UMBILICAL CORD CARE AND MANAGEMENT OUTCOME AMONG MOTHERS IN CALABAR SOUTH LOCAL GOVERNMENT AREA, CROSS RIVER STATE, NIGERIA
Umbilical cord remains the major means for the transmission of infection after birth and constitutes 33% of neonatal mortality in Nigeria. Most of the cord care in Nigeria is home based as two third of the delivery takes place at home. The purpose of this study was to determine the umbilical cord care and management outcome among mothers in Calabar South Local Government Area of Cross River State, Nigeria. The research method was a cross – sectional descriptive survey design. Four hundred and fifty (450) respondents were selected using a snow ball (networking) method. Data were collected using a researcher developed questionnaire. The instrument was validated by the supervisor, two lecturers in the Department of Nursing Sciences who are experts in child health and three neonatologists. The reliability was established using a test re-test method at interval of two weeks. The scores obtained were correlated using Pearson product correlation coefficient to obtain coefficient reliability of 0.993 – 0.99 at 0.05 level of significance. Data collected were analyzed using mean, simple percentage and standard deviation to answer the research questions. Findings revealed that 201 (44.7%) of the respondents had good knowledge of standard cord care and their major sources of information was from mothers / mothers-in-laws. Three hundred and fourteen (69.8%) used unhygienic and harmful materials for cord care. The major reason for choice of materials was mainly to wade away evil spirit which the respondents belief causes neonatal deaths. The technique for cord care was poor as only 92 (20.4%) cleaned the base of the cord before cleaning the surrounding skins. The management outcome was poor as 338 (75.1%) of respondents reported signs of umbilical infections in their neonates and only 5 (4.1%) reported the problem to the health facilities within 24hours of onset of problem. There was a significant association between age, educational level, income and cord management (p=<0.05). In conclusion, there was poor knowledge of standard cord care among the respondents in this study. Unhygienic materials were used in the care of umbilical cord by most of the respondents. Based on the findings, the study recommends that there should be increased home visits and education of the mothers by the health personnel to reduce the consequences of poor cord management after delivery.
CHAPTER ONE /INTRODUCTION
Background to the Study
In developing countries umbilical cord infections constitute a major cause of neonatal morbidity and pose significant risk for mortality (WHO, 2009). Cord management introduced to mothers in both developed and developing countries to reduce exposure of the cord to infectious pathogens include clean cord cutting, hygienic cleaning and washing of hands before and after cord care (Garner, 2008; Basil, Kayode, Mark & Mbe, 2009).
The umbilical cord is a unique tissue consisting of two arteries and one vein which at term is about 56cm in length and extends normally from the centre of the placenta to the umbilicus of the unborn baby (Abba, 2008). During pregnancy, the umbilical cord connects the fetus to the mother through the placenta. The blood flowing through the cord brings nutrients and oxygen from the mother to the fetus and carries away carbon dioxide and other metabolites from the fetus (World Health Organisation, 2009; Bello & Omotara, 2010; Ezenduka & Eze, 2002).
After the delivery of the baby, the cord should be clamped firmly and cut with sterile instrument to separate the baby from the placenta attached to the mother’s uterus leaving about 6cm with the baby. The instrument used in cutting the cord cuts across the living tissues and the blood vessels which are still connected to the baby. In view of the fact that this time the umbilical cord is wet with an open surface wound and blood vessels still patent, they provide a nutritive culture medium for bacterial growth. These require that some degree of hygiene practices must be adopted to prevent infection, which may present as yellow discharge from the cord, foul smelling, red skin around the base of the cord, pain when touched the skin around the stump and excessive crying. These strengthen the need for standard cord management among mothers (Bemor & Uta, 2011).
Methods of caring for the umbilical cord vary greatly between communities depending on their cultural and religious beliefs, level of education and resources. In the developing countries most deliveries occur at home where health care services may not be available. Sometimes materials used to tie the cord include strings, thread and strips of cloth, scissors and sharp stone (Obuekwe & Obuekwe, 2008). The risk of cord infection is increased by unhygienic cutting of the cord and application of unclean substances such substances sand from door post mixed with saliva, herbal preparations and lantern wax. Even babies delivered in hospitals may be affected by traditional practices after discharge which most times lead to umbilical cord infection and dead among the neonates (Sreeramaraddy, Josh, Sreekumaran & Giri, 2006).
The use of alcohol daily and as often as each diaper is changed has been recommended by the World Health Organisation (WHO) as standard care. With standard care the cord usually falls off between five to fifteen days after birth (WHO, 2007). Where clean cord care is not practiced, the cord is readily colonized and infected by pathogenic organisms (Bennet & Adetunde, 2010; WHO, 2007). Therefore, mothers who adopt clean cord management will by implication contribute to the survival of the neonates and prevent neonatal death from infections such as omphalitis, neonatal tetanus and septicaemia (Bemor &Uta, 2011; Bennet &Adetunde, 2010; WHO,2007).
Globally, neonatal tetanus accounts for 7% of neonatal deaths, but accounts for more than 48% in Africa (Peter & Johnson 2010). Nigeria has one of the highest infant mortality rates of 94 deaths/1,000 live births (WHO, 2009). According to the report, 26% was due to umbilical infection (Peter & Johnson 2010; WHO, 2009). In Calabar South Local Government Area of Cross River State, umbilical infection is responsible for 49% of neonatal deaths (Antai & Effiong, 2009). This study therefore addressed umbilical cord care and management outcome among mothers in Calabar South Local Government Area of Cross River State, Nigeria.
Statement of Problem
Globally, about 130million babies are delivered annually, 4million (3.1%) die within the first 4 weeks of life (Peter & Johnson, 2010). Twenty- five percent (25%) of these deaths are as a result of umbilical infection (Peter & Johnson, 2010). In developing countries, most of the cord care is home based since two third of births take place at home (WHO, 2009). Peter and Johnson (2010) reported that, globally, about 150,000 neonates die annually from omphalitis. Each year some 600,000 infants die of neonatal tetanus in Africa; in untreated cases, case fatality rate approach 100% and a further 460,000 die as a consequence of other severe bacterial infections (Peter & Johnson, 2010).
In Nigeria, several hospital-based studies have reported cases of umbilical cord infections. For instance, in Port Harcourt, umbilical cord infection accounted for 10% of neonatal admissions and 30% of neonatal deaths (Antai & Effiong, 2009). A review of umbilical infection in Ibadan showed that it accounts for 18% of neonatal deaths (Bennet & Adetunde, 2010). In Calabar South Local Government of Cross River State, 49% of neonatal deaths were due to umbilical cord infection while the condition was responsible for 19% of all newborn admissions (Antai & Effiong, 2009). Many of the neonatal deaths occur at home and therefore unseen and unaccounted for in official statistics (Ambe, Bello, Yahaya & Omotara, 2010; Green, Udoh & Peters, 2006; Garner, 2008). According to the reports, many of these neonates are brought in for admission in very bad state, consequently resulting in neonatal deaths. Unfortunately, these statistics reflect the hospital facility situation, little or no information is available for cases of home neonatal deaths from umbilical cord infection.
From the researcher’s experience as a practicing pediatric nurse, several cases of umbilical infections have been rushed to neonatal units often too late to be helped. It is not unusual at primary health facilities to witness several cases of umbilical cord infections. The question that comes to mind which is the problem is – how do mothers manage the umbilical cord since two third of births take place at home in developing countries and cord care is home based? It is therefore desirable to determine the Umbilical cord care and management outcome among mothers in Calabar South Local Government Area of Cross River State, Nigeria.
Purpose of the Study
The aim of this study was to examine umbilical cord care and management outcome among mothers in Calabar South Local Government Area of Cross River State – Nigeria.
Objectives of the Study
Specifically, the objectives of the study include to:
- determine the level of knowledge of standard cord management and sources of information among mothers in Calabar South Local Government Area.
- identify the various materials used by mothers for umbilical cord management.
- identify the reasons for the choice of materials used in umbilical cord management.
- determine the techniques for cord management among mothers in Calabar South Local Government Area.
- determine outcome of cord management in relation to materials used.
- determine the association between the demographic characteristics of mothers and cord management.
- What level of knowledge do mothers have regarding standard cord management and from which source of information?
- What materials do mothers use in the management of umbilical cord?
- What are the reasons for the choice of materials for umbilical cord management?
- What are the techniques used by mothers in umbilical cord management?
- What are the outcomes of cord management in relation to materials used?
- What is the association between demographic characteristics of mothers and cord management?
Significance of the Study
Findings from this study will provide information to the health personnel on the various materials used by mothers for umbilical cord care, reasons for the choice of materials, the basis on which health decision are made by mothers in relation to cord management. These will provide specific intervention(s) in form of health education to mothers to reinforce evidence – based strategies for effective cord management for better neonatal outcome.
It is also hoped that findings will serve as source of knowledge to mothers on standard cord management, thereby resulting in reduction in umbilical cord infections and neonatal deaths. The findings will also serve as source of knowledge to the community on standard cord management, thereby reducing umbilical infection and neonatal mortality in the community and society at large.
Academically, this work will serve as reference to other researchers in related fields.
Scope of the Study
The study focused on mothers in Calabar South Local Government Area of Cross River State, Nigeria. It was delimited to umbilical cord care and management outcome among mothers in Calabar South Local Government area of Cross River State. It was also delimited to the knowledge of standard cord management and sources of information, materials used by mothers, reasons for choice of materials, techniques of cord care, and the association between the demographic characteristics of mothers and cord management.
Operational Definition of Terms:
Umbilical Cord Care: the various materials used in cord care, the reason for the choice
of materials by mothers and the techniques used for cord care.
Knowledge of Standard Cord Management: implies awareness of the recommended methods
of cord care which are: tying the cord with cord clamp, cutting with clean object, cleaning with
methylated spirit and keeping it clean; the range of cord separation time which is between 15days and knowledge of advantages of cord care which is to prevent cord infection.
Materials used: tools for cutting and solutions/substances used for cleaning or applying on the
umbilical cord such as sterile scissors, surgical blade, sharp stones, alcohol (methylated spirit),
salty water, breast milk, herbal preparations, “Ndodop” lantern wax, salt, saliva and sand, triple
dye, strips of cloths and tree bark fiber.
Techniques Used by Mothers: method of cleaning the umbilical cord, the frequency, wet or
dry care, closed or open wound care.
Wet Care: use of liquid materials in cleaning the cord at the time of delivery and care is repeated daily until the umbilicus heals.
Dry care: no cleaning nor application of liquid / substances to the cord after birth till it heals
Closed wound care: the use of umbilical binders or bandage after cleaning the cord.
Open wound care: the umbilical cord is left uncovered after cleaning to promote drying, cord
separation and healing.
Reason for choice of substances: why mothers choosed the various materials for cord care. The
reasons may include cultural and religious beliefs, influence of health workers and significant
others (mothers/mother in-law, Traditional Birth Attendants, church members).
Management outcome: entails cord separation time and healing in relation to material used for
cord care. If there was any infection (red skin around the base of the cord, yellow discharge from
the cord, foul smelling cord, pain when touched the skin around the cord, unable to open
mouth/suck or twitching) and how it was managed.
Demographic characteristics: used in this study were age, educational attainment and income of