Maternal knowledge of neonatal danger signs and associated factors among postpartum mothers attending public health facilities in Adama town, Ethiopia

The neonatal period, defined as the first 28 days of life, remains a critical phase for child survival. According to the 2019 Ethiopian Demographic and Health Survey, the neonatal mortality rate was 33 deaths per 1,000 live births. Despite various interventions, neonatal mortality and morbidities related to neonatal danger signs persist. Previous studies on maternal knowledge of neonatal danger signs have reported inconsistent findings. This study replicates established associations between maternal characteristics and neonatal danger sign knowledge in a previously unstudied urban site within Oromia, Ethiopia, and also examines how prompted recognition affects the measured prevalence of knowledge compared with spontaneous-recall approaches. A facility-based cross-sectional study was conducted from April 1–30, 2022. A total of 426 postpartum women were selected using systematic random sampling. Data were collected through face-to-face exit interviews using a structured questionnaire. Data entry was done with EPI Info, and analysis was performed using SPSS version 26. Knowledge assessed via 9 World Health Organization (WHO) neonatal danger signs (NDS) items (prompted yes/no, mean cutoff ≥ 5 = good). Multivariable logistic regression identified factors ( p < 0.05). 75.5% (95% CI 71.6–79.7%) had good knowledge. Factors significantly associated with good maternal knowledge include educational level of college or above [AOR: 4.83; 95% CI: 1.49, 15.64], secondary educational level [AOR: 3.10; 95% CI: 1.09, 8.78], delivery by caesarean section [AOR: 2.47; 95% CI: 1.28, 4.80], multigravida [AOR: 2.11; 95% CI: 1.26, 3.52], and grand multigravida [AOR: 3.68; 95% CI: 1.08, 12.62]. Maternal knowledge of neonatal danger signs was relatively high in this urban postnatal sample, but the estimate is influenced by the recognition-based measurement approach. The findings reinforce previously reported associations and provide context-specific evidence from Adama town to inform newborn health education.