Participants’ Profile
A total of six FGDs were conducted using the FGD guide. The minimum and maximum age of respondents was 17 and 82 years respectively with a mean age of 36.7±12.7 years. Majority of the participants were farmers and completed their primary education.
Common Signs and Symptoms of common neonatal illnesses
The participants reported that neonatal illnesses can present in two forms; mild and severe forms. Most common features of the mild illnesses reported were fever and crying excessively, refusal of feeds (breast milk or any other food item), jaundice, weakness, vomiting and frequent passage of loose stools as well as. The severe ones were breathlessness/difficult or fast breathing, convulsion and draining of pus from the umbilicus. Majority of the participants were of the opinion that a caregiver will almost always know when a neonate is ill and that once treated, the baby responds and begins to accept food normally.
Perception of common neonatal illnesses
Jaundice: Popularly called ‘iba ocha na anya” (yellowness of the eyes). This occurs normally in neonates born to mothers with febrile illness during pregnancy and also in premature babies. For majority of the caregivers, this is a common presentation and usually nothing to worry about as it resolves within some days.
However, some mothers disagreed with this. One of the caregivers said,
“ jaundice should not be toyed with. It can cause convulsion in children and in severe cases, death.”
Umbilical redness or drainage of pus: It was generally reported that umbilical redness or drainage of pus is due to lack of care of the umbilical area and as such; it begins to smell, draining pus and the child can get febrile. In addition, a caregiver responded thus,
“neonates develop umbilical redness or pus draining from the umbilicusbecause they are circumcised without checking if they have jaundice as jaundice prevents healing of the umbilical cord.”
Eye discharge: The caregivers know that a child with discharge from the eyes is unwell. One of the caregivers opined that eye discharge is as a result of neonatal jaundice. Another caregiver corroborated this view as she recalled her experience few days after the birth of one of her children,
“when my child presented with eye discharge, I was advised to expose the child under the sun and the eye discharge stopped after some days.”
Another mother suggested that eye discharge could be as a result of application of local eye-liner; ‘otanjele’ on the child. According to her, the eye-liner is applied to help the baby have clear and bright eyes all his/her life and that also for beautification as it makes the eyes of the baby look sharp.
Skin disorders: Two common skin presentations reported in newborns were skin rashes and skin discolouration. Body rashes in children which commonly appear within one week after birth and is popularly known as ‘oku rice’; these rashes resemble burns sustained from boiling rice hence its name. The other symptom, hypo-pigmentation is known as ‘nlacha’ (seborrhaeic dermatitis). It presents first on the face and chest and occasionally spreads to the other parts of the body. An elderly caregiver reported thus,
“most children are born with ‘nlacha’. Whatever causes it is domicile in their mothers’ wombs. There is nothing much you can do to prevent this in these children.”
Failure to thrive (Nta): Another neonatal illness is ‘nta’. For the caregivers, an infant with a normal appetite who instead of gaining weight; is continuously losing weight (failure to thrive) has ‘nta’. This, the caregivers say is common in their communities and is easily identified by the elderly mothers. This disorder the participants claim is transmissible. Though there are no obvious signs or symptoms in adults, the mother can be a carrier thereby infecting other children when she carries them.
Depressed fontanelle (Ntiwa isi): Another presentation is ‘ntiwa isi’ (sunken or depressed anterior or posterior fontanelle). For the caregivers, there is something breathing inside the head which is another sign of illness in the baby. Babies with such depressions are irritable, lose weight and have slow developments (failure-to-thrive). The participants believe that this is not a normal occurrence and wondered why only children born to mothers in rural areas have this opening on their skulls. One mother said she was told it occurs if the mother was not adequately hydrated during pregnancy. Another caregiver proposes that this could also be a sign that the child’s head is not well formed.
Convulsion: Majority of the participants were opined that convulsion in neonates result following untreated febrile conditions. In rare cases, there might not be any fever as the fever is said to be ‘hidden’ yet capable of triggering fits in these babies. For some caregivers, convulsion is believed to be caused by presence of evil spirits that come around to harm babies. This they claim is why most episodes occur at night when the presence of these supernatural beings is vividly felt.
Breathlessness: If a child is breathless, it means the child has caught some cold. The child has not been covered well by the mother. It usually occurs with cough in neonates.
Management of common neonatal illnesses
The caregivers’ perception of management varied. It ranged from the use of local remedies to the use of orthodox medications. While some were of the opinion that these illnesses could be managed with unorthodox treatments, others perceived the need to visit the health centres for medical care.
Fever: For the caregivers, it is normal for a child to have fever occasionally. If a child has fever, a mother said she would use cold water to clean the baby’s body and expose the baby adequately. This controls the fever in some cases. Majority of the caregivers were of the opinion that giving the febrile child paracetamol (an analgesic) will combat the fever. Another mother said that palm kernel oil known as ‘enuaku’ can be applied on the body and also given orally to the child. It helps combat the fever. If the fever persists, it was generally recommended that the baby be taken to the health center.
Jaundice: When a child has jaundice, he/she should not be circumcised as it will make the jaundice linger more than expected. For majority of the rural dwellers, yellowness of the eyes can be managed at home. For one of the caregivers,
“Children with yellowness of the eyes are kept under the early morning sun; preferably before 10am daily till the yellowness of eyes clears. The child is also given glucose water and Abidec (a popular multivitamin) to clear the jaundice.”
However, if the symptom persists after a week, the caregivers echoed that the child is taken to the hospital. Occasionally they take the children to the maternities where they were born for immediate treatment.
“The nurses manage such cases but if severe, they know when to refer to health centers. “
They all said they don’t take the jaundiced children to TBAs because they believe they are no competent enough to manage such cases;
“no one wants to risk the life of her child,” a mother reported.
Convulsion: Convulsion has different causes. The causative factor determines how it is managed. Those caused by evil spirits can be managed at home. To drive away these evil spirits, topical local ointments are effective. Highly recommended is ‘enuaku’ as the smell repulses evil spirits. To make this local ointment more effective, the mothers recommend it is mixed together with ginger, garlic and dried ‘scent leaves’.
To manage convulsions resulting from febrile illnesses, a caregiver responded thus,
“first and foremost when a baby has fever, you have to apply the local remedy which reduces fever thereby preventing convulsion. Afterwards you can go ahead and find out the cause of the fever. These local ointments should be a household item for every woman within the childbearing age for emergency situations. They prevent and treat febrile convulsion in children. This practice is unknown to the orthodox health practitioners and is effective.“
Once a caregiver notices twitches with fixation of eyes or convulsions in the child, she immerses the child in a basin of cold water. This is a common practice. A mother’s recommendation is that,
“You will have to immerse the child in cold water. Once the baby passes faeces, it means the convulsion has subsided. After this, you will start applying ‘enuaku’ on the body of the child as it abates convulsion.”
A caregiver recalled an incident that happened in the community years back; a woman in a bid to manage neonatal convulsion placed the sole of the baby’s feet over flames of fire. Accidentally, the child while convulsing fell into the fire and died from the burns. After that incident she said, the use of flames of fire to manage convulsion in children is discouraged.
Umbilical redness or drainage of pus: it was generally reported that proper care of the umbilical cord will prevent this presentation. It was suggested that it could be a sign that the umbilicus is infected. On means of caring for the umbilical region, a caregiver responded,
“you have to use hot water on the region while bathing the child morning and night. Clean with methylated sprit about three times daily and apply Vaseline (a popular brand of mineral oils and petroleum jelly) on it. Such care will ensure the umbilicus is clean and prevent poor healing of the umbilical cord.”
For another caregiver, adequate management of jaundice before circumcision is recommended to avert this condition. She said,
“if jaundice is not well managed, it affects the entire body and results in poor healing of the umbilicus.”
It was generally recommended that a child with an umbilicus that is healing poorly or draining pus should be taken back to the health facility.
Eye discharge: To clear eye discharge, the application of mothers breast milk while breastfeeding the child was a popular opinion. Other recommendations include; fresh palmwine and sugar solution as eye drops. However, a young mother said these practices were condemned by health care workers during one of her visits to a health centre. She said her baby was placed on cordliver oil and Abidec (multivitamin syrup) which the healthcare worker claimed would keep the baby’s eyes cleared for life.
While several caregivers recommended the use of local eye liner ‘otanjele’ for management of abnormal eye discharge, a mother recounted her ordeal with its application. In order to beautify her child with the eyeliner as was popular in the setting, her child developed yellowish eye discharge which she attributed to how the ‘otanjele’ was applied to her eyes,
“perhaps during application of the local eye liner, the eye was traumatized resulting in the discharge. I can’t really say what happened. All I know is that my child had difficulty opening one of her eyes with yellowish fluid coming out of it and I had to discontinue application of the eye liner,” she said.
She recollected that the eye cleared without any intervention after three days.
Skin disorders: To manage body rashes, it is popularly recommended that you use warm ‘rice water’ to bathe the child for about three days to one week. Further probing reveals the ‘rice water’ is obtained after sieving boiled rice. This normally clears the rashes within days; unless there are underlying illnesses the mother transmitted to the child while in the womb. Another mother resorted to orthodox practice,
“with recent developments in medicine, it is no longer trendy to use the ‘rice water’. The baby continues to have rice odour throughout that period which is not nice. There are ointments which also clear the rashes like ‘vista-plus’ (contains Clotrimazole, Beclomethasone dipropionate and Gentamicin) , ‘nixoderm’(sulphur ointment) and ‘smuth cream’ (Calcium Dobesilate, Hydrocortisone, Lidocaine and Zinc).”
To treat the seborrheic dermatitis ‘nlacha’, a caregiver recommends this concoction,
“use local seeds known as ‘akiriso' (Guizotia abyssinica). After grinding it, mix with ashes and potash. It clears the dermatitis within days.”
Failure to thrive (Nta): Herbal leaves are used in the management of this disorder. The elderly women claim to make early diagnosis of this ailment. A grandmother recommends that special local herbs (leaves) are ground and applied on the child’s skin.
“With daily application of this herb, goat-like hairs will be seen coming out the child’s body. These hairs reduce over the days. As this process is ongoing the weight of the child improves gradually till the hairs do not appear at all during application of the herbs,” said the grandmother.
To prevent person-to-person transmission, it is recommended that the primary caregiver also applies the herbs on her own body to ensure she doesn’t contract this ailment.
Depressed fontanelle (Ntiwa isi): Once this is observed, the child it taken to herbalists who applies a semi-solid substance to cap the fontanelle. An elderly caregiver responds thus,
“There is a dedicated herbalist who specialises in managing this in our setting. Not all herbalists know how to do this. The topical medication applied on the opening stops the breathing. This substance is expected to stick to the fontanelle till the ailment heals which can take weeks”.
Breathlessness: To manage this, it was generally recommended that thicker clothing is used to cover the child. Other home remedies include massaging with towel and hot water (hot enough for the mother to immerse her hand in), application of Robb ointment which warms up the baby and relaxes the fast breathing. For another caregiver, nothing works as fast as applying local ointment,
‘if you want the breathing to normalise as fast as possible, apply ‘enuaku’ to the feet of the child and place the feet by the fire for a while.”