CASE REPORT

Niger J Paed 2015; 42 (2):151 –153

Peterside O

Duru CO

Anene N

Harmful traditional practices in a

newborn: A case report

DOI:http://dx.doi.org/10.4314/njp.v42i2.16

Accepted: 17th November 2014

2

Abstract: Ninetynine percent of

practices on newborn health . We

herein present a case of an eight-

een day old female who was

rushed to the hospital with severe

wasting, recto-vaginal prolapse

and septic umbilical cord resulting

from repeated traditional homecare

practices by her mother and grand-

mother. This case highlights the

impact of harmful traditional home

care practices on newborn health

and emphasizes the urgent need

for public enlightenment cam-

paigns and other policy decisions

and interventions aimed at reduc-

ing this societal menace.

the nearly four million newborn

deaths occur in developing coun-

tries with newborn deaths remain-

ing relatively invisible and

(

)

Peterside O

Duru CO, Anene N

Department of Paediatrics and Child

Health, Niger Delta University

Teaching Hospital, Okolobiri,

Bayelsa State, Nigeria.

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neglected . In these countries,

traditional attitudes and practices

dominate newborn care and are

Email: docolyemen@yahoo.com

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often harzadous . As most births

and newborn deaths in developing

countries occur outside health

care facilities, a reduction in neo-

natal mortality may depend

significantly on interventions

involving adaptation of traditional

care ₃ behaviours practiced at

home . However, despite the im-

portance of traditional practices in

the newborn period, little is

known about the impact of these

Keywords: Harmful traditional

practices, newborn, neonatal

morbidity, neonatal mortality

Introduction

grammes to reduce this societal menace which will ulti-

mately improve neonatal and infant survival rates.

Neonatal mortality which accounts for about two thirds

of infant mortality is a useful indicator of the socioeco-

nomic development of an area . Insufficient pre, peri

Case

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and post natal care negatively affects child health espe-

cially in developing countries . Though ninety nine per-

AB was an 18 day old female rushed by father and Pa-

ternal Aunt into the children emergency ward of the

Niger Delta University Teaching Hospital with com-

plaints of abdominal swelling since birth, recurrent sei-

zures of ten days duration, inability to suck of nine days,

inability to pass stool of seven days, protrusion of the

umbilicus, vagina and rectum of two days duration and

fast breathing which started six hours prior to presenta-

tion.

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cent of the nearly four million new born deaths occur in

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developing countries . Until the twenty first century,

newborn health was virtually absent from policies, pro-

1

grammes and research in these countries .

Culture is considered a dynamic factor which plays an

important role in health and disease with cultural values,

attitudes, beliefs and behaviours affecting lifestyle and

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health . Some traditional practices are harmful to the

Abdominal swelling was said to be initially more on the

left side but gradually progressed to involve the entire

abdomen. She passed meconium on the first day of life

and thereafter had a normal bowel opening of about

twice daily. Seizures were generalized tonic clonic in

nature, each episode lasted for about five minutes and

aborted spontaneously. She had about two epis_to_h des per

day with no loss of consciousness. On the 10 day of

life, she stopped sucking from her mother’s breast and

only accepted feeds from a feeding bottle until a day

prior to presentation when she stopped feeding alto-

gether. Seven days prior to presentation, she was noticed

to have stopped passing stool which necessitated mater-

nal grandmother to commence abdominal massage

child because they constitute physical and mental abuse

of children and are deleterious both to the individual as

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well as_,₈the process of national development . Several

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studies have shown that some traditional neonatal care

practices which vary with culture may cause infections,

anaemia, hypothermia and hypoglycaemia thus increas-

ing the risk of morbidity and mortality in this age group.

In developing countries like Nigeria, traditional attitudes

and practices dominate newborn care and are often haz-

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ardous . We hereby present a case of a female neonate

who was a victim of harmful traditional practices which

resulted in severe morbidity and eventual mortality. This

case highlights the urgent need for intervention pro-

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which resulted to progressive recto-vaginal prolapse.

Fast breathing was noticed after she was forcefully fed

with a cup and spoon. There was no history of bluish

discoloration of the body. On systemic review, there was

weight loss, reduced urinary output and vomiting.

She was managed as a case of overwhelming sepsis with

failure to thrive, aspiration pneumonia, septic umbilical

hernia and gangrenous recto-vaginal prolapse. Results of

serum electrolytes, urea and creatinine showed hypona-

tremia of 123mmol/l, hyperkalaemia of 13.1mmol/l,

uraemia of 36.5mmol/l and raised creatinine of 451u-

mol/l. Full blood count showed a normal packed cell

volume of 48% with leukocytosis of 17.5 x 10 /L. Her

random blood sugar was normal and she was non-

reactive to rapid HIV test.

Symptoms were initially managed at home with several

episodes of abdominal massage, administration of sev-

eral water based concoctions and incisions on the face

and abdomen. She was also given several unknown

drugs bought over the counter and ground red pepper

was applied to the umbilicus daily. When her condition

continued to deteriorate, father decided to bring her to

the hospital.

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The protruded organs were dressed with normal saline,

she was placed on intranasal oxygen, intravenous ceftri-

azone and metronidazole and a nasogastric tube was

passed and retained to decompress the abdomen. Anti-

tetanus serum was prescribed but was not given as par-

ents did not provide the drug prior to her demise. She

was reviewed by the surgeons who made the same diag-

nosis and planned surgery when she was more stable. A

fluid challenge was also done but she still failed to make

urine. Her clinical condition remained poor until she

died after 13 hours 45 minutes of admission.

Pregnancy was unsupervised and uneventful. Delivery

was at term, supervised by a traditional birth attendant.

She was initially on breast milk and water until the tenth

day of life when infant formula was commenced. She

was fed with about 30 to 40mls of infant formula three

times daily. Feeds were diluted with unboiled rain water.

She was the first child of unmarried parents. Her mother

is a 17 year old SS3 student while father is a 21 year old

commercial motor cyclist with secondary level of educa-

tion.

Discussion

On examination, she was wasted with prominent ribs,

and zygomatic bone as well as loss of subcutaneous fat

This case highlights the negative impact of harmful tra-

ditional practices on neonatal morbidity and mortality.

The harmful traditional practices in the index case in-

cluded abdominal massage, administration of herbal

concoctions, scarification marks and unsterile umbilical

cord care. This is similar to findings by Darmstadt and

(

fig 1). She was in respiratory distress, febrile with fresh

scarification marks on her face, trunk and abdomen. She

was dehydrated with a dry buccal mucosa. Her weight

was 1.65kg, occipitofrontal circumference 32cm, length

4

5cm.

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Saha who reported that more than 96% of caregivers

She was lethargic, had neck stiffness with fisting and

global hypertonia. She also had tachypnea and tachycar-

dia. There was abdominal distension with prominent

veins and an inflamed umbilical hernia (fig 1). The ab-

domen was tense and the organs were difficult to pal-

pate. There was protrusion of the rectum and vagina

with necrosis of the rectal mucosa (fig 2).

interviewed at Dhaka Shishu hospital and Matlab Health

Complex both in Bangladesh practiced oil massage on

their newborns irrespective of so₀cio-economic status and

1

place of residence. Akcan et al in Turkey also reported

a case of a five year old mentally retarded boy who died

from duodenal perforation as a result of blunt abdominal

trauma and ingestion of concoctions given to him by his

father and step-mother.

Fig 1: Wasting (loss

of subcutaneous fat)

with inflamed um-

bilicus

Similar to the scarifications given to the index case,

Beser et al reported that a quarter of mothers of infants

3

in Izmir, Western Turkey, cut their babies noses, backs

of ears, backs or limbs in order to cure jaundice. Opara

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et al reported that 62.4% of mothers attending three

health centres in Yenagoa, Southern Nigeria practiced

unhygienic cord care which included application of a₂nti-

1

biotic ointments and herbs. Joel-Madewase et al in

Osogbo, Western Nigeria, reported harmful cord care

practices to include fomentation with hot water, lantern,

and knife as well as application of menthol containing

Fig 2: Prolapsed

vagina and rectum

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creams. Thakur and Kumar also reported that 74% of

mothers in Ganda community, India applied paste of

mustard oil and turmeric powder on their babies umbili-

cal stumps.

Since the mother and grandmother who were caring for

the index case did not present to the hospital, their

reasons for using the earlier mentioned care practices

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53

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were not ascertained. Damstadt and Saha however

care givers is also suggestive of child abuse . Rather it

was her father and Aunt who visited and subsequently

rushed her to the hospital when they noticed her poor

clinical state.

reported perceived benefits of infant massage among

their subjects as being p₁revention of infections and hy-

1

pothermia. Opara et al reported low maternal educa-

tion, delivery outside health facilities and low parental

social class to be significantly associat₂ed with unsterile

1

cord care while Joel-Madewase et al identified igno-

rance as the number one reason given by their subjects

for poor cord care. These reasons may be applicable to

the index case who was born into a low socio-economic

household with an un-married teenage mother with in-

complete secondary education and delivery which was

supervised by a traditional birth attendant who may have

very lit₁t₃le knowledge of umbilical cord care. Ofili and

Okojie carried out a study to assess the role of tradi-

tional birth attendants in maternal health care in Oredo,

Edo State, Nigeria. Preparations used for umbilical cord

care by these traditional birth attendants included methy-

lated spirit, herbal concoctions, animal dung, flies, cow

urine, dry heated sand and engine oil. The influence of

the maternal grandmother in the index case also, cannot

be overemphasized as she was the one who repeatedly

performed abdominal massage in spite of all the compli-

cations that arose.

Conclusion

Traditional practices have been found to dominate

newborn care in developing countries . While some of

these practices may not have any harmful effect on

health, others do . Mothers not equipped with sufficient

knowledge about child care who use traditional child

care methods may cause harm to their childrens health .

It is therefore recommended that these practices should

be investigated, the useful ones should be preserved

while the harmful ones should be discarded. There is an

urgent need to educate mothers and other key family

members on early neonatal care. The roles of commu-

nity health actors such as mothers, mothers-in-law, hus-

bands, and traditional birth attendants should be taken

into consideration in intervention programmes. There is

also need for intervention programmes like provision of

health facilities in rural areas as well as employment of

more health workers to man these facilities. The role of

female education and poverty alleviation cannot be over-

emphasized.

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The index case brings to attention harmful traditional

child care practices which constitute physical abuse of

children. Common risk factors for child abuse in the

index case included low socio-econ₁₄o_-₁m₅ ic class, un-

married parents, and a teenage mother

. The fact that

Conflict of interest: None

Funding: None

the child was not brought to the hospital by her primary

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