Background
: Despite a substantial decrease in child mortality in Ethiopia over the
past decade, neonatal mortality remains relatively unchanged at 37/1000 live bir
ths.
This paper describes a qualitative study on immediate newborn and postnatal care
beliefs and practices in four rural communities of Ethiopia that was conducted to
inform the development of a package of community-based interventions for
newborns.
Methods:
The study team conducted eight key informant interviews with
grandmothers, 27 in-depth interviews with mothers, seven with traditional birth
attendants, and 15 with fathers from four purposively selected communities located i
n
Sidama Zone of Southern Nationalities, Nations, and Peoples Region and in East
Shewa and West Arsi Zones of Oromia Region.
Results:
In the study communities, the vast majority of deliveries occur at home.
After cutting the umbilical cord, the baby is put to the side of the mother, commonly
with no cloth wrapping. Immediately following birth, attendants focus largely on
delivery of the placenta, reinforced by the belief that the placenta is the ‘hous
e’ or
‘blanket’ of the baby and that any “harm” caused to the placenta will transfe
r to the
newborn. Applying butter or ointment to the cord “to speed drying” is common
practice. Initiation of breastfeeding is often delayed and women commonly repor
t
discarding colostrum before initiating breastfeeding. Sub-optimal breastfee
ding
practices often continue throughout the neonatal period due to perceptions of
insufficient breast milk resulting from inadequate maternal nutrition. In Si
dama Zone
communities, neonates are also given herbal drinks. Poor thermal care is
demonstrated through lack of continued skin-to-skin contact and frequent bathing—
often with cold water for low-birth weight or small babies. Thermal care prac
tices in some communities also expose the newborn to smoke from open fires. Poor hygienic
practices are also reported, particularly lack of or inconsistent hand washin
g prior to
contact with the newborn.
Interpretation:
Cultural beliefs and practices do not conform to recommended
standards of newborn care. Behaviour change messages should be informed by local
perspectives related to newborn care practices. Such messages should target
mothers,
grandmothers, TBAs, other female family members and fathers.