Maternal Knowledge of Neonatal Danger Signs: A Cross-Sectional Study in  a Tertiary Hospital, Moradabad, India

Authors

Background

The first 28 days of life, the neonatal period, is the most vulnerable time for a child’s survival. Globally, 2.3 million

children died in the first month of life in 2023 – approximately 6,300 neonatal deaths every day. According to a UN

IGME report, India's neonatal mortality rate (NMR) declined from 28 per 1,000 live births in 2015 to 17 per 1,000 live

births in 2023. Neonatal mortality occurs mainly due to preventable causes infections, asphyxia, prematurity,

hypothermia, hypoglycemia, and jaundice. Informed mothers can identify warning signs of illness in their newborns,

such as difficulty breathing, high fever, or symptoms of jaundice, and then promptly seek professional medical care.

This study assessed maternal awareness of neonatal danger signs

Methods

A hospital-based cross-sectional study was conducted from July to October 2024 among 378 mothers attending

antenatal and postnatal services at a tertiary care hospital in Moradabad, India. Participants were selected using

convenient sampling. Eligible participants included mothers with infants aged 18-45 years, who provided informed

consent; mothers who were critically ill or unwilling to participate were excluded. Data were collected using a pre

tested, structured questionnaire that covered sociodemographic characteristics (age, education, occupation,

parity, residence, etc.) and knowledge of neonatal danger signs, based on the World Health Organization (WHO)

classification. Ethical approval was obtained from the Institutional Ethics Committee of Teerthanker Mahaveer

Medical College, and informed consent was obtained from all participants. Data were entered and analyzed using

software, e.g., SPSS version 25, with descriptive statistics presented as frequencies and percentages, and

associations between maternal knowledge and sociodemographic factors assessed using a chi-square test, with a

p-value <0.05 considered statistically significant.

Results

The majority of participants were married, belonging to the age group of 26–33 years. And were homemakers. Most

were from rural areas. 73.28% of mothers had high knowledge scores (>4), 14.81% reported high confidence in

recognizing danger signs. Commonly recognized signs included fever (95.76%), breathing difficulty (90.74%),

whereas convulsions (21.42%) and lethargy (49.2%) were less known. Significant associations were between higher

knowledge scores and older maternal age (p=0.00), higher parity (p=0.00), receipt of postnatal care (p=0.01), and

full newborn immunization (p=0.00). Multivariate analysis showed that higher parity (AOR = 2.834, 95% CI: 1.494–

5.373), receiving postnatal care (AOR = 2.041, 95% CI: 1.209–3.445), and full immunization of the newborn (AOR =

1.693, 95% CI: 1.012–2.832) were significantly associated with better maternal knowledge.

Conclusion

Although the majority of mothers demonstrated good knowledge of neonatal danger signs, gaps remained in

specific areas such as recognition of convulsions and lethargy. Moreover, maternal exposure to structured health

education was limited. Strengthening postnatal counseling and enhancing communication during routine maternal

and child health visits may significantly improve maternal recognition of neonatal danger signs. Targeted

interventions of this kind have the potential to promote timely care-seeking, thereby contributing to reductions in

neonatal morbidity and mortality.