Percent of audience who know at least three warning/ danger signs of newborn complications
Community knowledge and awareness of the warning/ danger signs of newborn complications
The “audience,” the intended population for the program, will usually be mothers in the case of newborn babies. Husbands or other household members known to influence decisions about care seeking, as well as other health care providers (such as traditional birth attendants), may also need to know about signs of newborn illness.
“Know” refers to the percentage who can spontaneously name at least three warning/danger signs of newborn complications.
Danger signs that have been proposed include:
- Breathing difficulty, irregular or fast (>60 minute);
- Feeding poorly (less than half of usual consumption);
- Jaundice, pallor, bleeding;
- Convulsions, spasms, jitters;
- Fever temperature greater that 38°C or low temperature less than 36°C; and
- Vomiting green, no stool in 24 hours of life, swollen abdomen. (McCarthy, Lawn, and Ross, 2001).
This indicator is calculated as:
(# respondents who know the warning/ danger signs of newborn complications / Total # of respondents) x 100
Response to knowledge questions asked in surveys
Population-based survey, preferably with a representative sample of the audience
The purpose of this indicator is to assess community knowledge and awareness of the warning/danger signs of newborn complications in order to plan and monitor the impact of behavior change communication program efforts at the community level.
Because most babies are born at home or are discharged from the hospital in the first 24 hours, increasing community awareness of the danger signs of newborn complications is of critical importance for improving newborn survival. More babies die in the first week of life than at any other time in childhood, and those who become ill shortly after birth may deteriorate and die very rapidly. The warning signs of newborn illness may not be recognized, because they are often much less pronounced than those in an older child or adult. Community members can, nevertheless, learn to recognize signs and symptoms of newborn illness (Bang et al., 1999).
The limitations of assessing community knowledge of signs and symptoms of newborn illness are similar to those outlined for obstetric complications. (See indicator Percent of audience who know three primary warning/danger signs of obstetric complications.)
A major limitation with newborn complications is that little consensus exists on which signs and symptoms the general public can use to improve the early diagnosis of serious illness at the community level. Algorithms shown to be sensitive and specific in clinical settings are too complex for use by the general public (McCarthy, Lawn, and Ross, 2001). More simple measures are less specific and will lead to larger numbers of newborns receiving unnecessary treatment. However, having some healthy babies over-treated is preferable to having some sick babies being under-treated and dying as a result.
Programs aimed at raising community awareness of neonatal illness should carry out formative research to determine what signs of illness are already recognized in the community and how to adapt general recommendations to a specific setting. More fundamental research is required to reach consensus on which signs and symptoms caretakers in different settings can consistently recognize.
newborn (NB), knowledge, safe motherhood (SM)
Bang, A.T., R.A. Bang, S.B. Baitule, M.H. Reddy, and M.D. Deshmukh. 1999. “Effect of Home-based Neonatal Care and Management of Sepsis on Neonatal Mortality: Field Trial in Rural India (comments).” Lancet 354, 9194: 1955-1961.
McCarthy, B., J. Lawn, and S. Rae Ross. 2001. The Healthy Newborn: A Reference Manual for Program Managers. CARE, Center for Disease Control, CCHI, and World Health Organization. (Unpublished)