Abstract
Neonatal and maternal mortality rates remain high in Kenya. Knowledge of neonatal danger signs may reduce delay in deciding to seek care. Evidence is emerging on the influential role of male partners in improving maternal and newborn health. This study analysed the factors that determine men's and women's knowledge and practices in postnatal and neonatal care-seeking, in order to inform design of future interventions. A quantitative, cross-sectional study was undertaken in Bungoma County, Kenya. Women who had recently given birth (n = 348) and men whose wives had recently given birth (n = 82) completed questionnaires on knowledge and care-seeking practices relating to the postnatal period. Univariate and multivariate logistic regression analyses were performed to investigate associations with key maternal and newborn health outcomes. 51.2% of women and 50.0% of men knew at least one neonatal danger sign, however women knew more individual danger signs than men. In the univariate model, women's knowledge of a least one neonatal danger sign was associated with attending antenatal care ≥4 times (OR 4.46, 95%CI 2.73-7.29, p<0.001), facility birth (OR 3.26, 95%CI 1.89-5.72, p<0.001), and having a male partner accompany them to antenatal care (OR 3.34, 95%CI 1.35-8.27, p = 0.009). Higher monthly household income (≥10,000KSh, approximately US$100) was associated with facility delivery (AOR 11.99, 95%CI 1.59-90.40, p = 0.009). Knowledge of neonatal danger signs was low, however there was an association between knowledge of danger signs and increased healthcare service use, including male partner involvement in antenatal care. Future interventions should consider the extra costs of facility delivery and the barriers to men participating in antenatal and postnatal care.
Highlights
The 2030 Agenda for Sustainable Development emphasises the need to reduce preventable newborn deaths and the maternal mortality ratio [1]
Knowledge of neonatal danger signs was low, there was an association between knowledge of danger signs and increased healthcare service use, including male partner involvement in antenatal care
Over a third of women reported sharing pregnancy and childbirth decision making with their husband (38.8%), with the rest either making the decision themselves, their husband making the decision without them, or the decision was made by another family member, such as a mother in law (Table 1)
Summary
The 2030 Agenda for Sustainable Development emphasises the need to reduce preventable newborn deaths and the maternal mortality ratio [1]. Kenya’s neonatal mortality rate (NMR) is 22 deaths per 1,000 live births, and Kenya’s maternal mortality ratio (MMR) is 510 deaths per 100,000 live births [2] This represents a major challenge if the Sustainable Development Goal targets of a NMR of 12 per 1,000 live births or lower, and an MMR of less than 70 per 100,000 live births [3], are to be met. JHPIEGO’s birth preparedness and complication readiness framework proposes that increasing knowledge and awareness of these danger signs will improve problem identification, and will reduce the delay in deciding to seek care [9, 10]. Knowledge of neonatal danger signs may reduce delay in deciding to seek care.
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