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


RESULTS
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.


CONCLUSIONS
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.
Center for Global Health and Development, Boston University, Boston, Massachusetts, United States of America ; Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, United States of America ; Department of International Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.
Julie M
JM
Herlihy
Affan
A
Shaikh
Arthur
A
Mazimba
Natalie
N
Gagne
Caroline
C
Grogan
Chipo
C
Mpamba
Bernadine
B
Sooli
Grace
G
Simamvwa
Catherine
C
Mabeta
Peggy
P
Shankoti
Lisa
L
Messersmith
Katherine
K
Semrau
Davidson H
DH
Hamer
D000328:Adult; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D001294:Attitude to Health; D002710:Chlorhexidine / Q000008:administration & dosage*; D003469:Culture; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008875:Middle Aged; D011787:Quality of Health Care; D014470:Umbilical Cord; D015024:Zambia
D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine