Winch Peter J, Alam M Ashraful, Akther Afsana, Afroz Dilara, Ali Nabeel Ashraf, Ellis Amy A, Baqui Abdullah H, Darmstadt Gary L, El Arifeen Shams, Seraji M Habibur Rahman
Project to Advance the Health of Newborns and Mothers (PROJAHNMO), Sylhet, Bangladesh.
Lancet. 2005;366(9484):478-85. doi: 10.1016/S0140-6736(05)66836-5.
Understanding of local knowledge and practices relating to the newborn period, as locally defined, is needed in the development of interventions to reduce neonatal mortality. We describe the organisation of the neonatal period in Sylhet District, Bangladesh, the perceived threats to the well-being of neonates, and the ways in which families seek to protect them.
We did 39 in-depth, unstructured, qualitative interviews with mothers, fathers, and grandmothers of neonates, and traditional birth attendants. Data on neonatal knowledge and practices were also obtained from a household survey of 6050 women who had recently given birth.
Interviewees defined the neonatal period as the first 40 days of life (chollish din). Confinement of the mother and baby is most strongly observed before the noai ceremony on day 7 or 9, and involves restriction of movement outside the home, sleeping where the birth took place rather than in the mother's bedroom, and sleeping on a mat on the floor. Newborns are seen as vulnerable to cold air, cold food or drinks (either directly or indirectly through the mother), and to malevolent spirits or evil eye. Bathing, skin care, confinement, and dietary practices all aim to reduce exposure to cold, but some of these practices might increase the risk of hypothermia.
Although fatalism and cultural acceptance of high mortality have been cited as reasons for high levels of neonatal mortality, Sylheti families seek to protect newborns in several ways. These actions reflect a set of assumptions about the newborn period that differ from those of neonatal health specialists, and have implications for the design of interventions for neonatal care.
在制定降低新生儿死亡率的干预措施时，需要了解当地对新生儿期的定义以及与之相关的当地知识和做法。我们描述了孟加拉国锡尔赫特地区新生儿期的安排、新生儿福祉所面临的感知威胁以及家庭保护新生儿的方式。
我们对新生儿的母亲、父亲、祖母以及传统助产士进行了39次深入、无结构的定性访谈。关于新生儿知识和做法的数据还来自对6050名近期分娩妇女的家庭调查。
受访者将新生儿期定义为生命的前40天（乔利什丁）。在第7天或第9天的诺艾仪式之前，对母婴的 confinement 最为严格，包括限制外出活动、在出生地点而非母亲卧室睡觉以及睡在地板上的垫子上。新生儿被认为容易受到冷空气、冷食或冷饮（直接或通过母亲间接接触）以及恶意灵魂或邪眼的影响。洗澡、皮肤护理、confinement 和饮食习惯都旨在减少接触寒冷，但其中一些做法可能会增加体温过低的风险。
尽管宿命论和对高死亡率的文化接受被认为是新生儿死亡率高的原因，但锡尔赫特家庭通过多种方式寻求保护新生儿。这些行动反映了一套与新生儿健康专家不同的关于新生儿期的假设，对新生儿护理干预措施的设计具有启示意义。
文中“confinement”未找到完全对应的准确中文释义，暂保留英文，结合语境理解其大致意思为一种对母婴的限制、约束状态。
