Umbilical Cord Care Practices Research Articles

Knowledge and use of chorhexidine gel in umbilical cord care among postpartum women at Poly General Hospital, Enugu, Southeast Nigeria: a cross-sectional study.

Sepsis in the first week or two of life is a major cause of newborn deaths. People from diverse cultural backgrounds use different substances for umbilical cord care. Evidence-based umbilical cord care practices have a large potential to lower infant morbidity and mortality linked to infection. This study investigated the knowledge and use of chlorhexidine gel for umbilical cord care. A cross-sectional descriptive survey was employed among 191 postpartum women at the Poly General Hospital Asata, Enugu, selected through simple random sampling. A researcher-developed questionnaire was used for data collection. More than one-half (n=101; 52.1%) had poor knowledge of chlorhexidine gel use in umbilical cord care. There was no significant association between educational status and knowledge of chlorhexidine gel use in umbilical cord care among the participants (p=0.072). Only 89 (46.6%) had ever used chlorhexidine gel for umbilical cord care, while 49 (25.7%) used chlorhexidine gel for their last child. Parity was not significantly associated with the use of chlorhexidine gel (p=0.736). Both educational status (p=0.019) and knowledge of chlorhexidine use for umbilical cord care (p<0.001) were found to be significantly associated with its use. There was poor knowledge of chlorhexidine gel use for umbilical cord care among the participants. Use of chlorhexidine gel in this population is still suboptimal. Healthcare providers should continue to provide information on chlorhexidine gel use in umbilical cord care in order to optimise its knowledge and use. Other factors associated with the use of chlorhexidine gel for umbilical cord care should be explored.

Helping babies survive: Thermal and umbilical cord care practices for neonates in Ado-Ekiti, Southern Nigeria.

Newborn care practices immediately after delivery can decrease newborns' risk of diseases and death in early neonatal life. This study assessed thermal and umbilical cord care practices among mothers in randomly selected health care facilities in Ado-Ekiti, Ekiti State. Descriptive quantitative research design was used and 211 mothers were selected through convenience sampling techniques. Semi-structured questionnaire, adapted from a previous study was utilized to collect data which was analyzed using descriptive and inferential statistics. The majority of the respondents were Yoruba aged 20-29 years; 70% of the respondents were aware of the standard cord care practice; 90% agreed that heat should be applied to the newborn's umbilical cord. 70.5% of mothers used methylated spirit to clean the umbilical cord; 39.5% claimed that they used menthol ointment; while 20.5% used the standard prescribed chlorhexidine. On thermal care practices, 10% dried their babies, 39.5% bathed their babies immediately, while 50% of mothers wrapped their newborns in heavy clothing. Factors influencing common thermal and umbilical cord care include religion and cultural preferences. Efforts should be devoted towards providing tailored health education approaches on proper thermal and umbilical cord care practices to mothers and the community at large.

Care of the newborn’s umbilical cord: The perspectives of mothers in a developing country

This study assessed the perspectives of mothers on newborn umbilical cord care in Kumasi city, Ghana.Cross-sectional data on 393 puerperal women was collected at the Postnatal Care (PNC) clinics of three hospitals in the city using. a structured questionnaire and the analysis was implemented using the SPSS version 20.Majority (89%) of the respondents had both adequate knowledge and a positive attitude about appropriate umbilical cord care practices. Methylated spirit was the predominant cleaning agent for umbilical cord. An adjusted odds ratio of 6.333 (p = .003) was obtained for secondary school education.The umbilical cord of the newborn can be a source of neonatal infection which increases the likelihood of neonatal morbidity and mortality. Care of the umbilical cord requires joint effort of health workers and the mothers. Health education on umbilical cord care needs to be further intensified.

Mothers' cord care practices in an academic hospital in Kenya.

Nearly 99% of neonatal deaths globally occur in low- and middle-income countries with about three-quarters of the neonatal deaths resulting from sepsis including those arising from cord infections. Thus, good cord care practices have the potential to reduce the neonatal deaths in low and middle-income countries such as Kenya. Describe cord care practices of mothers in an academic hospital in Kenya. A questionnaire was administered to 114 mothers attending child welfare clinic at 6 weeks in an academic hospital in Western Kenya. Descriptive statistics were computed for continuous variables while frequencies were computed for categorical variables. Parametric and non-parametric tests were used to check for association between maternal variables and cord care practices. Most mothers applied chlorhexidine (n =73, 64%) or practiced dry cord care (n = 17, 14.9%). Some mothers (12.9%) applied potentially harmful substances including saliva, ash and soil. Mothers who attended at least three antenatal clinic visits practiced the recommended cord care (χ2 =16.02, p. = 0.03). Although mothers predominantly practiced the recommended cord care, some potentially deleterious practices were reported. There is need to encourage attendance to antenatal clinic in order to optimize umbilical cord care practices.

Quantitative assessment of umbilical cord care practices amongst mothers in Jos, Plateau State, Nigeria.

A newly cut neonatal umbilical stump is a potential portal of pathogen entry leading to omphalitis. Neonatal sepsis can complicate omphalitis, but good cord care practices can reduce this risk. The objective of this study was to assess umbilical cord care practices in tertiary-, secondary- and primary-level healthcare facilities in Jos, Nigeria. A multi-centre, cross-sectional study of 284 mothers of infants aged 3-6 weeks old attending immunisation clinics in the three-level healthcare facilities using multistage sampling technique between April and September 2019. Data were analysed using SPSS version 23.0. Pearson's Chi-squared test was used to compare categorical variables. Adjusted odds ratios (AORs) and 95% confidence interval (CI) were used as point and interval estimates, respectively. P < 0.05 was adjudged to be statistically significant. The mean age of the mothers and infants was 25 ± 6 years and 5 ± 1 week, respectively. Only 2.2% of mothers used chlorhexidine (CHX) gel for cord care. Mothers showed good knowledge but poor practice of cord care. A significant positive relationship was observed between quality of cord care practices and level of healthcare facility (χ2 = 15.213; df = 2; P < 0.001). Good cord care practices were predicted by mothers' age 30-46 (AOR = 3.6; CI: 1.4-9.1) and good knowledge of cord care (AOR = 4.7; 95% CI: 2.2-9.9). The study has highlighted the good knowledge but poor practices of cord care by mothers and the need to scale up the uptake of CHX gel in Jos. Mother's age and good knowledge of cord care are predictors of good cord care practices.

Umbilical Cord Care Practices and Cord Care Education of Mothers Attending Health Care (Pakistan Prospect)

Neonatal mortality is of global concern, it is the death in the first month of life. According to WHO, 2.4 million children died globally in the first month of life2. Globally the neonatal mortality rate declined slowly from 28/100 live births in 2000 to 17.9/100 live births in 2019. It is a major challenge for the low socioeconomic group of countries. Most neonatal deaths occurred in south Asia and African countries, in 2019 out of 2.4 million death 81% occurred in the Southeast Asia. Objective: To evaluate and improve cord care practices of mothers to reduce the risk of cord related infections. Methodology: The mixed method will be used in this research, questionnaire is used for data collection, total collected sample is 391. Results: 354 (91.0%) of the 394 patients analyzed obtained prenatal care (ANC) in both traditional and nontraditional settings. Among these, 288 (72.3%) got cord care health education, whereas 106 (27.7%) did not. The overall documentation of the instructions for the use of metabolized spirits alone included 116 (48.9%) teaching institutions and 103 (43.5%) private hospitals. the average results show the age of the baby 1 - 7 days, the average age of the mother is 18 - 25 years. The average education of the mothers is primary. Participation of health centers is average. Most of the participants has 1 child. Conclusion: This research concludes the poor umbilical cord practices and knowledge. Those with information used it better. Raise awareness about umbilical cord care and improper behaviors, including using mentholated balms. Before women leave the hospital, they should learn cord care. Mothers must clean wires. Several healthcare organizations don’t provide cord care instruction, and what they provide isn’t research-based.

Knowledge and practice of umbilical cord care among young mothers of neonates in Tabora region: Analytical cross-sectional study.

Knowledge of cord care influences the choice of cord care practices and has a great impact on neonate health. Poor cord care can lead to infection of the umbilical cord and thus have a bearing on the subsequent growth trajectory of the newborn. A health facility-based analytical cross-sectional study was carried out from January-March 2021 among 315 randomly selected young mothers aged 15 to 25 years with neonates aged between 7 and 28 days. An interviewer-administered structured questionnaire was used to collect data, and a chi-square test and a binary logistic regression model were used during data analysis. The level of significance was set at 5%. More than half of young mothers 196 (62.2%) had adequate knowledge of cord care, although practice of umbilical cord care was exceptionally poor, as only 21% of them had good cord care practice. Predictors of low knowledge were living in rural areas (adjusted odds ratio (AOR) = 2.54, P = .012), having no formal education (AOR = 15.4, P = .038), and delivering at home (AOR = 0.21. P = .001). While the predictors of poor umbilical cord care practices were having no formal education (AOR = 12.15, P = .001), having primary education (AOR = 7.8, P = .003), being a peasant (AOR = 6.6, P = .001), business woman (AOR = 3.6, P = .035), housewife (AOR = 4.2, P = .014) and prime para (AOR = 0.49, P = .004). Living in urban areas, having a higher education level, and having delivered in a health facility were important factors in having knowledge on cord care, while having a higher education level, being employed, and being a multipara were important factors in maintaining cord in a healthy state.

Enablers and Barriers to Chlorhexidine Use in Umbilical Cord Care: Voices of Care Givers and Healthcare Providers in Selected Counties in Kenya

Neonatal sepsis contributes to increased rates of mortality among newborns during their first month of life. Chlorhexidine (CHX) has proven effective in the prevention of neonatal sepsis due to umbilical stump infection after birth. Despite shifting from dry cord care techniques to CHX use, there is still a high prevalence of improper cord care in low-resource settings in Kenya. This study sought to explore barriers and enablers to CHX use in Kwale, Vihiga and Machakos counties in Kenya. We adopted mixed methods cross-sectional survey with 582 women of reproductive age with a young child less than one year as respondents to the quantitative survey. Qualitative data entailed thirty (30) key informant interviews with healthcare workers and national policymakers. Six (6) focus group discussions with mothers, caregivers, community health volunteers (CHVs) and traditional birth attendants were conducted. An observation checklist was used to assess the availability of CHX services and supplies in fourteen (14) health facilities was conducted. Results indicated variation in umbilical cord care practices for newborns across counties. Of 582 caregivers, only 1.3% reported having ever used CHX. Majority mentioned using methylated spirits (41.6%), other antiseptics (23.3%) and salty water (11.3%). Other substances used for cord care included plain water, herbal extracts, cow dung, soil, and breast milk. Despite 100% awareness of CHX among health workers, only a third of caregivers (38.7%) had heard of CHX. About 76.9% of participants preferred the gel formulation and 8.9% did not know where to get the product. Drivers of CHX use included faster cord healing, infection control in hospitals, ease of use, cost implications, ease of access, influence from key decision makers and preferred CHX formulation. Barriers included minimal awareness among caregivers, cultural practices and taboos on cord care, inadequate capacity building of CHVs on CHX, unclear CHX user guidelines for caregivers, prolonged stockouts and inadequate knowledge of CHX in communities. Healthcare workers highlighted poor dissemination of CHX guidelines by the Ministry of Health, unavailability in the Kenya Medical Supplies Authority (KEMSA) and Mission for Essential Drugs and Supplies logistic management information system making it difficult to procure. There is a need for advocacy to promote the uptake of CHX in facilities and increase knowledge of communities on CHX as well as manage the supply chain to increase CHX availability

How effective is antenatal care in preparing mothers for newborn care? An exploratory survey of lactating women in a rural Nigerian district

BackgroundNeonatal death rates are high in sub-Saharan Africa and the majority of these deaths are preventable. Antenatal care (ANC) is a good channel for the reduction of neonatal deaths. This study aimed to assess newborn care practices among lactating women in Nigeria and determine their relationship with ANC attendance. MethodologyThis was a cross-sectional survey involving 241 lactating mothers selected using the cluster sampling method. A structured interviewer-administered questionnaire was employed to obtain data. The Chi-square test was used to assess the associations between categorical variables. Logistic regression was used to determine the predictors of umbilical cord care, thermal care, and neonatal vaccination status. Good cord care was defined as having minimum of three appropriate practices concerning the use of clean instruments to tie the cord, use of clean instruments to cut the cord, and application of chlorhexidine, 70% alcohol, saltwater, or nothing on the cord), Results were presented as odds ratios (ORs). P < 0.05 was taken as statistically significant. ResultsThe mean age of participants was 29.0 ± 5.5 years. Most participants reported that sterile instruments were used to cut their baby's umbilical cords; that their babies were dried immediately after placenta delivery and that their babies were fully vaccinated (91.0%, 90.5%, and 85.1% respectively). ANC visits (aOR = 8.0, p = 0.02) and place of delivery (aOR = 10.6, p = 0.01) were significantly associated with good umbilical cord care practices. However, none of the participants' sociodemographic characteristics were significantly associated with newborn thermal care and vaccination status. ConclusionThe prevailing antenatal care services are ineffective in preparing mothers for newborn care. Place and frequency of ANC have positive associations with umbilical cord care. There is a need to implement quality ANC that will enhance maternal and neonatal outcomes and implement innovative interventions to enhance ANC attendance. The WHO positive pregnancy experience model should be implemented.

Umbilical Cord Care Attitude among the Caregivers and the Rate of Development of Omphalitis

Background: Of the annual 2.5 million global neonatal deaths, most occurring in developing countries, and one-third to one half are attributed to infections. In low-income countries like Bangladesh, where home delivery is common and attendance by skilled personnel is low, many babies are born in unhygienic conditions and infections of the umbilical cord stump are common. Exposure of the freshly cut umbilical cord stump to pathogens may lead to local cord infections (omphalitis) that may progress to systemic infection and death. Objective: To evaluate the pattern of umbilical cord care practices and the rate of development of omphalitis. Methodology: It was a prospective observational study included 80 neonates. This study was conducted over a period of six months from May to November 2013 in the obstetrics unit of department of obstetrics and gynaecology, Sher-E-Bangla Medical College Hospital, Barisal. Results: A total 80 out born neonates, accompanying their mothers who were admitted due to their post-partum complications from home delivery, were included in this study. Among them twelve (15%) were found to have omphalitis, of which nine (11.25%) were with mild omphalitis and three (3.75%) with moderate omphalitis. Umbilical cords were mostly (58.75%) cut by used shaving blades and tied by washed thread from home (88.75%). Most of the caregivers (65%) had educational qualification below primary level. Forty-two (52.5%) of the eighty caregivers had not heard about WHO recommended dry cord care method. All of the caregivers applied traditional substances to the cord and mustard oil was the commonest (75%) practice. It was applicable in all omphalitis cases. Statistically significant relationship (p &lt; 0.05) was found with omphalitis and cord cutting instrument, topical application of traditional substances to the cord, caregivers’ educational status and knowledge about dry cord care. Conclusion: Omphalitis rate among enrolled newborn was 15% cutting cord with unsterile instruments, applying traditional substances to the cord and low educational status among the care givers are related with development of omphalitis.

Umbilical Cord Care Practices and Associated Factor Among Mothers of Neonates Visiting Mizan-Tepi University Teaching Hospital Southwest Ethiopia 2021.

BackgroundDue to unsanitary cord care practices, cord infections are more common and prevalent in developing countries. In settings where mortality is low, dry and clean cord care is recommended for newborns delivered in health facilities or at home. Cord care practices would directly contribute to infection in newborns, accounting for a large proportion of millions of annual neonatal deaths. This study aimed to assess the cord care practices of mothers and to identify areas for intervention.MethodsAn institution-based cross-sectional study was conducted among mothers of neonates who gave birth in the last six months. Systematic random sampling technique was employed to include women who visited pediatric OPD and immunization clinics. Epi data version 3.1 was used to enter the data and then exported to SPSS version 26 for analysis. The association between the outcome and independent variables was examined using binary logistic regression. The strength of the association was measured using odds ratio (OR), 95% confidence intervals (CI) and p-value. Statistical significance was declared at a p-value <0.05.ResultsFour hundred twenty-two mothers were participated in the study. More than half (59.2%) of the respondents had good cord care practices, while nearly half (45.3%) mothers added nothing to the cord. Factors significantly associated with good cord care practices were educational status (AOR = 4.7; 95% CI = 1.34, 7.59), ANC follow-up (AOR = 3.58; 95% CI = 1.24, 10.32), initiation of breastfeeding (AOR = 1.74; 95% CI = 1.10, 2.77), and apply anything to the cord (AOR = 3.08; 95% CI = 1.92, 4.95).ConclusionThe proportion of mothers with good cord care practices was inadequate. For such a high cause of neonatal death, prevention should be the priority intervention, and improving its implementation requires further effort.

Assessment of knowledge and cord care practices among pregnant women in selected PHCs in Jos metropolis, Plateau state

Background: Umbilical cord care is an essential newborn care practice which determines newborn survival. Knowledge on cord care influences the choice of cord care practices. This study was therefore conducted to determine the umbilical cord care practices among mothers in Jos metropolis.Methods: A cross sectional study involving 119 study respondents who were selected by cluster sampling technique. Data was collected using a self-administered questionnaire and analyzed using SPSS version 23.0. At 95% confidence interval, a p value of &lt;0.05 was considered statistically significant.Results: Thirty-nine (35.1%) of the respondents had poor knowledge of cord care while 48 (43.3%) and 24 (21.6%) had fair and good knowledge respectively. Majority of the respondents used methylated spirit for the last delivery 54 (76.1%), 5 (6.9%) used chlorhexidine gel while 11 (15%) used substances such as salt and vaseline. Respondents with tertiary education were more likely than those with secondary and primary education to use aseptic cord care (OR 0.07; 95%CI 0.008-0.740) and (OR 0.15; 95%CI 0.047-0.507) respectively. The mean cord separation time among respondents who used chlorhexidine gel was 6.6±2.8 days, this was longer than those who used other substances (4.8±1.5 days).Conclusions: More respondents used aseptic cord care practices, however, a good number used a combination of septic and aseptic methods which could still pose a risk of infection to the neonate. There is need for health interventions to increase the awareness of mothers on using single aseptic cord care practices in order to prevent neonatal sepsis and mortality.

\u201cThe cord is the child\u201d: meanings and practices related to umbilical cord care in Central Uganda

BackgroundInfections account for a quarter of all newborn deaths and the umbilical cord has been identified as a major route of newborn infections.ObjectiveTo explore the meanings and practices related to the umbilical cord among caretakers of newborns in central Uganda.MethodsThis was a qualitative study, designed to inform the design, and interpretation of a randomized controlled trial assessing the effectiveness of chlorhexidine use for the umbilical cord. We conducted 22 in-depth interviews exploring umbilical cord care practices among ten mothers, four health workers, five traditional birth attendants, and three men. We also conducted three focus group discussions with young mothers and elderly women. We used qualitative content analysis to analyze our findings and we borrow upon Mary Douglas’ concepts of dirt to present our findings.ResultsThe umbilical cord had a symbolic position in newborn care. The way it was perceived and handled had far reaching consequences for the survival and wellbeing of the baby. The umbilical cord was a centre of anxiety, a possible gate to illness, a test of fatherhood and a signifier of parental responsibility. Hence, the umbilical cord and the way it was cared for played a part in the present and future survival of the baby, as well as the survival and wellbeing of the household. Persons other than the mother such as older female relatives were very influential in the care of the umbilical cord.ConclusionsThe umbilical cord carried symbolic meanings, which extended beyond the newborn and the newborn period, and in turn influenced the various practices of umbilical cord care. The important position of the cord in local newborn care practices should be recognized and taken into consideration when scaling up newborn care interventions in the country.

Neonatal Umbilical Cord Infections: Incidence, Associated Factors and Cord Care Practices by Nursing Mothers at a Tertiary Hospital in Western Uganda

Background: Umbilical cord infections complicate to neonatal sepsis that significantly contributes to neonatal mortality worldwide. There is paucity of data on the incidence, factors associated with neonatal umbilical cord infections in western Uganda, yet nursing mothers continue to practice potentially dangerous cord care practices. We described the incidence, factors associated with umbilical cord infections and cord care practices by nursing mothers at a tertiary hospital in western Uganda. Methods: This was a hospital based cross sectional study at a tertiary hospital in western Uganda between the months of March and June 2019. Two hundred and forty (240) neonates aged between 2 to 14 days attending the neonatal unit were recruited in the study. Umbilical cord infection was assessed based on the World Health Organisation (WHO) clinical definition: finding of any of discharge, redness and swelling on the umbilical stump. Data on sociodemographic characteristics, maternal and neonatal perinatal factors and cord care practices of the nursing mothers were analysed by bivariate and multivariate logistic regression using STATA 13.0 to determine factors associated with umbilical cord infection. Results: Sixty-five, 65 (27.1%) neonates had at least one sign of cord infection. Majority of the nursing mothers, 168 (70%) do not use the recommended umbilical cord care practices. Among these, 73 (30.4%) do not cleanse the cord while 95 (39.6%) cleanse with application of a dangerous substance. Application of dangerous substance to the cord (aOR: 3.0, 95% CI: 1.37 - 6.37, p = 0.006) and maternal secondary education level (aOR = 2.1, CI = 1.01 - 4.18, p = 0.046) were significantly associated with umbilical cord infection. Conclusions: The incidence of neonatal umbilical cord infection is high in this setting. Application of a dangerous substance to the umbilical stump and maternal secondary education level were significantly associated with umbilical cord infection. Clinicians should routinely examine the umbilical stump of every neonate for the signs of infection and encourage mothers to avoid application of dangerous substances to the cord. Maternal education on the recommended cord care practices during antenatal and postnatal period could reduce the incidence of umbilical cord infection among neonates in low resource setting.

Trends, determinants, and newborn mortality related to thermal care and umbilical cord care practices in South Asia

BackgroundAlthough child mortality has decreased over the last several decades, neonatal mortality has declined less substantially. In South Asia, neonatal deaths account for the majority of all under-five deaths, calling for further study on newborn care practices. We assessed five key practices: immediate drying and wrapping, delayed bathing, immediate skin-to-skin contact after birth, cutting the umbilical cord with a clean instrument, and substances placed on the cord.MethodsUsing data from Demographic and Health Surveys conducted in Bangladesh, India, and Nepal between 2005 and 2016, we examined trends in coverage of key practices and used multivariable logistic regression to analyze predictors of thermal care and hygienic cord care practices and their associations with neonatal mortality among home births. The analysis excluded deaths on the first day of life to ensure that the exposure to newborn care practices would have preceded the outcome. Given limited neonatal mortality events in Bangladesh and Nepal, we pooled data from these countries.ResultsWe found that antenatal care and skilled birth attendance was associated with an increase in the odds of infants' receipt of the recommended practices among home births. Hygienic cord care was significantly associated with newborn survival. After controlling for other known predictors of newborn mortality in Bangladesh and Nepal, antiseptic cord care was associated with an 80% reduction in the odds of dying compared with dry cord care. As expected, skilled care during pregnancy and birth was also associated with newborn survival. Missing responses regarding care practices were common for newborns that died, suggesting that recall or report of details surrounding the traumatic event of a loss of a child may be incomplete.ConclusionsThis study highlights the importance of maternal and newborn care and services for newborn survival in South Asia, particularly antenatal care, skilled birth attendance, and antiseptic cord care.

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.

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

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.

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.

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.