Symbolic Meaning Of Umbilical Cord
- Research article
- Open Access
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"The cord is the child": meanings and practices related to umbilical cord care in Central Uganda
BMC Pediatrics book 20, Article number:105 (2020) Cite this article
Abstract
Groundwork
Infections business relationship for a quarter of all newborn deaths and the umbilical string has been identified as a major route of newborn infections.
Objective
To explore the meanings and practices related to the umbilical cord amongst caretakers of newborns in primal Uganda.
Methods
This was a qualitative report, designed to inform the design, and estimation of a randomized controlled trial assessing the effectiveness of chlorhexidine utilise for the umbilical cord. Nosotros conducted 22 in-depth interviews exploring umbilical cord care practices among ten mothers, four wellness workers, five traditional birth attendants, and three men. Nosotros as well conducted three focus group discussions with immature mothers and elderly women. We used qualitative content analysis to analyze our findings and we infringe upon Mary Douglas' concepts of dirt to nowadays our findings.
Results
The umbilical string had a symbolic position in newborn care. The way it was perceived and handled had far reaching consequences for the survival and wellbeing of the baby. The umbilical cord was a heart of feet, a possible gate to illness, a test of fatherhood and a signifier of parental responsibleness. Hence, the umbilical string and the style it was cared for played a part in the present and future survival of the baby, as well as the survival and wellbeing of the household. Persons other than the female parent such every bit older female relatives were very influential in the intendance of the umbilical cord.
Conclusions
The umbilical cord carried symbolic meanings, which extended beyond the newborn and the newborn menses, and in turn influenced the various practices of umbilical cord care. The important position of the cord in local newborn intendance practices should exist recognized and taken into consideration when scaling up newborn care interventions in the country.
Peer Review reports
Background
In sub-Saharan Africa, umbilical cord intendance is embedded in larger cultural constructs such every bit rites of passage [1], and fertility [ii]. Substances such every bit salty water, soot, banana ash, herbs, surgical spirit, powder, ghee, papyrus reeds, saliva, water, butter and petroleum jelly are commonly practical to the cord [3,iv,5], but vary with the region and cultural group [6]. These cultural elaborations [6, 7] and beliefs associated with the umbilical string may increase the take a chance of umbilical cord infections [8,9,10], which often progress to neonatal sepsis. Neonatal sepsis accounts for well-nigh a quarter of all newborn deaths [xi] and contributes significantly to deaths from other causes such as prematurity [12]. Neonatal sepsis is as well associated with neurodevelopment complications like cognitive palsy [13, fourteen] and dumb motor development [15]. As a upshot, interventions that promote hygienic umbilical cord care are listed as prioritized interventions in newborn health [12, 16]. Agreement umbilical cord care practices and the rationale behind these practices is vital for the scale up of interventions addressing umbilical string care [2, vi], merely very few studies have addressed this issue [2].
Therefore, in this paper, we explore practices associated with umbilical cord intendance in Primal Uganda, and the meanings attached to the cord in this social and cultural context. To help in the estimation of our findings, nosotros describe upon Mary Douglas' concept of dirt as elaborated in her classical volume in social anthropology Purity and Danger (1966) [17], and the concept of risk as elaborated in her later book Take a chance and Blame (1992) [eighteen]. Mary Douglas aims to enhance our understanding of ideas and rituals related to cleanliness and pollution [17]. Dirt, defined as 'thing out of place', is seen as a contextual rather than an intrinsic characteristic of an item. Mary Douglas argues that we telephone call something dirty because it defies the order or normal separateness of various states [17]. Likewise she sees risk every bit culturally constructed rather than an individual'southward cognitive assessment [18], and she argues that information technology is closely linked to blame. People do not brand decisions involving risk without consulting others lest they may go blamed if something goes wrong. These ideas are as relevant to the assay of human practices and meaning making today and are extensively used in the literature on risk and in the assay of actual processes [19]. Still, to our knowledge, her insights have not been much used in the analysis of newborn care. Equally nosotros elaborate in this newspaper, the umbilical cord is filled with meanings related to both purity and to risk or danger, carrying with it hopes for the infant's wellness and survival, and fright of blame for illness and misfortune. Mary Douglas is concerned with social and bodily boundaries and states that when something does not fit into one bounded category, anxiety is created. One way of dealing with this anxiety is eliminating the item [20], in our case the umbilical cord. We will use this insight in our assay of the transition of the baby from inside the mother's womb to the outside, and how this informs the meaning and practices related to the umbilical string.
Methods
The study was conducted between June 2016 and Jan 2017 in Mukono district in Central Uganda in a hamlet neighbouring the health centre, an area where most people live equally subsistence farmers and are largely stationary. Mukono district is approximately 20 km east of the capital city Kampala and has a population of approximately 600,000 people of which 340,000 are below the age of 18 years. Trade and farming are the most common economic activities while fishing forth the shores of lake Victoria is an important supplementary source of food and income. A quarter of the population owns a television set, 5% own a computer and 64% own a radio. Approximately xviii% of persons aged 18 years and in a higher place are illiterate. Of the persons aged 6–12 years, 86% nourish a primary school. Only 44% of persons aged 13–18 years attend a secondary school. The Baganda, who belong to the Bantu indigenous group, constitute most of the population in Mukono district. The Baganda inhabit the central and largest region of Uganda, and establish the largest ethnic group in the country, accounting for 17% of the Ugandan population [21].
We conducted a descriptive qualitative study alongside a randomized controlled trial [22]. The randomised controlled trial was designed to assess the effectiveness of chlorhexidine apply for umbilical cord care in the prevention of severe illnesses amongst 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].
A total of 22 in-depth interviews exploring umbilical cord intendance perceptions and practices among 10 mothers, four wellness workers, five traditional birth attendants (TBAs), and three fathers were conducted. The study participant characteristics are listed in Table 1 below. Participants were selected purposefully, mainly looking for participants with rich experiences in umbilical cord intendance and/or key decision makers in matters related to newborn intendance. None of the approached participants declined to participate.
Our gatekeeper, a TBA in the area, nominated mothers who had recently given birth. TBAs were also interviewed because they were maternal and neonatal health intendance providers in the community. Interviews were conducted face to face at calm and private settings away from distractions. Participants were recruited until the point of saturation [25] when no new themes emerged. Three focus group discussions (FGDs) were also conducted. Two were conducted at the health centre and involved immature mothers recruited when they came to the wellness centre for postnatal follow-ups or immunization. The third FGD involved elderly women recruited through the gatekeeper (TBA) and was conducted at her dwelling.We developed separate interview guides for the interviews with the different categories of study participants and topic guides for the different FGDs. The guides were used flexibly and modified according to the preliminary findings and as demand arose in the course of the written report [25]. The interviews unremarkably lasted between twenty to 80 min. The commencement author (D.Yard.) conducted most interviews in Luganda, the local language and a few in English. A moderator and one note taker led the focus grouping discussions (FGDs). Participants were briefed on the main purpose of the discussion and emphasis was placed on inter participant discussions and confidentiality [26]. The first author wrote field notes to document impressions while in the field and our own experiences, beliefs, motives and assumptions. In addition to the IDI'south and FGDs, we used video recording to provide detailed clarification of the preparation and roles of kyogero, a local herbal mixture.
All the interviews were audiotaped. A professional transcribed and translated the interview/FGDs conducted in Luganda. The offset author, who was present during all the interviews and has a good command of Luganda, proofread the translated transcripts. Information analysis started in the field and was an iterative process guided by qualitative content analysis [27], which included immersion in the data, identifying significant units, abstracting content of meaning units and summarizing the importance (Table 2) [28]. Words, sentences or paragraphs that relayed a similar message were grouped as meaning units, which were then condensed and labelled with a lawmaking. I aggregated similar codes to form categories. Categories were made to be mutually exclusive, whenever that was possible and to include all the data related to the content surface area being discussed. Categories were farther analysed to form manifest sub themes and themes. Based on this first analysis we identified Mary Douglas' theories to take us to the next step of analysis/interpretation. This helped us define the latent themes. We used Nvivo 11.0.0 (QRS International, Cambridge, MA) to organize the analysis process.
We triangulated the information collection methods by using IDIs, FGDs and Picture, which increased the perspectives and deepened the agreement of the meanings attached to the umbilical cord and to umbilical cord intendance [29]. IDI'south enabled us to obtain individual experiences and perceptions and the FGDs enabled the states to get group and cultural norms. The motion picture captured the preparation of kyogero and was used for reference regarding this process. The starting time author was a master educatee at the time of the report, trained in qualitative methodology. Considering his medical training and gender, we initially worried that the study participants would exist shy and not be open about their ideas and practices [30]. Rather, we experienced that his condition as a medical doctor fostered trust, and hence did not seem to interfere with the way they described their understanding and practices. He belongs to a different ethnic group and did non know much about the culture of the participants, just assumed that participants were practicing what was being advocated at the health facilities. Ii co-authors read through the interviews, codes, categories and themes as a way of peer examination, which increased credibility [31]. We did 'participant checking' [29] by discussing the findings with two study participants and then incorporated their reflections and additional information.
Results
The findings are organized into 2 major sections. The first department focuses on the meanings fastened to the umbilical string, and the second section describes how the cultural agreement of the umbilical cord is reflected in umbilical cord care and other newborn care practices.
The cord and its significant: "The cord is the kid"
We constitute that the umbilical cord carried symbolic meanings that extended beyond the health of the child and the newborn flow. The style it was treated and kept reflected parental care and responsibleness and was understood to be important for the future wellbeing of the child. Ane written report participant explained the significance attributed to the cord by stating 'the cord is the child'. We will attempt to uncover what this concept involved and to describe the diverse meanings associated with the cord. Using Mary Douglas' conceptualisation of the torso and its boundaries, and her elaboration of how affair changes significant when it passes boundaries, we explore how the significant of the cord changes equally it transcends from inside the womb to the outside, and from the surface of the baby's body until it falls off.
Inside the womb: 'The umbilical cord is the middle of life'
The participants appreciated the umbilical cord as a vital organ necessary for child growth in the uterus. Well in line with biomedical thinking, the umbilical cord was seen as a source of nourishment to the baby and was associated with life and expiry. A TBA told usa: We run into this umbilical cord as the center of life (TBA IDI). Explaining further, a participant in a FGD told us: The umbilical string is the life of the child because information technology's where the child breathes. If it'south cutting off before time, the child could dice. (Grandmother FGD).
Below, nosotros shall see how the meanings/understandings of the umbilical string change every bit the infant passes through the birth canal and is detached from the mother.
On the surface of the baby's trunk: the cord as a source of tension
After the baby is born, the umbilical string is associated with anxiety and even fear. One participant told us:
The umbilical cord looks like meat (TBA IDI) and another said: Mothers fright the umbilical string because information technology looks like an intestine (Health worker IDI). A health worker explaining the fearfulness stated: They fear the cord because it doesn't look like the normal skin, and there is some niggling claret in the get-go, and as it shrinks it forms a certain discharge which makes them think it'due south painful for the infant. (Health worker IDI)
The discomfort and fear was also related to the perception that the umbilical string was a vulnerable point on the child'due south body and a bespeak of weakness. Through the umbilical cord, diverse illnesses could enter the torso of the kid. These illnesses could exist acquired by natural agents also as by social agents or strained social relationships. Diseases like tetanus and Etumbizi seemed to be explained in terms of natural agents while Busobe seemed to be caused by social conflict. Etumbizi was described every bit a disease caused by air entering the newborn, resulting in foaming around the rima oris and subsequently expiry. Etumbizi could besides outcome from negligence in roofing the infant well. Describing Etumbizi, young mothers in an FGD told usa: That air can enter through the umbilical cord and touch the baby if you don't cover him very well (FGD immature mothers). Busobe on the other mitt was described as a disease acquired past an cheating male parent coming in contact with a newborn that nevertheless has an intact umbilical string and causing convulsions. This was perceived as a very serious illness, with very few known effective cures and, in about cases, leading to death. A TBA described a case to united states:
I saw it happen. Mrs. Grand'due south child (not real proper noun) almost died. The human being came from somewhere and touched the baby and the infant started convulsing, its skin started turning yellow and it started producing foam from the mouth. (TBA IDI)
The child was seen equally vulnerable to these illnesses for every bit long as the cord was still attached to the torso of the babe and a mother illustrated this by saying: Before a child'south umbilical cord is closed, I don't count it as my child because the kid could dice whatever time (FGD immature mothers). Equally a result, in that location was a desire to accept the umbilical string detach as fast as possible to reduce this period of feet and uncertainty every bit a health worker informed united states of america:
The string is a delicate office on a baby and when it is yet there, it gives you tension. So, it has to go off and then that someone can be free. (IDI HW)
The scent of the umbilical string before detachment also contributed to the anxiety associated with the umbilical cord:
The more than it stays the more it smells. So, if you don't proceed it make clean it smells a lot and even attracts houseflies. (TBA IDI)
During the period when the umbilical string was on the surface of the baby, there was restricted access to the newborn to protect it from various dangers.
When I was growing upwardly, my grandparent told us that the baby is not taken out of the house earlier the cord has broken off and you should not cross-junctions with the baby. They also used to tell the states non to give the baby to people because you don't know where they are coming from and don't know what they take been doing. (TBA IDI)
After disengagement: "The string is the passport to the clan"
After the umbilical cord fell off the newborn, it took on an ambiguous status. On one hand, it was seen as a treasure that should exist kept safely as a TBA told united states of america:
At that place is even a saying that protect your child like you would protect the umbilical cord, the saying applies to annihilation, for example your phone, they say protect your telephone like you would protect the umbilical cord, they say this because the string has the role of proving that the child belongs to his association. (TBA IDI)
The umbilical string was seen as a sign of belonging. As was further explained to us: it'south [the cord is] the passport that allows y'all into the association. (Mother FGD young women) In the traditional practice known every bit kwalula, the cord was used to test if the kid truly belonged to the begetter, and hence to the paternal association.
The kwalula ceremony was usually performed at the husbands' habitation and would either lead to jubilations if the traditional paternity examination was positive or a rebuke and need to render the child to the true father if it turned out negative. One participant explained the kwalula ceremony:
They get a handbasket lined with cow dung and put water in it, they smear ghee on the cord so they put it in the basket containing water. If the cord sinks to the lesser of the basket and so we rejoice and say that information technology is our child but if information technology comes to the summit then we say the child is not ours. Even if you lot requite nativity to twenty children, you lot have to keep the cords from the first child to the last. (TBA IDI)
The kwalula anniversary was seen equally an alternative to mod day Dna testing. The older mothers preferred kwalula to Deoxyribonucleic acid testing, every bit they perceived information technology as cheap, genuine and impossible to bribe, while the younger mothers preferred the accuracy offered by the current DNA testing. Women were expected to store the umbilical cord remnant very safely away from predators like rats. A misplaced cord remnant could be a source of unease as a young female parent told us: I am worried. I keep searching for it all the time, because if someone picks information technology, he can exercise something bad to my kid. (Mother IDI).
Simply a misplaced cord remnant could also be used to harm the female parent as one of our written report participants explained: someone can perform witchcraft on the umbilical cord and the mother fails to conceive over again. (Female parent IDI).At the same time rubber handling of the string remnant was seen as the responsibility of the mother and carelessness could harm the baby for instance by the string getting into contact with a boy's genitals: The moment a woman leaves the cord to fall on the baby'southward penis, the child becomes impotent. It is considering the mother was careless. (TBA IDI).
String care practices
Cutting the umbilical cord
Study participants were aware of the importance of hygiene and cleanliness when cutting the umbilical cord. Mothers who delivered from health centres reported the use of brand-new razor blades or surgical blades, usually function of commitment kits, during the cutting of their baby'due south umbilical cord. For the deliveries that were conducted by the TBAs, endeavour was also made to ensure that the substances used to cutting the umbilical cord were sterile every bit ane TBA informed united states of america:
Ever since we started, we take been using razor blades simply if y'all are to use a razor blade, we ordinarily accept new razor blades, you get information technology when it is new. At present we mostly use scissors. Merely yous also boil them; we do not employ them before sterilizing. We do take stoves and local fireplaces for the sterilization procedure. You use usual water put the scissor in a pan, encompass then eddy like you lot eddy something to consume and so remove it and put on a clean plate to absurd off so that information technology doesn't burn you when y'all are using it. We practise this to prevent germs from infecting the baby. (TBA IDI)
In the by, substances like elephant grass and bamboo were used to cut the umbilical cord but this was now seen as an old tradition that was no longer practiced in this society as a TBA informed us: They would get a bamboo stick and use it to cut the umbilical cord. Just now in our era we are using razor blades. (TBA IDI).
"A wound takes long to heal without treatment"
Subsequently cutting the umbilical cord, a number of substances were put on the umbilical cord and this was partly done to hasten drying and eventually to quicken umbilical string fall off as a mother explained:
A wound without treatment takes long to heal but a wound on which you have applied medicine heals very fast. So if you accept medicine that you use, the cord goes off very fast. (Mother IDI)
Substances practical to the cord stump included: a herbal mixture locally known as kyogero, pulverization, banana (plantain) powder, ash, soap, normal saline, tealeaves, ghee, kiyondo (a local herb) and dung (lizard and cow).
There were besides other reasons why substances were applied on the umbilical cord:
We practise get surgical spirit from the hospital then yous get cotton, dip it in the spirit, and then clean the umbilical cord. I think information technology is besides to prevent it from rotting, smelling and to make it dry (TBA IDI)
There was likewise an sensation of the bio medical function of some substances applied on the umbilical cord in prevention of infections as a TBA told us:
Nosotros do get surgical spirit from the hospital so y'all get cotton fiber dip it in the spirit, then make clean the umbilical cord. I think it is also to forestall it from rotting, smelling and to make it dry (TBA IDI)
Substances were as well applied after the umbilical cord fell off, mainly to foreclose umbilical colic:
Most people use the kiyondo later on the cord has fallen off because after the string falls off, it leaves something similar a wound. So our elders say that the "kiyondo" prevents the baby from abdominal colic and over crying. (Mother IDI)
Other substances applied on the umbilical cord to foreclose colic included lycopersicon esculentum extract, saliva and mushroom (obutiko obubaala) as a female parent explained to u.s.a.:
Afterwards the cord had fallen off they told me to put mushrooms. They said that they put the mushrooms in a assistant leaf then steam it, after bathing the baby you squeeze water out of the mushrooms then put drops on the umbilical cord. (Mother IDI)
Healthcare workers oft gave varying instructions of umbilical cord care:
I tells you use, the other tells you don't use. And we in the community get confused. (TBA IDI)
"Our newly born child should not be bathed in plain water"
The bathing of a newborn was a topic that was brought up by most participants and was indirectly associated with the umbilical cord. Bathing was important because the umbilical cord was cleaned during bathing. Newborns were ordinarily bathed in a herbal solution called kyogero: A child from Buganda shouldn't exist bathed in plain water. (FGD older women).
Kyogero is a mixture of several herbs, boiled together and the resulting solution used to bath the newborn, and sometimes dropped in the mouth and on the umbilical cord. Kyogero mixture is often re-used because it is very cumbersome and expensive to gear up. Children were bathed in kyogero so that they would be blest. These blessings could manifest in diverse means: having a good for you childhood, good financial and marital fortune later in life and having a good personality.
At present for case a girl getting married to a rich man who also has good manners. Have you always sabbatum down and said and so and and then'due south children are all married to rich men or they all have jobs. So that is one of the benefits of the kyogero according to our grandparents (TBA IDI)
Kyogero was too popular among the midwives as the caput of the motherhood ward told us:
They believe in it so much including the midwives who are trained. So they experience those are drugs. They call them herbal medicines, which help the babe to become a clear peel like I said adept luck and all those sorts of things. (Wellness worker IDI)
Many of the younger mothers did not know how to set kyogero and left this part to their older female relatives. Most of the herbs are no longer available in urban areas and accept to be obtained from rural areas. When asked what they use if they don't have access to kyogero participants told us:
Virtually people use lather with Vaseline and powder for example Johnson or they use commercially prepared kyogero lather if they don't take the kyogero, (FGD immature mothers)
There were also a few participants who said they had never used or heard about kyogero:
At our home I have seen our mothers delivering children but they don't use kyogero and yet their children grow up well. Because of that, I take never bathed my son in kyogero. (FGD young mothers)
Discussion
The umbilical cord took upwards dissimilar meanings as it transitioned from being inside the mother's torso to detaching off the child's body. Within the body, the cord, in accordance with medical thinking, was seen as vital for the nutrition of the child. On the surface of the baby's body, the cord was a source of anxiety and fear, hence the use of substances to quicken its detachment. After detachment, the string took on an ambiguous nature; on one hand information technology was a very important item used to ostend the paternity of a child, on another hand information technology could result in impotence if it touched the genitals of a boy. The way it was treated and kept reflected parental intendance and responsibility and was important for the time to come wellbeing of the child. Using Mary Douglas' conception of torso boundaries and of how affair changes pregnant as it passes boundaries, we endeavor to sympathize the significant of the cord and of the practices related to information technology.
The appreciation of the importance of the umbilical cord within the uterus has as well been reported in a similar study in Republic of zambia [ii]. However afterward birth when the umbilical cord was cut and tied and it lingered on the surface of the newborn body, the umbilical cord became a source of fear, dread and doubt. Mary Douglas' boundary perspectives assist united states to empathize the fear and feet related to the umbilical cord. She argues that substances which defy boundaries, or threaten the proper separation offered by boundaries are treated as dangerous [20] due to their ambivalence, and one manner of dealing with this uncertainty is the separation of such substances from the torso [20]. When the umbilical cord is on the surface of the trunk, it breaks the purlieus that should be offered by the pare, past serving as an alternative connectedness between the outside and the within of the body and this could explicate the anxiety. This perception of feet is in line with the anthropological concept of liminality. Liminality is a transitional flow where the status of the subject is unclear and while it has left one category, it has not yet entered some other [32]. A usually cited example is a young significant woman who is transitioning from being a girl to becoming a mother. The menstruum of liminality elicits anxiety and unease. It commonly results in protective measures, only too in the desire for this period to end every bit fast every bit possible. In this case the newborn is seen every bit no longer a foetus, but not yet recognised as a baby every bit illustrated by the mother who explained that she could non count the babe as a child until the string had fallen off. The umbilical cord fall off marks the stop of this liminal phase.
This perception of fear and feet could also be attributed to the mode the umbilical cord physically appeared, with some participants stating that it 'looked like an intestine' an organ expected in the interior of the body. Newborns with an umbilical string on their surface were seen as very vulnerable to both physical and spiritual attacks, a finding reported past other authors [half-dozen, 33]. This discomfort and unease with the exteriorized umbilical cord may help to explain many umbilical cord care practices. Underlying nigh umbilical practices was the desire to take the umbilical cord separate every bit fast as possible, in society to reduce the period of anxiety but also to ensure wholeness of the torso through the closure of the umbilical cord. The want of mothers to take the umbilical string separate quickly has been reported in a number of studies from Uganda, Zambia, Ethiopia and other parts of Africa [2, vi, 34,35,36,37]. The umbilical cord also produced secretions which mothers were uncomfortable with. Powdered substances similar plantain ash, normal ash, lizard excreta, and babe powder were perceived to absorb these secretions and quicken the speed of drying of the umbilical cord. Other liquid substances like the herbal mixture kyogero and surgical spirit are also perceived to quicken the umbilical cord drying and separation. The concept of applying substances on the umbilical cord to quicken its disengagement has been reported in studies from other African settings [ii, 35, 36, 38]. When we asked some participants well-nigh what they thought was the single nearly of import feature of a substance designed for umbilical cord care, most of them stated that the substance should quicken umbilical string separation. To further illustrate how desire for umbilical cord separation influenced umbilical cord intendance practices, unfamiliar persons and extended family unit were discouraged from carrying newborns until the umbilical string separated, a way of protecting the newborn from ailments. Nalwadda and colleagues [39] constitute similar concepts in Eastern Uganda where children ceased to be called newborns equally soon equally the umbilical cord separated. The result of umbilical string separation is therefore very important when discussing umbilical cord care with mothers of newborns.
The meaning and perception of the umbilical string changed when the umbilical cord had detached from the infant. In the discrete form, the umbilical cord took on a mixed identity. The umbilical cord was generally highly regarded, and well kept, equally it was used to perform traditional paternity rituals that assessed whether the child truly belonged to the father. This symbolism surrounding the umbilical cord could exist harnessed in time to come endeavours to justify storage of umbilical stem cells [40]. On the other hand, the discrete umbilical cord was thought to crusade impotence if information technology touched the genitalia of the male child. Like perceptions have been document in Zambia [two]. This change in perception and meanings resonates with Douglas' theory almost dirt being a thing out of place (22). As long as the umbilical string stump stays within its symbolic borders, it is harmless, or even appreciated. The male genitals seem to constitute a symbolic border for the cord stump, and if the stump is to cross that border, we can sympathize it as being "matter out of identify" and thereby dirty, or fifty-fifty dangerous [17].
One style of dealing with the perceived vulnerabilities associated with the umbilical cord, and across, was bathing the newborn in the herbal solution kyogero. From a biomedical perspective, whereas we fright the possible contamination that kyogero might crusade, what is of more business is the reuse of kyogero. Kyogero is kept for about one to two weeks and warmed to body temperature prior to bathing the infant, something that could favour bacterial growth and cause infections in the newborn. In Risk and Blame, Mary Douglas argues that chance cess does not balance on individuals' cognitive abilities simply on socially predetermined assessments, which are politically and morally built. Douglas argues that a refusal to take audio hygienic advice should therefore non be attributed to weakness of understanding but on preference. With this understanding, policies that are targeted towards umbilical string intendance should acknowledge the practice of herbal washing of newborns, and find means of co-existing with it. This could be by encouraging newborns to delay washing the baby until the umbilical cord separates.
Despite the reduction in availability and popularity of herbs such every bit kyogero among the younger urban dwelling mothers, the herbs are still unremarkably used. This is, at to the lowest degree partly, because it is older female relatives who take care of newborns in the first days after birth. This demonstrates the importance of involving such persons in interventions promoting safe umbilical string intendance.
Because the study has investigated practices that have besides been documented in other areas of sub-Saharan Africa, we argue that the lessons learnt are transferable to similar socio-economic contexts. Hence, the study has implications to the scale upwards of recommended newborn care practices beyond Uganda. Prior efforts to calibration upwardly such recommended practices have been unsuccessful and this could exist related to the poor understanding of the cultural meanings surrounding newborn intendance [34]. The insights obtained from understanding the symbolic value of the umbilical cord and how this relates to umbilical cord care can contribute to the development of culturally acceptable guidelines with greater possibility of being adopted by members of the customs. The fear and danger associated with the string is paralleled with the risk of infections in biomedical thinking. What differs is the reasoning about cause and the practices to forbid affliction. Interventions designed to promote safer cord care should leverage on its symbolic value and address issues related to illness causation, and practices springing out of these behavior.
Study limitations
In studying a community practice similar umbilical cord intendance, participant observation would accept been an appropriate research approach, but due to the sacredness that was attached to the birth process and the early neonatal period we were unable to conduct observations. We also did not empirically explore the association of the umbilical cord with other newborn intendance practices like skin-to-peel care, and home visits; practices that could possibly be afflicted by behavior surrounding the umbilical string.
Conclusions
The umbilical cord carried symbolic meanings, which extended beyond the newborn and the newborn period, and in plow influenced the various practices of umbilical cord care. Unless treated with care, the umbilical cord was seen to cause immediate danger to the survival as well as the long-term wellbeing of the child. Public health interventions addressing newborn care should recognize the of import position of the umbilical cord in the local idea system and capitalize on the perceptions of risk associated with the cord when introducing new evidence based newborn care practices.
Availability of information and materials
Data generated and analyzed during this study are not publicly available due to potential breech of confidentiality, but are bachelor from the corresponding author on reasonable request. The data obtained is in the form of sound recordings and verbatim transcripts, which are very hard to remove all personal identifiers.
Abbreviations
- CHX:
-
Chlorhexidine
- FGD:
-
Focus Group Word
- IDI:
-
In Depth Interview
- RCT:
-
Randomized Controlled Trial
- TBA:
-
Traditional Birth Bellboy
- WHO:
-
Globe Health Organization
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Acknowledgements
We acknowledge the research assistants working with the CHX trial, and our community gatekeeper Ms. Namyalo Florence. We also admit Ms. Tumuhamye Josephine, and Dr. Namugga Olive for the tremendous work they did towards this projection. Finally nosotros acknowledge the written report participants for their cooperation.
Funding
The report was funded through the GLOBVAC programme (projection number 234500) and by the Research Council of Norway through its Centers of Excellence scheme to the Centre for Intervention Scientific discipline in Maternal and Child Health (CISMAC; project number 223269).
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VN conceived the study. DM, MH, JKT, TT, VN, and KMM designed and supervised the study, and participated in writing the manuscript. DM and MH collected the data. DM, MH, and KMM analysed the information, and wrote the first typhoon of manuscript. All authors read and approved the final version to be published.
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Nosotros obtained upstanding approval from the Makerere University, Schoolhouse of Medicine, Research and Ideals commission (reference number: 2015–118) and from the Uganda National Quango of Scientific discipline and Technology (reference number: HS-1927). Written informed consent was obtained from the participants prior to participation in the written report. For participants who could not write, a thumbprint was obtained. Participants received a ship compensation of 10,000 ($ii.86). Direct and indirect identifiers such as age were removed from the quotations in the findings to minimize potential alienation of confidentiality.
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Mukunya, D., Haaland, M.E.S., Tumwine, J.K. et al. "The string is the child": meanings and practices related to umbilical string care in Central Uganda. BMC Pediatr 20, 105 (2020). https://doi.org/x.1186/s12887-020-2002-9
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DOI : https://doi.org/10.1186/s12887-020-2002-nine
Keywords
- Umbilical string
- Newborn care
- Neonatal care
- Sepsis
- Chlorhexidine
Symbolic Meaning Of Umbilical Cord,
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