Understanding newborn hygiene practices in the home and community in rural Cambodia

Purpose: Cambodia is unlikely to meet its Millennium Development Goal target of 12 newborn deaths/1,000 live births by 2015 given that the newborn mortality rate has plateued and is 40/1,000 in certain areas. Formative research was conducted at community and first level facility (health center) to ascertain the underlying behavioral and sociocultural aspects that contribute to newborn survival. Particularly of interest were hygiene practices around birth in facility and referral to higher level care of ill newborns.

Methods: A rapid ethnographic approach was used and consisted of semistructured interviews, focus group discussions and observation with health center staff, families of infants, and Village Health Support Group volunteers.

Results: We found barriers to optimal hygiene and sanitation in the Health Center and home environment; suboptimal Health Center staff practices in hygiene and recognizing danger signs for newborn illness; families unable to recognize danger signs of newborn illness; and barriers to care seeking for newborns in the community.

Conclusion: Behavioral interventions which aim to reduce newborn mortality in the context of first level facility births should 1) include community-to-facility linked referral systems and 2) focus on creating an enabling environment for optimal hygiene practices such as handwashing by anyone coming into contact with the newborn, laundering of linens used for newborns, and clean birth practices.