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

Introduction

Health care seeking behavior is a functional motivation and ability of individuals to seek treatment from available health care facilities and other sources [1,2]. Health care seeking behavior for neonatal danger signs is not only treatment of the disease, but perceived seriousness, duration, cultural practices and socio- economic status of mothers [3]. Neonatal period is the most critical period for the newborn to survive its life [4]. Neonatal danger signs are those danger signs that occur in the first four weeks of life since birth [5,6]. About 2.6 million newborns die within the first four weeks of life [7]. Delayed health care seeking behavior for ill neonates contributes to high neonatal and infant mortality rates [8,9]. However, appropriate health care seeking behavior of mothers for neonatal danger signs is backbone in decreasing neonatal mortality [10]. In Ethiopia, traditional beliefs have greater influence over the prevailing attitudes and practices of governmental policies. Nearly half of all deaths in under-five childhood occur in the neonatal period, within the first four weeks of life [11]. According to the 2019 Mini EDHS, neonatal mortality rate is 30 deaths per 1,000 live births [12]. However, it was 29 deaths per 1,000 live births in 2016 EDHS report which needs improvement in health care seeking behavior [13]. Ethiopia has already made great initiatives to empower communities to improve maternal and child health through the Health Extension Workers (HEW) and Health Development Army (HAD) platforms. The Ministry of Health (MOH) of Ethiopia prepared an illustrated booklet called Family Health Card (FHC) through its flagship health extension program. The FHC includes recommended action points and important health messages on maternal, newborn and child health. In it, there are messages on neonatal danger signs to help families to recognize neonatal danger signs and seek prompt treatment [14]. Therefore, this study assessed health care seeking behavior of mothers towards their neonates.

Methods and Materials

Study Area and Period

The study was done in Kamba Zuria district of Gamo Zone, South Nation Nationalities and Peoples’ Regional State. Kamba Zuria district is located 559 Km away from Addis Ababa, 390 Km from Hawassa, the capital city of South Nation Nationalities and Peoples Regional State and 105 Km away from Arba Minch, the capital city of Gamo Zone. It has a primary Hospital, five health centers, one clinic, six private clinics and four drug stores. The total population of the district is 137,500 from which 3.46% (4,758) are reproductive age group mothers [15]. The study was conducted from February 1 to 30/2020.

Study Design and Population

A community based cross sectional study design was carried out. All mothers who had infants less than six months of age in the district were included. Severely ill mothers who could not respond during the data collection period were excluded.

Sample Size Determination

The sample size was determined using a single population proportion formula. The assumptions used to calculate the sample size was population proportion 0.413 that was taken from study done in Tenta district of Amhara Region [16] with 95% confidence level and margin of error 5% as follows.

With non-response rate of 5%and design effect of 1.5, the total sample size was 588.

Sampling Procedure

Seven rural kebeles and one semi-urban were included in the study by stratified sampling. Each Kebele was selected by simple random sampling technique. Mothers were identified by proportional allocation considering list of mothers in health post as a sampling frame. Finally, the data collectors visited the home of each mother to interview with the guidance of HEWs.

Terms and Operational Definitions

Neonatal Danger Signs

Danger signs that occur in the first four weeks of life since birth [6]. Included: unable to feed since birth or stopped later, convulsion, fast breathing or respiratory rate greater than or equal to 60 bpm, severe chest in-drowning or difficulty breathing, body temperature greater than or equal to 37.5C0 or fever, body temperature less than or equal to 35.5C0 or hypothermia, absence of movement even with stimulation or weakness and lethargy, yellow skin or jaundice and sign of local infections such as reddened eye or pus draining from umbilicus [7].

Health Care Seeking Behavior

Seeking health care for neonatal danger sign that faced neonates. It was measured by calculating all individual responses of question, from where you sought care for danger sign faced and then categorized as appropriate (if mothers visited health facility within 24 hours since onset of the sign) or inappropriate (if mothers visited health facility after 24hours or visited out of health facility for neonatal danger sign) [17].

Decision Making Ability

Is the way a mother reaches a decision by herself or somebody else to seek health care for her sick neonate. It was measured by calculating individual answers to decision-making questions and then categorized as higher (if mother made decision by herself) or lower (if the decision was made by husband or others) [16].

Data Collection Procedure and Quality Assurance

Tool contained semi-structured questionnaires and data was collected through face-to-face interview of mothers. Five data collectors (graduated diploma nurses) and four supervisors (experienced public health officers) were recruited. Pre-test was made on 5% of the total sample size in non-selected Kebele before actual data collection. Training was given to data collectors. The questionnaire was translated from English to Amharic and then to Gamogna (local language) before and back to English after data collection by language expert to assure consistency.

Data Management and Data Analysis

Data were entered into Epi Data version 3.1 and then exported to SPSS version 24 statistical package for analysis. Data cleaning was performed to check for missed values and then descriptive analysis such as proportions, percentages, median, tables and graphs were used. Multi-collinearity was checked, and logistic regression analysis was done using Hosmer-Lemeshow model goodness fit test. Variables significant in bivariate analysis were entered in multivariate analysis to identify the independent association of variables with health care seeking behavior of mothers towards neonatal danger signs. Finally, significant independent association was interpreted at P-value of less than 0.05 with 95%confidence 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.

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

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

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

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

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

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.

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

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 response rate 96.9%. Median age of mothers was 32 with SD±4.012 (Table 7, Figure 1).

Discussion

In this study, the magnitude of appropriate health care seeking behavior for the neonatal danger signs was 52.2% [95%CI: 47.0- 57.1%]. This finding was in line with a previous study done in Yemen (51.4%) [2], a study done in Enugu state, Nigeria (47.7%) [18]. However, it was higher than a study conducted in Edo state, Nigeria (35.9%) [19]and Tenta district, Amhara region (41.3%) [16]. In contrast, it was lower than a study conducted in Pakistan (81.1%) [20], Bahir Dar (72.7%) [21] and facility based study conducted in Ambo town, Central Ethiopia, (60.5%) [22]. These discrepancies might be due to social environment that does not encourage health care seeking behavior towards neonatal danger signs, difference in accessibility of health facilities and the time duration in this study was limited to twenty-four hours since the onset of neonatal danger sign. In the same time circumference, in study done in Addis Ababa, Ethiopia, 26.5% of mothers whose neonate faced neonatal danger sign sought health care within first day, [23] which was about half lower than this study. This difference might be a result of improvement in health care seeking behavior and incensed of infra statures from time to time.

Health care seeking behavior of mothers towards neonatal danger signs out of health facility within 24 was 24.6% sought care from health facility after 24 hrs,10.3% gave home remedies, 5.9% sought traditional care, 4.7% called priest/pastor to pry and 2.2% sought from drug seller which was lower than a community based study done in Wolkite town, South Nation Nationalities and Peoples Regional State, Ethiopia that justified 33.8% mothers gave home remedies and 24.2% sought from traditional healer [24]. This variation might be due to improvement of health care seeking behavior from health facility from time to time. Mothers who had number of children from 1-3 were 1.87 times more likely to seek appropriate health care than mothers who had number of children from 4-7 in the family [AOR: 1.87, 95%CI: 1.16, 3.01].This was almost the same as a facility based cross sectional study conducted in Addis Ababa, Ethiopia, in which mothers who have number of children less than or equal to three were four times more likely to seek health care than those having more than three children with 95% CI [23]. Again, it was in agreement with previous study that described number of children born for the family affects the health care seeking behavior of mothers towards neonatal danger signs [25].

Mothers who had higher decision-making ability were 1.53 times more likely to seek appropriate health care than mothers who had lower decision-making ability [AOR: 1.53, 95%CI: 1.01, 2.32]. This was in agreement with previous study done in Tenta District, Amhara Region of Ethiopia, in which mothers who had higher decision-making ability were 11.28 times more likely to seek medical care than mothers who had lower decision-making ability [16].

Conclusion

This study justified that appropriate health care seeking behavior of the mothers for neonatal danger signs was low in the study area. Independent variables that showed significant association in this study were number of children in the family and decision-making ability of mothers.

Acknowledgement

The authors are thankful for Debre Markos University funding. Also like to thank mothers for their willingness of participation, kindly provision of necessary information and scarification of their valuable time.

Ethical Consideration

A permission letter was provided from Debre Markos University Ethical Review Committee. Again, another permission letter was obtained from Kamba Zuria district Health Office to each selected health posts. Data collectors gave verbal informed consent, asked openness and explained the necessity including the aim and purpose of data collection, confidentiality and privacy was clearly introduced and kept.

Conflict of Interest

The author has declared no conflict of interest.

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