Research Article| Volume 31, ISSUE 4, e278-e285, August 2018

Download started.


Maternal cultural practices for neonates’ care in upper Egypt

Published:October 25, 2017DOI:



      Little is known about the home practices and care given to neonates born in Egypt.


      Two thirds of all infant deaths in Egypt occur in the neonatal period and many of these deaths occur in the home environment out of sight of health care providers. Understanding cultural practices and beliefs about caring for neonates may help direct appropriate interventions to improve infant outcomes.


      To describe maternal cultural care practices used with neonates and highlight harmful practices in order to identify areas of required change in care.


      A descriptive study using a convenience sample of 200 women recruiting from outpatient pediatric facilities in Qena, Egypt. Face to face interviews were used to gather data.


      More than one third (37.5%) of the studied women given birth in the home, and a traditional birth attendant assisted with the majority of home births (90%). Breast-feeding was delayed between 1 and 4 days in 27% of the women and they were more likely to use cultural practices, rather than modern medical practices, for neonatal eye and umbilical care. Maternal cultural practices used in the home can be categorized as being harmful, beneficial, and as having no-effect on neonatal health based upon available evidence.


      A variety of cultural practices are used by women for neonatal care in upper Egypt. Many of these practices may have a negative effect on neonatal health and should be discontinued.


      Comprehensive interventions are needed to modify women’ care practices.


      MCH (mother and child health centers), WHO (World Health Organization), TBA (traditional birth attendance), MC (Monte Carlo)


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Lawn E.
        • Cousens S.
        • Zupan J.
        Lancet neonatal survival steering team. 4 million neonatal deaths: when? where? why?.
        Lancet. 2005; 365
        • Ronald
        • Darmstadt Gary L.
        • Tinker A.
        Tools for newborn health. Qualitative research to improve newborn care practices.
        Saving Newborn Lives, Save the Childern, Washington, DC2004
        • WHO
        World health statistics.
        World Health Organization, Geneva2015
        • Darmstadt G.L.
        • Hussein M.H.
        • Winch P.J.
        • Haws R.A.
        • Lamia M.
        • El-Said M.A.
        • et al.
        Neonatal home care practices in rural Egypt during the first week of life.
        Trop Med Int Health. 2007; 12: 783-797
        • Black R.
        • Kelly L.
        Reducing perinatal and neonatal mortality.
        in: Child health research project special report: report of a meeting, Baltimon, MD, May 10–2, 1999, Johns Hopkins University, Baltimor, MD1999 (Vol. 3, No. 1)
        • Blencowe H.
        • Cousens S.
        • Mullany L.C.
        • Lee A.C.
        • Kerber K.
        • Wall S.
        • et al.
        Clean birth and postnatal care practices to reduce neonatal deaths from sepsis and tetanus: a systematic review and Delphi estimation of mortality effect.
        BMC Public Health. 2011; 11: S11
        • Arifeen S.E.
        • Mullany L.C.
        • Shah R.
        • Mannan I.
        • Rahman S.M.
        • Talukder M.R.
        • et al.
        The effect of cord cleansing with chlorhexidine on neonatal mortality in rural Bangladesh: a community-based, cluster-randomised trial.
        Lancet (London, England). 2012; 379: 1022-1028
        • Imdad A.
        • Bautista R.M.
        • Senen K.A.
        • Uy M.E.
        • Mantaring 3rd, J.B.
        • Bhutta Z.A.
        Umbilical cord antiseptics for preventing sepsis and death among newborns.
        Cochrane Database Syst Rev. 2013; Cd008635
        • Sazawal S.
        • Dhingra P.
        • Dhingra U.
        • Dutta A.
        • Ali S.
        • Ame S.
        • et al.
        4 trials of improved practices — a pilot study evaluating the acceptability and preferences for a chlorhexidine cord care intervention.
        Arch Dis Child. 2012; 97 (A1–A)
        • Leininger M.
        Becoming aware of types of health practitioners and cultural imposition. 1978.
        J Transcult Nurs. 1991; 2: 32-39
        • Ayaz S.
        • Yaman S.E.
        Potentially harmful traditional practices during pregnancy and postpartum.
        Eur J Contracept Reprod Health Care. 2008; 13: 282-288
        • Halfdansdottir B.
        • Smarason A.K.
        • Olafsdottir O.A.
        • Hildingsson I.
        • Sveinsdottir H.
        Outcome of planned home and hospital births among low-risk women in Iceland in 2005–2009: a retrospective cohort study.
        Birth (Berkeley, Calif). 2015; 42: 16-26
        • Catling-Paull C.
        • Coddington R.L.
        • Foureur M.J.
        • Homer C.S.
        Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years.
        Med J Aust. 2013; 198: 616-620
        • de Jonge A.
        • Mesman J.A.
        • Mannien J.
        • Zwart J.J.
        • van Dillen J.
        • van Roosmalen J.
        Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study.
        BMJ. 2013; 346f3263
        • Blix E.
        • Huitfeldt A.S.
        • Oian P.
        • Straume B.
        • Kumle M.
        Outcomes of planned home births and planned hospital births in low-risk women in Norway between 1990 and 2007: a retrospective cohort study.
        Sex Reprod Healthc. 2012; 3: 147-153
        • Chang J.J.
        • Macones G.A.
        Birth outcomes of planned home births in Missouri: a population-based study.
        Am J Perinatol. 2011; 28: 529-536
        • McDonald S.
        Management of the third stage of labor.
        J Midwifery Womens Health. 2007; 52: 254-261
        • Fahy K.M.
        Third stage of labour care for women at low risk of postpartum haemorrhage.
        J Midwifery Womens Health. 2009; 54: 380-386
      1. Developing Regions [Internet]. 2017 [cited 5/19/2017].

        • World Health Organization
        Success factors for woman’s and children’s health.
        Ministry of Health and Population Egypt, Partnership for Maternal, Newborn & Child Health WHO, 2014, Geneva2014
        • Egypt Network for Integrated Development
        Qena Governorate for ENID’s integrated approach to capacity building and job creation.
        • El-Zanaty and Associates
        Egyptian demogeaphic and health survey 2005.
        El-Zanaty and Associates & Macro international, 2005
        • Tinker A.
        • Ransom E.
        Healthy mothers, healthy newborns.
        Health Newborn Network, 2002 ([cited 2015 12/03])
        • Countdown
        Countdown to 2015 maternal, newborn & child survival: Haiti.
        2013 (retrieved from http://countdown2015mnchorg/country-profiles/haiti)
        • (UN) UN
        The millennium development goals report.
        2012 (Retrieved from http://wwwunorg/millenniumgoals/pdf/MDG%20Report%202012pdf)
        • Asia ROfS
        What works for children in South Sai; newborn care: an overwiew.
        The United Nations Children’s Fund (UNICEF), Nepal2004
        • Bhutta Z.A.
        • Darmstadt G.L.
        • Hasan B.S.
        • Haws R.A.
        Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: a review of the evidence.
        Pediatrics. 2005; 115: 519-617
        • Cortis J.D.
        Culture, values and racism: application to nursing.
        Int Nurs Rev. 2003; 50: 55-64
        • Sukhov A.
        • Wu Y.
        • Xing G.
        • Smith L.H.
        • Gilbert W.M.
        Risk factors associated with cerebral palsy in preterm infants.
        J Matern Fetal Neonatal Med. 2012; 25: 53-57
        • Hockenberry M.J.
        Wong’s nursing care of infants and children.
        9 ed. Mosby, USA2011: 1888
        • Beck D.
        • Ganges F.
        • Goldman S.
        • Long P.
        Care of the newborn reference manual.
        Saving Newborn Lives, Saving the Children, Washington DC2004
        • Darmstadt G.L.
        • Bhutta Z.A.
        • Cousens S.
        • Adam T.
        • Walker N.
        • de Bernis L.
        Evidence-based, cost-effective interventions: how many newborn babies can we save?.
        Lancet (London, England). 2005; 365: 977-988
        • WHO
        Pregnancy, childbirth, postpartum and newborn care: A guide for essential practice.
        World Health Organization, Geneva2015
        • Bergström A.
        • Byaruhanga R.
        • Okong P.
        The impact of newborn bathing on the prevalence of neonatal hypothermia in Uganda: a randomized, controlled trial.
        Acta Paediatr. 2005; 94: 1462-1467
        • Byaruhanga R.
        • Bergstrom A.
        • Okong P.
        Neonatal hypothermia in Uganda: prevalence and risk factors.
        J Trop Pediatr. 2005; 51: 212-215
        • McCall E.M.
        • Alderdice F.A.
        • Halliday H.L.
        • Jenkins J.G.
        • Vohra S.
        Interventions to prevent hypothermia at birth in preterm and/or low birthweight babies.
        Evid Based Child Health: Cochrane Rev J. 2006; 1: 287-324
        • Moss W.
        • Darmstadt G.L.
        • Marsh D.R.
        • Black R.E.
        • Santosham M.
        Research priorities for the reduction of perinatal and neonatal morbidity and mortality in developing country communities.
        J Perinatol. 2002; 22: 484-495
        • World Health Organization
        Care of the umbilical cord: a review of the evidence.
        Reproductive Health (Technical Support) Maternal and Newborn Health Safe Motherhood. World Health Organization, Geneva1998
        • Zupan J.
        • Garner P.
        Topical umbilical cord care at birth.
        Cochrane Database Syst Rev. 2004; CD001057
        • Fikree F.F.
        • Ali T.S.
        • Durocher J.M.
        • Rahbar M.H.
        Newborn care practices in low socioeconomic settlements of Karachi, Pakistan.
        Soc Sci Med. 2005; 60: 911-921
        • Winch P.J.
        • Alam M.A.
        • Akther A.
        • Afroz D.
        • Ali N.A.
        • Ellis A.A.
        • et al.
        Local understandings of vulnerability and protection during the neonatal period in Sylhet District, Bangladesh: a qualitative study.
        Lancet. 2005; 366: 478-485
        • Mullany L.C.
        • Darmstadt G.L.
        • Khatry S.K.
        • Katz J.
        • LeClerq S.C.
        • Shrestha S.
        • et al.
        Topical applications of chlorhexidine to the umbilical cord for prevention of omphalitis and neonatal mortality in southern Nepal: a community-based, cluster-randomised trial.
        Lancet. 2006; 367: 910-918
        • Mullany L.C.
        • Darmstadt G.L.
        • Tielsch J.M.
        Safety and impact of chlorhexidine antisepsis interventions for improving neonatal health in developing countries.
        Pediatr Infect Dis J. 2006; 25: 665-675
        • Saleem S.
        Application of 4% chlorhexidine solution for cord cleansing after birth reduces neonatal mortality and omphalitis.
        Evid Based Med. 2013; 18e15
        • World Health Organization
        WHO recommendations on postnatal care of the mother and newborn.
        World Health Organization Copyright (c) World Health Organization 2014, Geneva2013
        • Edmond K.M.
        • Zandoh C.
        • Quigley M.A.
        • Amenga-Etego S.
        • Owusu-Agyei S.
        • Kirkwood B.R.
        Delayed breastfeeding initiation increases risk of neonatal mortality.
        Pediatrics. 2006; 117: e380-e386
        • Kramer M.S.
        • Kakuma R.
        The optimal duration of exclusive breastfeeding: a systematic review.
        Adv Exp Med Biol. 2004; 554: 63-77
        • World Health Organization
        Nutrient adequacy of exclusive breastfeeding for the term infant during the first 6 months of life.
        World Health Organization, Geneva2002
        • Haider R.
        • Rasheed S.
        • Sanghvi T.G.
        • Hassan N.
        • Pachon H.
        • Islam S.
        • et al.
        Breastfeeding in infancy: identifying the program-relevant issues in Bangladesh.
        Int breastfeed J. 2010; 5: 21
        • Acikgoz A.
        • Orsal O.
        • Orsal O.
        • Balci-Alparslan G.
        Traditional practices used by Turkish mothers in the care of their babies.
        Holist Nurs Pract. 2014; 28: 198-207
        • Eğri Gamze
        • Gölbaşı Zehra
        Traditional postnatal infant-care practices of 15–49 years old married women.
        TAF Prev Med Bull. 2007; 6: 313-320
        • Rogers N.L.
        • Abdi J.
        • Moore D.
        • Nd'iangui S.
        • Smith L.J.
        • Carlson A.J.
        • et al.
        Colostrum avoidance, prelacteal feeding and late breast-feeding initiation in rural Northern Ethiopia.
        Public Health Nutr. 2011; 14: 2029-2036
        • Tamiru D.
        • Belachew T.
        • Loha E.
        • Mohammed S.
        Sub-optimal breastfeeding of infants during the first six months and associated factors in rural communities of Jimma Arjo Woreda, Southwest Ethiopia.
        BMC Public Health. 2012; 12: 363
        • Huffman S.L.
        • Zehner E.R.
        • Victora C.
        Can improvements in breast-feeding practices reduce neonatal mortality in developing countries?.
        Midwifery. 2001; 17: 80-92
        • Edmond K.M.
        • Kirkwood B.R.
        • Amenga-Etego S.
        • Owusu-Agyei S.
        • Hurt L.S.
        Effect of early infant feeding practices on infection-specific neonatal mortality: an investigation of the causal links with observational data from rural Ghana.
        Am J Clin Nutr. 2007; 86: 1126-1131
        • Barnett S.
        • Azad K.
        • Barua S.
        • Mridha M.
        • Abrar M.
        • Rego A.
        • et al.
        Maternal and newborn-care practices during pregnancy, childbirth, and the postnatal period: a comparison in three rural districts in Bangladesh.
        J Health Popul Nutr. 2006; 24: 394+
        • Khadduri R.
        • Marsh D.R.
        • Rasmussen B.
        • Bari A.
        • Nazir R.
        • Darmstadt G.L.
        Household knowledge and practices of newborn and maternal health in Haripur district, Pakistan.
        J Perinatol. 2008; 28: 182-187
        • Rahi M.
        • Taneja D.
        • Misra A.
        • Mathur N.
        • Badhan S.
        Newborn care practices in an urban slum of Delhi.
        2006: 506-513 (2006 December 1)
        • Visscher M.O.
        • Utturkar R.
        • Pickens W.L.
        • LaRuffa A.A.
        • Robinson M.
        • Wickett R.R.
        • et al.
        Neonatal skin maturation—vernix caseosa and free amino acids.
        Pediatr Dermatol. 2011; 28: 122-132
        • Fleming T.
        • Gruenwald J.
        • Brendler T.
        • Jaenicke
        • Mehta M.
        PDR for herbal medicines.
        4th ed. Medical Economics Company, Montvale2000: 557-559
        • Rahbar M.H.
        • White F.
        • Agboatwalla M.
        • Hozhabri S.
        • Luby S.
        Factors associated with elevated blood lead concentrations in children in Karachi, Pakistan.
        Bull World Health Organ. 2002; 80: 769-775
        • Al-Ashban R.M.
        • Aslam M.
        • Shah A.H.
        Kohl (surma): a toxic traditional eye cosmetic study in Saudi Arabia.
        Public Health. 2004; 118: 292-298
        • Counter S.A.
        • Buchanan L.H.
        • Ortega F.
        • Rifai N.
        Blood lead and hemoglobin levels in Andean children with chronic lead intoxication.
        Neurotoxicology. 2000; 21: 301-308
        • Padiyath M.A.
        • VB B.
        • Ekambaram M.
        Knowledge attitude and practices of neonatal care among postnatal mothers.
        Curr Pediatr Res. 2016; 14: 147-152
        • Alam M.A.
        • Ali N.A.
        • Sultana N.
        • Mullany L.C.
        • Teela K.C.
        • Khan N.U.
        • et al.
        Newborn umbilical cord and skin care in Sylhet District, Bangladesh: implications for the promotion of umbilical cord cleansing with topical chlorhexidine.
        J Perinatol. 2008; 28: S61-S68
        • Premji S.
        • Khowaja S.
        • Meherali S.
        • Forgeron R.
        Sociocultural influences on newborn health in the first 6 weeks of life: qualitative study in a fishing village in Karachi, Pakistan.
        BMC Pregnancy Childbirth. 2014; 14
        • Kesterton A.J.
        • Cleland J.
        Neonatal care in rural Karnataka: healthy and harmful practices, the potential for change.
        BMC Pregnancy Childbirth. 2009; 9: 20
        • Curtis V.
        • Cousens S.
        • Mertens T.
        • Traore E.
        • Kanki B.
        • Diallo I.
        Structured observations of hygiene behaviours in Burkina Faso: validity, variability, and utility.
        Bull World Health Organ. 1993; 71: 23-32
        • Daniels D.L.
        • Cousens S.N.
        • Makoae L.N.
        • Feachem R.G.
        A case-control study of the impact of improved sanitation on diarrhoea morbidity in Lesotho.
        Bull World Health Organ. 1990; 68: 455-463