TY - JOUR
T1 - Local understandings of vulnerability and protection during the neonatal period in Sylhet district, Bangladesh
T2 - A qualitative study
AU - Winch, Peter J.
AU - Alam, M. Ashraful
AU - Akther, Afsana
AU - Afroz, Dilara
AU - Ali, Nabeel Ashraf
AU - Ellis, Amy A.
AU - Baqui, Abdullah H.
AU - Darmstadt, Gary L.
AU - El Arifeen, Shams
AU - Seraji, M. Habibur Rahman
N1 - Funding Information:
This study was funded by the Office of Health, Infectious Diseases and Nutrition, Global Health Bureau, United States Agency for International Development (USAID; award HRN–A-00–96–90006–00), the USAID Mission in Dhaka, Bangladesh, and the Saving Newborn Lives initiative of Save the Children/USA through a grant from the Bill and Melinda Gates Foundation. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID, Save the Children/USA or the Gates Foundation. We thank the study participants in Sylhet District Bangladesh who were generous with their time and patient with interviewers through the several rounds of interviews. Neal Brandes and Ruth Frischer (USAID, Washington), R E Black, M Santosham and S Ahmed (Johns Hopkins University), D Sack and A Bhuiya (ICDDR, B) and many others both in Bangladesh and USA were very supportive throughout this study.
PY - 2005/8/6
Y1 - 2005/8/6
N2 - Background: Understanding of local knowledge and practices relating to the newborn period, as locally defined, is needed in the development of interventions to reduce neonatal mortality. We describe the organisation of the neonatal period in Sylhet District, Bangladesh, the perceived threats to the well-being of neonates, and the ways in which families seek to protect them. Methods: We did 39 in-depth, unstructured, qualitative interviews with mothers, fathers, and grandmothers of neonates, and traditional birth attendants. Data on neonatal knowledge and practices were also obtained from a household survey of 6050 women who had recently given birth. Findings: Interviewees defined the neonatal period as the first 40 days of life (chollish din). Confinement of the mother and baby is most strongly observed before the noai ceremony on day 7 or 9, and involves restriction of movement outside the home, sleeping where the birth took place rather than in the mother's bedroom, and sleeping on a mat on the floor. Newborns are seen as vulnerable to cold air, cold food or drinks (either directly or indirectly through the mother), and to malevolent spirits or evil eye. Bathing, skin care, confinement, and dietary practices all aim to reduce exposure to cold, but some of these practices might increase the risk of hypothermia. Interpretation: Although fatalism and cultural acceptance of high mortality have been cited as reasons for high levels of neonatal mortality, Sylheti families seek to protect newborns in several ways. These actions reflect a set of assumptions about the newborn period that differ from those of neonatal health specialists, and have implications for the design of interventions for neonatal care.
AB - Background: Understanding of local knowledge and practices relating to the newborn period, as locally defined, is needed in the development of interventions to reduce neonatal mortality. We describe the organisation of the neonatal period in Sylhet District, Bangladesh, the perceived threats to the well-being of neonates, and the ways in which families seek to protect them. Methods: We did 39 in-depth, unstructured, qualitative interviews with mothers, fathers, and grandmothers of neonates, and traditional birth attendants. Data on neonatal knowledge and practices were also obtained from a household survey of 6050 women who had recently given birth. Findings: Interviewees defined the neonatal period as the first 40 days of life (chollish din). Confinement of the mother and baby is most strongly observed before the noai ceremony on day 7 or 9, and involves restriction of movement outside the home, sleeping where the birth took place rather than in the mother's bedroom, and sleeping on a mat on the floor. Newborns are seen as vulnerable to cold air, cold food or drinks (either directly or indirectly through the mother), and to malevolent spirits or evil eye. Bathing, skin care, confinement, and dietary practices all aim to reduce exposure to cold, but some of these practices might increase the risk of hypothermia. Interpretation: Although fatalism and cultural acceptance of high mortality have been cited as reasons for high levels of neonatal mortality, Sylheti families seek to protect newborns in several ways. These actions reflect a set of assumptions about the newborn period that differ from those of neonatal health specialists, and have implications for the design of interventions for neonatal care.
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U2 - 10.1016/S0140-6736(05)66836-5
DO - 10.1016/S0140-6736(05)66836-5
M3 - Article
C2 - 16084256
AN - SCOPUS:23444442679
SN - 0140-6736
VL - 366
SP - 478
EP - 485
JO - The Lancet
JF - The Lancet
IS - 9484
ER -