Cord Care Practices Research Articles

Knowledge and Practice of Healthy Cord Care Among Mothers In Angwanrukuba

Standard Cord care as recommended by the World Health Organization (WHO) is an important community based intervention to reduce morbidity and mortality in newborns. Cord care refers to the series of steps applied in handling of the umbilical cord after delivery of the new born. Globally, an estimated 4 million deaths occur annually within the first four weeks of life and 1.5 millions of these deaths are attributable to infections. In Nigeria, studies have reported umbilical cord infections accounting for between 10 and 19% of neonatal admissions and resultant estimated 30–49% neonatal deaths. Hence, this study was conducted to assess the knowledge and practice of cord care within a contemporary setting, among Angwan Rukuba, Jos plateau state. Methods: This was a cross-sectional study carried out amongst market women in Angwan Rukuba. Data were collected using a semi - structured questionnaire. Information obtained included biodata, last child birth, monthly income, place of antenatal care and delivery, and cord care practices. Data was analysed using Epi info. Results: One hundred and fifty mothers participated in the study. About 95% (142 respondents) received antenatal care in recognized hospitals, while 20% (30 respondents) were attended to by traditional birth attendants (TBA) and had home deliveries. Mothers' level of education was significantly associated with place of antenatal care and place of delivery (p= 0.0001). 124 (82.7%) used Methylated spirit to clean the cord but 73 (48.7%) applied potentially dangerous substances after cleaning with Methylated spirit.116 (77%) had good practice of standard cord care. Conclusion: Although most mothers had antenatal care in Government hospitals, there was a high rate of use of potentially dangerous substances for cord care. There is need for continued education of mothers on correct cord care practices. This study has brought to light the level of cord care practices with health facility delivery and knowledge of cord care as its determinants.

NEW BORN CORD CARE PRACTICES AMONG PARTURIENT WOMEN IN A RURAL CONTEMPORARY NIGERIA SETTING

Background : Despite the progress made in recent decades to reduce the number of child deaths globally, many new-borns continue to die preventable deaths from conditions such as neonatal infections, especially in developing countries such as Nigeria. The umbilical cord remnants provide a good site for proliferation of infectious organisms which can lead to the death of new-born babies in their first month of life. Hence this study explored the new-born cord care practices of parturient women and the factors that contribute to such practices. Method: This study was a descriptive, cross-sectional survey of parturient women, who gave birth in the past one year. A Multi-stage sampling technique, was used to recruit respondents across selected communities. Ethical clearance was obtained, while informed consent was obtained from the study participants. A total of 400 volunteering respondents were consecutively recruited while a self-developed and validated questionnaire was used to collect data Result: The major findings of the study were that a significant percentage (12.2%) of the respondents did not deliver their babies in any health facility. There were evidences of potentially harmful new-born cord care practices among the respondents such as application of herbs and tooth-pastes to new-born’s umbilical cord (12% and 5.2% respectively) and 8% applied hot balms to hasten cord separation. Fifteen percent of the respondents indicated that they noticed signs of infection on the baby’s cord while place of delivery influenced their new born cord care practices. Conclusion: Therefore, there is need for public enlightenment programs specifically tailored for rural dwellers on good new-born cord care practices. Keywords: New-born; cord care practices; parturient women; South Eastern Nigeria.

Topical Application of Human Milk versus Alcohol and Povidine-Iodine on Clinical Outcomes of Umbilical Cord in Healthy Newborn: Impact of an Educational Program of Mothers’ Knowledge and Practice Regarding Umbilical Cord Care

Aim: This quasi-experimental study was conducted to evaluate the effect of an educational program of mothers` knowledge and practice about umbilical cord care; compare cord-cleansing using human milk versus alcohol 70% and povidine-iodine 10% on clinical outcomes of umbilical cord in healthy newborn. Subjects: Α total of 150 mothers who had just delivered with their newborn infants at the postnatal units at El-Fayoum University Hospital, Egypt, were recruited for this study. Tool: data was collected through а structured interview questionnaire; newborn follow-up sheet and an observation checklist. Results indicated that, before the intervention of the educational program, lake of satisfactory knowledge and practice among mothers in all groups related to cord care. The total mean scores for the immediate post/follow up tests of intervention educational program were statistically significantly higher (р<0. 001), compared to their pre-intervention of the educational program scores. Concerning newborn follow-up, there were highly statistically significant differences in umbilical cord base separation time, the sign of cord infection, bleeding continuation in mother milk group as compared with alcohol 70% and povidine-iodine 10% group. Conclusion: Educational program had а positive effect on mothers' knowledge and competency of their practice regarding umbilical cord cleansing. Topical application of mother milk on umbilical cord care leads to rapid cord separation time; diminish the umbilical cord infection as it can be used as an easy, cheap and non-invasive way for cord care. Recommendation: educational programs intervention regarding neonatal care is required during the period of antenatal visit. Researches to study the effect of newborn cord care practices on the incidence of newborn morbidity/mortality are required.

Factors Influencing Neonatal Practice in a Rural Community in Kano (Northern), Nigeria.

Nigeria has the highest number of neonatal and under-five deaths in Africa. Socio-cultural determinants play an important role in disease burden in low-middle income countries. This study aimed to describe knowledge, attitudes and neonatal care practice among household caregivers in a rural community in Nigeria, specifically uvulectomy, female genital mutilation (FGM), failure to routinely immunize and unsafe cord care. Further, relationships between demographic characteristics and knowledge, attitudes and neonatal care practices among caregivers were analyzed. The study design was descriptive correlational and cross-sectional. Consented caregivers (N = 298) were enrolled and interviewed using a structured questionnaire. Data were collected on demographic characteristics of the study participants and practice of uvulectomy, FGM, immunization and cord care. Statistically significant correlations were found between the practice of uvulectomy, FGM and failure to immunize based on occupation (p = 0.0202, p = 0.0290, p = 0.0071) and educational level (p =< 0.0001, p =< 0.0001, p =< 0.0001), with variations by ethnicity. Intense, preventative health measures and maternal education to eliminate harmful care practices are essential to influence outcomes.

A study to assess the newborn care practices among mothers at a tertiary care hospital in Hyderabad, Telangana

Background: Early neonatal period (&lt;1 week) is the crucial period in the life of an infant as the risk of death is greatest during the first 24- 48 hours after birth. In India, around 61.3% of all infant deaths occur during neonatal period (&lt;28 days) and more than half of these deaths occur during early neonatal period. Most of these deaths can be attributed to harmful newborn care practices in relation to bathing, feeding, cord care etc. The aims and objectives of the study were to assess the newborn care practices among women who delivered in Gandhi Hospital; to assess the relationship between maternal education and newborn care practices among study population.Methods: A cross sectional study was carried out among 200 women who delivered in Gandhi Hospital, Hyderabad, Telangana from March to June 2017 and a predesigned, pre tested questionnaire was used to obtain information.Results: The mean age of study population was 21.5±2.3 years. Around 61.9% of mother’s breastfed within first hour of life and 93.5% fed colostrum. Around 17% were given pre lacteal feeds like cow milk, honey, water etc. No harmful cord care practices like application of cow dung etc. were not followed.Conclusions: Majority of the study population had correct knowledge regarding newborn care practices. Although some of the traditional practices were still observed like giving pre lacteal feeds, discarding colostrum and avoidance of certain foods like pulses, meat, curd etc. by mother.

Comparison of the effectiveness of different umbilical cord care in infants: A protocol for systematic review and network meta-analysis.

Background:More and more studies were performed to explore the effectiveness of umbilical cord care practices. However, the results remain controversial. Hence, the aim of the review was to evaluate and compare the effectiveness of different umbilical cord care in infants through network meta-analysis.Methods:A systematic literature search for relevant articles published in the English language will be conducted in PubMed, EMBASE, the Cochrane library, and Chinese Biomedical Literature Database from their inception to December 2018. Randomized controlled trials (RCTs) that compared the effectiveness of different types of umbilical cord care practices will be included. Cord infection, illness, and death will be used to assess the clinical effect. Risk of bias assessment of the included RCTs will be conducted by the Cochrane risk of bias tool. The WinBUGS 1.4.3 software will be used to perform the network meta-analysis and the result figures will be generated by STATA V.15.0 software. Grading of recommendations assessment, development, and evaluation will be used to assess the quality of evidence.Results:The results will be published in a peer-reviewed journal.Conclusion:This will be the first network meta-analysis to evaluate and compare the effectiveness of different umbilical cord care in infants. Our study will generate evidence of cord care for infants and provide suggestions for clinical practice or guideline.PROSPERO registration number:CRD42018118052.

Determinants of Cord Care Practices among Mothers in Abakaliki, Ebonyi State, South East, Nigeria

Introduction: Unhygienic cord-care practices are major public health concern because of the associated gross neonatal and infant morbidity and mortality. Various factors have been linked to these practices. This study aims to identify the determinants of cord care practices among mothers in Abakaliki, Ebonyi State, South East, Nigeria. Methods: A cross sectional questionnaire based study involving women attending antenatal clinics and those who brought their babies to the immunization clinics of Federal Teaching Hospital, Mile Four Hospital and Maternal/Child Primary Health Care Center, all in Abakaliki. Results: Two hundred and seventy three mothers participated in the study. The majority of the participants aged 26 to 35 years (60.07%), had tertiary education (49.45%) and were business women (38.46%). Mothers who had secondary and tertiary education basically applied methylated spirit (p-value 0.0014) and chlorhexidine (p-value 0.0289) as a form cord care while those who had primary or no formal education cared for cord using hot water, Vaseline, close up tooth paste and local herbs. The mothers educational status, occupation and parity also determined the care given the umbilical cord after birth. Conclusion: Cord care practices are determined and influenced by several factors in Ebonyi State. Health education and awareness campaigns should be upheld and targeted among women of child bearing age found in women meetings, local markets and primary health care delivery centers especially in the rural setting.

Neonatal Cord Care Practices among Mothers and Caregivers in the Volta Region of Ghana.

Background:The umbilical cord is a major route of infection among newborns. In Ghana, infections among neonates accounts for majority of under-five deaths. This study sought to investigate what mothers apply to the umbilical cord of their newborns and what motivates them to put such applications on the cord.Methods:This was a descriptive cross-sectional study of neonatal cord care practices among mothers and caregivers in the Nkwanta South District of the Volta region of Ghana. Quantitative and qualitative methods were used.Results:Majority of the mothers/caregivers used substances that have not been recommended for umbilical cord dressing (64.3%). Factors such as level of education [χ2=8.2, p=0.02], place of delivery [χ2 = 40.1, p<0.001], relationship with whoever has made a recommendation for a particular dressing to be used [χ2=95.2, p<0.001] and number of days it takes the umbilical cord to fall off [χ2=6.2, p=0.05] were found to influence the type of dressing used on the umbilical cord.Conclusion and Global Health Implications:In order to reduce the number of neonates who die due to avoidable cord-related infections, the type of substances used on the umbilical cord should be approved substances. Health education particularly on neonatal cord care targeting community members and health care providers at the lower levels of the healthcare delivery system should be intensified.

Theory of Planned Behavior on Factors Affecting Tetanus Toksoid Immunization Uptake Among Pregnant Women in Boyolali, Central Java

Background : Tetanus is an infectious disease caused by Clostridium tetani bacteria. TT immunization in pregnant women can prevent neonatal deaths. Maternal and Neonatal Tetanus (MNT) has been among the most common life-threatening consequences of unclean deliveries and umbilical cord care practices, and are indicators of inequity in access to immunization and other maternal, newborn, and child health services. The neonatal mortality rate was still high in Boyolali Regency, Central Java. The purpose of this study was to determine the factors of TT immunization uptake among pregnant women in Boyolali, Central Java, using Theory of Planned Behavior. Subjects And Method : This was a cross-sectional study conducted in Boyolali, Central Java, from November to December 2018. A sample of 200 pregnant women from 25 community health centers was selected by simple random sampling and positioned at level 2 in a multilevel model analysis. Eight pregnant women were selected at random from each community health center. The dependent variable was TT immunization uptake. The independent variables were knowledge, education, the influence of midwife private practice, parity, income, intention, attitude, perceived behavior control, and social norm. The data on immunization uptake was obtained from the medical record. The other data were collected by questionnaire. The data were analyzed by multilevel multiple logistic regression analysis. Result s : The use of TT immunization increased with better maternal knowledge (b= 1.47; 95% CI= 0.02 to 2.92; p= 0.047), high maternal education (b = 2.19; 95% CI = 0.64 to 3.75; p= 0.006), influence of midwife private practice (b= 2.07; 95% CI= 0.41 to 3.72; p= 0.014), parity ≥2 (b= 1.81; 95% CI = 0.13 to 3.5; p= 0.034), income ≥minimum regional wage (b= 1.95; 95% CI= 0.39 to 3.50; p= 0.014), strong intention (b = 1.73; 95% CI = 0.11 to 3.34; p= 0.035), positive attitude (b= 2.11; 95% CI = 0.17 to 4.05; p= 0.033), strong perceived behavior control (b= 3.84; 95% CI = 1.47 to 6.20; p <0.001), supportive social norm (b= 2.26; 95% CI= 0.29 to 4.23; p= 0.024). Community health center had a contextual effect on TT immunization uptake with ICC= 35.86%. Conclusion : The use of TT immunization increased with better maternal knowledge, high maternal education, the influence of midwife private practice, parity ≥2, income ≥minimum regional wage, strong intention, positive attitude, strong perceived behavior control, supportive social norm. The community health center has a contextual effect on TT immunization uptake. Keywords: TT immunization, knowledge, education, midwife private practice, parity, income, intention, attitude, perceived behavior control, social norm, pregnant women Correspondence: Tiara Yumafita, Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 362A, Surakarta 57126, Central Java, Indonesia. Email: Tiarayumafita8@gmail.com. Mobile: +6281230492658. Journal of Maternal and Child Health (2019), 4(3): 190-200 https://doi.org/10.26911/thejmch.2019.04.03.06

Knowledge and attitude of essential newborn care among postnatal mothers in Bangladesh

Purpose Neonatal mortality rate is 24 deaths per 1,000 live births in Bangladesh and most of them die during early neonatal period. The purpose of this paper is to assess the knowledge and attitude of neonatal care practices among postnatal mothers in a tertiary care hospital in order to provide a basis for the development of strategies to improve further. Design/methodology/approach A cross-sectional study was carried out in the Dhaka Medical College Hospital, Bangladesh using a convenient sampling technique. In total 211 postnatal mothers were interviewed using a structured questionnaire and χ2 test was used to analyze the data. Findings Among mothers, 37.9 percent were aged between 16–20 years; 16.1 percent had no institutional education; 55 percent were primipara and only 26.5 percent had attended antenatal visit for more than four times. Mothers had apparently good knowledge and attitude about thermoregulation, early initiation of breast-feeding, importance of providing colostrum to the newborn, exclusive breast-feeding (EBF) up to six months of age and immunization at birth. However, this study identified knowledge gap about cord care, eye care, first bathing and hygiene practices. Overall, only a small proportion of respondents had good level of knowledge (37 percent) and attitude (47.4 percent) on newborn care. Highly significant statistical association was found between the knowledge, attitude level and socio-demographic characteristics of respondents. Knowledge and attitude were strongly associated as well. Research limitations/implications There is scope for improvement by providing health education to antenatal and postnatal mothers. Therefore, implementation of the guidelines outlined in the Maternal and Child Handbook (MCH) is highly recommended. Originality/value There is scope for improvement by providing health education to antenatal and postnatal mothers. Therefore, implementation of the guidelines outlined in the MCH is highly recommended to enhance the knowledge and attitude on newborn care among postnatal mothers.

Survey of umbilical cord care practices and separation time in healthy new-born in Maiduguri, Nigeria

This study aimed at assessing the umbilical cord care practices and separation time in healthy new-born in Maiduguri, Borno State, Nigeria. A descriptive survey design was adopted for the study. A total of 365 women attending child welfare clinic were selected through systematic random sampling technique from three health care facilities in Maiduguri Metropolis. A self-developed and validated questionnaire was used to collect information from the women on common cord care practices and knowledge of standard umbilical cord care practices. The questionnaire was pretested in State Specialist Hospital Maiduguri, Borno State and the correlation coefficient of 0.87 determined. The result of the study revealed that common cord care practices among women in Maiduguri include the use of methylated spirit, hot compress, charcoal, Vaseline and table salt. Others were mixture of methylated spirit with traditional concoctions, toothpaste and cow dung were also found to be commonly used by the mothers. The mean umbilical cord separation time of 3.5 days (± 0.397) was observed with the unorthodox treatment of the cord. Although there was a good knowledge among the respondents with regards to standard umbilical cord care practice, there was however no commensurate practice. Therefore, there is an urgent need for cultural re-orientation most especially of women with regard and unhygienic traditional cord care practices on the new born.

Cord Care Practices: A Perspective of Contemporary African Setting

Cord care is the series of steps applied in handling of the umbilical cord after delivery of the new born. Globally, an estimated 4 million deaths occur annually within the first 4 weeks of life and 1.5 million of these deaths are attributable to infections. In Nigeria, studies have reported umbilical cord infections accounting for between 10 and 19% of neonatal admissions and resultant estimated 30-49% neonatal deaths. Hence, this study was conducted to assess the knowledge and practice of cord care within a contemporary setting. This was a cross-sectional study conducted among 324 mothers of children less than 59 months using a multistage sampling technique and SSPS version 20 was used for data analysis. Crude and adjusted odds ratios as well as 95% confidence interval were used in this study with a P-value of ≤0.05 considered statistically significant. The mean age of the mothers in the study was 27.5 ± 6 years with majority of them having good overall knowledge and practice of cord care. Factors such residence in rural community (AOR = 0.26; 95% CI = 0.0915-0.7230) and heath facility delivery (AOR = 7.0; 95% CI = 4.7877-9.3948) were predictors of cord care practices. This study has brought to light the level of cord care practices with health facility delivery, place of residence, and knowledge of cord care as its determinants.

Effectiveness of a campaign to implement chlorhexidine use for newborns in rural Haiti

BackgroundChlorhexidine topical cord application is recommended to prevent umbilical cord infections in newborns delivered at home in low-resource settings. A community campaign introducing chlorhexidine for the first time in Haiti was developed. Traditional birth attendants (TBAs) were identified as implementers since they typically cut newborns’ cords. TBAs were trained to apply chlorhexidine to the cord and demonstrate this procedure to the mother. Concurrently TBAs explained reasons for using chlorhexidine exclusively instead of traditional cord care practices. The campaign’s effectiveness was evaluated 7–10 days post-delivery using a survey administered by community health workers (CHWs) to 198 mothers.ResultsNearly all mothers heard about chlorhexidine use and applied it as instructed. Most mothers did not initially report using traditional cord care practices. With further probing, the majority reported covering the cord but few applied an unhygienic substance. No serious cord infections were reported.ConclusionThe campaign was highly successful in reaching mothers and achieving chlorhexidine use. In this study, the concomitant use of traditional cloth coverings or bindings of the cord did not appear harmful; however more research is needed in this area. This campaign provides a model for implementing chlorhexidine use, especially where trained TBAs and CHWs are present.

Trends in newborn umbilical cord care practices in Sokoto and Bauchi States of Nigeria: the where, who, how, what and the ubiquitous role of traditional birth attendants: a lot quality assurance sampling survey

BackgroundNeonatal infections caused by unsafe umbilical cord practices account for the majority of neonatal deaths in Nigeria. We examined the trends in umbilical cord care practices between 2012 and 2015 that coincided with the introduction of chlorhexidine digluconate 7.1% gel in Bauchi and Sokoto States.MethodsWe obtained data from three rounds of lot quality assurance samples (LQAS) surveys conducted in 2012, 2013 and 2015. Households were randomly sampled in each round that totaled 1140 and 1311 households in Bauchi and Sokoto States respectively. Mothers responded to questions on cord care practices in the last delivery. Coverage estimates of practice indicators were obtained for each survey period. Local Government Area (LGA) estimates for each indicator were obtained with α ≤ 5%, and β ≤20% statistical errors and aggregated to State-level estimates with finite sample correction relative to the LGA population.ResultsOver 75 and 80% of deliveries in Bauchi and Sokoto States respectively took place at home. The proportion of deliveries in public facilities reported by mothers ranged from 19% in 2012 to 22.4% in 2015 in Bauchi State and from 12.9 to 13.2% in 2015 in Sokoto State. Approximately 50% of deliveries in Bauchi and more than 80% in Sokoto States were assisted by traditional birth attendants (TBAs) or relatives and friends, with little change in the survey periods. In Bauchi and in Sokoto States, over 75% and over 80% of newborn cords were cut with razor blades underscoring the pervasive role of the TBAs in the immediate postpartum period. Use of chlorhexidine digluconate 7.1% gel for cord dressing significantly increased to the highest level in 2015 in both States. Health workers who attended deliveries in health facilities switched from methylated spirit to chlorhexidine. There were no observable changes in cord care practices among the TBAs.ConclusionUnsafe umbilical cord care practices remained prevalent in Bauchi and Sokoto States of Nigeria, although a recent introduction of chlorhexidine digluconate 7.1% gel positively changed the cord care practices toward safer practices among public health providers. TBAs, friends and relatives played the strongest immediate postpartum roles and mostly retained the unsafe cord care practices such as use of ash, cow dung and hot compress. We recommend that existing TBAs are retrained and refocused to forge stronger links between communities and the primary health centers to increase mothers’ access to skilled birth attendants.

Traditional practices during pregnancy and childbirth among tribal women from Maharashtra: a review

There are various traditional beliefs and practices exist in relation to pregnancy and childbirth among various tribal communities in Maharashtra. A review of published literature has conducted and a total of 114 articles and reports were reviewed out of which 14 articles and reports were eligible for the final review. Utilization of maternal and child health (MCH) services during pregnancy and delivery period was reportedly poor among tribal communities due to strong traditional beliefs and trust in Dai, and preference for home delivery for the requirement of some rituals performance. Unhygienic cord care practices, delay in initiation of breastfeeding, and no colostrum feeding practice were also observed. Culturally sensitive tailored interventions are required to influence the existing maternal and child health related traditional practices

Knowledge, Practice and Techniques of Umbilical Cord Care among Mothers in Nwezenyi, Ebonyi State, Nigeria

Background: Umbilical cord care is the handling of the umbilical stump of new-born after delivery. Hygienic umbilical cord care is important for the well-being of the newborn infant. The study was to assess the knowledge, practice and techniques of umbilical cord care among mothers in Primary Health Care centre in Nwezenyi, Ebonyi State, Nigeria .&#x0D; Methodology: The study was cross-sectional descriptive in design. Systematic sampling method was used to select 222 participants. Data were collected with semi-structured interviewer administered questionnaire and analyzed using Statistical Package for Social Sciences version 22.&#x0D; Results: The study showed high (83.3%) awareness of umbilical cord care and low (11.7%) knowledge of proper material (chlorhexidine) for umbilical cord care, poor (8.1%) practice of the use of correct material. Factors influencing the choice of material used are cost (16.7%), availability (17.1%), convenience (10.4%), “works faster” (20.7%) and “type respondent is aware of” (35.1%).&#x0D; Conclusion: High awareness of umbilical cord care management in this study did not commensurately translate to use of correct materials for its care. Thus, there was high risk of neonatal infection including neonatal tetanus. Focused health education to mothers will help improve their knowledge, practice and the use of correct material in umbilical cord care to reduce neonatal morbidity and mortality.

Impact of different antiseptics on umbilical cord colonization and cord separation time.

There is still some uncertainty on cord care practices all around the world, especially in developing countries. The aim of our study was to investigate the effects of six different umbilical cord care practices on the rate of colonization and cord separation time. A total of 516 newborns were randomly allocated to the following six umbilical cord care groups: group 1 received dry care; groups 2-4 received a single application of 70% alcohol, 4% chlorhexidine, or povidon-iodine in the delivery room, respectively, which were discontinued thereafter; groups 5 and 6 received a single application of 70% alcohol or 4% chlorhexidine, respectively, starting in the delivery room andcontinuing every six hours until discharge. Umbilical cords were examined on the second and third days and between the fifth and seventh day for signs of omphalitis. Swab cultures were taken on the second or third day from all cases. Cord separation time (median [interquartile range]) was the shortest for group 1 (7 [6-7] days) and the longest for group 3 (10 [7-12] days) and group 6 (10 [8-12] days) (p < 0.001). The cord colonization in the swab cultures was significantly lower in groups 3 and 6 (p < 0.001). Omphalitis was detected in eight (1.5%) patients among the study population, and there was no significant difference between the groups. Our study showed that chlorhexidine application was the most effective agent in decreasing colonization, though it increased cord separation time significantly in both groups.

Umbilical cord-care practices in low- and middle-income countries: a systematic review

BackgroundNeonatal sepsis is the third leading cause of deaths for infants in their first month of life. The newly cut umbilical cord can be a pathway for bacteria that can cause newborn sepsis and death. Optimal umbilical cord care practices for newborns and during the first week of life, especially in settings with poor hygiene, has the potential to avoid these preventable neonatal deaths. The purpose of this review of cord care practices is to assist in the development of behavior-change strategies to support introduction of novel cord-care regimens, particularly 7.1% chlorhexidine digluconate for umbilical cord care.MethodsWe searched domestic and international databases for articles that were published in English between January 1, 2000, and August 24, 2016. We found 321 articles and reviewed 65 full-text articles using standardized inclusion criteria. The primary criteria for inclusion was a description of substances applied to the umbilical cord stump in the days following birth.ResultsWe included 46 articles in this review of umbilical cord-care practices. Articles included data from 15 low- and middle-income countries in sub-Saharan Africa (8 countries), Asia (5 countries), North Africa (1 country), and Latin America and the Caribbean (1 country). Findings from this review suggest that documentation of cord-care practices is not consistent throughout low- and middle-income countries, yet existing literature depicts a firm tradition of umbilical cord care in every culture. Cord-care practices vary by country and by regions or cultural groups within a country and employ a wide range of substances. The desire to promote healing and hasten cord separation are the underlying beliefs related to application of substances to the umbilical cord. The frequency of application of the substance (either the number of days or the number of times per day the substance was applied), and source and cost of products used is not well-characterized.ConclusionsThis desire to actively care for the umbilical cord of a newborn—as noted in the variety of cord care practices and beliefs identified in this review—points toward the need to contextualize any behavior change approach to align with the local culture.

Umbilical Cord Care in the Newborn Infant.

Postpartum infections remain a leading cause of neonatal morbidity and mortality worldwide. A high percentage of these infections may stem from bacterial colonization of the umbilicus, because cord care practices vary in reflection of cultural traditions within communities and disparities in health care practices globally. After birth, the devitalized umbilical cord often proves to be an ideal substrate for bacterial growth and also provides direct access to the bloodstream of the neonate. Bacterial colonization of the cord not infrequently leads to omphalitis and associated thrombophlebitis, cellulitis, or necrotizing fasciitis. Various topical substances continue to be used for cord care around the world to mitigate the risk of serious infection. More recently, particularly in high-resource countries, the treatment paradigm has shifted toward dry umbilical cord care. This clinical report reviews the evidence underlying recommendations for care of the umbilical cord in different clinical settings.

Effect of Village Health Team Home Visits and Mobile Phone Consultations on Maternal and Newborn Care Practices in Masindi and Kiryandongo, Uganda: A Community-Intervention Trial.

IntroductionThe World Health Organisation recommends home visits conducted by Community Health Workers (in Uganda known as Village Health Teams—VHTs) in order to improve maternal and newborn health. This study measured the effect of home visits combined with mobile phone consultations on maternal and newborn care practices.MethodIn a community intervention trial design 16 health centres in Masindi and Kiryandongo districts, Uganda were randomly and equally allocated to one of two arms: control and intervention arms. Eight control health centres received the usual maternal and newborn educational messages offered by professional health workers and eight intervention health centres that received an intervention package for maternal care and essential newborn care practices. In the intervention arm VHTs made two prenatal and one postnatal home visit to households. VHTs were provided with mobile phones to enable them make regular telephone consultations with health workers at the health centre serving the catchment area. The primary outcome was health facility delivery. Other outcomes included antenatal attendances, birth preparedness, cord and thermal care and breastfeeding practices. Analysis was by intention-to-treat.ResultsA total of 1385 pregnant women were analysed: 758 and 627 in the control and intervention arms respectively. Significant post-intervention differences were: delivery place [adjusted Odds Ratio aOR: 17.94(95%CI: 6.26–51.37); p<0.001], cord care [aOR: 3.05(95%CI: 1.81–5.12); p<0.001] thermal care [aOR: 7.58(95%CI: 2.52–22.82); p<0.001], and timely care-seeking for newborn illness [aOR: 4.93(95%CI: 1.59–15.31); p = 0.006].ConclusionVHTs can have an effect in promoting proper cord and thermal care for the newborn and improve timely care-seeking for health facility delivery and newborn illness, because they could answer questions and refer patients correctly. However, VHTs should be supported by professional health workers through the use of mobile phones.Trial RegistrationClinicalTrials.gov NCT02084680