Domains of maternal knowledge and practices in essential newborn care in Urban Ghana: A factor analysis

Neonatal mortality remains a major public health concern in low- and middle-income countries, including Ghana. Maternal knowledge and practices of essential newborn care (ENC) influence neonatal outcomes but remain inconsistent in many urban settings.

This study aimed to describe maternal knowledge and practices of ENC and to identify underlying domains of these practices using factor analysis, guided by the Health Belief Model (HBM).

A descriptive community-based cross-sectional study was conducted among 148 mothers in the Accra Metropolis. Data were collected through interviewer-administered electronic surveys with a pretested questionnaire. Descriptive statistics summarized reported practices, while exploratory and confirmatory factor analyses identified and validated underlying domains.

Most mothers adhered to key newborn care practices, including early breastfeeding, colostrum feeding, exclusive breastfeeding, delayed bathing, cord care, and vaccination, all of which demonstrated high compliance of >90 % mean score, though lower % mean scores were present for handwashing before breastfeeding (77.6 %), burping (84.2 %), and alcohol rub before newborn care (87.6 %) practices. Factor analysis revealed three domains: hygiene and safety practices, breastfeeding and thermal care, and cord and delivery practices, explaining 51.7 % of total variance. Sampling adequacy (KMO = 0.850; Bartlett's test, p < .001), and model fit indices (CFI = 0.913) supported the three-factor structure, although the RMSEA suggested some limitations.

Mothers demonstrated generally strong ENC practices, particularly in breastfeeding and cord care, but gaps persisted in hand hygiene, immunization knowledge, and burping. Interpreted through the HBM, these gaps reflect perceived barriers and limited cues to action. Strengthening community-based health education within antenatal and postnatal services could address these gaps, improve ENC adherence, and contribute to reducing neonatal mortality.