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)

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