Traditional neonatal care practices in Jordan: A ...
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R E S E A R CH AR T I C L E
Traditional neonatal care practices in Jordan: A qualitativestudy
Lina Mrayan RN, MSN, PhD | Sanaa Abujilban RN, MSN, PhD |
Jamila Abuidhail RN, MSN, PhD | Ali Alshraifeen RN, MSN, PhD
Department of Maternal, Child and Family
Health Nursing, Hashemite University, Zarqa,
Jordan
Correspondence
Lina Mrayan, Department of Maternal, Child
and Family Health Nursing, Faculty of Nursing,
Hashemite University, Zarqa, 13115 Jordan.
Email: [email protected]
AbstractTraditional practices during the first months of neonatal life are common in developing coun-
tries, such as Jordan. Many international studies and reports have highlighted the fact that tradi-
tional neonatal practices are the cause of high neonatal mortality and morbidity rates in some
countries. The aim of the present study was to identify neonatal care practices in Jordan.
A descriptive, qualitative research design was used across four Jordanian cities across diverse
regions. Forty mothers of neonates were interviewed over a period of 6 months (from January
to June 2016). Thematic and content analysis was undertaken following Braun and Clarke's six
step analysis. The results indicated that in Jordan, home-based neonatal care comprises non-
biomedical practices. Rubbing the neonate's skin with salt, swaddling, prelacteal feeding, and
other treatment modalities are common. Further studies are necessary to determine and report
on the pros and cons of these practices in regard to neonatal health.
KEYWORDS
cultural practice, Jordan, neonatal care, traditional care
1 | INTRODUCTION
According to the World Health Organization, a neonate is an infant
younger than 28 days of age (WHO, 2014). During the neonatal
period, health beliefs and practices influenced by local culture are
ardently practiced in many countries (Sutan & Berkat, 2014). Prelac-
teal feeding is a common practice in Turkey, Bangladesh, Tanzania,
and Ethiopia (Alparslan & Demirel, 2013; Legesse, Demena, Mesfin, &
Haile, 2014; Sacks et al., 2015; Winch et al., 2005). Prelacteal feeding
is food or drink other than human breast milk that is fed to newborns
before the introduction of breastfeeding, generally in the first few
days of life (Khanal, Adhikari, Sauer, & Zhao, 2013). Rubbing the neo-
nate’s swollen nipples, “making the forties” (bathing the mother and
neonate in a special ritual on the 40th day, postpartum), salting, using
“holluk” (a sand-filled nappy), and swaddling the baby are the most
common neonatal care practices in Turkey (Alparslan & Demirel,
2013). In Zambia, petroleum jelly and breast milk are generally used
for neonatal skin care. Vernix and castor oil are also used to care for
the skin of preterm babies (Sacks et al., 2015). Using “kohol” for
neonatal eyes is quite common in India (Goswami, 2013). The signifi-
cant implementation of some home-based traditional care practices
might reduce the neonatal mortality rate, because such practices
could reduce the risk of infection and hypothermia (Sacks et al.,
2015). Swaddling is a universal practice reported in studies from dif-
ferent countries (Blatt, 2015; Clarke, 2013). Approximately 90% of
infants in the USA are swaddled during the first few months of life
(Oden et al., 2012). Similar findings have been reported in Jordan, indi-
cating that most participants swaddle their newborn babies from the
first day after birth (Abuidhail, 2014; Al-Sagarat & Al-Kharabsheh,
2017; Jarrah & Bond, 2007). Keeping the newborn baby in the house
to protect him/her from cold air or from the evil eye, and rubbing
the baby's skin with oil, are also traditional practices reported in
Bangladesh (Winch et al., 2005).
In Jordan, the national neonatal mortality rate remains high at
14 neonatal deaths per 1000 live births (DOS, 2013), with a decrease
of only six points since 1998. A study conducted by UNICEF, the Min-
istry of Health, and the Higher Population Council indicated that 30%
Received: 29 September 2017 Revised: 13 April 2018 Accepted: 29 April 2018
DOI: 10.1111/nhs.12540
Nurs Health Sci. 2018;1–8. wileyonlinelibrary.com/journal/nhs © 2018 John Wiley & Sons Australia, Ltd 1
of all neonatal deaths were preventable, and that 44.3% were possibly
preventable with optimal care (The Jordan Times, 2013).
Most neonatal deaths are preventable by implementing simple
interventions, such as feeding with colostrum, the timing of the ini-
tial breastfeedings, the duration of every feeding, umbilical cord
care, and measures taken to prevent hypothermia in newborns
(Batieha et al., 2016; Lassi, Salam, Das, & Bhutta, 2014). Proper
intervention before pregnancy, during pregnancy, and during the
early postnatal period is crucial for the prevention and management
of conditions that cause neonatal death (Lassi, Mansoor, Salam,
Das, & Bhutta, 2014).
1.1 | Aim and research question
The aim of the current study was to identify the traditional home-
based neonatal care practices performed by mothers or family
members with neonates <1 month of age across four Jordanian cities:
Irbid (north), Al-Zarqa and Amman (middle), and Al-Karak (south).
The study sought to answer the following research question:
What are the traditional practices in terms of neonatal care performed
by mothers or family members for infants who are <1 month of age?
2 | METHODS
2.1 | Research design
A descriptive, qualitative research design was used (Colorafi & Evans,
2016). The choice of this method was influenced by our study aim of
exploring traditional neonatal care practices among Jordanian families.
2.2 | Participants
Our study was conducted at four comprehensive health-care centers
within four major cities in Jordan (Irbid, Al-Zarqa, Al-Karak, and
Amman) over a period of 6 months (January–June 2016). All mothers
of neonates aged 1–4 weeks who attended the health centers for a
variety of reasons were invited to participate in the study after a brief
explanation of its purpose. The data-collection process ended when
no new information was obtained and when redundancy was
achieved.
2.3 | Data-collection methods
In-depth interviews in the Arabic language were conducted by the
researcher with all of the participants at the health center or at a loca-
tion of their choice. To identify the traditional core practices, data
were collected using open-ended questions. Examples included
“Please tell me when you started to breastfeed your newborn” and
“Please describe your baby's bathing procedure”. To obtain a deeper
understanding and to clarify unclear answers, probing questions, such
as “What do you use for skin massage?” or “Why do you use that?”
were asked. All interviews were digitally recorded after obtaining per-
mission from the participants. Interviews lasted between 45 and
60 min.
2.4 | Ethical considerations
This study was approved by both the university's institutional
review board and the Ministry of Health Research Board
(no. 29/15/1200837). All participants were assigned a code attached
to relevant interviews and transcripts to ensure anonymity and confi-
dentiality (Burns & Grove, 2011). For example, W1 indicates the first
participant and W2 is the second participant. Potential participants
were informed that the study was voluntary and that they could
refuse to answer any question or withdraw at any time without any
explanation. Written informed consent was obtained for the study
and before conducting the interviews.
2.5 | Data analysis
The data were analyzed using a manual thematic and content analysis
tool. The study followed Braun and Clarke's six step analysis: (i) the
interviews were listened to repeatedly, and transcripts were read and
reread several times to familiarize the researchers with the data;
(ii) every woman was assigned the code “W” with a number in chrono-
logical order. The first interviewed woman was assigned the code W1,
and the second interviewed woman was given the code W2. Then,
interesting sentences in each interview relevant to the purpose of the
study were systematically assigned the code “Q” and a number. For
example, the first highlighted sentence was Q1, and the second
highlighted sentence was Q2. The seventh quote from the 12th
woman was W12, Q7. Quotations were extracted from the text using
the women's own words; (iii) all relevant data were grouped by topic,
and an initial theme was provided; (iv) initial themes were then
checked and rechecked in regard to the coded extracts and the entire
dataset to generate a thematic map; (v) after the thematic map was
completed, the themes were assigned final names; and (vi) finally, vivid
and compelling examples were extracted, and a final analysis of the
selected extracts was conducted. Final themes were linked back to
the research questions and to the literature to produce the final report
(Braun & Clarke, 2006) (Appendix I).
2.6 | Trustworthiness
Credibility was accomplished by relating a dense description to five
randomly-selected participants to determine whether the description
reflected their perceptions (Vaismoradi, Turunen, & Bondas, 2013).
The transferability of the study was ensured, because we provided a
dense description of the setting, the participants, and the data-
collection process (Lincoln & Guba, 1985). The data were collected,
analyzed, and reviewed by three researchers. Furthermore, we con-
firmed that the research findings were the result of the research and
not our assumptions or preconceptions. Confirmability demands that
the characteristics of the data are dependable. According to Holloway
and Wheeler (2002), an inquiry audit may be used to trace the data to
their sources (Holloway & Wheeler, 2002). In this manner, our means
of arriving at the constructs, themes and their interpretation can be
followed (Appendix I).
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3 | RESULTS
3.1 | Sociodemographic characteristics
The study participants included 40 mothers of neonates aged from
1 week to 2 months of age. Most were housewives (n = 35), three
were schoolteachers, and two were secretaries. All of the mothers
were literate; two thirds (n = 27) had finished high school, and one
third (n = 13) were university graduates. Nearly all were considered
to have low- to middle-range incomes, and the majority lived in a
nuclear family. All participants in this study gave birth in a hospital
(Table 1).
Primarily, we observed that “neonatal home-based care practices
are widely used in Jordan”, including both safe and unsafe traditional
neonatal practices. Five major themes emerged from the interviews,
each of which is supported by quotes using the participants' own words.
3.1.1 | Caring for the neonate's skin and eyes
Skin care practices were widely used among Jordanian women. Skin
care practices included rubbing the neonate's skin with salt, rubbing
the skin with olive oil, or using a baby oil that was bought from the
shops. The grandmother or one of the participants’ female family
members bathed the newborn with warm, salted water or rubbed
his/her skin with salt directly after birth. According to the participants,
the purpose of these skin practices was to strengthen the neonate's
skin, to prevent skin infection, to facilitate the drying of the umbilical
cord, and to prevent the body from having an unpleasant odor in the
future:
My mother-in-law put some salt in the water when
she gives the baby his bath...bathing the baby with
salted water will prevent a bad smell in the future.
(W4, Q8)
Rubbing the neonates’ skin with salt and keeping the salt on the
skin for a few days was mentioned by nearly all of the participants:
I rub his skin with salt, wrap him, and keep him
wrapped for 3 days before giving him a bath, and then
I massage him with olive oil. (W27, Q11)
Although rubbing the neonatal skin with salt made the skin irri-
tated, red, and dry, Jordanian mothers considered the practice to be
healthy.
Nearly all of the participants rubbed the baby's skin with olive oil
once a week to soften the skin, as indicated by the following partici-
pant: “I massaged her skin with olive oil because her skin was dry”
(W32, Q23).
Another skin practice was mentioned by some of the research
participants, specifically those from Al-Zarqaa and Alkarak. They said
that they rubbed the girls' skin with bat's blood immediately after birth
to prevent the growth of body hair:
My mother-in-law asked my husband to bring a bat's
blood to rub on the baby's skin...to prevent the growth
of body hair. (W12, Q19)
Nearly all of the mothers refrained from cutting the neonates'
nails. The mothers said that if you cut a newborn's fingernails, he/she
will become a stingy person, as indicated by the following participant:
“They said that if you cut his fingernails, he will be a
stingy adult” (W3, Q28).
All of the participants shaved their newborns' hair on the seventh
day after birth, consistent with the religious practice of “Sunnah”. The
neonate's hair is completely shaved, using clippers or a new razor, by
the father or the grandfather; generally, a male must do the shaving.
“Tahneek” is another religious practice (Sunnah) that is performed
on the baby by an older man, generally the grandfather. Tahneek is
performed using a soft piece of date on the finger, and then placing
the finger into the baby's mouth and rubbing it over the baby's gums:
“My father-in-law rubbed my baby's gum with the
mashed date” (W6, Q19).
This practice was mentioned by all participants.
Using kohol in the neonate's eye was primarily practiced in Al-
Karak, Irbid, and Al-Zarqa. Mothers generally used homemade kohol
that was often made by grinding galena (lead sulfide). Kohol contains
high levels of lead, which is harmful to newborn babies. Mothers
applied kohol to their neonates' eyes soon after birth. Some did this
to make their neonates' eyes beautiful, others used it to “strengthen
the neonatal's eyes”, and some believed it could prevent the child
from being cursed by the evil eye:
We use homemade kohol to make the girls' eyes beau-
tiful when they grow up. (W8, Q9)
Kohol can strengthen the eyes and make them healthy
in the future...It prevents eye infections, too.
(W8, Q15)
I use kohol to protect my baby from the evil eye.
(W2, Q13)
3.1.2 | Feeding the neonate: Traditional beliefs andhealthy practices
Although breastfeeding is a common practice in Jordan, there are
some traditional practices that might affect its success. For example,
neonates were bottle fed boiled herbs or sweetened water to relieve
abdominal pain and “colic” and to facilitate sleep. In addition, some
mothers felt breast milk was not sufficient for the baby. Babies were
fed the boiled herbs in a bottle twice a day (morning and before bed)
TABLE 1 Sociodemographic data of participants
Age, years No. children Occupation EducationMaritalstatus
15–20 (n = 7) Primis(n = 23)
School teachers(n = 3)
School(n = 27)
All weremarried
21–30 (n = 31) Multi(n = 17)
Secretaries(n = 2)
University(n = 13)
31–40 (n = 2) Not working(n = 25)
MRAYAN ET AL. 3
or when needed. The most common herb used to relieve perceived
neonatal colic was “anise” or “sagebrush”. Colic was diagnosed by
mothers or grandmothers when the baby did not stop crying for a long
time or when the newborn was constipated:
Because my baby was crying all the time, my mother
asked me to boil some herbs and give it to him....She
told me to give him boiled water with sugar too.
(W17, Q2)
I gave my baby sweetened water and sometimes
boiled herbs for 3 days…after 2 or 3 days, breast milk
always comes. (W17, Q5)
3.1.3 | Comforting the neonate
Swaddling was a common practice across the four cities; however,
there were differences in regard to duration and tightness in different
areas. Mothers from Irbid, Al-Zarqa, and Al-Karak swaddled their chil-
dren tightly all day for 40 days. However, we observed that mothers
from Amman swaddled their neonates less tightly and for a shorter
period of time. All of the participants wrapped or swaddled their
babies because they believed that wrapping the neonate in a cloth or
blanket helps to comfort the baby, promote sleep, and manage the
excessive and frequent crying of the child. Some mothers used swad-
dling to prevent or treat abdominal colic:
“I wrap my baby in a small blanket to keep him calm
and promote sleep” (W39, Q16).
Some mothers used a special cloth to swaddle the baby, and
others used a small blanket. Some swaddled the baby loosely, and
others wrapped the baby tightly.
All of the mothers described swaddling as placing the baby's
hands at his/her sides, straightening both legs, and wrapping the baby
tightly in the blanket.
Swaddling was performed for various lengths of time, depending
on the season. Babies born in winter were likely to be wrapped for a
longer period of time than those born in summer. Jordanian mothers
believe that swaddling prevents respiratory diseases and colic, and
ensures that babies will have straight legs in the future.
Giving the baby a date wrapped in a small cloth as a pacifier, a
“tamra”, occurred in Al-Karak and Irbid. Some of our participants said
that instead of using a pacifier, they wrapped a date in a clean cloth
and gave it to the neonate to help him sleep:
My mother wrapped a small date, a tamra, in a clean
cloth…she usually put it in his mouth to make him
sleep. (W16, Q37)
3.1.4 | Protecting the neonate from the evil eye
Typically, in Jordan, neonates are strictly kept indoors for at least
4 weeks. During this time, it is believed that neonates are vulnerable
to diseases, infections, and the evil eye. The evil eye causes the trans-
mission of a sickness, generally unintentionally, by someone who is
envious, jealous, or covetous. Jordanian mothers believe that receiv-
ing the evil eye causes misfortune or injury and requires “roqya”.
Roqya means reading a special suras or verses from the Quran and
making “prayer” for the baby to expel the evil eye. They believe that
the 4 week seclusion protects the neonate from such hazards. Only
close family members (brothers, sisters, aunts, and uncles) are allowed
to see the neonate:
In these 40 days, I had to stay home to protect my
infant from the evil eye....My mother believes that
strangers should not see the baby. (W7, Q18)
Fortunately, when the baby is sick, not all mothers adhere to this
rule of staying at home. They go to a health center for treatment or
vaccinations when necessary.
3.1.5 | Treatment modalities
Some mothers practiced some traditional remedies to address neona-
tal jaundice, such as increasing the frequency of breastfeeding, giving
sweetened water, and putting the baby under a household fluorescent
light or in front of the window in the sunlight. Some mothers men-
tioned using a garlic necklace for 7 days. They believed that when the
garlic cloves dried, the jaundice would disappear. If the jaundice lasted
past the drying of the garlic, then the neonate would be taken to hos-
pital for treatment:
I noticed that his skin became yellow. My mother-in-
law asked me to give him water with sugar.
(W14, Q45)
I put a necklace of seven garlic cloves around his neck.
When the cloves dried, the yellow color disappeared.
(W14, Q46)
However, a few mothers mentioned visiting the hospital to seek
medical care in the event of other signs, such as low level of activity,
inability to feed, or elevated temperature.
Breast milk was used to cure some types of infections, such as
eye infections, umbilical cord infection, and newborn genital redness.
Mothers used drops of breast milk in the baby's eyes if they noticed
redness or eye discharge. They applied breast milk to the umbilical
cord and female genitals to treat a neonate's nappy rash or pain
because of urination:
I put some drops of my breast milk in her eyes when I
saw some secretions…I use it for redness or pain in
her private parts too. (W26, Q23)
Many of the participants believed that they must squeeze
enlarged neonates' breasts (physiological at this age) to empty
them out:
Her breasts were large and congested; my mother-in-
law squeezed them hard to get the bad milk out and
discard it. (W11, Q54)
Some Jordanian mothers put antibiotic powder (from an opened
antibiotic capsule) or sulfa powder on the umbilical stump to facilitate
4 MRAYAN ET AL.
drying and to prevent infection. Others used ground coffee, salt, ciga-
rette ash, or talcum powder for the same reason:
I opened an antibiotic capsule and put it on his umbili-
cus. (W3, Q54)
My mother put some coffee on her (my daughter’s)
umbilicus. (W7, Q14)
The umbilical stump was generally covered by the nappy and was
not exposed to air. Mothers were afraid of touching the stump, and
thus were unable to clean or dry it properly after bathing the neonate:
It was impossible for me to bathe my baby in the first
week because of his umbilicus stump....My mother
bathed him....She covered the stump with his nappy.
(W49, Q56)
4 | DISCUSSION
In this study, we observed that home-based neonatal cultural
practices are quite common in Jordan. Different skin care practices
were explained by the research participants. Rubbing the neonatal
skin with salt was common in three areas (Irbid, Al-Zarqa, and Al-
Karak). This practice could be explained by the mothers' desire to pre-
vent an unpleasant body odor and by their attempts to strengthen the
skin texture. Salting the neonatal skin was reported in a study from
Turkey that explained that mothers used salt on the skin of neonates
to prevent an unpleasant body odor in the future (Alparslan &
Demirel, 2013).
Using kohol on the neonate's eyes directly after birth was also
common in Irbid, Al-Zarqa, and Al-Karak. Goswami (2013) observed a
close association between the use of kohol and a high lead concentra-
tion in the blood (Goswami, 2013). The prolonged application of kohol
could result in excessive lead storage in the body, which might affect
the neonate's brain, organs, and bone marrow formation. Some
experts believe that lead poisoning could also result in anemia, a low
IQ, and convulsions (Jaishankar, Tseten, Anbalagan, Mathew, & Beere-
gowda, 2014).
Nearly all of the neonates in our study received formula milk,
sweetened water, or herbal drinks once or twice per day because their
mothers believed that their breast milk was insufficient to meet the
baby's needs. The practice of prelacteal feeding has been known to be
a common practice in many countries, such as Turkey, Bangladesh,
Tanzania, and Ethiopia (Alparslan & Demirel, 2013; Hoque, Khan,
Begum, Chowdhury, & Person, 2011; Kesterton & Cleland, 2009;
Legesse et al., 2014; Sacks, Bailey, Robles, & Low, 2013; Salam et al.,
2014). However, this practice is a cause for concern, because it might
delay the initiation of breastfeeding and adversely affect the establish-
ment of lactation. None of the mothers in our study initiated breast-
feeding during the first hour after giving birth. The usefulness of the
early initiation of breastfeeding against the risk of neonatal mortality
was established in an ecological study covering 67 countries that
determined that breastfeeding in the first hour of life is beneficial for
all infants (Wendy, 2013). The findings from a study in sub-Saharan
Africa indicated that promoting the early initiation of breastfeeding is
potentially extremely beneficial: 16% of neonatal deaths could be pre-
vented if all infants were breastfed from the first day, and 22% if
breastfeeding began within the first hour after birth (Salam et al.,
2014). Breastfeeding in the first hour of life is recognized by the
WHO as an important component in the promotion, protection, and
support of breastfeeding, and should be implemented as routine hos-
pital practice in all countries to reduce neonatal mortality. Most neo-
natal diseases are preventable by simple interventions, such as
feeding with colostrum and the timing of breastfeeding onset
(Legesse et al., 2014).
Swaddling was an extremely common practice across the four cit-
ies. This practice was the most commonly reported cultural practice in
our study. Similar findings have been previously reported in two Jor-
danian studies (Abuidhail, 2014; Al-Sagarat & Al-Kharabsheh, 2017).
Our findings were consistent with those reported from Turkey, in
which swaddling involved wrapping neonates with the legs straight-
ened and the hips and knees extended (Alparslan & Demirel, 2013). In
contrast, an international report stressed that swaddling neonates in
this manner could cause hip problems (Pediatric Orthopaedic Society
of North America, 2015). When the newborn's legs are swaddled
tightly with the hips and knees straight, the ligaments that hold the
joints in place are stretched. The newborn will be at greater risk for
developing hip dislocation (Clarke, 2013). Joint abnormalities and
long-term complications, such as osteoarthritis, might result, and hip
replacement is sometimes required (Clarke, 2013). While the decision
to swaddle could be influenced by the parents' personal beliefs and
cultural practices, it appears to be generally recommended that, if par-
ents choose to swaddle their neonates, the neonate should not be
swaddled too tightly and their hips and knees should be given room to
move freely (Pediatric Orthopaedic Society of North America, 2015).
Therefore, health-care providers should discuss the decision to swad-
dle with mothers and inform them that tight swaddling might cause
injuries to their neonates, such as hip dislocation/dysplasia.
Neonates were also perceived to be particularly vulnerable to the
evil eye. The protection of neonates was viewed as being important,
and therefore, a number of practices were conducted to protect them.
Keeping the baby in a separate room, not showing the baby to anyone
except close family members, reading specific suras of the Quran daily
for the babies, and making the roqya and doaa were mentioned by
nearly all of the participants in our study. Prayers from the Quran and
Al-Hadith are commonly used by Muslims as incantations (roqya), as is
the writing of amulets (“ta'wiz”) for protection and a cure against the
evil eye. The most basic of all of these treatments is to trust in one
God and seek refuge with Him from all evil (Qamar, 2013).
In this study, we determined that some treatment modalities were
also used, such as garlic necklaces to treat jaundice and breast milk to
treat infections in the eye and female genitalia. Only one previous study
reported the practice of using breast milk as a treatment for some infec-
tions. In Zambia, mothers used breast milk on the umbilical stump to
prevent infection (Sacks et al., 2015). However, that study reported that
the effectiveness of breast milk against eye infections depended on the
type of infection, and that colostrum was more effective than mature
milk. However, this practice could delay professional treatment and
cause the infection to worsen. Enlargement of the neonatal breast
(physiological at this age) because of trans-placental-acquired maternal
MRAYAN ET AL. 5
hormones is normal in the first weeks of life. Some mothers in Jordan
squeezed the baby's breast to remove the milk. This practice leads to
greater enlargement, mastitis, and in some cases, abscesses. Identical
findings were reported from Bangladesh and Turkey (Alparslan &
Demirel, 2013; Winch et al., 2005).
Finally, the positives and negatives of these traditional practices
should be investigated and reported. Health-care providers should be
aware of the health-care practices of the communities they serve, and
should support and respect the beliefs and practices that are unlikely
to affect health and discourage practices that are shown to cause
harm. Integrating community health workers into the mainstream
health system is important, particularly in areas with low service cov-
erage. Building the capacity of community health workers in the early
detection and primary management of neonatal health cases can
greatly contribute to reducing morbidity and mortality. A well-trained
mothers' group can also help in sharing neonatal health-care informa-
tion in the community.
The findings of this study should be disseminated among midwives
and health-care providers to help them develop applicable plans for the
care of postpartum mothers and their neonates. Midwives' and nurses'
awareness should be raised to assess traditional neonatal practices
among new mothers and their care providers to support positive cul-
tural practices and discourage possibly harmful ones.
4.1 | Implications for nursing practice
Nurses should adopt a national policy that seeks to raise awareness of
the potentially harmful effects of some traditional practices on babies.
Efforts should be directed toward improving the knowledge of expec-
tant mothers and fathers regarding acceptable and non-acceptable
care practices. Mothers should be empowered to refuse to engage in
unacceptable practices when following their care providers' advice.
4.2 | Conclusion
In this descriptive, qualitative study, we reported on the traditional
home-based neonatal care practices in four cities in Jordan. Under the
influence of traditions, beliefs, families, or self-belief, nearly all of the
participants performed one or more of the traditional home-based
neonatal care practices.
Home-based neonatal care practices, such as rubbing the skin
with salt or bat's blood, kohol in the eyes, squeezing breast nipples,
and using breast milk to treat specific infections, were widely prac-
ticed by Jordanian mothers, although some of these practices might
harm the neonates. Therefore, the possible complications associated
with these practices should be discussed with all mothers.
Finally, we did not attempt to determine which practices are
recommended and which practices are not in this study. Further stud-
ies on this are recommended.
ACKNOWLEDGMENT
The authors would like to thank the mothers who participated in the
present study for sharing their experiences.
AUTHOR CONTRIBUTIONS
Study design: L.M., S.A., J.A., and A.A.
Data collection: L.M., S.A., J.A., and A.A.
Data analysis: L.M., S.A., J.A., and A.A.
Manuscript writing and revisions for important intellectual content:
L.M., S.A., J.A., and A.A.
ORCID
Lina Mrayan http://orcid.org/0000-0002-3782-6485
Jamila Abuidhail http://orcid.org/0000-0003-3145-119X
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How to cite this article: Mrayan L, Abujilban S, Abuidhail J,
Alshraifeen A. Traditional neonatal care practices in Jordan: A
qualitative study. Nurs Health Sci. 2018;1–8. https://doi.org/
10.1111/nhs.12540
MRAYAN ET AL. 7
APPENDIX I: Final thematic map showing the five themes
Tradition
cure
hair
care
gums
eyes
skin
nailsNappyrash
jaundiceEvileye
colic Congested breasts
infection
Caring for skin
Caring for Eyes
Caring for nails
Caring for gums
Caring for hair
comforting
Swaddling, feeding
Thematicmap
Caring for the neonate's
skin and eyes
Cure Jaundice
Cure nappy rash
Cure infections
Cure colic
Cure congested breasts
Protect + Cure evil eye
Treatment modalities
Protecting the
neonates from the
Feeding the neonate : between
traditional beliefs and healthy practice
evil eye
Comforting the neonate
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