International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571

Original Research Article

Indigenous Child Care Beliefs and Practices in the Region of : Implications for Health Care

Mildred E. John1*, Alberta D. Nsemo2*, Edidiong E. John3**, Margaret Opiah4#, Grace C. Robinson-Bassey4##, Josephine Yagba2#

1Professor, 2Lecturer 1, 3Consultant Physician, 4Senior Lecturer, *Department of Nursing Sciences, College of Medical Sciences, University of Calabar, Calabar, , Nigeria. **Department of Family Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria. #Faculty of Nursing, Niger Delta University, Wilberforce Island, , Nigeria. ##Department of Nursing Science, University of Port Harcourt, Port Harcourt, , Nigeria.

Corresponding Author: Mildred E. John

Received: 01/10/2015 Revised: 21/10/2015 Accepted: 27/10/2015

ABSTRACT

Traditional beliefs, attitudes and practices dominate the care of the newborn and child in most countries. Some common traditional practices, especially female genital mutilation, are harmful. However there are other subtle indigenous practices which are inimical to children's health but rarely reported. Aim of study was to describe the indigenous practices of child care in some Niger Delta communities of Nigeria and highlight their health implications. Three hundred and seven mothers/guardians of children 0 to 5 years were purposively selected from 10 rural communities in Cross River and Bayelsa states. Mixed methods, focus group discussion, in-depth interview and observation, were used to collect data on child care beliefs and practices, and these were grouped into five categories; "immediate care of the newborn", "routine and general care", "child protection/prevention of illness", "treatment of illness", and "delayed milestones". Indigenous childcare practices were similar across cultures in this region. Some of these, like the use of unsterilized instruments to cut the umbilical cord and application of cow dung or ash to the cord stump have negative effects on child health and development. We conclude that some beliefs and customs valued for child care by indigenous communities are harmful to health while other practices, like exclusive breastfeeding for 6 months and skin-to-skin contact of mother and baby, are beneficial and should be encouraged. Results call for community health action and incorporation of findings into health education and health action. This would ensure improved child care and the reduction of under- five morbidity/mortality in Nigeria.

Key words: Child care, Indigenous beliefs, indigenous practices, Niger Delta region.

INTRODUCTION a very important role in child care and Children are considered important child rearing, so in many indigenous in every society and early childhood is a societies cultural values, beliefs, and very critical period of development. norms shape child care attitudes and Therefore certain practices are put in place practices. Nigeria is one of the top 15 with the aim of providing appropriate child countries in the world for infant and under- care practices for child survival, growth, five mortality. [1, 2] Most of these deaths development and wellbeing. Culture plays occur in rural areas, are largely

International Journal of Health Sciences & Research (www.ijhsr.org) 235 Vol.5; Issue: 11; November 2015 preventable, and occur mostly in babies unlikely to be addressed successfully by born at home. To achieve the MDG-4 focus on orthodox practices and there is need to reduce this mortality rate programmes alone. Failure to achieve by considering every practice, both cultural understanding when planning traditional and orthodox that may put the health interventions may contribute to child at risk, and addressing all possible failure of implementation. Policies issues that relate to neonatal and child therefore need to consider wide scale survival. A significant number of community engagement, education and deliveries in the Niger Delta region modification of culture-related child care (especially in the rural, remote and strategies in order to reduce neonatal, underserved communities) take place infant and child mortality. Studies on outside the health care facilities and are indigenous practices of child care in mostly conducted by the elderly women in Nigeria are few and health planners seem the family or by traditional birth attendants to believe that all traditional/cultural (TBAs). In such communities folk practices are detrimental to health and so remedies are usually utilized at home for do not consider them when planning health sick children before seeking medical interventions. attention, sometimes when it is too late to This study documents the save the children. indigenous practices related to child care Many people, especially in rural in the Niger Delta communities and communities, are still involved in addresses their health implications. The indigenous (traditional) child rearing and paper highlights practices that are not child care practices. These practices vary commonly considered by health caregivers with culture and some of them may affect and planners but which may be harmful the health and development of the child and which should be considered for negatively, in the short or long run. community education and action. Data Several studies [3, 4] have shown that some elicited will provide an understanding of traditional neonatal care practices may put common indigenous child rearing practices the child at risk by causing infections, existing in the region; and will assist anaemia, hypothermia and hypoglycaemia childhood programme planners to model thereby increasing the risk of morbidity interventions taking into consideration the and mortality. In developing countries like traditional care behaviours of the society Nigeria, traditional attitudes and practices and adapt them for the improvement of dominate newborn and child care. Some of child health. Findings will also equip care these practices for example female genital providers with knowledge of different mutilation are obviously harmful and traditional child care practices which are contribute significantly to childhood beneficial and ensure incorporation of morbidity and mortality and are still these into community education to practised despite community health enhance culturally competent care. The education. Others on the other hand are purpose of the study was to explore and more subtle but are inimical to children's describe the indigenous (traditional) child health by either endangering health or care practices in rural communities of hindering health-seeking behaviours for Niger Delta region of Nigeria and children’s illnesses or resulting in highlight the health implications of such mismanagement of children’s sicknesses at practices. home. However policy makers seem to underscore the importance of socio- MATERIALS AND METHODS cultural beliefs and practices in child care. Design: This mixed methods (qualitative Yet the challenge of newborn survival is and quantitative) study lasting six months

International Journal of Health Sciences & Research (www.ijhsr.org) 236 Vol.5; Issue: 11; November 2015 was carried out in 10 rural communities in focus groups (with membership of two states (Cross River and Bayelsa) in the between 7 and 9). Each session lasted Niger Delta region of Nigeria using approximately 35 minutes and was focused ethnographic approach. recorded on audiotapes and field notes. Qualitative methods elicited beliefs and The interview schedule was translated into practices on child care while observation Efik and and re-translated of some women in their homes during into English. Re-translations gave a child care confirmed reports obtained reliability coefficient of 0.71 (Efik) and during focus group discussion (FGD) and 0.68 (Ijaw). The interview was carried out in-depth interview (IDI). using local languages and English Sample and sampling technique: Multi- (simplified English) and in respondents’ stage cluster sampling method was used to homes (which gave the opportunity to purposively select 307 participants (230 observe child care practices first hand). A mothers/grandmothers and guardians of check list was developed to record the children 0-5 years, and 77 traditional birth observations. attendants) in the selected communities. Data analysis: Data from FGD and in- Ethical clearance for the study was depth interview were manually checked obtained from the University of Calabar for completeness, transcribed, coded and and permission from Southern Ijaw and analyzed using Braun and Clarke (2006) Akpabuyo Local Government Councils. thematic analysis [5] and NVivo 9.0. Rigor Participants gave informed consent and was confirmed through prolonged participated willingly. engagement with participants, member- Data collection: Data on indigenous checking, validation of data by informants, beliefs and practices on child care were triangulation of data sources (interview, collected using focus group discussion and FGD and observation) and translation & in-depth interview. There were thirteen re-translation of instrument.

307 participants

Interviews Focus groups (n = 203) (13 Focus Groups, n = 104)

Traditional Traditional Mothers, Mothers, health health grandmothers & grandmothers & practitioners practitioners guardians guardians (THP) (n = 31) (n = 157) (n = 73) (n = 46)

Figure 1 Participants and method of data collection

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RESULTS Table 1: Socio-demographic characteristics of participants in both groups (N = 307) Characteristics Participants involved in Participants involved in Total No. % Focus Group Discussion in-depth interview (N = 104) (N = 203) Age (in years): Below 25 17 28 45 14.7 25 – 35 29 48 77 25.1 35 – 45 41 59 100 32.6 45 – 65 10 43 53 17.3 Above 65 7 25 32 10.4 Occupation Farming 26 51 77 25.1 Fishing 16 31 47 15.3 Trading 20 57 77 25.1 Traditional health practitioner (THP) 31 46 77 25.1 Civil servant Parity 11 18 29 9.4 1 – 2 13 27 40 13.1 3 – 5 69 104 173 56.4 More than 5 22 72 94 30.6 Educational status No formal education 25 49 74 24.1 Primary 47 96 143 46.6 Secondary 27 45 72 23.5 Tertiary 5 13 18 5.9 Type of care giving Mother/grandmother 52 115 167 54.4 Guardian 21 42 63 20.5 Traditional Health Practitioner 31 46 77 25.1 Ethnicity Efik 32 70 102 33.2 Ibibio/Annang 21 39 60 19.5 Ijaw 36 76 112 36.5 Others 15 18 33 10.7

Table 2: Common themes and sub-themes instillation); tying of charms and amulets Themes Sub-themes Immediate care of the newborn Cord care (made from dried chicken sacrum, cowry, Mother-baby bonding black string, beads etc.) around the neck, Breast feeding Routine and general care Infant feeding waist, wrist and ankle; use of various oils Baby bathing and massage and ointments for body massage; Excessive crying of baby Child protection/prevention of application of palm kernel oil and Shea illness butter ointment mixed with native garlic Treatment of illness Delayed milestones on the anterior fontanelle; and making of incisions on the skin of the forehead, side Socio-demographic data: The socio- of face, middle of chest, back of waist etc. demographic characteristics of participants Incisions were either smeared with gun are shown on Table 1. Participants were powder or burnt herbs to seal them. The mostly mothers and grandmothers, mostly beliefs and reasons for these practices of Ijaw and Efik ethnic groups; were also similar in the communities and predominantly farmers, traders and between ethnic groups, for example, to traditional health practitioners, 56.4% had “ward off malevolent spirits and the evil between 3 and 5 children each and highest eye”; to “protect baby from education obtained was primary education witchcraft/sorcery and from untimely in 46.6% participants. death, misfortune, bad luck” etc. Another Indigenous practices: Some indigenous common child care practice in the region childrearing practices believed to be was the traditional massage of the baby protective and preservative were similar with various substances (various oils, across cultures in this region, for example, sieved ash and sieved "native chalk" or use of herbal remedies (oral, bath, enema, "calabash chalk" etc.) from the third day

International Journal of Health Sciences & Research (www.ijhsr.org) 238 Vol.5; Issue: 11; November 2015 after birth till 9 months, but especially (especially colostrum). At birth majority within the first 6 months. None of the (except for one ethnic group) reported they cultures gave the baby a name during rub the cord with coarse table salt to pregnancy because names are often given "prevent it from smelling bad later". While based on the circumstances of birth. The some participants said they clean the cord traditional naming of the baby between the stump daily with warm saline water, none second and the eighth day after birth traditionally used methylated spirit or any involved some indigenous rituals. other disinfectant to clean the cord, unless Themes for traditional practices: Five they had the baby in the hospital. When themes and six sub-themes were identified the cord stump heals some mothers say and results are presented accordingly. The they apply a coin and tie it in place to 5 themes were "immediate care of the prevent protrusion of the umbilicus. newborn” (with cord care, mother-baby Mother-baby bonding: Rooming-in was bonding and breast feeding as sub- reportedly practised in the communities. themes); "routine and general care" (sub- "The new mother and her baby are put into themes: infant feeding, baby bath/baby seclusion until the umbilical cord drops". massage, and excessive crting of the "This is to keep the baby warm”, "make baby); “child protection/prevention of baby used to the mother's body scent" and illness”; “treatment of illnesses” and "to protect the baby from evil spirits". “care during delayed milestones”. (See Breast feeding: In the three ethnic groups, Table 2). the colostrum was discarded and the baby Immediate care of the newborn: Those fed with plain water or glucose water. "We from the riverine areas stated that they don't give the "yellow milk" (colostrum) to "throw the newborn into the river... to get the baby, we give the baby water for the them used to water and be able to swim first 3 days. But once the baby starts early in life". When asked if the baby breastfeeding we don't give anything else would not drown the typical response was except herbal medications when "No he used to swim in the womb, necessary" (27 year-old mother). Another moreover someone brings him out (of the mother said "it is not as if the yellow milk water) in a short while" (61 year-old is not given to the baby, but for the first 2 grandmother). Failure to cry at birth was or 3 days the breast milk does not flow. By also handled in a traditional manner; “If a the time it flows on the fourth or fifth day baby fails to cry at birth, he is given it is stale so we express it out and throw it “ogogoro” (native gin) to stimulate him” away" (35-year-old mother). Quite a (65 year-old TBA). number of mothers and grandmothers did Cord care: Participants reported that they not agree with exclusive breastfeeding and use hair thread or palm frond or slice of argued that the baby needs water, and a lot sharp bamboo stick to cut the umbilical of it, because of the hot weather. "Shortly cord. Reasons for this are expressed as after giving the baby breast milk you can "We don’t use razor blade to cut the cord notice the baby's lips being dry. So we because it makes the cord take longer to have to give the baby some water. I have separate". (59 year-old TBA). Another always nursed my children and grand woman said “using razor (blade) makes children that way" (70 year-old the umbilicus to protrude after healing” grandmother). (68 year-old grandmother). Several Routine and general care: substances were applied to the umbilical Baby bathing and Massage: Daily cord both before and after the cord falls hygiene care of the baby includes massage off, like engine oil or palm oil, sieved "Baby bathing procedure is actually a wood ash, heated herbs, breast milk ritual that combines massage, limb

International Journal of Health Sciences & Research (www.ijhsr.org) 239 Vol.5; Issue: 11; November 2015 stretching and body moulding before food and have to be force-fed. "At 6 bathing with warm water. We place the months we begin to give baby soft solid baby on our laps (thighs) to bathe, not in food and if child refuses to eat we force- the basin, so that we can massage the baby feed him and in extreme cases we give during the process" (62 year-old herbal concoctions to stimulate appetite" grandmother). "This is my second baby. I (38 year-old mother). In one such forced massage him whenever I am bathing him. I feeding session, it was observed that the press his neck, arms and spine, and throw baby was put across the mother’s knee and him up and shake him sometimes so that the "pap" (liquid corn cereal) was poured he does not grow up having fears" (28 into the cupped hand of the mother and year-old mother). In another culture the poured into the throat of the crying child. massage is done after a warm bath. "We At times the baby seemed to choke on the usually massage after giving the child a food. "We have different child feeding warm bath. The heat of the water relaxes patterns after weaning; we give boys more the muscles so that massage is not too protein to develop muscle but give girls uncomfortable for the baby" (54 year-old more carbohydrates to make them 'plump' TBA). Substances used for massage were (rounded) and feminine. For the girl child, diverse. "I massage my baby with coconut beauty is in the weight" (67 year-old oil or Shea butter to make her supple and grandmother) feminine if a girl or have well developed If baby cries excessively: Excessive crying muscles if a boy" (31 year-old mother). of the baby was attributed to a cause that "Massage is good, it relaxes the baby. We requires traditional attention. "When a call it Angor-Lor in Ijaw language and we baby cries too much it may be a sign of use different substances. It makes the baby discomfort, or because the baby is seeing look rounded and healthy, not thin and frightening things. Different practices were ugly. People don’t like carrying thin, dry- engaged in. "I cuddle him, stroke him looking babies" (58 year-old softly and gently rock him back and forth grandmother). "For young babies we use on my laps and throw him up in the air, sieved warm wood ash or clay (native and that makes him to stop crying" (26 chalk) or oil mixed with herbs to massage year-old mother). "Hmm the baby may be but when the baby is older we sometimes seeing ghosts and evil spirits so we arrange use hot sea sand and ground sea shells to for "separation rituals and 'feast' (65 year- smoothen and "polish" the baby's skin. old grandmother). The description of this These coarse materials get rid of rashes ritual involves cooking rice (the native and other skin blemishes" (47 year-old way with palm oil) and providing biscuits, TBA). "To prevent the newborn from soft drinks, groundnuts, and fruits and catching cold, I use herbs and spices inviting other children less than 5 years of mixed in coconut oil or palm kernel oil to age to eat with fingers from a common massage him" (26 year-old mother). tray. After the meal every child rubs the During observation of one baby bathing baby's body with their unwashed fingers cum massage session it was observed that and hands and the baby is left without bath the massage is very painful and harsh with till the following day. a lot of pinching and kneading the skin. Protection of child/ prevention of illness: Reasons for massage include, “to give Participants reported that they use various energy”, “to smoothen the skin”, “relieve methods to protect children from health abdominal colic” and “to relieve stress” problems and sicknesses. These include especially during teething. traditional incisions, use of charms and Infant feeding: As regards infant feeding, amulets made from different substances mothers said that children don't like new with incantations made over them; and the

International Journal of Health Sciences & Research (www.ijhsr.org) 240 Vol.5; Issue: 11; November 2015 use of leaves, roots and bark of certain prevent sickness. This is what my mother herbs which are prepared as concoctions or told me to do" (25 year-old mother). burnt in the room where the child sleeps. Another common practice was making of These are meant to ward off sorcery and skin incisions and applying gun powder to evil spirits that cause illness. "To prevent it to "ward off evil spirits". my child from falling ill, I give him herbal "My third child used to become ill juice to drink and also rub his body with very often so I took him to the traditional palm kernel oil" (30 year-old mother) "I healer who made incisions on his skin to give her (child) cold herbal enema every let out bad blood, and then he put gun two weeks" (47 year-old mother). "As you powder and herbs in the wounds" (31 year- can see I have tied some charms and old mother). This scarification practice amulets around his waist, arms and legs to seemed to be common among many ethnic protect him from the "evil eye" and groups.

Table 3: Common Indigenous practices with possible harmful health implications Practice area Always or sometimes Beliefs & Reasons for Health implications practiced practice Cord care Immediate care: Cutting the cord with hair To narrow the cut end These materials are usually not sterilized and may thread or “palm frond” (“mouth”) of the cord cause neonatal tetanus and infection Application of hot herbs on the For fast healing without Application of herbs to fresh cord may cause irritation cord stump bad odour Application of unsterile ash or clay on cord stump may Application of sieved ash or To dry out the cord so that cause cord infection, possible septicaemia & neonatal native chalk (clay) it doesn’t smell tetanus Application of engine oil To lubricate the cord stump Engine (motor) oil contains metallic additives and (motor oil) or palm oil so it is not too dry and hydrocarbons. Absorption may cause toxicity, irritation painful & rashes Circumcision Female circumcision To prevent the girl child Female circumcision is harmful to health and from being wayward later psychology of the girl child Bleeding Herbs are used to enhance Baby’s skin is tender, use of herbs on broken baby skin Use of herbs e.g. (fresh clotting and stop excessive may cause irritation & corrosion of the area with goldenseal, plantain leaf; bleeding subsequent infection Geranium, etc. to stop bleeding Ash used to stop bleeding Use of unsterile ash may cause infection especially Use of cold ash to stop Cannabis & cotton leaf neonatal tetanus bleeding reduce pain Cannabis is reported in literature as an effective pain Use of cotton leaf & cannabis killer to reduce pain Care during Diarrhoea illness Starving child of food for To “rest the stomach” May worsen the diarrhoea- malnutrition cycle in the duration of the diarrhoea child Melting "native chalk" in water To harden the stools and Koalin and calcium carbonate in native chalk have anti- and giving sips to child stop diarrhoea diarrhoeal action, some native chalk may contain lead Convulsion and arsenic Instillation of palm kernel oil To prevent the child from Palm kernel oil may cause eye irritation & affect vision and herbal juice into eyes “seeing demons” Placing feet of child near fire To keep the feet warm Convulsion is mostly caused by fever, “foot roasting” during convulsions (“foot further increases body temperature and may prolong roasting” ) convulsions Jaundice Instillation of herbal juice into “To reduce the Herbs may cause eye irritation eyes discoloration” Teething problems Give tea made from fresh To “settle the baby and Literature reveals therapeutic use of cannabis for adults cannabis to baby to drink prevent the child being but not for babies. When juiced fresh, cannabis irritable” contains ineffective alkaloids & is safer. Once heated (participants say they boil the leaves), cannabis may have psychotropic effects on the child Other Making skin incisions To “mark the baby as Gun powder contains sulphur, charcoal & potassium practices (scarification) & rubbing gun sacred”, for protection, “to nitrate. Literature reveals that it sterilises wounds, powder (black powder) or scare away evil spirits” and however it may cause allergy in sensitive individuals burnt plantain leaves in the prevent illness resulting in headache marks

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Table 4: Indigenous practices with beneficial or uncertain effects Practice area Always or sometimes Reasons for practice Health implications practised Immediate Care If not crying immediately: of the newborn Splash local alcohol To stimulate the baby to cry Sprinkling cold alcohol on the baby's skin may (distillate of palm wine) on cause cold in the newborn baby’s face and body and put a little into mouth of baby After bathing the baby: To keep baby warm and to “get Rooming-in practice is beneficial to both mother Keep the baby lying close to used to mother’s body scent” and baby mother (rooming-in) which makes baby “ contented”, and "to protect the baby" Umbilical cord Immediate care cares Application of table salt to To make it dry and fall off Use of salt on the fresh cord stump is useful to cord stump (always) easily without smelling prevent & treat umbilical granuloma. Later care Colostrum contains antibodies and may cause Instillation of breast milk To clean the cord and cause shorter time of cord separation (colostrums) to base of cord separation without leaving a piece Breastfeeding Exclusive breastfeeding for 6 To provide baby with Positive health effects /weaning months maximum nutrient and protection Other practices Traditional massage of baby To make baby strong, keep Massaging has been found in literature to promote muscles, limbs and spine warm and healthy and make warmth, improve mood, enhance sleep patterns, with different oils, ash or skin supple aid digestion, improve circulation. Although native clay To reduce abdominal colic and massage is beneficial some neonates may have aid bowel movement allergy to some of the oils used Giving sips of water of To provide energy Coconut water has been documented as readily tender coconut to the child available electrolyte solution in diarrhoeal with diarrhoea treatment Inserting a coin in navel and To push in the protruding Health implication of this not known tying it in place if child has umbilicus protruding umbilicus Tying cowry shell or dried To prevent & treat painful Health implication of this not known chicken sacrum, or enchanted urination and to ward off evil beads around baby’s neck, spirits, mishap, witchcraft, wrist, waist & ankle untimely death & prevent sickness Applying fresh palm wine To prevent/treat itching and aid Palm wine contains yeast which helps in reducing and tender coconut water on healing of the rashes itching and skin healing. Tender coconut water the skin in measles soothes irritated skin

Treatment of illnesses: Practices during are freely available and can be used for illness include herbal baths, enema and any illness, as long as you know what to drink; instillation of herbal juice and oils use, how to use it and what to use it for" into the eyes to prevent convulsion, (65 year-old grandmother). If a child has incantations, ritual incisions, sacrifices, teething problems and is fretful and therapeutic massage, “traditional feasts” irritable, a practice found in several and heat treatment depending on the communities was the giving of tea made illness and the belief concerning its from fresh cannabis leaves and flowers to causation. Herbal treatment was found to the child. be very common in all the communities. "If a child falls sick often, we Herbal mixtures of all types (infusion, arrange for a traditional "feast" with decoction, juices etc.) were commonly his/her age mates. When the child has used in the treatment of ailments. convulsions, we place the feet of the child Commonly used herbs include yarrow, near fire (called "feet roasting") and instil hibiscus leaves and flower, white sage, oil or herbs into the eyes “(55 year-old cotton leaf, cannabis, goldenseal, plantain TBA). A 30 year-old mother said, "Since I leaf; geranium, liverwort, marigold, don't know what herbs to use I rub my mistletoe, avocado leaves, cayenne, yellow baby's skin with palm kernel oil and also tassel flower etc. The general opinion was put (instil) some in the eyes, when he has that "herbs are free medicine from God; fever to prevent convulsion. If he has

International Journal of Health Sciences & Research (www.ijhsr.org) 242 Vol.5; Issue: 11; November 2015 convulsion I also do the same thing". cord care practices to include application Another common practice in illness was of hot fermentation, use of rag and lantern, the practice of starving the child who has use of Vaseline, ash / charcoal, groundnut / diarrhoea. Reasons given for this were to palm, mangrove oil, powder and red sand. "rest the stomach" and prevent further Both studies conclude that these practices stooling. "If there is nothing in the are harmful, because the substances are stomach there will be nothing to pass out, often contaminated with bacteria and so we do not give food to the child until spores, thus increasing the risk of the diarrhoea stops" (43 year-old mother). infection. The use of common salt on the It the child has measles, fresh or fermented cord is however said to be safe, cost- palm wine was applied on the skin to effective and beneficial as it prevents, soothe itching and enhance skin healing. treats and reduces umbilical granuloma. Delayed milestones: For delayed [7,8] The application of colostrum on the milestones like delayed sitting, crawling, cord also reported in a study in Turkey [9] and walking the practices were not has been found to be beneficial because unusual. However for delayed talking, colostrum contains antibodies and has no participants reported that they "cut the adverse effects on the cord but rather tongue tie" and give the child herbs mixed causes faster cord separation. However the in "hot drink" (native gin). For delayed practice of placing and tying a large coin walking "special broom" was used to beat on the healed umbilical stump, found in the feet of the child twice a day. Some said this study, has not been reported in any they apply heated herbs on the feet to literature. make them light so that the child can lift Some indigenous child care them up easily. practices identified in the current study Table 3 shows common indigenous child tend to have negative effects on child care practices and their harmful health and development. These include the implications; while Table 4 shows the use of unsterilized instruments to cut the indigenous child care practices that may umbilical cord, application of unsterile have beneficial or uncertain effects. substances and herbs to the cord stump; not giving the colostrum to neonates DISCUSSION (believed to be “sour milk” or “stale Traditional child care practices milk”); instillation of herbal juice in the existed in all the communities used for eyes (during jaundice and fever), starving study. Another study in the Niger Delta the child of food during diarrhoea; “foot region [3] also reported the practice of roasting” (putting the feet of a child with abdominal massage, administration of convulsions near the fire); and giving tea herbal concoctions, scarification marks made from boiled fresh cannabis to babies and unsterile umbilical cord care in their with teething problems. Harmful case study. In terms of umbilical cord care, traditional child care practices are not best practice involves keeping the cord peculiar to only Africa Asia, and the stump clean and dry without applying Caribbean but exist even in Europe. The anything since dry cord care causes faster existence of harmful practices like salting separation. However a related study in the of the newborn, restrictive swaddling and Niger Delta region of Nigeria [4] reported delayed feeding of the baby after birth are that although most women cleaned the also reported in Turkey [10,11] Some baby's cord daily, some thereafter applied practices however have beneficial some potentially harmful substances like implications, for example, exclusive herbs and cold ash. Another study in breastfeeding for 6 months and North-Eastern Nigeria [6] found traditional breastfeeding for up to one year to one-

International Journal of Health Sciences & Research (www.ijhsr.org) 243 Vol.5; Issue: 11; November 2015 and-half years; baby massaging, rubbing papaya etc. and their use in the treatment of cooking salt on the umbilical cord of diseases. These herbs are often used in stump; rubbing of palm wine on the skin combination and as juice (oral or as of a child with measles etc. Palm wine enema), decoction, paste, poultice, etc. contains yeast, Phosphorus and B Traditional massage of the baby is Vitamins, especially Riboflavin and another very common practice in the Nicotinic acid, and these may be beneficial settings used for this study and is not for healing of skin blemishes. Some limited to African societies alone. The practices have no documented beneficial time of initiating baby massage varied or adverse effects, for example, hanging from the day after birth in some cultures to enchanted beads, cowry shell, black string end of first week in others. A study in or dried chicken sacrum around child’s Bangladesh [18] reported the use of some neck, wrist, ankle or waist, as a means of natural oils and ointments in baby protection and preservation. This was a massage, either alone or in combination. common practice in all the settings However the authors opined that the use of studied, and was also reported in the certain oils on baby's skin may have Somali culture in Kenya [12] and in detrimental cutaneous and systemic Tanzania. [13] Both the Kenyan and effects, depending on the composition of Tanzanian studies reported the use of the oil and the sensitivity of the baby's different traditional methods to protect skin. [18] Baby massage has recently infants and children from illness, disease received so much attention that certain and mishaps. These include herbal organizations and child care experts remedies, wearing of enchanted bracelets actually advocate baby massage to and amulets, incisions made on the enhance baby's wellbeing. [19, 20] Several forehead and other parts of the body and benefits have been attributed to it smeared with burnt herbs to ward off the including improvement of skin barrier “evil eye,” witchcraft/sorcery and function, prevention of infection, keeping infectious diseases. Some of these the baby warm, making the skin smooth substances may be irritating like the gun and supple and the bones strong, [19,20] and powder found to be used in the current enhancing the expulsion of toxins and study. reducing bilirubin levels thus ameliorating The use of plants for indigenous neonatal jaundice. [21] However there are herbal remedies is common all over the certain conditions in which massage may world. Studies have documented the use of not be beneficial as reported in the case the leaves, stem, bark, whole plant, flower, study of a neonate who developed recto- fruit/seed, latex, and root of plants for vaginal prolapse because of traditional traditional mother and child care. Several abdominal massage given to the neonate species of plants have been reportedly because of constipation. [3] used for several reasons in the care, The practice of discarding the prevention and treatment of illnesses in colostrum, found in this study, is also children in India [14, 15] and Nigeria. [16, 17] reported in Nepal [22, 23] and Ethiopia. [24] Studies in South Eastern Nigeria [16] and Reasons given for discarding the South Western Nigeria, [17] report the colostrum include its colour and the belief beneficial effect of herbs like goldenseal, that colostrum is "bad blood in the breast" bryophyllum, Ocimum gratissimum (scent and that it causes abdominal problems like leaves), neem, bitter kola, siam weed, colic and vomiting. This practice deprives Vernonia amygdalina (bitter leaf), Acasia, the newborn of valuable nutrients and raffia palm, moringa, alligator pepper, antibodies. Geranium, liverwort, marigold, lime,

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Indigenous methods of treatment of CONCLUSION diseases are also reported in several Several common indigenous child studies. [25-27] In a study in care practices exist in the Niger Delta (another state in the Niger Delta region of region of Nigeria. While some of these Nigeria) indigenous treatment of diarrhoea have the capacity to put the child at health include the use of native chalk. [25] risk and have negative effects on child Although native chalk contains substances health and development, others have no that have anti-diarrhoeal actions, it may obvious ill effects. These practices have also contain lead and arsenic (depending implications for health education by nurses on where it is mined) and these may cause involved in maternal and child care. Other inflammation and oedema of the stomach practices however have positive outcomes lining [26] and are thus not beneficial for and should be encouraged. The need for use in children. Studies in South Western culturally-relevant and culturally-sensitive Nigeria [17,27] report the indigenous health education is recommended. methods used in the treatment of viral infections like measles, hepatitis, ACKNOWLEDGEMENT poliomyelitis, and chickenpox. Administrative support from the Implications of findings for health care Chairmen of the Local Government Councils of children: Socio-cultural beliefs and of Akpabuyo sand Southern Ijaw. practices play a major role in healthcare. REFERENCES Indigenous practices are deeply rooted in 1. UNICEF/WHO/The World Bank. the local culture and should be used as Levels and Trends in Child Mortality basis for health education and community Report. New York: UN Population health action. Clean cord care practices Division; 2013. should be incorporated into health 2. National Population Commission. education and health action especially by Nigeria Demographic and Health traditional birth attendants, health care Survey. Abuja: National Population providers working in the community. Commission; 2013. Mothers and guardians should be taught 3. Peterside O, Duru CO, Anene N. that the use of traditional remedies should Harmful traditional practices in a newborn: A case report. Nigerian not stop them from seeking medical Journal of Paediatrics 2015; 42(2): treatment for their sick children. Newborn, 151-153. infants and children need to be protected in 4. Opara PI, Jaja T, Dotimi DA, Alex- the community, where most of them are Hart BA. Newborn Cord Care likely to be born, by creating interventions Practices amongst Mothers in that consider the culture and traditions Yenagoa Local Government Area, surrounding their birth and rearing Bayelsa State, Nigeria. Int J Clin Med. practices. Results call for improved child 2012; 3: 22-27. care and prevention of morbidity/mortality 5. Braun V, Clarke V. Using thematic in children under 5 in Nigeria. Health analysis in psychology. Qual Res personnel working in the field of infant Psychol. 2006; 3:77-101. 6. Ambe JP, Bello M, Yahaya S, care should evaluate the traditional Omotara BA. Umbilical Cord Care characteristics of behaviour in the Practices In Konduga Local locations where they work and put Government Area Of interventions in place to correct negative North-Eastern Nigeria. The Internet J behaviours while encouraging beneficial Trop Med. 2009; 5(2): 34-41. ones. 7. Derakhshan MR. Curative effect of common salt on umbilical granuloma. Iran J Med Sci. 1998; 23(3&4): 132- 133. International Journal of Health Sciences & Research (www.ijhsr.org) 245 Vol.5; Issue: 11; November 2015

8. Hossain AZ, Hasan GZ, Islam KMD. among Yoruba tribe of South Western Therapeutic Effect of Common Salt Nigeria. Afr J Microbiol Res. 2011; (Table/ Cooking Salt) on Umbilical 5(19): 2991-3004. Granuloma in Infants Bangladesh. 18. Darmstadt GL, Saha SK. Traditional Journal of Child Health. 2010; 34(3): Practice of Oil Massage of Neonates 99-102. in Bangladesh J Health Popul Nutr. 9. Vural G, Kisa S. Umbilical cord care: 2002; 20(2): 184-188. a pilot study comparing topical human 19. Johnson and Johnson GmbH. The milk, povidone-iodine, and dry care. J. importance of touch and baby Obstet Gynaecol Neonat Nurs. 2006; massage. Symposium at International 35(1): 123-8. Confederation of Midwives 30th 10. Ozyazicioglu N, Polat S. Traditional Triennial Conference. 2014 June 1-5; practices frequently used for the Prague, Czech Republic. newborn in Turkey: a literature 20. Heath A, Bainbridge N. Baby review. Indian J Trad Knowledge. massage: The calming power of touch. 2014; 13(3): 445-452. London: Dorling Kindersley Books 11. Beser A, Topcu S, Coskun A, Erdem Limited; 2004. N, et al. Traditional child care 21. Chen J, Sadakata M, Ishida M, practices among mothers with infants Sekizuka N, Sayama M. Baby less than 1 year old. DEUHYO ED massage ameliorates neonatal jaundice 2010; 3(3): 137-145. in full-term newborn infants. Tohoku J 12. Otieno P, Miyienda C, Wanjiru A, Exp Med. 2011; 223: 97-102. David SN. Cultural Practices on 22. Odent PLG Early infant feeding and Maternal Neonatal Child Care in neonatal survival in Nepal: Kenya. [Online] 2013. [Accessed 5th breastfeeding, colostrum and April 2015]. Available from discarding of the first milk. Thesis http://www.academia.edu/5167228/Tr submitted in partial fulfilment of aditional_practices_in_maternal_neon requirements of University College atal_child-care.Html. London for the degree of Doctor of 13. Kayombo EJ. Traditional Methods of Philosophy. London: University Protecting the Infant and Child College. [Online] 2010. [Accessed: Illness/Disease Among the Wazigua at 20th December 2014]. Available Mvomero Ward, Morogoro, Region, fromhttp://www.discovery.ucl.ac.uk.p Tanzania. Altern Integr Med. 2013; 2: df. 103. doi 10.4172/2327-5162.1000103. 23. Joshi SK, Barakoti B, Lamsal S. 14. Rajith NP, Navas M, Thaha AM, et al. Colostrum Feeding: Knowledge, A study on traditional mother care Attitude and Practice in Pregnant plants of rural communities of South Women in a Teaching Hospital in Kerala. Indian J Trad Knowledge. Nepal. Web Med Cent Med Educ. 2010; 9 (1): 203-208. 2012; 3(8): WMC003601 doi: 15. Rawat DS, Kharwal AD. Studies on 0.9754/journal.wmc.2012.003601. traditional herbal paediatrics practices 24. Rogers NL, Abdi J, Moore D, in Jaisinghpur, district Kangra Nd'iangui S, Smith LJ, Carlson AJ, (Himachal Pradesh, India). Global J Carlson D. Colostrum avoidance, pre- Res Medicinal Plants Indigen Med. lacteal feeding and late breast-feeding 2013; 2(4): 219–230. initiation in rural Northern Ethiopia. 16. Uzodinma DE. Medico-Ethno- Public Health Nutr. 2011;14(11): botanical inventory of Ogii, Okigwe 2029-36. Imo State, South Eastern Nigeria. 25. Obuekwue IF, Obuekwue IC. Global Adv Res J Medicinal Plants Indigenous methods used for the (GARJMP). 2013; 2(2): 30-44. management of diarrhoea in an urban 17. Oladunmoye MK, Kehinde FY. community in Edo State, Nigeria. J Ethnobotanical survey of medicinal Med Biomed Res. 2002; 1(1): 12-17. plants used in treating viral infections International Journal of Health Sciences & Research (www.ijhsr.org) 246 Vol.5; Issue: 11; November 2015

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How to cite this article: John ME, Nsemo AD, John EE et al. Indigenous child care beliefs and practices in the Niger delta region of Nigeria: implications for health care. Int J Health Sci Res. 2015; 5(11):235-247.

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International Journal of Health Sciences & Research (www.ijhsr.org) 247 Vol.5; Issue: 11; November 2015