Clean delivery practices in rural northern Ghana: a qualitative study of community and provider knowledge, attitudes, and beliefs

BMC Pregnancy and Childbirth

Cyril Engmann⁴  Abraham Hodgson¹  John Williams¹  Philip B Adongo³  Sarah Rominski⁵  Gideon Affah¹  Gideon Logonia¹  Raymond Akawire Aborigo¹  Cheryl A Moyer² 

[1] Navrongo Health Research Centre, PO Box 114, Navrongo, UE/R, Ghana;Department of Medical Education, University of Michigan Medical School, Towsley Center, Ann Arbor, MI 48109, USA;Department of Social and Behavioral Science, School of Public Health, University of Ghana, Legon, Ghana;University of North Carolina, CB# 7596, 4th Floor, UNC Hospitals, Chapel Hill, NC 27599-7596, USA;Global REACH, University of Michigan Medical School, 5115 Med Sci 1 1301 Catherine Street, Ann Arbor, MI 48104, USA

关键词: Umbilicus;    Developing countries;    Cord care;    Maternal and child health;    Global health;   

Others  :  1152825
DOI  :  10.1186/1471-2393-12-50

 received in 2011-10-18, accepted in 2012-05-23,  发布年份 2012

【 摘 要 】

Background

Knowledge, attitudes and practices of community members and healthcare providers in rural northern Ghana regarding clean delivery are not well understood. This study explores hand washing/use of gloves during delivery, delivering on a clean surface, sterile cord cutting, appropriate cord tying, proper cord care following delivery, and infant bathing and cleanliness.

Methods

In-depth interviews and focus group discussions were audiotaped, transcribed, and analyzed using NVivo 9.0.

Results

253 respondents participated, including women with newborn infants, grandmothers, household and compound heads, community leaders, traditional birth attendants, and formally trained health care providers. There is widespread understanding of the need for clean delivery to reduce the risk of infection to both mothers and their babies during and shortly after delivery. Despite this understanding, the use of gloves during delivery and hand washing during and after delivery were mentioned infrequently. The need for a clean delivery surface was raised repeatedly, including explicit discussion of avoiding delivering in the dirt. Many activities to do with cord care involved non-sterile materials and practices: 1) Cord cutting was done with a variety of tools, and the most commonly used were razor blades or scissors; 2) Cord tying utilized a variety of materials, including string, rope, thread, twigs, and clamps; and 3) Cord care often involved applying traditional salves to the cord - including shea butter, ground shea nuts, local herbs, local oil, or “red earth sand.” Keeping babies and their surroundings clean was mentioned repeatedly as an important way to keep babies from falling ill.

Conclusions

This study suggests a widespread understanding in rural northern Ghana of the need for clean delivery. Nonetheless, many recommended clean delivery practices are ignored. Overarching themes emerging from this study included the increasing use of facility-based delivery, the disconnect between healthcare providers and the community, and the critical role grandmothers play in ensuring clean delivery practices. Future interventions to address clean delivery and prevention of neonatal infections include educating healthcare providers about harmful traditional practices so they are specifically addressed, strengthening facilities, and incorporating influential community members such as grandmothers to ensure success.

【 授权许可】

   
2012 Moyer et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R, Eisele T, Liu L, Mathers C: Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 2010, 375(9730):1969-1987.
• [2]Lawn JE, Cousens S, Zupan J: 4 million neonatal deaths: when? where? why? Lancet 2005, 365(9462):891-900.
• [3]Oestergaard MZ, Inoue M, Yoshida S, Mahanani WR, Gore FM, Cousens S, Lawn JE, Mathers CD: Neonatal Mortality Levels for 193 Countries in 2009 with Trends since 1990: A Systematic Analysis of Progress, Projections, and Priorities. PLoS Med 2011, 8(8):e1001080.
• [4]Lawn J, Kerber K: Opportunities for Africa’s Newborns: Practical data, policy and programmatic support for newborn care in Africa. PMNCH, Cape Town; 2006.
• [5]Ghana Demographic and Health Survey 2008. GSS, GHS, and ICF Macro, Accra, Ghana; 2009.
• [6]Engmann C, Walega P, Williams J, Aborigo RA, Adongo P, Lavasani L, Moyer CA, Bose C, Binka F, Hodgson A: Stillbirths and Early Neonatal Mortality in Rural Northern Ghana. Trop Med Int Health 2012, 17(3):272-282.
• [7]Baiden F, Hodgson A, Adjuik M, Adongo P, Ayaga B, Binka F: Trend and causes of neonatal mortality in the Kassena-Nankana district of northern Ghana, 1995-2002. Trop Med Int Health 2006, 11(4):532-538.
• [8]Haws RA, Thomas AL, Bhutta ZA, et al.: Impact of packaged interventions on neonatal health: a review of the evidence. Health Policy Plan 2007, 22:193-215.
• [9]Bhutta ZA, Darmstadt GL, Hasan BS, et al.: Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: a review of the evidence. Pediatrics 2005, 115(suppl 2):S519-S617.
• [10]Hill Z, Tawiah-Agyemang C, Okeyere E, Manu A, Fenty J, Kirkwood B: Improving hygiene in home deliveries in rural Ghana. Pediatr Infect Dis J 2010, 29(11):1004-1008.
• [11]Winani S, Wood S, Coffey P, Chirwa T, Mosha F, Changalucha J: Use of a Clean Delivery Kit and Factors Associated with Cord Infection and Puerperal Sepsis in Mwanza, Tanzania. J Midwifery Womens Health 2007, 52(1):37-43.
• [12]Engmann C: Improving neonatal mortality in sub-Saharan Africa: any cause for optimism? J Perinatol 2011, 31:745-748.
• [13]Alam MA, Ali NA, Sultana N, Mullany LC, Teela KC, Khan NUZ, Baqui AH, El Arifeen S, Mannan I, Darmstadt GL, Winch PJ: Newborn Umbilical Cord and Skin Care in Sylhet District, Bangladesh: implications for the promotion of umbilical cord cleansing with topical chlorhexidine. J Perinatol 2008, 28:S61-S68.
• [14]Mullany LC, Darmstadt GL, Katz J, Khatry SK, LeClerq SC, Adhikari RK, Tielsch JM: Risk factors for Umbilical Cord Infection among Newborns of Southern Nepal. Am J Epid 2007, 165(2):203-211.
• [15]Moran AC, Choudhury N, Khan NUZ, Karar ZA, Wahed T, Rashid SF, Alam MA: Newborn Care Practices Among Slum Dwellers in Dhaka, Bangladesh: a quantitative and qualitative exploratory study. BMC Preg Child 2009, 9:54. BioMed Central Full Text
• [16]Rahman M, Haque SE, Zahan S, Islam O: Noninstitutional Births and Newborn Care Practices Among Adolescent Mothers in Bangladesh. JOGNN 2011, 40(3):262-273.
• [17]Mull DS, Anderson JW, Mull JD: Cow Dung, Rock Salt, and Medical Innovation in the Hindu Kush of Pakistan: The Cultural Transformation of Neonatal Tetanus and Iodine Deficiency. SocSci Med 1990, 30(6):675-691.
• [18]Traverso HP, Bennett JV, Kahn AJ, Agha SB, Rahim H, Kamil S, Lang MH: Ghee Application to the Umbilical Cord: A Risk Factor for Neonatal Tetanus. Lancet 1989, 1(8636):486-488.
• [19]Khadduri R, Marsh DR, Rasmussen B, Bari A, Nazir R, Darmstadt GL: Household knowledge and practices of newborn and maternal health in Haripur district, Pakistan. J Perinatol 2008, 28:182-187.
• [20]Sreeramareddy CT, Joshi HR, Sreekumaran BV, Giri S, Chuni N: Home delivery and newborn care practices among urban women in western Nepal: a questionnaire survey. BMC Pregnancy Childbirth 2006, 6:27. Available at http://www.biomedcentral.com/1471-2393/6/27 webcite BioMed Central Full Text
• [21]Darmstadt GL, Badrawi N, Law PA, et al.: Topically applied sunflower seed oil prevents invasive bacterial infections in preterm infants in Egypt: a randomized, controlled clinical trial. Pediatr Infect Dis J 2004, 23:719-725.
• [22]Parlato RP, Darmstadt GL, Tinker A: Saving Newborn Lives Tools for Newborn Health: Qualitative Research to Improve Newborn Care Practices. Save the Children, Washington, DC; 2004. Available at: http://resourcecentre.savethechildren.se/content/library/documents/saving-newbornlives-tools-newborn-health-qualitative-research-improve-new webcite
• [23]Akazili J, Doctor HV, Abokyi L, Hodgson A, Phillips JF: Is there any relationship between antenatal care and place of delivery? Findings from rural northern Ghana. Afr J Health Sci 2011, 18:62-73.
• [24]Making Pregnancy Safer: The Critical Role of the Skilled Attendant. WHO, Geneva; 2004. Available at: http://whqlibdoc.who.int/publications/2004/9241591692.pdf webcite
• [25]Kanani S, Sharma M: Grandmothers’ influence on child care. Indian J Pediatr 2006, 73(4):295-298.
• [26]Bedri NM: Grandmothers’ influence on mother and child health. Ahfad j 1995, 12(1):74-86.
• [27]Giugliani ERJ, Kummer SC, Susin LRO: Influence of grandmothers on breastfeeding practices. Methods 2005, 39(2):141-147.
• [28]Susin LRO, Giugliani ERJ, Kummer SC: Influence of grandmothers on breastfeeding practices. Rev Saude Publica 2005, 39(2):141-147.
• [29]Hill Z, Manu A, Tawiah-Agyemang C, Gyan T, Turner K, Weobong B, Ten Asbroek AHA, Kirkwood BR: How did formative research inform the development of a home-based neonatal care intervention in rural Ghana? J Perinatol 2008, 28:S38-S45.
• [30]Mosha F, Winani S, Wood S, Changulacha J, Ngasalla B: Evaluation of the effectiveness of a clean delivery kit intervention in preventing cord infection and puerperal sepsis among neonates and their mothers in rural Mwanza Region, Tanzania. Tanz Health Res Bull 2005, 7(3):185-188.
• [31]Meegan ME, Conroy RM, Lengeny SO, Renhault K, Nyangole J: Effect on neonatal tetanus mortality after a culturally-based health promotion programme. Lancet 2001, 358:640-641.
• [32]Shoaeib FM, All SA, El-Barrawy MA: Alcohol or traditional methods versus natural drying for newborn’s cord care. J Egypt Public Health Assoc 2005, 80(1–2):169-201.
• [33]Powell-Jackson T, Neupane BD, Tiwari S, Tumbahangphe K, Manandhar D, Costello AM: The impact of Nepal’s National Incentive Programme to Promote Safe Delivery in the District of Makwanpur. Adv Health Econ Health Serv Res 2009, 21:221-249.
• [34]Dickerson T, Crookston B, Simonsen SE, Sheng X, Samenm A, Nkoy F: Pregnancy and Village Outreach Tibet: A Descriptive Report of a Community- and Home-Based Maternal-Newborn Outreach Program in Rural Tibet. J Perinat Neonat Nurs 2010, 24(2):113-125.