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Mulaudzi FM, Lebese RT, editors. Working with indigenous knowledge: Strategies for health professionals [Internet]. Cape Town: AOSIS; 2022. doi: 10.4102/aosis.2022.BK296.07
Child development outcome is determined by the quality of neonatal care provided. Globally, mother-baby relationships and caring for neonates are conceptualised based on Western culture. However, in African indigenous cultural systems, certain practices and treatment modalities are practised during the neonatal period. The purpose of this chapter is to focus on the documented indigenous beliefs, practices and treatment modalities regarding neonatal care. Confinement of a mother and a neonate for at least a month following birth is strictly recommended in African traditions. During this period, only a selected few are allowed in the room where the mother and the baby are. Failure to comply with this practice is not acceptable zwi a ila and can make the baby sick u kanda nwana. These practices are of great importance for the promotion of bonding, maintenance of the baby’s warmth as well as prevention of cross-infection. Indigenous African cultures have treatment modalities that are routinely administered; these practices are not formally documented. Knowledge and understanding of indigenous neonatal care practices by health care professionals might create awareness of such practices in the communities that they serve. This will enable health care practitioners to provide support, learn and respect the beliefs and practices that are beneficial to neonatal health and alert communities regarding those practices that are harmful. This may be achieved through effective collaboration between health care providers and traditional birth attendants.
According to the World Health Organization (WHO), a neonate is an infant during the first 28 days following birth (WHO 2016). This period is considered critical because a neonate is at the highest risk of dying. Currently, the number of neonatal deaths in the world is unacceptably high, despite the mortality rate being within the sustainable development goal (SDG) target (Rhoda et al. 2018). According to Gandhi et al. (2014) neonatal care practices contribute to the deaths of newborn babies during the first 28 days following birth.
In Africa, there are countries where females still deliver babies at home. Such deliveries are supervised by either experienced midwives or elderly females within the family. The deliveries are done by following the indigenous knowledge, beliefs and practices influenced by local culture and traditions. However, some of the indigenous neonatal care practices may have negative implications on neonatal health. Consequently, community members need to be made aware of how to identify life-threatening signs in newborn babies (Gandhi et al. 2014; Otieno et al. 2013). There are, however, traditional and cultural practices that may be beneficial to neonates. Effective collaboration between health care professionals and traditional birth attendants is therefore necessary for addressing neonatal care practices (to prevent harmful practices that may negatively affect neonatal health) and to promote good practices.
The purpose of this chapter is to formally document and report on the positive and the negative indigenous practices and treatment modalities regarding neonatal care. It is of paramount importance that health care professionals have indigenous knowledge and understanding regarding neonatal care practices. This will enable them to learn, support as well as adopt good practices. On the other hand, it will also identify practices that may pose threats to neonatal health.
This is the care provided to a newborn baby at birth. In rural and remote Africa, pregnant females still deliver babies at home; whereby deliveries are conducted by the grannies, experienced family members or traditional birth attendants. Based on tradition and culture, certain neonatal care practices are implemented as rituals immediately at birth by either an elderly female in the family or a traditional birth attendant who conducted the delivery. The rituals are aimed at saving the newborn baby’s life.
In Niger Delta, a district of Nigeria, babies who fail to cry immediately at birth are given traditional stimulants such as ogogoro (a traditional gin) to drink, and it is believed that this will stimulate the baby to cry. Palm wine is also splashed on the newborn baby’s face and body to make the baby cry at birth (John et al. 2015).
According to Nigerian tradition, a newborn baby is thrown into the river as it is believed that the neonates have to be introduced to the water so that they may get used to water; and this practice will enable the child to swim without difficulties early in life. The practice is commonly done in those villages situated next to the rivers. Traditional birth attendants do not worry much about newborns drowning because they believe that newborns are used to swimming, as they have been swimming in the mother’s uterus and are brought out of the water immediately (John et al. 2015).
According to John et al. (2015), in some rural parts of Nigeria, hair threads or a stick of an Areca tree are used for cutting the umbilical cord. The reason for such a practice is the belief that the cord cut with a razor blade takes longer to dry and fall off and the umbilicus protrudes after healing. It is believed that an umbilical cord cut with either the hair threads or an Areca stick heals and dries naturally and prevents bad odour from emanating from the cord. After cutting the cord, traditional birth attendants rub the umbilical cord with coarse table salt. This is done as it is believed that the practice helps in the prevention of a bad smell coming from the cord at a later stage (John et al. 2015).
In Tanzania, Ghana and Senegal, traditional birth attendants take long before drying and wrapping the newborn at birth, predisposing the baby to hypothermia. The reason for the delay is that in most cases, after the birth of the baby, traditional birth attendants are preoccupied with the delivery of the placenta, and no one is there to assist with the cutting of the umbilical cord (Bazzano 2006; Hill et al. 2010; Niang 2004; Shamba et al. 2014).
In Ethiopia, priority is given to the delivery of the placenta because it is a taboo to provide care to a newborn baby until the placenta is buried; this practice exposes the baby to hypothermia as immediate care is not given in the form of drying and wrapping of the newborn baby (Amare 2008).
There is a clear demonstration that most traditional birth attendants and mothers in African traditions still lack knowledge and understanding regarding some traditional practices that are performed immediately after the birth of a newborn baby, which poses threats to neonatal health.
In most patriarchal societies, the postpartum is a period during which the female and the newborn baby are unclean; and, therefore, seen as a threat to others. On the other hand, the female and the newborn baby are considered vulnerable, implying that the environment around them becomes dangerous for them. The fact that a postpartum mother and her newborn are considered unclean and vulnerable results in them being ritually secluded or isolated and confined in a separate room for a specified period following the birth of the baby. During this period, the mother is expected to stay in bed and is excluded from performing household chores. This gives the mother enough chance to rest and take full responsibility for neonatal care. The practice is beneficial for both the mother and the baby because not only does it promote rest for the mother, but it promotes maintenance of the baby’s warmth, promotion of bonding and feeding on demand as well as prevention of cross-infection (Bee, Shiroor & Hill 2018; Eberhard-Gran et al. 2010; John et al. 2015).
In the Vhembe district of South Africa, mothers and their neonates are placed in confinement for fear of mirunzi ya vhathu [evil spirits carried by people] as it is believed to be one of the common unnatural causes of neonatal illnesses, which are a serious concern to the mothers. In some families, confinement extends to abstinence from sexual relations between the parents of the neonate. The length of confinement varies according to the family. The period is two weeks in less strict families and three months in stricter families. Even if three months of confinement is preferred, the mother is allowed to leave her room and do some housework or even go to work, but the neonate must remain confined and away from people who are not an immediate family (Tulelo 2021). An investigation in Botswana and Tanzanian related to abstinence from sexual relations between parents of the neonate was found to have similar results (Kayombo 2013; Mwape et al. 2018; Rempel et al. 2019). This preventive strategy is thought to improve neonatal weight gain while protecting both the neonate and the mother from additional ailments brought by evil spirits.
In Nigeria, the postnatal female and the newborn are kept in isolation in a special room (‘fattening room’) for 2–3 months. During this period, the mother’s responsibilities include eating, resting and taking care of the baby (Eberhard-Gran et al. 2010; John et al. 2015). A similar custom is practised by the Masai people in Tanzania and Kenya. A postnatal female and her baby are isolated, and the main duty of the mother is to eat abundantly (Eberhard-Gran et al. 2010). During this time, the only people who can gain entrance into the mother’s room are immediate family members and the elderly who are providing care to the mother and the baby (Bee et al. 2018).
In rural Zambia, only selected people can touch and hold the baby. These include the grandmothers and other elderly people in the family. All single and or divorced people are not allowed to touch or hold the newborn baby for fear that they might have engaged in sexual intercourse (which is considered dirty). In that case, it is believed that the newborn baby may die or suffer infertility in the future (Buser et al. 2020). In Niger, the mother and her newborn baby are kept in isolation; and can only leave the room when the umbilical cord has fallen off. The reason for this practice is the protection of the newborn from evil spirits and those with evil intentions (John et al. 2015).
Confinement of the mother and baby in their room for weeks (or months, depending on the culture), is a good practice that promotes thermal care. This helps to keep the baby warm and free from cold and draughts that may cause hypothermia (nwana o dzhenwa nga phepho in Tshivenḓa) to the neonate, resulting in death (Eberhard-Gran et al. 2010). Keeping the baby away from draughts, application of oil all over the body, wrapping the newborn baby with blankets and warming the place where the female and the neonate are accommodated are common beneficial traditional African practices (Bee et al. 2018). Mothers in Niger are encouraged to stay indoors with the newborn baby for a stipulated period after giving birth. This is done to keep the baby warm and avoid exposure to cold (John et al. 2015).
Though the mother and the neonate are kept indoors following delivery which is beneficial for thermal care, literature based in Nigeria, Uganda, Ghana, Zambia and Malawi reveal that during delivery, traditional birth attendants leave the newborn baby exposed and unattended to, while attending to third and fourth stages of labour. This practice predisposes the newborn baby to a very high risk of neonatal hypothermia. The majority of the females were concerned that newborns were exposed to cold at birth because a lot of time elapsed before any attention was given to them. Maintenance of skin-to-skin contact between the newborn baby and the mother is a rare experience, and neither is a baby covered as traditional birth attendants are busy with the mothers (Bee et al. 2018; John et al. 2015; Lunze et al. 2014; Ministry of Health [MoH] 2008; Rajith et al. 2010; Zimba et al. 2007). Ethiopians, Ghanaians, Nigerians, Malawians, Tanzanians, Zambians and Ugandans believe that a newborn baby should be kept in a heated room to avoid exposure to drafts and cold, which can make the baby sick (Amare 2008; MoH 2008).
Traditionally, rooming-in during the initial stage of postnatal care is recommended, and this is beneficial for the promotion of bonding between the mother and the neonate. According to Eberhard-Gran et al. (2010), Bee et al. (2018), John et al. (2015), Hill and Flanagan (2020) mother–neonate bonding is vital as it provides the neonate’s first model for intimate relationships and fosters a sense of trust, security and positive self-esteem. The quality of the bonding relationship between both directly impacts the long-term mental health of the mother and the neonate. The authors further stated that the type of bond established between the mothers and the neonates determines the growth of the children and the way they will interact with other people and will raise their children. Bonding between the mother and her newborn baby is also promoted in Niger’s district of Nigeria. The mother and her newborn baby are encouraged to stay in a room so that they can get time to know each other and the baby can get used to the mother’s body scent (John et al. 2015).
Seclusion and confinement of the mother and the baby during the early postnatal period is considered beneficial for both the mother and the baby. Limitation of the number of family members, relatives and friends allowed to visit the mother and the baby minimises chances of transmission of infection to the neonate putting its life at risk (u kanda nwana), especially before the umbilical cord drops off.
The seclusion of the mother and the newborn baby after delivery is beneficial for both parties. The practice promotes rooming-in, maintenance of warmth, promotion of bonding and prevention of infection to both the mother and the baby.
Though it is advocated that the baby be breastfed immediately after delivery (within at least 60 min after delivery), most African traditions are still not in support of the practice. Some traditional birth attendants and elderly members of the family believe in feeding a warm, soft porridge mixed with herbs [tshiunza] to a newborn baby at birth and breastfeeding later. In the study by Ngunyulu, Mulaudzi and Peu (2015), it is reported that a traditional birth attendant considers it a norm that after conduction of delivery, she prepares soft porridge for the newborn baby as she believes that the porridge will promote relaxation and accelerate growth.
According to Alebila (2019), most Ghanaians believe that breastfeeding is not supposed to be initiated until after the call of three Azans (calls for three Islamic prayer sessions). They believe that when babies are kept waiting for that number of hours without having been fed, they become strong as they are being trained to be patient in life. The practice is believed to prepare the baby to become a strong and patient adult.
Another reason for the delay in the initiation of breastfeeding is that breastmilk is believed to be bitter during the first few days after delivery and the mother needs to have a cleansing ritual in the few days after delivery. Provision of substitutes is made if the baby has not been fed for more than one day, otherwise, nothing is given during the first day (Aborigo et al. 2012; Alebila 2019; Tawiah-Agyemang et al. 2008).
Several studies conducted in Ethiopia, Tanzania, Malawi, Nigeria, Ghana, Senegal, Uganda and Zambia, report delays in the initiation of breastfeeding and the following reasons were advanced for the delay: mothers did not have milk during the first few days, which according to culture is not a problem as it is believed that it ‘takes days for breasts to start secreting milk following delivery of a baby’ (Aborigo et al. 2012; Oche, Umar & Ahmed 2011; Rogers et al. 2011).
Another reason why Ethiopians and Tanzanians do not initiate breastfeeding within an hour after delivery is related to hygiene practices. It is believed that the blood of the mother, which is believed to be unclean, comes into contact with the baby at birth. Therefore, it is unhygienic for the mother to breastfeed before taking a bath. Both the mother and the baby should have a bath before the initiation of breastfeeding (Aborigo et al. 2012; Bee et al. 2018; Oche et al. 2011; Rogers et al. 2011).
In Uganda, Nigeria, Ethiopia, Malawi and Senegal, herbal concoctions are given as prelacteals to clear the bowels, clear and soothe the airways and throat and protect the baby against illness (Bee et al. 2018).
Newborn babies born in Ethiopia, Uganda, Ghana, Tanzania and Nigeria are fed with artificial feeds such as water mixed with sugar and milk products when the mother does not have breastmilk (Aborigo et al. 2012; Bee et al. 2018; Oche et al. 2011; Rogers et al. 2011; Zimba et al. 2007). In Uganda, the practice followed is that if the baby is born hungry, the mother initiates feeding ‘there and then’ (but it is not clear as to how immediately after delivery). If the mother had something to eat before giving birth, the newborn baby is not hungry; therefore, there would be no need to initiate breastfeeding early (Bee et al. 2018; Eberhard-Gran et al. 2010; John et al. 2015).
Water or milk imbibed with the Koran is given to Muslim babies born in Senegal, Nigeria and Ethiopia, according to Muslim tradition; this is called toxantal water, and it is given to a newborn baby as an initial drink before feeding on the mother’s breasts (Bee et al. 2018; Oche et al. 2011; Zimba et al. 2007).
In Ghana, colostrum is believed to have been contaminated with sex which causes abdominal pains in the baby; therefore, babies are not to be fed colostrum (Alebila 2019). In Uganda, Tanzania, Ethiopia and Nigeria, colostrum is said to be dirty, harmful and unhealthy and should therefore not be fed to the baby. Consequently, it is squeezed out of the breasts and discarded to avoid poisoning the baby. In Niger, instead of feeding the baby with colostrum, it is expressed and disposed of while the newborn is given water for the first three days after birth (John et al. 2015). The reason why colostrum is associated with dirtiness, harmfulness and being unhealthy is the yellowish colour (Aborigo et al. 2012; Bee et al. 2018; Oche et al. 2011; Rogers et al. 2011; Zimba et al. 2007).
Most African cultures do not consider exclusive breastfeeding as the best feeding option. It is believed that the baby who is exclusively fed breast milk suffers from hunger and cries continuously. According to VhaVenḓa, a very light and warm soft porridge with herbal concoctions (tshiunza/khongodoli) should be given as it is thought to be calming and satisfying to the newborn baby, thereby enhancing growth. This is confirmed by Ngunyulu et al. (2015) when they reported that in the Mopani district of Limpopo, infants who are only breastfed, suffer from colic and cry uncontrollably, resulting in fever. Therefore, breastfeeding should be preceded by the provision of a light soft porridge. In Mansa, the district of Zambia, the introduction of traditional porridge to a baby is done when the baby is about a month old. Soft porridge mixed with traditional herbs is given to make the baby strong, healthy and free from getting sick (Buser et al. 2020).
In Ghana, a baby is given cow’s milk mixed with honey. This is given to the baby because it is believed that the baby can never be satisfied with breast milk as it is watery. It is also believed that water mixed with shea butter and herbs makes the baby sleep longer. The baby is also fed with soft porridge (Alebila 2019).
Mothers and grandmothers in Niger do not support the baby being fed on the breast only. They believe that a neonate should be given a lot of water as the weather is hot. They believe that breastmilk does not quench thirst. Therefore, after breastfeeding, the baby is given water to quench their thirst (John et al. 2015).
It is evident that most traditional African communities need empowerment on the importance of observing safe feeding practices of neonates. These include initiation of breastfeeding within an hour after birth and the benefits of exclusive breastfeeding for the first six months. Traditional birth attendants, elderly family members and mothers are still not aware of the protective properties of colostrum. This explains why they squeeze it out of the breast instead of feeding it to the newborn baby. The dangers of the introduction of solids to newborns and those of giving herbal concoctions to newborn babies should be emphasised.
There seems to be a common belief among most African traditions that the initial baby bath should be done soon after birth. Mothers in East, West and Central Africa believe in immediate bathing of the newborn after birth because amniotic fluid has an unpleasant smell. They are afraid that if the baby is not bathed within an hour, the fluid may be absorbed into the baby’s skin, causing a permanent foul body odour (Aborigo et al. 2012; Bee et al. 2018; Oche et al. 2011; Rogers et al. 2011; Zimba et al. 2007).
In Ghana, massaging the baby with shea butter before bathing is believed to make them fat and intelligent; and covering them tightly after a bath keeps the baby warm (Alebila 2019). Hot and cold water mixed with herbs is used alternatively for bathing the baby, with the belief that cold water makes the bones strong and enables the baby to withstand rain and cold weather later in life, whereas hot water freshens and adds shine to the skin. During bathing, the newborn baby is folded like a smoked fish or a fowl so that they will become flexible when they grow up. After bathing, the baby is thrown up in the air and grabbed. This makes the baby strong and helps in the prevention of fainting (Alebila 2019).
Literature reveals that there is a common belief in Malawi, Senegal, Tanzania and Uganda that the initial baby bath should be done immediately (within 6 hours) following birth. The main aims for an immediate baby bath are (Aborigo et al. 2012; Bee et al. 2018; Oche et al. 2011; Rogers et al. 2011; Zimba et al. 2007):
Ethiopians believe that bathing the baby within the first six hours after birth keeps the baby clean and free from odour. They also believe that bathing the baby immediately after birth makes the baby strong (Amare 2008). The fact that the newborn baby is born dirty, combined with the ritual pollution associated with childbirth, provides the basis for the immediate bathing of a newborn in the Niger Delta, a region of Nigeria. The elderly believe that the white layer of vernix on the baby’s body is caused by the wrong food that the pregnant female was eating during the antenatal period or during labour and needs to be wiped off (John et al. 2015). Thereafter, the baby is bathed every day; and it is during bathing times whereby rituals such as the application of ointments (coconut oil and shea butter), massage, limb stretching and body moulding with warm water are performed before bathing. This is done to strengthen the newborn baby, soften the skin and relieve colic and stress (John et al. 2015).
Health education must be given to mothers and the elderly members of the communities so that they may understand the physiology around vernix. The fact that newborn babies are delicate and unable to generate heat, which puts newborn babies at a very high risk of hypothermia, should be made clear to elders and mothers. The empowerment of the community members might enable them to understand why bathing should be delayed after delivery.
It is a typical occurrence in Africa and elsewhere in the world that families opt to employ indigenous substances over those given biomedically by the health care system (Bee et al. 2018). In the East Mamprusi District of Ghana, mothers and elderly family members do not consider sepsis a serious issue but are worried about the period the cord takes to drop. This is because they believe that evil spirits intending to harm the baby pass through the cord. Hence, everything possible should be done to make it drop within seven days, before a ceremony for naming the baby is conducted. A mixture of shea butter, salt and fowl faeces applied on the cord makes it drop off within three days after birth. This is followed by the application of shea butter mixed with powdered dry roots to promote wound healing (Alebila 2019). In some rural parts of Ghana, shea butter is applied to the umbilical cord for the following reasons (Aborigo et al. 2012; Bazzano 2006; Bee et al. 2018; Oche et al. 2011; Rogers et al. 2011; Zimba et al. 2007):
In Zambia, grandmothers and mothers prefer the application of traditional plants and dust on the umbilical cord to facilitate speedy healing as well as falling off of the cord, which enables the mother and the baby to discontinue confinement. Common traditional herbs include pumpkin leaves and pumpkin flowers; some also apply the faeces of a rat (Buser et al. 2020). Substances are applied to the cord for the following reasons (see Table 7.1):
Substances applied on the umbilical cord in different countries and reasons thereof.
Nigerians apply several substances to the neonate’s cord while still fresh when it has dried up and even when it has dropped; such substances include engine oil, palm oil, sieved wood ash, heated herbs and breast milk (especially colostrum). When the cord stump is completely healed, a coin is placed over the stump and tied in place to prevent protrusion of the umbilicus (John et al. 2015).
According to the VhaVenḓa and Vatsonga traditions, cow dung is applied to the umbilical cord before and after it falls off. It is believed that cow dung facilitates dryness and falling of the cord. Some VhaVenḓa females apply extracted pig (pork) oil onto the umbilical cord stump to facilitate its separation and prevent it from getting septic. When the umbilical cord has fallen off, some grandmothers prepare powder from a broken clay eating bowl (tshidongo) and mix it with pork oil. The substance is then applied to the umbilical area to promote healing and closure (Tulelo 2021).
In most African traditions, crying is associated with hunger, and in that case, the baby will be overfed, resulting in abdominal discomfort, which will aggravate the condition. According to John et al. (2015), in the Niger Delta, excessive crying of the baby is associated with serious problems that require traditional attention. A baby who cries excessively is believed to be experiencing discomfort or seeing frightening things (such as ghosts and evil spirits). Practices such as cuddling, stroking them softly, rocking gently while placed on the thighs as well as throwing them up in the air may make them stop crying. However, if crying persists, separation rituals and a ‘feast’ are conducted, as a baby might be seeing ghosts and may be tormented by evil spirits (John et al. 2015). In this ritual, rice is cooked the traditional way and palm oil is added. Biscuits, soft drinks, groundnuts and fruits are provided and children under five years old are invited to eat with their fingers from a common tray. After the meal, every child rubs the baby’s body with their unwashed fingers and hands and the baby is not bathed till the following day (John et al. 2015).
It is common practice for the VhaVenḓa that a baby who cries excessively even after having been fed is interpreted as crying for the name of one of the ancestors who have already died. A ritual is performed whereby the grandmother will keep on calling the names of the ancestors one by one until the baby stops crying. If the baby stops crying after a particular name is called, it is believed that the ancestors and the baby are satisfied with the announced name; therefore, the baby will be given the name of the ancestor, and when called, the crying stops.
In most indigenous African traditions, it is believed that illnesses and health care problems are caused by sorcery and evil spirits. Therefore, a lot of traditional practices and rituals are performed to ward off sorcery and evil spirits that cause illness, thereby protecting the baby. These include traditional incisions, the use of charms and amulets made from different substances with incantations made over them, and the use of leaves, roots and bark of certain herbs which are prepared as concoctions or burnt in the room where the child sleeps (John et al. 2015).
Common practices believed to be able to ward off evil spirits include:
In Ghana, when a baby who is light in complexion or big in size is born, people with evil spirits become jealous and plan to kill the baby; thus, certain protective practices are performed as rituals for the baby. Nangbantori (bitter mouth) is made, whereby marks are drawn on the door of the room in which the mother and her neonate are accommodated to prevent evil spirits from causing any harm to them. A charcoal fire is also made in the room where the mother and the baby are staying; herbs are placed in the fire and the baby is made to inhale the smoke. ‘Mercury is poured over the head of the baby to repel evil spirits. A Koran, needles and a knife are placed under the pillow of the baby’ (Alebila 2019). The mother-in-law prepares a special concoction which is given to the newborn baby as a way of welcoming them into the family and protecting the baby from evil spirits. The baby is considered a qualified and safe member of the family only after having drunk the concoction. They also emphasise that a newborn baby should not be taken outside the home premise before the ‘child naming’ ceremony is conducted, for they believe that it is difficult for evil spirits to harm a baby who has a name. The vobeo [bad leaf] herb is mixed with garlic and is added to the baby’s bath water. In the case of a boy, the baby is bathed in this mixture for three days, but for a girl, four days should suffice. Ghanaians believe that witches are afraid of the smell of garlic; therefore, when it is added to the bath water with herbs, the baby is definitely protected (Alebila 2019).
According to Buser et al. (2020) and Kayombo (2013), among the Lundazi, Mansa and Chembe of Zambia, certain rituals are performed to prevent and protect the baby from coughing and contracting pneumonia. Fire is prepared in the house where the mother and the baby stay and traditional herbs are placed in the fire. Parents engage in sexual activity. Thereafter, semen (referred to as sperms) will be spread on the joints of the baby. Then, the baby is passed back and forth over the fire, expecting them to inhale the smoke, which will clear the lungs and avert cough. The ritual is expected to strengthen the baby and protect them from coughing (Buser et al. 2020; Kayombo 2013).
According to Tulelo (2021), in the VhaVenḓa tradition, a traditional health care practitioner or an indigenous knowledge holder is consulted for the performance of the mithuso, a commonly practised ritual. The practice is claimed to be ‘assisting a neonate to thrive’, protecting it from those with evil intentions as well as protecting an infant from environmental harm at home after discharge from the hospital. It is believed that if a neonate meets with people who use muthi and practice witchcraft, it becomes afflicted with evil spirits and will therefore become sick. Various plants and traditional remedies are used by indigenous knowledge holders or traditional health care practitioners during mithuso. Some of them are boiled in water and fed to the newborn. The traditional medication used for mithuso could be plant roots or leaves, animal fat, skin or dung or amulets for the neonate to wear on the wrist or waist (Tulelo 2021). Incisions are made on the anterior fontanelle by a traditional healer, and substances are applied to the incised area. Similar practices are prevalent in Tanzania, where mothers and caregivers use traditional remedies to protect neonates from illnesses supposedly caused by evil forces or spirits (Kayombo 2013).
It is evident that traditional birth attendants, elderly members of the family and mothers in most African traditions need empowerment on the dangers of making incisions and applying substances to the incised area. This practice could cause infection and even sepsis in the area. Administration of herbal concoctions to neonates is not safe because of the nonstandardisation of dosages. Overdosing a neonate with herbs might cause toxicity and gastrointestinal problems. Smoke inhalations should also be practised with caution as they may cause respiratory problems for the neonate. Rituals for the provision of comfort and protective measures for newborn babies may pose threats to neonatal health.
Traditions and cultures have different insights and modalities regarding the management of some ailments. In the Niger Delta, neonates with jaundice are given sweetened water and babies are also exposed to sunlight to clear jaundice. Herbal juice is administered in the eyes of the neonate as it is believed that it reduces the yellowish discolouration. In some instances, garlic cloves are pinned on a necklace that is prepared for the neonate to put on, believing that the drying up of garlic cloves is an indication of the disappearance of jaundice. The necklace is worn for seven days. If the neonate still presents with jaundice symptoms after the cloves have dried, hospitalisation is then considered for the management of neonatal jaundice (John et al. 2015).
In the case of diarrhoea, sips of a mixture of ‘native chalk’ melted in water are given to a neonate. It is believed that the concoction will harden the stools, thereby stopping the diarrhoea (John et al. 2015).
Palm kernel oil and herbal juice are administered in the eyes of a neonate with convulsions. ‘Foot roasting’ (placing the feet of a neonate next to the fire during convulsions) is also done as a treatment measure for convulsions. This is believed to be effective in keeping the feet warm, thereby preventing the child from ‘seeing demons’ during convulsions (John et al. 2015; Peterside, Duru & Anene 2015).
According to the VhaVenḓa, neonates have the natural ability to sense events occurring in the environment, such as animal sounds, which can adversely affect the neonate. When the mithuso ritual is performed, it also includes a procedure to prevent the neonate from experiencing convulsions or fits when baboons bark in the mountains or the forests. This kind of convulsion or fits is referred to as a thavha, loosely translated as ‘things of the mountain’, referring to baboons. It is believed that a neonate who did not go through the mithuso ritual will experience convulsions whenever a baboon barks from the mountain or in the forest (Tulelo 2021).
The VhaVenḓa also believe that neonates can be affected by the bark of a baboon to the point of having high temperatures and convulsions. To prevent this from happening, the traditional health care practitioner performing mithuso for the neonate must add baboon dung and skin to the concoction to prepare a herbal medicine that the neonate will inhale. The procedure is completed by throwing neonates on top of a roof of a thatched hut and catching them with luselo (a large indigenous tray made from reeds) as they come rolling down. In the case of a neonate who experiences convulsions before mithuso, the same procedure of throwing the neonate on top of a hut is performed. It is believed the practice is the solution to the problem of neonatal convulsions. The need to prevent convulsions is emphasised because families believe that the neonate could suffer irreparable harm later in life. This may include mental retardation or madness should they suffer from convulsions repeatedly (Tulelo 2021).
Several neonatal infections are treated with the mother’s breast milk. These include infection of the eyes, infection of the umbilical cord, redness of the genitalia and sore buttocks resulting from a nappy rash (John et al. 2015; Opara et al. 2012).
When the baby has a cough, the father is suspected of having had sexual relations with another female (other than the wife) and touching or holding the child when they returned home. As a treatment measure, the parents should engage in sexual intercourse; the father should ejaculate semen in his palm and apply it to the neonate’s body (Bee et al. 2018; Buser et al. 2020).
Ngoma (anterior fontanelle) presents with a wide, sunken and pulsating fontanelle. In such cases, an indigenous knowledge holder is consulted to cure the neonate. In treating ngoma, indigenous knowledge holders will smear a mixture of herbs and animal fat on the fontanelle to cure the neonate. This practice was also found in the study conducted by Nethra and Udgiri (2018) in India. That study found that 89% of the mothers applied oil to the baby’s anterior fontanelle to expedite its fusion.
Tshilala (neonatal reflux accompanied by abdominal cramps) or colic is an ailment of concern to VhaVenḓa females. In most societies, colic is viewed as a problematic condition that needs attention. The latter statement is supported by a Jordanian study, which revealed that a solution of boiled herbs or sweetened water is fed to neonates to facilitate sleep by relieving abdominal pain and colic (Mrayan et al. 2018). Ntswu is a mixture of boiled water and indigenous herbs used to treat tshilala.
Traditional birth attendants, elderly family members and mothers might not be aware of the dangers that might be caused by some of the treatment modalities they practice. Installation of herbal juices and palm kernel oil in the eyes is dangerous as these might cause irritation and serious damage to the eyes, which may negatively affect vision (John et al. 2015). Some native chalks are believed to be having antidiarrhoeal action as they contain lead and arsenic substances, and these are poisonous for human consumption (John et al. 2015).
Convulsions are mostly caused by fever; instead of managing convulsions, ‘foot roasting’ further raises the body temperature resulting in aggravation of the condition (John et al. 2015; Opara et al. 2012).
The smoke inhalation of baboon dung and skin has the potential to cause respiratory problems for the neonate. Equally, the practice of throwing the neonate on the rooftop of a hut could be harmful should the neonate hit hard on the roof or fall while rolling down (Tulelo 2021).
The practice of using breast milk is not harmful. Some clinical studies found that breastmilk, especially colostrum, contains leukocytes and various kinds of immunoglobulins that are effective in inhibiting the growth of N. gonorrhoeae and Staphylococcus aureus, which are among the main causal organisms of ophthalmia neonatorum in developing economies (Ghaemi et al. 2014). Meanwhile, a University of California (San Francisco) study on the antibacterial impact of breast milk on common paediatric conjunctivitis causes proved that human milk consistently inhibited the growth of N. gonorrhoea (Baynham et al. 2013). Therefore, the use of breastmilk for the prevention or treatment of minor infections should be endorsed to accommodate some of the safe practices regarding indigenous neonatal care.
The practice of putting substances on the fontanelle is viewed as unsafe as it can lead to delay in seeking medical intervention for a neonate suffering from dehydration. In this regard, community members need empowerment regarding the importance of immediately seeking medical assistance.
Knowledge and understanding of indigenous neonatal care practices by health care professionals might create awareness of such practices in the communities they serve. This might enable the health care professional to provide support, learn and respect the beliefs and practices that do not pose threats to neonatal health and help in the empowerment of the community members regarding those practices that are harmful.
Collaboration between health care professionals and traditional birth attendants is necessary for the promotion of quality neonatal care. This will enable both parties to work harmoniously as a team, learning from and advising each other regarding safe neonatal practices as well as identification of harmful practices.
Effective collaboration between health care professionals and traditional birth attendants is, therefore, necessary to prevent harmful traditional practices that may negatively affect neonatal health. Rooming-in, which is necessary for the maintenance of the baby’s warmth, should be preceded by immediate drying and wrapping of the baby to prevent hypothermia. Otherwise, the practice will not bear results as the damage would have been done by exposure to cold immediately after birth.
Rooming-in should benefit both the mother and the neonate. Though the mother needs to rest, it is of vital importance that the mother spend time holding and cuddling the newborn, looking into its eyes and speaking to the newborn to establish and maintain bonding.
Empowerment of community members regarding the importance and benefits of colostrum, exclusive breastfeeding for the first six months, the dangers of the introduction of solids to newborn babies as well as the dangers of giving herbal concoctions should be given due importance.
Health care education must be imparted to mothers and the elderly members of the communities so that they may understand the physiology around vernix. The fact that newborn babies are delicate and unable to generate heat puts them at a very high risk of hypothermia.
The empowerment of the community members might enable them to understand why bathing should be delayed after delivery. The empowerment of traditional birth attendants and family members regarding the dangers of applying substances on the umbilical cord is important as this might predispose the baby to serious infections such as neonatal tetanus.
Health care professionals working with mothers and infants in the communities should evaluate the traditional neonatal practices in the societies where they work and put interventions in place to correct negative behaviours while encouraging beneficial practices.
Indigenous beliefs, practices and treatment modalities exist in sub-Saharan and other African countries. While some of these have positive implications for the promotion of neonatal health and child development, others may pose threats to neonatal health. Practices that have positive outcomes should be supported and encouraged. However, there is a need to provide culturally relevant and culturally-sensitive health care education on those practices that may pose threats to neonatal health and child development.
How to cite: Simane-Netshisaulu, KG, Lebese, RT & Tulelo, PM 2022, ‘Provision of neonatal care: An African indigenous perspective’, in FM Mulaudzi & RT Lebese (eds.), Working with indigenous knowledge: Strategies for health professionals, AOSIS Books, Cape Town, pp. 107–125. https://doi
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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