{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T11:25:10Z","timestamp":1788434710192,"version":"build-2803163510"},"reference-count":20,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sage Open Medicine"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Maternal death is a foremost public health concern in underdeveloped countries, particularly in postwar Eastern Tigray, Ethiopia, where healthcare infrastructure is limited. Identifying obstetric risk factors is crucial to reducing unnecessary maternal mortality. Disparities in knowledge of obstetric danger signs are a critical barrier to reducing maternal mortality, particularly in fragile, post-conflict settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>The main goal is to measure the knowledge disparity of pregnant women about obstetric danger signs and associated factors at postwar Eastern Tigray, Ethiopia, health facility centers using penalized and Bayesian logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a health-facility-based cross-sectional study. Data were collected from 102 pregnant women, primarily from rural areas, using structured interviews. Predictors included socioeconomic factors (education, residence, and income), healthcare access (distance to a health facility), and obstetric history (parity). Knowledge of obstetric danger signs was the outcome, classified as \u201cgood\u201d (\u2a7e3 signs identified) or \u201cpoor.\u201d Associations were analyzed using penalized logistic regression and Bayesian logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Descriptive statistics revealed profound disparities in knowledge: prevalence was 92.3% in urban versus 12.7% in rural residents, 93.5% for the shortest versus 5.1% for the longest travel time, and 5.6% for the lowest versus 91.7% for higher education levels. Penalized regression identified urban residence as the strongest predictor (adjusted odds ratio\u2009=\u200927.4,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.002). Bayesian analysis affirmed significant associations for education Level 2 (median odds ratio\u2009=\u200978.2, 95% credible interval: 9.7, 1042.4). The longest travel time was associated with a 97% reduction in the odds of knowledge (odds ratio\u2009=\u20090.03, 95% credible interval: 0.002, 0.34). Model comparison confirmed the superiority of penalized regression over the failed standard model.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Knowledge of obstetric danger signs is predominantly determined by structural access factors specifically urban residence and travel time to health facilities followed by educational attainment. These findings highlight the urgent need for targeted, equity-focused interventions that address geographical and infrastructural barriers to health information in postwar Eastern Tigray, Ethiopia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20503121261426069","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T18:54:50Z","timestamp":1773255290000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Disparities in obstetric danger sign knowledge among pregnant women in postwar Eastern Tigray, Ethiopia: Robust logistic regression"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1347-6994","authenticated-orcid":false,"given":"Yemane Hailu","family":"Fissuh","sequence":"first","affiliation":[{"name":"Department of Statistics, College of Natural and Computational Sciences, Aksum University, Axum, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3914-5699","authenticated-orcid":false,"given":"Yemane Asmelash","family":"Gebretensae","sequence":"additional","affiliation":[{"name":"Department of Statistics, College of Natural and Computational Sciences, Aksum University, Axum, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2878-3612","authenticated-orcid":false,"given":"Tesfay Hailu","family":"Shifarre","sequence":"additional","affiliation":[{"name":"Department of Mathematics, College of Natural and Computational Sciences, Aksum University, Axum, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mebrihit Berihu","family":"Mesfun","sequence":"additional","affiliation":[{"name":"Department of Biotechnology, College of Natural and Computational Sciences, Aksum University, Axum, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.21767\/1791-809X.1000533"},{"key":"e_1_3_3_3_2","first-page":"167","article-title":"Awareness of obstetric danger signs and its associated factors among pregnant women in public health institutions, Mekelle City, Tigray, Ethiopia","volume":"2","author":"Abiyot T","year":"2015","unstructured":"Abiyot T, Kassa M, Buruh G, et al. Awareness of obstetric danger signs and its associated factors among pregnant women in public health institutions, Mekelle City, Tigray, Ethiopia. J Pregnancy Child Health 2015; 2: 167.","journal-title":"J Pregnancy Child Health"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-019-0979-7"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13104-019-4639-8"},{"key":"e_1_3_3_6_2","volume-title":"Maternal mortality","author":"Ethiopian Demographic and Health survey (EDSH)","year":"2016","unstructured":"Ethiopian Demographic and Health survey (EDSH). Maternal mortality. EDSH, 2016."},{"key":"e_1_3_3_7_2","volume-title":"Maternal mortality, 2018","author":"World Health Organization (WHO)","unstructured":"World Health Organization (WHO). Maternal mortality, 2018. WHO."},{"issue":"2","key":"e_1_3_3_8_2","first-page":"164","article-title":"Awareness of danger signs of pregnancy and its associated factors among pregnant women who visit ANC in Mekelle Public Hospitals","volume":"2","author":"Gebrehiwot H","year":"2014","unstructured":"Gebrehiwot H, Bahta S, Haile N. Awareness of danger signs of pregnancy and its associated factors among pregnant women who visit ANC in Mekelle Public Hospitals Am J Adv Drug Delivery 2014; 2(2): 164\u2013173.","journal-title":"Am J Adv Drug Delivery"},{"key":"e_1_3_3_9_2","first-page":"64","article-title":"Assessment of knowledge on danger sign of pregnancy and associated factors among ANC attendant pregnant women in Arbaminch Town Governmental Institutions, Southern Ethiopia","volume":"8","author":"Samuel D","year":"2018","unstructured":"Samuel D, Genet G. Assessment of knowledge on danger sign of pregnancy and associated factors among ANC attendant pregnant women in Arbaminch Town Governmental Institutions, Southern Ethiopia. Ann Med Health Sci Res 2018; 8: 64\u201369.","journal-title":"Ann Med Health Sci Res"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.21474\/IJAR01\/5072"},{"key":"e_1_3_3_11_2","volume-title":"National reproductive health strategy, 2006\u20132015","author":"Federal Demographic republic of Ethiopia (FDRE) Ministry of Health (MOH)","unstructured":"Federal Demographic republic of Ethiopia (FDRE) Ministry of Health (MOH). National reproductive health strategy, 2006\u20132015. FDRE and MOH."},{"issue":"8","key":"e_1_3_3_12_2","first-page":"656","article-title":"Knowledge attitude and practice of pregnant women to ward danger sign of pregnancy in Harar Towen Eastern Ethiopia","volume":"8","author":"Masresha L.","year":"2019","unstructured":"Masresha L. Knowledge attitude and practice of pregnant women to ward danger sign of pregnancy in Harar Towen Eastern Ethiopia. EC Gynaecology 2019; 8(8): 656\u2013662.","journal-title":"EC Gynaecology"},{"key":"e_1_3_3_13_2","first-page":"30","article-title":"Lamessa Knowledge of obstetric danger signs and associated factors among pregnant women in Erer district, Somali region","volume":"16","author":"Nebiyu M","year":"2016","unstructured":"Nebiyu M, Kifle W and Lamessa Knowledge of obstetric danger signs and associated factors among pregnant women in Erer district, Somali region. Ethiopia Women\u2019s Health 2016; 16: 30.","journal-title":"Ethiopia Women\u2019s Health"},{"key":"e_1_3_3_14_2","first-page":"50","article-title":"Knowledge of obstetric danger signs and associated factors among pregnant women attending ANC service at Gedo Town Health Facilities","volume":"28","author":"Tolera GD.","year":"2016","unstructured":"Tolera GD. Knowledge of obstetric danger signs and associated factors among pregnant women attending ANC service at Gedo Town Health Facilities. J Health Med Nurs 2016; 28: 50.","journal-title":"J Health Med Nurs"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.5897\/IJNM2016.0230"},{"issue":"1","key":"e_1_3_3_16_2","first-page":"16","article-title":"Knowledge of obstetric danger signs among pregnant women attending antenatal care clinic at health facilities within Bureti Sub-County of Kericho County, Kenya","volume":"6","author":"Omari K","year":"2018","unstructured":"Omari K, Phanice J, Masimba O, et al. Knowledge of obstetric danger signs among pregnant women attending antenatal care clinic at health facilities within Bureti Sub-County of Kericho County, Kenya. Res Obstetr Gynecol 2018; 6(1): 16\u201321.","journal-title":"Res Obstetr Gynecol"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-017-1253-4"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13690-017-0203-y"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-7-29"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.4172\/2090-7214.1000290"},{"key":"e_1_3_3_21_2","volume-title":"Assessment of knowledge, attitude and practice of obstetric danger signs during pregnancy among mothers in Debrebirhan city administration, North Shewa, Amhara Region, Ethiopia","author":"Nurgi S.","year":"2014","unstructured":"Nurgi S. Assessment of knowledge, attitude and practice of obstetric danger signs during pregnancy among mothers in Debrebirhan city administration, North Shewa, Amhara Region, Ethiopia. Department of Nursing and Midwifery, Allied School of Health Sciences, College of Health Science, Addis Ababa University, 2014."}],"container-title":["Sage Open Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20503121261426069","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/20503121261426069","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20503121261426069","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T10:13:00Z","timestamp":1779185580000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/20503121261426069"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":20,"alternative-id":["10.1177\/20503121261426069"],"URL":"https:\/\/doi.org\/10.1177\/20503121261426069","relation":{},"ISSN":["2050-3121","2050-3121"],"issn-type":[{"value":"2050-3121","type":"print"},{"value":"2050-3121","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"article-number":"20503121261426069"}}