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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Umbilical cord-care practices in low- and middle-income countries: a systematic review</title><author><name sortKey="Coffey, Patricia S" sort="Coffey, Patricia S" uniqKey="Coffey P" first="Patricia S." last="Coffey">Patricia S. Coffey</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author><author><name sortKey="Brown, Siobhan C" sort="Brown, Siobhan C" uniqKey="Brown S" first="Siobhan C." last="Brown">Siobhan C. Brown</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28219420</idno><idno type="pmc">5319165</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5319165</idno><idno type="RBID">PMC:5319165</idno><idno type="doi">10.1186/s12884-017-1250-7</idno><date when="2017">2017</date><idno type="wicri:Area/Pmc/Corpus">000685</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000685</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Umbilical cord-care practices in low- and middle-income countries: a systematic review</title><author><name sortKey="Coffey, Patricia S" sort="Coffey, Patricia S" uniqKey="Coffey P" first="Patricia S." last="Coffey">Patricia S. Coffey</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author><author><name sortKey="Brown, Siobhan C" sort="Brown, Siobhan C" uniqKey="Brown S" first="Siobhan C." last="Brown">Siobhan C. Brown</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author></analytic><series><title level="j">BMC Pregnancy and Childbirth</title><idno type="eISSN">1471-2393</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Neonatal sepsis is the third leading cause of deaths for infants in their first month of life. The newly cut umbilical cord can be a pathway for bacteria that can cause newborn sepsis and death. Optimal umbilical cord care practices for newborns and during the first week of life, especially in settings with poor hygiene, has the potential to avoid these preventable neonatal deaths. The purpose of this review of cord care practices is to assist in the development of behavior-change strategies to support introduction of novel cord-care regimens, particularly 7.1% chlorhexidine digluconate for umbilical cord care.</p></sec><sec><title>Methods</title><p>We searched domestic and international databases for articles that were published in English between January 1, 2000, and August 24, 2016. We found 321 articles and reviewed 65 full-text articles using standardized inclusion criteria. The primary criteria for inclusion was a description of substances applied to the umbilical cord stump in the days following birth.</p></sec><sec><title>Results</title><p>We included 46 articles in this review of umbilical cord-care practices. Articles included data from 15 low- and middle-income countries in sub-Saharan Africa (8 countries), Asia (5 countries), North Africa (1 country), and Latin America and the Caribbean (1 country). Findings from this review suggest that documentation of cord-care practices is not consistent throughout low- and middle-income countries, yet existing literature depicts a firm tradition of umbilical cord care in every culture. Cord-care practices vary by country and by regions or cultural groups within a country and employ a wide range of substances. The desire to promote healing and hasten cord separation are the underlying beliefs related to application of substances to the umbilical cord. The frequency of application of the substance (either the number of days or the number of times per day the substance was applied), and source and cost of products used is not well-characterized.</p></sec><sec><title>Conclusions</title><p>This desire to actively care for the umbilical cord of a newborn—as noted in the variety of cord care practices and beliefs identified in this review—points toward the need to contextualize any behavior change approach to align with the local culture.</p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1186/s12884-017-1250-7) contains supplementary material, which is available to authorized users.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Liu, L" uniqKey="Liu L">L Liu</name></author><author><name sortKey="Oza, S" uniqKey="Oza S">S Oza</name></author><author><name sortKey="Hogan, D" uniqKey="Hogan D">D Hogan</name></author><author><name sortKey="Perin, J" uniqKey="Perin J">J Perin</name></author><author><name sortKey="Rudan, I" uniqKey="Rudan I">I Rudan</name></author><author><name sortKey="Lawn, Je" uniqKey="Lawn J">JE Lawn</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Traverso, Hp" uniqKey="Traverso H">HP Traverso</name></author><author><name sortKey="Bennett, Jv" uniqKey="Bennett J">JV Bennett</name></author><author><name sortKey="Kahn, Aj" uniqKey="Kahn A">AJ Kahn</name></author><author><name sortKey="Agha, Sb" uniqKey="Agha S">SB Agha</name></author><author><name sortKey="Rahim, H" uniqKey="Rahim H">H Rahim</name></author><author><name sortKey="Kamil, S" uniqKey="Kamil S">S Kamil</name></author><author><name sortKey="Lang, Mh" uniqKey="Lang M">MH Lang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mull, Ds" uniqKey="Mull D">DS Mull</name></author><author><name sortKey="Anderson, Jw" uniqKey="Anderson J">JW Anderson</name></author><author><name sortKey="Mull, Jd" uniqKey="Mull J">JD Mull</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Karumbi, J" uniqKey="Karumbi J">J Karumbi</name></author><author><name sortKey="Mulaku, M" uniqKey="Mulaku M">M Mulaku</name></author><author><name sortKey="Aluvaala, J" uniqKey="Aluvaala J">J Aluvaala</name></author><author><name sortKey="English, M" uniqKey="English M">M English</name></author><author><name sortKey="Opiyo, N" uniqKey="Opiyo N">N Opiyo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Imdad, A" uniqKey="Imdad A">A Imdad</name></author><author><name sortKey="Bautista, Rm" uniqKey="Bautista R">RM Bautista</name></author><author><name sortKey="Senen, Ka" uniqKey="Senen K">KA Senen</name></author><author><name sortKey="Uy, Mv" uniqKey="Uy M">MV Uy</name></author><author><name sortKey="Mantaring Iii, Jb" uniqKey="Mantaring Iii J">JB Mantaring III</name></author><author><name sortKey="Bhutta, Za" uniqKey="Bhutta Z">ZA Bhutta</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Byaruhanga, Rn" uniqKey="Byaruhanga R">RN Byaruhanga</name></author><author><name sortKey="Nsungwa Sabiiti, J" uniqKey="Nsungwa Sabiiti J">J Nsungwa-Sabiiti</name></author><author><name sortKey="Kiguli, J" uniqKey="Kiguli J">J Kiguli</name></author><author><name sortKey="Balyeku, A" uniqKey="Balyeku A">A Balyeku</name></author><author><name sortKey="Nsabagasani, X" uniqKey="Nsabagasani X">X Nsabagasani</name></author><author><name sortKey="Peterson, S" uniqKey="Peterson S">S Peterson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Herlihy, Jm" uniqKey="Herlihy J">JM Herlihy</name></author><author><name sortKey="Shaikh, A" uniqKey="Shaikh A">A Shaikh</name></author><author><name sortKey="Mazimba, A" uniqKey="Mazimba A">A Mazimba</name></author><author><name sortKey="Gagne, N" uniqKey="Gagne N">N Gagne</name></author><author><name sortKey="Grogan, C" uniqKey="Grogan C">C Grogan</name></author><author><name sortKey="Mpamba, C" uniqKey="Mpamba C">C Mpamba</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Khan, Gn" uniqKey="Khan G">GN Khan</name></author><author><name sortKey="Memon, Za" uniqKey="Memon Z">ZA Memon</name></author><author><name sortKey="Bhutta, Za" uniqKey="Bhutta Z">ZA Bhutta</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sharkey, A" uniqKey="Sharkey A">A Sharkey</name></author><author><name sortKey="Yansaneh, A" uniqKey="Yansaneh A">A Yansaneh</name></author><author><name sortKey="Bangura, Ps" uniqKey="Bangura P">PS Bangura</name></author><author><name sortKey="Kabano, A" uniqKey="Kabano A">A Kabano</name></author><author><name sortKey="Brady, E" uniqKey="Brady E">E Brady</name></author><author><name sortKey="Yumkella, F" uniqKey="Yumkella F">F Yumkella</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Abhulimhen Iyoha, Bi" uniqKey="Abhulimhen Iyoha B">BI Abhulimhen-Iyoha</name></author><author><name sortKey="Ibadin, Mo" uniqKey="Ibadin M">MO Ibadin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Alparslan, O" uniqKey="Alparslan O">Ö Alparslan</name></author><author><name sortKey="Dem Rel, Y" uniqKey="Dem Rel Y">Y Demırel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Amare, Y" uniqKey="Amare Y">Y Amare</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hill, Z" uniqKey="Hill Z">Z Hill</name></author><author><name sortKey="Tawiah Agyemang, C" uniqKey="Tawiah Agyemang C">C Tawiah-Agyemang</name></author><author><name sortKey="Okeyere, E" uniqKey="Okeyere E">E Okeyere</name></author><author><name sortKey="Manu, A" uniqKey="Manu A">A Manu</name></author><author><name sortKey="Fenty, J" uniqKey="Fenty J">J Fenty</name></author><author><name sortKey="Kirkwood, B" uniqKey="Kirkwood B">B Kirkwood</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Degefie, T" uniqKey="Degefie T">T Degefie</name></author><author><name sortKey="Amare, Y" uniqKey="Amare Y">Y Amare</name></author><author><name sortKey="Mulligan, B" uniqKey="Mulligan B">B Mulligan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Moran, Ac" uniqKey="Moran A">AC Moran</name></author><author><name sortKey="Choudhury, N" uniqKey="Choudhury N">N Choudhury</name></author><author><name sortKey="Uz Zaman Khan, N" uniqKey="Uz Zaman Khan N">N Uz Zaman Khan</name></author><author><name sortKey="Ahsan Karar, Z" uniqKey="Ahsan Karar Z">Z Ahsan Karar</name></author><author><name sortKey="Wahed, T" uniqKey="Wahed T">T Wahed</name></author><author><name sortKey="Faiz Rashid, S" uniqKey="Faiz Rashid S">S Faiz Rashid</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sacks, E" uniqKey="Sacks E">E Sacks</name></author><author><name sortKey="Moss, Wj" uniqKey="Moss W">WJ Moss</name></author><author><name sortKey="Winch, Pj" uniqKey="Winch P">PJ Winch</name></author><author><name sortKey="Thuma, P" uniqKey="Thuma P">P Thuma</name></author><author><name sortKey="Van Dijk, Jh" uniqKey="Van Dijk J">JH van Dijk</name></author><author><name sortKey="Mullany, Lc" uniqKey="Mullany L">LC Mullany</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shamba, Dd" uniqKey="Shamba D">DD Shamba</name></author><author><name sortKey="Schellenberg, J" uniqKey="Schellenberg J">J Schellenberg</name></author><author><name sortKey="Penfold, Sc" uniqKey="Penfold S">SC Penfold</name></author><author><name sortKey="Mashasi, I" uniqKey="Mashasi I">I Mashasi</name></author><author><name sortKey="Mrisho, M" uniqKey="Mrisho M">M Mrisho</name></author><author><name sortKey="Manzi, F" uniqKey="Manzi F">F Manzi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Waiswa, P" uniqKey="Waiswa P">P Waiswa</name></author><author><name sortKey="Kemigisa, M" uniqKey="Kemigisa M">M Kemigisa</name></author><author><name sortKey="Kiguli, J" uniqKey="Kiguli J">J Kiguli</name></author><author><name sortKey="Naikoba, S" uniqKey="Naikoba S">S Naikoba</name></author><author><name sortKey="Pariyo, Gw" uniqKey="Pariyo G">GW Pariyo</name></author><author><name sortKey="Peterson, S" uniqKey="Peterson S">S Peterson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Moyer, Ca" uniqKey="Moyer C">CA Moyer</name></author><author><name sortKey="Aborigo, Ra" uniqKey="Aborigo R">RA Aborigo</name></author><author><name sortKey="Logonia, G" uniqKey="Logonia G">G Logonia</name></author><author><name sortKey="Affah, G" uniqKey="Affah G">G Affah</name></author><author><name sortKey="Rominski, S" uniqKey="Rominski S">S Rominski</name></author><author><name sortKey="Adongo, Pb" uniqKey="Adongo P">PB Adongo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Walsh, S" uniqKey="Walsh S">S Walsh</name></author><author><name sortKey="Norr, K" uniqKey="Norr K">K Norr</name></author><author><name sortKey="Sankar, G" uniqKey="Sankar G">G Sankar</name></author><author><name sortKey="Sipsma, H" uniqKey="Sipsma H">H Sipsma</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mrisho, M" uniqKey="Mrisho M">M Mrisho</name></author><author><name sortKey="Schellenberg, Ja" uniqKey="Schellenberg J">JA Schellenberg</name></author><author><name sortKey="Mushi, Ak" uniqKey="Mushi A">AK Mushi</name></author><author><name sortKey="Obrist, B" uniqKey="Obrist B">B Obrist</name></author><author><name sortKey="Mshinda, H" uniqKey="Mshinda H">H Mshinda</name></author><author><name sortKey="Tanner, M" uniqKey="Tanner M">M Tanner</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dhingra, U" uniqKey="Dhingra U">U Dhingra</name></author><author><name sortKey="Gittelsohn, J" uniqKey="Gittelsohn J">J Gittelsohn</name></author><author><name sortKey="Suleiman, Am" uniqKey="Suleiman A">AM Suleiman</name></author><author><name sortKey="Suleiman, Sm" uniqKey="Suleiman S">SM Suleiman</name></author><author><name sortKey="Dutta, A" uniqKey="Dutta A">A Dutta</name></author><author><name sortKey="Ali, Sm" uniqKey="Ali S">SM Ali</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Geckil, E" uniqKey="Geckil E">E Geçkil</name></author><author><name sortKey="Sahin, T" uniqKey="Sahin T">T Sahin</name></author><author><name sortKey="Ege, E" uniqKey="Ege E">E Ege</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mullany, Lc" uniqKey="Mullany L">LC Mullany</name></author><author><name sortKey="Faillace, S" uniqKey="Faillace S">S Faillace</name></author><author><name sortKey="Tielsch, Jm" uniqKey="Tielsch J">JM Tielsch</name></author><author><name sortKey="Stolzfus, Rj" uniqKey="Stolzfus R">RJ Stolzfus</name></author><author><name sortKey="Nygaard, Ke" uniqKey="Nygaard K">KE Nygaard</name></author><author><name sortKey="Kavle, Ja" uniqKey="Kavle J">JA Kavle</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Winch, Pj" uniqKey="Winch P">PJ Winch</name></author><author><name sortKey="Alam, Ma" uniqKey="Alam M">MA Alam</name></author><author><name sortKey="Akther, A" uniqKey="Akther A">A Akther</name></author><author><name sortKey="Afroz, D" uniqKey="Afroz D">D Afroz</name></author><author><name sortKey="Ali, Na" uniqKey="Ali N">NA Ali</name></author><author><name sortKey="Ellis, Aa" uniqKey="Ellis A">AA Ellis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sharma, S" uniqKey="Sharma S">S Sharma</name></author><author><name sortKey="Van Teijlingen, E" uniqKey="Van Teijlingen E">E van Teijlingen</name></author><author><name sortKey="Hundley, V" uniqKey="Hundley V">V Hundley</name></author><author><name sortKey="Angell, C" uniqKey="Angell C">C Angell</name></author><author><name sortKey="Simkhada, P" uniqKey="Simkhada P">P Simkhada</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Upadhyay, Rp" uniqKey="Upadhyay R">RP Upadhyay</name></author><author><name sortKey="Rai, Sk" uniqKey="Rai S">SK Rai</name></author><author><name sortKey="Anand, K" uniqKey="Anand K">K Anand</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Adejuyigbe, Ea" uniqKey="Adejuyigbe E">EA Adejuyigbe</name></author><author><name sortKey="Odebiyi, Ai" uniqKey="Odebiyi A">AI Odebiyi</name></author><author><name sortKey="Aina, O" uniqKey="Aina O">O Aina</name></author><author><name sortKey="Bamiwuye, S" uniqKey="Bamiwuye S">S Bamiwuye</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Darmstadt, Gl" uniqKey="Darmstadt G">GL Darmstadt</name></author><author><name sortKey="Hussein, Mh" uniqKey="Hussein M">MH Hussein</name></author><author><name sortKey="Winch, Pj" uniqKey="Winch P">PJ Winch</name></author><author><name sortKey="Haws, Ra" uniqKey="Haws R">RA Haws</name></author><author><name sortKey="Lamia, M" uniqKey="Lamia M">M Lamia</name></author><author><name sortKey="El Said, Ma" uniqKey="El Said M">MA El-Said</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Madhu, K" uniqKey="Madhu K">K Madhu</name></author><author><name sortKey="Chowdary, S" uniqKey="Chowdary S">S Chowdary</name></author><author><name sortKey="Masthi, R" uniqKey="Masthi R">R Masthi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Khadduri, R" uniqKey="Khadduri R">R Khadduri</name></author><author><name sortKey="Marsh, Dr" uniqKey="Marsh D">DR Marsh</name></author><author><name sortKey="Rasmussen, B" uniqKey="Rasmussen B">B Rasmussen</name></author><author><name sortKey="Bari, A" uniqKey="Bari A">A Bari</name></author><author><name sortKey="Nazir, R" uniqKey="Nazir R">R Nazir</name></author><author><name sortKey="Darmstadt, Gl" uniqKey="Darmstadt G">GL Darmstadt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gul, S" uniqKey="Gul S">S Gul</name></author><author><name sortKey="Khalil, R" uniqKey="Khalil R">R Khalil</name></author><author><name sortKey="Yousafzai, Mt" uniqKey="Yousafzai M">MT Yousafzai</name></author><author><name sortKey="Shoukat, F" uniqKey="Shoukat F">F Shoukat</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mar Di, L" uniqKey="Mar Di L">L Maródi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Raza, Sa" uniqKey="Raza S">SA Raza</name></author><author><name sortKey="Akhtar, S" uniqKey="Akhtar S">S Akhtar</name></author><author><name sortKey="Avan, Bi" uniqKey="Avan B">BI Avan</name></author><author><name sortKey="Hamza, H" uniqKey="Hamza H">H Hamza</name></author><author><name sortKey="Rahbar, Mh" uniqKey="Rahbar M">MH Rahbar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Alhaji, Ma" uniqKey="Alhaji M">MA Alhaji</name></author><author><name sortKey="Bello, Ma" uniqKey="Bello M">MA Bello</name></author><author><name sortKey="Elechi, Ha" uniqKey="Elechi H">HA Elechi</name></author><author><name sortKey="Akuhwa, Rt" uniqKey="Akuhwa R">RT Akuhwa</name></author><author><name sortKey="Bukar, Fl" uniqKey="Bukar F">FL Bukar</name></author><author><name sortKey="Ibrahim, Ha" uniqKey="Ibrahim H">HA Ibrahim</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Roper, Mh" uniqKey="Roper M">MH Roper</name></author><author><name sortKey="Vandelaer, Jh" uniqKey="Vandelaer J">JH Vandelaer</name></author><author><name sortKey="Gasse, Fl" uniqKey="Gasse F">FL Gasse</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Meegan, Me" uniqKey="Meegan M">ME Meegan</name></author><author><name sortKey="Conroy, Rm" uniqKey="Conroy R">RM Conroy</name></author><author><name sortKey="Lengeny, So" uniqKey="Lengeny S">SO Lengeny</name></author><author><name sortKey="Renhault, K" uniqKey="Renhault K">K Renhault</name></author><author><name sortKey="Nyangole, J" uniqKey="Nyangole J">J Nyangole</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Mullany, Lc" uniqKey="Mullany L">LC Mullany</name></author><author><name sortKey="Darmstadt, Gl" uniqKey="Darmstadt G">GL Darmstadt</name></author><author><name sortKey="Khatry, Sk" uniqKey="Khatry S">SK Khatry</name></author><author><name sortKey="Katz, J" uniqKey="Katz J">J Katz</name></author><author><name sortKey="Leclerq, Sc" uniqKey="Leclerq S">SC LeClerq</name></author><author><name sortKey="Shrestha, S" uniqKey="Shrestha S">S Shrestha</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Arifeen, Se" uniqKey="Arifeen S">SE Arifeen</name></author><author><name sortKey="Mullany, Lc" uniqKey="Mullany L">LC Mullany</name></author><author><name sortKey="Shah, R" uniqKey="Shah R">R Shah</name></author><author><name sortKey="Mannan, I" uniqKey="Mannan I">I Mannan</name></author><author><name sortKey="Rahman, Sm" uniqKey="Rahman S">SM Rahman</name></author><author><name sortKey="Talukder, Mr" uniqKey="Talukder M">MR Talukder</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Soofi, S" uniqKey="Soofi S">S Soofi</name></author><author><name sortKey="Cousens, S" uniqKey="Cousens S">S Cousens</name></author><author><name sortKey="Imdad, A" uniqKey="Imdad A">A Imdad</name></author><author><name sortKey="Bhutto, N" uniqKey="Bhutto N">N Bhutto</name></author><author><name sortKey="Ali, N" uniqKey="Ali N">N Ali</name></author><author><name sortKey="Bhutta, Za" uniqKey="Bhutta Z">ZA Bhutta</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Imdad, A" uniqKey="Imdad A">A Imdad</name></author><author><name sortKey="Mullany, Lc" uniqKey="Mullany L">LC Mullany</name></author><author><name sortKey="Baqui, Ah" uniqKey="Baqui A">AH Baqui</name></author><author><name sortKey="El Arifeen, S" uniqKey="El Arifeen S">S El Arifeen</name></author><author><name sortKey="Tielsch, Jm" uniqKey="Tielsch J">JM Tielsch</name></author><author><name sortKey="Khatry, Sk" uniqKey="Khatry S">SK Khatry</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Semrau, K" uniqKey="Semrau K">K Semrau</name></author><author><name sortKey="Herlihy, J" uniqKey="Herlihy J">J Herlihy</name></author><author><name sortKey="Grogan, C" uniqKey="Grogan C">C Grogan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sazawal, S" uniqKey="Sazawal S">S Sazawal</name></author><author><name sortKey="Dhingra, U" uniqKey="Dhingra U">U Dhingra</name></author><author><name sortKey="Ali, Sm" uniqKey="Ali S">SM Ali</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Glanz, K" uniqKey="Glanz K">K Glanz</name></author><author><name sortKey="Rimer, Bk" uniqKey="Rimer B">BK Rimer</name></author><author><name sortKey="Viswanath, K" uniqKey="Viswanath K">K Viswanath</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Alam, Ma" uniqKey="Alam M">MA Alam</name></author><author><name sortKey="Ali, Na" uniqKey="Ali N">NA Ali</name></author><author><name sortKey="Sultana, N" uniqKey="Sultana N">N Sultana</name></author><author><name sortKey="Mullany, Lc" uniqKey="Mullany L">LC Mullany</name></author><author><name sortKey="Teela, Kc" uniqKey="Teela K">KC Teela</name></author><author><name sortKey="Khan, Nu" uniqKey="Khan N">NU Khan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ayaz, A" uniqKey="Ayaz A">A Ayaz</name></author><author><name sortKey="Saleem, S" uniqKey="Saleem S">S Saleem</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Callaghan Koru, Ja" uniqKey="Callaghan Koru J">JA Callaghan-Koru</name></author><author><name sortKey="Seifu, A" uniqKey="Seifu A">A Seifu</name></author><author><name sortKey="Tholandi, M" uniqKey="Tholandi M">M Tholandi</name></author><author><name sortKey="De Graft Johnson, J" uniqKey="De Graft Johnson J">J de Graft-Johnson</name></author><author><name sortKey="Daniel, E" uniqKey="Daniel E">E Daniel</name></author><author><name sortKey="Rawlins, B" uniqKey="Rawlins B">B Rawlins</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Falle, Ty" uniqKey="Falle T">TY Falle</name></author><author><name sortKey="Mullany, Lc" uniqKey="Mullany L">LC Mullany</name></author><author><name sortKey="Thatte, N" uniqKey="Thatte N">N Thatte</name></author><author><name sortKey="Khatry, Sk" uniqKey="Khatry S">SK Khatry</name></author><author><name sortKey="Leclerq, Sc" uniqKey="Leclerq S">SC LeClerq</name></author><author><name sortKey="Darmstadt, Gl" uniqKey="Darmstadt G">GL Darmstadt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ghosh, R" uniqKey="Ghosh R">R Ghosh</name></author><author><name sortKey="Sharma, Ak" uniqKey="Sharma A">AK Sharma</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gilani, I" uniqKey="Gilani I">I Gilani</name></author><author><name sortKey="Kayani, Za" uniqKey="Kayani Z">ZA Kayani</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Grant, E" uniqKey="Grant E">E Grant</name></author><author><name sortKey="Munube, D" uniqKey="Munube D">D Munube</name></author><author><name sortKey="Lumala, P" uniqKey="Lumala P">P Lumala</name></author><author><name sortKey="Sentongo, Sa" uniqKey="Sentongo S">SA Sentongo</name></author><author><name sortKey="Dodds, L" uniqKey="Dodds L">L Dodds</name></author><author><name sortKey="Bortolussi, R" uniqKey="Bortolussi R">R Bortolussi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jennings, L" uniqKey="Jennings L">L Jennings</name></author><author><name sortKey="Yebadokpo, A" uniqKey="Yebadokpo A">A Yebadokpo</name></author><author><name sortKey="Affo, J" uniqKey="Affo J">J Affo</name></author><author><name sortKey="Agbogbe, M" uniqKey="Agbogbe M">M Agbogbe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Karas, Dj" uniqKey="Karas D">DJ Karas</name></author><author><name sortKey="Mullany, Lc" uniqKey="Mullany L">LC Mullany</name></author><author><name sortKey="Katz, J" uniqKey="Katz J">J Katz</name></author><author><name sortKey="Khatry, Sk" uniqKey="Khatry S">SK Khatry</name></author><author><name sortKey="Leclerq, Sc" uniqKey="Leclerq S">SC LeClerq</name></author><author><name sortKey="Darmstadt, Gl" uniqKey="Darmstadt G">GL Darmstadt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kesterton, Aj" uniqKey="Kesterton A">AJ Kesterton</name></author><author><name sortKey="Cleland, J" uniqKey="Cleland J">J Cleland</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kumar, V" uniqKey="Kumar V">V Kumar</name></author><author><name sortKey="Mohanty, S" uniqKey="Mohanty S">S Mohanty</name></author><author><name sortKey="Kumar, A" uniqKey="Kumar A">A Kumar</name></author><author><name sortKey="Misra, Rp" uniqKey="Misra R">RP Misra</name></author><author><name sortKey="Santosham, M" uniqKey="Santosham M">M Santosham</name></author><author><name sortKey="Awasthi, S" uniqKey="Awasthi S">S Awasthi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mangwi Ayiasi, R" uniqKey="Mangwi Ayiasi R">R Mangwi Ayiasi</name></author><author><name sortKey="Kolsteren, P" uniqKey="Kolsteren P">P Kolsteren</name></author><author><name sortKey="Batwala, V" uniqKey="Batwala V">V Batwala</name></author><author><name sortKey="Criel, B" uniqKey="Criel B">B Criel</name></author><author><name sortKey="Orach, Cg" uniqKey="Orach C">CG Orach</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Memon, Za" uniqKey="Memon Z">ZA Memon</name></author><author><name sortKey="Khan, Mi" uniqKey="Khan M">MI Khan</name></author><author><name sortKey="Soofi, S" uniqKey="Soofi S">S Soofi</name></author><author><name sortKey="Muhammad, S" uniqKey="Muhammad S">S Muhammad</name></author><author><name sortKey="Bhutta, Za" uniqKey="Bhutta Z">ZA Bhutta</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mullany, Lc" uniqKey="Mullany L">LC Mullany</name></author><author><name sortKey="Darmstadt, Gl" uniqKey="Darmstadt G">GL Darmstadt</name></author><author><name sortKey="Katz, J" uniqKey="Katz J">J Katz</name></author><author><name sortKey="Khatry, Sk" uniqKey="Khatry S">SK Khatry</name></author><author><name sortKey="Leclerq, Sc" uniqKey="Leclerq S">SC LeClerq</name></author><author><name sortKey="Adhikari, Rk" uniqKey="Adhikari R">RK Adhikari</name></author><author><name sortKey="Tielsch, Jm" uniqKey="Tielsch J">JM Tielsch</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sreeramareddy, Ct" uniqKey="Sreeramareddy C">CT Sreeramareddy</name></author><author><name sortKey="Joshi, Hs" uniqKey="Joshi H">HS Joshi</name></author><author><name sortKey="Sreekumaran, Bv" uniqKey="Sreekumaran B">BV Sreekumaran</name></author><author><name sortKey="Giri, S" uniqKey="Giri S">S Giri</name></author><author><name sortKey="Chuni, N" uniqKey="Chuni N">N Chuni</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Waiswa, P" uniqKey="Waiswa P">P Waiswa</name></author><author><name sortKey="Peterson, S" uniqKey="Peterson S">S Peterson</name></author><author><name sortKey="Tomson, G" uniqKey="Tomson G">G Tomson</name></author><author><name sortKey="Pariyo, Gw" uniqKey="Pariyo G">GW Pariyo</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Pregnancy Childbirth</journal-id><journal-id journal-id-type="iso-abbrev">BMC Pregnancy Childbirth</journal-id><journal-title-group><journal-title>BMC Pregnancy and Childbirth</journal-title></journal-title-group><issn pub-type="epub">1471-2393</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28219420</article-id><article-id pub-id-type="pmc">5319165</article-id><article-id pub-id-type="publisher-id">1250</article-id><article-id pub-id-type="doi">10.1186/s12884-017-1250-7</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>Umbilical cord-care practices in low- and middle-income countries: a systematic review</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Coffey</surname><given-names>Patricia S.</given-names></name><address><email>pcoffey@path.org</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Brown</surname><given-names>Siobhan C.</given-names></name><address><email>scbrown@path.org</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0000 8940 7771</institution-id><institution-id institution-id-type="GRID">grid.415269.d</institution-id><institution></institution><institution>PATH,</institution></institution-wrap>2201 Westlake Avenue, Suite 200, Seattle, WA 98121 USA</aff></contrib-group><pub-date pub-type="epub"><day>20</day><month>2</month><year>2017</year></pub-date><pub-date pub-type="pmc-release"><day>20</day><month>2</month><year>2017</year></pub-date><pub-date pub-type="collection"><year>2017</year></pub-date><volume>17</volume><elocation-id>68</elocation-id><history><date date-type="received"><day>20</day><month>9</month><year>2016</year></date><date date-type="accepted"><day>8</day><month>2</month><year>2017</year></date></history><permissions><copyright-statement>© The Author(s). 2017</copyright-statement><license license-type="OpenAccess"><license-p><bold>Open Access</bold>This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>) applies to the data made available in this article, unless otherwise stated.</license-p></license></permissions><abstract id="Abs1"><sec><title>Background</title><p>Neonatal sepsis is the third leading cause of deaths for infants in their first month of life. The newly cut umbilical cord can be a pathway for bacteria that can cause newborn sepsis and death. Optimal umbilical cord care practices for newborns and during the first week of life, especially in settings with poor hygiene, has the potential to avoid these preventable neonatal deaths. The purpose of this review of cord care practices is to assist in the development of behavior-change strategies to support introduction of novel cord-care regimens, particularly 7.1% chlorhexidine digluconate for umbilical cord care.</p></sec><sec><title>Methods</title><p>We searched domestic and international databases for articles that were published in English between January 1, 2000, and August 24, 2016. We found 321 articles and reviewed 65 full-text articles using standardized inclusion criteria. The primary criteria for inclusion was a description of substances applied to the umbilical cord stump in the days following birth.</p></sec><sec><title>Results</title><p>We included 46 articles in this review of umbilical cord-care practices. Articles included data from 15 low- and middle-income countries in sub-Saharan Africa (8 countries), Asia (5 countries), North Africa (1 country), and Latin America and the Caribbean (1 country). Findings from this review suggest that documentation of cord-care practices is not consistent throughout low- and middle-income countries, yet existing literature depicts a firm tradition of umbilical cord care in every culture. Cord-care practices vary by country and by regions or cultural groups within a country and employ a wide range of substances. The desire to promote healing and hasten cord separation are the underlying beliefs related to application of substances to the umbilical cord. The frequency of application of the substance (either the number of days or the number of times per day the substance was applied), and source and cost of products used is not well-characterized.</p></sec><sec><title>Conclusions</title><p>This desire to actively care for the umbilical cord of a newborn—as noted in the variety of cord care practices and beliefs identified in this review—points toward the need to contextualize any behavior change approach to align with the local culture.</p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1186/s12884-017-1250-7) contains supplementary material, which is available to authorized users.</p></sec></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Neonatology</kwd><kwd>Umbilical cord care</kwd><kwd>Low- and middle-income countries</kwd><kwd>Behavior change</kwd></kwd-group><funding-group><award-group><funding-source><institution-wrap><institution-id institution-id-type="FundRef">http://dx.doi.org/10.13039/100006641</institution-id><institution>UNICEF</institution></institution-wrap></funding-source><award-id>100054671</award-id></award-group></funding-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2017</meta-value></custom-meta></custom-meta-group></article-meta></front><body><sec id="Sec1"><title>Background</title><p>Neonatal sepsis is responsible for more than 15% of neonatal deaths worldwide [<xref ref-type="bibr" rid="CR1">1</xref>] and is the third leading cause of deaths for infants in their first month of life. A newly cut umbilical cord can be a pathway for bacteria that can cause newborn sepsis and death.. Optimal umbilical cord care practices for newborns and during the first week of life, especially in settings with poor hygiene, has the potential to avoid these preventable neonatal deaths.</p><p>Harmful traditional cord-care practices are often cited as an important public health concern [<xref ref-type="bibr" rid="CR2">2</xref>, <xref ref-type="bibr" rid="CR3">3</xref>]. A clear understanding of behavioral intention underlying traditional cord care practices in low- and middle-income countries can be helpful in addressing high rates of neonatal sepsis. Although systematic evidence reviews of cord-cleansing practices have been conducted previously [<xref ref-type="bibr" rid="CR4">4</xref>, <xref ref-type="bibr" rid="CR5">5</xref>], the qualitative nature of cord-care practices has not been summarized to-date. This review fills a gap in the literature by systematically reviewing available evidence related to traditional cord-care practices and assessing the likely impact of product categories on infection risk.</p></sec><sec id="Sec2"><title>Methods</title><p>Our initial search focused on studies that described traditional umbilical cord care practices globally. For the purposes of this article, traditional practices were those that focused on the cultural beliefs and customs that guided how the umbilical cord was cared for, including the length of the cord stump, substances applied, and the decisions regarding disposal of the cord stump. We developed systematic searches for PubMed and Google Scholar using controlled vocabulary (Additional file <xref rid="MOESM1" ref-type="media">1</xref>: Search Terminology). Initial criteria for eligibility were determined by topic, time period, and language of the publication. We included articles that were published between January 1, 2000, and January 30, 2016. A second search was performed in August 2016 to account for any publications during the intervening months. The language of publication was limited to English. References in the identified articles were reviewed to determine if other sources would be pertinent and additional articles were abstracted if relevant.</p><p>The original search yielded 321 articles, from which 107 duplicates were excluded. A reviewer then screened titles and abstracts of the remaining 214 articles to determine suitability for inclusion. Articles that did not meet the criteria included those unrelated to the application of substances to the umbilical cord, articles focused on clinical trials comparing a variety of antiseptic applications to the umbilical cord, articles wherein the authors related only secondary data sources regarding umbilical cord-care practices, and articles that were unrelated to umbilical cord care, but had appeared in the search due to a common term, such as spinal cord. A total of 65 full-text articles were then reviewed using standardized inclusion criteria. The primary criterion for inclusion was a description of substances applied to the umbilical cord stump in the days following birth. Based on these criteria, a total of 46 of the 65 articles were included in this review. Secondary data about beliefs in relation to umbilical cord care and other cord-care practices were also recorded, if available. Data regarding cord-care practices were extracted from the articles using a standardized tracking form in Excel. Data items included:<list list-type="bullet"><list-item><p>○ What was used to cut the umbilical cord?</p></list-item><list-item><p>○ What was used to tie the umbilical cord?</p></list-item><list-item><p>○ Applications of a substance to the umbilical cord stump.<list list-type="bullet"><list-item><p>○ What substance was applied?</p></list-item><list-item><p>○ How often it was applied?</p></list-item><list-item><p>○ How many days it was applied?</p></list-item><list-item><p>○ Why was it applied (belief)?</p></list-item><list-item><p>○ Who applied the substance?</p></list-item><list-item><p>○ Source of product supply.</p></list-item><list-item><p>○ Cost of product applied.</p></list-item></list></p></list-item><list-item><p>○ Other newborn skin-care practices, such as infant massage, that could contribute to the development of neonatal sepsis or tetanus were also tracked.</p></list-item></list></p><p>We synthesized data relating to cord-care practices and substance used on the cord by country. Because most of the studies were qualitative or observational in design, we were unable to draw any statistical comparisons. This review reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (known as PRISMA) reporting guidelines [<xref ref-type="bibr" rid="CR6">6</xref>], as warranted.</p></sec><sec id="Sec3"><title>Results</title><p>A total of 46 articles were included in this review of umbilical cord-care practices. Figure <xref rid="Fig1" ref-type="fig">1</xref> presents the flow diagram of the review process.<fig id="Fig1"><label>Fig. 1</label><caption><p>PRISMA flow diagram for this review article</p></caption><graphic xlink:href="12884_2017_1250_Fig1_HTML" id="MO1"></graphic></fig></p><p>The 46 articles included data from 15 distinct low- and middle-income countries in sub-Saharan Africa (8 countries), Asia (5 countries), North Africa (1 country), and Latin America and the Caribbean (1 country). In sub-Saharan Africa, the majority of articles came from Uganda (6), followed by Tanzania (4), Ethiopia and Nigeria (3 each), Ghana and Zambia (2 each), and Benin and Sierra Leone (1 each). In Asia, the majority of articles came from Pakistan (7), followed by India and Nepal (5 each), Bangladesh (3), and Turkey (2). In North Africa, one article came from Egypt. In the Latin America/Caribbean region, one article came from Haiti. Table <xref rid="Tab1" ref-type="table">1</xref> provides general details about the articles included in this review. While country income classification was not a predetermined criteria for inclusion or exclusion, umbilical cord care articles from high-income countries were solely focused on the comparisons and uses of antiseptics and; therefore, none are included in this review based on the exclusion criteria.<table-wrap id="Tab1"><label>Table 1</label><caption><p>Articles included in this review, with study details</p></caption><table frame="hsides" rules="groups"><thead><tr><th>First author</th><th>Journal</th><th>Study type</th><th>Data collection year(s)</th><th>Country</th><th>Region</th><th>Rural/urban</th><th>Place of birth</th><th>Sample size</th></tr></thead><tbody><tr><td>Abhulimhen-Iyoha [<xref ref-type="bibr" rid="CR12">12</xref>]</td><td>Niger J Clin Pract. 2012</td><td>Cross-sectional survey</td><td>2009</td><td>Nigeria</td><td>Benin City</td><td>Urban</td><td>Community and facility</td><td>497 mothers.</td></tr><tr><td>Adejuyigbe [<xref ref-type="bibr" rid="CR30">30</xref>]</td><td>Matern Child Nutr. 2008</td><td>Mixed-methods, cross-sectional</td><td>2003</td><td>Nigeria</td><td>Ekiti State</td><td>Rural</td><td>Community and facility</td><td>60 household surveys.<break></break>12 IDIs (healers, TBAs, birth home staff, nurses/midwives).<break></break>8 FGDs (total of 42 individuals. Elderly males and females).<break></break>4 questionnaires (fathers and grandmothers).</td></tr><tr><td>Alam [<xref ref-type="bibr" rid="CR54">54</xref>]</td><td>J Perinatol. 2008</td><td>Cross-sectional, descriptive</td><td>2006</td><td>Bangladesh</td><td>Sylhet District</td><td>Not indicated</td><td>Community and facility</td><td>400 household surveys.<break></break>60 semi-structured interviews: 20 recently delivered women, 20 senior females, 10 husbands, 10 senior males.</td></tr><tr><td>Alhaji [<xref ref-type="bibr" rid="CR37">37</xref>]</td><td>Niger Med J. 2013</td><td>Retrospective record review</td><td>2009–2010</td><td>Nigeria</td><td>North-eastern</td><td>Not indicated</td><td>Community and facility</td><td>51 cases of tetanus.</td></tr><tr><td>Alparslan [<xref ref-type="bibr" rid="CR13">13</xref>]</td><td>Jpn J Nurs Sci. 2013</td><td>Descriptive and cross-sectional</td><td>2008</td><td>Turkey</td><td>Sivas</td><td>Urban</td><td>Not indicated</td><td>263 mothers.</td></tr><tr><td>Amare [<xref ref-type="bibr" rid="CR14">14</xref>]</td><td>BMC Int Health Hum Rights. 2014</td><td>Qualitative</td><td>2013</td><td>Ethiopia</td><td>Oromia, Amhara, Tigray, and SNNPR (Sidama Zone)</td><td>Rural</td><td>Community and facility</td><td>IDIs with 32 total.<break></break>One community in each region. Each study community:<break></break>6 mothers, 4 grandmothers, 2 TBAs, 2 HEWs.</td></tr><tr><td>Ayaz [<xref ref-type="bibr" rid="CR55">55</xref>]</td><td>PLoS One. 2010</td><td>Community-based, cross-sectional</td><td>2006</td><td>Pakistan</td><td>Karachi (squatter settlement)</td><td>Urban</td><td>Community and facility</td><td>565 women between 28 to 33 days post-delivery.</td></tr><tr><td>Byaruhanga [<xref ref-type="bibr" rid="CR7">7</xref>]</td><td>Midwifery. 2011</td><td>Qualitative</td><td>2008</td><td>Uganda</td><td>Kayunga, Soroti, and Ntugamo Districts</td><td>Rural</td><td>Community</td><td>6 IDIs with TBAs.<break></break>9 FGDs with 10 to 15 participants each (mothers, older females, and husbands).</td></tr><tr><td>Callaghan-Koru [<xref ref-type="bibr" rid="CR56">56</xref>]</td><td>BMC Pediatr. 2013</td><td>Cross-sectional household survey of newborn care practices</td><td>2012</td><td>Ethiopia</td><td>Tigray, Oromiya, Amhara, and SNNPR</td><td>Not indicated</td><td>Community and facility</td><td>218 mothers.</td></tr><tr><td>Darmstadt [<xref ref-type="bibr" rid="CR31">31</xref>]</td><td>Trop Med Int Health. 2007</td><td>Qualitative</td><td>2000</td><td>Egypt</td><td>Governorates of Aswan, Luxor, and Fayoum</td><td>Rural</td><td>Not indicated</td><td>217 households interviewed within 7 days of birth.</td></tr><tr><td>Degefie [<xref ref-type="bibr" rid="CR16">16</xref>]</td><td>BMC Int Health Hum Rights. 2014</td><td>Qualitative</td><td>2012</td><td>Ethiopia</td><td>Sidama Zone of SNNP and East Shewa and West Arsi Zones of Oromia</td><td>Rural</td><td>Community and facility</td><td>8 KIIs with grandmothers.<break></break>27 IDIs with mothers.<break></break>7 IDIs with TBAs.<break></break>15 IDIs with fathers.</td></tr><tr><td>Dhingra [<xref ref-type="bibr" rid="CR24">24</xref>]</td><td>BMC Pregnancy Childbirth. 2014</td><td>Qualitative</td><td>Not stated</td><td>Tanzania</td><td>Pemba Island</td><td>Urban and rural</td><td>Community and facility</td><td>11 FGDs and 80 IDIs with mothers, grandmothers, untrained and trained TBAs.</td></tr><tr><td>Falle [<xref ref-type="bibr" rid="CR57">57</xref>]</td><td>J Health Popul Nutr. 2009</td><td>Qualitative</td><td>Unknown</td><td>Nepal</td><td>Sarlahi district, Southern Nepal</td><td>Rural</td><td>Community</td><td>93 TBAs.</td></tr><tr><td>Geçkil [<xref ref-type="bibr" rid="CR25">25</xref>]</td><td>Midwifery. 2009</td><td>Descriptive</td><td>2004</td><td>Turkey</td><td>Adiyaman</td><td>Urban</td><td>Facility</td><td>273 mothers.</td></tr><tr><td>Ghosh [<xref ref-type="bibr" rid="CR58">58</xref>]</td><td>J Biosoc Sci. 2010</td><td>Qualitative</td><td>2008</td><td>India</td><td>Uttar Pradesh</td><td>Peri-urban</td><td>Community and facility</td><td>892 women.</td></tr><tr><td>Gilani [<xref ref-type="bibr" rid="CR59">59</xref>]</td><td>Rural Remote Health. 2014</td><td>Community-based, cross-sectional</td><td>2011</td><td>Pakistan</td><td>Muzaffarabad in Azad Jammu & Kashmir</td><td>Urban and rural</td><td>Community and facility</td><td>104 mothers of neonates with current illness or illness within previous 2 weeks.</td></tr><tr><td>Grant [<xref ref-type="bibr" rid="CR60">60</xref>]</td><td>Paediatr Child Health. 2014</td><td>Qualitative, cross-sectional</td><td>2013</td><td>Uganda</td><td>Luwero district, Bamunanika sub-district</td><td>Rural</td><td>Not indicated</td><td>101 mothers or infant caregivers of deceased infants.</td></tr><tr><td>Gul [<xref ref-type="bibr" rid="CR34">34</xref>]</td><td>Int J Health Sci (Qassim). 2014</td><td>Cross-sectional</td><td>2010</td><td>Pakistan</td><td>Karachi</td><td>Urban</td><td>Community and facility</td><td>170 mothers.</td></tr><tr><td>Herlihy [<xref ref-type="bibr" rid="CR8">8</xref>]</td><td>PLoS One. 2013</td><td>Qualitative</td><td>2010</td><td>Zambia</td><td>Southern. Choma and Monze districts (rural) Livingstone and Mazabuka (urban)</td><td>Urban and rural</td><td>Community and facility</td><td>36 FGDs with grandmothers, breastfeeding mothers, midwives, TBAs.<break></break>42 IDIs with CHWs, community leaders, health professionals, religious leaders, TBAs, traditional healers.</td></tr><tr><td>Hill [<xref ref-type="bibr" rid="CR15">15</xref>]</td><td>Pediatr Infect Dis J. 2010</td><td>Qualitative</td><td>2006–2007 (qualitative)<break></break>2008–2009 (quantitative)</td><td>Ghana</td><td>Brong Ahafo region</td><td>Rural</td><td>Community</td><td>9167 quantitative surveys of women who delivered between April 2008 and May 2009.<break></break>25 birth narratives.<break></break>30 IDS with women delivered in past 2 months.<break></break>2 FGDs with women delivered in past year or were pregnant.<break></break>20 IDIs and 6 FGDs with birth attendants/grandmothers.<break></break>12 IDIs and 2 FGDs with husbands.</td></tr><tr><td>Jennings [<xref ref-type="bibr" rid="CR61">61</xref>]</td><td>Matern Child Health J. 2015</td><td>Pre-post randomized design; data drawn from interviews and observations</td><td>Unknown</td><td>Benin</td><td>Zou/Collines Region</td><td>Rural</td><td>Facility</td><td>411 mother-newborn pairs.</td></tr><tr><td>Karas [<xref ref-type="bibr" rid="CR62">62</xref>]</td><td>J Trop Pediatr. 2012</td><td>Data collected within a community-based, cluster-randomized trial</td><td>2002–2006</td><td>Nepal</td><td>Sarlahi district, Southern Nepal</td><td>Rural</td><td>Community and facility</td><td>23662 infants.</td></tr><tr><td>Kayom [<xref ref-type="bibr" rid="CR9">9</xref>]</td><td>Int J Pediatr. 2015</td><td>Cross-sectional descriptive</td><td>2012</td><td>Uganda</td><td>Kampala</td><td>Urban</td><td>Community and facility</td><td>335 mothers.</td></tr><tr><td>Kesterton [<xref ref-type="bibr" rid="CR63">63</xref>]</td><td>BMC Pregnancy Childbirth. 2009</td><td>Mixed-methods</td><td>Quantitative (1996–1998), qualitative (2004–2005)</td><td>India</td><td>Karnataka</td><td>Rural</td><td>Community and facility</td><td>388 surveys of mothers.<break></break>39 IDIs with mothers, grandmothers, birth attendants, and key informants.<break></break>8 FGDs.</td></tr><tr><td>Khadduri [<xref ref-type="bibr" rid="CR33">33</xref>]</td><td>J Perinatol. 2008</td><td>Qualitative</td><td>2000</td><td>Pakistan</td><td>Haripur District, NW Frontier Province</td><td>Rural and peri-urban</td><td>Community and facility</td><td>64 IDIs with mothers, fathers, TBAs.<break></break>34 FGDs.</td></tr><tr><td>Khan [<xref ref-type="bibr" rid="CR10">10</xref>]</td><td>J Neonatal Perinatal Med. 2013</td><td>Cross-sectional</td><td>Unknown</td><td>Pakistan</td><td>Gilgit-Baltistan</td><td>Rural</td><td>Not indicated</td><td>708 mothers.</td></tr><tr><td>Kumar [<xref ref-type="bibr" rid="CR64">64</xref>]</td><td>Lancet. 2008</td><td>Cluster-randomized, controlled efficacy trial</td><td>2006</td><td>India</td><td>Shivgarh, Uttar Pradesh</td><td>Rural</td><td>Community and facility</td><td>3400 mothers.</td></tr><tr><td>Madhu [<xref ref-type="bibr" rid="CR32">32</xref>]</td><td>Indian J Community Med. 2009</td><td>Cross-sectional</td><td>2006</td><td>India</td><td>Kengeri, Karnataka</td><td>Rural</td><td>Community and facility</td><td>100 mothers.</td></tr><tr><td>Mangwi Ayiasi [<xref ref-type="bibr" rid="CR65">65</xref>]</td><td>PLoS One. 2016</td><td>Randomized community intervention trial</td><td>2013–2014</td><td>Uganda</td><td>Masindi and Kiryandongo districts</td><td>Not indicated</td><td>Community and facility</td><td>1385 pregnant women.</td></tr><tr><td>Memon [<xref ref-type="bibr" rid="CR66">66</xref>]</td><td>J Neonatal Perinatal Med. 2013</td><td>Cross-sectional KAP (knowledge, attitudes, and practices)</td><td>2005–2006</td><td>Pakistan</td><td>Matiari district, Sindh Province</td><td>Rural</td><td>Community and facility</td><td>1490 mothers.</td></tr><tr><td>Moran [<xref ref-type="bibr" rid="CR16">16</xref>]</td><td>BMC Pregnancy Childbirth. 2009</td><td>Mixed-methods</td><td>2007</td><td>Bangladesh</td><td>Dhaka slums (Korali and Kamrangir Char)</td><td>Urban</td><td>Community and facility</td><td>36 women who were currently pregnant or those who had had at least one delivery.</td></tr><tr><td>Moyer [<xref ref-type="bibr" rid="CR21">21</xref>]</td><td>BMC Pregnancy Childbirth. 2012</td><td>Qualitative</td><td>2010</td><td>Ghana</td><td>Northern. Kassena-Nankana districts</td><td>Rural</td><td>Community and facility</td><td>72 IDIs with women with newborns, health care providers, TBAs/herbalists, community leaders.<break></break>Unspecified number of FGDs with grandmothers, compound heads, heads of household.</td></tr><tr><td>Mrisho [<xref ref-type="bibr" rid="CR23">23</xref>]</td><td>Trans R Soc Trop Med Hyg. 2008</td><td>Qualitative</td><td>2005–2007</td><td>Tanzania</td><td>Lindi and Mtwara regions</td><td>Rural</td><td>Community and facility</td><td>40 IDIs with recently delivered women, pregnant women, TBAs.<break></break>16 FGDs with women who had given birth at least once.</td></tr><tr><td>Mullany [<xref ref-type="bibr" rid="CR67">67</xref>]</td><td>Am J Epidemiol. 2007</td><td>Data collected within a community-based, cluster-randomized trial.</td><td>2002–2005</td><td>Nepal</td><td>Southern</td><td>Not indicated</td><td>Not indicated</td><td>15755 newborns.</td></tr><tr><td>Mullany [<xref ref-type="bibr" rid="CR26">26</xref>]</td><td>Pediatr Infect Dis J. 2009</td><td>Data collected within a community-based, cluster-randomized trial.</td><td>2004–2005</td><td>Tanzania</td><td>Pemba Island</td><td>Rural</td><td>Community and facility</td><td>1653 infants (but only those born at home were evaluated for substances applied [1158]).</td></tr><tr><td>Raza [<xref ref-type="bibr" rid="CR36">36</xref>]</td><td>J Postgrad Med. 2004</td><td>Case–control</td><td>1998–2001 (record review parameters)</td><td>Pakistan</td><td>Karachi (squatter settlement)</td><td>Urban</td><td>Not indicated</td><td>375 newborns.</td></tr><tr><td>Sacks [<xref ref-type="bibr" rid="CR18">18</xref>]</td><td>BMC Pregnancy Childbirth. 2015</td><td>Qualitative</td><td>2010–2011</td><td>Zambia</td><td>Choma District</td><td>Rural</td><td>Community and facility</td><td>36 IDIs, 5 FGDs, and 8 observational sessions with recently-delivered women, TBAs, clinic and hospital staff.</td></tr><tr><td>Shamba [<xref ref-type="bibr" rid="CR19">19</xref>]</td><td>J Health Popul Nutr. 2013</td><td>Qualitative</td><td>2008</td><td>Tanzania</td><td>Lindi Region</td><td>Rural</td><td>Community</td><td>11 birth narratives.<break></break>6 FGDs with women who delivered at home.<break></break>2 FGDs with birth attendants (any woman who assisted someone with a delivery in the last year).</td></tr><tr><td>Sharkey [<xref ref-type="bibr" rid="CR11">11</xref>]</td><td>Health Policy Plan. 2016</td><td>Mixed-methods</td><td>2012</td><td>Sierra Leone</td><td>Kambia, Tonkolili, Kailahun, and Pujehun Districts</td><td>Rural</td><td>Community and facility</td><td>98 IDIs and 24 FGDs with pregnant women, caretakers, mothers, fathers, health care providers, CHWs, and TBAs.<break></break>6000 household surveys.</td></tr><tr><td>Sharma [<xref ref-type="bibr" rid="CR28">28</xref>]</td><td>BMC Pregnancy Childbirth. 2016</td><td>Qualitative</td><td>2012</td><td>Nepal</td><td>Not indicated</td><td>Rural</td><td>Not indicated</td><td>5 IDIs and 14 FGDs with mothers, grandmothers, men, and health care workers.</td></tr><tr><td>Sreeramareddy [<xref ref-type="bibr" rid="CR68">68</xref>]</td><td>BMC Pregnancy Childbirth. 2006</td><td>Cross-sectional survey</td><td>2006</td><td>Nepal</td><td>Western</td><td>Urban</td><td>Community</td><td>240 mothers.</td></tr><tr><td>Upadhyay [<xref ref-type="bibr" rid="CR29">29</xref>]</td><td>Acta Paediatr. 2012</td><td>Cross-sectional survey</td><td>2010</td><td>India</td><td>Haryana (northern India)</td><td>Rural</td><td>Community and facility</td><td>415 mothers.</td></tr><tr><td>Waiswa [<xref ref-type="bibr" rid="CR20">20</xref>]</td><td>BMC Pregnancy Childbirth. 2008</td><td>Qualitative</td><td>2006–2007</td><td>Uganda</td><td>Busoga (eastern Uganda)</td><td>Rural</td><td>Community and facility</td><td>10 FGDs with younger mothers (aged <30 years), older mothers with grandchildren, fathers, older children (up to age 13) who act as child minders.<break></break>KIIs with 6 health workers and 4 TBAs.</td></tr><tr><td>Waiswa [<xref ref-type="bibr" rid="CR69">69</xref>]</td><td>BMC Pregnancy Childbirth. 2010</td><td>Cross-sectional</td><td>2007</td><td>Uganda</td><td>Iganga-Mayuge Demographic Surveillance Site</td><td>Rural</td><td>Community and facility</td><td>393 mothers.</td></tr><tr><td>Walsh [<xref ref-type="bibr" rid="CR22">22</xref>]</td><td>Glob Public Health. 2015</td><td>Qualitative</td><td>2013</td><td>Haiti</td><td>Petit-Gôave</td><td>Rural</td><td>Community and facility</td><td>5 FGDs with mothers with newborns, mothers with children under age two, and grandmothers and pregnant women, TBAs, CHWs, and traditional healers (voudou priests and priestesses).</td></tr><tr><td>Winch [<xref ref-type="bibr" rid="CR27">27</xref>]</td><td>Lancet. 2005</td><td>Mixed methods</td><td>2001–2002</td><td>Bangladesh</td><td>Beanibazar, Zakiganj, and Kanaighat sub-districts in Sylhet District</td><td>Not indicated</td><td>Community and facility</td><td>39 IDIs with mothers, fathers, grandmothers, and TBAs.<break></break>6050 household surveys of mothers.</td></tr></tbody></table><table-wrap-foot><p>Abbreviations</p><p><italic>CHW</italic> community health worker</p><p><italic>FGD</italic> focus group discussion</p><p><italic>IDI</italic> in-depth interview</p><p><italic>KII</italic> key informant interview</p><p><italic>TBA</italic> traditional birth attendant</p></table-wrap-foot></table-wrap></p><sec id="Sec4"><title>Beliefs</title><p>Beliefs related to the application of substances to the umbilical cord varies by country and by regions or cultural groups within a country. The intention behind applying a substance to the umbilical cord is to promote healing [<xref ref-type="bibr" rid="CR7">7</xref>–<xref ref-type="bibr" rid="CR11">11</xref>] and hasten the separation of the cord [<xref ref-type="bibr" rid="CR7">7</xref>, <xref ref-type="bibr" rid="CR12">12</xref>–<xref ref-type="bibr" rid="CR14">14</xref>] either by keeping the cord stump moist [<xref ref-type="bibr" rid="CR10">10</xref>, <xref ref-type="bibr" rid="CR14">14</xref>, <xref ref-type="bibr" rid="CR15">15</xref>] or by drying it out [<xref ref-type="bibr" rid="CR8">8</xref>, <xref ref-type="bibr" rid="CR16">16</xref>–<xref ref-type="bibr" rid="CR20">20</xref>] to prevent pain/infection/bleeding [<xref ref-type="bibr" rid="CR10">10</xref>, <xref ref-type="bibr" rid="CR12">12</xref>, <xref ref-type="bibr" rid="CR16">16</xref>, <xref ref-type="bibr" rid="CR17">17</xref>, <xref ref-type="bibr" rid="CR21">21</xref>], or to keep the “wind” (evil spirits) or cold/air [<xref ref-type="bibr" rid="CR10">10</xref>, <xref ref-type="bibr" rid="CR16">16</xref>, <xref ref-type="bibr" rid="CR22">22</xref>] out of the infant. Table <xref rid="Tab2" ref-type="table">2</xref> provides an overview of cord-care practices described in each article included in this review.<table-wrap id="Tab2"><label>Table 2</label><caption><p>Articles included in this review, with cord care practices</p></caption><table frame="hsides" rules="groups"><thead><tr><th>First author</th><th>Journal</th><th>Country</th><th>Purpose of study and overall cord care practices (if stated)</th><th>What substance was applied to the cord</th></tr></thead><tbody><tr><td>Abhulimhen-Iyoha [<xref ref-type="bibr" rid="CR12">12</xref>]</td><td>Niger J Clin Pract. 2012</td><td>Nigeria</td><td>A study to determine the factors that influence cord care practices among mothers in Benin City, Nigeria.</td><td>Beneficial cord care (as defined by study authors): methylated spirits (20.5%), or non-beneficial substances: hot compress, herbs, native chalk, salt, sand, saliva, palm oil, menthol-containing balm, petroleum jelly, and toothpaste (substances were used alone or in combination and mainly applied at home) (76.9%).</td></tr><tr><td>Adejuyigbe [<xref ref-type="bibr" rid="CR30">30</xref>]</td><td>Matern Child Nutr. 2008</td><td>Nigeria</td><td>Study examines differences in feeding and care between low-birthweight and normal-weight newborns. It is no clear from the article whether the cord care practices mentioned were specific to low-birthweight babies.</td><td>Fomentation with dry heat, application of white powder, and bandaging to prevent infection.</td></tr><tr><td>Alam [<xref ref-type="bibr" rid="CR54">54</xref>]</td><td>J Perinatol. 2008</td><td>Bangladesh</td><td>An assessment of umbilical and skin care knowledge and practices for neonates in Sylhet District, Bangladesh. A boiled or new blade was used in over half the births (64%). Half of the families applied a substance to the cord.</td><td>Turmeric (83%), boric powder (53%), mustard oil, ash, Dettol, coconut oil, Nebanol ointment, ginger, chewed rice. Also practiced shek dewa (heat treatment of cord). Respondents did not indicate any concern about having clean hands or using a clean cloth during shek dewa.</td></tr><tr><td>Alhaji [<xref ref-type="bibr" rid="CR37">37</xref>]</td><td>Niger Med J. 2013</td><td>Nigeria</td><td>Review of neonatal tetanus cases at Maiduguri Teaching Hospital.</td><td>Hot fomentation, charcoal, mixed, toothpaste, other.</td></tr><tr><td>Alparslan [<xref ref-type="bibr" rid="CR13">13</xref>]</td><td>Jpn J Nurs Sci. 2013</td><td>Turkey</td><td>A study to identify traditional neonatal care practices applied by women ages 15 to 49. Cord cutting and tying practices were not discussed. Mothers reported putting something on the cord to make it separate faster, tying the belly with a rope, and also putting a buttered cloth over the infant’s infected belly.</td><td>This study reports on previous studies from Turkey which identified the following substances placed on the umbilical cord: dry coffee, olive oil, rotten tree powder, myrtle, sugared fat, hellebore, black sesame, and burnt cloth. This study did not inquire about specific substances, but did report that 10.3% of the women put a substance on the cord, 7.2% tied the belly with a rope, and 1.5% put a buttered cloth over the infant’s infected belly.</td></tr><tr><td>Amare [<xref ref-type="bibr" rid="CR14">14</xref>]</td><td>BMC Int Health Hum Rights. 2014</td><td>Ethiopia</td><td>Investigation of practices and perspectives related to umbilical care in Ethiopia. A new razor blade which is sometimes boiled (22/24 mothers), cord tie varies (sewing thread, thread from kerosene stove, sisal, blanket strips, etc.). Cord is usually cut before delivery of placenta. Application of substance in most cases. Those who did not apply substance were either advised by health workers or said it was not customary (5/24 mothers).</td><td>Butter, petroleum jelly, hair lotion (Oromia).<break></break>Butter or nothing (Amhara).<break></break>Butter (Tigray).<break></break>Petroleum jelly, hair lotion, or nothing (Sidama).<break></break>Iodine or Gentian violet (applied by health extension workers in Oromia and Tigray). One health extension worker in Sidama advised application of tetracycline.</td></tr><tr><td>Ayaz [<xref ref-type="bibr" rid="CR55">55</xref>]</td><td>PLoS One. 2010</td><td>Pakistan</td><td>A study to understand newborn care practices in a squatter settlement of Karachi, Pakistan. For home births, clean instruments were used to cut the cord in 53.2% of births, 0.4% reported unclean instruments (unclean blade, etc.), and 46.4% did not know. It is assumed that clean instruments were used for facility births. Substances were put on the cord in 57.7% of births regardless of place of birth.</td><td>Ointment (33%), ghee (27%), coconut oil (19%), mustard oil (9.5%). Some also applied surma (locally made kohl), clove oil, turmeric, and talcum powder.</td></tr><tr><td>Byaruhanga [<xref ref-type="bibr" rid="CR7">7</xref>]</td><td>Midwifery. 2011</td><td>Uganda</td><td>A study to explore acceptability and feasibility of newborn care practices at the household and family level in rural Uganda. Dry cord care was stated as difficult to follow.</td><td>Herbs, onions, ash from burnt papyrus, petroleum jelly, powder, saliva, ghee, soot mixed with ghee, surgical spirit, water, butter.</td></tr><tr><td>Callaghan-Koru [<xref ref-type="bibr" rid="CR56">56</xref>]</td><td>BMC Pediatr. 2013</td><td>Ethiopia</td><td>A study describing newborn care practices reported by recently-delivered women in four regions of Ethiopia. New string was used to tie cord in 46% of births, but fiber from the false banana (<italic>ensete</italic>) plant was also common. New razor or blade was used in home births to cut the cord 88% of the time and scissors were most commonly used in facilities. Women delivering at home applied a substance 27% of the time. While women who delivered in facilities stated that no substance was applied 47% of the time, 43% did not know if a substance had been applied.</td><td>Most commonly applied substance was butter. Other substances were applied, but not identified.</td></tr><tr><td>Darmstadt [<xref ref-type="bibr" rid="CR31">31</xref>]</td><td>Trop Med Int Health. 2007</td><td>Egypt</td><td>Survey of home care practices during the first week of life in three rural Egyptian Governorates. Handwashing is not routine. Three-quarters of infants had a substance applied to their umbilical cords. Cord stump was also frequently covered by diaper.</td><td>Antiseptic (alcohol was used in 80% of antiseptic applications). Kohl (9%) was also used. Kohl contains lead.</td></tr><tr><td>Degefie [<xref ref-type="bibr" rid="CR16">16</xref>]</td><td>BMC Int Health Hum Rights. 2014</td><td>Ethiopia</td><td>A study on the beliefs and practices related to immediate newborn and postnatal care in four rural communities in Ethiopia. Cord is typically cut with a new blade. Grandmothers and TBAs rub cord before cutting to prevent blood seeping out (not all wear gloves or wash hands before receiving baby). Cord usually tied with thread. Applications to the cord differ by region.</td><td>Ointment (Sidama) or butter (East Shewa).</td></tr><tr><td>Dhingra [<xref ref-type="bibr" rid="CR24">24</xref>]</td><td>BMC Pregnancy Childbirth. 2014</td><td>Tanzania</td><td>An exploration of attitudes, beliefs, and practices related to delivery and newborn care in Pemba, Tanzania. The cord is cut soon after delivery. Clean cutting instrument appeared to be commonly understood among all participants (TBAs generally boil items in water). Cord tied with normal tailoring thread, but a few used special thread provided by the hospital. Cord is usually covered with a cloth to protect it from dust, flies, and mosquitos (and cord and surrounding area of male babies are also covered to prevent cord from falling on genitals). While the practice of dry cord care had reached all levels of society, substances were sometimes applied.</td><td>Saliva (<italic>mate</italic>), dirty door powder from old door (<italic>ganda la popoo</italic>), hot knife, charcoal powder, shells (<italic>gamba la koa</italic>), PPF powder, burning wood (<italic>kijinga</italic>), banana steam [sic] (<italic>tojo</italic>), fish bone. Substances were also applied AFTER cord fell off.<break></break>Upon recognition of danger signs: hot knife, door dust, charcoal powder, sandalwood powder, ground sea shell, PPF or talcum powder, and fire steam.</td></tr><tr><td>Falle [<xref ref-type="bibr" rid="CR57">57</xref>]</td><td>J Health Popul Nutr. 2009</td><td>Nepal</td><td>A study of the practices of traditional birth attendants working in Maithili-speaking (Madeshi) and Nepali-speaking (Pahadi) communities. About 27% of the TBAs reported applying a substance to the cord. New blade was used to cut cord in 89% of deliveries. Remaining 11% were cut with scissors (not clear if they were boiled or sterilized).</td><td>Mustard oil (64%), saliva (16%), antiseptics (12%).</td></tr><tr><td>Geçkil [<xref ref-type="bibr" rid="CR25">25</xref>]</td><td>Midwifery. 2009</td><td>Turkey</td><td>A study of traditional cord care practices in southeastern Turkey. Practices included application of a substance, keeping the cord in a special place after it separated, and then discarding it in a place that would create significant meaning for the infant’s future.</td><td>Olive oil (37.7%), coffee, tar (15%).</td></tr><tr><td>Ghosh [<xref ref-type="bibr" rid="CR58">58</xref>]</td><td>J Biosoc Sci. 2010</td><td>India</td><td>A study of antenatal, delivery, and postnatal practices of women in India who had experienced a neonatal death compared to current living children and also compared to women who had not experienced a neonatal death. Study showed better care practices for living children. Use of sterilized instrument for cutting cord was high across all groups (75% to 85%). Eight-six percent of the deceased infants had herbal paste or mustard oil applied to their umbilical cords (compared to 64% in the group of women with no neonatal deaths).</td><td>Herbal paste, mustard oil, other, antiseptic.</td></tr><tr><td>Gilani [<xref ref-type="bibr" rid="CR59">59</xref>]</td><td>Rural Remote Health. 2014</td><td>Pakistan</td><td>A study to understand practices of mothers in regard to seeking healthcare for neonates in rural and urban settings of the capital district of Azad Jammu and Kashmir, Pakistan. The use of sterilized string to tie the cord was more common in urban areas vs. rural areas (44% vs. 27%). Use of a sterilized or boiled cutting tool was slightly more common in urban areas. Rural place of residence had a statistically significant association with use of unsterilized cutting and tying.</td><td>Not stated.</td></tr><tr><td>Grant [<xref ref-type="bibr" rid="CR60">60</xref>]</td><td>Paediatr Child Health. 2014</td><td>Uganda</td><td>Article describes verbal autopsy procedure to determine probably causes of 72 neonatal deaths (30% occurred in first week of life) in Uganda. Sepsis due to infected umbilical cord was identified as the probable cause in 42% of deaths (highest of all identified causes).</td><td>Herbs, powder of papyrus reeds, soot from cooking pot, and saliva.</td></tr><tr><td>Gul [<xref ref-type="bibr" rid="CR34">34</xref>]</td><td>Int J Health Sci (Qassim). 2014</td><td>Pakistan</td><td>A study to understand newborn care knowledge and practices among mothers in urban Pakistan. In 60% of home deliveries a new razor was used to cut the cord and 10% recalled the use of a household knife. Seventy-four percent (74%) or respondents applied a substance to the cord.</td><td>Coconut oil, mustard oil, ghee, olive oil, surma/kohl, turmeric, machine oil</td></tr><tr><td>Herlihy [<xref ref-type="bibr" rid="CR8">8</xref>]</td><td>PLoS One. 2013</td><td>Zambia</td><td>A study to understand local perceptions of cord health and illness and the beliefs that shape cord care knowledge and practices. The cord was most frequently tied with white or black cotton knitting wool (home) or clamps (facility). In an emergency, women would use part of their <italic>chitenge</italic> (traditional fabric wrap). Traditional practice no longer used is the tying of the cord with <italic>loozi</italic> (fiber from the bark of a tree).<break></break>A razor blade was the tool of choice for cutting the cord at home or scissors in a clinic. Despite the HIV epidemic, traditional healers and TBAs rarely sterilized tools, but CHWs and midwifes reported some type of disinfection (boiling or alcohol).</td><td>Different substances had different purposes. If cord is too brittle, cracking, bleeding, then a substance that increases softness (Vaseline®, cooking or motor oil, <italic>mabono</italic> (wild fruit) oil, or cream from sour milk). While warmed cooking or motor oil were rare, they were sometimes used as a base for other ingredients (charcoal, herbs).<break></break>If cord takes too long to separate, items to dry it include: baby powder, charcoal dust, dried cow dung, dried chicken droppings, dust from threshold of home, ash from burnt pumpkin stem, crushed <italic>loma</italic> (wasps nest), or mud. Any of these would be pounded or ground into a fine powder.<break></break>Medicinal substances: breast milk, python snake oil, banana, cow dung, <italic>mukunku</italic> (tree bark), traditional herbs, and dirt from pounding stick.</td></tr><tr><td>Hill [<xref ref-type="bibr" rid="CR15">15</xref>]</td><td>Pediatr Infect Dis J. 2010</td><td>Ghana</td><td>A study exploring delivery practices in Ghana. The cord is generally cut with new razor blade (98%) and tied with new thread (90%), but dry cord care (the standard) was only practiced 8% of the time.</td><td>Hospital medicine (spirit) (31%), shea butter (47%), herbs (5%), other (16%). Also common to drip hot water on stump or apply a hot damp towel.</td></tr><tr><td>Jennings [<xref ref-type="bibr" rid="CR61">61</xref>]</td><td>Matern Child Health J. 2015</td><td>Benin</td><td>A study focused on use of job aids to improve facility based postnatal counseling. The only discussion regarding cord care was in regard to substances applied.</td><td>Traditional substances include clay, ash, salt/spices, ground almonds.</td></tr><tr><td>Karas [<xref ref-type="bibr" rid="CR62">62</xref>]</td><td>J Trop Pediatr. 2012</td><td>Nepal</td><td>An analysis of newborn care practices as part of a community-based trial investigating clean birthing kits. Although 97.7% of participants used the new razor blade with the kit, authors note that this is not customary practice. 95% waited until placenta was delivered to cut cord. Substance was applied to 18.8% of cords.</td><td>Mustard oil, antiseptic, ash, mud, other (other oil, breast milk, herbs/spices, saliva, and other substances).</td></tr><tr><td>Kayom [<xref ref-type="bibr" rid="CR9">9</xref>]</td><td>Int J Pediatr. 2015</td><td>Uganda</td><td>A study to investigate newborn care practices in urban Uganda. Almost 70% of mothers had received teachings on cord care, but only 45% of those were from health professionals. Majority (89.6%) cleaned the cord twice a day. About 58% of the mothers in the study applied a substance to the cord.</td><td>Salty water, powder, Vaseline, spirit, normal saline, ripe banana (<italic>gonja</italic>), sap, soot, ash, saliva, herbs.</td></tr><tr><td>Kesterton [<xref ref-type="bibr" rid="CR63">63</xref>]</td><td>BMC Pregnancy Childbirth. 2009</td><td>India</td><td>A study to understand local practices in rural Karnataka, India to improve implementation of essential newborn care practices. A sickle was used in about 1/3 of home births and a used blade in a majority of others. A substance is applied to the cord in some cases.</td><td>Turmeric, burning tip with castor oil lamp, antiseptic ointment.</td></tr><tr><td>Khadduri [<xref ref-type="bibr" rid="CR33">33</xref>]</td><td>J Perinatol. 2008</td><td>Pakistan</td><td>A study to learn about maternal and newborn health knowledge and practices in rural Pakistan. A used blade, knife, or scissors was used often. The TBAs claimed to have washed the implements, but the mothers and father asserted that their TBAs had not washed the cutting instrument. Substances are applied to the cord using an uncleaned chicken feather either from the ground or freshly plucked.</td><td>Ghee and sometimes a paste of ghee with fried onions or mustard oil.</td></tr><tr><td>Khan [<xref ref-type="bibr" rid="CR10">10</xref>]</td><td>J Neonatal Perinatal Med. 2013</td><td>Pakistan</td><td>A study to explore traditional newborn care beliefs and practices in Gilgit, Pakistan. The cord was cut with scissors (most common), blade (28%), or knife (5%). The cord was tied with available thread (55%) or a cord clamp (43.6%). The majority of households (77%) applied a substance to the cord.</td><td><italic>Matti</italic> (crushed apricot seeds), cold cream, ghee, <italic>haldi</italic> (turmeric), mustard seed oil, Dettol, powder/wheat flour, antimony.</td></tr><tr><td>Kumar [<xref ref-type="bibr" rid="CR64">64</xref>]</td><td>Lancet. 2008</td><td>India</td><td>Study conducted as part of a three-arm cluster randomized trial (control, newborn care package, and newborn care package + thermospot). Evaluated tying cord within 1/2 h of birth, cutting cord within 1/2 h of birth, cutting cord with clean blade, re-tying cord, application of substance on the cord and on the body.</td><td>Ash or clay on cord (60.9% of control group, 38% of ENC group, and 36.1% of ENC + TS group).</td></tr><tr><td>Madhu [<xref ref-type="bibr" rid="CR32">32</xref>]</td><td>Indian J Community Med. 2009</td><td>India</td><td>A study to describe breastfeeding and other newborn care practices in rural Bangalore, India. In the small number of home deliveries (10% of total), a household knife was used to cut the cord in half (5 deliveries). Thirty-three percent of total births had something applied to the cord (regardless of place of birth).</td><td>Talcum powder or turmeric.</td></tr><tr><td>Mangwi Ayiasi [<xref ref-type="bibr" rid="CR65">65</xref>]</td><td>PLoS One. 2016</td><td>Uganda</td><td>Study compared the effect of village health team (community health workers) visits and mobile phone consultations on maternal and newborn care practices. In the intervention group 60% of women used clean cord care practices while only 30% in the control group.</td><td>Baby powder was the most prevalent substance applied to the cord, followed by soot powder, herbal medicines, and animal dung.</td></tr><tr><td>Memon [<xref ref-type="bibr" rid="CR66">66</xref>]</td><td>J Neonatal Perinatal Med. 2013</td><td>Pakistan</td><td>A study to assess knowledge, attitudes, and practices of women of reproductive age in rural Pakistan. Sixty-nine percent of participants applied a substance to the umbilical cord.</td><td>Mustard oil (54.4%), antimony (20.5%), and clarified butter (1.8%).</td></tr><tr><td>Moran [<xref ref-type="bibr" rid="CR16">16</xref>]</td><td>BMC Pregnancy Childbirth. 2009</td><td>Bangladesh</td><td>A study to describe newborn care practices in the urban slums in Dhaka, Bangladesh. The cord is usually cut with a new or boiled blade. Thread used to tie the cord was generally not sterile. After cutting cord women reported cleaning the stump and surrounding areas (with wet cloth and soap or antiseptic liquid) and then applying heat and/or a substance to the cord.</td><td>Mustard oil, mustard with chopped, smashed garlic, coconut oil, boric powder, talcum powder, Savlon, <italic>chular mati</italic> (earth from a clay oven), homeopathic medicine. Also practiced <italic>shek dewa</italic> (heat treatment).</td></tr><tr><td>Moyer [<xref ref-type="bibr" rid="CR21">21</xref>]</td><td>BMC Pregnancy Childbirth. 2012</td><td>Ghana</td><td>A study exploring clean birth practices and immediate newborn care in Ghana. The cord is typically cut with scissors or razor blade. Unprompted, women described the importance of sterilizing the tool. Cord was tied with rags, twigs, linen, string, rope, or plastic clamp. Substance were applied by 70% of women in the sample despite advice from providers to apply nothing.</td><td>Shea butter, ground shea nuts, local herbs, local oil, or “red earth sand”. Another person described application of juice from <italic>pou</italic> plant, spirits. Healthcare provider described practices no longer in use of using cow dung.</td></tr><tr><td>Mrisho [<xref ref-type="bibr" rid="CR23">23</xref>]</td><td>Trans R Soc Trop Med Hyg. 2008</td><td>Tanzania</td><td>A study to understand childbirth and neonatal care practices. The cord usually cut with razor blade and tied with thread (or sometimes cut with millet stem). Razors generally not new. Substance applied to cord.</td><td>Traditional herbs + cooking oil or water that has been used to wash an adult woman’s genitals (<italic>numbati</italic>). Other substances include ash, breast milk, fluid from pumpkin flowers, and powder ground from local tree.</td></tr><tr><td>Mullany [<xref ref-type="bibr" rid="CR67">67</xref>]</td><td>Am J Epidemiol. 2007</td><td>Nepal</td><td>An analysis of data on potential risk factors for omphalitis as part of a community-based, umbilical cord care trial. Substances were applied to the cord during the newborn period. Sometimes multiple substances were applied.</td><td>Mustard oil (80.4%), ash (7.1%), mud (6.8%), other substances (5.5%), non-study antiseptics (15.4%).</td></tr><tr><td>Mullany [<xref ref-type="bibr" rid="CR26">26</xref>]</td><td>Pediatr Infect Dis J. 2009</td><td>Tanzania</td><td>Part of a larger clinical trial evaluating a suite of antenatal regimens and use of clean delivery kit in Tanzania. The cord was cut with items from a clean delivery kit. The study looked at two different definitions of cord infection (a broad definition and restrictive definition). Substances were applied to the cords in 10% of cases (home births only).</td><td>Dust, spirits/antibiotics, baby powder, charcoal, saliva, bark, vegetable oil, and dried roots; most common application was saliva.</td></tr><tr><td>Raza [<xref ref-type="bibr" rid="CR36">36</xref>]</td><td>J Postgrad Med. 2004</td><td>Pakistan</td><td>Matched case control study of 125 cases of neonatal tetanus reported by 2 hospitals in Karachi between January 1998 and February 2001. There were 125 cases and 250 controls. Each case had two controls matched on gender, area of residency, time of birth within 2 months of case birth, and survived neonatal period and mothers had no history of tetanus toxoid immunization.</td><td>Mustard oil, ghee, surma (contains antimony and lead).</td></tr><tr><td>Sacks [<xref ref-type="bibr" rid="CR18">18</xref>]</td><td>BMC Pregnancy Childbirth. 2015</td><td>Zambia</td><td>A study to understand local practices during the postnatal period. TBAs reported that they try to buy a new blade, but if there is no time to prepare then they use an old blade. Substances applied to the stump vary by whether child is classified (at birth) as “sick” or “healthy”. If there are blood clots in the umbilical cord, a sign of abnormality and future illness, the child is taken to a healer who treats the stump with herbs or the child is taken to a hospital. Until the cord separates, mother is expected to apply a wrap around the infant’s waist so that the cord does not touch the genitals (will make them infertile as an adult) and the cord is not supposed to fall on to the floor. Once the cord separates, the baby is bathed in cold water to make them strong.</td><td>Breast milk dripped onto cord.<break></break>Full-term healthy babies: black powder (made from burn stem of pumpkin).<break></break>Pre-term babies: green powder (ground dried roots of <italic>mweeye</italic> plant). This is considered gentler for preterm babies.<break></break>If the appropriate herbs cannot be found then brick ash is used.<break></break>Less common: after the cord falls off, fresh dried chicken dung is mashed and put onto the wound (rooster for male babies, hen for female babies). Participants explained that this tradition originated in Zimbabwe.</td></tr><tr><td>Shamba [<xref ref-type="bibr" rid="CR19">19</xref>]</td><td>J Health Popul Nutr. 2013</td><td>Tanzania</td><td>A study to explore childbirth-related hygiene and newborn care practices in community deliveries in southern Tanzania. New blades were used in almost all instance, but new cord ties were rarely used. Substance was applied to cord by many mothers.</td><td>Breast milk, talcum powder, oil, petroleum jelly, ash, and dirt.</td></tr><tr><td>Sharkey [<xref ref-type="bibr" rid="CR11">11</xref>]</td><td>Health Policy Plan. 2016</td><td>Sierra Leone</td><td>A study to understand maternal and neonatal care practices in four rural districts of Sierra Leone.</td><td>Pounded cassava.</td></tr><tr><td>Sharma [<xref ref-type="bibr" rid="CR28">28</xref>]</td><td>BMC Pregnancy Childbirth. 2016</td><td>Nepal</td><td>A study to understand beliefs around childbirth and postnatal card in rural Nepal, particularly focusing on beliefs related to women being polluted following childbirth. A hasiya (scythe), a sickle, or a razor blade may be used to cut the umbilical cord and then a substance may be applied.</td><td>Antiseptic, cooking oil, ghee, plain water, toothpaste, and ash.</td></tr><tr><td>Sreeramareddy [<xref ref-type="bibr" rid="CR68">68</xref>]</td><td>BMC Pregnancy Childbirth. 2006</td><td>Nepal</td><td>A study to understand reasons for delivering at home and about newborn care practices in urban areas of Nepal. The umbilical cord cut after delivery of placenta in 64.2% of cases, cut with new/boiled blade in 90.4% of cases (sickle, old knife, unboiled blade in 7.1%), no substance applied in 73.8% of cases. Newborn wrapped in old, washed cloth in 73.8% of cases.</td><td>Mustard oil (19.6%), oil + turmeric (2.1%), antiseptic (0.8%), unknown (9.6%), nothing applied (67.9%).</td></tr><tr><td>Upadhyay [<xref ref-type="bibr" rid="CR29">29</xref>]</td><td>Acta Paediatr. 2012</td><td>India</td><td>A study to document neonatal care practices in the home and their associate with birth-attendant type. The cord was cut immediately after birth (50.6%) and cut after delivery after placenta in 29.6% (cutting immediately after birth was more common in skilled birth attendant deliveries). Clean instrument used in 70% and sterile tie used in 90%. Cord stump left dry in only 26.7%.</td><td>Antibiotic powder (46.4%), oil/ghee (42.8%).</td></tr><tr><td>Waiswa [<xref ref-type="bibr" rid="CR20">20</xref>]</td><td>BMC Pregnancy Childbirth. 2008</td><td>Uganda</td><td>A study to explore the acceptability of evidence-based interventions to reduce maternal and newborn mortality in two rural districts in Uganda. Cord is usually cut with a new razor blade. Substances are applied.</td><td>Baby powder, spirit, herbs, soapy water, salty water.</td></tr><tr><td>Waiswa [<xref ref-type="bibr" rid="CR69">69</xref>]</td><td>BMC Pregnancy Childbirth. 2010</td><td>Uganda</td><td>A study to explore the socioeconomic differences in the use of newborn care practices in Uganda. Most cords were cut with a clean razor blade and cords were tied with clean thread in the majority of cases. Half the mothers applied a substance to the cord.</td><td>Powder, surgical spirit, salty water, lizard droppings, ash, medicinal drugs.</td></tr><tr><td>Walsh [<xref ref-type="bibr" rid="CR22">22</xref>]</td><td>Glob Public Health. 2015</td><td>Haiti</td><td>An exploration of current cord care practices in Petit-Goâve, Haiti. The cord needs to be covered by a cloth or substance to protect against evil spirits.</td><td>Burnt nutmeg, dirt from threshold of home, crushed charcoal, ash, burned cotton, palm oil, mixture of leaves and animal dung.</td></tr><tr><td>Winch [<xref ref-type="bibr" rid="CR27">27</xref>]</td><td>Lancet. 2005</td><td>Bangladesh</td><td>A study to describe the beliefs surrounding the neonatal period in Sylhet District, Bangladesh. The cord is usually cut with a blade and then tied with a white thread, and then a substance is applied.</td><td>Chewed turmeric, chewed ginger, mustard oil with garlic, ash. <italic>Shek dewa</italic> (heat treatment) is also practiced.</td></tr></tbody></table><table-wrap-foot><p><italic>Abbreviation</italic></p><p><italic>TBA</italic> traditional birth attendant</p></table-wrap-foot></table-wrap></p><p>Table <xref rid="Tab3" ref-type="table">3</xref> illustrates the types of substances applied to the cord by country. The substance applied may depend upon the perceived nature of the cord. A moisturizing substance is applied if the cord is too brittle and a drying substance is applied if the cord takes too long to separate. For example, in southern Zambia, petroleum jelly or <italic>mabono</italic> (wild fruit) oil might be used if the cord is cracking or bleeding, while charcoal dust, baby powder, or burnt pumpkin stem may be used if the cord takes too long to separate [<xref ref-type="bibr" rid="CR8">8</xref>]. In areas of Tanzania, Uganda, and Zambia [<xref ref-type="bibr" rid="CR7">7</xref>, <xref ref-type="bibr" rid="CR8">8</xref>, <xref ref-type="bibr" rid="CR18">18</xref>, <xref ref-type="bibr" rid="CR20">20</xref>, <xref ref-type="bibr" rid="CR23">23</xref>], the infant cannot leave the home until the cord separates and/or the mother cannot return to her chores until that time. In the Tonkolili district of Sierra Leone, a traditional birth attendant noted the purpose of applying pounded cassava to the cord: “It will help the umbilical recover easily and the child will walk fast” [<xref ref-type="bibr" rid="CR11">11</xref>].<table-wrap id="Tab3"><label>Table 3</label><caption><p>Substances used, by category</p></caption><table frame="hsides" rules="groups"><thead><tr><th>Category</th><th>Substances</th><th>Country/Countries</th></tr></thead><tbody><tr><td rowspan="13">Oils</td><td>Clove oil [<xref ref-type="bibr" rid="CR55">55</xref>]</td><td>Pakistan</td></tr><tr><td>Coconut oil [<xref ref-type="bibr" rid="CR17">17</xref>, <xref ref-type="bibr" rid="CR34">34</xref>, <xref ref-type="bibr" rid="CR54">54</xref>, <xref ref-type="bibr" rid="CR55">55</xref>]</td><td>Bangladesh, Pakistan</td></tr><tr><td>Cooking oil (sometimes recycled) [<xref ref-type="bibr" rid="CR8">8</xref>, <xref ref-type="bibr" rid="CR23">23</xref>, <xref ref-type="bibr" rid="CR28">28</xref>]</td><td>Nepal, Tanzania, Zambia</td></tr><tr><td><italic>Mabono</italic> (wild fruit) oil [<xref ref-type="bibr" rid="CR8">8</xref>]</td><td>Zambia</td></tr><tr><td>Machine/motor oil [<xref ref-type="bibr" rid="CR8">8</xref>, <xref ref-type="bibr" rid="CR34">34</xref>]</td><td>Pakistan, Zambia</td></tr><tr><td>Mustard oil [<xref ref-type="bibr" rid="CR10">10</xref>, <xref ref-type="bibr" rid="CR17">17</xref>, <xref ref-type="bibr" rid="CR34">34</xref>, <xref ref-type="bibr" rid="CR36">36</xref>, <xref ref-type="bibr" rid="CR54">54</xref>, <xref ref-type="bibr" rid="CR55">55</xref>, <xref ref-type="bibr" rid="CR57">57</xref>, <xref ref-type="bibr" rid="CR58">58</xref>, <xref ref-type="bibr" rid="CR62">62</xref>, <xref ref-type="bibr" rid="CR66">66</xref>–<xref ref-type="bibr" rid="CR68">68</xref>]</td><td>Bangladesh, India, Nepal, Pakistan</td></tr><tr><td>Mustard oil with garlic [<xref ref-type="bibr" rid="CR27">27</xref>]</td><td>Bangladesh</td></tr><tr><td>Oil (unspecified) [<xref ref-type="bibr" rid="CR19">19</xref>, <xref ref-type="bibr" rid="CR21">21</xref>, <xref ref-type="bibr" rid="CR29">29</xref>, <xref ref-type="bibr" rid="CR62">62</xref>]</td><td>Ghana, India, Nepal, Tanzania</td></tr><tr><td>Oil with turmeric [<xref ref-type="bibr" rid="CR68">68</xref>]</td><td>Nepal</td></tr><tr><td>Olive oil [<xref ref-type="bibr" rid="CR13">13</xref>, <xref ref-type="bibr" rid="CR25">25</xref>, <xref ref-type="bibr" rid="CR34">34</xref>]</td><td>Pakistan, Turkey</td></tr><tr><td>Palm oil [<xref ref-type="bibr" rid="CR12">12</xref>, <xref ref-type="bibr" rid="CR22">22</xref>]</td><td>Haiti, Nigeria</td></tr><tr><td>Python oil [<xref ref-type="bibr" rid="CR8">8</xref>]</td><td>Zambia</td></tr><tr><td>Vegetable oil [<xref ref-type="bibr" rid="CR26">26</xref>]</td><td>Tanzania</td></tr><tr><td rowspan="17">Herbs/spices/plants</td><td>Banana stem [<xref ref-type="bibr" rid="CR24">24</xref>]</td><td>Tanzania</td></tr><tr><td>Black sesame [<xref ref-type="bibr" rid="CR13">13</xref>]</td><td>Turkey</td></tr><tr><td>Burnt nutmeg [<xref ref-type="bibr" rid="CR22">22</xref>]</td><td>Haiti</td></tr><tr><td>Cassava [<xref ref-type="bibr" rid="CR11">11</xref>]</td><td>Sierra Leone</td></tr><tr><td>Dried roots [<xref ref-type="bibr" rid="CR26">26</xref>]</td><td>Tanzania</td></tr><tr><td>Ginger/chewed ginger [<xref ref-type="bibr" rid="CR27">27</xref>, <xref ref-type="bibr" rid="CR54">54</xref>]</td><td>Bangladesh</td></tr><tr><td>Hellebore [<xref ref-type="bibr" rid="CR13">13</xref>]</td><td>Turkey</td></tr><tr><td>Herbs (unspecified) [<xref ref-type="bibr" rid="CR7">7</xref>–<xref ref-type="bibr" rid="CR9">9</xref>, <xref ref-type="bibr" rid="CR12">12</xref>, <xref ref-type="bibr" rid="CR15">15</xref>, <xref ref-type="bibr" rid="CR20">20</xref>, <xref ref-type="bibr" rid="CR21">21</xref>, <xref ref-type="bibr" rid="CR23">23</xref>, <xref ref-type="bibr" rid="CR58">58</xref>, <xref ref-type="bibr" rid="CR60">60</xref>, <xref ref-type="bibr" rid="CR62">62</xref>]</td><td>Ghana, India, Nepal, Nigeria, Tanzania, Uganda, Zambia</td></tr><tr><td><italic>Kijinga</italic> (burning wood) [<xref ref-type="bibr" rid="CR24">24</xref>]</td><td>Tanzania</td></tr><tr><td><italic>Mukunku</italic> (bark of a tree) [<xref ref-type="bibr" rid="CR8">8</xref>]</td><td>Zambia</td></tr><tr><td>Mustard with chopped, smashed garlic [<xref ref-type="bibr" rid="CR17">17</xref>]</td><td>Bangladesh</td></tr><tr><td>Myrtle [<xref ref-type="bibr" rid="CR13">13</xref>]</td><td>Turkey</td></tr><tr><td><italic>Pou</italic> plant (juice) [<xref ref-type="bibr" rid="CR21">21</xref>]</td><td>Ghana</td></tr><tr><td>Pumpkin flowers (fluid) [<xref ref-type="bibr" rid="CR23">23</xref>]</td><td>Tanzania</td></tr><tr><td>Sap [<xref ref-type="bibr" rid="CR9">9</xref>]</td><td>Uganda</td></tr><tr><td>Spices (unspecified) [<xref ref-type="bibr" rid="CR61">61</xref>, <xref ref-type="bibr" rid="CR62">62</xref>]</td><td>Benin, Nepal</td></tr><tr><td>Turmeric/chewed turmeric [<xref ref-type="bibr" rid="CR10">10</xref>, <xref ref-type="bibr" rid="CR27">27</xref>, <xref ref-type="bibr" rid="CR32">32</xref>, <xref ref-type="bibr" rid="CR34">34</xref>, <xref ref-type="bibr" rid="CR54">54</xref>, <xref ref-type="bibr" rid="CR55">55</xref>, <xref ref-type="bibr" rid="CR63">63</xref>]</td><td>Bangladesh, India, Pakistan</td></tr><tr><td rowspan="28">Minerals/powders</td><td>Antimony [<xref ref-type="bibr" rid="CR10">10</xref>, <xref ref-type="bibr" rid="CR66">66</xref>]</td><td>Pakistan</td></tr><tr><td>Ash [<xref ref-type="bibr" rid="CR9">9</xref>, <xref ref-type="bibr" rid="CR19">19</xref>, <xref ref-type="bibr" rid="CR22">22</xref>, <xref ref-type="bibr" rid="CR23">23</xref>, <xref ref-type="bibr" rid="CR27">27</xref>, <xref ref-type="bibr" rid="CR28">28</xref>, <xref ref-type="bibr" rid="CR54">54</xref>, <xref ref-type="bibr" rid="CR61">61</xref>, <xref ref-type="bibr" rid="CR62">62</xref>, <xref ref-type="bibr" rid="CR64">64</xref>, <xref ref-type="bibr" rid="CR67">67</xref>, <xref ref-type="bibr" rid="CR69">69</xref>]</td><td>Bangladesh, Benin, Haiti, India, Nepal, Tanzania, Uganda</td></tr><tr><td>Ash from burnt papyrus [<xref ref-type="bibr" rid="CR7">7</xref>]</td><td>Uganda</td></tr><tr><td>Bark [<xref ref-type="bibr" rid="CR26">26</xref>]</td><td>Tanzania</td></tr><tr><td>Black powder (burnt pumpkin stem) [<xref ref-type="bibr" rid="CR8">8</xref>, <xref ref-type="bibr" rid="CR18">18</xref>]</td><td>Zambia</td></tr><tr><td>Boric powder [<xref ref-type="bibr" rid="CR17">17</xref>, <xref ref-type="bibr" rid="CR54">54</xref>]</td><td>Bangladesh</td></tr><tr><td>Brick ash [<xref ref-type="bibr" rid="CR18">18</xref>]</td><td>Zambia</td></tr><tr><td>Chalk [<xref ref-type="bibr" rid="CR12">12</xref>]</td><td>Nigeria</td></tr><tr><td>Charcoal [<xref ref-type="bibr" rid="CR8">8</xref>, <xref ref-type="bibr" rid="CR22">22</xref>, <xref ref-type="bibr" rid="CR24">24</xref>, <xref ref-type="bibr" rid="CR26">26</xref>, <xref ref-type="bibr" rid="CR37">37</xref>]</td><td>Haiti, Nigeria, Tanzania, Zambia</td></tr><tr><td><italic>Chular mati</italic> (earth from clay oven) [<xref ref-type="bibr" rid="CR17">17</xref>]</td><td>Bangladesh</td></tr><tr><td>Clay [<xref ref-type="bibr" rid="CR61">61</xref>, <xref ref-type="bibr" rid="CR64">64</xref>]</td><td>Benin, India</td></tr><tr><td>Dirt from pounding stick [<xref ref-type="bibr" rid="CR8">8</xref>]</td><td>Zambia</td></tr><tr><td>Dust/dust from threshold of home [<xref ref-type="bibr" rid="CR8">8</xref>, <xref ref-type="bibr" rid="CR22">22</xref>, <xref ref-type="bibr" rid="CR24">24</xref>, <xref ref-type="bibr" rid="CR26">26</xref>]</td><td>Haiti, Tanzania, Zambia</td></tr><tr><td><italic>Ganda la popoo</italic> (dirty door powder from old door) [<xref ref-type="bibr" rid="CR24">24</xref>]</td><td>Tanzania</td></tr><tr><td>Green powder (ground dried roots of <italic>mweeye</italic> plant) [<xref ref-type="bibr" rid="CR18">18</xref>]</td><td>Zambia</td></tr><tr><td>Ground sea shell [<xref ref-type="bibr" rid="CR24">24</xref>]</td><td>Tanzania</td></tr><tr><td>Mud [<xref ref-type="bibr" rid="CR8">8</xref>, <xref ref-type="bibr" rid="CR62">62</xref>, <xref ref-type="bibr" rid="CR67">67</xref>]</td><td>Nepal, Zambia</td></tr><tr><td>Powder (unspecified) [<xref ref-type="bibr" rid="CR7">7</xref>, <xref ref-type="bibr" rid="CR9">9</xref>, <xref ref-type="bibr" rid="CR10">10</xref>, <xref ref-type="bibr" rid="CR69">69</xref>]</td><td>Pakistan, Uganda</td></tr><tr><td>Powder from ground local tree [<xref ref-type="bibr" rid="CR23">23</xref>]</td><td>Tanzania</td></tr><tr><td>Powder of papyrus reeds [<xref ref-type="bibr" rid="CR60">60</xref>]</td><td>Uganda</td></tr><tr><td>PPF powder (pyriproxyfen pesticide) [<xref ref-type="bibr" rid="CR24">24</xref>]</td><td>Tanzania</td></tr><tr><td>Red earth sand [<xref ref-type="bibr" rid="CR21">21</xref>]</td><td>Ghana</td></tr><tr><td>Rotten tree powder [<xref ref-type="bibr" rid="CR13">13</xref>]</td><td>Turkey</td></tr><tr><td>Salt [<xref ref-type="bibr" rid="CR12">12</xref>, <xref ref-type="bibr" rid="CR61">61</xref>]</td><td>Benin, Nigeria</td></tr><tr><td>Sandalwood powder [<xref ref-type="bibr" rid="CR24">24</xref>]</td><td>Tanzania</td></tr><tr><td>Soil/dirt/sand [<xref ref-type="bibr" rid="CR12">12</xref>, <xref ref-type="bibr" rid="CR19">19</xref>]</td><td>Nigeria, Tanzania</td></tr><tr><td>Soot/soot from cooking pot [<xref ref-type="bibr" rid="CR9">9</xref>, <xref ref-type="bibr" rid="CR60">60</xref>, <xref ref-type="bibr" rid="CR65">65</xref>]</td><td>Uganda</td></tr><tr><td>White powder [<xref ref-type="bibr" rid="CR30">30</xref>]</td><td>Nigeria</td></tr><tr><td rowspan="5">Dung</td><td>Animal (unspecified) [<xref ref-type="bibr" rid="CR65">65</xref>]</td><td>Uganda</td></tr><tr><td>Animal (unspecified) mixed with leaves [<xref ref-type="bibr" rid="CR22">22</xref>]</td><td>Haiti</td></tr><tr><td>Chicken [<xref ref-type="bibr" rid="CR8">8</xref>, <xref ref-type="bibr" rid="CR18">18</xref>]</td><td>Zambia</td></tr><tr><td>Cow [<xref ref-type="bibr" rid="CR8">8</xref>]</td><td>Zambia</td></tr><tr><td>Lizard [<xref ref-type="bibr" rid="CR69">69</xref>]</td><td>Uganda</td></tr><tr><td rowspan="5">Water</td><td>Hot water [<xref ref-type="bibr" rid="CR15">15</xref>]</td><td>Ghana</td></tr><tr><td><italic>Numbati</italic> (water that has been used to wash an adult woman’s genitals) [<xref ref-type="bibr" rid="CR23">23</xref>]</td><td>Tanzania</td></tr><tr><td>Plain water [<xref ref-type="bibr" rid="CR7">7</xref>, <xref ref-type="bibr" rid="CR28">28</xref>]</td><td>Nepal, Uganda</td></tr><tr><td>Salty water [<xref ref-type="bibr" rid="CR9">9</xref>, <xref ref-type="bibr" rid="CR20">20</xref>, <xref ref-type="bibr" rid="CR69">69</xref>]</td><td>Uganda</td></tr><tr><td>Soapy water [<xref ref-type="bibr" rid="CR20">20</xref>]</td><td>Uganda</td></tr><tr><td rowspan="2">Bodily fluids</td><td>Breast milk [<xref ref-type="bibr" rid="CR8">8</xref>, <xref ref-type="bibr" rid="CR18">18</xref>, <xref ref-type="bibr" rid="CR19">19</xref>, <xref ref-type="bibr" rid="CR23">23</xref>, <xref ref-type="bibr" rid="CR62">62</xref>]</td><td>Nepal, Tanzania, Zambia</td></tr><tr><td>Saliva [<xref ref-type="bibr" rid="CR7">7</xref>, <xref ref-type="bibr" rid="CR9">9</xref>, <xref ref-type="bibr" rid="CR12">12</xref>, <xref ref-type="bibr" rid="CR24">24</xref>, <xref ref-type="bibr" rid="CR26">26</xref>, <xref ref-type="bibr" rid="CR57">57</xref>, <xref ref-type="bibr" rid="CR60">60</xref>, <xref ref-type="bibr" rid="CR62">62</xref>]</td><td>Nepal, Nigeria, Tanzania, Uganda</td></tr><tr><td rowspan="14">Food</td><td>Banana [<xref ref-type="bibr" rid="CR8">8</xref>, <xref ref-type="bibr" rid="CR9">9</xref>]</td><td>Uganda, Zambia</td></tr><tr><td>Butter [<xref ref-type="bibr" rid="CR7">7</xref>, <xref ref-type="bibr" rid="CR14">14</xref>, <xref ref-type="bibr" rid="CR16">16</xref>, <xref ref-type="bibr" rid="CR56">56</xref>]</td><td>Ethiopia, Uganda</td></tr><tr><td>Chewed rice [<xref ref-type="bibr" rid="CR54">54</xref>]</td><td>Bangladesh</td></tr><tr><td>Cream from sour milk [<xref ref-type="bibr" rid="CR8">8</xref>]</td><td>Zambia</td></tr><tr><td>Dry coffee [<xref ref-type="bibr" rid="CR13">13</xref>, <xref ref-type="bibr" rid="CR25">25</xref>]</td><td>Turkey</td></tr><tr><td>Fat and sugared fat [<xref ref-type="bibr" rid="CR13">13</xref>]</td><td>Turkey</td></tr><tr><td>Ghee [<xref ref-type="bibr" rid="CR7">7</xref>, <xref ref-type="bibr" rid="CR10">10</xref>, <xref ref-type="bibr" rid="CR28">28</xref>, <xref ref-type="bibr" rid="CR29">29</xref>, <xref ref-type="bibr" rid="CR33">33</xref>, <xref ref-type="bibr" rid="CR34">34</xref>, <xref ref-type="bibr" rid="CR36">36</xref>, <xref ref-type="bibr" rid="CR55">55</xref>, <xref ref-type="bibr" rid="CR66">66</xref>]</td><td>India, Nepal, Pakistan, Uganda</td></tr><tr><td>Ghee mixed with fried onions or mustard oil [<xref ref-type="bibr" rid="CR33">33</xref>]</td><td>Pakistan</td></tr><tr><td>Ghee mixed with soot [<xref ref-type="bibr" rid="CR7">7</xref>]</td><td>Uganda</td></tr><tr><td>Ground almonds [<xref ref-type="bibr" rid="CR61">61</xref>]</td><td>Benin</td></tr><tr><td>Ground shea nuts [<xref ref-type="bibr" rid="CR21">21</xref>]</td><td>Ghana</td></tr><tr><td><italic>Matti</italic> (crushed apricot seeds) [<xref ref-type="bibr" rid="CR10">10</xref>]</td><td>Pakistan</td></tr><tr><td>Onion [<xref ref-type="bibr" rid="CR7">7</xref>]</td><td>Uganda</td></tr><tr><td>Wheat flour [<xref ref-type="bibr" rid="CR10">10</xref>]</td><td>Pakistan</td></tr><tr><td rowspan="23">Personal care/medical</td><td>Alcohol [<xref ref-type="bibr" rid="CR31">31</xref>]</td><td>Egypt</td></tr><tr><td>Antibiotic powder [<xref ref-type="bibr" rid="CR29">29</xref>]</td><td>India</td></tr><tr><td>Antiseptic ointment [<xref ref-type="bibr" rid="CR63">63</xref>]</td><td>India</td></tr><tr><td>Antiseptics (unspecified) [<xref ref-type="bibr" rid="CR26">26</xref>, <xref ref-type="bibr" rid="CR28">28</xref>, <xref ref-type="bibr" rid="CR31">31</xref>, <xref ref-type="bibr" rid="CR57">57</xref>, <xref ref-type="bibr" rid="CR58">58</xref>, <xref ref-type="bibr" rid="CR62">62</xref>, <xref ref-type="bibr" rid="CR67">67</xref>, <xref ref-type="bibr" rid="CR68">68</xref>]</td><td>Egypt, India, Nepal, Tanzania</td></tr><tr><td>Baby powder/talcum powder [<xref ref-type="bibr" rid="CR8">8</xref>, <xref ref-type="bibr" rid="CR17">17</xref>, <xref ref-type="bibr" rid="CR19">19</xref>, <xref ref-type="bibr" rid="CR20">20</xref>, <xref ref-type="bibr" rid="CR24">24</xref>, <xref ref-type="bibr" rid="CR26">26</xref>, <xref ref-type="bibr" rid="CR32">32</xref>, <xref ref-type="bibr" rid="CR55">55</xref>, <xref ref-type="bibr" rid="CR65">65</xref>]</td><td>Bangladesh, India, Pakistan, Tanzania, Uganda, Zambia</td></tr><tr><td>Cold cream [10</td><td>Pakistan</td></tr><tr><td>Dettol [<xref ref-type="bibr" rid="CR10">10</xref>, <xref ref-type="bibr" rid="CR52">52</xref>]</td><td>Bangladesh, Pakistan</td></tr><tr><td>Gentian violet [<xref ref-type="bibr" rid="CR14">14</xref>]</td><td>Ethiopia</td></tr><tr><td>Hair lotion [<xref ref-type="bibr" rid="CR14">14</xref>]</td><td>Ethiopia</td></tr><tr><td>Herbal medicine (unspecified) [<xref ref-type="bibr" rid="CR65">65</xref>]</td><td>Uganda</td></tr><tr><td>Homeopathic medicine (unspecified) [<xref ref-type="bibr" rid="CR17">17</xref>]</td><td>Bangladesh</td></tr><tr><td>Iodine [<xref ref-type="bibr" rid="CR14">14</xref>]</td><td>Ethiopia</td></tr><tr><td>Kohl/surma (can contain lead and antimony) [<xref ref-type="bibr" rid="CR31">31</xref>, <xref ref-type="bibr" rid="CR34">34</xref>, <xref ref-type="bibr" rid="CR36">36</xref>, <xref ref-type="bibr" rid="CR55">55</xref>]</td><td>Egypt, Pakistan</td></tr><tr><td>Medicinal drugs (unspecified) [<xref ref-type="bibr" rid="CR69">69</xref>]</td><td>Uganda</td></tr><tr><td>Menthol-containing balm [<xref ref-type="bibr" rid="CR12">12</xref>]</td><td>Nigeria</td></tr><tr><td>Methylated spirit [<xref ref-type="bibr" rid="CR12">12</xref>]</td><td>Nigeria</td></tr><tr><td>Nebanol ointment [<xref ref-type="bibr" rid="CR52">52</xref>]</td><td>Bangladesh</td></tr><tr><td>Ointment (unspecified) [<xref ref-type="bibr" rid="CR16">16</xref>, <xref ref-type="bibr" rid="CR55">55</xref>]</td><td>Ethiopia, Pakistan</td></tr><tr><td>Petroleum jelly [<xref ref-type="bibr" rid="CR7">7</xref>–<xref ref-type="bibr" rid="CR9">9</xref>, <xref ref-type="bibr" rid="CR12">12</xref>, <xref ref-type="bibr" rid="CR14">14</xref>, <xref ref-type="bibr" rid="CR19">19</xref>]</td><td>Ethiopia, Nigeria, Tanzania, Uganda, Zambia</td></tr><tr><td>Savlon [<xref ref-type="bibr" rid="CR17">17</xref>]</td><td>Bangladesh</td></tr><tr><td>Shea butter [<xref ref-type="bibr" rid="CR15">15</xref>, <xref ref-type="bibr" rid="CR21">21</xref>]</td><td>Ghana</td></tr><tr><td>Surgical spirit [<xref ref-type="bibr" rid="CR7">7</xref>, <xref ref-type="bibr" rid="CR9">9</xref>, <xref ref-type="bibr" rid="CR15">15</xref>, <xref ref-type="bibr" rid="CR20">20</xref>, <xref ref-type="bibr" rid="CR26">26</xref>, <xref ref-type="bibr" rid="CR69">69</xref>]</td><td>Ghana, Tanzania, Uganda</td></tr><tr><td>Toothpaste [<xref ref-type="bibr" rid="CR12">12</xref>, <xref ref-type="bibr" rid="CR28">28</xref>, <xref ref-type="bibr" rid="CR37">37</xref>]</td><td>Nigeria, Nepal</td></tr><tr><td rowspan="6">Other</td><td>Burnt cloth/burned cotton [<xref ref-type="bibr" rid="CR13">13</xref>, <xref ref-type="bibr" rid="CR22">22</xref>]</td><td>Haiti, Turkey</td></tr><tr><td>Fish bone [<xref ref-type="bibr" rid="CR24">24</xref>]</td><td>Tanzania</td></tr><tr><td><italic>Gamba la koa</italic> (shells) [<xref ref-type="bibr" rid="CR24">24</xref>]</td><td>Tanzania</td></tr><tr><td><italic>Loma</italic> (crushed wasps nest) [<xref ref-type="bibr" rid="CR8">8</xref>]</td><td>Zambia</td></tr><tr><td>Tar [<xref ref-type="bibr" rid="CR25">25</xref>]</td><td>Turkey</td></tr><tr><td>“Other substances” [<xref ref-type="bibr" rid="CR15">15</xref>, <xref ref-type="bibr" rid="CR56">56</xref>, <xref ref-type="bibr" rid="CR58">58</xref>, <xref ref-type="bibr" rid="CR62">62</xref>, <xref ref-type="bibr" rid="CR67">67</xref>]</td><td>Ethiopia, Ghana, India, Nepal</td></tr><tr><td rowspan="4">Heat</td><td>Burning tip of cord [<xref ref-type="bibr" rid="CR63">63</xref>]</td><td>India</td></tr><tr><td>Fire steam [<xref ref-type="bibr" rid="CR24">24</xref>]</td><td>Tanzania</td></tr><tr><td>Hot fomentation or <italic>shek dewa</italic> (dry or moist heat) [<xref ref-type="bibr" rid="CR12">12</xref>, <xref ref-type="bibr" rid="CR15">15</xref>, <xref ref-type="bibr" rid="CR17">17</xref>, <xref ref-type="bibr" rid="CR27">27</xref>, <xref ref-type="bibr" rid="CR30">30</xref>, <xref ref-type="bibr" rid="CR37">37</xref>, <xref ref-type="bibr" rid="CR54">54</xref>]</td><td>Bangladesh, Ghana, Nigeria</td></tr><tr><td>Hot knife [<xref ref-type="bibr" rid="CR24">24</xref>]</td><td>Tanzania</td></tr></tbody></table></table-wrap></p><p>The substances applied may also vary by the infant’s perceived gestational age or state of health. For example, in the Choma District in Zambia, the substance applied to a newborn’s umbilical cord differs by the newborn’s perceived gestational age, as substances used for full-term babies are considered too strong for preterm babies. A black powder made from the burnt stem of the pumpkin plant is applied to the umbilical cord of full-term infants while a green powder made from the dried roots of the <italic>mweeye</italic> plant is applied to the cord of preterm/small infants as it is considered to be gentler than the black powder [<xref ref-type="bibr" rid="CR18">18</xref>]. Also in southern Zambia, substances such as petroleum jelly, <italic>mabono</italic> (wild fruit) oil, cooking/motor oil, charcoal, dried cow dung or chicken droppings, burnt pumpkin stem, and crushed <italic>loma</italic> (wasps’ nest) are applied to the cord of the healthy infant. However, a separate set of substances that are considered to be medicinal are applied if the cord is red or if pus appears. The substances that are considered to be medicinal include: python oil, breast milk, alcohol, banana, cow dung, <italic>mukunku</italic> (bark of a tree), traditional herbs, or dirt from a pounding stick [<xref ref-type="bibr" rid="CR8">8</xref>].</p><p>The length of the cord may have specific importance. In southern Zambia, it is believed that if the cord is too long, it will take too long to heal, and if it is too short, “the air will go in and this will make the baby die” [<xref ref-type="bibr" rid="CR8">8</xref>]. The length of the cord is also believed to indicate the length of the genitals in both men and women [<xref ref-type="bibr" rid="CR8">8</xref>]. Further, in southern Zambia and on the island of Pemba in the Zanzibar archipelago, Tanzania, the umbilical cord may be wrapped or bound with a strip of cloth to prevent it from touching the groin area [<xref ref-type="bibr" rid="CR8">8</xref>, <xref ref-type="bibr" rid="CR18">18</xref>, <xref ref-type="bibr" rid="CR24">24</xref>], which is sometimes believed to cause infertility as an adult [<xref ref-type="bibr" rid="CR18">18</xref>]. In areas of Zambia and Tanzania, where it is important to protect the cord from being taken by someone who wishes the infant or the family ill, the cord, and often the placenta, are disposed of through burial in a sacred place or by burning, or are sometimes put in a pit latrine/toilet to prevent them from being unearthed [<xref ref-type="bibr" rid="CR8">8</xref>, <xref ref-type="bibr" rid="CR23">23</xref>]. In southeastern Turkey, the cord may be buried in a special place to help define the child’s path in life, such as burying the cord at a mosque or a school to help the child grow up to be a religious or educated person, respectively [<xref ref-type="bibr" rid="CR25">25</xref>].</p></sec><sec id="Sec5"><title>Frequency of application</title><p>Few articles reported on the frequency of application of the substance (either the number of days or the number of times per day the substance was applied). In Ethiopia, the substance is applied one to three times per day up to the seventh day of life. However, the applications may not begin until the newborn is two or three days old [<xref ref-type="bibr" rid="CR14">14</xref>]. In the Brong Ahafo region of Ghana, a substance is applied anywhere from every 30 min to 3 times per day [<xref ref-type="bibr" rid="CR15">15</xref>]. In urban Uganda, mothers reported cleaning the cord with a substance at least twice per day [<xref ref-type="bibr" rid="CR9">9</xref>]. On Pemba Island in the Zanzibar archipelago, Tanzania, multiple substances were applied to the umbilical area beginning on the sixth day after birth. In this study of more than 1000 infants born at home, only 10% (<italic>n</italic> = 109) had a substance applied to the umbilical cord and less than 11% of those applications were made in the first 48 h of life [<xref ref-type="bibr" rid="CR26">26</xref>]. A study in Sylhet District in Bangladesh, involving 39 in-depth interviews of mothers, fathers, grandmothers, and traditional birth attendants and data from more than 6000 household surveys of mothers, found that substances were applied until the cord separated and that either turmeric or ginger are applied at birth and then a combination of mustard oil and garlic are applied twice daily until the separation of the cord [<xref ref-type="bibr" rid="CR27">27</xref>].</p><p>Few studies identified who usually applied the substance to the cord. In the 19 studies where it was reported, either the mother or grandmother of the infant [<xref ref-type="bibr" rid="CR9">9</xref>, <xref ref-type="bibr" rid="CR12">12</xref>–<xref ref-type="bibr" rid="CR19">19</xref>, <xref ref-type="bibr" rid="CR21">21</xref>, <xref ref-type="bibr" rid="CR25">25</xref>, <xref ref-type="bibr" rid="CR27">27</xref>–<xref ref-type="bibr" rid="CR32">32</xref>] or a senior woman [<xref ref-type="bibr" rid="CR15">15</xref>, <xref ref-type="bibr" rid="CR19">19</xref>, <xref ref-type="bibr" rid="CR33">33</xref>] in the household applied the substance to the cord. In only a very few cases did a traditional birth attendant or health worker [<xref ref-type="bibr" rid="CR11">11</xref>, <xref ref-type="bibr" rid="CR14">14</xref>, <xref ref-type="bibr" rid="CR19">19</xref>] apply a substance to the cord.</p></sec><sec id="Sec6"><title>Cost and source of substance</title><p>Few articles investigated the source of the substances applied to the umbilical cord and none reported on the cost of the substances applied. Shea butter or cooking oil were purchased from the market [<xref ref-type="bibr" rid="CR15">15</xref>, <xref ref-type="bibr" rid="CR18">18</xref>]. One study reported that the cooking oil applied to the cord is generally a recycled product bought at the local market that had been previously used [<xref ref-type="bibr" rid="CR18">18</xref>].</p></sec></sec><sec id="Sec7"><title>Discussion</title><p>This study presents a view of traditional cord-care practices as reported during the last fifteen years in low- and middle-income countries. The desire to care for the umbilical cord of an infant appears to be universal in all cultures. Of interest is the description of the range of products applied to the newly cut cord and that substances are applied to the umbilical cord to infants born at home as well as in facilities. Participants in studies from Petit-Gôave, Haiti, and Karachi, Pakistan, reported that if an infant was born in a health facility, a substance would be applied to the umbilical cord upon returning home [<xref ref-type="bibr" rid="CR22">22</xref>, <xref ref-type="bibr" rid="CR34">34</xref>].</p><p>The possible harm of these substances has not been fully quantified. In some cases, such as with kohl and surma used in Egypt and Pakistan, the lead and antimony included in the product is most likely harmful. Anecdotal literature often refers to the use of dung as a harmful traditional practice. In contrast, we found use of chicken/lizard/cow dung reported in only three countries (Haiti, Uganda, and Zambia), thereby suggesting that this practice is not as widespread as depicted or that it, as reported by a traditional birth attendant in northern Ghana, was practiced in the past and has since ceased [<xref ref-type="bibr" rid="CR21">21</xref>]. It is also possible that application of preparations using dung is underreported in published literature. For example, unpublished formative research from the Kenieba and Koutiala Districts of Mali report use of <italic>bassa bo</italic> (lizard excrement powder mixed with shea butter) and <italic>bagani dji</italic> (insect powder mixed with shea butter, sap, or powder of <italic>pourghère</italic>) to help the stump fall off and heal the umbilicus [unpublished data from formative research conducted in Mali in 2015 by the Maternal Child Survival Program of the US Agency for International Development]. Data from the Kita and Diema Districts in Mali report application of cow dung, shea butter, ash, alcohol, and Maggi cubes to the umbilical cord [unpublished data from endline survey conducted in Mali in 2014 by the Maternal and Child Health Integrated Program, predecessor to Maternal Child Survival Program].</p><p>Other product categories (i.e., oils, herbs/spices/plants, mineral/powder, water, bodily fluids, food, personal care/medical products) and processes such as heat treatment may or may not be harmful and could warrant further investigation. Neonates and young infants are more prone to infection than older children and adults and evidence suggests that their immune systems are still developing rather than being fully formed at the time of birth. Further, newborns appear to be particularly vulnerable to the types of intracellular pathogens that commonly cause neonatal sepsis [<xref ref-type="bibr" rid="CR35">35</xref>], such as some strains of streptococcus, <italic>Escherichia coli</italic>, and <italic>Listeria monocytogenes</italic>.</p><p>Concern has been expressed about transmission of HIV from mother to child through the application of breast milk to the umbilical cord [<xref ref-type="bibr" rid="CR18">18</xref>]. Also, the use of <italic>numbati</italic> (water that has been used to wash an adult woman’s genitals) in Tanzania [<xref ref-type="bibr" rid="CR23">23</xref>], could potentially pose a risk for transmission of HIV or other diseases. The application of unhygienic substances to or around the umbilical cord stump has been linked to tetanus in infants [<xref ref-type="bibr" rid="CR2">2</xref>, <xref ref-type="bibr" rid="CR13">13</xref>, <xref ref-type="bibr" rid="CR25">25</xref>, <xref ref-type="bibr" rid="CR36">36</xref>–<xref ref-type="bibr" rid="CR39">39</xref>]. <italic>Clostridium tetani</italic> bacteria, found in soil, dust, saliva, animal dung, and other sources, are the cause of tetanus infection [<xref ref-type="bibr" rid="CR40">40</xref>].</p><p>Some substances, which are known to be harmful in other contexts, pose an unclear risk when applied to the umbilical cord. For example, motor/machine oil contains high levels of chemical additives and, once used for its intended purpose, can contain high levels of heavy metals and other minerals [<xref ref-type="bibr" rid="CR41">41</xref>, <xref ref-type="bibr" rid="CR42">42</xref>]. While used motor/machine oil is well known to be harmful to the environment and causes dermatitis through long-term exposure, the health risks due to short-term exposure through an open wound is not well defined. Boric acid powder is used as a pesticide and has caused seizures and death in infants when ingested [<xref ref-type="bibr" rid="CR43">43</xref>], but also has known antifungal properties and has been used as a treatment for conditions such yeast infections [<xref ref-type="bibr" rid="CR44">44</xref>]. However, sources differ on whether it is safe to use boric acid on open wounds. Pyriproxyfen powder, a pesticide, poses minimal risk to humans in small quantities [<xref ref-type="bibr" rid="CR45">45</xref>]. Other substances, such as oils, herbs, plants, food products, and heat treatments applied to the cord may be harmful depending on whether they have been contaminated in some way, such as through unhygienic preparation or storage.</p><p>This critical information regarding traditional cord-care practices can serve as the stepping stone to behavior change. We focused our review on a comprehensive description of reported cord-care practices with the intention of employing the knowledge to develop behavior-change strategies to support introduction of novel cord-care regimens, particularly 7.1% chlorhexidine digluconate for umbilical cord care. Randomized controlled trials investigating the use of 7.1% chlorhexidine digluconate for umbilical cord care have been conducted in Nepal [<xref ref-type="bibr" rid="CR46">46</xref>], Bangladesh [<xref ref-type="bibr" rid="CR47">47</xref>], and Pakistan [<xref ref-type="bibr" rid="CR48">48</xref>]. A meta-analysis of the three studies demonstrated that application of chlorhexidine to the umbilical cord of the newborn led to a 23% reduction in all-cause neonatal mortality and a reduction in omphalitis ranging from 27 to 56% compared to control group depending on severity of infection [<xref ref-type="bibr" rid="CR49">49</xref>]. Further, the World Health Organization recommends the application of 7.1% chlorhexidine digluconate (gel or solution) to the umbilical cord of neonates who are born at home in settings with high neonatal mortality or to replace the use of a harmful, traditional substances [<xref ref-type="bibr" rid="CR50">50</xref>]. Despite previously reported substantial reductions in South Asia, results from recent trials in Zambia [<xref ref-type="bibr" rid="CR51">51</xref>] and Tanzania [<xref ref-type="bibr" rid="CR52">52</xref>] show that application of 7.1% chlorhexidine to the umbilical cord did not significantly reduce neonatal mortality rates in the study sites. This suggests that programmatic context and level of risk in the population as well as cord care practices must be considered in any behavior change initiative.</p><p>Findings from this review suggest that documentation of cord-care practices is not consistent throughout low- and middle-income countries. Given the heterogeneity of practices described in the literature, it is not clear if data from one country in a region also pertains to other surrounding countries and/or nearby ethnic groups. Overall, however, existing literature depicts a firm tradition of umbilical cord care in every culture. The desire to take some kind of action to address the newly cut umbilical cord seems to be a strong human desire. Participants in several studies noted that adhering to dry cord care was very difficult. For example, in Ghana, there was a belief that applying nothing to the cord would delay separation, cause discomfort, and potentially cause death for the infant by preventing the sore from healing and causing a sickness in the stomach [<xref ref-type="bibr" rid="CR15">15</xref>]. In Uganda, the practice of dry cord care was noted as difficult to follow as it delays the cord separation and the return of the mother to chores [<xref ref-type="bibr" rid="CR7">7</xref>]. This desire to actively care for a newborn could be utilized as a trigger for behavior change. For example, as applied in the Health Belief Model [<xref ref-type="bibr" rid="CR53">53</xref>], knowledge of effective cord care (i.e., product, application procedure, number of days to use, number of times/day to apply) could function as a “cue to action” to allow caretakers to act in a positive manner.</p><p>This review has limitations, as noted. Reporting is not global in nature as the review was limited to sources published in English in peer-reviewed journals. Few of the studies conducted have been in-depth, qualitative assessments of umbilical cord care practices; therefore, much of the detailed information about beliefs and practices surrounding umbilical cord care comes from a few sources or countries, such as Tanzania and Zambia. This could lead to the assumption that some countries place greater importance on umbilical cord care practices than other countries where the data collection focused on a variety of newborn care practices. The paucity of data from Latin America and the Caribbean reflected in this review could stem from our decision to include only English-language material. Also, it is likely that additional anecdotal information is available in gray literature.</p><p>Additional research around cost and source of products used in cord care practices could assist programs that are targeting newborn care behavior change. Likewise, deeper ethnographic and/or qualitative investigation into the underlying meaning and significance of traditional cord-care practices could assist in formulating key messages being used to generate demand for novel prophylactic products.</p></sec><sec id="Sec8"><title>Conclusions</title><p>Findings from this review suggest that documentation of cord-care practices is not consistent throughout low- and middle-income countries, yet existing literature depicts a firm tradition of umbilical cord care in every culture studied. Cord-care practices vary by country and by regions or cultural groups within a country and employ a wide range of substances. The desire to promote healing and hasten cord separation are the underlying beliefs related to application of substances to the umbilical cord. The frequency of application of the substance (either the number of days or the number of times per day the substance was applied) and source and cost of products used are not well characterized. This desire to actively care for the umbilical cord of a newborn could be utilized to promote positive behavior change such as the introduction of 7.1% chlorhexidine digluconate for umbilical cord care. The variety in cord care practices and beliefs noted in this review however points toward the need to contextualize any behavior change approach to align with the local culture.</p></sec></body><back><app-group><app id="App1"><sec id="Sec9"><title>Additional file</title><p><media position="anchor" xlink:href="12884_2017_1250_MOESM1_ESM.docx" id="MOESM1"><label>Additional file 1:</label><caption><p>Search Terminology. Exact narrative sequences used for literature search. (DOCX 12 kb)</p></caption></media></p></sec></app></app-group><ack><title>Acknowledgements</title><p>Not applicable/none.</p><sec id="FPar1"><title>Funding</title><p>Funding for this project has been provided by the UN Commission for Life-Saving Commodities. The funding body was not involved in the design of the study and collection, analysis, and interpretation of data or in writing the manuscript.</p></sec><sec id="FPar2"><title>Availability of data and materials</title><p>All articles reviewed are available online. Two instances of unpublished data from Mali have been mentioned in this manuscript; the data can be requested from the Maternal Child Survival Program of the US Agency for International Development (<ext-link ext-link-type="uri" xlink:href="http://www.mcsprogram.org/">http://www.mcsprogram.org/</ext-link>).</p></sec><sec id="FPar3"><title>Authors’ contributions</title><p>PSC conceived of the idea for the paper, assessed the quality of the included studies, analyzed the data, and wrote the manuscript. SB conducted the title/abstract and full-text screening, extracted and analyzed the data, and wrote the manuscript. PSC had full access to all the data in the study and had final responsibility for the decision to submit for publication. Both authors have read and approved the final version of this manuscript.</p></sec><sec id="FPar4"><title>Competing interests</title><p>The authors declare that they have no competing interests.</p></sec><sec id="FPar5"><title>Consent for publication</title><p>Not applicable.</p></sec><sec id="FPar6"><title>Ethics approval and consent to participate</title><p>Not applicable.</p></sec></ack><ref-list id="Bib1"><title>References</title><ref id="CR1"><label>1.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Liu</surname><given-names>L</given-names></name><name><surname>Oza</surname><given-names>S</given-names></name><name><surname>Hogan</surname><given-names>D</given-names></name><name><surname>Perin</surname><given-names>J</given-names></name><name><surname>Rudan</surname><given-names>I</given-names></name><name><surname>Lawn</surname><given-names>JE</given-names></name><etal></etal></person-group><article-title>Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis</article-title><source>Lancet</source><year>2015</year><volume>385</volume><issue>9966</issue><fpage>430</fpage><lpage>40</lpage><pub-id pub-id-type="doi">10.1016/S0140-6736(14)61698-6</pub-id><pub-id pub-id-type="pmid">25280870</pub-id></element-citation></ref><ref id="CR2"><label>2.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Traverso</surname><given-names>HP</given-names></name><name><surname>Bennett</surname><given-names>JV</given-names></name><name><surname>Kahn</surname><given-names>AJ</given-names></name><name><surname>Agha</surname><given-names>SB</given-names></name><name><surname>Rahim</surname><given-names>H</given-names></name><name><surname>Kamil</surname><given-names>S</given-names></name><name><surname>Lang</surname><given-names>MH</given-names></name></person-group><article-title>Ghee applications to the umbilical cord: a risk factor for neonatal tetanus</article-title><source>Lancet</source><year>1989</year><volume>1</volume><issue>8636</issue><fpage>486</fpage><lpage>8</lpage><pub-id pub-id-type="doi">10.1016/S0140-6736(89)91378-0</pub-id><pub-id pub-id-type="pmid">2563851</pub-id></element-citation></ref><ref id="CR3"><label>3.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mull</surname><given-names>DS</given-names></name><name><surname>Anderson</surname><given-names>JW</given-names></name><name><surname>Mull</surname><given-names>JD</given-names></name></person-group><article-title>Cow dung, rock salt, and medical innovation in the Hindu Kush of Pakistan: the cultural transformation of neonatal tetanus and iodine deficiency</article-title><source>Soc Sci Med</source><year>1990</year><volume>30</volume><issue>6</issue><fpage>675</fpage><lpage>91</lpage><pub-id pub-id-type="doi">10.1016/0277-9536(88)90253-5</pub-id><pub-id pub-id-type="pmid">2315737</pub-id></element-citation></ref><ref id="CR4"><label>4.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Karumbi</surname><given-names>J</given-names></name><name><surname>Mulaku</surname><given-names>M</given-names></name><name><surname>Aluvaala</surname><given-names>J</given-names></name><name><surname>English</surname><given-names>M</given-names></name><name><surname>Opiyo</surname><given-names>N</given-names></name></person-group><article-title>Topical umbilical cord care for prevention of infection and neonatal mortality</article-title><source>Pediatr Infect Dis J</source><year>2013</year><volume>32</volume><issue>1</issue><fpage>78</fpage><lpage>83</lpage><pub-id pub-id-type="doi">10.1097/INF.0b013e3182783dc3</pub-id><pub-id pub-id-type="pmid">23076382</pub-id></element-citation></ref><ref id="CR5"><label>5.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Imdad</surname><given-names>A</given-names></name><name><surname>Bautista</surname><given-names>RM</given-names></name><name><surname>Senen</surname><given-names>KA</given-names></name><name><surname>Uy</surname><given-names>MV</given-names></name><name><surname>Mantaring III</surname><given-names>JB</given-names></name><name><surname>Bhutta</surname><given-names>ZA</given-names></name></person-group><article-title>Umbilical cord antiseptics for preventing sepsis and death among newborns</article-title><source>Cochrane Database Syst Rev</source><year>2013</year><volume>5</volume><fpage>CD008635</fpage></element-citation></ref><ref id="CR6"><label>6.</label><mixed-citation publication-type="other">Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). <ext-link ext-link-type="uri" xlink:href="http://www.prisma-statement.org/">http://www.prisma-statement.org/</ext-link>. Accessed 14 Sep 2016.</mixed-citation></ref><ref id="CR7"><label>7.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Byaruhanga</surname><given-names>RN</given-names></name><name><surname>Nsungwa-Sabiiti</surname><given-names>J</given-names></name><name><surname>Kiguli</surname><given-names>J</given-names></name><name><surname>Balyeku</surname><given-names>A</given-names></name><name><surname>Nsabagasani</surname><given-names>X</given-names></name><name><surname>Peterson</surname><given-names>S</given-names></name></person-group><article-title>Hurdles and opportunities for newborn care in rural Uganda</article-title><source>Midwifery</source><year>2011</year><volume>27</volume><issue>6</issue><fpage>775</fpage><lpage>80</lpage><pub-id pub-id-type="doi">10.1016/j.midw.2010.02.005</pub-id><pub-id pub-id-type="pmid">20685016</pub-id></element-citation></ref><ref id="CR8"><label>8.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Herlihy</surname><given-names>JM</given-names></name><name><surname>Shaikh</surname><given-names>A</given-names></name><name><surname>Mazimba</surname><given-names>A</given-names></name><name><surname>Gagne</surname><given-names>N</given-names></name><name><surname>Grogan</surname><given-names>C</given-names></name><name><surname>Mpamba</surname><given-names>C</given-names></name><etal></etal></person-group><article-title>Local perceptions, cultural beliefs and practices that shape umbilical cord care: a qualitative study in Southern Province, Zambia</article-title><source>PLoS One</source><year>2013</year><volume>8</volume><issue>11</issue><fpage>e79191</fpage><pub-id pub-id-type="doi">10.1371/journal.pone.0079191</pub-id><pub-id pub-id-type="pmid">24244447</pub-id></element-citation></ref><ref id="CR9"><label>9.</label><mixed-citation publication-type="other">Kayom VO, Kakuru A, Kiguli S. Newborn care practices among mother-infant dyads in urban Uganda. Int J Pediatr. 2015;2015:815938. doi:10.1155/2015/815938.</mixed-citation></ref><ref id="CR10"><label>10.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Khan</surname><given-names>GN</given-names></name><name><surname>Memon</surname><given-names>ZA</given-names></name><name><surname>Bhutta</surname><given-names>ZA</given-names></name></person-group><article-title>A cross sectional study of newborn care practices in Gilgit, Pakistan</article-title><source>J Neonatal Perinatal Med</source><year>2013</year><volume>6</volume><issue>1</issue><fpage>69</fpage><lpage>76</lpage><pub-id pub-id-type="pmid">24246461</pub-id></element-citation></ref><ref id="CR11"><label>11.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sharkey</surname><given-names>A</given-names></name><name><surname>Yansaneh</surname><given-names>A</given-names></name><name><surname>Bangura</surname><given-names>PS</given-names></name><name><surname>Kabano</surname><given-names>A</given-names></name><name><surname>Brady</surname><given-names>E</given-names></name><name><surname>Yumkella</surname><given-names>F</given-names></name><etal></etal></person-group><article-title>Maternal and newborn care practices in Sierra Leone: a mixed methods study of four underserved districts</article-title><source>Health Policy Plan</source><year>2016</year><pub-id pub-id-type="pmid">27524265</pub-id></element-citation></ref><ref id="CR12"><label>12.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Abhulimhen-Iyoha</surname><given-names>BI</given-names></name><name><surname>Ibadin</surname><given-names>MO</given-names></name></person-group><article-title>Determinants of cord care practices among mothers in Benin City, Edo State, Nigeria</article-title><source>Niger J Clin Pract</source><year>2012</year><volume>15</volume><issue>2</issue><fpage>210</fpage><lpage>3</lpage><pub-id pub-id-type="doi">10.4103/1119-3077.97320</pub-id><pub-id pub-id-type="pmid">22718175</pub-id></element-citation></ref><ref id="CR13"><label>13.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Alparslan</surname><given-names>Ö</given-names></name><name><surname>Demırel</surname><given-names>Y</given-names></name></person-group><article-title>Traditional neonatal care practices in Turkey</article-title><source>Jpn J Nurs Sci</source><year>2013</year><volume>10</volume><issue>1</issue><fpage>47</fpage><lpage>54</lpage><pub-id pub-id-type="doi">10.1111/j.1742-7924.2012.00209.x</pub-id><pub-id pub-id-type="pmid">23735089</pub-id></element-citation></ref><ref id="CR14"><label>14.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Amare</surname><given-names>Y</given-names></name></person-group><article-title>Umbilical cord care in Ethiopia and implications for behavioral change: a qualitative study</article-title><source>BMC Int Health Hum Rights</source><year>2014</year><volume>14</volume><fpage>12</fpage><pub-id pub-id-type="doi">10.1186/1472-698X-14-12</pub-id><pub-id pub-id-type="pmid">24742223</pub-id></element-citation></ref><ref id="CR15"><label>15.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hill</surname><given-names>Z</given-names></name><name><surname>Tawiah-Agyemang</surname><given-names>C</given-names></name><name><surname>Okeyere</surname><given-names>E</given-names></name><name><surname>Manu</surname><given-names>A</given-names></name><name><surname>Fenty</surname><given-names>J</given-names></name><name><surname>Kirkwood</surname><given-names>B</given-names></name></person-group><article-title>Improving hygiene in home deliveries in rural Ghana: how to build on current attitudes and practices</article-title><source>Pediatr Infect Dis J</source><year>2010</year><volume>29</volume><issue>11</issue><fpage>1004</fpage><lpage>8</lpage><pub-id pub-id-type="pmid">20811311</pub-id></element-citation></ref><ref id="CR16"><label>16.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Degefie</surname><given-names>T</given-names></name><name><surname>Amare</surname><given-names>Y</given-names></name><name><surname>Mulligan</surname><given-names>B</given-names></name></person-group><article-title>Local understandings of care during delivery and postnatal period to inform home based package of newborn care interventions in rural Ethiopia: a qualitative study</article-title><source>BMC Int Health Hum Rights</source><year>2014</year><volume>14</volume><fpage>17</fpage><pub-id pub-id-type="doi">10.1186/1472-698X-14-17</pub-id><pub-id pub-id-type="pmid">24885760</pub-id></element-citation></ref><ref id="CR17"><label>17.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Moran</surname><given-names>AC</given-names></name><name><surname>Choudhury</surname><given-names>N</given-names></name><name><surname>Uz Zaman Khan</surname><given-names>N</given-names></name><name><surname>Ahsan Karar</surname><given-names>Z</given-names></name><name><surname>Wahed</surname><given-names>T</given-names></name><name><surname>Faiz Rashid</surname><given-names>S</given-names></name><etal></etal></person-group><article-title>Newborn care practices among slum dwellers in Dhaka, Bangladesh: a quantitative and qualitative exploratory study</article-title><source>BMC Pregnancy Childbirth</source><year>2009</year><volume>9</volume><fpage>54</fpage><pub-id pub-id-type="doi">10.1186/1471-2393-9-54</pub-id><pub-id pub-id-type="pmid">19919700</pub-id></element-citation></ref><ref id="CR18"><label>18.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sacks</surname><given-names>E</given-names></name><name><surname>Moss</surname><given-names>WJ</given-names></name><name><surname>Winch</surname><given-names>PJ</given-names></name><name><surname>Thuma</surname><given-names>P</given-names></name><name><surname>van Dijk</surname><given-names>JH</given-names></name><name><surname>Mullany</surname><given-names>LC</given-names></name></person-group><article-title>Skin, thermal and umbilical cord care practices for neonates in southern, rural Zambia: a qualitative study</article-title><source>BMC Pregnancy Childbirth</source><year>2015</year><volume>15</volume><fpage>149</fpage><pub-id pub-id-type="doi">10.1186/s12884-015-0584-2</pub-id><pub-id pub-id-type="pmid">26177637</pub-id></element-citation></ref><ref id="CR19"><label>19.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Shamba</surname><given-names>DD</given-names></name><name><surname>Schellenberg</surname><given-names>J</given-names></name><name><surname>Penfold</surname><given-names>SC</given-names></name><name><surname>Mashasi</surname><given-names>I</given-names></name><name><surname>Mrisho</surname><given-names>M</given-names></name><name><surname>Manzi</surname><given-names>F</given-names></name><etal></etal></person-group><article-title>Clean home-delivery in rural Southern Tanzania: barriers, influencers, and facilitators</article-title><source>J Health Popul Nutr</source><year>2013</year><volume>31</volume><issue>1</issue><fpage>110</fpage><lpage>7</lpage><pub-id pub-id-type="doi">10.3329/jhpn.v31i1.14755</pub-id><pub-id pub-id-type="pmid">23617211</pub-id></element-citation></ref><ref id="CR20"><label>20.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Waiswa</surname><given-names>P</given-names></name><name><surname>Kemigisa</surname><given-names>M</given-names></name><name><surname>Kiguli</surname><given-names>J</given-names></name><name><surname>Naikoba</surname><given-names>S</given-names></name><name><surname>Pariyo</surname><given-names>GW</given-names></name><name><surname>Peterson</surname><given-names>S</given-names></name></person-group><article-title>Acceptability of evidence-based neonatal care practices in rural Uganda - implications for programming</article-title><source>BMC Pregnancy Childbirth</source><year>2008</year><volume>8</volume><fpage>21</fpage><pub-id pub-id-type="doi">10.1186/1471-2393-8-21</pub-id><pub-id pub-id-type="pmid">18570672</pub-id></element-citation></ref><ref id="CR21"><label>21.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Moyer</surname><given-names>CA</given-names></name><name><surname>Aborigo</surname><given-names>RA</given-names></name><name><surname>Logonia</surname><given-names>G</given-names></name><name><surname>Affah</surname><given-names>G</given-names></name><name><surname>Rominski</surname><given-names>S</given-names></name><name><surname>Adongo</surname><given-names>PB</given-names></name><etal></etal></person-group><article-title>Clean delivery practices in rural northern Ghana: a qualitative study of community and provider knowledge, attitudes, and beliefs</article-title><source>BMC Pregnancy Childbirth</source><year>2012</year><volume>12</volume><fpage>50</fpage><pub-id pub-id-type="doi">10.1186/1471-2393-12-50</pub-id><pub-id pub-id-type="pmid">22703032</pub-id></element-citation></ref><ref id="CR22"><label>22.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Walsh</surname><given-names>S</given-names></name><name><surname>Norr</surname><given-names>K</given-names></name><name><surname>Sankar</surname><given-names>G</given-names></name><name><surname>Sipsma</surname><given-names>H</given-names></name></person-group><article-title>Newborn cord care practices in Haiti</article-title><source>Glob Public Health</source><year>2015</year><volume>10</volume><issue>9</issue><fpage>1107</fpage><lpage>17</lpage><pub-id pub-id-type="doi">10.1080/17441692.2015.1012094</pub-id><pub-id pub-id-type="pmid">25727359</pub-id></element-citation></ref><ref id="CR23"><label>23.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mrisho</surname><given-names>M</given-names></name><name><surname>Schellenberg</surname><given-names>JA</given-names></name><name><surname>Mushi</surname><given-names>AK</given-names></name><name><surname>Obrist</surname><given-names>B</given-names></name><name><surname>Mshinda</surname><given-names>H</given-names></name><name><surname>Tanner</surname><given-names>M</given-names></name><etal></etal></person-group><article-title>Understanding home-based neonatal care practice in rural southern Tanzania</article-title><source>Trans R Soc Trop Med Hyg</source><year>2008</year><volume>102</volume><issue>7</issue><fpage>669</fpage><lpage>78</lpage><pub-id pub-id-type="doi">10.1016/j.trstmh.2008.04.029</pub-id><pub-id pub-id-type="pmid">18513769</pub-id></element-citation></ref><ref id="CR24"><label>24.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Dhingra</surname><given-names>U</given-names></name><name><surname>Gittelsohn</surname><given-names>J</given-names></name><name><surname>Suleiman</surname><given-names>AM</given-names></name><name><surname>Suleiman</surname><given-names>SM</given-names></name><name><surname>Dutta</surname><given-names>A</given-names></name><name><surname>Ali</surname><given-names>SM</given-names></name><etal></etal></person-group><article-title>Delivery, immediate newborn and cord care practices in Pemba Tanzania: a qualitative study of community, hospital staff and community level care providers for knowledge, attitudes, belief systems and practices</article-title><source>BMC Pregnancy Childbirth</source><year>2014</year><volume>14</volume><fpage>173</fpage><pub-id pub-id-type="doi">10.1186/1471-2393-14-173</pub-id><pub-id pub-id-type="pmid">24885689</pub-id></element-citation></ref><ref id="CR25"><label>25.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Geçkil</surname><given-names>E</given-names></name><name><surname>Sahin</surname><given-names>T</given-names></name><name><surname>Ege</surname><given-names>E</given-names></name></person-group><article-title>Traditional postpartum practices of women and infants and the factors influencing such practices in South Eastern Turkey</article-title><source>Midwifery</source><year>2009</year><volume>25</volume><issue>1</issue><fpage>62</fpage><lpage>71</lpage><pub-id pub-id-type="doi">10.1016/j.midw.2006.12.007</pub-id><pub-id pub-id-type="pmid">17335945</pub-id></element-citation></ref><ref id="CR26"><label>26.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mullany</surname><given-names>LC</given-names></name><name><surname>Faillace</surname><given-names>S</given-names></name><name><surname>Tielsch</surname><given-names>JM</given-names></name><name><surname>Stolzfus</surname><given-names>RJ</given-names></name><name><surname>Nygaard</surname><given-names>KE</given-names></name><name><surname>Kavle</surname><given-names>JA</given-names></name><etal></etal></person-group><article-title>Incidence and risk factors for newborn umbilical cord infections on Pemba Island, Zanzibar, Tanzania</article-title><source>Pediatr Infect Dis J</source><year>2009</year><volume>28</volume><issue>6</issue><fpage>503</fpage><lpage>9</lpage><pub-id pub-id-type="doi">10.1097/INF.0b013e3181950910</pub-id><pub-id pub-id-type="pmid">19504734</pub-id></element-citation></ref><ref id="CR27"><label>27.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Winch</surname><given-names>PJ</given-names></name><name><surname>Alam</surname><given-names>MA</given-names></name><name><surname>Akther</surname><given-names>A</given-names></name><name><surname>Afroz</surname><given-names>D</given-names></name><name><surname>Ali</surname><given-names>NA</given-names></name><name><surname>Ellis</surname><given-names>AA</given-names></name><collab>Bangladesh PROJAHNMO Study Group</collab><etal></etal></person-group><article-title>Local understandings of vulnerability and protection during the neonatal period in Sylhet District, Bangladesh: a qualitative study</article-title><source>Lancet</source><year>2005</year><volume>366</volume><issue>9484</issue><fpage>478</fpage><lpage>85</lpage><pub-id pub-id-type="doi">10.1016/S0140-6736(05)66836-5</pub-id><pub-id pub-id-type="pmid">16084256</pub-id></element-citation></ref><ref id="CR28"><label>28.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sharma</surname><given-names>S</given-names></name><name><surname>van Teijlingen</surname><given-names>E</given-names></name><name><surname>Hundley</surname><given-names>V</given-names></name><name><surname>Angell</surname><given-names>C</given-names></name><name><surname>Simkhada</surname><given-names>P</given-names></name></person-group><article-title>Dirty and 40 days in the wilderness: eliciting childbirth and postnatal cultural practices and beliefs in Nepal</article-title><source>BMC Pregnancy Childbirth</source><year>2016</year><volume>16</volume><issue>1</issue><fpage>147</fpage><pub-id pub-id-type="doi">10.1186/s12884-016-0938-4</pub-id><pub-id pub-id-type="pmid">27381177</pub-id></element-citation></ref><ref id="CR29"><label>29.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Upadhyay</surname><given-names>RP</given-names></name><name><surname>Rai</surname><given-names>SK</given-names></name><name><surname>Anand</surname><given-names>K</given-names></name></person-group><article-title>Community neonatal practices and its association with skilled birth attendance in rural Haryana, India</article-title><source>Acta Paediatr</source><year>2012</year><volume>101</volume><issue>12</issue><fpage>e535</fpage><lpage>9</lpage><pub-id pub-id-type="doi">10.1111/j.1651-2227.2012.02833.x</pub-id><pub-id pub-id-type="pmid">22928520</pub-id></element-citation></ref><ref id="CR30"><label>30.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Adejuyigbe</surname><given-names>EA</given-names></name><name><surname>Odebiyi</surname><given-names>AI</given-names></name><name><surname>Aina</surname><given-names>O</given-names></name><name><surname>Bamiwuye</surname><given-names>S</given-names></name></person-group><article-title>Feeding and care of low-birthweight babies in two rural communities in south-western Nigeria</article-title><source>Matern Child Nutr</source><year>2008</year><volume>4</volume><issue>1</issue><fpage>55</fpage><lpage>64</lpage><pub-id pub-id-type="doi">10.1111/j.1740-8709.2007.00101.x</pub-id><pub-id pub-id-type="pmid">18171407</pub-id></element-citation></ref><ref id="CR31"><label>31.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Darmstadt</surname><given-names>GL</given-names></name><name><surname>Hussein</surname><given-names>MH</given-names></name><name><surname>Winch</surname><given-names>PJ</given-names></name><name><surname>Haws</surname><given-names>RA</given-names></name><name><surname>Lamia</surname><given-names>M</given-names></name><name><surname>El-Said</surname><given-names>MA</given-names></name><etal></etal></person-group><article-title>Neonatal home care practices in rural Egypt during the first week of life</article-title><source>Trop Med Int Health</source><year>2007</year><volume>12</volume><issue>6</issue><fpage>783</fpage><lpage>97</lpage><pub-id pub-id-type="doi">10.1111/j.1365-3156.2007.01849.x</pub-id><pub-id pub-id-type="pmid">17550476</pub-id></element-citation></ref><ref id="CR32"><label>32.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Madhu</surname><given-names>K</given-names></name><name><surname>Chowdary</surname><given-names>S</given-names></name><name><surname>Masthi</surname><given-names>R</given-names></name></person-group><article-title>Breast feeding practices and newborn care in rural areas: a descriptive cross-sectional study</article-title><source>Indian J. Community Med.</source><year>2009</year><volume>34</volume><issue>3</issue><fpage>243</fpage><lpage>6</lpage><pub-id pub-id-type="doi">10.4103/0970-0218.55292</pub-id><pub-id pub-id-type="pmid">20049304</pub-id></element-citation></ref><ref id="CR33"><label>33.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Khadduri</surname><given-names>R</given-names></name><name><surname>Marsh</surname><given-names>DR</given-names></name><name><surname>Rasmussen</surname><given-names>B</given-names></name><name><surname>Bari</surname><given-names>A</given-names></name><name><surname>Nazir</surname><given-names>R</given-names></name><name><surname>Darmstadt</surname><given-names>GL</given-names></name></person-group><article-title>Household knowledge and practices of newborn and maternal health in Haripur district, Pakistan</article-title><source>J Perinatol</source><year>2008</year><volume>28</volume><issue>3</issue><fpage>182</fpage><lpage>7</lpage><pub-id pub-id-type="doi">10.1038/sj.jp.7211903</pub-id><pub-id pub-id-type="pmid">18059464</pub-id></element-citation></ref><ref id="CR34"><label>34.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Gul</surname><given-names>S</given-names></name><name><surname>Khalil</surname><given-names>R</given-names></name><name><surname>Yousafzai</surname><given-names>MT</given-names></name><name><surname>Shoukat</surname><given-names>F</given-names></name></person-group><article-title>Newborn care knowledge and practices among mothers attending pediatric outpatient clinic of a hospital in Karachi, Pakistan</article-title><source>Int J Health Sci (Qassim)</source><year>2014</year><volume>8</volume><issue>2</issue><fpage>167</fpage><lpage>75</lpage><pub-id pub-id-type="doi">10.12816/0006083</pub-id><pub-id pub-id-type="pmid">25246884</pub-id></element-citation></ref><ref id="CR35"><label>35.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Maródi</surname><given-names>L</given-names></name></person-group><article-title>Neonatal innate immunity to infectious agents</article-title><source>Infect Immun</source><year>2006</year><volume>74</volume><issue>4</issue><fpage>1999</fpage><lpage>2006</lpage><pub-id pub-id-type="doi">10.1128/IAI.74.4.1999-2006.2006</pub-id><pub-id pub-id-type="pmid">16552028</pub-id></element-citation></ref><ref id="CR36"><label>36.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Raza</surname><given-names>SA</given-names></name><name><surname>Akhtar</surname><given-names>S</given-names></name><name><surname>Avan</surname><given-names>BI</given-names></name><name><surname>Hamza</surname><given-names>H</given-names></name><name><surname>Rahbar</surname><given-names>MH</given-names></name></person-group><article-title>A matched case–control study of risk factors for neonatal tetanus in Karachi, Pakistan</article-title><source>J Postgrad Med</source><year>2004</year><volume>50</volume><issue>4</issue><fpage>247</fpage><lpage>51</lpage><pub-id pub-id-type="pmid">15623963</pub-id></element-citation></ref><ref id="CR37"><label>37.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Alhaji</surname><given-names>MA</given-names></name><name><surname>Bello</surname><given-names>MA</given-names></name><name><surname>Elechi</surname><given-names>HA</given-names></name><name><surname>Akuhwa</surname><given-names>RT</given-names></name><name><surname>Bukar</surname><given-names>FL</given-names></name><name><surname>Ibrahim</surname><given-names>HA</given-names></name></person-group><article-title>A review of neonatal tetanus in University of Maiduguri Teaching Hospital, North-eastern Nigeria</article-title><source>Niger Med J</source><year>2013</year><volume>54</volume><issue>6</issue><fpage>398</fpage><lpage>401</lpage><pub-id pub-id-type="doi">10.4103/0300-1652.126294</pub-id><pub-id pub-id-type="pmid">24665154</pub-id></element-citation></ref><ref id="CR38"><label>38.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Roper</surname><given-names>MH</given-names></name><name><surname>Vandelaer</surname><given-names>JH</given-names></name><name><surname>Gasse</surname><given-names>FL</given-names></name></person-group><article-title>Maternal and neonatal tetanus</article-title><source>Lancet</source><year>2007</year><volume>370</volume><issue>9603</issue><fpage>1947</fpage><lpage>59</lpage><pub-id pub-id-type="doi">10.1016/S0140-6736(07)61261-6</pub-id><pub-id pub-id-type="pmid">17854885</pub-id></element-citation></ref><ref id="CR39"><label>39.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Meegan</surname><given-names>ME</given-names></name><name><surname>Conroy</surname><given-names>RM</given-names></name><name><surname>Lengeny</surname><given-names>SO</given-names></name><name><surname>Renhault</surname><given-names>K</given-names></name><name><surname>Nyangole</surname><given-names>J</given-names></name></person-group><article-title>Effect on neonatal tetanus mortality after a culturally-based health promotion programme</article-title><source>Lancet</source><year>2001</year><volume>358</volume><issue>9282</issue><fpage>640</fpage><lpage>1</lpage><pub-id pub-id-type="doi">10.1016/S0140-6736(01)05787-7</pub-id><pub-id pub-id-type="pmid">11530155</pub-id></element-citation></ref><ref id="CR40"><label>40.</label><mixed-citation publication-type="other">Centers for Disease Control. Tetanus causes and transmission. <ext-link ext-link-type="uri" xlink:href="http://www.cdc.gov/tetanus/about/causes-transmission.html">http://www.cdc.gov/tetanus/about/causes-transmission.html</ext-link>. Accessed 24 Aug 2016.</mixed-citation></ref><ref id="CR41"><label>41.</label><mixed-citation publication-type="other">Agency for Toxic Substances and Disease Registry. Toxicological profile for used mineral-based crankcase oil. <ext-link ext-link-type="uri" xlink:href="http://www.atsdr.cdc.gov/toxprofiles/tp102.pdf">http://www.atsdr.cdc.gov/toxprofiles/tp102.pdf</ext-link>. Accessed 24 Aug 2016.</mixed-citation></ref><ref id="CR42"><label>42.</label><mixed-citation publication-type="other">Agency for Toxic Substances and Disease Registry. Toxicological profile for fuel oil. <ext-link ext-link-type="uri" xlink:href="http://www.atsdr.cdc.gov/toxprofiles/tp75.pdf">http://www.atsdr.cdc.gov/toxprofiles/tp75.pdf</ext-link>. Accessed 24 Aug 2016.</mixed-citation></ref><ref id="CR43"><label>43.</label><mixed-citation publication-type="other">National Pesticide Information Center. Boric acid general fact sheet. <ext-link ext-link-type="uri" xlink:href="http://npic.orst.edu/factsheets/boricgen.html">http://npic.orst.edu/factsheets/boricgen.html</ext-link>. Accessed 24 Aug 2016.</mixed-citation></ref><ref id="CR44"><label>44.</label><mixed-citation publication-type="other">University of Washington. UW Medicine Health Library: Boric acid for recurrent vaginal yeast infections. <ext-link ext-link-type="uri" xlink:href="http://www.uwmedicine.org/health-library/Pages/boric-acid-for-recurrent-vaginal-yeast-Infections.aspx">http://www.uwmedicine.org/health-library/Pages/boric-acid-for-recurrent-vaginal-yeast-Infections.aspx</ext-link>. Accessed 24 Aug 2016.</mixed-citation></ref><ref id="CR45"><label>45.</label><mixed-citation publication-type="other">National Pesticide Information Center. Pyriproxifen general fact sheet. <ext-link ext-link-type="uri" xlink:href="http://npic.orst.edu/factsheets/pyriprogen.html">http://npic.orst.edu/factsheets/pyriprogen.html</ext-link>. Accessed 24 Aug 2016.</mixed-citation></ref><ref id="CR46"><label>46.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mullany</surname><given-names>LC</given-names></name><name><surname>Darmstadt</surname><given-names>GL</given-names></name><name><surname>Khatry</surname><given-names>SK</given-names></name><name><surname>Katz</surname><given-names>J</given-names></name><name><surname>LeClerq</surname><given-names>SC</given-names></name><name><surname>Shrestha</surname><given-names>S</given-names></name><etal></etal></person-group><article-title>Topical applications of chlorhexidine to the umbilical cord for prevention of omphalitis and neonatal mortality in southern Nepal: A community-based, cluster-randomised trial</article-title><source>Lancet</source><year>2006</year><volume>367</volume><issue>9514</issue><fpage>910</fpage><lpage>18</lpage><pub-id pub-id-type="doi">10.1016/S0140-6736(06)68381-5</pub-id><pub-id pub-id-type="pmid">16546539</pub-id></element-citation></ref><ref id="CR47"><label>47.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Arifeen</surname><given-names>SE</given-names></name><name><surname>Mullany</surname><given-names>LC</given-names></name><name><surname>Shah</surname><given-names>R</given-names></name><name><surname>Mannan</surname><given-names>I</given-names></name><name><surname>Rahman</surname><given-names>SM</given-names></name><name><surname>Talukder</surname><given-names>MR</given-names></name><etal></etal></person-group><article-title>The effect of cord cleansing with chlorhexidine on neonatal mortality in rural Bangladesh: A community-based, cluster-randomised trial</article-title><source>Lancet</source><year>2012</year><volume>379</volume><issue>9820</issue><fpage>1022</fpage><lpage>28</lpage><pub-id pub-id-type="doi">10.1016/S0140-6736(11)61848-5</pub-id><pub-id pub-id-type="pmid">22322124</pub-id></element-citation></ref><ref id="CR48"><label>48.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Soofi</surname><given-names>S</given-names></name><name><surname>Cousens</surname><given-names>S</given-names></name><name><surname>Imdad</surname><given-names>A</given-names></name><name><surname>Bhutto</surname><given-names>N</given-names></name><name><surname>Ali</surname><given-names>N</given-names></name><name><surname>Bhutta</surname><given-names>ZA</given-names></name></person-group><article-title>Topical application of chlorhexidine to neonatal umbilical cords for prevention of omphalitis and neonatal mortality in a rural district of Pakistan: a community-based, cluster-randomised trial</article-title><source>Lancet</source><year>2012</year><volume>379</volume><issue>9820</issue><fpage>1029</fpage><lpage>36</lpage><pub-id pub-id-type="doi">10.1016/S0140-6736(11)61877-1</pub-id><pub-id pub-id-type="pmid">22322126</pub-id></element-citation></ref><ref id="CR49"><label>49.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Imdad</surname><given-names>A</given-names></name><name><surname>Mullany</surname><given-names>LC</given-names></name><name><surname>Baqui</surname><given-names>AH</given-names></name><name><surname>El Arifeen</surname><given-names>S</given-names></name><name><surname>Tielsch</surname><given-names>JM</given-names></name><name><surname>Khatry</surname><given-names>SK</given-names></name><etal></etal></person-group><article-title>The effect of umbilical cord cleansing with chlorhexidine on omphalitis and neonatal mortality in community settings in developing countries: a meta-analysis</article-title><source>BMC Public Health</source><year>2013</year><volume>13 Suppl 3</volume><fpage>S15</fpage><pub-id pub-id-type="doi">10.1186/1471-2458-13-S3-S15</pub-id><pub-id pub-id-type="pmid">24564621</pub-id></element-citation></ref><ref id="CR50"><label>50.</label><mixed-citation publication-type="other">World Health Organization. WHO Recommendations on Postnatal Care of the Mother and Newborn. 2013. <ext-link ext-link-type="uri" xlink:href="http://apps.who.int/iris/bitstream/10665/97603/1/9789241506649_eng.pdf">http://apps.who.int/iris/bitstream/10665/97603/1/9789241506649_eng.pdf</ext-link>. Accessed 24 Aug 2016.</mixed-citation></ref><ref id="CR51"><label>51.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Semrau</surname><given-names>K</given-names></name><name><surname>Herlihy</surname><given-names>J</given-names></name><name><surname>Grogan</surname><given-names>C</given-names></name><etal></etal></person-group><article-title>Effectiveness of 4% chlorhexidine umbilical cord care on neonatal mortality in Southern Province, Zambia (ZamCAT): a cluster-randomised controlled trial</article-title><source>Lancet Glob. Health</source><year>2016</year><volume>4</volume><issue>11</issue><fpage>e827</fpage><lpage>e836</lpage><pub-id pub-id-type="doi">10.1016/S2214-109X(16)30215-7</pub-id><pub-id pub-id-type="pmid">27693439</pub-id></element-citation></ref><ref id="CR52"><label>52.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sazawal</surname><given-names>S</given-names></name><name><surname>Dhingra</surname><given-names>U</given-names></name><name><surname>Ali</surname><given-names>SM</given-names></name><etal></etal></person-group><article-title>Efficacy of chlorhexidine application to umbilical cord on neonatal mortality in Pemba, Tanzania: a community-based randomised controlled trial</article-title><source>Lancet Glob. Health</source><year>2016</year><volume>4</volume><issue>11</issue><fpage>e837</fpage><lpage>e844</lpage><pub-id pub-id-type="doi">10.1016/S2214-109X(16)30223-6</pub-id><pub-id pub-id-type="pmid">27693438</pub-id></element-citation></ref><ref id="CR53"><label>53.</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Glanz</surname><given-names>K</given-names></name><name><surname>Rimer</surname><given-names>BK</given-names></name><name><surname>Viswanath</surname><given-names>K</given-names></name></person-group><source>Health behavior and health education: theory, research, and practice</source><year>2008</year><edition>4</edition><publisher-loc>San Francisco</publisher-loc><publisher-name>Jossey-Bass</publisher-name></element-citation></ref><ref id="CR54"><label>54.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Alam</surname><given-names>MA</given-names></name><name><surname>Ali</surname><given-names>NA</given-names></name><name><surname>Sultana</surname><given-names>N</given-names></name><name><surname>Mullany</surname><given-names>LC</given-names></name><name><surname>Teela</surname><given-names>KC</given-names></name><name><surname>Khan</surname><given-names>NU</given-names></name><etal></etal></person-group><article-title>Newborn umbilical cord and skin care in Sylhet District, Bangladesh: implications for the promotion of umbilical cord cleansing with topical chlorhexidine</article-title><source>J Perinatol</source><year>2008</year><volume>28</volume><issue>Suppl 2</issue><fpage>S61</fpage><lpage>8</lpage><pub-id pub-id-type="doi">10.1038/jp.2008.164</pub-id><pub-id pub-id-type="pmid">19057570</pub-id></element-citation></ref><ref id="CR55"><label>55.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ayaz</surname><given-names>A</given-names></name><name><surname>Saleem</surname><given-names>S</given-names></name></person-group><article-title>Neonatal mortality and prevalence of practices for newborn care in a squatter settlement of Karachi, Pakistan: a cross-sectional study</article-title><source>PLoS One</source><year>2010</year><volume>5</volume><issue>11</issue><fpage>e13783</fpage><pub-id pub-id-type="doi">10.1371/journal.pone.0013783</pub-id><pub-id pub-id-type="pmid">21072175</pub-id></element-citation></ref><ref id="CR56"><label>56.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Callaghan-Koru</surname><given-names>JA</given-names></name><name><surname>Seifu</surname><given-names>A</given-names></name><name><surname>Tholandi</surname><given-names>M</given-names></name><name><surname>de Graft-Johnson</surname><given-names>J</given-names></name><name><surname>Daniel</surname><given-names>E</given-names></name><name><surname>Rawlins</surname><given-names>B</given-names></name><etal></etal></person-group><article-title>Newborn care practices at home and in health facilities in 4 regions of Ethiopia</article-title><source>BMC Pediatr</source><year>2013</year><volume>13</volume><fpage>198</fpage><pub-id pub-id-type="doi">10.1186/1471-2431-13-198</pub-id><pub-id pub-id-type="pmid">24289501</pub-id></element-citation></ref><ref id="CR57"><label>57.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Falle</surname><given-names>TY</given-names></name><name><surname>Mullany</surname><given-names>LC</given-names></name><name><surname>Thatte</surname><given-names>N</given-names></name><name><surname>Khatry</surname><given-names>SK</given-names></name><name><surname>LeClerq</surname><given-names>SC</given-names></name><name><surname>Darmstadt</surname><given-names>GL</given-names></name><etal></etal></person-group><article-title>Potential role of traditional birth attendants in neonatal healthcare in rural southern Nepal</article-title><source>J Health Popul Nutr</source><year>2009</year><volume>27</volume><issue>1</issue><fpage>53</fpage><lpage>61</lpage><pub-id pub-id-type="pmid">19248648</pub-id></element-citation></ref><ref id="CR58"><label>58.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ghosh</surname><given-names>R</given-names></name><name><surname>Sharma</surname><given-names>AK</given-names></name></person-group><article-title>Intra- and inter-household differences in antenatal care, delivery practices and postnatal care between last neonatal deaths and last surviving children in a peri-urban area of India</article-title><source>J Biosoc Sci</source><year>2010</year><volume>42</volume><issue>4</issue><fpage>511</fpage><lpage>30</lpage><pub-id pub-id-type="doi">10.1017/S0021932010000040</pub-id><pub-id pub-id-type="pmid">20202272</pub-id></element-citation></ref><ref id="CR59"><label>59.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Gilani</surname><given-names>I</given-names></name><name><surname>Kayani</surname><given-names>ZA</given-names></name></person-group><article-title>Household practices of mothers regarding neonatal care in rural & urban settings of the capital district of Azad Jammu & Kashmir</article-title><source>Rural Remote Health</source><year>2014</year><volume>14</volume><fpage>2503</fpage><pub-id pub-id-type="pmid">24702463</pub-id></element-citation></ref><ref id="CR60"><label>60.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Grant</surname><given-names>E</given-names></name><name><surname>Munube</surname><given-names>D</given-names></name><name><surname>Lumala</surname><given-names>P</given-names></name><name><surname>Sentongo</surname><given-names>SA</given-names></name><name><surname>Dodds</surname><given-names>L</given-names></name><name><surname>Bortolussi</surname><given-names>R</given-names></name><etal></etal></person-group><article-title>Neonatal deaths and umbilical cord care practices in Luweero district, Uganda</article-title><source>Paediatr. Child Health</source><year>2014</year><volume>19</volume><issue>6</issue><fpage>333</fpage><pub-id pub-id-type="pmid">25332664</pub-id></element-citation></ref><ref id="CR61"><label>61.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Jennings</surname><given-names>L</given-names></name><name><surname>Yebadokpo</surname><given-names>A</given-names></name><name><surname>Affo</surname><given-names>J</given-names></name><name><surname>Agbogbe</surname><given-names>M</given-names></name></person-group><article-title>Use of job aids to improve facility-based postnatal counseling and care in rural Benin</article-title><source>Matern Child Health J</source><year>2015</year><volume>19</volume><issue>3</issue><fpage>557</fpage><lpage>65</lpage><pub-id pub-id-type="doi">10.1007/s10995-014-1537-5</pub-id><pub-id pub-id-type="pmid">24916207</pub-id></element-citation></ref><ref id="CR62"><label>62.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Karas</surname><given-names>DJ</given-names></name><name><surname>Mullany</surname><given-names>LC</given-names></name><name><surname>Katz</surname><given-names>J</given-names></name><name><surname>Khatry</surname><given-names>SK</given-names></name><name><surname>LeClerq</surname><given-names>SC</given-names></name><name><surname>Darmstadt</surname><given-names>GL</given-names></name><etal></etal></person-group><article-title>Home care practices for newborns in rural southern Nepal during the first 2 weeks of life</article-title><source>J Trop Pediatr</source><year>2012</year><volume>58</volume><issue>3</issue><fpage>200</fpage><lpage>7</lpage><pub-id pub-id-type="doi">10.1093/tropej/fmr057</pub-id><pub-id pub-id-type="pmid">21705765</pub-id></element-citation></ref><ref id="CR63"><label>63.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kesterton</surname><given-names>AJ</given-names></name><name><surname>Cleland</surname><given-names>J</given-names></name></person-group><article-title>Neonatal care in rural Karnataka: healthy and harmful practices, the potential for change</article-title><source>BMC Pregnancy Childbirth</source><year>2009</year><volume>9</volume><fpage>20</fpage><pub-id pub-id-type="doi">10.1186/1471-2393-9-20</pub-id><pub-id pub-id-type="pmid">19457266</pub-id></element-citation></ref><ref id="CR64"><label>64.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kumar</surname><given-names>V</given-names></name><name><surname>Mohanty</surname><given-names>S</given-names></name><name><surname>Kumar</surname><given-names>A</given-names></name><name><surname>Misra</surname><given-names>RP</given-names></name><name><surname>Santosham</surname><given-names>M</given-names></name><name><surname>Awasthi</surname><given-names>S</given-names></name><collab>Saksham Study Group</collab><etal></etal></person-group><article-title>Effect of community-based behaviour change management on neonatal mortality in Shivgarh, Uttar Pradesh, India: a cluster-randomised controlled trial</article-title><source>Lancet</source><year>2008</year><volume>372</volume><issue>9644</issue><fpage>1151</fpage><lpage>62</lpage><pub-id pub-id-type="doi">10.1016/S0140-6736(08)61483-X</pub-id><pub-id pub-id-type="pmid">18926277</pub-id></element-citation></ref><ref id="CR65"><label>65.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mangwi Ayiasi</surname><given-names>R</given-names></name><name><surname>Kolsteren</surname><given-names>P</given-names></name><name><surname>Batwala</surname><given-names>V</given-names></name><name><surname>Criel</surname><given-names>B</given-names></name><name><surname>Orach</surname><given-names>CG</given-names></name></person-group><article-title>Effect of village health team home visits and mobile phone consultations on maternal and newborn care practices in Masindi and Kiryandongo, Uganda: a community-intervention trial</article-title><source>PLoS One</source><year>2016</year><volume>11</volume><issue>4</issue><fpage>e0153051</fpage><pub-id pub-id-type="doi">10.1371/journal.pone.0153051</pub-id><pub-id pub-id-type="pmid">27101379</pub-id></element-citation></ref><ref id="CR66"><label>66.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Memon</surname><given-names>ZA</given-names></name><name><surname>Khan</surname><given-names>MI</given-names></name><name><surname>Soofi</surname><given-names>S</given-names></name><name><surname>Muhammad</surname><given-names>S</given-names></name><name><surname>Bhutta</surname><given-names>ZA</given-names></name></person-group><article-title>A cross sectional survey of newborn care practices in rural Sindh, Pakistan: implications for research and policy</article-title><source>J Neonatal Perinatal Med</source><year>2013</year><volume>6</volume><issue>2</issue><fpage>137</fpage><lpage>44</lpage><pub-id pub-id-type="pmid">24246516</pub-id></element-citation></ref><ref id="CR67"><label>67.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mullany</surname><given-names>LC</given-names></name><name><surname>Darmstadt</surname><given-names>GL</given-names></name><name><surname>Katz</surname><given-names>J</given-names></name><name><surname>Khatry</surname><given-names>SK</given-names></name><name><surname>LeClerq</surname><given-names>SC</given-names></name><name><surname>Adhikari</surname><given-names>RK</given-names></name><name><surname>Tielsch</surname><given-names>JM</given-names></name></person-group><article-title>Risk factors for umbilical cord infection among newborns of southern Nepal</article-title><source>Am J Epidemiol</source><year>2007</year><volume>165</volume><issue>2</issue><fpage>203</fpage><lpage>11</lpage><pub-id pub-id-type="doi">10.1093/aje/kwj356</pub-id><pub-id pub-id-type="pmid">17065275</pub-id></element-citation></ref><ref id="CR68"><label>68.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sreeramareddy</surname><given-names>CT</given-names></name><name><surname>Joshi</surname><given-names>HS</given-names></name><name><surname>Sreekumaran</surname><given-names>BV</given-names></name><name><surname>Giri</surname><given-names>S</given-names></name><name><surname>Chuni</surname><given-names>N</given-names></name></person-group><article-title>Home delivery and newborn care practices among urban women in western Nepal: a questionnaire survey</article-title><source>BMC Pregnancy Childbirth</source><year>2006</year><volume>6</volume><fpage>27</fpage><pub-id pub-id-type="doi">10.1186/1471-2393-6-27</pub-id><pub-id pub-id-type="pmid">16928269</pub-id></element-citation></ref><ref id="CR69"><label>69.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Waiswa</surname><given-names>P</given-names></name><name><surname>Peterson</surname><given-names>S</given-names></name><name><surname>Tomson</surname><given-names>G</given-names></name><name><surname>Pariyo</surname><given-names>GW</given-names></name></person-group><article-title>Poor newborn care practices – a population based survey in eastern Uganda</article-title><source>BMC Pregnancy Childbirth</source><year>2010</year><volume>10</volume><fpage>9</fpage><pub-id pub-id-type="doi">10.1186/1471-2393-10-9</pub-id><pub-id pub-id-type="pmid">20178626</pub-id></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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