‘As soon as the umbilical cord gets off, the child ceases to be called a newborn’: sociocultural beliefs and newborn referral in rural Uganda
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Date
2015
Journal Title
Journal ISSN
Volume Title
Publisher
Global Health Action
Abstract
The first week of life is the time of greatest risk of death and disability, and is also associated with
many traditional beliefs and practices. Identifying sick newborns in the community and referring them to
health facilities is a key strategy to reduce deaths. Although a growing area of interest, there remains a lack of
data on the role of sociocultural norms and practices on newborn healthcare-seeking in sub-Saharan Africa
and the extent to which these norms can be modified.
Objective: This study aimed to understand the community’s perspective of potential sociocultural barriers and
facilitators to compliance with newborn referral.
Method: In this qualitative study, focus group discussions (n12) were conducted with mothers and fathers
of babies aged less than 3 months. In addition, in-depth interviews (n11) were also held with traditional
birth attendants and mothers who had been referred by community health workers to seek health-facilitybased care. Participants were purposively selected from peri-urban and rural communities in two districts in
eastern Uganda. Data were analysed using latent content analysis.
Results: The community definition of a newborn varied, but this was most commonly defined by the period
between birth and the umbilical cord stump falling off. During this period, newborns are perceived to be
vulnerable to the environment and many mothers and their babies are kept in seclusion, although this practice
may be changing. Sociocultural factors that influence compliance with newborn referrals to seek care
emerged along three sub-themes: community understanding of the newborn period and cultural expectations;
the role of community health actors; and caretaker knowledge, experience, and decision-making autonomy.
Conclusion: In this setting, there is discrepancy between biomedical and community definitions of the
newborn period. There were a number of sociocultural factors that could potentially affect compliance
to newborn referral. The widely practised cultural seclusion period, knowledge about newborn sickness,
individual experiences in households, perceived health system gaps, and decision-making processes were
facilitators of or barriers to compliance with newborn referral. Designers of newborn interventions need to
address locally existing cultural beliefs at the same time as they strengthen facility care
Description
Keywords
Care-seeking, Newborn, Neonatal, Qualitative, Referral, Sociocultural influences, Uganda
Citation
Christine K. Nalwadda, Peter Waiswa, David Guwatudde, Kate Kerber, Stefan Peterson & Juliet Kiguli (2015) ‘As soon as the umbilical cord gets off, the child ceases to be called a newborn’: sociocultural beliefs and newborn referral in rural Uganda, Global Health Action, 8:1, 24386, DOI: 10.3402/gha.v8.24386