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Improving Hygiene in Home Deliveries in Rural Ghana: How to Build on Current Attitudes and Practices

Hill, Zelee PhD*; Tawiah-Agyemang, Charlotte MSc; Okeyere, Eunice BSc; Manu, Alexander MSc; Fenty, Justin MSc; Kirkwood, Betty MSc

The Pediatric Infectious Disease Journal: November 2010 - Volume 29 - Issue 11 - p 1004-1008
doi: 10.1097/INF.0b013e3181f5ddb1
Original Studies

Introduction: Clean delivery of newborns is a key intervention for reducing infection-related neonatal mortality. Understanding local practices and beliefs is important for designing appropriate interventions. There are few data from Africa. This study explored delivery practices in Ghana to identify behaviors for intervention and to determine behavioral influencers.

Methods: Data on the prevalence of clean delivery behaviors, collected through a demographic surveillance system, were analyzed for 2631 women who delivered at home within a 1-year period. Qualitative data on delivery practices were collected through birth narratives, in-depth interviews, and focus groups with recently delivered/pregnant women, traditional birth attendants, grandmothers, and husbands.

Results: Most women delivered on a covered surface (79%), had birth attendants who washed their hands (79%), cut the cord with a new blade (98%), and tied it with a new thread (90%). Eight percent of families practiced dry cord care. Families understood the importance of a clean delivery surface and many birth attendants knew the importance of hand-washing. Delivering on an uncovered surface was linked to impromptu deliveries and a belief that a swept floor is clean. Not washing hands was linked to rushing to help the woman, not being provided with soap, forgetfulness, and a belief among some that the babies are born dirty. The frequent application of products to the cord was nearly universal and respondents believed that applying nothing to the cord would have serious negative consequences.

Conclusions: Delivery surfaces, hand-washing, and cord cutting and tying appear appropriate for the majority of women. Changing cord care practices is likely to be difficult unless replacement products are provided.

From the *Centre for International Health and Development, Institute of Child Health, University College London, London, United Kingdom; †Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana; and ‡Nutrition & Public Health Intervention Unit, Department of Epidemiology & Population health, London School of Hygiene & Tropical Medicine, London, United Kingdom.

Accepted for publication May 6, 2010.

Supported by the World Health Organization through funds from USAID, the Bill & Melinda Gates Foundation through the Saving Newborn Lives program of Save the Children, and DFID.

Address for correspondence: Zelee E. Hill, PhD, Centre for International Health and Development, Institute of Child Health, University College London, London WC1E 6BT, United Kingdom. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.