Local perceptions, cultural beliefs and practices that shape umbilical cord care: a qualitative study in Southern Province, Zambia

• Published in: PloS one Vol. 8; no. 11; p. e79191
• Main Authors: Herlihy, Julie M, Shaikh, Affan, Mazimba, Arthur, Gagne, Natalie, Grogan, Caroline, Mpamba, Chipo, Sooli, Bernadine, Simamvwa, Grace, Mabeta, Catherine, Shankoti, Peggy, Messersmith, Lisa, Semrau, Katherine, Hamer, Davidson H
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 07.11.2013; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Analysis; Anti-Infective Agents, Local - administration & dosage; Attitude to Health; Blood coagulation; Breast feeding; Breast milk; Cattle manure; Charcoal; Childbirth & labor; Chlorhexidine; Chlorhexidine - administration & dosage; Cooking; Cooking oils; Cow's milk; Culture; Desiccants; Drying; Dung; Evidence-based medicine; Female; Health facilities; Home births; Humans; Illnesses; Infant Mortality; Infant, Newborn; Lubrication; Medical research; Middle Aged; Mortality; National libraries; Neonates; Newborn babies; Newborn infants; Pediatrics; Powder; Public health; Qualitative research; Quality of Health Care; Razor blades; Sepsis; Studies; Tetanus; Umbilical Cord; Umbilical cords; Womens health; Zambia; Zambia; Bangladesh; United States > US; Massachusetts; Nepal; India
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0079191

Global 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. This 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. Umbilical 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.