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Open Access Highly Accessed Research article

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

Cheryl A Moyer15*, Raymond Akawire Aborigo2, Gideon Logonia2, Gideon Affah2, Sarah Rominski1, Philip B Adongo3, John Williams2, Abraham Hodgson2 and Cyril Engmann4

Author Affiliations

1 Global REACH, University of Michigan Medical School, 5115 Med Sci 1 1301 Catherine Street, Ann Arbor, MI 48104, USA

2 Navrongo Health Research Centre, PO Box 114, Navrongo, UE/R, Ghana

3 Department of Social and Behavioral Science, School of Public Health, University of Ghana, Legon, Ghana

4 University of North Carolina, CB# 7596, 4th Floor, UNC Hospitals, Chapel Hill, NC 27599-7596, USA

5 Department of Medical Education, University of Michigan Medical School, Towsley Center, Ann Arbor, MI 48109, USA

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BMC Pregnancy and Childbirth 2012, 12:50  doi:10.1186/1471-2393-12-50

Published: 15 June 2012

Abstract

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.

Keywords:
Global health; Maternal and child health; Cord care; Developing countries; Umbilicus