Umbilical cord care in Ethiopia and implications for behavioral change: a qualitative study.

Yared Amare

doi:10.1186/1472-698x-14-12

Abstract

BackgroundInfections account for up to a half of neonatal deaths in low income countries. The umbilicus is a common source of infection in such settings. This qualitative study investigates practices and perspectives related to umbilical cord care in Ethiopia.MethodsIn-depth interviews (IDI) were conducted in a district in each of the four most populous regions in the country: Oromia, Amhara, Tigray and Southern Nations, Nationalities and Peoples Region (SNNPR). In each district, one community was purposively selected; and in each study community, IDIs were conducted with 6 mothers, 4 grandmothers, 2 Traditional Birth Attendants and 2 Health Extension Workers (HEWs). The two main questions in the interview guide related to cord care were: How was the umbilical cord cut and tied? Was anything applied to the cord stump immediately after cutting/in the first 7 days? Why was it applied/not applied?ResultsThe study elucidates local cord care practices and the rational for these practices. Concepts underlying cord tying practices were how to stem blood flow and facilitate delivery of the placenta. Substances were applied on the cord to moisturize it, facilitate its separation and promote healing. Locally recognized cord problems were delayed healing, bleeding or swelling. Few respondents reported familiarity with redness of the cord - a sign of infection. Grandmothers, TBAs and HEWs were influential regarding cord care.ConclusionsThis study highlights local rationale for cord practices, concerns about cord related problems and recognition of signs of infection. Behavioral change messages aimed at improving cord care including cleansing with CHX should address these local perspectives. It is suggested that HEWs and health facility staff target mothers, grandmothers, TBAs and other community women with messages and counseling.

Highlights

Infections account for up to a half of neonatal deaths in low income countries
In settings where the majority of deliveries occur at home, often under sub-optimal and unhygienic conditions, infections account for half of neonatal deaths [3,4]
In each of the four study communities, In-depth interviews (IDI) were conducted with 6 mothers, 4 grandmothers, 2 Traditional Birth Attendants (TBAs) and 2 Health Extension Workers (HEWs)

Summary

Introduction

Infections account for up to a half of neonatal deaths in low income countries. The umbilicus is a common source of infection in such settings. This qualitative study investigates practices and perspectives related to umbilical cord care in Ethiopia. In settings where the majority of deliveries occur at home, often under sub-optimal and unhygienic conditions, infections account for half of neonatal deaths [3,4]. The umbilicus is an important source of infection in the first few days of life due to unhygienic cord care practices including cord cutting and tying [5,6]. To eliminate the incidence of omphalitis and subsequent mortality, improved cord care practices such as hand washing, the use of a new blade to cut the cord and hygienic cord tying have been widely promoted. The World Health Organization has recommended dry cord care as well as the use of topical antiseptics in settings with a high risk of infection [5]

Methods

Results

Conclusion