“We shall count it as a part of kyogero”: acceptability and considerations for scale up of single dose chlorhexidine for umbilical cord care in Central Uganda

Abstract

BackgroundCleansing the umbilical cord with chlorhexidine reduces neonatal morbidity and mortality, particularly in communities where newborn deaths and home births are common. As a result, the World Health Organization and national authorities are advocating the scale up of this intervention. In order for such a scale up to be effective, it has to be acceptable to the targeted population. With the overall aim to clarify conditions for scale-up, this study explored the acceptability of single dose chlorhexidine solution for umbilical cord care among health workers and infant care providers in the districts of Kampala and Mukono in Central Uganda.MethodsThis was a qualitative study that involved mothers of neonates enrolled in a chlorhexidine trial, nurses implementing the trial, key community members and opinion leaders in childcare. We conducted 30 in depth interviews (IDIs) with mothers (18), health workers (8), traditional birth attendants (2), a father (1) and a grandmother (1) and 4 focus group discussions (FGDs), 3 with mothers and 1 with health workers. We used qualitative content analysis to analyze our findings and borrow upon Sekhon’s model when presenting our findings.ResultsCognitive and emotional responses to chlorhexidine use included ease of use, and a perception that chlorhexidine reduced smell and abdominal colic. We also found that wider social and cultural factors were important to chlorhexidine use. These included cultural value put on quick separation of the umbilical cord as well as the practice of bathing the baby in a herbal mixture called kyogero. We also found that older relatives were key decision makers in umbilical cord care for newborns, but were seldom present during health workers’ counseling of mothers about hygienic care of the cord.ConclusionsThe application of chlorhexidine on the umbilical cord stump at birth was acceptable as an addition rather than a total replacement of traditional substances. The scale up of chlorhexidine should consider how to accommodate local beliefs and practices in a way that does not compromise the effect of the intervention; encouraging mothers to delay the bathing of babies in kyogero could be one way of doing this.

“The cord is the child”: meanings and practices related to umbilical cord care in Central Uganda

“…The randomised controlled trial was designed to assess the effectiveness of chlorhexidine use for umbilical cord care in the prevention of severe illnesses among newborns [23]. This formative study had two components: the first, reported in this paper, explored meanings and practices related to the umbilical cord; the other which investigated the acceptability of chlorhexidine for umbilical cord care, has been published elsewhere [24].…”

Acceptability of nurse-led reviews for inflammatory rheumatological conditions: A qualitative study

“… 28 Mukunya et al suggested that social and cultural dimensions of acceptability are undervalued currently in the TFA. 30 Our study has also contributed to the development of the TFA, recommending the TFA findings be presented in a more dynamic model to illustrate interconnectedness and significance of constructs for the proposed intervention (see Figure 1 ). As only two of the original 43 reviews used to develop the TFA were qualitative reviews, 15 future qualitative studies will have an important role in providing and then assessing new insights on acceptability domains and adding to the model as it is used in wider contexts and settings.…”

“…The TFA is fast gaining recognition in health research and has been used throughout studies in different ways, including: to highlight how their findings were in line with TFA constructs 19 – 25 ; in aspects of study design or analysis 26 – 30 ; and in protocol papers outlining how they will use the TFA in future. 31 – 34 Unlike this study, Nadarzynski et al 27 used the TFA to inform questions on a topic guide about acceptability of artificial intelligence led chatbox services; however, they did not analyse the data using the TFA.…”

Acceptability of a Prime Vendor System in Public Healthcare Facilities in Tanzania

“…Acceptability usually looks at the introduction of a new device/technology 15,38,39 or innovative ways to improve service delivery. [40][41][42][43] Acceptability assessment can take place 'before' the implementation of the healthcare intervention; during the intervention period, 'concurrent assessment, ' or after the implementation, 'post-intervention. ' 22,23 The present study has been done after implementation of Jazia PVS as a 'post-intervention assessment.…”