Mothers’ hygiene experiences in confinement centres: a cohort study

Abstract Ethnic Malaysian Chinese used to observe the 1-month postpartum confinement period at home and many families would engage a traditional postpartum carer (TPC) to help care for the mother and newborn. A recent trend has been the development of confinement centres (CCs) which are private non-healthcare establishments run by staff not trained in health care. Concerns about hygiene in CCs arose after infections were reported. We describe the practice of hand hygiene observed in CCs, the availability of resources for hygiene and to determine the prevalence of health related problems in CCs. Methods This is a cohort study of ethnic Chinese mothers intending to breastfeed their healthy infants. They were recruited post-delivery along with a comparison group who planned to spend their confinement period at home, then all were telephone interviewed after their 1-month confinement period about their experience. To avoid any alteration in behaviour, mothers were not told at recruitment that they had to observe hygiene practices. Multiple logistic regression was used to assess the effect of place of confinement on rates of infant health problems. Results Of 187 mothers, 88 (47%) went to 27 different CCs while 99 (53%) stayed at home. Response rates for the 1-month interviews were 88% (CC) versus 97% (home). Mothers in CC group stayed in one to four-bedded rooms and 92% of them had their baby sleeping separately in a common nursery described to have up to 17 babies at a time; 74% of them spent less than six hours a day with their babies; 43% noticed that CC staff had inadequate hand hygiene practices; 66% reported no hand-basins in their rooms; 30% reported no soap at hand-basins; 28% reported inexperienced or inadequate staff and 4% reported baby item sharing. Of mothers staying at home, 35% employed a TPC to care for her baby; 32% did not room-in with their babies, but only 11% spent less than 6 hours a day with their babies. 18% of mothers who employed TPCs reported that their TPC had unsatisfactory hand hygiene practices. Health problems that were probably related to infection (HPRI) like fever and cough were similar between the groups: 14% (CC) versus 14% (home) (p=0.86). Multiple logistic regression did not show that CCs were a factor for HPRI: aOR 1.28 (95% CI 0.36 to 4.49). Three mothers reported events that could indicate transmission of infection in CCs. Conclusion We found unsatisfactory hygiene practices in CCs as reported by mothers who spent their confinement period there. Although we were not able to establish any direct evidence of infection transmission but based on reports given by the mothers in this study, it is likely to be happening. Therefore, future studies, including intervention studies, are urgently needed to establish an appropriate hygiene standard in CCs as well as the best method to implement this standard. Empowering CC staff with hygiene knowledge so that they can be involved and contribute to the development of the development of these standards would be important.