Clean delivery practices in rural northern Ghana: a qualitative study of community and provider knowledge, attitudes, and beliefs

BACKGROUND: Knowledge, attitudes and practices of community members and healthcare providers in rural northern Ghana regarding clean delivery are not well understood. This study explores hand washing/use of gloves during delivery, delivering on a clean surface, sterile cord cutting, appropriate cord tying, proper cord care following delivery, and infant bathing and cleanliness. METHODS: In-depth interviews and focus group discussions were audiotaped, transcribed, and analyzed using NVivo 9.0. RESULTS: 253 respondents participated, including women with newborn infants, grandmothers, household and compound heads, community leaders, traditional birth attendants, and formally trained health care providers. There is widespread understanding of the need for clean delivery to reduce the risk of infection to both mothers and their babies during and shortly after delivery. Despite this understanding, the use of gloves during delivery and hand washing during and after delivery were mentioned infrequently. The need for a clean delivery surface was raised repeatedly, including explicit discussion of avoiding delivering in the dirt. Many activities to do with cord care involved non-sterile materials and practices: 1) Cord cutting was done with a variety of tools, and the most commonly used were razor blades or scissors; 2) Cord tying utilized a variety of materials, including string, rope, thread, twigs, and clamps; and 3) Cord care often involved applying traditional salves to the cord - including shea butter, ground shea nuts, local herbs, local oil, or “red earth sand.” Keeping babies and their surroundings clean was mentioned repeatedly as an important way to keep babies from falling ill. CONCLUSIONS: This study suggests a widespread understanding in rural northern Ghana of the need for clean delivery. Nonetheless, many recommended clean delivery practices are ignored. Overarching themes emerging from this study included the increasing use of facility-based delivery, the disconnect between healthcare providers and the community, and the critical role grandmothers play in ensuring clean delivery practices. Future interventions to address clean delivery and prevention of neonatal infections include educating healthcare providers about harmful traditional practices so they are specifically addressed, strengthening facilities, and incorporating influential community members such as grandmothers to ensure success

Prevenção e cuidados com a pele da criança e do recém-nascido Children and newborn skin care and prevention

A pele do neonato é submetida a um progressivo processo de adaptação ao ambiente extrauterino, para o qual cuidados especiais se tornam necessários. A sua pele caracteriza-se por ser sensível, fina e frágil. A imaturidade da sua barreira epidérmica diminui significativamente a defesa contra a excessiva proliferação microbiana, torna a pele mais susceptível ao trauma e à toxicidade por absorção percutânea de drogas. Devido às características próprias da pele do recém-nascido (RN), de lactentes e de crianças, o uso dos produtos cosméticos destinados à sua higiene e proteção requer um cuidado especial. Com o intuito de preservar a integridade da pele neonatal e infantil, este artigo revisou os cuidados preventivos básicos que se devem ter com a pele dos bebês quanto à higiene, ao banho, ao uso de agentes de limpeza, a produtos tópicos e a sua toxicidade percutânea.<br>Neonatal skin suffers a progressive adaptation to the extrauterine environment and special care is needed during this period. This skin is very sensitive, thin and fragile. Immaturity of the epidermal barrier reduces the defense against the excessive proliferation of microbes and makes the skin more vulnerable to trauma and percutaneous drug toxicity. Because of the peculiar characteristics of newborn, infant and children's skin, the use of cosmetic products designed for hygiene and protection requires caution. In order to preserve the integrity of neonatal and child's skin, this article reviewed basic preventive care practices in relation to hygiene, bathing, cleansing agents, topical products and their percutaneous toxicity