Abstract

Newborn cord infections commonly lead to neonatal sepsis and death, particularly in low-resource countries where newborns may receive unhygienic cord care. Topical application of chlorhexidine to the newborn's cord has been shown to prevent infection. Such benefits may be particularly important in Haiti. We explored current cord care practices by conducting a qualitative study using five focus groups among key community stakeholders (mothers of newborns/children under age two years, pregnant women, traditional birth attendants, community health workers, traditional healers) in Petit-Goâve, Haiti. Data collection was guided by the Health Belief Model. Results suggest community stakeholders recognise that infants are susceptible to cord infection and that cord infection is a serious threat to newborns. Long-held traditional cord care practices are potential barriers to adopting a new cord care intervention. However, all groups acknowledged that traditional practices could be harmful to the newborn while expressing a willingness to adopt practices that would protect the newborn. Results demonstrate potential acceptability for altering traditional cord care practices among neonatal caretakers in Haiti. An informational campaign designed to educate local health workers and new mothers to eliminate unhygienic cord applications while promoting chlorhexidine application may be a strong approach for preventing neonatal cord infections.

Highlights

  • Approximately seven million children under the age of five die each year (WHO, 2014), and an estimated 44% of these deaths are concentrated within the first month of life (WHO, 2013)

  • The recommended use of chlorhexidine requires the discontinuation of many traditional cord care practices as they likely reduce the effectiveness of chlorhexidine to prevent omphalitis (Alam et al, 2008; Mullany et al, 2006a)

  • Participants discussed the acceptability of modern health care for their community in terms of the perceived susceptibility of the neonate to omphalitis, the perceived severity of infection, perceived barriers and benefits to adopting a new cord care practice, and cues to action for adopting a new cord care practice to avoid infection

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Summary

Introduction

Approximately seven million children under the age of five die each year (WHO, 2014), and an estimated 44% of these deaths are concentrated within the first month of life (WHO, 2013). Recent large scale randomized controlled trials conducted in Bangladesh, Nepal, Pakistan and Tanzania suggest high levels of acceptability of chlorhexidine use among new mothers (Alam et al, 2008; Alper, 2007; Arifeen et al, 2012; Imdad et al, 2013; Mullany et al, 2006 a,b; Mullany et al, 2007; Sazawal et al, 2012b; Soofi et al, 2012) These studies, are limited to South Asia and East Africa, and their generalizability to other low-resource settings is unclear

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