Disparities in obstetric danger sign knowledge among pregnant women in postwar Eastern Tigray, Ethiopia: Robust logistic regression.

Background: 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. Objective: 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. Methods: 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 "good" (⩾3 signs identified) or "poor." Associations were analyzed using penalized logistic regression and Bayesian logistic regression. Results: 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 = 27.4, Conclusion: 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.