Volume 92, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Conducting research in areas with diverse cultures requires attention to community sensitization and involvement. The process of community engagement is described for a large community-based, cluster-randomized, controlled trial comparing daily 4% chlorhexidine umbilical cord wash to dry cord care for neonatal mortality prevention in Southern Province, Zambia. Study preparations required baseline formative ethnographic research, substantial community sensitization, and engagement with three levels of stakeholders, each necessitating different strategies. Cluster-specific birth notification systems developed with traditional leadership and community members using community-selected data collectors resulted in a post-natal home visit within 48 hours of birth in 96% of births. Of 39,679 pregnant women enrolled (93% of the target of 42,570), only 3.7% were lost to follow-up or withdrew antenatally; 0.2% live-born neonates were lost by day 28 of follow-up. Conducting this trial in close collaboration with traditional, administrative, political, and community stakeholders facilitated excellent study participation, despite structural and sociocultural challenges.


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  1. Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R, Eisele T, Liu L, Mathers C, , 2010. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 375: 19691987.[Crossref] [Google Scholar]
  2. Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, Rudan I, Campbell H, Cibulskis R, Li M, Mathers C, Black RE, , 2012. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 379: 21512161.[Crossref] [Google Scholar]
  3. Oestergaard MZ, Inoue M, Yoshida S, Mahanani WR, Gore FM, Cousens S, Lawn JE, Mathers CD, , 2011. Neonatal mortality levels for 193 countries in 2009 with trends since 1990: a systematic analysis of progress, projections, and priorities. PLoS Med 8: e1001080.[Crossref] [Google Scholar]
  4. Lawn JE, Cousens S, Zupan J, , 2005. 4 million neonatal deaths: when? Where? Why? Lancet 365: 891900.[Crossref] [Google Scholar]
  5. Soofi S, Cousens S, Imdad A, Bhutto N, Ali N, Bhutta ZA, , 2012. Topical application of chlorhexidine to neonatal umbilical cords for prevention of omphalitis and neonatal mortality in a rural district of Pakistan: a community-based, cluster-randomised trial. Lancet 379: 10291036.[Crossref] [Google Scholar]
  6. Imdad A, Mullany LC, Baqui AH, El Arifeen S, Tielsch JM, Khatry SK, Shah R, Cousens S, Black RE, Bhutta ZA, , 2013. The effect of umbilical cord cleansing with chlorhexidine on omphalitis and neonatal mortality in community settings in developing countries: a meta-analysis. BMC Public Health 13: S15.[Crossref] [Google Scholar]
  7. Mullany LC, Darmstadt GL, Khatry SK, Katz J, LeClerq SC, Shrestha S, Adhikari R, Tielsch JM, , 2006. Topical applications of chlorhexidine to the umbilical cord for prevention of omphalitis and neonatal mortality in southern Nepal: a community-based, cluster-randomised trial. Lancet 367: 910918.[Crossref] [Google Scholar]
  8. Arifeen SE, Mullany LC, Shah R, Mannan I, Rahman SM, Talukder MR, Begum N, Al-Kabir A, Darmstadt GL, Santosham M, Black RE, Baqui AH, , 2012. The effect of cord cleansing with chlorhexidine on neonatal mortality in rural Bangladesh: a community-based, cluster-randomised trial. Lancet 379: 10221028.[Crossref] [Google Scholar]
  9. Mullany LC, Darmstadt GL, Tielsch JM, , 2006. Safety and impact of chlorhexidine antisepsis interventions for improving neonatal health in developing countries. Pediatr Infect Dis J 25: 665675.[Crossref] [Google Scholar]
  10. Imdad A, Bautista RM, Senen KA, Uy ME, Mantaring JB, 3rd Bhutta ZA, , 2013. Umbilical cord antiseptics for preventing sepsis and death among newborns. Cochrane Database Syst Rev 5: CD008635. [Google Scholar]
  11. Alam MA, Ali NA, Sultana N, Mullany LC, Teela KC, Khan NU, Baqui AH, El Arifeen S, Mannan I, Darmstadt GL, Winch PJ, , 2008. Newborn umbilical cord and skin care in Sylhet District, Bangladesh: implications for the promotion of umbilical cord cleansing with topical chlorhexidine. J Perinatol 28 (Suppl 2): S61S68.[Crossref] [Google Scholar]
  12. Choudhry UK, , 1997. Traditional practices of women from India: pregnancy, childbirth, and newborn care. J Obstet Gynecol Neonatal Nurs 26: 533539.[Crossref] [Google Scholar]
  13. Hill Z, Tawiah-Agyemang C, Okeyere E, Manu A, Fenty J, Kirkwood B, , 2010. Improving hygiene in home deliveries in rural Ghana: how to build on current attitudes and practices. Pediatr Infect Dis J 29: 10041008.[Crossref] [Google Scholar]
  14. Moran AC, Choudhury N, Uz Zaman Khan N, Ahsan Karar Z, Wahed T, Faiz Rashid S, Alam MA, , 2009. Newborn care practices among slum dwellers in Dhaka, Bangladesh: a quantitative and qualitative exploratory study. BMC Pregnancy Childbirth 9: 54.[Crossref] [Google Scholar]
  15. Maimbolwa MC, Yamba B, Diwan V, Ransjo-Arvidson AB, , 2003. Cultural childbirth practices and beliefs in Zambia. J Adv Nurs 43: 263274.[Crossref] [Google Scholar]
  16. Arenas-Lopez S, Fajardo C, Valls i Soler A, Garcia-Corzo JR, Lima-Rogel MV, Calle G, Leite R, Lobos E, Hume-Wright Q, MacLeod S, , 2011. Pediatric clinical trials in Latin America and Guyana: present views of local practitioners and ways to embrace the future. Paediatr Drugs 13: 257265.[Crossref] [Google Scholar]
  17. Idoko OT, Kochhar S, Agbenyega TE, Ogutu B, Ota MO, , 2013. Impact, challenges, and future projections of vaccine trials in Africa. Am J Trop Med Hyg 88: 414419.[Crossref] [Google Scholar]
  18. Zambia Central Statistical Office, 2012. Zambia 2010 Census of Population and Housing: Population Summary Report. Lusaka, Zambia: Zambia Central Statistical Office. [Google Scholar]
  19. Ministry of Health, 2009. Health Management Information System. Lusaka, Zambia: Ministry of Health. [Google Scholar]
  20. Campbell ML, Gregor FM, , 2002. Mapping Social Relations: A Primer in Doing Institutional Ethnography. Aurora, Canada: Rowman Altamira. [Google Scholar]
  21. Herlihy J, Shaikh A, Mazimba A, Gagne N, Grogan C, Mpamba C, Sooli B, Simamavwa G, Mabeta C, Shankoti P, Messersmith LJ, Semrau K, Hamer DH, , 2013. Local perceptions, cultural beliefs and practices that shape umbilical cord care: a qualitative study in Southern Province, Zambia. PLoS ONE 8: e79191.[Crossref] [Google Scholar]
  22. Gill CJ, Phiri-Mazala G, Guerina NG, Kasimba J, Mulenga M, MacLeod WB, Waitolo N, Knapp AB, Mirochnick M, Mazimba A, Fox MP, Sabin LL, Seidenberg P, Simon JL, Hamer DH, , 2011. Effect of training traditional birth attendants on neonatal mortality (Lufwanyama Neonatal Survival Project): randomised controlled study. Brit Med J 342: d346.[Crossref] [Google Scholar]
  23. Kirkwood BR, Manu A, ten Asbroek AH, Soremekun S, Weobong B, Gyan T, Danso S, Amenga-Etego S, Tawiah-Agyemang C, Owusu-Agyei S, Hill Z, , 2013. Effect of the Newhints home-visits intervention on neonatal mortality rate and care practices in Ghana: a cluster randomised controlled trial. Lancet 381: 21842192.[Crossref] [Google Scholar]

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  • Received : 09 Apr 2014
  • Accepted : 12 Nov 2014
  • Published online : 04 Mar 2015

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