Abstract
BackgroundIn 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.MethodsWe 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.ResultsNewborns 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.ConclusionsThermal 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.
Highlights
In Choma District, southern Zambia, the neonatal mortality rate is approximately 40 per 1000 live births and, the rate is decreasing, many deliveries take place outside of formal facilities
Sacks et al BMC Pregnancy and Childbirth drying, head covering, delayed bathing and cord clamping, and cord cleansing with antiseptics; extra thermal care and topical emollient therapy is recommended for low birth weight and preterm infants [9]
Some single interventions can reduce multiple risks: delayed bathing may reduce the risk of infection and hypothermia, and skin-to-skin care may be beneficial for thermoregulation, breastfeeding, and reduction of infection and primary apnea [17, 18]
Summary
In Choma District, southern Zambia, the neonatal mortality rate is approximately 40 per 1000 live births and, the rate is decreasing, many deliveries take place outside of formal facilities. Some single interventions can reduce multiple risks: delayed bathing may reduce the risk of infection and hypothermia, and skin-to-skin care may be beneficial for thermoregulation, breastfeeding, and reduction of infection and primary apnea [17, 18]. Many of these interventions are even more effective in protecting the health of preterm and low birth weight infants, who have underdeveloped lungs, skin barrier function, and immune defenses [18]
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