title: Improving hygiene in home deliveries in rural Ghana: how to build on current attitudes and practices.
abstract: BACKGROUND
  Clean delivery of newborns is a key intervention for reducing infection-related neonatal mortality. Understanding local practices and beliefs is important for designing appropriate interventions. There are few data from Africa. This study explored delivery practices in Ghana to identify behaviors for intervention and to determine behavioral influencers.
  
  
  METHODS
  Data on the prevalence of clean delivery behaviors, collected through a demographic surveillance system, were analyzed for 2631 women who delivered at home within a 1-year period. Qualitative data on delivery practices were collected through birth narratives, in-depth interviews, and focus groups with recently delivered/pregnant women, traditional birth attendants, grandmothers, and husbands.
  
  
  RESULTS
  Most women delivered on a covered surface (79%), had birth attendants who washed their hands (79%), cut the cord with a new blade (98%), and tied it with a new thread (90%). Eight percent of families practiced dry cord care. Families understood the importance of a clean delivery surface and many birth attendants knew the importance of hand-washing. Delivering on an uncovered surface was linked to impromptu deliveries and a belief that a swept floor is clean. Not washing hands was linked to rushing to help the woman, not being provided with soap, forgetfulness, and a belief among some that the babies are born dirty. The frequent application of products to the cord was nearly universal and respondents believed that applying nothing to the cord would have serious negative consequences.
  
  
  CONCLUSIONS
  Delivery surfaces, hand-washing, and cord cutting and tying appear appropriate for the majority of women. Changing cord care practices is likely to be difficult unless replacement products are provided.
authors.affiliation: Centre for International Health and Development, Institute of Child Health, University College London, London, United Kingdom. zhill.ich@gmail.com
authors.forename: Zelee
authors.initials: Z
authors.lastname: Hill
authors.forename: Charlotte
authors.initials: C
authors.lastname: Tawiah-Agyemang
authors.forename: Eunice
authors.initials: E
authors.lastname: Okeyere
authors.forename: Alexander
authors.initials: A
authors.lastname: Manu
authors.forename: Justin
authors.initials: J
authors.lastname: Fenty
authors.forename: Betty
authors.initials: B
authors.lastname: Kirkwood
mesh_terms: D036861:Delivery, Obstetric; D005260:Female; D005869:Ghana; D006235:Hand Disinfection; D007722:Health Knowledge, Attitudes, Practice; D006700:Home Childbirth / Q000379:methods* / Q000523:psychology / Q000592:standards; D006801:Humans; D006920:Hygiene; D007224:Infant Care / Q000379:methods* / Q000523:psychology / Q000592:standards; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000517:prevention & control; D011247:Pregnancy; D012424:Rural Population; D014470:Umbilical Cord