Background: Omphalitis (umbilical cord infection) among new-borns is common and a major cause of neonatal deaths in developing countries. Annually about 4 million neonatal deaths occur around the world; of these, more than 30% are caused by infections. Majority of these infections start as umbilical cord infection. Objective: The aim of the present study was to establish cord care practices associated with omphalitis among neonates aged 3-28 days at Pumwani Maternity Hospital, Kenya. Methodology: Cross-sectional descriptive study was employed among 178 mothers with neonates of 3-28 days. Participants were selected systematically and data was collected on new-born cord care practices. Omphalitis was defined as pus discharge, redness with or without pus and swelling of umbilical cord. Pearson’s chi-square test (P < 0.05) was performed to compare the significant discrepancies. Crude and adjusted odds ratios with corresponding 95% confidence interval were also used to determine the strength of association between omphalitis and cord care practices. Results: Among 178 neonates, 67 (37.6%) were diagnosed with omphalitis. In logistic regression analysis, the main predictors of omphalitis were initiation of breastfeeding after one hour of delivery [AOR = 2.47; 95%CI = 1.15 - 5.30; P < 0.05] compared to within one hour and application of saliva to the cord [AOR = 6.59; 95%CI = 2.02 - 21.46; P < 0.01] compared to dry cord. Conclusion: The prevalence of omphalitis among neonates was high. Health workers need to participate in educating the mothers to initiate breastfeeding within one hour and to avoid application of harmful cord care practices.
Each year, approximately four million neonatal deaths occur globally and infections account for 36% of these deaths [
Data on the incidence of omphalitis in low-income countries is generally scarce, the available data estimate the risk to range between 2 and 77 per 1000 live births in hospital settings, with fatality rates of between 1% and 15% depending on the definition of omphalitis used [
As cord infections should be preventable in most cases [
Furthermore, many maternal and new-born deaths can be averted through changes in household level practices regarding delivery and new-born care [
In Kenya though there is no available information on the prevalence/incidence of omphalitis, it is presumed to be a problem. It is also reported that mothers in Nairobi had good knowledge on need for hygiene when cutting the cord, but had poor practices in other aspects of cord care, and were afraid of handling the cord [
This was a cross sectional study carried out at the Pumwani Maternity Hospital, Nairobi, Kenya. Participants consisted of mothers presenting with neonates aged 3 to 28 days at the child welfare clinic of the hospital. The sample size of 178 was calculated by using single population proportion formula (n = Z2pq/d2). They were selected using systematic sampling method. A structured questionnaire was administered to collect information on cord care practices including instruments used to cut and tie the cord, initiation of breastfeeding, thermal care, any substance application on the cord, methods used to care for the cord, appropriate application of diaper, washing hands and etc. Moreover, omphalitis was defined as pus discharge, redness with or without pus and swelling of umbilical cord.
The data were coded and then entered into a Microsoft excel spread sheet and analysed using Statistical Pack- age for Scientific Solutions (SPSS) Version 20.0. Results were expressed as frequencies and proportions. Chi- square statistics was used to test for significance. Odds ratios with corresponding 95% confidence interval were also calculated for the variables. Binary logistic regression was used to assess the roles of the cord care practices on omphalitis. Level of significance was set at a p value of less than or equal to 0.05.
The study received ethical approval from Kenyatta National Hospital/University of Nairobi (KNH/UON), Ethics and Research Committee. Written informed consent was sought from all study participants before being interviewed.
The background characteristic of study participants is shown in
Background attributes | n = 178 | % |
---|---|---|
Neonate’s sex | ||
Female | 95 | 53.4 |
Male | 83 | 46.6 |
Neonate’s age in days | ||
3 to 14 | 134 | 75.3 |
15 to 28 | 44 | 24.7 |
Birth weight in Kg | ||
2.0 - 3.0 | 84 | 47.2 |
3.1 - 4.2 | 94 | 52.8 |
Current status of umbilical cord infection | ||
Present | 67 | 37.6 |
Absent | 111 | 62.4 |
Description of umbilical cord infection (n = 67) | ||
Reddened | 33 | 49.3 |
Swollen | 9 | 13.4 |
Pus | 25 | 37.3 |
Mother’s age in years | ||
16 - 22 | 61 | 34.3 |
23 - 29 | 83 | 46.6 |
31 - 39 | 34 | 19.1 |
Mother’s level of education | ||
Primary | 59 | 33.2 |
Secondary | 94 | 52.8 |
College/University | 25 | 14.0 |
Mother’s religion | ||
Christian | 168 | 94.4 |
Muslim | 10 | 5.6 |
Mother’s marital status | ||
Married | 127 | 71.3 |
Single | 51 | 28.7 |
The table further shows that about half of the mothers (46.6%) were in the age category of 23 - 29 years and about a third (34.3%) were 16 - 22 years. The educational level of education for the mothers was as follows; 33.2% in primary, 52.8% in secondary and 14.0% in tertiary. Most of the mothers (94.4%) were Christians whereas the remaining 5.6% were Muslims. More than two thirds (71.9%) of the mothers were married.
A large percentage (94.9%) of the mothers indicated that the umbilical cord was tied with a cord clamp while only 5.1% used thread. About two thirds (63.5%) of the mothers initiated breastfeeding after one hour of delivery. Most of the mothers (93.3%) reported that they stay with the baby in the same room (
Variables | n = 178 | % |
---|---|---|
Things used to tie umbilical cord | ||
Cord clamp | 169 | 94.9 |
Thread | 9 | 5.1 |
Things used to cut umbilical cord | ||
Scissors | 178 | 100.0 |
Initiation of breast feeding | ||
>1 hour | 113 | 63.5 |
<1 hour | 65 | 36.5 |
Staying with the baby in the same room | ||
Yes | 166 | 93.3 |
No | 12 | 6.7 |
Thermal care | ||
Wearing hat | 76 | 42.7 |
Warming the room | 17 | 9.6 |
Wrapping the baby warmly | 61 | 34.3 |
Skin-to-skin contact | 24 | 13.5 |
Methods used to care baby’s cord | ||
Apply saliva | 19 | 10.7 |
Apply spirit | 44 | 24.7 |
Applying warm salty water | 18 | 10.1 |
Air dry | 97 | 54.5 |
Whether wearing the diaper above or below the cord | ||
Above cord | 82 | 46.1 |
Below cord | 96 | 53.9 |
Bathing practice | ||
Not yet | 18 | 10.1 |
Every day | 151 | 84.8 |
Every other day or more | 9 | 5.1 |
Substances (hand/body soap) added to the bath water | ||
Yes | 108 | 67.5 |
No | 52 | 32.5 |
Not applicable | 18 | |
Ways of bathing the baby | ||
Immersion in water | 33 | 20.6 |
Pour water over baby | 41 | 25.6 |
Wipe baby with cloth | 86 | 53.8 |
Not applicable | 18 | |
How do you wash your hands | ||
Basin | 86 | 48.3 |
Running water | 92 | 51.7 |
Air drying was the main method (54.5%) used for caring the baby’s umbilical cord followed by spirit application at 24.7%, saliva at 10.7% and warm salty water at 10.1%. Ninety six (53.9%) of the mothers tied the diaper below umbilical cord while the remaining (46.1%) tied the diaper above the cord. Majority of the mothers (84.8%) bathed their babies every day and 67.5% added hand/body soap to the bath water. About half (51.7%) of the mothers were using running water to wash their hands while the remaining 48.3% were using basin (
In the bivariate analysis, initiation of breastfeeding after one hour, application of saliva on cord, substances (hand/body soap) added to the bath water and using basin to wash hands were factors associated with omphalitis. However, in the multivariate analysis, initiation of breastfeeding after one hour and application of saliva on the cord remained significantly and independently associated with omphalitis.
Babies who were initiated breastfeeding after one hour of delivery were about 2.5 times more likely to develop omphalitis than those who were initiated within the first one hour [AOR = 2.47; 95%CI = 1.15 - 5.30; P < 0.05]. Babies whose mothers applied saliva to their umbilical cord had significantly 6.5 times more likely to have omphalitis [AOR = 6.59; 95%CI = 2.02 - 21.46; P < 0.01] than babies whose mothers practiced air drying (
The umbilical stump represents a unique but universally acquired wound in which devitalized tissue provides a medium that could support bacterial growth. Thus, the immediate care of the umbilical cord requires strict aseptic techniques following healthy clamping and severance of the cord. If these basic conditions of the best cord care practices are overlooked, grievous infections may occur [
The study shows that initiation of breastfeeding was a predicting factor for umbilical cord infection. Babies who initiated breastfeeding after one hour of delivery were about 2.5 times more likely to develop cord infection than those who were initiated within one hour. This is in agreement with a study carried out by Mullany et al. [
In the present study, babies whose mothers applied saliva to care the cord had significantly 6.5 times more likely to have omphalitis than babies whose mothers practiced air drying. This practice is often harmful, because the mother’s saliva is liable to being contaminated with micro-organism, thus increasing the risk of infection. Internationally, WHO has advocated since 1998 for the use of dry umbilical cord care (keeping the cord clean without application of anything and leaving it exposed to air or loosely covered by a clean cloth, in case it becomes soiled it is only cleaned with water). World Health Organization recommends topical antiseptics (e.g., chlorhexidine) in situations where hygienic conditions are poor and/or infection rates are high [
In conclusion, the prevalence of omphalitis among neonates was high. The study shows that initiation of breast feeding after one hour and application of saliva on the cord are predicators of omphalitis. Programs promoting cord care among mothers should raise awareness by emphasizing immediate initiation of breast feeding after delivery and discouraging the application of potentially harmful substances (e.g. saliva) to the umbilical cord.
The study relied only on physical examination to assess umbilical cord infection. It did not include swab sam-
Variables | Cord infection | Bivariate analysis | Multivariate analysis | ||
---|---|---|---|---|---|
Yes, n (%) | No, n (%) | COR (95%CI) | AOR (95%CI) | ||
Things used to tie umbilical cord | |||||
Cord clamp | 61 (36.1%) | 108 (63.9%) | 0.28 (0.07 - 1.17) | - | |
Thread | 6 (66.7%) | 3 (33.3%) | Reference | ||
Initiation of breast feeding | |||||
>1 hour | 51 (45.1%) | 62 (54.9%) | 2.52 (1.28 - 4.95) | 2.47 (1.15 - 5.30)* | |
<1 hour | 16 (24.6%) | 49 (75.4%) | Reference | Reference | |
Staying with the baby in the same room | |||||
Yes | 60 (36.1%) | 106 (63.9%) | 0.40 (0.12 - 1.33) | - | |
No | 7 (58.3%) | 5 (41.7%) | Reference | ||
Thermal care | |||||
Wearing hat | 36 (47.4%) | 40 (52.6%) | 1.80 (0.69 - 4.71) | - | |
Warming the room | 7 (41.2%) | 10 (58.8%) | 1.40 (0.39 - 5.06) | ||
Wrapping the baby warmly | 16 (26.2%) | 45 (73.8%) | 0.71 (0.26 - 1.98) | ||
Skin-to-skin contact | 8 (33.3%) | 16 (66.7%) | Reference | ||
Methods used to care for baby’s cord | |||||
Apply saliva | 9 (64.3%) | 5 (35.7%) | 4.41 (1.36 - 14.28) | 6.59 (2.02 - 21.46)** | |
Apply spirit | 20 (44.4%) | 25 (55.6%) | 1.96 (0.94 - 4.06) | 1.62 (0.72 - 3.67) | |
Applying warm salty water | 9 (47.4%) | 10 (52.6%) | 2.20 (0.81 - 4.06) | 1.52 (0.47 - 4.90) | |
Air dry | 29 (29.0%) | 71 (71.0%) | Reference | Reference | |
Whether wearing the diaper above or below the cord | |||||
Above cord | 32 (39.0%) | 50 (61.0%) | 1.12 (0,61 - 2.05) | - | |
Below cord | 35 (36.5%) | 61 (63.5%) | Reference | ||
Bathing practice | |||||
Not yet (3 - 13 days) | 7 (38.9%) | 11 (61.1%) | 1.27 (0.24 - 6.82) | - | |
Every day | 57 (37.7%) | 94 (62.3%) | 1.21 (0.29 - 5.04) | ||
Every other day or more | 3 (33.3%) | 6 (66.7%) | Reference | ||
Bathing was started after delivery | |||||
First day | 17 (41.5%) | 24 (58.5%) | 1.15 (0.54 - 2.44) | - | |
Second day | 16 (33.3) | 32 (66.7%) | 0.81 (0.39 - 1.69) | ||
Third day and above | 34 (38.2%) | 55 (61.8%) | Reference | ||
Substances (hand/body soap) added to the bath water | |||||
Yes | 47 (43.5%) | 61 (56.5%) | 2.31 (1.11 - 4.82) | 2.14 (0.89 - 5.11) | |
No | 13 (25.0%) | 39 (75.0%) | Reference | Reference | |
Ways of bathing the baby | |||||
Immersion in water | 13 (39.4%) | 20 (60.6%) | 0.90 (0.40 - 2.05) | - | |
Pour water over baby | 11 (26.8%) | 30 (73.2%) | 0.51 (0.23 - 1.15) | ||
Wipe baby with cloth | 36 (41.9%) | 50 (58.1%) | Reference | ||
How do you wash your hands | |||||
Basin | 44 (50.0%) | 44 (50.0%) | 2.91 (1.55 - 5.48) | 2.16 (0.98 - 4.46) | |
Running water | 23 (25.6%) | 67 (74.4%) | Reference | Reference | |
Abbreviations: COR = Crude Odds Ratio, AOR = Adjusted Odds Ratio, CI = Confidence Interval, *P < 0.05, **P < 0.01.
ples for culture test that would have determined the specific bacteria. Another limitation was reliance on the par- ticipants’ response to the questionnaire. However, collecting data with trained interviewers and anonymity would facilitate participants in disclosing their information.
We wish to express our profound gratitude to the respondents involved in this study for their cooperation and time. We also acknowledge the health workers and management staff of the Pumwani Maternity Hospital for their assistance.
The funding is from the Linked-Strengthening Maternal, Newborn and Child Health (MNCH) Research Training in Kenya. The grant is linked to Partnership for Innovative Medical Education in Kenya (PRIME-K). The project was supported by Award Number 5R24TW008907 from the US National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the US National Institutes of Health
The authors declare that they have no competing interests.
LucyKinanu,EuniceOdhiambo,JamesMwaura,MichaelHabtu, (2016) Cord Care Practices and Omphalitis among Neonates Aged 3 - 28 Days at Pumwani Maternity Hospital, Kenya. Journal of Biosciences and Medicines,04,27-36. doi: 10.4236/jbm.2016.41004
Serial Number (Nambari).………………………..
Date (Tarehe): ……………………………………
Demographic data of mothers (Takwimu za wakazi wa akina mama)
1. Age in years: ______
Umri (miaka) _________
2. Level of education: Primary
Masomo Yako: Msingi
3. Religion: Christian
Dini: Ukristo
4. Marital status: Married
Hali ya ndoa: ndio
Baby’s information (Maelezo ya mtoto)
1. Sex Male
Jinsia: mume
2. Age in days: ……………………….
Umri (siku) ……………………….
3. Birth weight: ………………………
Uzito wa kuzaliwa ………………….
4. Status of the umbilical cord infection (assessed by the researchers):
Present
5. Description of umbilical cord infection
Redness/erythema
Cord care practices (Mazoea huduma kamba)
1. What was used to tie your baby’s umbilical cord?
Cord clamp
Ni nini ilitumiwa kufunga kitovu cha mototo wako?
Chaka ya kitofu
2. What was used to cut your baby’s umbilical cord?
Scissors
Ni nini ilitumiwia kukata kitovu cha mototo wako? Makasi
kisu
3. When did you initiate breastfeeding to your child? ………………………………………
Ulianzisha kunyonya motto wako baada ya mda gani? ……………………………………
4. Do you always stay with your baby in the same room?
Yes
Unakaa na mtoto kwa chumba kimoja kila wakati?
Ndio
5. What do you apply on your baby’s umbilical cord?
Air dry
Unatunza aje kiziki cha kitovu cha motto wako?
Hakuna
6. What do you do to keep the baby warm? …………………………………………………..
Nini kufanya ili kuweka mtoto mtamu? ..............................................................
7. How often do you bath your child? ………………………………………………………..
Ni mara ngapi wewe umwagaji wa mtoto wako? ......................
8. Do you add any substances (hand/body soap or Dettol) to the baby’s bath water?
Yes
Je, kuongeza vitu yoyote ( mkono / mwili sabuni au Dettol ) kwa umwagaji wa maji mtoto ?
Ndio
9. How do you bath your baby?
Immersion in water
Jinsi gani unaweza umwagaji mtoto wako ?
Kuzamisha katika maji
10. How do you apply Diaper/Napkin on your baby?…………………………….( Explain-observe)
Unamfung aje Diaper/Kitambaa motto wako? ……………………………….(eleza).
11. How do you wash your hands?
Basin
Ni vipi unanawa mikono?
bonde la
Thank you