title: Newborn care practices in rural Bangladesh: Implications for the adaptation of kangaroo mother care for community-based interventions.
abstract: Bangladesh has one of the world's highest rates of low birth weight along with prevalent traditional care practices that leave newborns highly vulnerable to hypothermia, infection, and early death. We conducted formative research to explore existing newborn care practices in rural Bangladesh with an emphasis on thermal protection, and to identify potential facilitators, barriers, and recommendations for the community level delivery of kangaroo mother care (CKMC). Forty in-depth interviews and 14 focus group discussions were conducted between September and December 2012. Participants included pregnant women and mothers, husbands, maternal and paternal grandmothers, traditional birth attendants, village doctors, traditional healers, pharmacy men, religious leaders, community leaders, and formal healthcare providers. Audio recordings were transcribed and translated into English, and the textual data were analyzed using the Framework Approach. We find that harmful newborn care practices, such as delayed wrapping and early initiation of bathing, are changing as more biomedical advice from formal healthcare providers is reaching the community through word-of-mouth and television campaigns. While the goal of CKMC was relatively easily understood and accepted by many of the participants, logistical and to a lesser extent ideological barriers exist that may keep the practice from being adopted easily. Women feel a sense of inevitable responsibility for household duties despite the desire to provide the best care for their new babies. Our findings showed that participants appreciated CKMC as an appropriate treatment method for ill babies, but were less accepting of it as a protective method of caring for seemingly healthy newborns during the first few days of life. Participants highlighted the necessity of receiving help from family members and witnessing other women performing CKMC with positive outcomes if they are to adopt the behavior themselves. Focusing intervention messages on building a supportive environment for CKMC practice will be critical for the intervention's success.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA. Electronic address: ehunter@jhsph.edu.
authors.forename: Erin C
authors.initials: EC
authors.lastname: Hunter
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Suite E8608, Baltimore, MD 21205, USA. Electronic address: Jcallag1@jhu.edu.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Callaghan-Koru
authors.affiliation: Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), GPO Box 128, Dhaka 1000, Bangladesh. Electronic address: mahmud@icddrb.org.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al Mahmud
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA. Electronic address: mshah34@jhu.edu.
authors.forename: Rashed
authors.initials: R
authors.lastname: Shah
authors.affiliation: International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, 1800 Orleans Street, Suite 8513-8S, Baltimore, MD 21287, USA. Electronic address: afarzin1@jhu.edu.
authors.forename: Azadeh
authors.initials: A
authors.lastname: Farzin
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, 1800 Orleans Street, Suite 8513B-8S, Baltimore, MD 21287, USA. Electronic address: ecristofalo@jhmi.edu.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Cristofalo
authors.affiliation: Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), GPO Box 128, Dhaka 1000, Bangladesh. Electronic address: sadika@icddrb.org.
authors.forename: Sadika
authors.initials: S
authors.lastname: Akhter
authors.affiliation: International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA. Electronic address: abaqui@jhsph.edu.
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Baqui
mesh_terms: D001459:Bangladesh; D001942:Breast Feeding / Q000379:methods; D003469:Culture; D005190:Family; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006920:Hygiene; D007035:Hypothermia / Q000517:prevention & control; D007223:Infant; D007224:Infant Care / Q000379:methods*; D007226:Infant Mortality; D007407:Interviews as Topic; D060127:Kangaroo-Mother Care Method; D008297:Male; D012424:Rural Population
keywords: Bangladesh; Formative research; Kangaroo mother care; Low birth weight; Neonatal hypothermia; Neonatal mortality; Newborn care practices