Public Health of Indonesia Zaman SB, et al.
Public Health of Indonesia.
2017 June.
:50-60
http://stikbar.
org/ycabpublisher/index.
php/PHI/index ISSN: 2477-1570
Original Research
FACTORS RELATED TO KNOWLEDGE ON NEWBORN DANGER
SIGNS AMONG THE RECENTLY DELIVERED WOMEN IN SUBDISTRICT HOSPITALS OF BANGLADESH
Sojib Bin Zaman1, 9*.
Naznin Hossain2.
Muhammed Awlad Hussain3.
Vidhuna Abimanue4.
Nushrat Jahan5.
Rafid Bin Zaman6.
Zubair Ahmed Ratan2, 7.
Raihan Kabir Khan8.
Shuchita Sharmin9 Maternal and Child Health Division.
International Centre for Diarrhoeal Disease Research.
Bangladesh Department of Pharmacology.
Dhaka Medical College.
Bangladesh Projahnmo Study Site.
Johns Hopkin's University Bangladesh Gordon House surgery.
Ealing General Practice Training Scheme.
London North West Healthcare NHS trust.
UK Department of Earth and Atmospheric Sciences.
University of Alberta.
Canada Notre Dame College.
Dhaka.
Bangladesh Department of Biomedical Engineering.
Khulna University of Engineering and Technology.
Bangladesh School of Public Health.
West Virginia University.
Morgantown.
West Virginia.
USA Department of Development Studies.
University of Dhaka.
Bangladesh Accepted: 7 June 2017 *Correspondence:
Sojib Bin Zaman Maternal and Child Health Division.
International Centre for Diarrhoeal Disease Research.
Bangladesh.
Shahid Tajuddin Ahmed Sharani.
Mohakhali.
Dhaka -1212.
Bangladesh.
Telephone: 8801717043257 Email: sojibbz@gmail.
Copyright: A the author.
YCAB publisher and Public Health of Indonesia.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Background: Bangladesh continues to be one of the top ten countries with the highest burden of neonatal While, most of the neonatal deaths are preventable.
health system delays, delayed identification of newborn danger signs, late diagnosis and initiation of treatment are claimed to be the main challenges.
Objective: .
to determine the level of knowledge among the recently delivered women (RDW) about newborn danger signs and .
to distinguish the factors associated with ability of identifying the danger Methods: A facility based cross-sectional study was conducted in three sub-district hospitals of Bangladesh among 135 RDW between 1 January 2015 and 30 April 2015.
Seven key danger signs were identified, and responses were categorized accordingly.
Bivariable logistic regression was conducted to determine the likelihood of the association of factors with danger signs identification.
Results: About 51% of RDW could identify one key danger sign.
Knowledge on AufeverAoAo was the most commonly known danger sign .
%).
Middle age (OR 1.
67, 95% CI: 1.
09 - 2.
, high education (OR 2.
95% CI: 1.
46 - 2.
, increased parity (OR 1.
91, 95% CI: 1.
17 - 2.
, and previous hospital delivery (OR 79, 95% CI: 1.
14 - 2.
were found associated with the knowledge of the danger signs.
Conclusion: The findings indicate the immediate need to enhance health education among the RDW about newborn danger signs before their hospital discharge.
Community based health education programs can be a cost effective intervention to increase awareness and early recognition of neonatal danger signs.
Key words: Knowledge.
Newborn danger signs.
Recently delivered women APublic Health of Indonesia Ae YCAB Publisher.
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Issue 2.
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BACKGROUND
With the introduction of Millennium Development Goals (MDG.
, remarkable progress has been made worldwide to reduce childhood mortality.
Bangladesh was one of the first 25 countries to reach the targets of MDG in time, as the underfive mortality rate reduced from 133 per thousand live births in 1989-93 to 46 per thousand live births in 2010-14.
1, 2 Despite this remarkable achievement.
Bangladesh continues to be one of the top ten countries with the highest rate of neonatal mortality.
For Bangladesh, achieving health-related targets of Sustainable Development Goals (SDG.
to reduce neonatal mortality by 2030 will pose a big challenge.
However, it is very much possible to achieve this SDG Approximately 44% of all under five deaths occur within the first few days of life around the world.
4 Reducing the neonatal mortality has been recognized as both the global and national public health challenge, where Bangladesh is no Neonatal danger signs are the indicators for early recognition of sickness among infants and children.
Newborns can develop bacterial infection which is also known as neonatal sepsis.
It may turn to septicemia and consequently, can be involved to cause multi-organ dysfunction.
5 Neonatal mortality is highest on the very first day of life particularly within first five-hour of birth which is also known as window period.
6 During this period, newborns are susceptible to develop lifelong complications if they remain 7 As the day's progress, prematurity, and newborn infection inscribed as the fundamental cause of neonatal death throughout first week of Studies in the past have not only identified targeting reduction of neonatal mortality as a priority, but also highlighted the impact and value of the introduction of community-based programs during the window period.
9 Research suggests that universal coverage of basic essential interventions could reduce neonatal deaths by an estimated 71%.
10 To make the interventions effective, community mobilization and danger sign identification related health awareness are vital needs.
is also essential to circulate knowledge about maternal and newbornAos health condition during gestation and after the delivery so that the recently delivered women (RDW) could take care of their newborns through identifying the danger 11, 12 Recognizing danger signs during pregnancy, childbirth, and postnatal period is also essential for neonatal survival as it will ensure early recognition of lifethreatening illness and early prompt access to medical care.
Study findings suggest that early diagnosis and proper treatment can prevent a remarkable number of child deaths in resource scarce settings.
14 However, there are information gaps regarding the level of knowledge among RDW about newborn danger signs and also about the factors which can influence the level of knowledge of RDW in Bangladesh.
The aim of this study was .
to determine the level of knowledge among the RDW about the newborn danger signs and .
to identify the determinant factors associated with identifying the danger signs.
METHODS
Study Design The present study was a facility based cross-sectional study which was conducted between 1 January 2015 and 30 April The study was undertaken in three sub-district hospitals which are located around 120-150 km in the North West to Dhaka City, the capital of Bangladesh.
Part of administrative requirement, each sub-district has a public hospital AuUpazila health complexAy (UHC) for a population of APublic Health of Indonesia Ae YCAB Publisher.
Volume 3.
Issue 2.
April-June 2017 | A51 300,000-500,000 in the catchment area.
The literacy rate in the study area is around 60%, and the main occupations are farming and small business.
15 UHC receives patients directly from the community and conducts 30-35 normal deliveries take questionnaire was formulated and validated through interjudge validation by a group of public health expertise.
For reliability and finalization of the questionnaire, a pre-testing was carried out in two nearby sub-districts.
Data collection A total of 135 RDW were purposively selected for the interview .
from each UHC).
Participants were interviewed in the selected UHCs with a structured The questionnaire allowed collection of data about the level of knowledge on newborn sickness, focusing on RDWAos recognition of danger signs and determinant factors associated with identifying the newborn danger signs.
Inclusion criteria were: women with normal vaginal delivery, live born baby and physically stable.
With the help of three nurses, the participants were selected based on inclusion criteria in each UHC.
From the selected RDW, data had been collected during their visit to UHCs.
Two medical officers supervised the data Finally, a technical team comprising one research officer and three research assistant did quality control during the data entry process.
Variables and measurements The study participants were RDW who had given birth in the hospitals where the study took place.
Respondents were categorized as AoAoruralAoAo or AoAosemi-urbanAoAo according to their place of living.
Age was categorized as Ao< 20 yearsAo.
Ao20-25Ao.
Ao26-30Ao and Ao>30 yearsAo.
A wealth quintile was considered based on possession of electronic items or vehicles: radio, mobile phone, television, computer, bicycle, and motorcycle.
Respondents who possessed less than two items were considered as AolowAo in wealth.
The education level of the RDW and their husbands were also collected.
Occupation was categorized as unemployed, housewife and employed.
Women were categorized as housewives if they lived and worked at home without any additional income to look after their family and complete household chores.
Employed were those who worked outside of the home and earned a livelihood for her family.
RDW
were asked about their access and attendance to antenatal care (ANC), parity, and knowledge on danger signs of Danger signs .
ypothermia, hyperthermia, convulsion, lethargic, fast breathing, stopped feeding well, and severe chest in-drawin.
were incorporated according to WHO Pocket Book of Inpatient Newborn Care.
Ethics Consideration Permission was taken from the health managers of UHC before conducting the Informed written consent was received from the participants in their native language.
The participating women were informed about the objective of the study and were given the freedom to skip any question.
Ethical clearance was taken from the Ethics committee of Community Medicine Department.
Dhaka Medical College.
Bangladesh.
Statistical Analysis All the analyses were performed using STATA version 13 SE (College Station.
Texas.
USA).
Frequency and proportions were used to present categorical variables.
Mean, and Standard Deviation (SD) were used for the continuous variables.
Bivariable logistic regression analysis was performed to find out factors influencing maternal knowledge on newborn danger APublic Health of Indonesia Ae YCAB Publisher.
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Odds ratio (OR) and 95% Confidence interval (CI) were expressed to identify the association of different relevant factors with the knowledge of at least one danger sign among the RDW.
RESULTS
More than half of the participants .
%) were residents of semi-urban areas.
The mean age of the RDW was 26.
8 years, and 40% of them were either 25 years or older.
Around 72% of the participants received secondary education, 62% of them came from low-asset households, and 72% of the RDW were categorized as housewives.
Around 60% of women had a previous history of hospital delivery (Table .
Table 1.
Basic characteristics of the respondent RDW .
Variables Number
Percent (%) Place of residence Rural
Semi-Urban Age
< 20
25 - 29
Ou 30 Mean (SD) 8 .
Occupation Housewife Employed MotherAos Education level < SSC .
Ou SSC .
Number of Parity 2 to 3 Number of ANC taken 2 to 3 Ou4 Husband Education < HSC .
Ou HSC .
Household assets Low Moderate Previous hospital delivery Yes SSC: Secondary School Certificate (Class .
HSC: Higher Secondary School Certificate (Class .
ANC: Antenatal care The number of RDW having knowledge on at least one danger sign was 51% .
hown in Figure .
About 39% of participants were able to provide correct information on two danger signs.
APublic Health of Indonesia Ae YCAB Publisher.
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n%) At least one danger signs At least two danger signs Fig 1.
Participants in groups having level of knowledge on newborn danger signs Figure 2 displays the respondentsAo knowledge of newborn danger signs.
the 51% of RDW.
Knowledge on Auhyperthermia .
AoAo was the most commonly known danger sign and referred to by almost 66% of them.
More than 62% of them knew about the danger signs AoAolethargicAoAo and AoAofast breathingAy.
Less than 40% of total respondents were able to tell the interviewers about the danger signs of AoAohypothermiaAoAo, and AoAostopped feeding wellAoAo.
Thus the most commonly known AuhyperthermiaAy followed by AoAolethargicAoAo and Aufast breathingAy.
Level of Knowledge .
n %) on newborn danger signs 89 A 87 A 84 A 75 A 46 A 53 A 61 A Fig 2.
Knowledge on seven key newborn danger signs among the participants .
APublic Health of Indonesia Ae YCAB Publisher.
Volume 3.
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April-June 2017 | A54 This study found that middle age [OR 1.
95% CI: 1.
09 - 2.
P<0.
, high education [OR 2.
37, 95% CI: 1.
46 - 2.
P<0.
, increased parity [OR 1.
91, 95%
CI: 1.
17 - 2.
P<0.
, and previous hospital delivery [OR 1.
79, 95% CI: 1.
P<0.
were associated with the knowledge of key newborn danger signs among the participants (Table .
Table 2.
Factors associated with knowing at least one danger sign among the RDW .
Odds Ratio Characteristics P-Value .
% CI) Location of residence Rural Semi-Urban 05 .
83 - 1.
> 0.
Age <25 Years Ou25 Years 67 .
09 - 2.
< 0.
MotherAos Occupation Housewife Employed 88 .
51 - 1.
> 0.
MotherAos Education level < SSC .
Ou SSC .
46 - 2.
< 0.
HusbandAos Education Level < HSC .
Ou HSC .
78 Ae 1.
> 0.
Parity Ou3 91 .
17 - 2.
< 0.
ANC taken Ou2 06 .
91 - 1.
> 0.
Household assets Low Moderate 37 .
78 - 1.
> 0.
Previous Hospital Delivery Yes 79 .
14 Ae 2.
< 0.
RDW: Recently Delivered Women.
ANC: Antenatal Care However, no significant association was found between residence or occupation or household assets with having the knowledge of at least one danger sign (Table .
It was also noted that there was no significant association observed between the knowledge level of danger signs with place of living [Odds Ratio (OR) 1.
67, 95% CI: 1.
09 - 2.
, motherAos occupation [OR 0.
88, 95% CI: 0.
51 - 1.
or husbandAos education [OR 1.
17, 95% CI:
78 Ae 1.
or increase ANC [OR 1.
95% CI: 0.
91 - 1.
or household asset [OR 1.
37, 95% CI: 0.
78 - 1.
among the RDW.
DISCUSSION