Local Perceptions, Cultural Beliefs and Practices That Shape Umbilical Cord Care: A Qualitative Study in Southern Province, Zambia

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.

“The cord is the child”: meanings and practices related to umbilical cord care in Central Uganda

“…The appreciation of the importance of the umbilical cord inside the uterus has also been reported in a similar study in Zambia [2]. However after birth when the umbilical cord was cut and tied and it lingered on the surface of the newborn body, the umbilical cord became a source of fear, dread and uncertainty.…”

“…As a result, interventions that promote hygienic umbilical cord care are listed as prioritized interventions in newborn health [12,16]. 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]. Therefore, in this paper, we explore practices associated with umbilical cord care in Central Uganda, and the meanings attached to the cord in this social and cultural context.…”

Traditional Practices Adopted by Jordanian Mothers When Caring for Their Infants in Rural Areas

“…In India, Reshma and Sujatha (2014) reported that 95% of the mothers apply oil massaging for the baby before bathing, 53% of them provided home remedies for the baby, such as exposing babies to sunlight in case of Jaundice, 55% applied ashes, soot, powder, or dry cow dung on the umbilical cord. Another study in Zambia by Herlihy et al, (2013) found that cord applications included drying agents (e.g., charcoal, baby powder, dust), lubricating agents (e.g. cooking oil, used motor oil) and agents intended for protective and treatment purposes (e.g., breast milk, cow dung, chicken feces) were adotped by the majority of mothers.…”

Analysis of factors affecting outcome in pediatric omphalitis

“…Local cord care practices in developing countries included application of charcoal, baby powder, dust, Vaseline, mustard oil, breast milk, cow dung and chicken feces. 10 The recent trends have moved back to dry cord care, without routine application of topical antiseptic agents. These trends have been accepted by American Academy of Pediatrics.…”