Cord Care Research Articles

A qualitative systematic review of umbilical cord care practices in Nigeria

BackgroundUmbilical cord care is an important aspect of newborn health, and different practices exist around the world, often influenced by cultural, healthcare infrastructure, and socioeconomic factors. The objective of this systematic review is to synthesize current literature on umbilical cord care practices in Nigeria, with an emphasis on the impact of cultural beliefs, healthcare infrastructure, and socioeconomic factors.MethodsA comprehensive search for literature was performed across PubMED, MEDLINE and Google scholar for studies published between 2010 and 2023. The preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines was followed for the execution of this study. Eligibility criteria included only English studies investigating umbilical cord care practices in Nigeria, with outcomes connected to cultural, healthcare, or socioeconomic factors. Critical Appraisal Skills Programme (CASP) checklist was used to critically appraise the quality and rigor of selected studies. Due to the heterogeneity of the studies (qualitative and quantitative), qualitative narrative synthesis was used to synthesize the studies in a textual format for comprehensive understanding.ResultsA total of 11 included studies were found out of 1532 studies. The findings reveal a range of cord care practices, emphasizing the use of various methods such as methylated spirit, hot compresses, and indigenous substances. Cultural beliefs, a lack of healthcare infrastructure, and socioeconomic circumstances all have a big impact on cord care decisions. Disparities in knowledge and adherence to evidence-based procedures are noticeable, particularly in the use of chlorhexidine gel. Infections continue to be a problem, highlighting the significance of appropriate therapies.ConclusionThis systematic review offers a comprehensive perspective of Nigerian umbilical cord care practices, emphasizing the importance of culturally responsive educational interventions, enhanced healthcare infrastructure, and targeted legislative measures. Despite its limitations, the study is an important resource for guiding future research, policy creation, and interventions to improve maternal and newborn health outcomes in Nigeria.

Umbilical Cord Care Practices and Knowledge among Primiparous in Northern Ghana.

Background: Umbilical cord care remains a serious health concern in the rural part of Ghana. The study sought to examine the knowledge and practices concerning umbilical cord care among first-time mothers residing in the Northern regions of Ghana. Methods: Institutional-based cross-sectional study design was employed using quantitative research approach. The study was conducted among primiparous mothers of neonates seeking postnatal services in rural Ghana. Descriptive statistical methods were used to analyze the data. Frequency, percentages, and bar charts were used to present the data. A chi-square test was carried out to examine the association between demographic variables and knowledge of umbilical cord care. Results: Most primiparous mothers displayed a commendable level of knowledge regarding cord care, with 95% exhibiting familiarity with essential practices. Notably, 30.7% acknowledged using hot water with salt or holy water from a pastor/mallam for cleansing their baby's umbilical cord/stump, while 39.4% disagreed with this practice. Statistical Analysis (ꭕ2(12.56), p-value <0.001) highlighted a significant association between education and mothers' comprehension of cord care. Moreover, correlations were observed between mothers' knowledge of cord care and factors such as occupation, insurance status, place of residence, place of delivery, and education received regarding cord care. Conclusion: The findings of this study revealed a disconnect between knowledge and practice regarding newborn umbilical cord care. While it is evident that many individuals are well-informed about proper umbilical cord care, their actions do not align with this knowledge. Additionally, a portion of the population continues to use unapproved substances such as shea butter and toothpaste due to factors like the unavailability of recommended products (such as chlorhexidine gel or methylated spirit), religious considerations, and cultural beliefs.

Newborn care knowledge and practices among mothers in Baguio City, Philippines: A descriptive correlational study

Background: Maternal knowledge and practices on newborn care are crucial in ensuring the well-being of infants, particularly in areas such as cord care, pain and fever management, and stimulation of senses. The Department of Health (DOH) and other health programs aim to promote better newborn care practices, but maternal knowledge gaps may persist. Objective: The study aimed to assess the level of knowledge and practice of mothers regarding newborn care, specifically focusing on cord care, pain and fever management, and stimulation of senses. Methods: A quantitative descriptive correlational design was used. The study involved 308 mothers from three barangays in Baguio City, selected using stratified random sampling. Data were collected from 6 February 2023 to 20 March 2023 through a self-administered questionnaire. Descriptive and inferential statistics were used to analyze the data. Results: Mothers had high knowledge of cord care and stimulation of senses, and average knowledge of pain and fever management. For practice, mothers scored highly in cord care, pain and fever management, and stimulation of senses. Significant differences were found in knowledge of pain and fever management by age (p = 0.044) and civil status (p = 0.015). A weak, significant positive correlation (r = 0.229, p <0.001) was observed between knowledge and practice. Conclusion: The study found a positive relationship between knowledge and practice, indicating that informed mothers are more likely to implement appropriate newborn care practices. There is a need to enhance maternal education, especially on pain and fever management, to promote better neonatal outcomes. Health programs should continue to focus on improving maternal knowledge through accessible information and support.

Use of chlorhexidine digluconate 7.1% gel for umbilical cord care in selected regions in Northern Ghana: qualitative perspectives of key stakeholders

Use of chlorhexidine digluconate 7.1% gel for umbilical cord care in selected regions in Northern Ghana: qualitative perspectives of key stakeholders

Postnatal cord care practices and associated factors in Arba Minch town, southern Ethiopia.

Cord care is one component of essential newborn care that reduces newborn morbidity and mortality. Poor cord care practice leads to a large amount of neonatal death due to infection. In Ethiopia, many women give birth at home, where neonates are exposed to unclean cord care practices or application of different traditional substances. Despite the severity of the problem, studies related to postnatal cord care practice are scarce. Hence, this study is aimed to assess umbilical cord care practices and associated factors in the postnatal period in Arba Minch town. To assess postnatal cord care practices and associated factors among mothers who gave birth in the last six months in Arba Minch Town, southern Ethiopia, 2019. Cross-sectional study design was conducted and using simple random sampling method 423 mothers who gave birth with in the last six months in Arba Minch town from November 11 to December 02, 2019, were selected. Data was collected using structured questionnaire administered by the interviewer. EpiData version 4.4 was used for data entry and SPSS version 25 was used for data analysis. Variables with p ≤ 0.25 in bivarible logistic regressions were considered as potential candidates for multivariable logistic regression analysis to control confounders. Adjusted Odds Ratio with 95% confidence interval was applied in multivariable logistic regression models, to identify variable, which has significant association. The overall proportion of women who had good postnatal cord care was 67.1%. The maternal age group of 25 to 29 years (AOR = 2.51; 95% CI: 1.35-4.68), maternal educational status of secondary school and above (AOR = 4.19; 95% CI: 2.05-8.54), mothers with good knowledge of cord care (AOR = 1.77; 95% CI: 1.03-3.05), and health facility delivery (AOR = 2.60; 95%CI: 1.05-6.41) were independent factors associated with good cord care. The proportion of good cord-care practice reported in this study was relatively worthy. Maternal age group of 25-29 years, maternal educational status of secondary school and above, having good knowledge of cord care, and delivering at health facility were factors that increased good postnatal cord care practice. Therefore, investing in improving these factors would positively affect maternal postnatal cord care practice. In order to reduce neonatal morbidity and mortality, routine counseling of cord care practice to mothers would attain good knowledge about postnatal cord care practices. Community health education would also increase awareness and practice of postnatal cord care.

The nexus between maternal antenatal care attendance, newborn postnatal care and neonatal mortality in India: a matched case-control study

IntroductionOur study examines the relationship between newborn postnatal care and neonatal mortality stratified by maternal antenatal care attendance under a matched case-control framework.MethodsData from the fifth round of the National Family Health Survey was used. A total of 172,079 recent births to eligible women (15–49 years) in five years preceding the survey were included in the study. We used the conditional logistic regression model, a commonly used regression model to fit matched case-control data to examine the effects of newborn postnatal care on neonatal mortality. The mother’s age at birth of the newborn, previous birth intervals, birth order of the newborn, and birthsize of the newborn were included as the matching variables.ResultsNewborns receiving postnatal care within two days or more than two days of birth are less likely to die during the neonatal period. Preferences for newborn postnatal care were also observed to increase with more maternal antenatal care visits. Our study also found a lower risk of neonatal mortality among those newborns whose umbilical cord was examined within two days of birth, regardless of the number of maternal antenatal care visits. Similarly, the risk of newborn deaths was lower among babies whose body temperature was measured within two days of birth. The tendency to breastfeed their newborns within an hour after delivery was considerably higher among those births that occurred to mothers who had a higher number of maternal antenatal care visits. The risk of newborn deaths was also observed to be lower among those born in public or private healthcare facilities.ConclusionConsidering the cohesive nature of the relationship between neonatal mortality and maternal and child healthcare utilisation, strategic planning and management of the existing policies and programmes related to accessibility, availability, and affordability of maternal and child healthcare services is needed to achieve goal 3.2 of the Sustainable Development Goals. Promoting cost-effective measures such as continuous monitoring of the baby’s body temperature and umbilical cord care could also effectively help reduce neonatal mortality.

Association of umbilical cord care practices with neonatal infection in Katsina, northwest Nigeria

Background: Significant numbers of neonatal deaths occurring each year are caused by infections that can be directly associated with improper and unhygienic umbilical cord care practices. The objectives of this study were to describe the umbilical cord care practices among mothers whose babies were admitted for suspected sepsis at the Federal Teaching Hospital and Turai Umaru Yar’adua Maternal and Children Hospital Katsina, Nigeria, assess the relationship between umbilical cord care practices and neonatal sepsis, and the influence of home delivery on this relationship. Methodology: This was a hospital-based descriptive observational study of 60 selected neonates with clinical features of sepsis admitted into the special care baby unit (SCBU) of the two hospitals between July and December 2022. The study involved the collection and microbiological analysis of blood samples using the BacT/Alert microbial detection system, and the administration of a structured questionnaire on the mother of each enrollee to collect relevant information about cord care practices. Data were analyzed using SPSS version 22.0. The Chisquare (x2) test and Odds ratio (with 95% confidence interval) were used to determine the association of risk factors with culture-confirmed sepsis, and a p value less than 0.05 was considered statistically significant. Results: Of the 60 neonates blood samples, 31 (51.7%) were culture-positive for neonatal sepsis while 29 (48.3%) were culture-negative. There was no statistically significant association between risk factors such as application of traditional materials for cord care and place of delivery, and culture-confirmed neonatal sepsis (p>0.05). However, neonates whose mothers use traditional materials for cord care were more likely to develop sepsis than those who do not (OR=2.027, 95% CI=0.716-5.736). Concerning place of delivery, which is an important determinant of umbilical cord hygiene, babies delivered at home were almost 3 times more likely to have culture-confirmed sepsis than those delivered in the hospital (OR=2.975, 95% CI=1.040-8.510). A total of 26 out of the 60 (45.3%) mothers of the neonates agreed to have used unhygienic and traditional materials for cord care, with charcoal (39.0%), local herbs (27.0%), cow dung/urine concoction (19.0%), and others (15.0%), such as lubricants, ash, and balm, being the most commonly used materials for cord care. Conclusion: Neonatal infection is common among newborns in Federal Teaching Hospital and Turai Umaru Yar’adua Maternal and Children Hospital (TUYMCH), Katsina, northwest Nigeria, with a prevalence of culture-confirmed neonatal sepsis of 51.7%. Although there was no statistically significant association between unhygienic cord practices and neonatal sepsis in this study, babies whose mothers use traditional materials for cord care were more likely to develop sepsis. There is a high rate of use of harmful and unhygienic traditional materials for cord care in our environment. This habit can be discouraged through health education using the mass media and health talks in health facilities. The use of chlorhexidine, the recommended antiseptic for cord care by the World Health Organization and the Nigeria Federal Ministry of Health, should be encouraged.

Neonatal tetanus in South Sudan: a case series

Introduction: Neonatal tetanus is a life-threatening disease of public health importance; it is yet to be eliminated and is still occurring in South Sudan. It is caused by a neurotoxin from a bacterium Clostridium tetani whose spores exist in the environment. Compared to high-income countries, most low-income countries lack intensive care units, and magnesium sulfate shown to improve neonatal tetanus outcomes. Objectives: We aimed to determine the outcome of neonatal tetanus in Al Sabah Children’s Hospital, Juba, South Sudan. Methods: We conducted a case series study in Al Sabah Children’s Hospital in Juba, South Sudan. It described three neonates who presented within the first seven days of life with a history of excessive crying, inability to breastfeed, and tetanic muscle spasms when stimulated. They had signs of respiratory distress, fever, and labile heart rates. We made a diagnosis of neonatal tetanus with autonomic dysfunction, and started them on phenobarbitone because diazepam was not available, oxygen, and antibiotics. However, tetanus immune globulin and anti-tetanus serum were not available. Results: Unfortunately, all three neonates died within 24 hours of admission. Conclusion: Our primary focus as a nation is to improve access to quality health services and the prevention of neonatal tetanus through encouraging appropriate antenatal care, facility delivery, clean delivery and healthy umblical cord care practices, and tetanus vaccinations in teenage girls and young adults. When prevention fails, there is a need for neonatal intensive care with recommended medicines to significantly decrease mortality in this preventable tragic illness. Keywords: Neonatal tetanus; low-income countries; neonates; Al sabah children hospital; South Sudan.

Real-world use of the CarestartTM glucose-6-phosphate dehydrogenase rapid diagnostic test to determine G6PD deficiency in Nigerian neonates.

G6PD deficiency (G6PDd) is the most common X-linked genetic disease worldwide and the most common cause of severe neonatal hyperbilirubinemia (NH) in Nigeria. Screening for G6PDd has been recommended for over thirty years but is still not routinely done in Nigeria. We sought to investigate a low-cost rapid diagnostic test to determine G6PDd in Nigerian neonates. Enrolled neonates were screened using the CareStartTM G6PD point-of-care rapid diagnostic test; and mothers/caregivers of neonates with G6PDd were asked about their cord care product(s); transcutaneous bilirubin levels were done on neonates with G6PDd using the JM 103 meter. One hundred and forty neonates were enrolled between 15 January and 1 July 2022. Eighteen (12.8%) of all neonates enrolled and 13.9% of enrolled males (0% of females) were G6PDd. Seventeen of the mothers/caregivers of the G6PDd neonates were asked about cord care. The majority of mothers/caregivers (15/17, 88%%) reported including methylated spirits in their neonate's cord care; seven of these used chlorohexidine plus methylated spirits (41.2%) while only one mother/caregiver used chlorohexidine alone. One mother/caregiver used mentholatum alone and another used mentholatum, chlorhexidine gel, and methylated spirits. Maximum bilirubin levels for those infants with G6PDd ranged from 3.2 to 18.8 mg/dl with 16/17 (94.1%) of bilirubin levels exceeding 5.5 mg/dl. This study again highlights the need for large-scale G6PDd screening. Additionally, it highlights the need to correlate the type of cord care with the risk of NH in future studies.

Evaluation of Nurses’ practices about Umbilical Cord Care for Neonates in Neonatal Intensive Care Units

Background: The umbilical cord, made of Wharton's jelly, is a gelatinous material that extends from the fetus's umbilicus to the placenta. It consists of two umbilical arteries and one vein, and the urachus, a remnant of the allantois. Infections can lead to complications, including sepsis, abdominal button inflammation, abscess, necrotizing fasciitis, and liver abscesses. Objective(s): This study aims to evaluate nurses’ practices about umbilical cord care for Neonates. Methodology: A quantitative approach using a descriptive-analysis design was used in the present study in order to evaluate nurses’ practices about umbilical cord care for Neonates. . The period of the study was from January 13th ,2024 to May 13th, 2024 . A questionnaire was completed by 64 nurses staff from Welfare Teaching Hospital and Central Teaching Hospital of Pediatric. The sample consisted of 50 nurses. Results: The practices levels was assessed using a three-point scale. A study of nurses found that while 70% were female, the majority had a diploma in nursing and a bachelor's degree. Most had between 1 and 6 years of hospital experience and a significant number of specific NICU experience. Most nurses actively sought to update their knowledge about neonatal umbilical cord care. However, the majority of practices were rated as 'Poor', indicating a gap in compliance with established protocols and standards for umbilical cord hygiene and maintenance. The study found no significant correlation between demographic characteristics or experience in hospitals and NICUs, and suggested that knowledge alone may not translate into effective practice without continuous training and strict adherence to protocols. Conclusion: while our study agrees with some existing literature it also challenges studies indicating an interplay of factors affecting neonatal care practices beyond just the demographic characteristics of nursing staff. Future research should delve into systemic influences on practice adherence along with evaluating targeted interventions effectiveness in enhancing cord care quality, in neonatal units. Recommendation :From the results of this study and also from the previous literatures and researches its became essential to establish a mandatory training sessions for all the staff in the NICU focusing on the best practices for the care of umbilical cord, and this sessions has to include a standardized protocols to ensure that the knowledge is efficiently translated into practice.

Digital communication between mothers and community health workers to support neonatal health (CHV-NEO): study protocol for a randomized controlled trial

BackgroundProvision of essential newborn care at home, rapid identification of illness, and care-seeking by caregivers can prevent neonatal mortality. Mobile technology can connect caregivers with information and healthcare worker advice more rapidly and frequently than healthcare visits. Community health workers (CHWs) are well-suited to deliver such interventions. We developed an interactive short message service (SMS) intervention for neonatal health in Kenya, named CHV-NEO. CHV-NEO sends automated, theory-based, actionable, messages throughout the peripartum period that guide mothers to evaluate maternal and neonatal danger signs and facilitate real-time dialogue with a CHW via SMS. We integrated this intervention into Kenya’s national electronic community health information system (eCHIS), which is currently used at scale to support CHW workflow.MethodsThe effect of CHV-NEO on clinical and implementation outcomes will be evaluated through a non-blinded cluster randomized controlled trial. Twenty sites across Kisumu County in Western Kenya were randomized 1:1 to provide either the national eCHIS with integrated CHV-NEO messaging (intervention) or standard of care using eCHIS without CHV-NEO (control). We will compare neonatal mortality between arms based on abstracted eCHIS data from 7200 pregnant women. Secondary outcomes include self-reported provision of essential newborn care (appropriate cord care, thermal care, and timely initiation of breastfeeding), knowledge of neonatal danger signs, and care-seeking for neonatal illness, compared between arms based on questionnaires with a subgroup of 2000 women attending study visits at enrollment in pregnancy and 6 weeks postpartum. We will also determine CHV-NEO’s effect on CHW workflows and evaluate determinants of intervention acceptability, adoption, and fidelity of use through questionnaires, individual interviews, and messaging data.DiscussionWe hypothesize that the CHV-NEO direct-to-client communication strategy can be successfully integrated within existing CHW workflows and infrastructure, improve the provision of at-home essential newborn care, increase timely referral of neonatal illness to facilities, and reduce neonatal mortality. The intervention’s integration into the national eCHIS tool will facilitate rapid scale-up if it is clinically effective and successfully implemented.Trial registrationClinicalTrials.gov, NCT05187897. The CHV-NEO study was registered on January 12, 2022.

Breast Milk Application as a Natural Method for Umbilical Cord Care: A Community-Label 3-Arm Pilot Clinical Trial

Abstract Objective To compare the effects of human breast milk with those of chlorhexidine and the dry method on umbilical cord separation in Ethiopia. Methods This open-label 3-arm nonrandomized pilot clinical trial was conducted among 45 neonates (15 in each arm) with more than 630 home visits. After a standard cord cut, human breast milk, chlorhexidine, or nothing was applied once per day for 7 days. The primary outcome was the duration of cord separation, while the secondary outcomes were umbilical cord infection, neonatal fever, jaundice, feeding and breathing difficulty, and persistent crying. Results There were statistically significant differences in the time-to-cord separation between the human breast milk group and the chlorhexidine (P < 0.001) and dry alone (P = 0.038) groups. Compared to those of chlorhexidine, the rates of cord separation among human breast milk and the dry-alone group were 16.02, with 95% confidence intervals (3.81, 37.43; P < 0.001) and 3.15 (0.99, 10.00; P = 0.052), respectively. One (6.7%) cord site infection was observed in the dry-alone groups only. Conclusion This community-label study indicated that human breast milk application significantly shortened the length of umbilical cord separation time compared to chlorhexidine and dry methods. A large-scale randomized controlled trial is needed to confirm these results. Registration PACTR202310902873290; https://pactr.samrc.ac.za

Promotive and Preventive Programs for Health Workers and Mothers on Newborn Umbilical Cord Care to Prevent Infection During the Neonatal Period

Umbilical cord infections can be prevented by caring for the umbilical cordproperly. The data regarding proper and correct umbilical cord care of newborn babiesby mothers in North Sumatra Province is limited. Hence, this community serviceaimed to determine the proportion of knowledge in umbilical cord care for newbornbabies using the open-dry cord care method. Thew community service project washeld on August 24, 2023, in Pematang Siantar City, North Sumatra Province. In thisactivity, we provided counseling on the open-dry cord care method for umbilical cordcare by presentation and discussion using modules, posters, and leaflets. We used apre-test and post-test questionnaire to assess the knowledge level of health workersand mothers. Participant demographic data and results are presented in the form ofproportion data. This counseling was attended by 150 participants consisting of 52health workers and 98 mothers. Before the counseling, 39 health workers and 93mothers did not know how to take care of the umbilical cord properly. After thecounseling, the knowledge of umbilical cord care using the open-dry cord methodincreased by 15.4% for health workers and 24.5% for mothers. Based on the results,over 80% of participants were found to have had a satisfactory level of knowledgeabout umbilical cord care after the counseling session. This community serviceprogram should be conducted regularly to further enhance the knowledge of healthworkers and mothers on proper umbilical cord care.

The Effect of using E-Booklet Media on Increasing the Knowledge of Primigravida Mothers about Breastfeeding Techniques and Newborn Umbilical Cord Care

Primigravida mothers often lack sufficient knowledge about newborn care, including umbilical cord care and breastfeeding techniques. Better education and support from healthcare professionals are essential to enhance their knowledge and skills in infant care. Effective training and counseling can help primigravida mothers feel more confident and competent in caring for their children. This study aims to determine the effect of e-booklet media on the knowledge of primigravida mothers regarding breastfeeding techniques and umbilical cord care in the service area of the Pamandegan Health Center and Midwife Clinic. This research uses a quantitative method with a pre-experimental design and a one-group pretest-posttest research design. The sample size in this study was 68 respondents, selected using total sampling, and all respondents received the intervention for 1 month. The measurement tool used in this study was a questionnaire that had undergone normality and validity tests. Normality was tested using the Shapiro-Wilk test, and data analysis was conducted using univariate analysis and bivariate analysis with the Wilcoxon test. The hypothesis test results showed a p-value = 0.000 < 0.05, indicating that the use of e-booklet media significantly affected the knowledge of primigravida mothers regarding breastfeeding techniques and umbilical cord care. It is crucial for primigravida mothers to improve their knowledge in these two aspects as it can greatly impact their ability to care for their babies effectively.

Adoption and factors associated with 7.1% chlorhexidine digluconate cord care standards in public health facilities in Kiambu County, Kenya

BackgroundThe Government of Kenya adopted the practice of 7.1% chlorhexidine digluconate (CHX) application for all newborns. However, challenges in implementation have arisen, as some counties in Kenya do not align with the underlying criteria for this recommendation. Therefore, we aimed to evaluate CHX adoption and associated factors in Kiambu County, Kenya. MethodsA cross-sectional survey was conducted among 434 caregivers attending their 6-week well-child clinics using multistage sampling. Descriptive statistics summarized sociodemographic data and CHX cord care uptake, while logistic regression analyzed associations between variables and CHX uptake. ResultsThe prevalence of use of CHX in Kiambu county was 41.0%. Twenty-two percent (22%) of the mothers were provided CHX post-delivery and 100% used it. Of the 78% who weren't provided CHX post-delivery, 39% were given prescriptions for CHX. The 61% who were not issued a prescription resorted to the use of surgical spirit (34.8%), dry cord care (9.2%) and saliva (3%). In public facilities, being married [AOR 0.19 (0.11–0.33)] and index use of CHX [AOR 0.17 (0.08–0.35)] were associated with non-adherence. Being employed [AOR 2.46 (1.26–4.77)] and delivering in hospital [COR 3.29 (1.69–7.08)] increased the likelihood of using CHX. ConclusionWeak prescription and adherence to the CHX cord care policy in Kiambu county has led to women turning to alternative substances for cord care. Quality improvement strategies are necessary to enhance adherence to guidelines, such as refining county-specific recommendations for cord care and providing corresponding patient education, or issuing definitive prescriptions for CHX post-delivery.

Pengaruh Pengetahuan Ibu terhadap Perawatan Tali Pusat pada Bayi Baru Lahir

Improper care of the umbilical cord can lead to premature detachment and increase the risk of umbilical cord infection (neonatal tetanus). As long as the umbilical cord has not detached naturally, it needs to be properly cared for. Failure to do so can result in infection characterized by moisture, pus, and a foul odor around the umbilical cord. This review aims to determine the influence of mothers' knowledge on the care of the umbilical cord in newborns. This review aims to investigate the impact of mothers' knowledge on the care of the umbilical cord in newborns. This study utilizes a literature review method, utilizing journal articles obtained from Google Scholar, SINTA, and Garuda databases, published between 2019 and 2023, with full text available in the Indonesian language. Based on the reviewed journals, it was found that 7 journals discovered the influence of maternal knowledge on umbilical cord care in newborns, while 4 journals stated that there are still mothers who perform umbilical cord care incorrectly according to the procedure. Based on the literature review of 10 research journals, respondents' characteristics among postpartum mothers can be classified based on age, educational level, and occupation. All these factors significantly impact a mother's knowledge regarding the care of the umbilical cord in newborns, highlighting the importance of health education in enhancing maternal knowledge.

Comparative Analysis on Safe Traditional Practices by Iraqi and Philippine Mothers in the Treatment of Newborn Health Problems: A Narrative Review

Background: Traditional practices are usually derived from the relationships with the environment and human attitude towards nature. Various societies, especially in developing nations, have unsafe traditional practices for newborns, traditionally associated with poverty, low educational levels, religiosity, culture, and by word of mouth intergenerationally handed over advice by elders in the families. Objectives: This narrative review points out the prevalence, cultural significance, and health implications of unsafe traditional newborn care practices in Iraq and the Philippines. Methods: Literature was searched in PubMed, Scopus, Web of Science, CINAHL, and Google. All iterations searched literature among mothers whose neonates were at issues, favoring traditional techniques rather than modern medicine—a total of 51 articles to be reviewed from articles published from 2019 to June 2024. Results: The following ten critical themes of unsafe practices were identified: care of the umbilical cord, feeding, traditional healing, bathing rituals, circumcision, swaddling, and treatments for gastrointestinal, respiratory, and eye problems, besides newborn isolation and practices of exposure. All these practices are comparatively prevalent in the rural setup and are ingrained in the fabric of cultural beliefs and traditions. These could include exposure to infection, complications, developmental delays, and neonatal mortality. The practices have also been associated with the perpetuation of poverty, low literacy levels, and cultural backgrounds. Conclusion: This review indicates that interventions towards these problems have to be multi-faceted. Multiple dimensions can be integrated into evidence-based interventions to improve education and economic opportunities, engagement with religious and cultural leaders, health system strengthening, fomenting research, and community engagement to develop culturally relevant solutions linking tradition and evidence-based care to improve newborn health outcomes.

An Investigation into how Primary Care Nurses Practices affect clinical competence in Emergency Maternal Obstetric and Newborn Care skills in Nakuru County

To reduce the risks of maternal morbidity, mortality and newborn death worldwide, the use of high-quality emergency obstetric and new born care (EMONC) was proposed to ensure women and their babies receive high-quality care. The government of Kenya with non-profit health programs have jointly invested resources with the aim of achieving SDG’s goal of zero rating maternal and neonatal death cases in the country. Despite these efforts, maternal and neonatal death cases have not reduced significantly. Most of the contributing factors to the deaths occur in the lower levels of the health care delivery system. Majority of the health care providers at these levels are the primary care nurses. It is on this background that the study sought to investigate how primary care nurses practice affect clinical competency in emergency maternal, obstetric, and new born care skills in Nakuru county. Madeleine Leininger’s Transcultural Theory of Nursing anchored the study. It deployed correlational cross-sectional survey design, targeting midwives and nurses in 184 KEPH level II and III facilities in all the 11 sub counties in Nakuru County. The study used stratified sampling technique to sample 126 health facilities distributed in every Sub County. A sample size of 196 primary health care nurses from the sampled facilities were involved. Key informant interview and questionnaires were used to collect both qualitative and quantitative data. To analyze data, SPSS version 26 was used to generate inferential and descriptive statistics, correlation analysis was carried using multiple regression model to ascertain the relationship between dependent and independent variables. Results found that Maternal and newborn care practice was found to have a significant positive relationship with competence in EmONC skills. (P<0.05). This was achieved through clean and safe delivery, thermal care and cord care which were carried out in KEPH level II and III facilities. It was concluded that maternal and neonatal care practices had positive significant relationship with competent EmONC. The study advised that the practice of fundamental maternal and newborn care has to be improved. The primary care nurses should be culturally competent in engaging the community members. Through community-based health care efforts, mothers need to be sensitized about delayed bathing, umbilical cord care, feeding, and thermal care for newborns. Further, County Government of Nakuru should support programs that enables primary health care nurses pursue maternal and neonatal care courses. County Government of Nakuru should ensure ambulance services are easily accessible to all, equipment availability at all time, consistent supply of all drugs needed and the need to create awareness among women, family and community members on newborn and early neonatal care

Progress Toward Achieving and Sustaining Maternal and Neonatal Tetanus Elimination - Worldwide, 2000-2022.

Tetanus remains a considerable cause of mortality among undervaccinated mothers and their infants following unhygienic deliveries, especially in low-income countries. Strategies of the maternal and neonatal tetanus elimination (MNTE) initiative, which targets 59 priority countries, include strengthening antenatal immunization of pregnant women with tetanus toxoid-containing vaccines (TTCVs); conducting TTCV supplementary immunization activities among women of reproductive age in high-risk districts; optimizing access to skilled birth attendants to ensure clean deliveries and umbilical cord care practices; and identifying and investigating suspected neonatal tetanus cases. This report updates a previous report and describes progress toward MNTE during 2000-2022. By December 2022, 47 (80%) of 59 priority countries were validated to have achieved MNTE. In 2022, among the 50 countries that reported coverage with ≥2 doses of TTCV among pregnant women, 16 (32%) reported coverage of ≥80%. In 2022, among 47 validated countries, 26 (55%) reported that ≥70% of births were assisted by skilled birth attendants. Reported neonatal tetanus cases worldwide decreased 89%, from 17,935 in 2000 to 1,995 in 2021; estimated neonatal tetanus deaths decreased 84%, from 46,898 to 7,719. However, the global disruption of routine immunization caused by the COVID-19 pandemic impeded MNTE progress. Since 2020, reported neonatal tetanus cases have increased in 18 (31%) priority countries. Integration of MNTE strategies into priority countries' national postpandemic immunization recovery activities is needed to achieve and sustain global elimination.

A Ten-Year Review of Neonatal Tetanus Seen in a Tertiary Health Facility in Sokoto North-Western Nigeria: Before and During the Covid-19 Pandemic

Background: Neonatal tetanus (NNT) remains among the leading cause of preventable morbidity and mortality among neonates in Nigeria. Nigeria remains among the countries carrying the global NNT burden. At the onset of the COVID-19 pandemic, reports have predicted that the pandemic will significantly impact on the health system globally, and low-resource countries where vaccination programs fared even worse are likely to see a surge in vaccine-preventable diseases during and after COVID-19 pandemic. Aims: To determine the prevalence, yearly trend, risk factors, and outcome of NNT cases seen in the Special Care Baby Unit (SCBU) of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria over a ten year period: before and during COVID-19 pandemic. Methods: This was a retrospective study. Data was retrieved from all the case notes of neonates admitted with a clinical diagnosis of NNT into the SCBU of the UDUTH, Sokoto from 1st January, 2013 to 31st December, 2022. The data obtained was analyzed using SPSS version 21. Results: During the 10 years period of the study, NNT accounted for 0.4% of admissions. The majority 15(57.0%) of the mothers of the neonates with NNT were from rural areas, 15(56.0%) had no antenatal care (ANC), and only 10(37.0%) of the mothers received vaccination against tetanus. All the mothers were from lower socio-economic classes. Most 17(63.0%) of the neonates were delivered at home by traditional birth attendants. The umbilical cord was the portal of entry in 26(96.0%) of cases, while 1(4.0%) followed traditional uvulectomy. Cord care was done using hot water fermentation in more than half of the neonates 17(63.0%), while only 1(4.0%) of the mothers used chlorhexidine gel for cord care. The case- fatality rate was 6(22.0%). the yearly trend showed an increased incidence of NNT admissions in 2022. Conclusion: The study showed that NNT is still a public health problem, with an increased scourge during the COVID-19 pandemic, which can be tackled through health education of mothers via mass media, improving the quality and access to ANC services, tetanus toxoid vaccination, hospital delivery and avoidance of traditional uvulectomy particularly in rural areas by the Sokoto state government. Antenatal and vaccination services should be given priority in response to future pandemics to sustain gains of the SDG 3.