Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2015

Open Access 01-12-2015 | Research article

Skin, thermal and umbilical cord care practices for neonates in southern, rural Zambia: a qualitative study

Authors: Emma Sacks, William J. Moss, Peter J. Winch, Philip Thuma, Janneke H. van Dijk, Luke C. Mullany

Published in: BMC Pregnancy and Childbirth | Issue 1/2015

Login to get access

Abstract

Background

In Choma District, southern Zambia, the neonatal mortality rate is approximately 40 per 1000 live births and, although the rate is decreasing, many deliveries take place outside of formal facilities. Understanding local practices during the postnatal period is essential for optimizing newborn care programs.

Methods

We conducted 36 in-depth interviews, five focus groups and eight observational sessions with recently-delivered women, traditional birth attendants, and clinic and hospital staff from three sites, focusing on skin, thermal and cord care practices for newborns in the home.

Results

Newborns were generally kept warm by application of hats and layers of clothing. While thermal protection is provided for preterm and small newborns, the practice of nighttime bathing with cold water was common. The vernix was considered important for the preterm newborn but dangerous for HIV-exposed infants. Mothers applied various substances to the skin and umbilical cord, with special practices for preterm infants. Applied substances included petroleum jelly, commercial baby lotion, cooking oil and breastmilk. The most common substances applied to the umbilical cord were powders made of roots, burnt gourds or ash. To ward off malevolent spirits, similar powders were reportedly placed directly into dermal incisions, especially in ill children.

Conclusions

Thermal care for newborns is commonly practiced but co-exists with harmful practices. Locally appropriate behavior change interventions should aim to promote chlorhexidine in place of commonly-reported application of harmful substances to the skin and umbilical cord, reduce bathing of newborns at night, and address the immediate bathing of HIV-infected newborns.
Footnotes
1
The most commonly available type of cooking oil in this region is a mixture, similar to vegetable oil, often made with sunflower seed. It is common for oil to be reused and “recycled oil” is available at local markets.
 
2
For male newborns, the practice is to cut the cord at the same length as the newborn’s arms (elbow to wrist); this is thought to correspond with future length of the penis.
 
3
Breast milk is also reportedly applied to the newborn’s nostrils to smooth the skin and make it easier for the newborn to breathe, and on penis, under the foreskin, or in the vagina, to ease urination and to make the newborn “sweet to the opposite sex” as an adult.
 
4
Prior to the widespread uptake of the antenatal tetanus toxoid vaccine, this practice likely caused many cases of neonatal tetanus.
 
Literature
1.
Blencowe H, Cousens S. Addressing the challenge of neonatal mortality. Trop Med Int Health. 2013;18(3):303–12.PubMed
2.
Dickson KE, Simen-Kapeu A, Kinney MV, Huicho L, Vesel L, Lackritz E, et al. Every Newborn: health-systems bottlenecks and strategies to accelerate scale-up in countries. Lancet. 2014;384(9941):438–54.CrossRefPubMed
3.
Moran AC, Kerber K, Sitrin D, Guenther T, Morrissey CS, Newby H, et al. Measuring coverage in MNCH: indicators for global tracking of newborn care. PLoS Med. 2013;10(5):e1001415.CrossRefPubMedPubMedCentral
4.
Lunze K, Bloom DE, Jamison DT, Hamer DH. The global burden of neonatal hypothermia: systematic review of a major challenge for newborn survival. BMC Med. 2013;11:24.CrossRefPubMedPubMedCentral
5.
Ades V, Mwesigwa J, Natureeba P, Clark TD, Plenty A, Charlebois E, et al. Neonatal Mortality in HIV-Exposed Infants Born to Women Receiving Combination Antiretroviral Therapy in Rural Uganda. J Trop Pediatr. 2013;59(6):441–6.CrossRefPubMedPubMedCentral
6.
Slogrove A, Reikie B, Naidoo S, De Beer C, Ho K, Cotton M, et al. HIV-exposed uninfected infants are at increased risk for severe infections in the first year of life. J Trop Pediatr. 2012;58(6):505–8.CrossRefPubMedPubMedCentral
7.
Gabrysch S, Cousens S, Cox J, Campbell OM. The influence of distance and level of care on delivery place in rural Zambia: a study of linked national data in a geographic information system. PLoS Med. 2011;8(1):e1000394.CrossRefPubMedPubMedCentral
8.
United States Government Zambia Ineragency Team. Global Health Initiative Strategy. Zambia 2011–2015. In. Washington DC; 2012
9.
Bhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA, Paul VK, et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet. 2014;384(9940):347–70.CrossRefPubMed
10.
Baqui AH, El-Arifeen S, Darmstadt GL, Ahmed S, Williams EK, Seraji HR, et al. Effect of community-based newborn-care intervention package implemented through two service-delivery strategies in Sylhet district, Bangladesh: a cluster-randomised controlled trial. Lancet. 2008;371(9628):1936–44.CrossRefPubMed
11.
Kumar V, Mohanty S, Kumar A, Misra RP, Santosham M, Awasthi S, et al. Effect of community-based behaviour change management on neonatal mortality in Shivgarh, Uttar Pradesh, India: a cluster-randomised controlled trial. Lancet. 2008;372(9644):1151–62.CrossRefPubMed
12.
Kirkwood BR, Manu A, ten Asbroek AH, Soremekun S, Weobong B, Gyan T, et al. Effect of the Newhints home-visits intervention on neonatal mortality rate and care practices in Ghana: a cluster randomised controlled trial. Lancet. 2013;381(9884):2184–92.CrossRefPubMed
13.
Penfold S, Manzi F, Mkumbo E, Temu S, Jaribu J, Shamba DD, et al. Effect of home-based counselling on newborn care practices in southern Tanzania one year after implementation: a cluster-randomised controlled trial. BMC Pediatr. 2014;14:187.CrossRefPubMedPubMedCentral
14.
Darmstadt GL, Lee AC, Cousens S, Sibley L, Bhutta ZA, Donnay F, et al. 60 Million non-facility births: who can deliver in community settings to reduce intrapartum-related deaths? Int J Gynaecol Obstet. 2009;107 Suppl 1:S89–112.CrossRefPubMedPubMedCentral
15.
Bhutta ZA, Darmstadt GL, Hasan BS, Haws RA. Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: a review of the evidence. Pediatrics. 2005;115(2 Suppl):519–617.PubMed
16.
Costello AM, Manandhar D. Improving Newborn Health in Developing Countries. London: World Scientific Publishing Company; 2000.CrossRef
17.
WHO. Pregnancy, Childbirth, Postpartum and Newborn Care: A guide for essential practice. In. Geneva: World Health Organization; 2006.
18.
Brodsky D, Christou H. Current concepts in intrauterine growth restriction. J Intensive Care Med. 2004;19(6):307–19.CrossRefPubMed
19.
Baqui AH, Arifeen SE, Williams EK, Ahmed S, Mannan I, Rahman SM, et al. Effectiveness of home-based management of newborn infections by community health workers in rural Bangladesh. Pediatr Infect Dis J. 2009;28(4):304–10.CrossRefPubMedPubMedCentral
20.
Darmstadt GL, Kumar V, Yadav R, Singh V, Singh P, Mohanty S, et al. Introduction of community-based skin-to-skin care in rural Uttar Pradesh, India. J Perinatol. 2006;26(10):597–604.CrossRefPubMed
21.
Marsh DR, Darmstadt GL, Moore J, Daly P, Oot D, Tinker A. Advancing newborn health and survival in developing countries: a conceptual framework. J Perinatol. 2002;22(7):572–6.CrossRefPubMed
22.
Parlato R, Darmstadt G, Tinker A. Qualitative Research to Improve Newborn Care Practices. In: Saving Newborn Lives: Tools for Newborn Health. Washington: Save the Children; 2004.
23.
Winch PJ, Alam MA, Akther A, Afroz D, Ali NA, Ellis AA, et al. Local understandings of vulnerability and protection during the neonatal period in Sylhet District, Bangladesh: a qualitative study. Lancet. 2005;366(9484):478–85.CrossRefPubMed
24.
Mrisho M, Schellenberg JA, Mushi AK, Obrist B, Mshinda H, Tanner M, et al. Understanding home-based neonatal care practice in rural southern Tanzania. Trans R Soc Trop Med Hyg. 2008;102(7):669–78.CrossRefPubMed
25.
Thairu L, Pelto G. Newborn care practices in Pemba Island (Tanzania) and their implications for newborn health and survival. Matern Child Nutr. 2008;4(3):194–208.CrossRefPubMed
26.
Waiswa P, Kemigisa M, Kiguli J, Naikoba S, Pariyo GW, Peterson S. Acceptability of evidence-based neonatal care practices in rural Uganda - implications for programming. BMC Pregnancy Childbirth. 2008;8:21.CrossRefPubMedPubMedCentral
27.
Malhotra S, Zodpey SP. Can traditional birth attendants be trained to reduce neonatal mortality rate? Lessons from Lufwanyama Neonatal Survival Project. Natl Med J India. 2011;24(4):220–2.PubMed
28.
Herlihy JM, Shaikh A, Mazimba A, Gagne N, Grogan C, Mpamba C, et al. Local perceptions, cultural beliefs and practices that shape umbilical cord care: a qualitative study in Southern Province, Zambia. PLoS One. 2013;8(11):e79191.CrossRefPubMedPubMedCentral
29.
Hill Z, Tawiah-Agyemang C, Manu A, Okyere E, Kirkwood BR. Keeping newborns warm: beliefs, practices and potential for behaviour change in rural Ghana. Trop Med Int Health. 2010;15(10):1118–24.CrossRefPubMed
30.
Shamba D, Schellenberg J, Hildon ZJ, Mashasi I, Penfold S, Tanner M, et al. Thermal care for newborn babies in rural southern Tanzania: a mixed-method study of barriers, facilitators and potential for behaviour change. BMC Pregnancy and Childbirth. 2014;14:267.CrossRefPubMedPubMedCentral
31.
Lunze K, Yeboah-Antwi K, Marsh DR, Kafwanda SN, Musso A, Semrau K, et al. Prevention and management of neonatal hypothermia in rural Zambia. PLoS One. 2014;9(4):e92006.CrossRefPubMedPubMedCentral
32.
van Stam G. Report on Macha Area. In. Choma: MachaWorks; 2009.
33.
UNICEF. Country Statistics: Zambia. New York: In. United Nations Children's Fund; 2012.
34.
35.
Darmstadt GL, Saha SK, Ahmed AS, Choi Y, Chowdhury MA, Islam M, et al. Effect of topical emollient treatment of preterm neonates in Bangladesh on invasion of pathogens into the bloodstream. Pediatr Res. 2007;61(5 Pt 1):588–93.CrossRefPubMed
36.
Conde-Agudelo A, Belizan JM, Diaz-Rossello J. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev. 2011;3:CD002771.PubMed
37.
Bergstrom A, Byaruhanga R, Okong P. The impact of newborn bathing on the prevalence of neonatal hypothermia in Uganda: a randomized, controlled trial. Acta Paediatr. 2005;94(10):1462–7.CrossRefPubMed
38.
Yoshio H, Tollin M, Gudmundsson GH, Lagercrantz H, Jornvall H, Marchini G, et al. Antimicrobial polypeptides of human vernix caseosa and amniotic fluid: implications for newborn innate defense. Pediatr Res. 2003;53(2):211–6.CrossRefPubMed
39.
Marchini G, Lindow S, Brismar H, Stabi B, Berggren V, Ulfgren AK, et al. The newborn infant is protected by an innate antimicrobial barrier: peptide antibiotics are present in the skin and vernix caseosa. Br J Dermatol. 2002;147(6):1127–34.CrossRefPubMed
40.
Akinbi HT, Narendran V, Pass AK, Markart P, Hoath SB. Host defense proteins in vernix caseosa and amniotic fluid. Am J Obstet Gynecol. 2004;191(6):2090–6.CrossRefPubMed
41.
Kiesler J, Ricer R. The abnormal fontanel. Am Fam Physician. 2003;67(12):2547–52.PubMed
42.
Blencowe H, Vos T, Lee AC, Philips R, Lozano R, Alvarado MR, et al. Estimates of neonatal morbidities and disabilities at regional and global levels for 2010: introduction, methods overview, and relevant findings from the Global Burden of Disease study. Pediatr Res. 2013;74 Suppl 1:4–16.CrossRefPubMedPubMedCentral
43.
Prost A, Colbourn T, Seward N, Azad K, Coomarasamy A, Copas A, et al. Women's groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: a systematic review and meta-analysis. Lancet. 2013;381(9879):1736–46.CrossRefPubMedPubMedCentral
44.
Saleem S. Application of 4% chlorhexidine solution for cord cleansing after birth reduces neonatal mortality and omphalitis. Evid Based Med. 2013;18(2):e15.CrossRefPubMed
45.
Imdad A, Mullany LC, Baqui AH, El Arifeen S, Tielsch JM, Khatry SK, et al. The effect of umbilical cord cleansing with chlorhexidine on omphalitis and neonatal mortality in community settings in developing countries: a meta-analysis. BMC Public Health. 2013;13 Suppl 3:S15.CrossRefPubMed
46.
World Health Organization: WHO Recommendations on Postnatal Care of the Mother and Newborn. In. Geneva; 2013.
47.
Sazawal S. CHX-Pemba; Chlorhexidine Cordcare for Reduction in Neonatal Mortality and Omphalitis. ClinicalTrialsgov Identifier: NCT01528852. 2012.
48.
ZamCAT (Zambia Chlorhexidine Trial): Impact of Chlorhexidine Cord Cleansing for Prevention of Neonatal Mortality in Zambia. ClinicalTrialsgov: NCT01241318. 2011.
49.
Adejuyigbe EA, Odebiyi AI, Aina O, Bamiwuye S. Feeding and care of low-birthweight babies in two rural communities in south-western Nigeria. Matern Child Nutr. 2008;4(1):55–64.CrossRefPubMed
50.
Byaruhanga RN, Bergstrom A, Tibemanya J, Nakitto C, Okong P. Perceptions among post-delivery mothers of skin-to-skin contact and newborn baby care in a periurban hospital in Uganda. Midwifery. 2008;24(2):183–9.CrossRefPubMed
51.
Byaruhanga RN, Nsungwa-Sabiiti J, Kiguli J, Balyeku A, Nsabagasani X, Peterson S. Hurdles and opportunities for newborn care in rural Uganda. Midwifery. 2011;27(6):775–80.CrossRefPubMed
52.
Hill Z, Tawiah-Agyemang C, Okeyere E, Manu A, Fenty J, Kirkwood B. Improving hygiene in home deliveries in rural Ghana: how to build on current attitudes and practices. Pediatr Infect Dis J. 2010;29(11):1004–8.PubMed
53.
Potgieter ST, Kibel MA. Sleeping positions of infants in the Cape Peninsula. S Afr Med J. 1992;81(7):355–7.PubMed
54.
Task Force on Sudden Infant Death S, Moon RY. SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics. 2011;128(5):e1341–1367.CrossRef
55.
Garofalo M, Abenhaim HA. Early versus delayed cord clamping in term and preterm births: a review. J Obstet Gynaecol Can. 2012;34(6):525–31.CrossRefPubMed
Metadata
Title
Skin, thermal and umbilical cord care practices for neonates in southern, rural Zambia: a qualitative study
Authors
Emma Sacks
William J. Moss
Peter J. Winch
Philip Thuma
Janneke H. van Dijk
Luke C. Mullany
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2015
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-015-0584-2

Other articles of this Issue 1/2015

BMC Pregnancy and Childbirth 1/2015 Go to the issue

Research article

Alcohol consumption among pregnant women in Northern Tanzania 2000–2010: a registry-based study

Research article

Specific antenatal interventions for Black, Asian and Minority Ethnic (BAME) pregnant women at high risk of poor birth outcomes in the United Kingdom: a scoping review

Research article

Differences in pregnancy outcomes and characteristics between insulin- and diet-treated women with gestational diabetes

Research article

A qualitative exploration of the emotional wellbeing and support needs of new mothers from Afghanistan living in Melbourne, Australia

Research article

Quality of websites of obstetrics and gynecology departments: a cross-sectional study

Research article

Obesity and normal birth: A qualitative study of clinician’s management of obese pregnant women during labour