Domain of newborn care | Barriers | Facilitators | Article number per table 2, year | Total number of article mentions |
Cord care | Lack of supplies, including water or infection prevention supplies. Using surgical spirits and powder. Unhygienic cutting practices, including used, unsterilised razor blades or scissors. Unskilled attendants. Delayed cord cutting, resulting in infection. Mixed perception about the length at which cord should detach and heal. Use of topical applications to the cord, including herbs, butter and indigenously made substances, for medicinal/protective purposes. Application of traditional remedies and substances on the cord to moisturise or dry it and facilitate its separation and promote healing. Belief that cord infections caused by mother’s diet. Lack of understanding about cord cleaning. Lack of understanding of risks and infections affecting the cord and certain signs of infection, such as redness. Cultural belief and newborn care practices not conforming to recommended practices. Cost of supplies, including chlorhexidine solution. Religious and cultural beliefs about cord cutting and cleaning. Umbilical cord thought to make baby vulnerable to witchcraft. Mothers cutting the cord themselves. Umbilical cord not tied prior to cutting, can lead to tetanus. Practice of only tying to cord on the side of the baby. Recontamination of washed hands before attending to newborn. Seclusion of mother and baby in postpartum period may lead to late identification of illness and delay to seeking care. Using materials, such as rope and twigs, in cord tying. Disconnect between healthcare providers and community. Local conceptions regarding role of cord tying in stemming blood flow. Concerns regarding the length of time until cord detachment. Presence of blood clots associated with curses. | Knowledge about cord care. Community stakeholder recognition that infants are susceptible to cord infection. Delivery in hospital. Informed at health facility. Tailored behaviour change communication. Appropriate compromises between existing and recommended practices. Community education. Outreach education. Inclusion of grandmothers and other female household members, who are key decision-makers and caregivers. Participatory health promotion techniques, such as women’s groups. Programmes targeting traditional birth attendants (TBAs) and community mothers. Importance of cord care and tying recognised in community and understood culturally. Recognition of cord problems, such as delayed healing, bleeding or swelling. TBAs counselling mothers to protect the cord from infections. Consensus regarding liquid cord cleaning. Raising awareness about usefulness of CHX in cord cleaning. Willingness to adopt practices that would protect the newborn and alter traditional cord care practices. Behaviour change communication messages beginning at pregnancy. Prescribed practices making their way into traditional care. Efforts to promote hand-washing and to avoid recontamination. Promotion of efforts to avoid unclean home applications to the cord. Programmes, promoting cord cleansing with antiseptics, should provide educational messages about the balance between the benefits and the likelihood that separation of umbilical cord may be slightly delayed. Using materials, such as clean cotton, other than fingers to apply medicine/antiseptic. Programmes in urban slum areas Interventions to improve social support to women, especially first-time mothers. Educating healthcare providers about harmful, traditional practices so they are specifically addressed. Explaining rationale for tying the cord on both sides of the cut. Cultural health systems model that depicts all stakeholders. Presence of blood clots leading to seeking medical treatment at health centres. Promotion of chlorhexidine in place of commonly-reported application of harmful substances. Scale-up of evidenced based practices. Health promotion programmes taking into account health system barriers and financial burden. | 3, 2018 4, 2014 9, 2017 10, 2011 11, 2014 12, 2014 15, 2013 18, 2009 19, 2008 22, 2014 23, 2009 24, 2012 25, 2008 26, 2014 27, 2015 30, 2014 32, 2015 36, 2008 37, 2014 | 19/37 |
Drying and wrapping | Behaviours vary among home deliveries. Perception of dirtiness of baby. Perception of birthing process as polluting. Vulnerability of baby. Opinions of other household stakeholders, such as the mother-in-law. Home and hospital delivery. Not attending to baby until placenta delivered. Prioritisation of the mothers. | Knowledge about drying and wrapping. Understanding that baby should be kept warm. Delivery in hospital. Informed at health facility. Tailored behaviour change communication. Appropriate compromises between existing and recommended practices. Community education. Outreach education. Inclusion of grandmothers who are key decision-makers. Participatory health promotion techniques, such as women’s groups. Traditional practice of wrapping in new clean cloth. Use of warm water and traditional herbs to protect baby. Behaviour change communication messages beginning at pregnancy. Babies dried and wrapped due to awareness of reduction of cold. Having more than one attendant to help both the mother and baby. Programmes in urban slum areas. Interventions to improve social support to women, especially first-time mothers. | 2, 2015 8, 2011 10, 2014 14, 2010 16, 2009 19, 2014 20, 2014 21, 2009 28, 2014 30, 2015 31, 2014 | 11/37 |
Bathing | Traditional or historical practice. Lack of knowledge of when to bathe baby, especially in home deliveries. Early bathing due to societal pressure. Cultural norm of frequent bathing. Cultural belief and newborn care practices not conforming to recommended practices. Negative perception of vernix, including association with sperm. Vernix considered dangerous for HIV-exposed infants. Bathing in close proximity to smoking fires. Early bathing due to association with dirtiness as well as body odour later in life. Differences in practice by untrained TBAs. Spiritual beliefs attached to use of local herbs for bathing. Bathing practices, such as using pond water. Substances added to water, including Dettol or Savlon. Bathing immediately after birth due to concerns about ‘ritual pollution’ can cause hypothermia. Early bathing linked to shaping the baby’s head. Early bathing to help the baby sleep and feel clean. Early bathing in facilities. | Delayed bathing when delivery in hospital. Informed at health facility. Quality of care in health facility. Health worker advice. Tailored behaviour change communication, addressing community norms and based on formative research. Appreciation of newborn vulnerability to encourage behaviour change. Appropriate compromises between existing and recommended practices. Community education. Outreach education. Inclusion of grandmothers who are key decision-makers. Participatory health promotion techniques, such as women’s groups. Behaviour change communication messages beginning at pregnancy. Having more than one attendant to help both the mother and baby. Delayed bathing due to concerns about pneumonia. Identifying and addressing cultural rationales that underlie negative practices. Reinforcing ad protecting beliefs that support positive practices. Improving health worker communication skills and social management of patients. Lowering healthcare costs. Programmes in urban slum areas. Interventions to improve social support to women, especially first-time mothers. Scale-up of evidenced based practices. Health promotion programmes taking into account health system barriers and financial burden. Using religious leaders, trained health workers, family health action groups and radio to disseminate messages. | 2, 2015 3, 2008 8, 2011 9, 2014 10, 2014 14, 2010 16, 2009 19, 2014 20, 2014 21, 2009 24, 2014 26, 2014 28, 2014 30, 2015 31, 2014 33, 2008 34, 2008 | 17/37 |
Thermal control | Lack of practice when delivery at home or with TBA. Lack of knowledge of keeping baby indoors. Suboptimal practices. Early bathing. Length of time baby undressed during bathing. Bathing with warm water. Use of blankets, rather than skin-to-skin care. Newborn massage, including use of mustard oil, can compromise the skin barrier function. Cultural belief and newborn care practices not conforming to recommended practices. Lack of maintaining thermoprotective practices in the first few hours postpartum, when newborns are at greatest risk. | Informed at health facility. Beliefs about importance of thermal care. Quality of care in health facility. Tailored behaviour change communication based on formative research. Appropriate compromises between existing and recommended practices. Community education. Outreach education. Inclusion of grandmothers who are key decision-makers. Participatory health promotion techniques, such as women’s groups. Behaviour change communication messages beginning at pregnancy. Knowledge and practice that baby should be kept warm. Having more than one attendant to help both the mother and baby. Use of low-cost newborn warmers. Community-based practices on hypothermia prevention and management. | 2, 2015 3, 2008 8, 2011 9, 2014 10, 2014 14, 2010 17, 2008 19, 2014 24, 2014 28, 2014 30, 2015 31, 2014 | 12/37 |
Skin-to-skin contact | Few mothers given baby immediately after birth. Concerns of disease transmission, harm to umbilicus. Perception of dirtiness after birth. Maternal rest. Concerns of baby becoming cold. Delayed due to early bathing. Perception that it might be harmful to fragile newborns. Lack of understanding that kangaroo mother care is a protective method of caring for healthy newborns. Use of blankets, rather than skin-to-skin care. Lack of continued skin to skin contact. Cultural belief and newborn care practices not conforming to recommended practices. Women feeling responsible for household duties. | Behaviour change interventions based on formative research. Quality of care in health facility. Tailored behaviour change communication. Appropriate compromises between existing and recommended practices. Community education. Outreach education. Inclusion of grandmothers who are key decision-makers. Participatory health promotion techniques, such as women’s groups. Behaviour change communication messages beginning at pregnancy. Association with reduced risk of cord infection. Concept easily understood and women willing to try if good for the baby. Appreciation of kangaroo mother care as an appropriate treatment for ill babies. Biomedical advice from healthcare providers reaching community through word-of-mouth and television campaigns. Receiving help from family members. Witnessing other women perform kangaroo mother care with positive outcomes. Focusing intervention messages on building supportive a environment for kangaroo mother care practice. | 2, 2015 3, 2008 8, 2011 9, 2014 14, 2010 15, 2014 16, 2009 19, 2014 31, 2014 | 9/37 |
Hygiene | Lack of knowledge on hand-washing with soap. Recontamination of washed hands before attending to the newborn. Cultural belief and newborn care practices not conforming to recommended practices. | Health education. Tailored behaviour change communication. Appropriate compromises between existing and recommended practices. Community education. Outreach education. Inclusion of grandmothers who are key decision-makers. Participatory health promotion techniques, such as women’s groups. Efforts to promote hand-washing and to avoid recontamination. Understanding of keeping babies and their surroundings clean. Educating healthcare providers about harmful, traditional practices so they are specifically addressed. | 3, 2008 9, 2014 16, 2009 17, 2008 22, 2012 24, 2014 | 6/37 |
Breast feeding (initiation of and provision of colostrum) | Traditional or historical practice. Belief that it is unhealthy. Mother’s exhaustion. Limited knowledge. Maternal education status. Geographical isolation. Inconsistency in health education. Learning from relatives. Prelacteal feeds given on fingertip, increasing risk of infection. Low urgency in initiating breast feeding as mother and child believed to be polluted after birth. Negative beliefs regarding colostrum. Traditional practices to test colostrum for bitterness. Perception of a lack of breast milk. Onset of post-birth activities, such as bathing. Perception that baby needs rest. Baby not crying for milk. Perception of inadequate maternal nutrition and breast milk. Premature breast milk supplementation (water and other fluids), which may expose newborns to pathogens. Work served as a barrier. Difference in advice received from different people by first-time mothers. Cultural belief and newborn care practices not conforming to recommended practices. Perception that hunger is not met or satisfied by breast-milk alone. | Community members knowledgeable about importance of breast feeding. Delivery in a health facility, where staff encouraged early breast feeding. Culturally-tailored health education. Targeting isolated villages. Cross-generational education interventions. Interventions through community health clinic workers. Appropriate compromises between existing and recommended practices. Community education. Outreach education. Inclusion of grandmothers/mother-in-laws and religious leaders who are key decision-makers. Participatory health promotion techniques, such as women’s groups. Awareness of nutritive value of breast milk. Positive perception regarding infant feeding. TBAs trained by ministry of health. Raising awareness of early initiation of breast feeding in the policy arena. Cultural belief and practices. Identifying and addressing cultural rationales that underlie negative practices. Reinforcing ad protecting beliefs that support positive practices. Improving health worker communication skills and social management of patients. Lowering healthcare costs. Programmes in urban slum areas. Interventions to improve social support to women, especially first-time mothers. First-time mothers’ mothers. Working with employers and developing supportive employment policies. Providing postnatal support and working with lay people and health professionals. Research to identify optimal combination of interventions. Using religious leaders, trained health workers, family health action groups and radio to disseminate messages. | 1, 2012 6, 2017 9, 2017 10, 2011 11, 2014 12, 2014 18, 2009 19, 2008 20, 2013 22, 2014 23, 2009 25, 2008 26, 2014 28, 2014 30, 2014 31, 2014 33, 2008 35, 2008 | 18/37 |
Care-seeking for illness | Lack of transportation. Geographical isolation/remoteness from health facilities. Financial ability/constraints. Seclusion of mother and baby in postpartum period may lead to late identification of illness and delay to seeking care. Community understanding of the newborn period and cultural expectations. Caretaker knowledge about newborn sickness. Individual experiences in household and caretaker autonomy. Women’s inability to seek care without being accompanied by a male relative. Healthcare decisions influenced by community members. Perceived health system gaps. Confidence in healthcare providers is issue-specific. Sequential care-seeking practices, with traditional medicine as first-line of treatment for 7 days. Untimely action after recognition of danger signs. Previous negative experiences with health services facilities. Local understanding of illness affects treatment practices. Mothers blamed for infant illness. Use of traditional home remedies and self-medication instead of care in health facilities. Shame about utilisation of maternal and neonatal services. Care-seeking for local community members for serious health concerns. Postpartum depression. ‘Asram’ perceived as common illness which cannot be treated at health facilities. ‘Asram’ treatments including frequent cold herbal baths, air-dying and oral treatments. Modification of ‘asram’ treatment required the sanction of a healer. | Addressing locally existing cultural beliefs. Strengthening facility care. Urging families to seek medical care for any symptom of illness in a newborn. Addressing financial barriers. Recognition of danger signs. Targeted behaviour-change communication programmes. Using religious leaders, trained health workers, family health action groups and radio to disseminate messages. Understanding traditional illnesses in designing care-seeking interventions. | 7, 2008 8, 2011 11, 2013 17, 2008 25, 2015 26, 2014 27, 2010 | 7/37 |
Other newborn care | Cultural perception of emollients as improving the skin, keeping the baby warm and shaping the baby. Social pressure to use emollients. Emollient choice influenced by cost, availability and traditional norms. Massage, associated with application of emollients, is potentially damaging to skin. Potential impact of emollients, such as engine oil, on harm and even mortality. TBAs applying mild pressure inside baby’s mouth on the soft palate with water and local herb. Application of powders directly into dermal incisions of ill children to ward off malevolent spirits. | Association of emollient therapy in reduction of mortality among preterm infants. Newborn emollient trials, specifically designed to reflect contextual differences. If emollients are proven effective, policy-makers deciding whether to provide emollients free of charge or through social marketing. Improving practice of massage associated with emollient application. Understanding traditional illnesses in designing care-seeking interventions. | 4, 2014 20, 2014 26, 2010 30, 2015 | 4/37 |
Low birthweight recognition | Babies not weighed. Belief in supernatural powers. Less knowledge of home care practices when baby delivered at home or in lower level health facility. Lack of knowledge of how to provide care or when to take baby to health facility. Perceptions of preterm birth, including young and old maternal age, heredity, sexual impurity and maternal illness during pregnancy. Poverty. Women placed with main responsibility for preterm newborns. High time burden of care for preterm babies leading to neglect of household, farming and business duties. | Better knowledge of home care practices when delivery at health facility. Health education at community level to reach mothers that deliver at home. Mechanisms to support mothers. Provision of warmth to preterm newborns. Addressing cultural practices for preterm babies among community members. Vernix considered important for preterm newborns. | 9, 2014 12, 2014 24, 2014 | 3/37 |