Improving Newborn Health Knowledge Through Structured Maternal Education in Dar es Salaam, Tanzania

Abstract

Background: Neonatal mortality remains high in low- and middle-income countries. Mothers’ knowledge of Essential
Newborn Care (ENC) and neonatal danger signs is crucial for promoting appropriate neonatal care, facilitating early
recognition of illness, and reducing neonatal mortality. Structured health education may improve maternal knowledge;
however, evidence of its effectiveness in routine hospital settings remains limited.
Objective: To evaluate the effectiveness of health education intervention on postnatal mothers’ knowledge of ENC
and neonatal danger signs.
Methods: A quasi-experimental pre–post study using independent cross-sectional samples was conducted among postnatal
mothers in four public hospitals in Dar es Salaam, Tanzania. The post- intervention survey (2021) included 825 mothers
and was compared with a pre-intervention sample of 825 mothers from 2019. A structured maternal health education
package was implemented between the two time points. Data were collected using structured questionnaires assessing
maternal knowledge of ENC and neonatal danger signs. Descriptive statistics and logistic regression analyses were
performed, adjusting for sociodemographic and care-related confounders. Statistical significance was set at P<.05.
Results: Post-intervention mothers had higher levels of education (34.7% vs 28.7%. P=.001), employment (10.2%
vs 5.2%; P=.001), and caesarean delivery (30.9% vs 21.9%; P=.025), but lower uptake of ≥4 antenatal care visits
(81.0% vs 85.4%; P=.003). A higher proportion of post- intervention mothers had heard of neonatal danger signs
(92.4% vs 85.8%; P<.001) and correctly identified at least 50% of them (41.6% vs 36.7%; P=.044). They were more
than twice as likely to correctly identify danger signs (adjusted OR, 2.38; 95% CI, 1.63–3.48). Maternal knowledge
was also positively associated with ≥4 antenatal care visits, receipt of postnatal health education, and delivery at lower
volume hospitals.
Conclusion: The structured health education intervention was associated with higher maternal knowledge of neonatal
danger signs and ENC, although gaps remained in breastfeeding and some infection prevention practices. Knowledge
was greater among mothers with four or more antenatal care visits, those delivering at lower-volume hospitals, and
those exposed to postnatal education. Future longitudinal studies are needed to assess knowledge retention and how it
translates into actual newborn care practices.