This protocol is for a scoping review of literature reporting on common neonatal skin care practices throughout sub-Saharan Africa, with a focus on bathing, the application of oils and other products, and massage. A scoping review method was selected for its aims to delineate and identify gaps in available evidence on the area of focus. The proposed review will follow a methodological framework proposed by Arksey and O’Malley ¹⁴ . The framework consists of the following five steps: (i) identifying the research question, (ii) identifying relevant studies, (iii) selection of eligible studies, (iv) charting the data, and (v) collating and summarizing the results. Quality appraisal will not be done as this review aims to map all research activities in this field.

The main research questions are “what are the common newborn skin care practices throughout sub-Saharan Africa, with a focus on bathing, the application of oils and other products, and massage?” and “what is the reported impact of newborn skin care practices throughout Africa, for example the impact of emollient therapy on survival, growth, infection and neurodevelopment?”

This study will use a series of guiding queries to align the study selection with the research question (see below, Charting the data). Since most of the studies relevant to this review are qualitative or observational in design (interviews, focus group discussions, and surveys), this approach was selected in lieu of the Population, Exposure, Comparator, and Outcomes (PECO) framework to allow for the inclusion of these studies. Randomized control trials (RCTs) and quasi experimental clinical trials will also be aligned in this manner.

A search will be conducted for published and unpublished (grey) literature on the research question in the following electronic databases: PubMed, Scopus (Elsevier), Embase, Web of Science (Clarivate Analytics), and PsycINFO (Ovid). Sources of grey literature will include: OpenGrey and GreyNet. Studies published prior to July 2021 that have the keywords or Medical Subject Headings (MeSH) terms delineated in the search strategy ( Table 1) will be identified. The search strategy will be piloted to check the appropriateness of keywords and databases. A hand (“snowballing”) search will also be conducted of the references of the included studies and websites such as the World Health Organization (WHO) to identify potentially relevant literature. Grey literature will also be identified through direct queries to authors of included literature to explore whether they are aware of unpublished literature on the topic

Title and abstract screening will be guided by a series of queries ( Table 2). Further eligibility criteria will ensure that the content of the included studies is relevant to the research question.

Inclusion criteria

For studies to be included, they must meet the following criteria:

Exclusion criteria

Studies will be excluded if they have any of the following characteristics:

The electronic database search will be recorded in a table (see Table 3). All eligible articles will be uploaded into the Covidence software, and duplicates identified and removed. Title and abstract screening of all eligible articles will be conducted to determine whether the study should be included in the review or not. All attempts will be made to obtain full texts of selected articles, by searching the web, engaging with librarians from University of Oxford, University of Makerere in Uganda, Busitema University Faculty of Health Science in Uganda, and Stanford University, or contacting an author if necessary. Two investigators will conduct full-text screening of the selected studies. A third reviewer will be employed if there are significant discrepancies that cannot be resolved by discussion and consensus. The degree of agreement between reviewers will be calculated and reported.

The selection process will follow the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist ¹⁵ and will be mapped using the PRISMA-P chart ¹⁶ .

Important protocol amendments will be documented in future protocol files and in the narrative report of the scoping review.

A data charting form will be used to electronically capture relevant information from each included study. The extracted data will include fields outlined in Table 2.

A narrative report will be produced to summarize the extracted data for the following outcomes: region (country, province) of study, prevalence of skin care-related health conditions, associated factors for skin care-related health conditions and skin care practices for newborns. The final outcome will include two sub-foci: emollient and massage. For the former, data around the following outcomes will be extracted and summarized: sample size; location of study (city/district/province/country and hospital/home setting); gestational age of neonates; chronological age of neonates; type of substance applied to the skin; whether substance was applied to the umbilical cord; how often substance was applied; by whom the substance was applied; how the substance was applied; how the substance was distributed on the body (i.e. the scalp, nappy area etc.); health impacts of product application; acceptability of the product to those involved in the study; product preferences of those involved in the study; whether the neonate was massaged, and if so, how the massage was performed; why the substance was applied; with what the neonate was bathed; temperature of the bath water; whether anything was applied to the skin after bathing, and if so, what substance; by whom the neonates were bathed; how often the neonates were bathed; why the neonate was bathed in a particular way; the mode of delivery if recorded (i.e. SVD/CS); outcome measures, if any; observations about neonate response to care; descriptive, injunctive, and/or perceived sanctions of norm(s), if any, that influenced the scenario. Regarding massage, the following data will be extracted and summarized: type of massage performed, how massage is performed, how often massage is performed, when massage is performed, who performs the massage, rationale behind the selected massage technique, perceived benefits of the technique, any harms or concerns about the technique, and health impacts of the massage technique. These results will be described in relation to the research question and in the context of the overall study purpose. Gap analysis will identify areas where data on neonatal emollient therapy are still needed in sub-Saharan Africa.

The narrative report summarizing the data from the review will be disseminated in the public domain via publication in a relevant journal; circulation through the academic networks of review authors; and direct sharing to a team of researchers representing the University of Makerere in Uganda, Busitema University Faculty of Health Science in Uganda, Mbale Clinical Research Institute, Save the Children and Stanford University who are preparing for a clinical trial on neonatal emollient therapy in Uganda.

As of 5 August 2021, we have developed and validated the ability of the search strategy to capture a set of articles of known relevance ¹⁰ , employed the search strategy to identify eligible articles, uploaded the titles and abstracts into Covidence software, and completed an initial screening of titles and abstracts to identify articles for full-text review.

Stanford Digital Repository: PRISMA-P checklist for ‘Protocol for a scoping review of neonatal emollient therapy and massage practices throughout sub-Saharan Africa’.

https://purl.stanford.edu/zx021fw5637 ¹³ .

Data are available under the terms of the Creative Commons Zero "No rights reserved" data waiver (CC0 1.0 Public domain dedication).