Abstract
Background
Unsafe traditional practices are performed in different societies, especially in developing countries, owing to poverty and low levels of education. Traditional practices are usually derived from the relationship between the environment and human attitudes toward nature. Some traditional practices originate from religious beliefs, cultures, or relatives advising new mothers.
Objectives
To identify the types of unsafe traditional practices, understand the factors influencing their prevalence, and explore the potential consequences of these practices on newborn health.
Methods
This descriptive, correlational study included 200 newborns whose mothers visited primary healthcare centers in Baghdad City. This study was conducted between January 2023 and June 2023. Data were collected from mothers by answering a questionnaire during interviews. The questionnaire consisted of two main parts: sociodemographic characteristics of the mothers and their newborns and 26 questions about traditional practices used to treat health problems in newborns.
Results
A high percentage (84%) of Iraqi mothers used unsafe traditional practices to treat their newborns’ problems (jaundice, gastrointestinal problems, sleep problems, eye problems, respiratory problems, bathing, and daily care).
Conclusion
Many Iraqi mothers prefer to use traditional practices such as herbs, oils, burning, and Sagwa to treat their newborns' health problems. These practices can be harmful to newborns and threaten their lives. Therefore, it is recommended that mothers’ awareness of traditional practices be increased.
Keywords: Unsafe traditional practices, Newborn care, Primary health care centers, Nursing
Highlights
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Unsafe traditional practices are still used in some developing countries.
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Some Iraqi mothers use unsafe traditional practices to treat newborns' problems.
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These practices can be burning, piercing, or using toxic substances.
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Unsafe traditional practices may lead to serious complications among newborns.
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Evidence-based practices should be preferred over traditional practices.
Abbreviations
- GIT
Gastrointestinal Tract
- IRB
Institutional Review Board
- SPSS
Statistical Package for the Social Sciences
- M
Mean
- SD
Standard Deviation
- No
Number
1. Introduction
Traditional practices usually derive from relationships with the environment and human attitudes toward nature. Unsafe traditional practices for newborns exist in different societies, especially in developing countries, and are related to poverty, low education levels, religion, culture, relatives, and grandmothers communicating with and advising new mothers [[1], [2], [3]]. In Iraq, mothers treat common health problems in newborns using traditional practices [4,5]. Some types of unsafe traditional practices are administered to newborns by divination, such as burning, piercing the ear or abdomen, or placing toxic and dangerous substances on the newborn's head, eyes, and body [4,5]. The most common dangerous traditional treatment used in Iraq is Sagwa, which is a mixture of substances that may consist of herbs with dead animal parts, such as skin or nails, or it may be a mixture of toxic chemical substances that differ from one divination to another, such as lead. After shaving the newborn's head, this mixture is placed on it and left for at least 24 h to ensure the absorption of all the substances. These treatments are dangerous, leading to serious complications, and can cause death in newborns [2,4,5].
Burning is an unsafe traditional practice [2,3] that uses hot iron rods placed on the skin to treat various ailments. Traditional healing methods are used in several countries [1,5,6]. The burning is believed to treat pneumonia, jaundice, and spasms. This practice may lead to injuries, hospitalization, and even mortality [1]. In some countries, such as India, a law has been enacted by the government to criminalize practices that are common in rural areas [7]. Modern medicine innovations and evidence-based medicine should be promoted over these traditional practices [6]. However, these practices remain dominant in some regions of the world. Although these practices are harmful to the body, they have been used to treat various ailments, including physiological jaundice in newborns, pneumonia, and convulsions. This causes serious morbidity and delays the seeking of appropriate medical care in neonates [2].
Different countries use various traditional methods. For example, 95% of mothers in India use oil massages on their newborns before bathing [8]. In addition, 53% of these mothers give home remedies to newborns, 55% expose babies to sunlight to treat jaundice, and some place ashes, soot, powder, or dry cow dung on the umbilical cord [8]. In Zambia, cord applications including drying agents (e.g., charcoal, newborn powder, and dust), lubricating agents (e.g., cooking oil, used motor oil), and agents intended for protective and curing purposes (e.g., breast milk, cow dung, and chicken feces) have been adopted by mothers [9].
In some developing countries like Jordan, unsafe traditional practices for treating newborns are common within their society [1]. Swaddling to straighten newborns’ legs, salting to prevent sweat, and covering the newborns with yellow gauze to prevent jaundice are the most common practices in treating newborns in Jordan [1]. Indeed, these practices can be dangerous or harmful. In Turkey, located north of Iraq, some traditional practices that may compromise newborn health are still practiced [2].
Few studies have been conducted on the traditional practices in Iraq. One study assessed the malpractice of Iraqi mothers in treating diarrhea in newborns [5]. The study showed that 11% of Iraqi mothers preferred to use some form of unsafe traditional practice preparation, such as Sagwa, to treat diarrhea. Of these mothers, 52.5% used antimotility suspensions without medical consultation, and 17% used herbs [5]. Another study assessed the morbidity and mortality rates of newborns as a result of using Sagwa in a case of acute gastroenteritis in Diyala, Iraq [10]. Sagwa is a dangerous gastroenteritis treatment because it contains heavy metals. In this study, 66% of the participants stated that grandmothers were responsible for deciding whether to use Sagwa to treat diarrhea [10]. Another study conducted in Iraq assessed primigravida mothers’ knowledge, practices, and attitudes toward neonatal jaundice [11]. The study showed that several harmful practices are applied for the treatment of jaundice. These practices include cutting the post-auricular area of newborns, using herbal treatments, exposing neonates to sunshine instead of ultraviolet phototherapy, or providing newborns with a mix of sugar and water [11].
Although studies have revealed some traditional practices used by mothers to treat specific problems, no studies have assessed these aspects among Iraqi mothers with newborns. Therefore, this study aimed to identify the types of unsafe traditional practices used to treat different health problems in newborns, understand the factors influencing their prevalence and explore the potential consequences of these practices on newborn health.
2. Materials and methods
2.1. Study design, setting, and participants
A descriptive correlational design was used to assess unsafe traditional practices of Iraqi mothers in treating newborn health problems. This design is appropriate for describing the relationship between unsafe traditional practices and newborn problems without making any claims about cause and effect. A non-probability convenience sampling method was used to select mothers of 200 newborns visiting primary healthcare centers in Baghdad City. This sampling method was appropriate, as mothers did not have a set schedule to visit these centers. Therefore, these samples were selected because they were conveniently available to the researchers. The mothers provided informed consent and agreed to participate. This study was conducted between January 2023 and June 2023. Official permission was obtained from the Iraqi Ministry of Health for two primary healthcare centers in Baghdad City (Bab Al Muadham and Al-Washash).
2.2. Survey questionnaire
The questionnaire was developed by the authors based on a literature review and related articles and consisted of two main parts: sociodemographic characteristics of mothers and 26 questions regarding traditional practices to treat problems in newborns. These problems included jaundice, the gastrointestinal tract (GIT), sleep problems, eye problems, respiratory problems, bathing, and daily care. The questionnaire was sent to a panel of experts to assess its content validity. To assess its reliability, a validated questionnaire was distributed to 20 mothers. Cronbach's alpha was 0.768, indicating the questionnaire's consistent reliability.
2.3. Sampling procedure, sample size, and data collection procedure
The study sample size was calculated with a confidence interval of 85%, a population of one million mothers, and a 5% margin of error. The sample size was calculated as 208 using OpenEpi (Open Source Epidemiologic Statistics for Public Health) [12]. A total of 210 mothers were included; however, 10 withdrew. The data of 200 participants were statistically analyzed. The inclusion criteria were mothers with a newborn (1–28 days old), primiparous and multiparous mothers, and mothers who visited primary healthcare centers. Samples were collected daily from 8:30 a.m. to 2:30 p.m. during official working days. The questionnaire took approximately 20 min for each mother to complete.
2.4. Statistical analysis
Data were analyzed using Statistical Package for the Social Sciences (SPSS; version 22.0; IBM Corp., Armonk, N.Y., USA). Frequencies and percentages were calculated to describe the data. Correlations were used to determine the relationship between mothers’ educational levels and the practice of unsafe traditional treatment at a p-value of 0.001.
Ethical approval
The study protocol was approved by the Scientific Research Ethical Committee in the College of Nursing at the University of Baghdad (Ref. No. 553: August 25, 2021). In addition, permission was obtained from the Iraqi Ministry of Health/Training and Developmental Department to collect data from primary healthcare centers. Ethical considerations, including the nature and aims of the study, voluntary participation, right to withdraw from participation, protection of confidentiality, privacy of the informants, use and publication of the study results, storage of data, and benefits of the study, were explained to the participants by the researchers. This information was conveyed in the human ethics form and verbally reinforced before data collection. The mothers who agreed to participate were asked to sign an informed consent form.
3. Results
Two hundred ten mothers agreed to participate in this study. Ten of them withdrew during the process of data collection. The total of 200 samples were included in the data analysis. The analysis of Table 1 shows that mothers had an average age of 26.8 ± 6 years in which the highest percentage is seen with age group of 21–26 years (39.5%). 60.5% of them are resident in urban and 36.5% are resident in sub-urban. Regarding level of education, the highest percentage is seen with 29% who graduated from primary schools followed by 20% who graduated from intermediate school.
Table 1.
Distribution of mothers’ socio-demographic characteristics.
| Characteristics | No. | % | |
|---|---|---|---|
|
Age M ± SD = 26.8 ± 6 |
15–20 years | 31 | 15.5 |
| 21–26 years | 79 | 39.5 | |
| 27–32 years | 52 | 26 | |
| 33–37 years | 24 | 12 | |
| 38–43 years | 12 | 6 | |
| 44 ≤ years | 2 | 1 | |
| Total | 200 | 100 | |
| Residency | Urban | 121 | 60.5 |
| Rural | 6 | 3 | |
| Sub-urban | 73 | 36.5 | |
| Total | 200 | 100 | |
| Educational level | Doesn't read & write | 11 | 5.5 |
| Read and write | 37 | 18.5 | |
| Primary | 58 | 29 | |
| Intermediate | 40 | 20 | |
| Secondary/Institute | 30 | 15 | |
| College + | 24 | 12 | |
| Total | 200 | 100 | |
No.: Number, %: Percentage, M: Mean, SD: Standard deviation.
Table 2 reveals that newborns had an average age of M±SD = 13.5 ± 8 days in which 30% of them are seen with age group of 8–14 days and 31.5% of newborns are second among their siblings. 91% of newborns were with normal weight and 75.5% of them had a height of 55–65 cm. Regarding newborns' gender, 52.5% of them were males and the remaining were females. More than half of the newborns had no history of illnesses, and 22% of them had respiratory diseases. 26% of newborns had previous admissions to hospitals.
Table 2.
Distribution of children socio-demographic characteristics.
| Characteristics | No. | % | |
|---|---|---|---|
|
Child's age (days) M ± SD = 13.5 ± 8 |
1–7 | 58 | 29 |
| 8–14 | 64 | 32 | |
| 15–21 | 40 | 20 | |
| 22–28 | 38 | 19 | |
| Total | 200 | 100 | |
| Birth order | First | 58 | 29 |
| Second | 63 | 31.5 | |
| Third | 55 | 27.5 | |
| Fourth + | 24 | 12 | |
| Total | 200 | 100 | |
| Weight (Kg) | Normal (2.5–4) | 182 | 91 |
| Low (<2.5) | 0 | 0 | |
| High (>4) | 18 | 9 | |
| Total | 200 | 100 | |
| Height (cm) | 45–54 | 49 | 24.5 |
| 55–65 | 151 | 75.5 | |
| Total | 200 | 100 | |
| Gender | Male | 105 | 52.5 |
| Female | 95 | 47.5 | |
| Total | 200 | 100 | |
| Illnesses | None | 110 | 55 |
| Respiratory diseases | 44 | 22 | |
| Jaundice | 14 | 7 | |
| Blood diseases | 1 | 0.5 | |
| Diarrhea | 24 | 12 | |
| Eye infection | 1 | 0.5 | |
| Brain atrophy | 6 | 3 | |
| Total | 200 | 100 | |
| Previous admission | None | 147 | 73.5 |
| 1 | 52 | 26 | |
| 2 | 1 | 0.5 | |
| Total | 200 | 100 | |
No.: Number, %: Percentage.
Table 3 exhibits that most of mothers are using unsafe traditional practices for treating newborn illnesses as revealed by 84% of them (Mean ± SD = 26.90 ± 6.692).
Table 3.
Evaluation of mothers’ unsafe traditional practices for treating newborn.
| Practices | No. | % | M | SD | Evaluation |
|---|---|---|---|---|---|
| Unused | 32 | 16 | 26.90 | 6.692 | Used |
| Used | 168 | 84 | |||
| Total | 200 | 100 |
No.: Number, %: Percentage, M: Mean for total score, SD: Standard Deviation for total score Unused = 0–20, Used = 20.1–40.
Table 4 displays that mothers show unsafe traditional practices for treating jaundice, the highly frequent practices seen with (Give the child water and sugar to treat jaundice, 72%), (I treat my child from jaundice by placing him under a (neon) candle at home, and I do not take him to the hospital, 67.5%), and (Garlic treats jaundice if it is placed in the form of a necklace on the child's neck or a bracelet on his hand or on his clothes, 61%).
Table 4.
Mothers’ unsafe practices for treating jaundice (No. = 200).
| Unsafe practices for treating jaundice | No |
YES |
|---|---|---|
| No. (%) | No. (%) | |
| Give the child water and sugar to treat congenital jaundice | 56(28) | 144(72) |
| Give the child molasses to treat congenital jaundice | 137(68.5) | 63(31.5) |
| I treat my child from jaundice by placing him under a (neon) lamp at home, and I do not take him to the hospital | 65(32.5) | 135(67.5) |
| I take my child to divination and she does ear razor dissections to treat jaundice | 178(89) | 22(11) |
| Garlic treats jaundice if it is placed in the form of a necklace on the child's neck or a bracelet on his hand or on his clothes | 78(39) | 122(61) |
| I give my child grape juice for jaundice | 158(79) | 42(21) |
No.: Number, %: Percentage.
Table 5 shows that mothers show unsafe traditional practices for treating GIT problems, the highly frequent practices seen with (When my son has diarrhea, I do not go to the doctor, 32%), (I used boiled chamomile to treat my child's cough, 51%), (I treat my child's constipation by giving him spoons of molasses, 63%), (For the treatment of diarrhea in my child, I give him Flagyl syrup without consulting the doctor, 31.5%), and (The use of ironing the abdomen with fire when divination to treat digestive problems, 39.5%).
Table 5.
Mothers’ unsafe practices for treating GIT problems (No. = 200).
| Unsafe practices for treating GIT problems | NO |
YES |
|---|---|---|
| No. (%) | No. (%) | |
| When my son has diarrhea, I do not go to the doctor | 136(68) | 64(32) |
| When my son has diarrhea, I go to see him for treatment | 169(84.5) | 31(15.5) |
| I use cardamom boiled with water to treat gases in my child | 169(84.5) | 31(15.5) |
| I used boiled chamomile to treat my child's colic pain | 98(49) | 102(51) |
| He used the sukkot that he took from the divination to cure my child's diarrhea | 165(82.5) | 35(17.5) |
| I treat my child's gases by taking him to a fortune teller to pierce his stomach | 184(92) | 16(8) |
| I treat gases in my child by putting a coin on his navel and tying it with a belt | 162(81) | 38(19) |
| I sleep my child on his stomach to relieve colic and gas and leave him for a long time | 162(81) | 38(19) |
| I treat my child's constipation by giving him spoons of molasses | 74(37) | 126(63) |
| For the treatment of diarrhea in my child, I give him Flagyl syrup without consulting the doctor | 137(68.5) | 63(31.5) |
| The use of ironing the abdomen with fire when divination to treat digestive problems | 121(60.5) | 79(39.5) |
No.: Number, %: Percentage.
Table 6 indicates that mothers show unsafe traditional practices for treating sleep problems among their newborns; the high frequent use was seen with (Shake the newborn vigorously when he cries at night, 33.5%), (Use sedatives and sleeping syrup for my child without a doctor's prescription, 22%), and (I give my child some hypnotic herbs from an expert herbalist, 28.5%).
Table 6.
Mothers’ unsafe practices for treating sleep problems (No. = 200).
| Unsafe practices for treating Sleep problems | NO |
YES |
|---|---|---|
| No. (%) | No. (%) | |
| Shake the newborn vigorously when he cries at night | 133(66.5) | 67(33.5) |
| Use sedatives and sleeping syrup for my child without a doctor's prescription | 156(78) | 44(22) |
| I use a decoction of hypnotic home herbs for my child, such as lemon balm | 168(84) | 32(16) |
| I give my child mixtures prepared by fortune tellers to calm the child | 178(89) | 22(11) |
| I give my child some hypnotic herbs from an expert herbalist | 143(71.5) | 57(28.5) |
No.: Number, %: Percentage.
Table 7 shows that mothers use unsafe traditional practices for treating eye problems. The highly frequent practices seen with (I treat my child's eye problems with kohl, 77%), and (I treat my child's eye problems by wiping it with tea, 64.5%).
Table 7.
Mothers’ unsafe practices for treating eyes problems (No. = 200).
| Unsafe practices for treating Eye problems | NO |
YES |
|---|---|---|
| No. (%) | No. (%) | |
| I treat my child's eye diseases by dripping into his eye with materials I get from divination | 188(94) | 12(6) |
| I treat eye diseases in my child by dripping into his eye with a mixture that I get from an herbal expert | 182(91) | 18(9) |
| I treat my child's eye problems with kohl | 46(23) | 154(77) |
| I treat my child's eye problems by wiping it with tea | 71(35.5) | 129(64.5) |
| I treat my child's eye problems by using the eye drops I have in the fridge to treat adult eyes | 185(92.5) | 15(7.5) |
No.: Number, %: Percentage.
Table 8 indicates that mothers use unsafe traditional practices for treating respiratory problems among their newborns. The high frequent practices use was with (To treat coughs and colds, give him anti-inflammatory and cough medicine without consulting a doctor, 31%), (I give my child herbal decoctions from a herbalist, 31%), and (I treat my child with suppositories to lower his temperature without consulting a doctor, 37%)
Table 8.
Mothers’ unsafe practices for treating respiratory problems (No. = 200).
| Unsafe practices for treating Respiratory problems | NO |
YES |
|---|---|---|
| No. (%) | No. (%) | |
| To treat coughs and colds, give him anti-inflammatory and cough medicine without consulting a doctor | 138(69) | 62(31) |
| I give my child herbal decoctions from a herbalist | 138(69) | 62(31) |
| Inhaling the mud to treat breathing problems | 197(98.5) | 3(1.5) |
| I just steamed my newborn with Vicks | 162(81) | 38(19) |
| I treat my child with suppositories to lower his temperature without consulting a doctor | 126(63) | 74(37) |
| I give my child cortisone syrup to treat respiratory problems without consulting a doctor | 150(75) | 50(25) |
No.: Number, %: Percentage.
Table 9 shows that mothers use unsafe traditional practices for bathing and daily care. The highly frequent practices seen with (I squeeze the newborn's breast to extract milk from it, 37%), (Use cortisone ointment to treat diaper redness, 78%), (I remove the layers of dandruff on my child's head by hand or by applying oils to it, 64%), and (Putting eyeliner on the navel area to help heal it, 35%)
Table 9.
Mothers’ unsafe practices for bathing and daily care (No. = 200).
| Unsafe practices for Bathing and Daily Care | NO |
YES |
|---|---|---|
| No. (%) | No. (%) | |
| I squeeze the newborn's breast to extract milk from it | 126(63) | 74(37) |
| Use cortisone ointment to treat diaper redness | 44(22) | 156(78) |
| I put herbs and oils in the bathtub that I took from the herbalist | 166(83) | 34(17) |
| I remove the layers of dandruff on my child's head by hand or by applying oils to it | 72(36) | 128(64) |
| Putting cow dung on the navel area to help heal it | 197(98.5) | 3(1.5) |
| Putting charcoal ash on the navel area to help heal it | 184(92) | 16(8) |
| Putting eyeliner on the navel area to help heal it | 130(65) | 70(35) |
No.: Number, %: Percentage.
Table 10 indicates that there is a reverse significant relationship among mothers' practicing unsafe traditional treatment and their age at p-value = 0.025 particularly with practices for treating GIT problems, eye problems, and bathing at p-value = 0.048, 0.001, and.010. The finding also shows that there is a strong positive relationship between mothers’ educational level and practicing unsafe traditional treatment at p-value = 0.001 that reveal significant with practices for treating jaundice, GIT problems, sleep problems, eye problems, and bathing at p-values = 0.018, 0.011, 0.001, 0.001, and 0.001.
Table 10.
Association among Mothers’ Variables and their Unsafe Traditional Practices.
| Practices for treating | Correlation | Age | Residency | Educational level |
|---|---|---|---|---|
| Jaundice |
Correlation coefficient Significance |
−0.081 0.252 |
−0.028 0.689 |
0.167a 0.018 |
| GIT problems |
Correlation coefficient Significance |
−0.123 0.082 |
−0.140a 0.048 |
0.180a 0.011 |
| Sleep problems |
Correlation coefficient Significance |
−0.092 0.193 |
−0.106 0.134 |
0.228** 0.001 |
| Eye problems |
Correlation coefficient Significance |
−0.047 0.511 |
−0.306** 0.001 |
0.327** 0.001 |
| Respiratory problems |
Correlation coefficient Significance |
−0.112 0.115 |
−0.094 0.184 |
0.128 0.071 |
| Bathing and daily care |
Correlation coefficient Significance |
−0.048 0.502 |
−0.183** 0.010 |
0.335** 0.001 |
| Overall |
Correlation coefficient Significance |
−0.107 0.131 |
−0.159a 0.025 |
0.273** 0.001 |
Correlation is significant at the 0.05 level (2-tailed).
Table 11 indicates that there is reverse significant relationship among mothers' practicing unsafe traditional treatment and newborn's birth order at p-value = 0.009 particularly with practices of treating jaundice, GIT problems, sleep problems, and respiratory problems at p-values = 0.015, 0.010, 0.013, and 0.028 respectively.
Table 11.
Association among newborns' variables and mothers’ unsafe traditional practices.
| Practices for treating | Correlation | Age | Birth order | Gender |
|---|---|---|---|---|
| Jaundice |
Correlation coefficient Significance |
−0.092 0.194 |
−0.171b 0.015 |
−0.007 0.927 |
| GIT problems |
Correlation coefficient Significance |
−0.113 0.111 |
−0.181b 0.010 |
−0.022 0.753 |
| Sleep problems |
Correlation coefficient Significance |
−0.028 0.689 |
−0.175b 0.013 |
−0.002 0.979 |
| Eye problems |
Correlation coefficient Significance |
−0.075 0.292 |
−0.102 0.150 |
−0.030 0.669 |
| Respiratory problems |
Correlation coefficient Significance |
−0.099 0.161 |
−0.156b 0.028 |
0.036 0.611 |
| Bathing and daily care |
Correlation coefficient Significance |
−0.050 0.478 |
−0.083 0.241 |
−0.095 0.179 |
| Overall |
Correlation coefficient Significance |
−0.118 0.096 |
−0.184a 0.009 |
−0.034 0.632 |
Correlation is significant at the 0.01 level (2-tailed).
Correlation is significant at the 0.05 level (2-tailed).
4. Discussion
The results show that most Iraqi mothers use unsafe traditional practices for treating newborn problems, as revealed by 84% of them (mean ± standard deviation = 26.90 ± 6.692). Many factors, such as sex, age, education, ethnicity, and social class, have important relationships with the prevalence of herbal use. Most Iraqi women use unsafe traditional practices for treating illnesses in newborns, regardless of their mothers' ages and levels of education. This is because of the inherited traditions of society and the influence of grandmothers’ advice, especially for new mothers who have no previous experience caring for newborns [1,9,[13], [14], [15]].
Based on the questionnaire responses, mothers use unsafe traditional practices for treating jaundice. The most frequently used practices, as shown in 72%, 67.5%, and 61% of the mothers' responses, were seen in the following statements: “I give the child water and sugar to treat jaundice,” “I treat my child for jaundice by placing him under a (neon) lamp at home, and I do not take him to the hospital,” and “garlic treats jaundice if it is placed in the form of a necklace on the child's neck or a bracelet on his hand or his clothes,” respectively. Mothers' awareness of jaundice symptoms in newborns was high: 71% knew two signs, whereas 21.9% knew one of the symptoms. Despite women's knowledge of jaundice symptoms, their knowledge was inadequate in many aspects, such as the dangerous features and complications of jaundice. Most women (78.8%) were unaware of the dangerous features of jaundice, whereas 21.2% knew of one serious symptom. Moreover, 57.6% of women did not know anything about the complications of severe jaundice. This result indicates that the knowledge of women in our population regarding the serious symptoms and complications of severe jaundice is lacking [10,11,16].
Iraqi women use many traditional practices to treat jaundice. They treat jaundice with a solution of sugar and water and give it to newborns. They also use a neon lamp, believing it performs the same function as the ultraviolet rays in hospitals. In addition, they do not take newborns to the hospital when symptoms of jaundice appear, and they prefer to stay at home and treat them using traditional practices. According to the belief that garlic treats jaundice, mothers make a garlic necklace and place it on the neck of the newborn, waiting for it to turn yellow as a result of the oxidation of garlic in the air. Garlic is believed to extract the yellow substance from the newborn's body, a common tradition among Iraqi women.
Based on the questionnaire responses, mothers adopt unsafe traditional practices for treating GIT problems. The most frequently used practices, as shown in 32%, 51%, 63%, 31.5%, and 39.5% of the mothers' responses, were seen in the following statements: “When my son has diarrhea, I do not go to the doctor,” “I used boiled chamomile to treat my child's colic,” “I treat my child's constipation by giving him spoons of molasses,” “for the treatment of diarrhea in my child, I give him Flagyl syrup without consulting the doctor,” and “the use of ironing the abdomen with fire used by divinations to treat digestive problems,” respectively.
Iraqi mothers resort to malpractice in treating diarrhea and digestive problems in their newborns, such as using antibiotics unnecessarily or using a more harmful mixture called Sagwa. Sagwa is a harmful traditional method involving a strange mixture of many substances. Sagwa is obtained from a dead animal (hedgehog) and mixed with other toxic substances, such as lead, which is administered to infants to stop diarrhea [11]. Three doses and more of Sagwa cause the positive association with the toxicity by 57% among newborns [10].
The results indicate that mothers frequently perform unsafe traditional practices for treating sleep problems among their newborns. Based on the questionnaire, the mothers' responses were 33.5%, 22%, and 28.5% regarding the following statements: “Shake the newborn vigorously when he cries at night,” “use sedatives and sleeping syrup for my child without a doctor's prescription,” and “I give my child some hypnotic herbs from an expert herbalist,” respectively. An increasing number of parents use complementary therapies to induce sleep in their children. The safety profile of these treatments is insufficiently defined; however, mothers believe these treatments are natural and, therefore, safe. Parents of newborns and infants experience a lack of sleep owing to their baby's irregular sleep patterns. This lack of sleep makes parents tired and leads them to look for various solutions, including quick remedies, such as over-the-counter antihistamines or cough syrups. Some parents have turned to alternative or herbal remedies because of the misconception that these “natural” products are safer. Examples include melatonin, chamomile, lemon balm, and other commercial products [[17], [18], [19]].
Some women resort to hypnotic drugs (without a doctor's prescription) or sleeping herbs and administer them to their newborns, ignoring the side effects of this practice. The results indicate that mothers perform unsafe traditional practices for treating respiratory problems in their newborns. The most frequently used practices, as shown in 31%, 31%, and 37% of the mothers' responses, were seen in the following statements: “To treat coughs and colds, giving him anti-inflammatory and cough medicine without consulting a doctor,” “I give my child boiled herbs from a herbalist,” and “I treat my child with suppositories to lower his temperature without consulting a doctor,” respectively. Although modern therapeutic methods have been developed in our country and worldwide, traditional practices are still used in areas of low socioeconomic status. These practices carry negative health risks for which sufficient scientific evidence is lacking [2,20,21]. Iraqi women use cough medicine without a doctor's prescription, and some use the medicine that the doctor prescribed for the children of their friends, or they use adult cough medicine and give it to their newborns, or they use herbs in case their newborns have a cough.
The results show that mothers engage in unsafe traditional practices for bathing and daily care. The most frequently used practices, as shown in 37%, 78%, 64%, and 35% of the mothers' responses, were seen in the following statements: “I squeeze the newborn's breast to extract milk from it,” “use cortisone ointment to treat diaper redness,” “I remove the layers of dandruff on my child's head by hand or by applying oils to it,” and “putting an eyeliner on the navel area to help heal it,” respectively. Experiences and the lack of modern medical services in the area can explain the current use of traditional practices. Social, economic, and cultural factors determine the quality of care. However, it is reported that parents learn about newborn care from their grandmothers and initially treat their newborns with traditional beliefs and practices [[13], [14], [15]]. Mothers take their newborns to a doctor when they realize they cannot recover. Therefore, midwives/nurses are essential for educating the community on newborn care and encouraging mothers to provide quality care to their newborns [[13], [14], [15]].
Despite the existence of newborn care products, Iraqi mothers still use materials that may be unsafe for newborn care, such as kohl or some oils for the newborn's head or body, as well as squeezing the newborn's breasts, which causes infections and pain. The findings show a strong positive relationship between mothers' educational level and practicing unsafe traditional treatment (p = 0.001). This is significant for treating jaundice, GIT problems, sleep problems, eye problems, and bathing (p = 0.018, 0.011, 0.001, 0.001, and 0.001, respectively). In addition, there is an inversely significant relationship between mothers practicing unsafe traditional treatment and newborn birth order (p = 0.009), particularly with treating jaundice, GIT, sleep, and respiratory problems (p-values = 0.015, 0.010, 0.013, and 0.028, respectively).
A significant association existed between Sagwa use and rural residency (81%), mothers’ education level (57%, illiterate mothers), and order of the child in family (13%) [10]. Newborns are considered small, incapable, and entirely dependent on others, so the mother and nurse play important roles, especially in the first days of life [[22], [23], [24]]. The use of unsafe traditional practices among new mothers and their level of education is lower in rural and suburban areas than in cities.
5. Conclusion
Many Iraqi mothers use unsafe traditional practices to treat their newborns' problems, such as (jaundice, GIT, sleep problems, eye problems, respiratory problems, bathing, and daily care). Although modern medicine is available in urban areas, many Iraqi mothers still prefer to use traditional practices, such as herbs, oils, burning, or Sagwa, which can be harmful or even deadly to newborns. Increasing mothers' awareness of traditional practices for treating newborn problems can save lives. Mothers should be aware of the consequences of using traditional practices instead of seeking medical consultation. We recommend the Iraqi Ministry of Health send healthcare visitors to homes to provide information about newborn care based on scientific methods. The purpose of this recommendation is for mothers to not receive information from others, such as grandmothers or family members. In addition, the media plays a vital role in increasing mothers’ knowledge of newborn care. Conducting a study comparing the knowledge of mothers who receive information from different sources is recommended to further assess traditional practices in newborns.
This study is not without limitations. The sample was collected from mothers who visited primary healthcare centers. However, not all mothers visit these clinics; therefore, the results may be different and more catastrophic among this demographic. Also, the study was conducted in Baghdad City, and the practices of mothers in rural areas, which could have been different, were not assessed in this study.
Mothers in urban and rural areas may have different traditions. Therefore, researchers recommend conducting studies in rural areas to assess mothers’ traditional practices regarding newborn problems and compare the results with those in urban areas. Moreover, further studies are needed to assess the unsafe traditional practices used by mothers who do not visit healthcare centers to treat their newborns.
Declarations
The ethical approval was obtained from the Institutional Review Board (IRB) in College of Nursing at University of Baghdad with a reference number 553 in August 25, 2021.
All participants provided informed consent to participate in the study.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Data availability statement
There is no research related data stored in publicly available repositories, and the data will be made available on request from the corresponding author.
CRediT authorship contribution statement
Hawraa Hussein Ghafel: Writing – original draft, Supervision, Resources, Project administration, Investigation, Funding acquisition, Data curation, Conceptualization. Mohammed Baqer Al-Jubouri: Writing – review & editing, Methodology, Formal analysis, Data curation.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgments
We appreciate the efforts and dedication of Dr. Sadeq Abdul Hussein Hassan, Dr. Qahtan Qassem Mohammed, and Dr. Mohammed Baqer Habbeb (faculty members at College of Nursing, University of Baghdad) for their help. Without the mothers' cooperation and assistance, the data could not have been gathered. We greatly value their participation and cooperation.
Footnotes
Supplementary data to this article can be found online at https://doi.org/10.1016/j.heliyon.2024.e27842.
Contributor Information
Hawraa Hussein Ghafel, Email: hawraah@conursing.uobaghdad.edu.iq.
Mohammed Baqer Al-Jubouri, Email: maaljubouri@conursing.uobaghdad.edu.iq.
Appendix ASupplementary data
The following is the Supplementary data to this article:
References
- 1.Al-Sagarat A.Y., Al-Kharabsheh A. Traditional practices adopted by Jordanian mothers when caring for their infants in rural areas. Afr. J. Tradit., Complementary Altern. Med. 2017 Feb 20;14(1):1–9. doi: 10.21010/ajtcam.v14i1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Bastug O., Korkmaz L., Korkut S., Halis H., Guneş T., Kurtoglu S. A harmful traditional practice in newborns with adrenocorticotropic hormone resistance syndrome: branding. Turkish Archives of Pediatrics/Türk Pediatri Arşivi. 2016 Dec;51(4):224. doi: 10.5152/TurkPediatriArs.2016.2218. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Hailu M., Mohammed A., Sintayehu Y., Solomon M., Ali M., Dejene Y., Mellese D., Weldeamaniel T., Girma M., Mengesha T., Hailemariyam T. Eastern Ethiopia; 2023. Cultural Malpractice and its Associated Factors during Pregnancy, Child Birth and Postnatal Period Among Women's Who Give Birth once at Dire Dawa City Administration. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Hussein Z. first ed. AL-Hawraa Center; Karbalaa, Iraq: 2020. Instructional Health Tips in Pediatrics; pp. 7–10. [Google Scholar]
- 5.Mohammed S.I., Sabry A.T., Sabry D.T., Mohammed B.H. Knowledge and malpractices in pediatrics diarrhea management by Iraqi mothers. Asian J. Pharmaceut. Clin. Res. 2018;10(8):503–507. doi: 10.22159/ajpcr.2018.v11i8.27454. [DOI] [Google Scholar]
- 6.Guleç C. A transcultural perspective to the disease and health concepts in the Anatolian culture. Turkish Journal Clinical Psychiatry. 2000;3(1):34–39. [Google Scholar]
- 7.Mehta M.H., Anand J.S., Mehta L., Modha H.C., Patel R.V. Neonatal branding-towards branding eradication. Indian Pediatr. 1992;29:788–789. [PubMed] [Google Scholar]
- 8.Sujatha R. Cultural practices and beliefs on newborn care among mothers in a selected hospital of Mangalore taluk. Journal of Health and Allied Sciences NU. 2014 Jun;4(2):21–26. doi: 10.1055/s-0040-1703759. [DOI] [Google Scholar]
- 9.Herlihy J.M., Shaikh A., Mazimba A., Gagne N., Grogan C., Mpamba C., Sooli B., Simamvwa G., Mabeta C., Shankoti P., Messersmith L. Local perceptions, cultural beliefs and practices that shape umbilical cord care: a qualitative study in Southern Province, Zambia. PLoS One. 2013 Nov 7;8(11) doi: 10.1371/journal.pone.0079191. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Shukur A.M., Alezzi J.I., Kadhim T.J. Morbidity and mortality associated with community used herbal (sagwa) use in children with acute gastroenteritis in Diyala governorate. Diyala Journal of Medicine. 2019 Dec 1;17(2):92–106. doi: 10.26505/DJM.17024690527. [DOI] [Google Scholar]
- 11.Ji AL-Ezzi, Shareef A.J. Neonatal jaundice: knowledge, practice, and attitude among primigravida women. Genel Tıp Dergisi. 2022 Oct 10;32(5):530–533. doi: 10.54005/geneltip.1142356. [DOI] [Google Scholar]
- 12.Sullivan K.M., Dean A. OpenEpi a web-based epidemiologic and statistical calculator for public health. Publ. Health Rep. 2009;124:471–474. doi: 10.1177/003335490912400320. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Alparslan Ö., Demirel Y. Traditional neonatal care practices in Turkey. Jpn. J. Nurs. Sci. 2013 Jun;10(1):47–54. doi: 10.1111/j.1742-7924.2012.00209.x. [DOI] [PubMed] [Google Scholar]
- 14.Solomon N., Tesfaye M. SAGE Open Medicine; 2022 May. Traditional Practices during Pregnancy and Childbirth Among Mothers in Shey Bench District, South West Ethiopia.https://doi:10.1177/20503121221098139 [Google Scholar]
- 15.Nazan Gürarslan BaşGülnaz KaratayDuygu ArıkanKazım Baş Intergenerational transmission of traditional practices at newborn care: an explorative study newborn care. Indian Journal of Traditional Knowledge. 2019;18(1) [Google Scholar]
- 16.Hameed N.N., Abdul-Hussain N.J., Ahmed M.E. Assessment of mother's Knowledge, practices and believes toward home management of Neonatal jaundice in two pediatric teaching hospitals: study of mother's Knowledge, practices and believes about home management of Neonatal jaundice in two pediatric teaching hospitals. J. Fac. Med. Baghdad. 2019;61(3, 4) doi: 10.32007/jfacmedbagdad.613,41710. [DOI] [Google Scholar]
- 17.Alnaim L. Infant sleep and the use of common remedies: a case report. Global Pharm Res. 2019;5 https://DOI:10.15761/GPR.1000106 [Google Scholar]
- 18.Aholi P. Enfants et pratiques traditionelles. Children and traditional practices. Vie Sante. 1990;(4):11–14. French. PMID: 12342828. [PubMed] [Google Scholar]
- 19.Kesterton A.J., Cleland J. Neonatal care in rural Karnataka: healthy and harmful practices, the potential for change. BMC Pregnancy Childbirth. 2009 Dec;9(1):1–3. doi: 10.1186/1471-2393-9-20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Earan S., Reddu D., Arunagirinathan A. Newborn care practices in rural Puducherry; a peek into the harmful practices-a cross sectional study. International Journal of Contemporary Pediatrics. 2023;10(6) doi: 10.18203/2349-3291.ijcp20231432. 2023. [DOI] [Google Scholar]
- 21.Grover P., Chhabra P. Biblioteca Virtual em Saude; 2012. Neonatal Care Practices in Urban Villages.https://pesquisa.bvsalud.org/portal/resource/pt/sea-157375 [Google Scholar]
- 22.Ali S.H., Ghafel H.H. Nurse-Midwives’ knowledge and practices about immediate newborn care. Int. J. Health Sci. 2022;6(S1):8915–8940. doi: 10.53730/ijhs.v6nS1.7033. [DOI] [Google Scholar]
- 23.Shabila N.P., Ahmed H.M., Yasin M.Y. Women's views and experiences of antenatal care in Iraq: a Q methodology study. BMC Pregnancy Childbirth. 2014 Dec;14(1) doi: 10.1186/1471-2393-14-43. 1-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Gurung G. Practices on immediate care of newborn in the communities of Kailali district. Nepal Med Coll J. 2008 Mar 1;10(1):41–44. [PubMed] [Google Scholar]; (a) Sinha L.N., Kaur P., GuptaR, Dalpath S., Goyal V., Murhekar M. Newborn care practices and home-based postnatal newborn care programme–Mewat, Haryana, India. Western Pacific Surveillance and Response Journal: WPSAR. 2013;5(3):22. doi: 10.5365/WPSAR.2014.5.1.006. 2014 Jul. [DOI] [PMC free article] [PubMed] [Google Scholar]
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Data Availability Statement
There is no research related data stored in publicly available repositories, and the data will be made available on request from the corresponding author.