title: Delivery, immediate newborn and cord care practices in Pemba Tanzania: a qualitative study of community, hospital staff and community level care providers for knowledge, attitudes, belief systems and practices.
abstract: BACKGROUND
  Deaths during the neonatal period account for almost two-thirds of all deaths in the first year of life and 40 percent of deaths before the age of five. Most of these deaths could be prevented through proven cost-effective interventions. Although there are some recent data from sub-Saharan Africa, but there is paucity of qualitative data from Zanzibar and cord care practices data from most of East Africa. We undertook a qualitative study in Pemba Island as a pilot to explore the attitudes, beliefs and practices of the community and health workers related to delivery, newborn and cord care with the potential to inform the main chlorhexidine (CHX) trial.
  
  
  METHODS
  80 in-depth interviews (IDI) and 11 focus group discussions (FGD) involving mothers, grandmothers, fathers, traditional birth attendants and other health service providers from the community were undertaken. All IDIs and FGDs were audio taped, transcribed and analyzed using ATLAS ti 6.2.
  
  
  RESULTS
  Poor transportation, cost of delivery at hospitals, overcrowding and ill treatment by hospital staff are some of the obstacles for achieving higher institutional delivery. TBAs and health professionals understand the need of using sterilized equipments to reduce risk of infection to both mothers and their babies during delivery. Despite this knowledge, use of gloves during delivery and hand washing before delivery were seldom reported. Early initiation of breastfeeding and feeding colostrum was almost universal. Hospital personnel and trained TBAs understood the importance of keeping babies warm after birth and delayed baby's first bath. The importance of cord care was well recognized in the community. Nearly all TBAs counseled the mothers to protect the cord from dust, flies and mosquitoes or any other kind of infections by covering it with cloth. There was consensus among respondents that CHX liquid cord cleansing could be successfully implemented in the community with appropriate education and awareness.
  
  
  CONCLUSIONS
  The willingness of community in accepting a CHX cord care practice was very high; the only requirement was that a MCH worker needs to do and demonstrate the use to the mother.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT01528852.
authors.forename: Usha
authors.initials: U
authors.lastname: Dhingra
authors.forename: Joel
authors.initials: J
authors.lastname: Gittelsohn
authors.forename: Atifa Moh'd
authors.initials: AM
authors.lastname: Suleiman
authors.forename: Shekhia Moh'd
authors.initials: SM
authors.lastname: Suleiman
authors.forename: Arup
authors.initials: A
authors.lastname: Dutta
authors.forename: Said Mohammed
authors.initials: SM
authors.lastname: Ali
authors.forename: Shilpi
authors.initials: S
authors.lastname: Gupta
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Room E 5521, 615 North Wolfe Street, Baltimore, MD 21205, USA. ssazawal@jhsph.edu.
authors.forename: Sunil
authors.initials: S
authors.lastname: Sazawal
mesh_terms: D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D001494:Baths; D001942:Breast Feeding; D002710:Chlorhexidine / Q000627:therapeutic use; D003150:Community Health Workers; D036861:Delivery, Obstetric / Q000592:standards*; D005220:Fathers; D005260:Female; D017575:Gloves, Protective; D006235:Hand Disinfection; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006920:Hygiene; D007224:Infant Care; D007231:Infant, Newborn; D007749:Labor Stage, Third; D008297:Male; D008880:Midwifery; D009035:Mothers; D010353:Patient Education as Topic; D010564:Personnel, Hospital; D010865:Pilot Projects; D011247:Pregnancy; D036301:Qualitative Research; D013636:Tanzania; D014470:Umbilical Cord
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine