Abstract
BackgroundGlobal policy regarding optimal umbilical cord care to prevent neonatal illness is an active discussion among researchers and policy makers. In preparation for a large cluster-randomized control trial to measure the impact of 4% chlorhexidine as an umbilical wash versus dry cord care on neonatal mortality in Southern Province, Zambia, we performed a qualitative study to determine local perceptions of cord health and illness and the cultural belief system that shapes umbilical cord care knowledge, attitudes, and practices.Methods and FindingsThis study consisted of 36 focus group discussions with breastfeeding mothers, grandmothers, and traditional birth attendants, and 42 in-depth interviews with key community informants. Semi-structured field guides were used to lead discussions and interviews at urban and rural sites. A wide variation in knowledge, beliefs, and practices surrounding cord care was discovered. For home deliveries, cords were cut with non-sterile razor blades or local grass. Cord applications included drying agents (e.g., charcoal, baby powder, dust), lubricating agents (e.g., Vaseline, cooking oil, used motor oil) and agents intended for medicinal/protective purposes (e.g., breast milk, cow dung, chicken feces). Concerns regarding the length of time until cord detachment were universally expressed. Blood clots in the umbilical cord, bulongo-longo, were perceived to foreshadow neonatal illness. Management of bulongo-longo or infected umbilical cords included multiple traditional remedies and treatment at government health centers.ConclusionUmbilical cord care practices and beliefs were diverse. Dry cord care, as recommended by the World Health Organization at the time of the study, is not widely practiced in Southern Province, Zambia. A cultural health systems model that depicts all stakeholders is proposed as an approach for policy makers and program implementers to work synergistically with existing cultural beliefs and practices in order to maximize effectiveness of evidence-based interventions.
Highlights
Despite considerable reductions in the under-five mortality rate in Zambia since 1990, infant and neonatal mortality rates remain undesirably high and preventable[1]
A United Nations Statistics Division 2012 progress report indicates that the under-five mortality rate has decreased to 82.9 deaths per 1,000 live births; at this pace, it is unlikely that Zambia will meet its Millennium Development Goal target of 61 deaths per 1,000 live births by 2015 [3]
Research from Nepal, Bangladesh and Pakistan demonstrates the efficacy of 4% chlorhexidine when used as an umbilical wash to lower omphalitis risk and neonatal mortality [7,8,9,10]
Summary
Despite considerable reductions in the under-five mortality rate in Zambia since 1990, infant and neonatal mortality rates remain undesirably high and preventable[1]. Research from Nepal, Bangladesh and Pakistan demonstrates the efficacy of 4% chlorhexidine when used as an umbilical wash to lower omphalitis risk and neonatal mortality [7,8,9,10] This evidence has led global policy makers to focus on creating umbilical cord care policy and practice guidelines. Global policy regarding optimal umbilical cord care to prevent neonatal illness is an active discussion among researchers and policy makers. In preparation for a large cluster-randomized control trial to measure the impact of 4% chlorhexidine as an umbilical wash versus dry cord care on neonatal mortality in Southern Province, Zambia, we performed a qualitative study to determine local perceptions of cord health and illness and the cultural belief system that shapes umbilical cord care knowledge, attitudes, and practices. A cultural health systems model that depicts all stakeholders is proposed as an approach for policy makers and program implementers to work synergistically with existing cultural beliefs and practices in order to maximize effectiveness of evidence-based interventions
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