title: Local understandings of vulnerability and protection during the neonatal period in Sylhet District, Bangladesh: a qualitative study.
abstract: BACKGROUND
  Understanding of local knowledge and practices relating to the newborn period, as locally defined, is needed in the development of interventions to reduce neonatal mortality. We describe the organisation of the neonatal period in Sylhet District, Bangladesh, the perceived threats to the well-being of neonates, and the ways in which families seek to protect them.
  
  
  METHODS
  We did 39 in-depth, unstructured, qualitative interviews with mothers, fathers, and grandmothers of neonates, and traditional birth attendants. Data on neonatal knowledge and practices were also obtained from a household survey of 6050 women who had recently given birth.
  
  
  RESULTS
  Interviewees defined the neonatal period as the first 40 days of life (chollish din). Confinement of the mother and baby is most strongly observed before the noai ceremony on day 7 or 9, and involves restriction of movement outside the home, sleeping where the birth took place rather than in the mother's bedroom, and sleeping on a mat on the floor. Newborns are seen as vulnerable to cold air, cold food or drinks (either directly or indirectly through the mother), and to malevolent spirits or evil eye. Bathing, skin care, confinement, and dietary practices all aim to reduce exposure to cold, but some of these practices might increase the risk of hypothermia.
  
  
  CONCLUSIONS
  Although fatalism and cultural acceptance of high mortality have been cited as reasons for high levels of neonatal mortality, Sylheti families seek to protect newborns in several ways. These actions reflect a set of assumptions about the newborn period that differ from those of neonatal health specialists, and have implications for the design of interventions for neonatal care.
authors.affiliation: Project to Advance the Health of Newborns and Mothers (PROJAHNMO), Sylhet, Bangladesh. pwinch@jhsph.edu
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Winch
authors.forename: M Ashraful
authors.initials: MA
authors.lastname: Alam
authors.forename: Afsana
authors.initials: A
authors.lastname: Akther
authors.forename: Dilara
authors.initials: D
authors.lastname: Afroz
authors.forename: Nabeel Ashraf
authors.initials: NA
authors.lastname: Ali
authors.forename: Amy A
authors.initials: AA
authors.lastname: Ellis
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Baqui
authors.forename: Gary L
authors.initials: GL
authors.lastname: Darmstadt
authors.forename: Shams
authors.initials: S
authors.lastname: El Arifeen
authors.forename: M Habibur Rahman
authors.initials: MH
authors.lastname: Seraji
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D003469:Culture; D003625:Data Collection; D005260:Female; D006801:Humans; D007224:Infant Care; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008519:Medicine, Traditional; D008880:Midwifery; D010290:Parents; D011247:Pregnancy; D012959:Socioeconomic Factors