Influence of newborn health messages on care-seeking practices and community health behaviors among participants in the Zambia Chlorhexidine Application Trial.

Kasthuri Sivalogan,Kojo Yeboah-Antwi,Caroline Grogan,Julie M Herlihy,Katherine E A Semrau,Paul G Ashigbie,Bowen Banda,Davidson H Hamer,Godfrey Biemba,Sheila Mwangi,Emma Sacks

doi:10.1371/journal.pone.0198176

Abstract

BackgroundIdentifying and understanding traditional perceptions that influence newborn care practices and care-seeking behavior are crucial to developing sustainable interventions to improve neonatal health. The Zambia Chlorhexidine Application Trial (ZamCAT), a large-scale cluster randomized trial, assessed the impact of 4% chlorhexidine on neonatal mortality and omphalitis in Southern Province, Zambia. The main purpose of this post-ZamCAT qualitative study was to understand the impact of newborn care health messages on care-seeking behavior for neonates and the acceptability, knowledge, and attitudes towards chlorhexidine cord care among community members and health workers in Southern Province.Methods & findingsFive focus group discussions and twenty-six in-depth interviews were conducted with mothers and health workers from ten health centers (5 rural and 5 peri-urban/urban). Community perceptions and local realities were identified as fundamental to care-seeking decisions and influenced individual participation in particular health-seeking behaviors. ZamCAT field monitors (data collectors) disseminated health messages at the time of recruitment at the health center and during subsequent home visits. Mothers noted that ZamCAT field monitors were effective in providing lessons and education on newborn care practices and participating mothers were able to share these messages with others in their communities. Although the study found no effect of chlorhexidine cord washes on neonatal mortality, community members had positive views towards chlorhexidine as they perceived that it reduced umbilical cord infections and was a beneficial alternative to traditional cord applications.ConclusionThe acceptability of health initiatives, such as chlorhexidine cord application, in community settings, is dependent on community education, understanding, and engagement. Community-based approaches, such as using community-based cadres of health workers to strengthen referrals, are an acceptable and potentially effective strategy to improve care-seeking behaviors and practices.

Highlights

Mothers noted that Zambia Chlorhexidine Application Trial (ZamCAT) field monitors were effective in providing lessons and education on newborn care practices and participating mothers were able to share these messages with others in their communities
The main trial was conducted from February 2011 to October 2013 in Southern Province, Zambia [4] and a baseline qualitative study and intensive community engagement were conducted in Southern Province [5,6]
The focus group discussions (FGD) conducted in Monze included 10 Tonga mothers ranging from 19–37 years of age with a median age of 29 years

Summary

Introduction

Neonatal mortality accounts for 2.6 million deaths annually, approximately 46% of all underfive deaths worldwide, and more than 80% of these deaths are preventable [1]. Identifying newborn care practices and traditional experiences that influence care-seeking behavior in Zambia is crucial to implementing evidence-based sustainable interventions to reduce neonatal mortality. To address this challenge, the Zambia Chlorhexidine Application Trial (ZamCAT), a community-based cluster randomized controlled effectiveness trial, compared the impact of daily cord cleansing with 4% chlorhexidine against the standard practice of dry cord care on neonatal mortality. The results from the baseline qualitative study aimed to identify local perceptions of umbilical cord health, illness, and cultural perception that shape cord care knowledge, attitudes and practices [5] This baseline study demonstrated that diverse umbilical cord care practices existed and, at the time of the study, the WHO recommendations of dry cord care were not widely practiced in Southern Province [5]. The main purpose of this post-ZamCAT qualitative study was to understand the impact of newborn care health messages on care-seeking behavior for neonates and the acceptability, knowledge, and attitudes towards chlorhexidine cord care among community members and health workers in Southern Province

Methods

Results

Conclusion