Parental Knowledge and Determinants of Neonatal Danger Signs Recognition: A Cross-Sectional Study

Background/Objectives: Iraq's the rate of neonatal is still high amid international efforts to improve child survival. Reversing the trend is determined by caregivers' ability to spot newborn danger signs (NDSs) early on, concentrating on the "first delay" in the care-seeking procedure. The objectives of this research were to evaluate parents' basic understanding of NDSs in Al-Hilla, Iraq, and identify the particular sociodemographic variables that impact these awareness levels. Methods: We performed a multicenter, cross-sectional study at seven primary care centers. Our sample included 383 parents of babies (ages 0–12 months), selected sequentially. Data were collected by structured in-person interviews using the validated Arabic Questionnaire for Neonatal Danger Signs (AQ-KNDS). Knowledge was evaluated on a scale of 0 to 28 and classified as poor, moderate, or good. Binary logistic regression with SPSS v.26 identified significant characteristics associated with high-level knowledge (p < 0.05). Results: The survey found that 73.6% of respondents had "good" knowledge, with a mean of 23.31 ± 3.71. Important clinical gaps were noted: only 22.2% correctly recognized the absence of an anal opening as a surgical crisis and 36.6% correctly identified the startle reflex as a normal biological response, despite nearly everyone (99.2%) recognizing acute symptoms such as fever and difficulty breathing. Prior neonatal risk training (AOR = 2.85, 95% CI: 1.18–6.87, p = 0.020), maternal gender (AOR = 2.81, 95% CI: 1.54–5.10, p = 0.001), and a history of hospital admission for a child (AOR = 2.00, 95% CI: 1.18–3.39, p = 0.010) were the strongest independent predictors of adequate knowledge. Conclusions: In Al-Hilla, parental awareness is characterized by a "crisis-driven" approach to health literacy, with knowledge often gained through medical trauma rather than proactive education. Due to large gaps in the recognition of neurological and congenital symptoms, a comprehensive change toward nursing-led, family-centered counseling is required. NDS modules should be integrated into routine immunization schedules to improve infant survival rates and shorten recognition times.