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J Family Med Prim Care
J Family Med Prim Care
JFMPC
J Family Med Prim Care
Journal of Family Medicine and Primary Care
2249-4863
2278-7135
Wolters Kluwer - Medknow India

JFMPC-13-3150
10.4103/jfmpc.jfmpc_86_24
Original Article
Cultural practices and beliefs followed for new born care in Santhal pargana - A cross sectional study
Gaur Rakhi 1
Kumar Rajan 2
Kaur Navjot 1
Kumar Manoj 3
Das Sarthak 2
Patel Rashmi B. 4
1 College of Nursing, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
2 Department of Paediatrics, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
3 Department of Paediatrics, All India Institute of Medical Sciences, Patna, Bihar, India
4 Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
Address for correspondence: Dr. Navjot Kaur, Assistant Professor, College of Nursing, All India Institute of Medical Sciences, Deoghar, Jharkhand, India. E-mail: mann.navjot87@gmail.com
8 2024
26 7 2024
13 8 31503155
16 1 2024
09 3 2024
15 3 2024
Copyright: © 2024 Journal of Family Medicine and Primary Care
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
ABSTRACT

Introduction:

Newborn care practices and beliefs vary word-wide, country to country and region to region. These care practices play a vital role in morbidity and mortality of newborn. A descriptive cross-sectional study was conducted to assess the newborn care practices and beliefs of newborn care.

Methods:

Data was collected from 429 post-natal mothers, who delivered in selected government hospitals of Santhal parganas, Deoghar, Jharkhand. Convenience sampling technique was used to collect the data from February 2023 to April 2023.

Results:

Findings of the study are, 86.9% mothers accepted that they massage the baby with oil before bath, 89.3% participants have given breastfeeding within one hour of delivery, 93.7% have given prelacteal feeds to the newborn. Applying Heeng (Asafoetida) over the umbilicus was found a common practice to cure the abdominal pain, 70.8% accepted that they apply ashes or powder or cow dung on the umbilical cord, and 88.3% rub the dough on baby’s skin to remove excess hairs, 99.3% mothers had firm belief that hot and cold foods in their diet could harm the baby. In continuation 98.8% believed that tooth eruption is associated with diarrhoea, 95.6% are applying kajal in the eyes of new born. Majority 98.8% believed that baby’s skin should be exposed to sunlight in case of jaundice and 94% avoid dressing of new born with yellow clothes.

Conclusion:

Continuous Health Education programs must be organized in Community to Educate the people about beneficial and harmful newborn care practices, which will help to reduce morbidity and mortality in newborn.

Beliefs
cultural practices
newborn care
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pmcIntroduction

India stands as a vast nation renowned for its remarkable geographical, linguistic, religious, and socio-cultural diversity. While these diverse customs and traditions have their significance, it’s important to note that some of them can pose health risks to both newborns and mothers.[123] Newborn mortality remains a substantially overlooked area of global health. The postnatal period, spanning the days and weeks following childbirth, holds pivotal importance in the well-being of newborns, as it represents a critical phase. A noteworthy statistic underscores this urgency: in 2021, 2.3 million children met demise within the first month of life worldwide, translating to approximately 6,400 neonatal deaths each day.[4] India has made commendable strides in mitigating newborn mortality, evident in its diminishing share of the universal newborn mortality load, which has decreased from approximately one-third deaths of newborns in 1990 to less than a quarter of newborn deaths.[56] The significance of culturally rooted beliefs and customs in shaping the way newborn care is conducted at home should not be underestimated. The crucial practices, referred to as Essential Newborn Care (ENC) practices,[7] encompass aspects like maintaining hygienic cord care, ensuring appropriate thermal care, and initiating breastfeeding promptly, ideally within the first hour after birth. It is the need of the hour to know about various cultural practices and beliefs related to newborn care, which in turn helps to find out the practices beneficial or harmful to newborn babies. The Santhal Parganas in Deoghar, Jharkhand is less explored in terms of newborn care practices. This study aimed to determine the cultural practices and beliefs related to newborn care prevalent in the Santhal pargana of Jharkhand, among postnatal mothers.

Materials and Methods

A descriptive cross-sectional study was conducted on postnatal mothers who were delivered and admitted to postnatal wards in certain government hospitals in the Deoghar district of Jharkhand.

For the study, sample size was estimated by applying a 5% margin of error and a 95% confidence interval, assuming a 50% response rate.[8] Based on these parameters, the calculated sample size was 377. To account for potential non-responses amounting to 20%, the final sample size aimed for was 429 participants. A convenience sampling technique was used to select participants and approached postnatal mothers who had given birth either through a caesarean section or a normal vaginal delivery. After providing them with an information sheet, those who expressed their willingness to participate and met the inclusion and exclusion criteria were selected.

Data was collected using a structured survey questionnaire.[9] Before its use, the questionnaire was validated by seven experts and it was found to be reliable based on a pilot trial (with a reliability coefficient of 0.724). This questionnaire consisted of two sections. The first section gathered information on the socio-demographic characteristics of the participants, including their age, education, occupation, place of residence, family income, mode of delivery, and more. The second section focused on seven significant aspects of cultural practices related to topics such as breastfeeding, digestion, umbilical cord care, beliefs regarding the evil eye, jaundice, and other prevalent customs and beliefs within their family.

Ethical approval was obtained from the Institute Ethics Committee, identified by reference number AIIMS-DEO/RC-IEC-Full committee/2023-Jan/64. Data collection commenced after receiving official authorization from the pertinent authorities.

The data collection process spanned three months, commencing in February 2023 and concluding in April 2023. Following an explanation of the study’s objectives and the solicitation of both verbal and written informed consent, the questionnaire items were either read aloud to some respondents or self-administered by others, depending on their proficiency in the Hindi/English language. On average, the survey and recording of participant responses took approximately 20 minutes per individual.

SPSS version 23.0 was used to analyse data in line with the objectives of the study, utilizing descriptive statistics.

Results and Analysis

Sociodemographic characteristics of the participants [Table 1]

Table 1 Sociodemographic characteristics of the participants (n=429)

Variables	Frequency (%)	
Age (in years)		
 18-21	177 (41.4)	
 22-25	129 (30.3)	
 26-29	99 (23.1)	
 30 and above	24 (5.2)	
Educational Qualification		
 Illiterate	25 (5.8)	
 Primary	83 (19.3)	
 Secondary	264 (61.5)	
 Graduation	52 (12.1)	
 PG and above	5 (.11)	
Type of Family		
 Nuclear	125 (29.1)	
 Joint	304 (70.9)	
Occupation		
 Home maker	425 (99.0)	
 Private Job/Business	2 (.5)	
 Govt. Job	2 (.5)	
Area of residence		
 Rural	230 (53.6)	
 Semi-urban	54 (12.6)	
 Urban	145 (33.8)	
Monthly income (per month in rupees)		
 <10000	27 (6.6)	
 10001-20000	238 (55.5)	
 20001-30000	141 (32.9)	
 >30000	23 (5)	
Type of Delivery		
 Normal vaginal delivery	332 (77.4)	
 Caesarean Section	97 (22.6)	

Cultural practices and beliefs followed for newborn care

Mothers follow various cultural practices for the baby before, during and after bath [Table 2]. Although all the deliveries in the current study were conducted in the hospital yet only 89.3% of participants could start the breastfeeding within one hour of delivery. There were various other beliefs and practices related to breastfeeding which were found during the study [Table 3]. Further the cultural beliefs and practices related to digestion in newborn was explored [Table 4].

Table 2 Cultural practices and beliefs related to bath for new born in Santhal pargana n=429

	Yes f (%)	No f (%)	
Oil-massaging the baby before to bathing	373 (86.9)	56 (13.1)	
Rubbing turmeric paste prior to bathing.	29 (6.8)	400 (93.2)	
Not considered appropriate for two members to give bath to the baby	414 (96.5)	15 (3.5)	
Exposing baby over a ‘Dhoopam’ smoke after bath	13 (3)	416 (97)	

Table 3 Cultural practices and beliefs related to feeding for new born in Santhal pargana n=429

	Yes f (%)	No f (%)	
Started breastfeeding within one hour of delivery	383 (89.3)	46 (10.7)	
Providing exclusive breast feeding till 6 months of delivery	429 (100)	0	
Providing prelacteals like sugar water or honey or jaggery powder shortly after birth	402 (93.7)	27 (6.3)	

Table 4 Cultural practices and beliefs related to digestion for new born in Santhal pargana n=429

	Yes f (%)	No f (%)	
Allowing the feces to be removed with hot water	40 (9.3)	389 (90.7)	
Using herbs, ginger or garlic as home cures for digestive issues	385 (89.7)	44 (10.3)	
Giving ‘Ghutti’ after baby takes breastfeed	374 (87.2)	55 (12.8)	
Applying ‘Heeng’ over umbilicus to cure pain abdomen	389 (90.7)	40 (9.3)	

When it came to umbilical cord care, more than two thirds 70.8% accepted that they apply ashes or powder or cow dung on the umbilical cord. Burying the cord after it falls is practiced by 85.5% of participants. The majority 88.1% do apply oil on the umbilical cord before bath [Table 5].

Table 5 Cultural practices and beliefs related to umbilical cord care for new born in Santhal Pargana (n=429)

	Yes f (%)	No f (%)	
Applying ashes or powder or dry cow dung or any ointment (over the counter) on the umbilical cord of the baby	303 (70.8)	125 (29.2)	
Burying the cord when it dries and falls	367 (85.5)	62 (14.5)	
Putting oil on the cord before bath	51 (11.9)	378 (88.1)	

Table 6 illustrates the common rituals and beliefs prevalent for new born care in Santhal Pargana. The majority of participants 97% believed that the empty cradle should not be moved. 98.1% believed that it is not safe to take the baby outside of the home after 6 pm. Most of the participants 97.2% believed that a baby’s nails should not be cut until he becomes 40 days older and 88.3% rub the dough on the baby’s skin to remove excess hairs. 99.3% of mothers had a firm belief that hot and cold foods in their diet could harm the baby. In continuation 98.8% believed that tooth eruption is associated with diarrhoea.

Table 6 Common rituals and beliefs prevalent for new born care in Santhal pargana (n=429)

	Yes f (%)	No f (%)	
Removing coated tongue with a baby’s pee-soaked towel	3 (.7)	426 (99.3)	
Do you believe “empty cradle should not be moved”	416 (97)	13 (3)	
Refrain from taking the baby outside after 6 pm	421 (98.1)	8 (1.9)	
Baby’s cloths should not leave outside at night	420 (97.9)	9 (2.1)	
Put the infant’s first stool beaneath the carpet	3 (.7)	426 (99.3)	
Blood from the umbilical cord is applied to the baby’s back and placed in the mouth	3 (.7)	426 (99.3)	
Keep the baby’s nail untrimmed until the baby is 40 days of age	417 (97.2)	12 (2.8)	
Do you think isolating mother and baby for 30-40 days is beneficial for mother and baby?	10 (2.3)	419 (97.7)	
Do you keep a knife under baby’s pillow?	36 (8.4)	393 (91.6)	
Do you keep matchbox under baby’s cloth?	5 (1.2)	424 (98.8)	
Do you massage dough on to the baby’s skin?	379 (88.3)	50 (11.7)	
Do you believe certain hot and cold items in your diet may be harmful for your baby?	426 (99.3)	3 (.7)	
Have you ever placed hot iron needles/rods over baby’s abdomen?	0	429 (100)	
Do you believe tooth eruption is associated with diarrhoea?	424 (98.8)	5 (1.2)	
Do you put mustard oil in ear for earache/soothing purpose?	16 (3.7)	413 (96.3)	
Immunization can cause sterility in the babies	0	429 (100)	
Baby’s cloth should not be squeezed strongly with hands to make them dry	0	429 (100)	
Baby’s cloth should not be hanged upside down	26 (6.1)	403 (93.9)	

People have a firm belief in Evil’s eye [Figure 1], 95.6% are applying kajal in the eyes of new born, 90.2% tie the black thread around the wrist of new born and 98.6% tie the amulet around the neck of baby as well.

Figure 1 Practices to prevent Evil’s eye

Practices followed during care of Jaundice in this region [Figure 2], Majority 98.8% believed that a baby’s skin should be exposed to sunlight in case of jaundice and most of them 94% avoid dressing of new born with yellow clothes during disease. 95.2% of participants agreed to continue breastfeeding during jaundice.

Figure 2 Practices followed during care of jaundice

Discussion

To implement effective interventions in improving newborn care practices, it’s crucial to comprehend the cultural nuances associated with home care.

Research findings indicate that among the 429 postnatal mothers surveyed, 100% were providing their newborns with initial milk (colostrum). This marks a departure from the traditional practices of discarding colostrum after delivery. This might be due to the promotion of institutional deliveries and raising awareness about exclusive breastfeeding among women of reproductive age. Interestingly, this discovery contradicts a previous Indian study where cultural beliefs strongly discouraged the use of colostrum. In a study conducted in north Karnataka, Nethra and Udgiri[10] found that 15.5% of mothers discarded colostrum, a result consistent with the findings reported by Reshma and Sujatha[11] Similarly, Ganjoo and Rowlands[12] also revealed that 57% of mothers considered colostrum unhygienic and refrained from giving it to their babies. On the other hand, Khan et al.[13] and Bangari A et al.[9] reported that 41% and 96% of mothers were offering colostrum to their newborns respectively.

Pre lacteal feedings impede breastfeeding, which can have a significant impact on newborn and infant mortality in nations with high neonatal mortality rates, such as India. A maximum of 93.7% of the participants in our study reported prelacteal feeding as a custom in their families. Our findings are consistent with research conducted in rural North India, which indicated that around 40.1% of mothers provided prelacteal meals in one form or another[14] In a related study, Kaur N and Kaur J[15] discovered that 48% of neonates were fed prelacteal feed in the form of sugar water, jaggery, and honey. In our study, 87.2% of individuals reported administering ghutti and applying heeng around the umbilicus for proper digestion of newborn. 98.8% of respondents were adamant that diarrhoea and teeth eruption are related. That might be due to the firm familial belief in Indian societies regarding tooth eruption.

Another aspect of newborn care that was prioritized was the care of the umbilical cord. Clean cord care methods, such as refraining from applying native substances and keeping the cord dry, have been proven to dramatically reduce infant mortality. Umbilical cord infections are a common cause of neonatal sepsis and mortality.[16] On the umbilical cord, about 70.8% of participants apply ashes, powder, and cow dung. According to a study by Reshma and Sujatha[11] 55% of participants applied cow dung or ashes to their umbilical cords. Other research’ findings indicate that some materials were applied to the cord, including herbal paste, talcum powder, ash or clay turmeric, oil, and antiseptic treatments.[131415]

86.9% of mothers accepted that they massage the baby with oil before bath. No preference of oil was found out as they commonly use mustard oil, coconut oil and other massaging oils available in the local market. A study conducted by Bangari A et al.[9] showed that 71% of mothers reported practicing daily baby massage. Among them, the majority (40.3%) used commercially advertised baby oil, while 27.3% opted for mustard oil. Only 15.3% of mothers used coconut oil for baby massage. In a study by Sasikala P et al.[17] 79.4% reported using oil massage before bathing. Nethra and Udgiri[10] found that 87% of mothers in their study massaged their newborns with oil, and Reshma and Sujatha[11] reported that 92% of mothers massaged their babies with oil before bath.

According to the results of our study, 99.3% of participants thought that certain foods, both hot and cold, could be harmful to a newborn child. Food concepts of “Hot” and “Cold” were reported by Benakappa and Shivamurthy[18] As per beliefs of some people, cold foods induce colds (runny nose, cough, etc.), and hot foods, generate heat in the body. According to a study by Cacodcar et al.[19] which supports the findings of our study, 62.54% of the participants strongly believed in the “hot” and “cold” foods—mangoes, beef, and eggs, for example—because they were thought to produce huge amounts of body heat. According to Altuntuğ et al.[20] during the puerperium, 97.9% of women had dietary restrictions. According to Catherin et al.[21] some women felt that drinking warm water made their infant’s veins more noticeable, which made the newborn look ugly. As a result, the mothers preferred to drink cool water. According to a study by Bangari A et al.[9] 71.3% of mothers think, eating hot or cold food could be bad for their child’s health. These ideas place needless restrictions on a mother’s diet.

In this survey, 95.6% of the subjects used kajal to prevent evil eye. According to research by Bangari A et al.[9] 57.3% of women thought it was necessary to apply kajal to a newborn’s eyes or behind their ears. Additionally, 70% of the mothers said it keeps the newborn healthy. In order to protect their newborn from evils eye, 84% of participants, according to Sasikala P et al.[17] applied kajal to their faces. This figure was comparable to that of Reshma and Sujatha[11] (82%). According to Cacodcar et al.[19] 39.08% mothers used kajal to protect their baby’s eye from evil. In a similar vein, Akkamamba[22] found that 93.9% of mothers apply kajal to their eyes and Ganjoo C and Rowlands R[12] found that 97% of mothers applied kajal to their infants in their study conducted in Aligarh. On the other hand, applying it to the eyes might result in fingernail harm to the eye as well as conjunctivitis and dacryocystitis.

In our study 98.6% of mothers tie amulet around the baby’s neck to prevent evil eyes which is in line with a study result noted by Cacodcar et al.[19] that mothers tie amulets to fend off evil and wrapping black thread around the baby’s neck and waist (97.72%).

Only 8.4% of participants in our survey kept a knife beneath their baby’s pillow, despite other studies’ findings suggesting that this behavior is more common in other cultures. According to a study by Bangari A et al.[9] 16.7% of mothers would place a matchbox under their baby’s clothing, while 74.7% of parents would place a knife under their newborn’s pillow. It maintains their health and shields the infant from the negative effects of ghosts and djinn. According to research conducted in Mangalore by Sunanda and Paul.[23] 65% of women store a stick, broomstick, or metal rod under their bed or close to the pillow to protect the mother and child from evil gaze.[24] According to Premji et al.[25] a knife (or other iron object) should always be kept close by to protect the infant from spirits.

Remarkably, only 3.7% of participants in our study reported using oil to ease a newborn’s ear discomfort. This is in contrast to findings by Bangari A et al.[9] and Nethra and Udgiri[10] reported that 81% and 75% of mothers, respectively, used oil to relieve a newborn’s ear pain because they thought the infant’s ears might close otherwise.

Conclusion

The study’s specific goals were to evaluate mothers’ and families’ cultural behaviors and attitudes on newborn care in Santhal Pragana. Every culture has customs and ideas about how to care for infants. Numerous customs, rites, beliefs, and offerings exist that can either benefit or hurt the newborn and child’s health. Improving newborn health in India requires addressing the significant program and policy implications of these findings. Strategies for health education must take into account traditional knowledge and practices. It could be advantageous to launch a comprehensive campaign that uses education, information, and communication tools to both impart new information and explain or reinforce existing knowledge and behaviour related to the care of newborns.

Ethical consideration

Approval for the study has been taken from institutional ethical committee.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.
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