ASSOSA UNIVERSITY

COLLEGE OF HEALTH SCIENCE

DEPARTMENT OF PUBLIC HEALTH

ASSESSMENT OF KNOWLEDGE ABOUT DANGER SIGNS O F

NEONATAL ILLNESS AMONG MOTHERS VISITING
IMMUNIZATION UNIT IN ASSOSA GENERAL HOSPITAL 2019.

Investigators
Mahlet eyob
Habtie gashaw
Yonas gashaw
Advisor Mrs’s Solen abera(MSC)

THESIS PROPOSAL TO BE SUBMITTED TO ASSOSA UNIVERSITY

COLLEGE OF HEALTH SCIENCES DEPARTMENT OF PUBLIC HEALTH IN
PARTIAL FULLFILMENT OF THE REQUIREMENTS FOR BACHELOR
DEGREE IN PUBLIC HEALTH.

May,2019

Assosa,Ethiopia

i
Table of content

Summary.............................,.......,................................................................................................. i
Acronym/Abbreviation......,........................................................................................................... ii

UNIT ONE: INTRODUCTION

1.1 Background of the study....................................... ....................................................................1

1.2 Statement of the problem......................................................................................................,...7

1.3 Justification of the study...........................................................................................................10

CHAPTER TWO: LITERATURE REVIEW.......................... ...................................................................11

CHAPTER THREE: OBJECTIVE OF THE STUDY

3.1 General Objective................................,....................... .............................................................14

3.2 Specific Objective......................................................................................................................14

CHAPTER FOUR: METHODOLOGY

4.1 Study area and period................................................ ...............................................................14

4.2 Study design...............................................................................................................................14

4.3 Source population....,.................................................................................................................15

4.4 Study population.......................................................... ............. ................................................15

i
4.5 Inclusion and Exclusion Criteria

4.5.1 Inclusion...............................................................................................................................15

4.5.2 Exclusion........................................................,.....................................................................15

4.6 Sampling Technique...............................................................................................................16

4.7 Variable of the study.........................,....................................................................................17

4.8 Operational Definitions..............................................,...........................................................17

4.9 Data collection instrument and procedure............,...............................................................18

4.9.1Data collection instrument...........,......................................................................................18

4.9.2 Data collection procedures.................................................................................................18

4.10 Data quality control..............................................................................................................18

4.11 Data analysis.........,...............................................................................................................19

4.12Ethical consideration.............................................................................................................19

4.13Plan of Dissemination...........................................................................................................19

5.Work Plan..................................................................................................................................20
6.Budget ......................................................................................................................................21

REFERENCE....................................................................................................................................22

Annex 1 Questionnaire..................................................................................................................25

i
Summary

Background

A neonate is also called a newborn. The neonatal period is the first 4 weeks of a child’s life.It is a time
when changes are very rapid.They need strict monitoring with skilled personnel.A mother is the nearest
person to a neonate to identify,present and manage the neonates problem,which ensure that neonate
can lead a healthy life.If so,we need to educate mother’s about neonatal danger signs to enable them to
recognize early symptoms of illness and to enhance their health seeking behavior in order to
minimize early neonatal mortality.

OBJECTIVE: To assess knowledge about neonatal danger signs among mother attending
immunization unit in ASSOSA HOSPITAL2019.
METHOD; Institution based cross-sectional study will be conducted on 176 Mothers visiting
immunization unit in AGH from June 1 -5 , 2011 E.C. A well structured pre tested interviewer
administered questionnaire will be used to collect data. Variables will code then data will enter into the
computer and clean to assure accuracy and completeness before data analysis.

TOTAL BUDGET: The total coast of this research will be 3490 Ethiopian birr.

i
Acronym

ANC............................Antenatal Care

AGH………………....Assosa General Hospital

CI.................................Confidence Level

EDHS..........................Ethiopian Demographic Health Survey

IMNCI.........................Integrated Management Of Neonatal and Child Hood Illness

IMR..............................Infant Mortality Rate

NMR............................Neonatal Mortality Rate

SNNPR........................South Nation Nationality and People Of Region

WHO...........................World Health Organization

BGRS........................Benishangul Gumuz Regional State

i
CHAPTER ONE

1. INTRODUCTION

1.1 Background of the study

A neonate is also called a newborn.The neonatal period is the first 4 weeks of a child’s
life.It is a time when changes are very rapid.They need strict monitoring with skilled
personnel.A mother is the nearest person to a neonate to identify,present and manage the
neonates problem,which ensure that neonate can lead a healthy life.If so,we need to
educate mother’s about neonatal danger signs to enable them to recognize early
symptoms of illness and to enhance their health seeking behavior in order to minimize
early neonatal mortality.

Most neonatal death result from complications related to preterm birth or during
birth.Another significant causes of neonatal death is sepsis including ( meningitis,
diarrhea ,pneumonia and neonatal tetanus),birth asphyxia and injuries, congenital
anomalies and with low birth weight contributing to a large proportion of infant
death[1].

Newborn danger signs refers to warning signs that indicate the newborn needs urgent
medical support in order to survive. Early identification of a sick newborn however, has
some problems. The clinical features are nonspecific e.g. whether the illness is of
infective or metabolic origin; the signs do not help us in differentiating the cause.
Moreover, the distinction between variation of normal behavior and early signs of illness
becomes more difficult in low birth weight and preterm infants [2,3].

1
2
WHO and UNICEF identify the following twelve symptoms as a danger sign in
neonates;

Lethargy/poor feeding

Lethargy and poor sucking in a full term neonate is an indicator of neonatal

illness.Mothers are the most concerned body to give such history,but poor feeding and
lethargy may normal in preterm baby.They need early assessment and referral to
equipped health facility for better management[4].

Convulsions

A sudden onset abnormal electrical activity in the brain is called convulsion. When the
temperature recording more than 380C we said febrile seizure.It might come with
infection.Children who have their first febrile convulsion before the age of one year have
a higher risk of having recurrent febrile convulsions. This type of convulsion tends to run
in families, and affects boys more often than girls [4].

Respiratory problems

Many neonatal illness have a manifestation of respiratory problems .It may lead to
increased respiratory rate more than 60 per minute in one minute full count and other
signs of respiratory distress such as nasal flaring, chest in drawing,accessory muscle
use,bluish discoloration are an indicator of serious underlying problem.It could be due to
pneumonia, hyaline membrane disease, heart failure or malformation. The normal
breathing pattern in the new born is characterized by brief periods of cessation of
breathing called periodic breathing. The common causes of apnea in a neonate can be
(any one or in combination): hypo or hyper thermia , hypoglycemia, septicemia, anemia,
meningitis, intracranial hemorrhage or apnea of pre-maturity [4].

3
Vomiting

Vomiting in case of persistent, projectile or bile stained vomiting in association with

failure to pass meconium during the first 24 hours and or abdominal distension, the baby
should be investigated for intestinal obstruction. Such neonates must reach the hospital
before becoming dehydrated or worse due to electrolyte imbalance [4].

Diarrhea

Is a condition in which a bowel habit change occurs and can be manifested by increasing
the frequency and loosening of stool. It is mainly infectious in origin and should be taken
seriously. Breast fed babies pass more frequent stools than formula fed babies. Maternal
ingestion of drugs (ampicillin, laxatives) and certain fruits like mango may result in loose
stool in breast fed babies; it does not need any specific treatment [4].

Thermal imbalances

It is one of the neonatal danger signs which need urgent management.It can be
hypothermia or hyperthermia.Hypothermia (temperature below 36.5 degrees centigrade)
is a common signs in sick neonates especially in low birth weight babies. Axillary
temperature recorded for at least three minutes will indicate the extent of hypothermia in
a baby who is "cold to touch”. Unlike adults, neonates often manifest hypothermia as a
sign of infection. Fever (temperature above 37.5 degrees centigrade) is a sign of illness
usually in term neonates [4].

4
Jaundice
Is a yellowish discoloration of a new born baby’s skin and eyes.It is particularly
common in pre -term babies.Jaundice can be physiological or pathological, but
when it appears on the first day of life or the skin staining is up to palms and soles
or it persists beyond 2 weeks of life, needs investigation and appropriate
treatment. Hyper-bilirubinemia in the first week could lead to kernicterus and
severe disabilities [4].

Failure to Pass Meconium and Urine

All healthy babies must pass meconium within 24 hours of age . Non passage of
meconium by 24 hours age is an indication for doing appropriate investigations to
exclude intestinal obstruction.After birth,most pass urine by 48 hours of age.Infants
with delayed passage of urine should be investigated for congenital conditions like
obstructive uropathy and a genesis of kidneys.Normal neonates pass urine 6 to 10 times
in a day if feeding is adequate[5].

Tracheo-esophageal fistula

A new born baby with excessive drolling,frothy saliva and chocking and cyanosis
during first feed should alert staff to rule out atresia of the upper digestive tract.Over
flow of milk and saliva from o esophagus and regurgitation of secretions through the
fistulous tract into the lungs results pneumonia[5].

Excessive weight loss

5
If birth weight or previous weight records are available,weight loss pattern is an
objective indicator of not being well in a new born.Weight loss more than 10% over
birth weight in a term baby and more than 15% in preterm any acute loss of more
than5% should be viewed with concern and should attempt to seek the cause as early
as possible[5].

Congenital Heart Disease

.cardiac disease should be suspected when there is significant distress with cyanosis
,tachycardia,murmur and hepatomegaly.’Tachypnea may be marked but chest retractions
are minimal.If the baby presents in shock and distress one should suspect cardiac
disease[5].

These danger signs in newborns are non-specific and each danger sign can be a sign of
almost any disease or illness .lack of knowledge about these neonatal danger signs is also
a major barrier to treatment seeking which may ultimately lead to neonatal death[6].

Approximately third-quarter of neonatal deaths easily preventable by using antibiotics

for infectious conditions and implementing appropriate post natal care such as using
sterile blades,using knit caps and kangaroo mother care to prevent hypothermia
.regarding to this better understandings of mothers about neonatal illness is mandatory to
early health care seeking. Different tools to facilitate identification of neonatal health
problems and management were introduced into the health programs in several countries
like Ethiopia. IMNCI developed by WHO attempted to provide a standard case
definitions of various neonatal morbidities,for example neonatal sepsis ,jaundice and
pneumonia ,based on presence of certain clinical signs.For effective implementation of
IMNCI strategy it is neccesary for mothers to recognize danger signs in a sick
neonate and thereafter seek the appropriate level of health care,which in turn would
reduce mortality[7].
6
The Ethiopian Ministry of Health ,through its flagship health extension program,prepared
an illustrated booklet called Family Health Card(FHC).The FHC contains recommended
action points and key health messages on maternal ,new born and child health.It also
messages on neonatal danger signs to help families recognize these danger signs and
seek prompt treatment[8].

Despite the implementation of the FHC and other new born focused interventions such as
Community Based Newborn Care(CBNC),Integrated Community Case
Management(ICCM),and Integrated Management of new born and childhood
illness(IMNCI),Ethiopia still has the highest neonatal mortality rates in the world.
Modern treatment seeking for neonatal danger signs is also negatively influenced by
social ,cultural and religious factors in the country.So far, studies in different countries
reported the inconsistency of finding related to level of mothers’ knowledge and related
factors about neonatal danger signs. The repeatedly reported danger signs were: difficulty
in breathing, poor sucking of breast milk, and lethargy/unconsciousness [8].

..

7
 1.2 Statement of The Problem

Every year over 140 million babies are born.The 28 days of life is the neonatal period
present the most vulnerable time for a child’s survival.In 2012, approximately 3 million
(46%)of under 5 death occur during this period.Every day,an estimated7,700 newborns
die globally. The vast majority these death happen in limited settings mainly in the 3 rd
world. Most new born deaths occur due to lack of awareness about danger signs of
neonatal illness. This leads the disease to complicate which makes the management
process so difficult and worsens the progress and results in the neonatal mortality and
morbidity[9].

.Each year in Africa,around 1.16 million babies die on their first month ;among this half
of them on their first day of life . Sub-saharan Africa ,where about a third of under 5
death occur during the neonatal period,have the highest neonatal mortality rate(31 death
per 1000 live births in 2013) and account for 39% of global neonatal deaths[10].

Neonatal morbidity and mortality rates in Ethiopia are among the highest in the world
and stem from a range of socioeconomic, political and demographic factors. Ethiopia is
the 6th country were 81,700 new born deaths occur each year and has the 6 th highest
burden with the nearly 28,000 first day deaths or 3% share of the global total first day
neonatal deaths following India, Nigeria,Pakistan, china,democratic republic of Congo.
Many of these deaths are preventable. Around 120,000 newborns die every year and the
neonatal mortality rate is 37 per1000 live births.The neonatal mortality is really a
concern for all countries specially in Ethiopia. As neonatal mortality contributes to over
62 % of infant deaths in Ethiopia[ 2,11].
8
Interventions to improve child survival must address the neonatal period. The World
Health Organization guidelines for essential newborn care encompass cleanliness during
delivery practice, thermal protection, initiation of breathing, early and exclusive
breastfeeding, eye and cord care, immunization, management of illness, and care of low
birth weight infants[ 12].

In managing neonatal illness better understandings of mothers on neonatal danger signs is

very crucial to early diagnose and management of the illness.Thus the knowledge of the
mother’s regarding newborn danger signs has a great influence on the health of the
newborn. Integrated Management of Newborn and Childhood Illnesses (IMNCI)
emphasize on mothers, community leaders and health workers to identify danger signs
among newborns for early referral to appropriate health care provider/ facility. Early
identification with prompt and appropriate referral serves as backbone of the programs
aiming at reduction in neonatal mortality. Mothers need to know the danger signs of sick
newborn. They can explain these signs to others or family member in a simple language
so as to enable them to identify the danger signs and to seek early and prompt medical
help.Therefore ,the main purpose of this study is to asses mother’s knowledge about
neonatal danger signs of illness[13].

9
1.3 SIGNIFICANCE OF THE STUDY

In low and middle income countries approximately third -quarter of death occur in the
first 24 hours of which more than half occur at home so increasing the awareness about
danger signs for mothers is considered as one of the most important components of the
strategy to reduce mortality among new born babies.early identification of any danger
sign of illness can ensure that mothers approach the health facility entirely.Numerous
studies have examined the determinants of neonatal mortality,but few have explored
maternal level of knowledge on neonatal danger signs.So, it will be used as information
to AGH to improve mothers knowledge about neonatal danger signs.

Better understanding about danger signs is necessary in order to fulfill the knowledge
gap. The study findings will help to provide appropriate information for regional health
office, policy makers, pediatricians, governmental or non-governmental organizations
and other stakeholders.It also helps in designation and development of locally targeted
and prioritized interventions and strategies that will effectively address the problem of
neonatal morbidity and mortality. The research hasn’t done in BGRS in this topic.It may
also serve as a baseline for other researchers to study such problems in depth in the
study area besides filling the literature gap.

10
CHAPTER TWO: LITERATURE- REVIEW
Knowledge about neonatal danger signs

According to WHO report every year over 4 million babies die during the neonatal period
globally;98% of the death occur in developing world[14].In developing nations death
mostly occur at home up two third of which can be prevented if timely and efficiently
health measures are taken.A lot of this deaths are due to late recognition of neonatal
danger signs by mothers[15].

A study conducted in Northern India on the perception of care giver about the danger
signs of neonatal illness with 200 mothers reported that more than one-third of the
caregivers recognized fever, irritability, weakness, abdominal distension/vomiting, slow
breathing and diarrhea as danger signs in neonates. Seventy-nine (39.5%) of the
caregivers had seen a sick neonate in their own family in the past 2 years. Continuous
crying was reported as a common manifestation of neonatal illness and this was
supported by the findings of eight key informant interviews with caregivers who had
experienced adverse neonatal events[16].

A study conducted in Nigeria on knowledge of mothers about neonatal danger signs

showed that the percentage of mothers who were able to recognize three or more
neonatal danger signs was 30.3% of all women in the study:27.5% of mothers could
name at least two danger signs.The rest 43.2% mothers mentioned one danger sign.From
this study the most known neonatal danger sign was fever it was mentioned by(92%) of
11
mothers.The least mentioned neonatal danger sign was discharge from umbilicus(1.5%)
[17].
A study conducted in Uganda on inadequate Knowledge of Neonatal Danger Signs
among Recently Delivered Women showed that Knowledge of at least one of the defined
key danger signs was present in 58.3% of all women: however, only 14.8% could name at
least two signs. “Fast or difficulty breathing” was the most commonly known danger sign
and referred to by almost 30% of the women. The response “fever” and “difficulty
feeding” was given by approximately 20% of the women. The least known danger signs
were “convulsions”, “movement only when stimulated” and “hypothermia”, stated by
less than 5% of the respondents[18].

A study conducted in Kenya on knowledge of mothers about neonatal danger sign

showed that 84.5% of the maternal level of knowledge is poor to identify at least 3
neonatal danger signs .The rest 16.5% mentioned only one danger sign. The most
mentioned danger signs by the mothers was unable to suck or breastfeed it accounts 79%
of mothers response.The least known neonatal danger sign was hypothermia(5%)[18].

In Ethiopia according to EDHS 2016 the neonatal mortality rate was 29 per 1000 live
births[19].Ethiopia was one of the countries which met the target for MDG-4 on child
survival 3 years a head of time ,as under 5 mortality rate has declined by 2/3 from 1990
figure of 204 per 1000 live birth to 68/1000 live births in 2012.Despite this remarkable
achievement the mortality data by age reveals that the decline in neonatal mortality is
not as impressive as the infant and child mortality rate[19].

Another study conducted in Mekele city public health institution shows that from a total
of 350 respondents 90% of mothers had known at least one neonatal danger sign
.However ,only 50.6% of mothers had known at least three neonatal danger sign .Fever
was more commonly known neonatal danger sign by almost
12 81.4% of mothers followed

by persistent vomiting and poor feeding was given by 57.1% and 42% of respondent
respectively [20].
A study conducted in Gonder town in North West of Ethiopia shows that more than
79% of mothers mentioned at least one key dangers sign. Two hundred-forty (39.8%)
mothers were responded high temperature, 205(34%) mothers were responded vomiting,
163(27%) mothers were responded diarrhea, and 104(17.2%) mothers were responded
unable to feed as a key dangers sign. The prevalence of mothers good knowledge about
neonatal danger sign was 18.2%[20].

A study conducted in Chencha District in Gamo Gofa Zone, South Nation Nationality
and People's Region of Ethiopian (SNNPR) shows that out of the total respondent's
360(57.1%)mentioned fever and 13(2.1%)mentioned jaundice or yellowish discoloration
of palms/soles353(56.0%) mentioned unable to breastfeeding, 265(42.1%)mentioned
lethargy/unconscious ,38(6.0%)mentioned convulsions The prevalence of mother’s
‘knowledge about neonatal danger sign was 50.3%[21].

A study in Wolkite town, Gurage Zone, SNNPR ,Ethiopia knowledge of neonatal danger
signs among mother's shows that, out of the total respondent's diarrhea 160(57.3%),fever
136(48.4%),persistent vomiting 127(45.2%),poor feeding or unable to suck55(19%),and
convulsions 37(13.2%).The prevalence of mother's good knowledge about neonatal
danger signs was31.32%[22].

13
Conceptual frame-work

This is the conceptual frame -work developed specifically for the study by the principal
investigator through reviewing related literature.The frame work need to focus on the
mothers’ knowledge about neonatal danger signs and the variables that affect it.And it is
believed to support the study entitled as”Assessment of Knowledge of neonatal danger
signs among mothers.

Maternal
education
Occupation

Ethnicity

Marital Knowledge of
status mothers about
neonatal danger sex
signs

Religion
Number of
children Maternal
age

14
CHAPTER THREE: OBJECTIVE OF THE STUDY

3.1 General Objective

To asses knowledge about danger signs of neonatal illness among mothers who gave birth
within 12 month in Assosa town on April 25-May25 in 2019.

3.2 Specific Objective

1. To determine the level of knowledge of mothers towards

15 neonatal danger signs in
Assosa town on April 25-May25 in 2019.
CHAPTER FOUR: METHODOLOGY

4.1 Study Area and Period

The study will be conducted in North west part of Ethiopia, Benishangul gumuz region ,
Assosa town which is 661Km far from Addis Ababa, the capital city of Ethiopia. Located
in the assosa zone ,this town has latitude and longtiude of 10º
04’N34º31’E/10.067ºN34.517ºE,with an elevation of 1570meters.The town is boarderd
on the south by Mao-komo special woreda ,on the west by sudan and northeast by
kamashi.specifically in AGH Based on the data from Assosa town health bureau, the
total population of the town is 63,840 of this 32,112 are male and 31,728 are females. The
town consists of 1 hospital, 1 health center, 2 governmental clinics and 9 private clinics.
The governmental hospital serves about greater than 250,000 peoples. According to
Assosa General Hospital Human Resource’s Office There are 29 physicians, 3
specialists, 6; Integrated emergency surgeons and obstetric surgeons, 5’---Health
Officers, 107’ nurses,38 ‘ midwives 16’ laboratory professionals and 22 ‘ pharmacists.

4.2 Study Design

Institutional based cross -sectional study using quantitative methods will be conducted to
assess knowledge about neonatal danger signs among mother who gave birth with in12
months.

4.3 Source Population

16
The source population for this study will be all mother who gave birth within 12 month
and come for immunization for their infant In AGH .
4.4 Study population

The study population is mother who gave birth within 12 month and who present during
data collection period in AGH.

4.5 Inclusion and exclusion criteria

4.5.1 Inclusion

All mother those who gave birth within 12 month in Assosa town and Mothers’ those
who come for immunization for their infant .

4.5.2 Exclusion

Mother those who is who are not mentally capable of being interviewed

4.6 Sample Size Determination And Sampling Technique

4.6.1 Sample Size Determination

Sample size was determined by using single population formula based on the following
assumptions;95%confidence level, 31.32% MTUTH and 5% margin of error.

N=z2(p(1-p)/d2. (1.96)2(0.6668)(.3132)/(0.05)2=330
17

N=sample size required

Z=standard normal distribution (1.96) with confidence level (CI=95%).

P=Prevalence (p=0.3132) d=margin of error (d=.05)

With the above input the sampling required for this study was 330.Since source
population <10,000 ,correction formula will be employed:

nf=n/1+n/N=330/1+330/312=160

n = minimum sample size (330), N = total number of mothers attending immunization

unit (312), Nf =minimum final sample size Thus nf =160. After which n f become
160and considering 10% non-response rate of 16 lastly the final sample size become
176.

4.6.2 Sampling Technique

.Individual study participants will be selected by consecutive sampling at immunization

unit during the data collection period. .

4.7 Variable in this study

Dependent variable

Knowledge about neonatal danger signs.

Independent variable

-Mothers educational status - Occupation 18 -sex

-Mother’s age - Ethnicity

 -Marital status - Religion

4.8 Operational Definition

Neonatal period refers to the first 28days of life (dividing in to early neonatal period (the
first 7days ) and late neonatal period (day 8-28).

Neonatal danger signs are symptoms that complicate the lives of the neonate and
happen during the neonatal period.

Knowledge is a state of awareness of mothers on neonatal danger signs; defined on the

basis of the score .

Good knowledgeable mother those who answers more than or equal to three neonatal
danger signs.

Poor knowledgeable mother those who answer less than three neonatal danger signs.

4.9 Data collection instrument and procedure

4.9.1 Data collection instrument

Interviewer administered questionnaire will be prepared in this study which is developed after
reviewing different literature .The questionnaire will be prepared in English and translation
Amharic . The principal investigator , w ill be a data collector
19 in order to maintain its
consistency. It includes two main parts about other socio-demographic factors and knowledge of
mothers about neonatal danger signs.
4.9.2 Data collection procedures

Before the data collection period pre- testing of the questionnaire will be conducted on mother's
who had under twelve month infant by taking 5% of total sample size in Assosa health center
then necessary modifications will be made before being applied on the study participants . The
data collected until the required sample size will be achieved.

4.10 Data quality control

To ensure the appropriate and quality of the data collection, interviewers will discuss half day
about the aim of the study, the contents of the instrument, and how to conduct it before starting
data collection properly. On each day the filled format will be checked by principal investigator
for completeness and correctness of data. Finally the completeness of the questionnaire is
checked before analysis and interpretation.

4.11 Data analysis

After data collection, the questionnaires will be checked for completeness, manually ,then
Variables will code then data will enter into the computer and clean to assure accuracy
and completeness before data analysis. Descriptive statistics will be used. For categorical
variables either statistics with frequency and percentage or graphic presentation using
bar-chart , For continuous variables, median and IQR methods of analysis will be used.

20
4.12 Ethical Consideration

Paper of approval and letter of permission will be obtained before the beginning of data
collection from Head of department of public health officer, college health science,
Assosa university. The purpose of the study is briefly explained for the respondents and
informed consent will be obtained. During data the study participants will be informed
that the information collected will be kept confidential.

4.13PLAN OF DISSEMINATION

The finding will be presented to Assosa University College of Health Science. It will
also presented in different seminars,meetings and workshops and disseminated to
different stakeholders.As information to AGH to improve mother’s knowledge about
neonatal danger signs. It might also be published in scientific journals.

5.WORK PLAN

21
n Activities April May June
o
1 Proposal development
2 Questionnaire
development
3 Data collection
4 Data management
5 Data analysis
6 Presentation

22
23
Budget
Pape Breakdown
Description of Items Unit of Quantity Unit Cost Total Cost
r Measure
Table 2: Budget breakdown
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m
3150
450P
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Num
ber1
0550
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1055
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200
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Agency Addis ababa ,Ethiopia ICF Calverton.

.13,A,R,Dongre,P,R Deshmukh and B,S,Gang Perception and health care seeking about
newborn danger signs among mother in rural Ward Halnchian J pediatric, 2008 April;
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75(4).pub med Abstract full text.
14, Jacob Sandberg, Mail,Kerenod berg Peffersson ,Gustar Asp,Jerome Kaba
kyenga,Annette Agarde inadequate knowledge of neonatal danger signs among recently
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Annex I Information Sheet
Questionnaire Identification Number ____________
We are Assosa university students and we are conducting this reasearch for the parital
fullfilment of our Bachelor degree in public health in Assosa University.we are trying to
assess knoweldge of mothers about neonatal danger signs among mothers visiting
immunization unit in AGH.We would like your honest opinion pertaining to the questions.
Name of the investigators Mahlet eyob
Yonas gashaw
Habtie gashaw
Name of advisor Mrs’s Solen Abera
Name of the organization: Assosa University, College of Health Sciences, And Department of
public health.
Introduction:
Information sheet and consent form is prepared for mothers who will participate in research
project, across-sectional study of assessment of knowledge about neonatal dangersigns among
mothers in AGH.This information sheet and consent form is prepared to explain the study you are
being asked to join.
Please listen carefully and ask any questions about the study before you agree to join. You may
ask questions at any time after joining the study. The investigators are final year public health
Department of Public health , College of Health Science, Assosa University, and one advisor
from Assosa University.
Purpose
We are hopeful that this research will benefit the maternal child health care improvement and
quality of care.
We will provide each of the units with research results and conclusions for your information.
Procedure
In assessment of Knowledge of mothers about Neonatal Danger Signs among Mothers visiting
immunization unit in AGH. If you are willing to participate in this project, you need to
understand and say ‘yes’ on the agreement form. Then after, you will be interviewed by the data
collector. All your responses and the results obtained will be kept confidential by using coding
system whereby no one will have access to your response.
Risk/ Discomfort
By participating in this research project, you may feel that it has some discomfort especially on
wasting time about 20 minutes. We hope you will participate in the study for the sake of the
benefit of the research result. There is no risk in participating in this research project.
29

Benefits
If you participate in this research project, there may not be direct benefit to you but your
participation is likely to help us in assessing of Knowledge of mothers about Neonatal Danger
Signs.Ultimately, this will help us to identify the gap and take the appropriate intervention by the
authorized stakeholder. You will not be provided any incentive or payment to take part in this
project.
Confidentiality:
The information collect from this research project will be kept confidential and information about
you that will be collected by this study will be stored in a file, without your name, but a code
number assigned to it. In addition, it will not be revealed to anyone except the principal
investigator and will be kept locked with key.
Right to refuse or withdraw:
You have full right to refuse from participating in this research. You can choose not to respond to
some or all questions if you do not want to give your response. You have also the full right to
withdraw from this study at any time you wish, without losing any of your right.

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Annex I Consent form

I undersigning this document ,I am giving my consent to participate in the study

entitled as ’’Assessment of knowledge of mothers about neonatal danger signs among
mothers visiting immunization unit AGH.” I have been informed that the purpose of this
study is to asses knowledge of mothers about neonatal danger sign.I have been told that
my answers to the questions will not be given to anyone else and no reports of this study
ever identify me in any way .I can refuse to participate in this study without giving a
reason and this willn’t affect me.

Do you have your agreement to procced? If yes continue,if no,Stop, Thank you!

-Name of the facility.......................................

-Date............./............../............

-Interviewer’s name..................... Signature........... 31

-Supervisor’s name.............................Signature...........
-

AnnexII.Questionnaire section A: socio-demographic characteristics

No Question Coding catagories Skip

1 Where do you live now? Sub-city
Kebele

32
2 Age of mother (in complete year)
3 Age of child(wk)
4 Religion Orthodox……………. 1
Catholic………………2
Protestant……………..3
Muslim………………..4
Others(specify)………..5

5 Ethnicity Oromo………………. 1
Amhara……………….. 2
Berta ……………….. 3
Shinasha……………….4
Gumuz………………….5
Others(specify)…………6
6 What is your level of education? Didn’t attend school…….1
Read and write………….2
Primary(1-4)………… 3
Primary(5-8)………… 4
Secondary(9-12)……… 5
Tertiary(above 12)……. .6

7 Husbands’ level of education Didn’t attend school…….1

Read and write ………….2
Primary(1-4)…………….3
Primary(5-8)…………….4
Secondary(9-12)……… 5
Teritary(above 12)…… 6

8 What is your occupation? Employed……………….1

Student…………………..2
Merchant………………....3
Farmer……………………4
House wife……………….5
Others(specify)……………6
9 What is your marital status? Not married………….1
Married………………2
Separated…………….3
Divorced……………..4
Widowed…………….5

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10 Income(ETB) Not income…………...1
Below200……………..2
201-500……………….3
501-1000…………… 4
1001-1500…………….5
Above1500……………6

11 Family size 1-3……………….1

4-6………………..2
7-9………………..3
>9…………………4

Section B: knowledge about danger signs

S Question Coding34categories skip

No
12 Do you know any neonatal danger signs? Yes........................................1
No..........................................2

13 Can you mention neonatal danger signs? Difficulty of breathing.................1

Lethargy/Unconsciousness.........2
Convulsion...................................3
Baby won’t cry.............................4
Fever............................................5
Baby is cold..................................6
Pus discharge from umbilicus.......7
Poor feeding or unable to suck.....8
Persistent vomiting.......................9
Diarrhea........................................10
Unable to pass stool......................11
Unable to pass urine.....................12
Red/discharge from eyes...............13
Yellow skin color (jaundice).............14
Others(specify).................................15

14 Do you know what causes neonatal illnesses Lack of cleanliness...........................1

problems?
Hunger..............................................2
Coldness.............................................3
Evil spirit(eye).....................................4
I don’t know........................................5
Other(specify)....................................6

15 Do you know complications/ conditions of a Yes.........................................................1

newborn that need medical care?
No..........................................................2

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16 What are the complications/conditions of a Difficulty of breathing.................1
new born that need medical care?
Lethargy/Unconsciousness.........2
Convulsion...................................3
Baby won’t cry.............................4
Fever............................................5
Baby is cold..................................6
Pus discharge from umbilicus.......7
Poor feeding or unable to suck.....8
Persistent vomiting.......................9
Diarrhea........................................10
Unable to pass stool......................11
Unable to pass urine.....................12
Red/discharge from eyes...............13
Yellow skin color (jaundice).............14
Others(specify).................................15

17 From whom did you get the information? Health processionals.........................1

Media..................................................2
Neighbors.............................................3
Friends..................................................4
Reading books.......................................5
Others(specify).......................................6

18 Sign of unable to breastfeed Unable to suck.......................................1

Unable to swallow.................................2
Breast engorgement..............................3
Suck long time............................................4
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Crying..........................................................5
Lack of interest.............................................6
 I don’t know ...........................................,.....7
Others(specify)............................................8

19 Sign of lethargy/unconsciousness No energy............................................1

Weakness.............................................2
Sleep long time...................................3
Unable to awake for feeding................4
Unable to suck......................................5
I don’t know..........................................6
Others(specify)......................................7

20 How did you check of fever? Hot to touch forehead...........................1

Hot to touch body..................................2
Sweating..................................................3
Weakness/lethargic..................................4
Using thermometer...................................5
I don’t know............................................6
Others(specify).........................................7

21 If a new born have diarrhea what will you Increase breast feeding...........................1
do?
Give LEMLEM/ORS....................................2
Take to health institutions.........................3
Not gain any fluid orally..............................4
I don’t know................................................5
Others (specify0...........................................6
37
22 How did you identify sign of unable to pass Irritable /cry................................................1
stool?
Pain during defecation.................................2
Hard abdomen..............................................3
Dry stool........................................................4
I don’t know.........................................5
Others(specify)........................................6

23 If a newborn is sick do you continue breast Yes......................................................1

feeding?
No.......................................................2

24 Reason for not continuing breast feeding? Cause vomiting....................................1

Cause chocking.....................................2
Cause diarrhea......................................3
I don’t know...........................................4
Other(specify)..........................................5

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