An Observational Study of Neonatal Skin Care in Rural and Urban Communities in Southwest Nigeria and Possible Relevance to the Prevalence of Atopic Dermatitis


  • Olufolakemi Cole-Adeife Lagos State University Teaching Hospital
  • FO Ajose
  • Sherifat Katibi


atopic dermatitis, neonatal skin care, emollients, cleansers, skin microbiome


Background: Atopic dermatitis (AD) is the most common chronic inflammatory dermatosis in children, with
increasing global prevalence. Modes of birth and skincare practices in early life are postulated to influence
the development of AD and other atopic conditions. This study sought to explore neonatal skin care practices
and the prevalence of AD in rural and urban communities in Southwest Nigeria.
Methods: This exploratory observational study was conducted over six months (Jan – June 2017) in
Southwest Nigeria. Birth processes and postpartum skin care products were compared between 50
parturient women at six government-licensed traditional birth attendant (TBA) centres in 3 rural communities
and 50 parturient women in 3 urban government maternity centres. The frequency of AD in under-five clinic
records of these communities was also compared.
Results: All births were vaginal at the TBA centres, while 44% were via caesarean section at the urban
maternity hospitals. The neonatal skin care regimen at the TBA centres comprised herb-infused water,
traditional black soap, and vegetable oil moisturizers, all pH 5-7. The skin care regimen in urban centres
included tap water, olive oil, baby soaps, and proprietary moisturizers, all pH 8-10. The frequency of AD in
under-5 children at rural community clinics was 0.08%, and 6% at the urban health facilities (p=0.001).
Conclusion: In rural communities in Southwest Nigeria, vaginal deliveries were the norm, and the skin care
regimen during the neonatal period comprised early skin-to-skin contact and pH-neutral or acidic skin care
products, while in urban areas, caesarean section births were common, skin-to-skin contact was often
delayed, and skin care products were mostly alkaline. The prevalence of atopic dermatitis was much lower in
rural communities than in urban communities, but further studies are needed to determine if there is a direct
relationship between neonatal skin care practices, modes of birth, and AD prevalence.