title: Umbilical cord care in Ethiopia and implications for behavioral change: a qualitative study.
abstract: BACKGROUND
  Infections account for up to a half of neonatal deaths in low income countries. The umbilicus is a common source of infection in such settings. This qualitative study investigates practices and perspectives related to umbilical cord care in Ethiopia.
  
  
  METHODS
  In-depth interviews (IDI) were conducted in a district in each of the four most populous regions in the country: Oromia, Amhara, Tigray and Southern Nations, Nationalities and Peoples Region (SNNPR). In each district, one community was purposively selected; and in each study community, IDIs were conducted with 6 mothers, 4 grandmothers, 2 Traditional Birth Attendants and 2 Health Extension Workers (HEWs). The two main questions in the interview guide related to cord care were: How was the umbilical cord cut and tied? Was anything applied to the cord stump immediately after cutting/in the first 7 days? Why was it applied/not applied?
  
  
  RESULTS
  The study elucidates local cord care practices and the rational for these practices. Concepts underlying cord tying practices were how to stem blood flow and facilitate delivery of the placenta. Substances were applied on the cord to moisturize it, facilitate its separation and promote healing. Locally recognized cord problems were delayed healing, bleeding or swelling. Few respondents reported familiarity with redness of the cord - a sign of infection. Grandmothers, TBAs and HEWs were influential regarding cord care.
  
  
  CONCLUSIONS
  This study highlights local rationale for cord practices, concerns about cord related problems and recognition of signs of infection. Behavioral change messages aimed at improving cord care including cleansing with CHX should address these local perspectives. It is suggested that HEWs and health facility staff target mothers, grandmothers, TBAs and other community women with messages and counseling.
authors.affiliation: Consultancy for Social Development, Addis Ababa, Ethiopia. yaredamare@yahoo.com.
authors.forename: Yared
authors.initials: Y
authors.lastname: Amare
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D001424:Bacterial Infections / Q000517:prevention & control*; D017028:Caregivers; D002710:Chlorhexidine / Q000008:administration & dosage; D005002:Ethiopia; D005260:Female; D006235:Hand Disinfection; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000517:prevention & control*; D007249:Inflammation / Q000517:prevention & control*; D008875:Middle Aged; D008880:Midwifery / Q000379:methods; D009035:Mothers / Q000523:psychology; D036301:Qualitative Research; D014470:Umbilical Cord; D055815:Young Adult
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine
references.citation: Trop Med Int Health. 2002 Jul;7(7):622-4
references.pmid: 12100446
references.citation: Lancet. 2012 Mar 17;379(9820):1022-8
references.pmid: 22322124
references.citation: Pediatrics. 2013 Apr;131(4):708-15
references.pmid: 23509175
references.citation: J Perinatol. 2008 Dec;28 Suppl 2:S61-8
references.pmid: 19057570
references.citation: Int J Epidemiol. 1999 Dec;28(6):1172-5
references.pmid: 10661665
references.citation: Lancet. 2006 Mar 18;367(9514):910-8
references.pmid: 16546539
references.citation: Int J Epidemiol. 1996 Aug;25(4):879-84
references.pmid: 8921470
references.citation: J Trop Pediatr. 1982 Dec;28(6):299-302
references.pmid: 7154157
references.citation: Bull World Health Organ. 2006 Sep;84(9):706-13
references.pmid: 17128340
references.citation: Pediatrics. 2006 Nov;118(5):1864-71
references.pmid: 17079556
references.citation: Lancet. 2010 Jun 5;375(9730):1969-87
references.pmid: 20466419
references.citation: Lancet. 2005 Mar 5-11;365(9462):891-900
references.pmid: 15752534
references.citation: Soc Sci Med. 1990;30(6):675-91
references.pmid: 2315737
references.citation: Pediatr Infect Dis J. 2009 Jan;28(1 Suppl):S3-9
references.pmid: 19106760
references.citation: Int J Epidemiol. 2002 Jun;31(3):648-53
references.pmid: 12055169
references.citation: Am J Epidemiol. 2007 Jan 15;165(2):203-11
references.pmid: 17065275
references.citation: Lancet. 2012 Mar 17;379(9820):1029-36
references.pmid: 22322126