Knowledge of pregnancy danger signs and associated factors among pregnant teenagers in Western Hararghe, Ethiopia: a facility-based cross-sectional study

Obstetric danger signs are often unpredictable, making timely recognition critical for preventing maternal complications. Enhancing maternal knowledge, ensuring quality maternal care, and promoting prompt health-seeking behavior are essential strategies for reducing maternal mortality. While previous studies have primarily focused on the general population of women of reproductive age, empirical evidence regarding pregnant teenagers’ knowledge of these signs, and the factors influencing it, remains limited and largely unexamined in Ethiopia. This study aimed to assess the level of knowledge regarding pregnancy danger signs and identify associated factors among pregnant teenagers in public health facilities in Western Hararghe Zone, Ethiopia, from October 1 to 30, 2024. A facility-based cross-sectional study was carried out among 402 pregnant teenagers attending antenatal care (ANC) in public health facilities within the Western Hararghe zone. A total of seven facilities, comprising five hospitals and two health centers, were selected via simple random sampling, while study participants were recruited using systematic random sampling techniques. Data were collected through face-to-face interviews using a pre-tested structured questionnaire administered by six diploma-level midwives. The collected data were coded and entered into EpiData version 3.1, then exported to SPSS version 27 for analysis. Variables with p -value < 0.25 in bivariable analysis were entered into multivariable logistic regression model. The strength of associations was measured using adjusted odds ratios (AOR) with 95% confidence intervals, and statistical significance was declared at p < 0.05. This study demonstrated that 23% (95% CI: 19.03–27.26) of pregnant teenagers possessed good knowledge of pregnancy danger signs. Several factors were significantly associated with higher knowledge levels: achieving a secondary education or higher [AOR = 3.1; 95% CI (1.52, 6.17)], having a spouse with formal education [AOR = 5.52; 95% CI (2.36, 12.66)], being multigravida [AOR = 5.96; 95% CI (2.91, 12.19)], and residing within 30 min of a health facility [AOR = 2.8; 95% CI (1.33, 5.88)]. In conclusion, the level of knowledge regarding pregnancy danger signs among pregnant teenagers was poor. These findings underscore the urgent need for coupled-based educational health program to enhance awareness. Furthermore, tailored interventions should prioritize primigravida teenagers and those residing in remote areas to bridge the existing gaps in maternal health literacy.