Relationship Between Umbilical Cord Care Factors and Outcomes Among Neonates Attending Meru Teaching and Referral Hospital, Meru County, Kenya
Hiuhu, Esther Mumbi
MetadataShow full item record
Global neonatal mortality stands at 22 per 1000 live births and about 41% of deaths in children under 5 years old occur in the neonatal period. In Kenya, neonatal mortality was 22 deaths per 1000 live births between the years 2004 and 2008 and 60 % of infant deaths in Kenya occur during the first month of life. Neonatal sepsis is the leading cause (15%) of all neonatal deaths worldwide. Umbilical infections are an important cause of neonatal morbidity and mortality in developing countries with incidence rates as high as 55-197 per 1000 live births in community-based studies. Poor cord care practices may predispose to poor cord outcomes. The findings of this study will be used to make relevant recommendations on cord care and will probably trigger other researchers to study the subject of cord care and eventually influence cord care policies, guidelines and practices targeting reduction in morbidity and mortality related to umbilical cord infections and other umbilical cord conditions (prolonged cord separation and umbilical granulomas). The broad objective of the study was to determine the relationship between cord care practices and cord outcomes among neonates attending Meru Teaching and Referral Hospital, Meru County, Kenya. The study population was 132 mothers/caregivers and baby pairs of neonates. A case control design was used to compare cord care factors (sterility of cord cutting tools, application of substances on the umbilicus, hand washing before substance application, method of bathing, skilled birth attendance and source of advice on cord care) and cord outcomes. A focused group discussion and three key informant interviews provided secondary data. Cases were neonates presenting with omphalitis, tetanus, prolonged cord separation and umbilical granuloma while controls were neonates without the aforementioned conditions. A sample of 132 neonates (66 cases and 66 controls) was recruited. Data was collected using interviewer administered questionnaires, Key Informant Interview guides and a Focus Group Discussion guide. Data was analyzed using SPSS 20.0. Logistic regression was used to predict the probability of the outcomes of interest relative to the independent variables. P values and confidence intervals were used as inferential statistics. Thematic content analysis was used in analysis of qualitative data. P value of <0.05 was considered significant. Dry cord care was associated with omphalitis (p=0.000, OR 15) but was protective for prolonged cord separation (p=0.015, OR 0.18). Home delivery, unskilled birth attendance and receiving advice on cord care from a non-health care worker were associated with neonatal omphalitis (p=0.001 for the three variables, OR 8.1 for home delivery and unskilled birth attendance and OR 7 for advice from a non-health care worker) and prolonged cord separation (p=0.000 for both variables, OR 13.6 and 10.8 respectively). Immersion bathing was associated with omphalitis (p=0.001, OR 5.7). From the FGD, it was reported that following most home deliveries, non-sterile cord cutting tools were often used and hand washing was not practiced before substance application to the umbilical cord. In conclusion, findings of the study indicate that dry cord care was significantly associated with neonatal omphalitis and use of antiseptics was significantly associated with delayed cord separation. Recommendations made include promotion of use of antiseptics for cord care and nationwide dissemination of current Ministry of Health Kenya guidelines on cord care to health care workers in order to harmonize cord care practice.