SPSS data set.

Introduction
One of the key strategies to achieve the sustainable development goal by reducing maternal deaths below 70 per 100,000 is improving knowledge of obstetric danger signs (ODS). However, mothers’ knowledge of ODS is low in general and very low in rural settings, regardless of local and national efforts in Ethiopia. Further, there is significant variation of ODS knowledge among women from region to region and urban/rural settings. Most studies are limited only to northern Ethiopia and focused on individual-level determinants. Thus, this study aimed to assess the individual and community-level determinants of knowledge of obstetrics danger signs among women who delivered in the last 12 months in the northern zone of the Sidama region, Ethiopia.
Methods
We conducted a community-based cross-sectional study from October 21 to November 11, 2022. A multi-stage sampling procedure was utilized to select study participants. A structured and pretested questionnaire was utilized to collect data. Open Data Kit (ODK) smartphone application was used to collect data at women’s homes. A multi-level mixed-effects negative binomial regression model was used to control effects of clusters and confounders.
Results
The overall response rate of this study was 99.12%. The proportion of knowledge of obstetrics danger sign was 22.3% (95% CI: 18.7, 25.9). Government-employed women [adjusted incidence ratio (AIR) = 1.37; 95% CI: 1.20, 1.56], women who had exposure to mass media (AIR = 1.16; 95% CI: 1.08, 1.25), women who had received model family training (AIR = 1.15; 95% CI: 1.10, 1.25), autonomous women (AIR = 1.34; 95% CI: 1.25, 1.46), women who had faced health problems during pregnancy (AIR = 1.21; 95% CI: 1.11, 1.32), and urban women (AIR = 1.22; 95% CI: 1.09, 1.62) were determinants positively affect knowledge of ODS.
Conclusion
Only one in five women has good knowledge of ODS in the study setting. Urban residence, mass media exposure, receiving model family training, facing health problems during pregnancy, and women’s autonomy were the main determinants of knowledge of ODS. Any intervention strategies should focus on multi-sectorial collaboration to address determinants of knowledge of ODS at the individual and community level. Reinforcing the existing model family training, particularly focusing on rural women and women who denied autonomy in decision-making about health care, should be considered. Awareness creation should be increased about ODS through mass media exposure.

引言
将孕产妇死亡率降至每10万人70例以下以实现可持续发展目标的关键策略之一，是提升民众对产科危险征象（obstetric danger signs, ODS）的认知水平。尽管埃塞俄比亚当地及国家层面已采取相关举措，但总体而言民众对ODS的认知水平偏低，农村地区的认知情况尤为堪忧。此外，不同地区以及城乡女性群体间的ODS认知水平存在显著差异。现有多数研究仅聚焦于埃塞俄比亚北部地区，且仅探讨了个体层面的影响因素。有鉴于此，本研究旨在评估埃塞俄比亚锡达马地区北部辖区内，过去12个月内分娩过的女性群体，其ODS认知水平的个体及社区层面影响因素。

方法
本研究于2022年10月21日至11月11日期间开展了一项社区横断面研究。研究采用多阶段抽样法选取研究对象，使用经过预试验的结构化问卷开展数据采集，并借助开源数据工具包（Open Data Kit, ODK）智能手机应用程序，在产妇家中完成数据收集。本研究采用多水平混合效应负二项回归模型，以控制集群效应与混杂因素的影响。

结果
本研究的整体应答率为99.12%。研究对象中对ODS具备良好认知的比例为22.3%（95%置信区间：18.7, 25.9）。公职女性[校正发病比（adjusted incidence ratio, AIR）=1.37；95%置信区间：1.20, 1.56]、接触过大众媒体的女性（AIR=1.16；95%置信区间：1.08, 1.25）、接受过示范家庭培训的女性（AIR=1.15；95%置信区间：1.10, 1.25）、具备自主决策权的女性（AIR=1.34；95%置信区间：1.25, 1.46）、孕期遭遇健康问题的女性（AIR=1.21；95%置信区间：1.11, 1.32）以及城镇女性（AIR=1.22；95%置信区间：1.09, 1.62）均为正向影响ODS认知水平的因素。

结论
本研究辖区内仅五分之一的女性具备良好的ODS认知水平。城镇居住身份、大众媒体接触、接受示范家庭培训、孕期遭遇健康问题以及女性自主决策权，均为影响ODS认知水平的主要因素。相关干预策略应聚焦多部门协作，以应对个体及社区层面的ODS认知影响因素。应考虑强化现有示范家庭培训项目，尤其将目标群体锁定为农村女性以及在医疗决策方面缺乏自主决策权的女性。应通过大众媒体渠道提升公众对ODS的认知水平。