"Why not bathe the baby today?": A qualitative study of thermal care beliefs and practices in four African sites.

BACKGROUND: Recommendations for care in the first week of a newborn's life include thermal care practices such as drying and wrapping, skin to skin contact, immediate breastfeeding and delayed bathing. This paper examines beliefs and practices related to neonatal thermal care in three African countries. METHODS: Data were collected in the same way in each site and included 16-20 narrative interviews with recent mothers, eight observations of neonatal bathing, and in-depth interviews with 12-16 mothers, 9-12 grandmothers, eight health workers and 0-12 birth attendants in each site. RESULTS: We found similarities across sites in relation to understanding the importance of warmth, a lack of opportunities for skin to skin care, beliefs about the importance of several baths per day and beliefs that the Vernix caseosa was related to poor maternal behaviours. There was variation between sites in beliefs and practices around wrapping and drying after delivery, and the timing of the first bath with recent behavior change in some sites. There was near universal early bathing of babies in both Nigerian sites. This was linked to a deep-rooted belief about body odour. When asked about keeping the baby warm, respondents across the sites rarely mentioned recommended thermal care practices, suggesting that these are not perceived as salient. CONCLUSION: More effort is needed to promote appropriate thermal care practices both in facilities and at home. Programmers should be aware that changing deep rooted practices, such as early bathing in Nigeria, may take time and should utilize the current beliefs in the importance of neonatal warmth to facilitate behaviour change.

Current Neonatal Skin Care Practices in Four African Sites.

Data for this study on skin care practices and emollient use in four African sites were collected using in-depth interviews, focus-group discussions and observations. Respondents were mothers, grandmothers, fathers, health workers, birth attendants and people selling skin-care products. Analysis included content and framework analyses.Emollient use was a normative practice in all sites, with frequent application from an early age in most sites. There were variations in the type of emollients used, but reasons for use were similar and included improving the skin, keeping the baby warm, softening/strengthening the joints/bones, shaping the baby, ensuring flexibility and encouraging growth and weight gain. Factors that influenced emollient choice varied and included social pressure, cost, availability and deep-rooted traditional norms. Massage associated with application was strong and potentially damaging to the skin in some sites.Given the widespread use of emollients, the repeated exposure of newborns in the first month of life and the potential impact of emollients on mortality, trials such as those that have been conducted in Asia are needed in a range of African settings.

Scientific rationale for study design of community-based simplified antibiotic therapy trials in newborns and young infants with clinically diagnosed severe infections or fast breathing in South Asia and sub-Saharan Africa.

BACKGROUND: Newborns and young infants suffer high rates of infections in South Asia and sub-Saharan Africa. Timely access to appropriate antibiotic therapy is essential for reducing mortality. In an effort to develop community case management guidelines for young infants, 0-59 days old, with clinically diagnosed severe infections, or with fast breathing, 4 trials of simplified antibiotic therapy delivered in primary care clinics (Pakistan, Democratic Republic of Congo, Kenya and Nigeria) or at home (Bangladesh and Nigeria) are being conducted. METHODS: This article describes the scientific rationale for these trials, which share major elements of trial design. All the trials are in settings of high neonatal mortality, where hospitalization is not feasible or frequently refused. All use procaine penicillin and gentamicin intramuscular injections for 7 days as reference therapy and compare this to various experimental arms utilizing comparatively simpler combination regimens with fewer injections and oral amoxicillin. CONCLUSION: The results of these trials will inform World Health Organization policy regarding community case management of young infants with clinical severe infections or with fast breathing.

Feeding and care of low-birthweight babies in two rural communities in south-western Nigeria.

The aim of this cross-sectional study was to highlight the sociocultural beliefs and practices relating to the care and feeding of low-birthweight (LBW) babies in two rural communities in the south-west of Nigeria. Data from 60 mothers and their newborns and community care providers were collected using qualitative instruments. The 60 mothers [30 mothers of LBW and 30 of normal-birthweight (NBW) infants] were identified through key informants, snowball approach and information obtained from community healthcare providers. The mean weight at recruitment of the LBW and NBW babies studied was 1680 +/- 440 and 2990 +/- 450 g respectively. Only two of the 60 mothers in the study delivered in orthodox health facilities, because in most cases these facilities were unaffordable, inaccessible and incompatible with rural lifestyles/beliefs. Most of the mothers believed that exclusive breastfeeding was not adequate for the LBW babies, and so herbal mixtures believed to accelerate growth were given in addition to breast milk. The use of forced hand-feeding and feeding bottles was universal among the mothers of LBW babies in order to 'increase the volume of feeds the baby gets'. Herbal dressing was used for cord and anterior fontanel care, while the babies were kept warm by using extra clothing, lighted lanterns and shutting of the windows. Five (16.7%) LBW infants and 1 (3.3%) NBW baby died, while 12 (40%) LBW, compared with 4 (13.3%) NBW infants, were hospitalized during the study. The findings of this study serve to identify the cultural beliefs and values around the care of LBW infants. Interventions designed to improve neonatal survival must therefore, take cognizance of these beliefs, customs and practices, in order to ensure effective and proper care of the LBW infants.