Abstract
The study explored the childbirth-related hygiene and newborn care practices in home-deliveries in Southern Tanzania and barriers to and facilitators of behaviour change. Eleven home-birth narratives and six focus group discussions were conducted with recently-delivering women; two focus group discussions were conducted with birth attendants. The use of clean cloth for delivery was reported as common in the birth narratives; however, respondents did not link its use to newborn's health. Handwashing and wearing of gloves by birth attendants varied and were not discussed in terms of being important for newborn's health, with few women giving reasons for this behaviour. The lack of handwashing and wearing of gloves was most commonly linked to the lack of water, gloves, and awareness. A common practice was the insertion of any family member's hands into the vagina of delivering woman to check labour progress before calling the birth attendant. The use of a new razor blade to cut the cord was near-universal; however, the cord was usually tied with a used thread due to the lack of knowledge and the low availability of clean thread. Applying something to the cord was near-universal and was considered essential for newborn's health. Three hygiene practices were identified as needing improvement: family members inserting a hand into the vagina of delivering woman before calling the birth attendant, the use of unclean thread, and putting substances on the cord. Little is known about families conducting internal checks of women in labour, and more research is needed before this behaviour is targeted in interventions. The use of clean thread as cord-tie appears acceptable and can be addressed, using the same channels and methods that were used for successfully encouraging the use of new razor blade.
Highlights
Ninety-nine percent of neonatal deaths occur in low- and middle-income countries, with two-thirds of these occurring in Asia and Africa [1]
60 women were included in the interviews and focus group discussions (FGDs)
The results are divided into four analysis categories: delivery surface, handwashing or wearing of gloves, dry cord-care, and the acceptability and likelihood of behaviour change
Summary
Ninety-nine percent of neonatal deaths occur in low- and middle-income countries, with two-thirds of these occurring in Asia and Africa [1]. There have been slow declines in neonatal mortality, especially in sub-Saharan Africa [2]; yet, many deaths could. Clean delivery practices include delivering on a clean surface, the birth attendant having clean hands during delivery, cutting and tying the cord. The importance of clean delivery behaviours for reducing infections is widely accepted; there is little empirical evidence on the impact of individual hygiene behaviours on infection or mortality. A recent observational study in Nepal found that birth attendants’ hand washing was associated with a 25% reduction in neonatal deaths [4], illustrating the importance of further studies in this area. As over half of the babies in sub-Saharan Africa [7] are born at home where contamination levels may be high, interventions that include clean delivery may have the potential to significantly reduce infections in newborns
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