Abstract
BackgroundInfections account for a quarter of all newborn deaths and the umbilical cord has been identified as a major route of newborn infections.ObjectiveTo explore the meanings and practices related to the umbilical cord among caretakers of newborns in central Uganda.MethodsThis was a qualitative study, designed to inform the design, and interpretation of a randomized controlled trial assessing the effectiveness of chlorhexidine use for the umbilical cord. We conducted 22 in-depth interviews exploring umbilical cord care practices among ten mothers, four health workers, five traditional birth attendants, and three men. We also conducted three focus group discussions with young mothers and elderly women. We used qualitative content analysis to analyze our findings and we borrow upon Mary Douglas’ concepts of dirt to present our findings.ResultsThe umbilical cord had a symbolic position in newborn care. The way it was perceived and handled had far reaching consequences for the survival and wellbeing of the baby. The umbilical cord was a centre of anxiety, a possible gate to illness, a test of fatherhood and a signifier of parental responsibility. Hence, the umbilical cord and the way it was cared for played a part in the present and future survival of the baby, as well as the survival and wellbeing of the household. Persons other than the mother such as older female relatives were very influential in the care of the umbilical cord.ConclusionsThe umbilical cord carried symbolic meanings, which extended beyond the newborn and the newborn period, and in turn influenced the various practices of umbilical cord care. The important position of the cord in local newborn care practices should be recognized and taken into consideration when scaling up newborn care interventions in the country.
Highlights
Infections account for a quarter of all newborn deaths and the umbilical cord has been identified as a major route of newborn infections
The umbilical cord carried symbolic meanings, which extended beyond the newborn and the newborn period, and in turn influenced the various practices of umbilical cord care
The important position of the cord in local newborn care practices should be recognized and taken into consideration when scaling up newborn care interventions in the country
Summary
Infections account for a quarter of all newborn deaths and the umbilical cord has been identified as a major route of newborn infections. In sub-Saharan Africa, umbilical cord care is embedded in larger cultural constructs such as rites of passage [1], and fertility [2] Substances such as salty water, soot, banana ash, herbs, surgical spirit, powder, ghee, papyrus reeds, saliva, water, butter and petroleum jelly are commonly applied to the cord [3,4,5], but vary with the Mukunya et al BMC Pediatrics (2020) 20:105 region and cultural group [6]. Understanding umbilical cord care practices and the rationale behind these practices is vital for the scale up of interventions addressing umbilical cord care [2, 6], but very few studies have addressed this issue [2]
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