imam, K. S. Syed, S. A. Ali et al., “Patients’ satisfaction
and opinions of their experiences during admission in a ter-
tiary care hospital in Pakistan—a cross sectional study,” BMC
Health Services Research, vol. 7, no. 1, pp. 161–168, 2007.
[22] Central Statistical Agency and ICF International, Ethiopia
Demographic and Health Survey 2011. Addis Ababa, Ethiopia
and Calverton, Central Statistical Agency and ICF In-
ternational, Calverton, MD, USA, 2012.
[23] S. K. Chowdhury, S. M. Billah, S. E. Arifeen, and
D. M. E. Hoque, “Care-seeking practices for sick neonates:
fndings from cross-sectional survey in 14 rural sub-districts
of Bangladesh,” PLoS One, vol. 13, no. 9, Article ID e0204902,
2018.
[24] J. Sandberg, K. Odberg Pettersson, G. Asp, J. Kabakyenga, and
A. Agardh, “Inadequate knowledge of neonatal danger signs
among recently delivered women in southwestern rural
Uganda: a community survey,” PLoS One, vol. 9, no. 5, Article
ID e97253, 2014.
[25] G. A. Bulto, D. B. Fekene, B. E. Moti, G. A. Demissie, and
K. B. Daka, “Knowledge of neonatal danger signs, care seeking
practice and associated factors among postpartum mothers at