R E S E A R CH AR T I C L E

Traditional neonatal care practices in Jordan: A qualitativestudy

Lina Mrayan RN, MSN, PhD | Sanaa Abujilban RN, MSN, PhD |

Jamila Abuidhail RN, MSN, PhD | Ali Alshraifeen RN, MSN, PhD

Department of Maternal, Child and Family

Health Nursing, Hashemite University, Zarqa,

Jordan

Correspondence

Lina Mrayan, Department of Maternal, Child

and Family Health Nursing, Faculty of Nursing,

Hashemite University, Zarqa, 13115 Jordan.

Email: lina285@gmail.com

AbstractTraditional practices during the first months of neonatal life are common in developing coun-

tries, such as Jordan. Many international studies and reports have highlighted the fact that tradi-

tional neonatal practices are the cause of high neonatal mortality and morbidity rates in some

countries. The aim of the present study was to identify neonatal care practices in Jordan.

A descriptive, qualitative research design was used across four Jordanian cities across diverse

regions. Forty mothers of neonates were interviewed over a period of 6 months (from January

to June 2016). Thematic and content analysis was undertaken following Braun and Clarke's six

step analysis. The results indicated that in Jordan, home-based neonatal care comprises non-

biomedical practices. Rubbing the neonate's skin with salt, swaddling, prelacteal feeding, and

other treatment modalities are common. Further studies are necessary to determine and report

on the pros and cons of these practices in regard to neonatal health.

KEYWORDS

cultural practice, Jordan, neonatal care, traditional care

1 | INTRODUCTION

According to the World Health Organization, a neonate is an infant

younger than 28 days of age (WHO, 2014). During the neonatal

period, health beliefs and practices influenced by local culture are

ardently practiced in many countries (Sutan & Berkat, 2014). Prelac-

teal feeding is a common practice in Turkey, Bangladesh, Tanzania,

and Ethiopia (Alparslan & Demirel, 2013; Legesse, Demena, Mesfin, &

Haile, 2014; Sacks et al., 2015; Winch et al., 2005). Prelacteal feeding

is food or drink other than human breast milk that is fed to newborns

before the introduction of breastfeeding, generally in the first few

days of life (Khanal, Adhikari, Sauer, & Zhao, 2013). Rubbing the neo-

nate’s swollen nipples, “making the forties” (bathing the mother and

neonate in a special ritual on the 40th day, postpartum), salting, using

“holluk” (a sand-filled nappy), and swaddling the baby are the most

common neonatal care practices in Turkey (Alparslan & Demirel,

2013). In Zambia, petroleum jelly and breast milk are generally used

for neonatal skin care. Vernix and castor oil are also used to care for

the skin of preterm babies (Sacks et al., 2015). Using “kohol” for

neonatal eyes is quite common in India (Goswami, 2013). The signifi-

cant implementation of some home-based traditional care practices

might reduce the neonatal mortality rate, because such practices

could reduce the risk of infection and hypothermia (Sacks et al.,

2015). Swaddling is a universal practice reported in studies from dif-

ferent countries (Blatt, 2015; Clarke, 2013). Approximately 90% of

infants in the USA are swaddled during the first few months of life

(Oden et al., 2012). Similar findings have been reported in Jordan, indi-

cating that most participants swaddle their newborn babies from the

first day after birth (Abuidhail, 2014; Al-Sagarat & Al-Kharabsheh,

2017; Jarrah & Bond, 2007). Keeping the newborn baby in the house

to protect him/her from cold air or from the evil eye, and rubbing

the baby's skin with oil, are also traditional practices reported in

Bangladesh (Winch et al., 2005).

In Jordan, the national neonatal mortality rate remains high at

14 neonatal deaths per 1000 live births (DOS, 2013), with a decrease

of only six points since 1998. A study conducted by UNICEF, the Min-

istry of Health, and the Higher Population Council indicated that 30%

Received: 29 September 2017 Revised: 13 April 2018 Accepted: 29 April 2018

DOI: 10.1111/nhs.12540

Nurs Health Sci. 2018;1–8. wileyonlinelibrary.com/journal/nhs © 2018 John Wiley & Sons Australia, Ltd 1

of all neonatal deaths were preventable, and that 44.3% were possibly

preventable with optimal care (The Jordan Times, 2013).

Most neonatal deaths are preventable by implementing simple

interventions, such as feeding with colostrum, the timing of the ini-

tial breastfeedings, the duration of every feeding, umbilical cord

care, and measures taken to prevent hypothermia in newborns

(Batieha et al., 2016; Lassi, Salam, Das, & Bhutta, 2014). Proper

intervention before pregnancy, during pregnancy, and during the

early postnatal period is crucial for the prevention and management

of conditions that cause neonatal death (Lassi, Mansoor, Salam,

Das, & Bhutta, 2014).

1.1 | Aim and research question

The aim of the current study was to identify the traditional home-

based neonatal care practices performed by mothers or family

members with neonates <1 month of age across four Jordanian cities:

Irbid (north), Al-Zarqa and Amman (middle), and Al-Karak (south).

The study sought to answer the following research question:

What are the traditional practices in terms of neonatal care performed

by mothers or family members for infants who are <1 month of age?

2 | METHODS

2.1 | Research design

A descriptive, qualitative research design was used (Colorafi & Evans,

2016). The choice of this method was influenced by our study aim of

exploring traditional neonatal care practices among Jordanian families.

2.2 | Participants

Our study was conducted at four comprehensive health-care centers

within four major cities in Jordan (Irbid, Al-Zarqa, Al-Karak, and

Amman) over a period of 6 months (January–June 2016). All mothers

of neonates aged 1–4 weeks who attended the health centers for a

variety of reasons were invited to participate in the study after a brief

explanation of its purpose. The data-collection process ended when

no new information was obtained and when redundancy was

achieved.

2.3 | Data-collection methods

In-depth interviews in the Arabic language were conducted by the

researcher with all of the participants at the health center or at a loca-

tion of their choice. To identify the traditional core practices, data

were collected using open-ended questions. Examples included

“Please tell me when you started to breastfeed your newborn” and

“Please describe your baby's bathing procedure”. To obtain a deeper

understanding and to clarify unclear answers, probing questions, such

as “What do you use for skin massage?” or “Why do you use that?”

were asked. All interviews were digitally recorded after obtaining per-

mission from the participants. Interviews lasted between 45 and

60 min.

2.4 | Ethical considerations

This study was approved by both the university's institutional

review board and the Ministry of Health Research Board

(no. 29/15/1200837). All participants were assigned a code attached

to relevant interviews and transcripts to ensure anonymity and confi-

dentiality (Burns & Grove, 2011). For example, W1 indicates the first

participant and W2 is the second participant. Potential participants

were informed that the study was voluntary and that they could

refuse to answer any question or withdraw at any time without any

explanation. Written informed consent was obtained for the study

and before conducting the interviews.

2.5 | Data analysis

The data were analyzed using a manual thematic and content analysis

tool. The study followed Braun and Clarke's six step analysis: (i) the

interviews were listened to repeatedly, and transcripts were read and

reread several times to familiarize the researchers with the data;

(ii) every woman was assigned the code “W” with a number in chrono-

logical order. The first interviewed woman was assigned the code W1,

and the second interviewed woman was given the code W2. Then,

interesting sentences in each interview relevant to the purpose of the

study were systematically assigned the code “Q” and a number. For

example, the first highlighted sentence was Q1, and the second

highlighted sentence was Q2. The seventh quote from the 12th

woman was W12, Q7. Quotations were extracted from the text using

the women's own words; (iii) all relevant data were grouped by topic,

and an initial theme was provided; (iv) initial themes were then

checked and rechecked in regard to the coded extracts and the entire

dataset to generate a thematic map; (v) after the thematic map was

completed, the themes were assigned final names; and (vi) finally, vivid

and compelling examples were extracted, and a final analysis of the

selected extracts was conducted. Final themes were linked back to

the research questions and to the literature to produce the final report

(Braun & Clarke, 2006) (Appendix I).

2.6 | Trustworthiness

Credibility was accomplished by relating a dense description to five

randomly-selected participants to determine whether the description

reflected their perceptions (Vaismoradi, Turunen, & Bondas, 2013).

The transferability of the study was ensured, because we provided a

dense description of the setting, the participants, and the data-

collection process (Lincoln & Guba, 1985). The data were collected,

analyzed, and reviewed by three researchers. Furthermore, we con-

firmed that the research findings were the result of the research and

not our assumptions or preconceptions. Confirmability demands that

the characteristics of the data are dependable. According to Holloway

and Wheeler (2002), an inquiry audit may be used to trace the data to

their sources (Holloway & Wheeler, 2002). In this manner, our means

of arriving at the constructs, themes and their interpretation can be

followed (Appendix I).

2 MRAYAN ET AL.

3 | RESULTS

3.1 | Sociodemographic characteristics

The study participants included 40 mothers of neonates aged from

1 week to 2 months of age. Most were housewives (n = 35), three

were schoolteachers, and two were secretaries. All of the mothers

were literate; two thirds (n = 27) had finished high school, and one

third (n = 13) were university graduates. Nearly all were considered

to have low- to middle-range incomes, and the majority lived in a

nuclear family. All participants in this study gave birth in a hospital

(Table 1).

Primarily, we observed that “neonatal home-based care practices

are widely used in Jordan”, including both safe and unsafe traditional

neonatal practices. Five major themes emerged from the interviews,

each of which is supported by quotes using the participants' own words.

3.1.1 | Caring for the neonate's skin and eyes

Skin care practices were widely used among Jordanian women. Skin

care practices included rubbing the neonate's skin with salt, rubbing

the skin with olive oil, or using a baby oil that was bought from the

shops. The grandmother or one of the participants’ female family

members bathed the newborn with warm, salted water or rubbed

his/her skin with salt directly after birth. According to the participants,

the purpose of these skin practices was to strengthen the neonate's

skin, to prevent skin infection, to facilitate the drying of the umbilical

cord, and to prevent the body from having an unpleasant odor in the

future:

My mother-in-law put some salt in the water when

she gives the baby his bath...bathing the baby with

salted water will prevent a bad smell in the future.

(W4, Q8)

Rubbing the neonates’ skin with salt and keeping the salt on the

skin for a few days was mentioned by nearly all of the participants:

I rub his skin with salt, wrap him, and keep him

wrapped for 3 days before giving him a bath, and then

I massage him with olive oil. (W27, Q11)

Although rubbing the neonatal skin with salt made the skin irri-

tated, red, and dry, Jordanian mothers considered the practice to be

healthy.

Nearly all of the participants rubbed the baby's skin with olive oil

once a week to soften the skin, as indicated by the following partici-

pant: “I massaged her skin with olive oil because her skin was dry”

(W32, Q23).

Another skin practice was mentioned by some of the research

participants, specifically those from Al-Zarqaa and Alkarak. They said

that they rubbed the girls' skin with bat's blood immediately after birth

to prevent the growth of body hair:

My mother-in-law asked my husband to bring a bat's

blood to rub on the baby's skin...to prevent the growth

of body hair. (W12, Q19)

Nearly all of the mothers refrained from cutting the neonates'

nails. The mothers said that if you cut a newborn's fingernails, he/she

will become a stingy person, as indicated by the following participant:

“They said that if you cut his fingernails, he will be a

stingy adult” (W3, Q28).

All of the participants shaved their newborns' hair on the seventh

day after birth, consistent with the religious practice of “Sunnah”. The

neonate's hair is completely shaved, using clippers or a new razor, by

the father or the grandfather; generally, a male must do the shaving.

“Tahneek” is another religious practice (Sunnah) that is performed

on the baby by an older man, generally the grandfather. Tahneek is

performed using a soft piece of date on the finger, and then placing

the finger into the baby's mouth and rubbing it over the baby's gums:

“My father-in-law rubbed my baby's gum with the

mashed date” (W6, Q19).

This practice was mentioned by all participants.

Using kohol in the neonate's eye was primarily practiced in Al-

Karak, Irbid, and Al-Zarqa. Mothers generally used homemade kohol

that was often made by grinding galena (lead sulfide). Kohol contains

high levels of lead, which is harmful to newborn babies. Mothers

applied kohol to their neonates' eyes soon after birth. Some did this

to make their neonates' eyes beautiful, others used it to “strengthen

the neonatal's eyes”, and some believed it could prevent the child

from being cursed by the evil eye:

We use homemade kohol to make the girls' eyes beau-

tiful when they grow up. (W8, Q9)

Kohol can strengthen the eyes and make them healthy

in the future...It prevents eye infections, too.

(W8, Q15)

I use kohol to protect my baby from the evil eye.

(W2, Q13)

3.1.2 | Feeding the neonate: Traditional beliefs andhealthy practices

Although breastfeeding is a common practice in Jordan, there are

some traditional practices that might affect its success. For example,

neonates were bottle fed boiled herbs or sweetened water to relieve

abdominal pain and “colic” and to facilitate sleep. In addition, some

mothers felt breast milk was not sufficient for the baby. Babies were

fed the boiled herbs in a bottle twice a day (morning and before bed)

TABLE 1 Sociodemographic data of participants

Age, years No. children Occupation EducationMaritalstatus

15–20 (n = 7) Primis(n = 23)

School teachers(n = 3)

School(n = 27)

All weremarried

21–30 (n = 31) Multi(n = 17)

Secretaries(n = 2)

University(n = 13)

31–40 (n = 2) Not working(n = 25)

MRAYAN ET AL. 3

or when needed. The most common herb used to relieve perceived

neonatal colic was “anise” or “sagebrush”. Colic was diagnosed by

mothers or grandmothers when the baby did not stop crying for a long

time or when the newborn was constipated:

Because my baby was crying all the time, my mother

asked me to boil some herbs and give it to him....She

told me to give him boiled water with sugar too.

(W17, Q2)

I gave my baby sweetened water and sometimes

boiled herbs for 3 days…after 2 or 3 days, breast milk

always comes. (W17, Q5)

3.1.3 | Comforting the neonate

Swaddling was a common practice across the four cities; however,

there were differences in regard to duration and tightness in different

areas. Mothers from Irbid, Al-Zarqa, and Al-Karak swaddled their chil-

dren tightly all day for 40 days. However, we observed that mothers

from Amman swaddled their neonates less tightly and for a shorter

period of time. All of the participants wrapped or swaddled their

babies because they believed that wrapping the neonate in a cloth or

blanket helps to comfort the baby, promote sleep, and manage the

excessive and frequent crying of the child. Some mothers used swad-

dling to prevent or treat abdominal colic:

“I wrap my baby in a small blanket to keep him calm

and promote sleep” (W39, Q16).

Some mothers used a special cloth to swaddle the baby, and

others used a small blanket. Some swaddled the baby loosely, and

others wrapped the baby tightly.

All of the mothers described swaddling as placing the baby's

hands at his/her sides, straightening both legs, and wrapping the baby

tightly in the blanket.

Swaddling was performed for various lengths of time, depending

on the season. Babies born in winter were likely to be wrapped for a

longer period of time than those born in summer. Jordanian mothers

believe that swaddling prevents respiratory diseases and colic, and

ensures that babies will have straight legs in the future.

Giving the baby a date wrapped in a small cloth as a pacifier, a

“tamra”, occurred in Al-Karak and Irbid. Some of our participants said

that instead of using a pacifier, they wrapped a date in a clean cloth

and gave it to the neonate to help him sleep:

My mother wrapped a small date, a tamra, in a clean

cloth…she usually put it in his mouth to make him

sleep. (W16, Q37)

3.1.4 | Protecting the neonate from the evil eye

Typically, in Jordan, neonates are strictly kept indoors for at least

4 weeks. During this time, it is believed that neonates are vulnerable

to diseases, infections, and the evil eye. The evil eye causes the trans-

mission of a sickness, generally unintentionally, by someone who is

envious, jealous, or covetous. Jordanian mothers believe that receiv-

ing the evil eye causes misfortune or injury and requires “roqya”.

Roqya means reading a special suras or verses from the Quran and

making “prayer” for the baby to expel the evil eye. They believe that

the 4 week seclusion protects the neonate from such hazards. Only

close family members (brothers, sisters, aunts, and uncles) are allowed

to see the neonate:

In these 40 days, I had to stay home to protect my

infant from the evil eye....My mother believes that

strangers should not see the baby. (W7, Q18)

Fortunately, when the baby is sick, not all mothers adhere to this

rule of staying at home. They go to a health center for treatment or

vaccinations when necessary.

3.1.5 | Treatment modalities

Some mothers practiced some traditional remedies to address neona-

tal jaundice, such as increasing the frequency of breastfeeding, giving

sweetened water, and putting the baby under a household fluorescent

light or in front of the window in the sunlight. Some mothers men-

tioned using a garlic necklace for 7 days. They believed that when the

garlic cloves dried, the jaundice would disappear. If the jaundice lasted

past the drying of the garlic, then the neonate would be taken to hos-

pital for treatment:

I noticed that his skin became yellow. My mother-in-

law asked me to give him water with sugar.

(W14, Q45)

I put a necklace of seven garlic cloves around his neck.

When the cloves dried, the yellow color disappeared.

(W14, Q46)

However, a few mothers mentioned visiting the hospital to seek

medical care in the event of other signs, such as low level of activity,

inability to feed, or elevated temperature.

Breast milk was used to cure some types of infections, such as

eye infections, umbilical cord infection, and newborn genital redness.

Mothers used drops of breast milk in the baby's eyes if they noticed

redness or eye discharge. They applied breast milk to the umbilical

cord and female genitals to treat a neonate's nappy rash or pain

because of urination:

I put some drops of my breast milk in her eyes when I

saw some secretions…I use it for redness or pain in

her private parts too. (W26, Q23)

Many of the participants believed that they must squeeze

enlarged neonates' breasts (physiological at this age) to empty

them out:

Her breasts were large and congested; my mother-in-

law squeezed them hard to get the bad milk out and

discard it. (W11, Q54)

Some Jordanian mothers put antibiotic powder (from an opened

antibiotic capsule) or sulfa powder on the umbilical stump to facilitate

4 MRAYAN ET AL.

drying and to prevent infection. Others used ground coffee, salt, ciga-

rette ash, or talcum powder for the same reason:

I opened an antibiotic capsule and put it on his umbili-

cus. (W3, Q54)

My mother put some coffee on her (my daughter’s)

umbilicus. (W7, Q14)

The umbilical stump was generally covered by the nappy and was

not exposed to air. Mothers were afraid of touching the stump, and

thus were unable to clean or dry it properly after bathing the neonate:

It was impossible for me to bathe my baby in the first

week because of his umbilicus stump....My mother

bathed him....She covered the stump with his nappy.

(W49, Q56)

4 | DISCUSSION

In this study, we observed that home-based neonatal cultural

practices are quite common in Jordan. Different skin care practices

were explained by the research participants. Rubbing the neonatal

skin with salt was common in three areas (Irbid, Al-Zarqa, and Al-

Karak). This practice could be explained by the mothers' desire to pre-

vent an unpleasant body odor and by their attempts to strengthen the

skin texture. Salting the neonatal skin was reported in a study from

Turkey that explained that mothers used salt on the skin of neonates

to prevent an unpleasant body odor in the future (Alparslan &

Demirel, 2013).

Using kohol on the neonate's eyes directly after birth was also

common in Irbid, Al-Zarqa, and Al-Karak. Goswami (2013) observed a

close association between the use of kohol and a high lead concentra-

tion in the blood (Goswami, 2013). The prolonged application of kohol

could result in excessive lead storage in the body, which might affect

the neonate's brain, organs, and bone marrow formation. Some

experts believe that lead poisoning could also result in anemia, a low

IQ, and convulsions (Jaishankar, Tseten, Anbalagan, Mathew, & Beere-

gowda, 2014).

Nearly all of the neonates in our study received formula milk,

sweetened water, or herbal drinks once or twice per day because their

mothers believed that their breast milk was insufficient to meet the

baby's needs. The practice of prelacteal feeding has been known to be

a common practice in many countries, such as Turkey, Bangladesh,

Tanzania, and Ethiopia (Alparslan & Demirel, 2013; Hoque, Khan,

Begum, Chowdhury, & Person, 2011; Kesterton & Cleland, 2009;

Legesse et al., 2014; Sacks, Bailey, Robles, & Low, 2013; Salam et al.,

2014). However, this practice is a cause for concern, because it might

delay the initiation of breastfeeding and adversely affect the establish-

ment of lactation. None of the mothers in our study initiated breast-

feeding during the first hour after giving birth. The usefulness of the

early initiation of breastfeeding against the risk of neonatal mortality

was established in an ecological study covering 67 countries that

determined that breastfeeding in the first hour of life is beneficial for

all infants (Wendy, 2013). The findings from a study in sub-Saharan

Africa indicated that promoting the early initiation of breastfeeding is

potentially extremely beneficial: 16% of neonatal deaths could be pre-

vented if all infants were breastfed from the first day, and 22% if

breastfeeding began within the first hour after birth (Salam et al.,

2014). Breastfeeding in the first hour of life is recognized by the

WHO as an important component in the promotion, protection, and

support of breastfeeding, and should be implemented as routine hos-

pital practice in all countries to reduce neonatal mortality. Most neo-

natal diseases are preventable by simple interventions, such as

feeding with colostrum and the timing of breastfeeding onset

(Legesse et al., 2014).

Swaddling was an extremely common practice across the four cit-

ies. This practice was the most commonly reported cultural practice in

our study. Similar findings have been previously reported in two Jor-

danian studies (Abuidhail, 2014; Al-Sagarat & Al-Kharabsheh, 2017).

Our findings were consistent with those reported from Turkey, in

which swaddling involved wrapping neonates with the legs straight-

ened and the hips and knees extended (Alparslan & Demirel, 2013). In

contrast, an international report stressed that swaddling neonates in

this manner could cause hip problems (Pediatric Orthopaedic Society

of North America, 2015). When the newborn's legs are swaddled

tightly with the hips and knees straight, the ligaments that hold the

joints in place are stretched. The newborn will be at greater risk for

developing hip dislocation (Clarke, 2013). Joint abnormalities and

long-term complications, such as osteoarthritis, might result, and hip

replacement is sometimes required (Clarke, 2013). While the decision

to swaddle could be influenced by the parents' personal beliefs and

cultural practices, it appears to be generally recommended that, if par-

ents choose to swaddle their neonates, the neonate should not be

swaddled too tightly and their hips and knees should be given room to

move freely (Pediatric Orthopaedic Society of North America, 2015).

Therefore, health-care providers should discuss the decision to swad-

dle with mothers and inform them that tight swaddling might cause

injuries to their neonates, such as hip dislocation/dysplasia.

Neonates were also perceived to be particularly vulnerable to the

evil eye. The protection of neonates was viewed as being important,

and therefore, a number of practices were conducted to protect them.

Keeping the baby in a separate room, not showing the baby to anyone

except close family members, reading specific suras of the Quran daily

for the babies, and making the roqya and doaa were mentioned by

nearly all of the participants in our study. Prayers from the Quran and

Al-Hadith are commonly used by Muslims as incantations (roqya), as is

the writing of amulets (“ta'wiz”) for protection and a cure against the

evil eye. The most basic of all of these treatments is to trust in one

God and seek refuge with Him from all evil (Qamar, 2013).

In this study, we determined that some treatment modalities were

also used, such as garlic necklaces to treat jaundice and breast milk to

treat infections in the eye and female genitalia. Only one previous study

reported the practice of using breast milk as a treatment for some infec-

tions. In Zambia, mothers used breast milk on the umbilical stump to

prevent infection (Sacks et al., 2015). However, that study reported that

the effectiveness of breast milk against eye infections depended on the

type of infection, and that colostrum was more effective than mature

milk. However, this practice could delay professional treatment and

cause the infection to worsen. Enlargement of the neonatal breast

(physiological at this age) because of trans-placental-acquired maternal

MRAYAN ET AL. 5

hormones is normal in the first weeks of life. Some mothers in Jordan

squeezed the baby's breast to remove the milk. This practice leads to

greater enlargement, mastitis, and in some cases, abscesses. Identical

findings were reported from Bangladesh and Turkey (Alparslan &

Demirel, 2013; Winch et al., 2005).

Finally, the positives and negatives of these traditional practices

should be investigated and reported. Health-care providers should be

aware of the health-care practices of the communities they serve, and

should support and respect the beliefs and practices that are unlikely

to affect health and discourage practices that are shown to cause

harm. Integrating community health workers into the mainstream

health system is important, particularly in areas with low service cov-

erage. Building the capacity of community health workers in the early

detection and primary management of neonatal health cases can

greatly contribute to reducing morbidity and mortality. A well-trained

mothers' group can also help in sharing neonatal health-care informa-

tion in the community.

The findings of this study should be disseminated among midwives

and health-care providers to help them develop applicable plans for the

care of postpartum mothers and their neonates. Midwives' and nurses'

awareness should be raised to assess traditional neonatal practices

among new mothers and their care providers to support positive cul-

tural practices and discourage possibly harmful ones.

4.1 | Implications for nursing practice

Nurses should adopt a national policy that seeks to raise awareness of

the potentially harmful effects of some traditional practices on babies.

Efforts should be directed toward improving the knowledge of expec-

tant mothers and fathers regarding acceptable and non-acceptable

care practices. Mothers should be empowered to refuse to engage in

unacceptable practices when following their care providers' advice.

4.2 | Conclusion

In this descriptive, qualitative study, we reported on the traditional

home-based neonatal care practices in four cities in Jordan. Under the

influence of traditions, beliefs, families, or self-belief, nearly all of the

participants performed one or more of the traditional home-based

neonatal care practices.

Home-based neonatal care practices, such as rubbing the skin

with salt or bat's blood, kohol in the eyes, squeezing breast nipples,

and using breast milk to treat specific infections, were widely prac-

ticed by Jordanian mothers, although some of these practices might

harm the neonates. Therefore, the possible complications associated

with these practices should be discussed with all mothers.

Finally, we did not attempt to determine which practices are

recommended and which practices are not in this study. Further stud-

ies on this are recommended.

ACKNOWLEDGMENT

The authors would like to thank the mothers who participated in the

present study for sharing their experiences.

AUTHOR CONTRIBUTIONS

Study design: L.M., S.A., J.A., and A.A.

Data collection: L.M., S.A., J.A., and A.A.

Data analysis: L.M., S.A., J.A., and A.A.

Manuscript writing and revisions for important intellectual content:

L.M., S.A., J.A., and A.A.

ORCID

Lina Mrayan http://orcid.org/0000-0002-3782-6485

Jamila Abuidhail http://orcid.org/0000-0003-3145-119X

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How to cite this article: Mrayan L, Abujilban S, Abuidhail J,

Alshraifeen A. Traditional neonatal care practices in Jordan: A

qualitative study. Nurs Health Sci. 2018;1–8. https://doi.org/

10.1111/nhs.12540

MRAYAN ET AL. 7

APPENDIX I: Final thematic map showing the five themes

Tradition

cure

hair

care

gums

eyes

skin

nailsNappyrash

jaundiceEvileye

colic Congested breasts

infection

Caring for skin

Caring for Eyes

Caring for nails

Caring for gums

Caring for hair

comforting

Swaddling, feeding

Thematicmap

Caring for the neonate's

skin and eyes

Cure Jaundice

Cure nappy rash

Cure infections

Cure colic

Cure congested breasts

Protect + Cure evil eye

Treatment modalities

Protecting the

neonates from the

Feeding the neonate : between

traditional beliefs and healthy practice

evil eye

Comforting the neonate

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