title: Skin, thermal and umbilical cord care practices for neonates in southern, rural Zambia: a qualitative study.
abstract: BACKGROUND
  In Choma District, southern Zambia, the neonatal mortality rate is approximately 40 per 1000 live births and, although the rate is decreasing, many deliveries take place outside of formal facilities. Understanding local practices during the postnatal period is essential for optimizing newborn care programs.
  
  
  METHODS
  We conducted 36 in-depth interviews, five focus groups and eight observational sessions with recently-delivered women, traditional birth attendants, and clinic and hospital staff from three sites, focusing on skin, thermal and cord care practices for newborns in the home.
  
  
  RESULTS
  Newborns were generally kept warm by application of hats and layers of clothing. While thermal protection is provided for preterm and small newborns, the practice of nighttime bathing with cold water was common. The vernix was considered important for the preterm newborn but dangerous for HIV-exposed infants. Mothers applied various substances to the skin and umbilical cord, with special practices for preterm infants. Applied substances included petroleum jelly, commercial baby lotion, cooking oil and breastmilk. The most common substances applied to the umbilical cord were powders made of roots, burnt gourds or ash. To ward off malevolent spirits, similar powders were reportedly placed directly into dermal incisions, especially in ill children.
  
  
  CONCLUSIONS
  Thermal care for newborns is commonly practiced but co-exists with harmful practices. Locally appropriate behavior change interventions should aim to promote chlorhexidine in place of commonly-reported application of harmful substances to the skin and umbilical cord, reduce bathing of newborns at night, and address the immediate bathing of HIV-infected newborns.
authors.affiliation: Department of International Health, Johns Hopkins School of Public Health, 615 North Wolfe Street, E8011, Baltimore, MD, 21205, USA. esacks@jhu.edu.|USAID Maternal and Child Survival Program (MCSP)/ICF International, Washington, DC, USA. esacks@jhu.edu.
authors.forename: Emma
authors.initials: E
authors.lastname: Sacks
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E6547, Baltimore, MD, 21205, USA. wmoss1@jhu.edu.
authors.forename: William J
authors.initials: WJ
authors.lastname: Moss
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E5533, Baltimore, MD, 21205, USA. pwinch@jhu.edu.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Winch
authors.affiliation: Macha Research Trust, PO Box 630 166, Choma, Zambia. Phil.thuma@macharesearch.org.
authors.forename: Philip
authors.initials: P
authors.lastname: Thuma
authors.affiliation: Macha Research Trust, PO Box 630 166, Choma, Zambia. Janneke.h.vandijk@gmail.com.
authors.forename: Janneke H
authors.initials: JH
authors.lastname: van Dijk
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E5533, Baltimore, MD, 21205, USA. lmullany@jhu.edu.
authors.forename: Luke C
authors.initials: LC
authors.lastname: Mullany
mesh_terms: D001294:Attitude to Health / Q000208:ethnology*; D001494:Baths / Q000379:methods; D003020:Clothing; D003466:Cultural Characteristics; D003879:Dermatologic Agents / Q000008:administration & dosage; D005260:Female; D017144:Focus Groups; D006700:Home Childbirth; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008880:Midwifery; D009035:Mothers; D018743:Perinatal Care / Q000379:methods*; D066087:Perinatal Death / Q000209:etiology / Q000517:prevention & control; D011247:Pregnancy; D036301:Qualitative Research; D012424:Rural Population; D017592:Skin Care / Q000379:methods*; D013483:Superstitions; D014470:Umbilical Cord; D014708:Vernix Caseosa; D015024:Zambia / Q000208:ethnology
chemical_list: D003879:Dermatologic Agents