Open Access Research article

Thermal care for newborn babies in rural southern Tanzania: a mixed-method study of barriers, facilitators and potential for behaviour change

Donat Shamba1*, Joanna Schellenberg2, Zoe Jane-Lara Hildon256, Irene Mashasi1, Suzanne Penfold12, Marcel Tanner4, Tanya Marchant2 and Zelee Hill3

Author Affiliations

1 Ifakara Health Institute, P.O. Box 78373, Dar Es Salaam, Tanzania

2 Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

3 Center for International Health and Development, Institute of Child Health, University College London, London, UK

4 Swiss Tropical and Public Health Institute, Basel, Switzerland

5 Saw Swee Hock School of Public Health, National University Singapore, Singapore, Singapore

6 Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK

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BMC Pregnancy and Childbirth 2014, 14:267  doi:10.1186/1471-2393-14-267

Published: 11 August 2014



Hypothermia contributes to neonatal morbidity and mortality in low-income countries, yet little is known about thermal care practices in rural African settings. We assessed adoption and community acceptability of recommended thermal care practices in rural Tanzania.


A multi-method qualitative study, enhanced with survey data. For the qualitative component we triangulated birth narrative interviews with focus group discussions with mothers and traditional birth attendants. Results were then contrasted to related quantitative data. Qualitative analyses sought to identify themes linked to a) immediately drying and wrapping of the baby; b) bathing practices, including delaying for at least 6 hours and using warm water; c) day to day care such as covering the baby’s head, covering the baby; and d) keeping the baby skin-to-skin. Quantitative data (n = 22,243 women) on the thermal care practices relayed by mothers who had delivered in the last year are reported accordingly.


42% of babies were dried and 27% wrapped within five minutes of birth mainly due to an awareness that this reduced cold. The main reason for delayed wrapping and drying was not attending to the baby until the placenta was delivered. 45% of babies born at a health facility and 19% born at home were bathed six or more hours after birth. The main reason for delayed bathing was health worker advice. The main reason for early bathing believed that the baby is dirty, particularly if the baby had an obvious vernix as this was believed to be sperm. On the other hand, keeping the baby warm and covered day-to-day was considered normal practice. Skin-to-skin care was not a normalised practice, and some respondents wondered if it might be harmful to fragile newborns.


Most thermal care behaviours needed improving. Many sub-optimal practices had cultural and symbolic origins. Drying the baby on birth was least symbolically imbued, although resisted by prioritizing of the mothers. Both practical interventions, for instance, having more than one attendant to help both mother and baby, and culturally anchored sensitization are recommended.

Thermal care; Hypothermia; Newborn; Formative research; Behaviour change; Mixed methods