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Publications 2023 ONLINE ISSN:2992-5479

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NEWPORT INTERNATIONAL JOURNAL OF PUBLIC HEALTH AND

PHARMACY (NIJPP)
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Volume 3 Issue 3 2023 43

Knowledge And Practices of Umbilical Cord Care

Among Mothers Attending Post Natal Clinic At
Kampala International University Teaching Hospital,
Bushenyi District
Sekyondwa David

Department of Medicine and Surgery, Kampala International University,

Uganda.
ABSTRACT
Globally, 2·9 million new born babies die of neonatal sepsis each year which as a result of poor cord care, in sub-Saharan Africa,
it has been reported that about 3.3 million neonataldeaths occur annually of which more than 30% are caused by infections of
which some of these start as umbilical cord infections and neonatal sepsis accounted for 60% of neonatal admissions atKIUTH in
2019/2020.To determine knowledge and practices on umbilical cord care among post-natal mothers at KIUTHA cross-sectional
study design was used to determine the knowledge and practices on umbilical cord care among post-natal mothers Primary data
was be obtained using a structured questionnaire administered in English and Runyankole languages. Data was entered into
Microsoft Excel in which it was sorted, organized and checked for completeness then imported into STATAv15 for statistical
analysis. Descriptive statistics were computed for each categoricalvariable. To test for associations between the categorical
variables that was found to be statisticalassociated with knowledge and practices were tested in a multivariate logistic regression
analysis.The level of significance was set at 5% and a p value of less than 0.05 was considered statisticallysignificant. The results
were presented in tables as frequencies and /or percentages, means, adjusted odds ratios, 95% confidence intervals and p
values.The study population was largely made up of middle aged mothers between 21 – 30yrs (52.98%), with majority having
obtained Primary level education at 36.90% and 41.07% of peasantry background with majority of para 2-3 (63.10%). Majority
of the mothers 124 (73.81%) have heard about standard umbilical cord care while 44 (26.91%) where oblivious of standard
umbilical cord care. Maternal knowledge on umbilical cord care improved with increased education and better source of income
(peasant, salary employment or business) (OR 2.5, 95% CI 2.1 – 2.9, p=0.04) and income source or mother’s occupation (OR 1.5,
95% CI 0.5 – 2.4, P=0.04)showed significant independent association with good knowledge on postnatal umbilical code care.
Mothers attending Hoima Regional Referral Hospital have optimal knowledge of umbilical cord care for new born babies,
however the level is limited by lack of sufficient education about the subject. Umbilical cord care practices KIUTH are
not standardized with different materials and methods of care preferred by different mothers although the preferences are
determined by a range of social and economic factors.
Keywords: Knowledge, Practices, Umbilical Cord Care, Mothers

INTRODUCTION
Globally, 2·9 million new born babies die of neonatal sepsis each year which as a result of poor cord care and has emerged as a
principal challenge to further reductions in neonatal mortality [1]. Severe cord sepsis is one of the top three causes of neonatal
death worldwide causing 13 % of all neonatal death [2]. In sub-Saharan Africa, it has been reported that about 3.3 million neonatal
deaths occur annually of which more than 30% are caused by infections of which some of these start as umbilical cord infections
[3].According to a study done in Zambia, optimal umbilical cord care practices for newborns during the first week of life,
especially in settings with poor hygiene, has the potential to avoid these preventable neonatal deaths and that harmful traditional
cord-care practices are often cited as an important public health concern [4]. [5], reported that the umbilical cord area supports
growth of some innocuous or beneficial microorganisms (commensals) whereas others are harmful for example, Clostridium tetani
and therefore its necessary to properly care for the cord after birth. Sources of these bacteriainclude the mother’s birth canal, the
environment in which the neonate is delivered and hands of the person assisting with the delivery [6-8]. Cord infection may be
localized to the umbilical cord (omphalitis) or, after entry into the blood stream, become systemic [9]. [10], reported that nearly
a third of the neonatal deaths are associated with infectionsfor example omphalitis and this proportion is higher in areas and
countries where nearly half of the births occur at home, such as Uganda and infections of the umbilical cord stump (omphalitis)
are a significant contributor to these infections in new born babies in developing countries.In Uganda, over 50% of the mothers
apply various substances to the cord of their babies to quickenthe healing and most of the mothers do not bathe their babies within Page |
the first 24 hours of birth [11]. 44

Methodology
Study design
The study applied a across sectional descriptive study employing quantitative data collection methods.
Study area
The study was conducted at the postnatal ward of KIU-TH in Bushenyi District, Western Uganda.
Study population
The study population were mothers in postnatal ward at KIU-TH.
These mothers were considered to have best information about the subject since at that momentthey were nursing babies after
delivery in real time
Sample Size Determination
The sample size was calculated using the Cochran equation (1963:75); that is

Where;
n is the desired sample size,
Z - The value for Z is found in statistical tables which contain the area under the normal curve.
e.g. Z = 1.96 for 95 % level of confidencee = is the desired level of precision=5%
p is the estimated proportion of an attribute that is present in the population.
24.0% is the percentage of mothers whose children develop umbilical cord infections in Ugandain a study done at Naguru hospital
[12].

q = (1-p)

q= 1-0.24 = 0.76
Sample size, n = (1.96)2 x 0.24x 0.76
0.05x 0.05
n= 0.357504
0.0025
n= 143
Therefore, to cater for incomplete forms the sample size to be considered will be 150 168 mothers were recruited for the study after
their consent
Sampling Procedure
Convenience sampling method was applied for the study. This was in light of the time available for the study, therefore mothers in
the postnatal ward who consented to the study were consideredat convenience until 168 mothers were realized surpassing the
desired target of 150 mothers.
Inclusion criteria
All mothers nursing days old babies with umbilical cords still attached in postnatal ward at KIU- TH.
Exclusion criteria
Mothers that met the inclusion criteria but dint consent to participate in the study
Data Collection procedures
Primary data was be obtained using a structured questionnaire administered in English and Runyankole languages. A questionnaire
that was developed based on the objectives of the study, and pretested at Ishaka Adventist Hospital – Teaching Hospital for quality
assurance purposes andvalidation was used for data collection. From initial contact with a mother, formal introduction was conducted
after exchange of greetings,purpose of the study was clearly communicated, to some in Runyankole, and mothers were clearlyinformed
of their right to stop the discussion at any time they felt like. A facilitated question and answer session then followed until the full
questionnaire is filled. The process was always concluded with a formal appreciation from the Research assistant to the mother.

Data Analysis
The data collected was entered into Microsoft Excel in which it was sorted, organized and checkedfor completeness then imported into
STATAv15 for statistical analysis. Descriptive statistics werecomputed for each categorical variable. To test for associations between
the categorical variablesthat was found to be statistical associated with knowledge and practices were tested in a multivariate logistic
regression analysis. The level of significance was set at 5% and a p value of less than 0.05 was considered statistically significant.
The results were presented in tables as frequencies and /or percentages, means, adjusted odds ratios, 95% confidence intervals and
Page |
p values. 45
Ethical considerations
Permission was sought from the university and KIU-TH authorities to collect data required for thestudy. A written consent form
explaining the rationale for the study, benefits, and rights of respondents and confidentiality to protect the respondents was presented
to the respondents for them to provide consent before participation in the study.
RESULTS
The median age of the 168 mothers interviewed was 24 yrs (range 17 to 45 years). 102 (60.71 %) were married, 49 (29.17%) single
and 17 (10.12%) divorced or separated. Median maternal paritywas 2 (range 1 -7). 21 (12.50%) of the mothers where illiterate, of
those who had received an education; 62 (36.90%) had a primary education, 48 (28.57%) secondary and 37 (22.03%) tertiary
qualification. Majority of the mothers in the study were peasants 69 (41.07%), while 41(24.40%) had salaries or formal employment
and 58 (34.53%) sourced their livelihood through trade and business as shown in Table 1.
Table 1: Demographics of the mothers studied
Characteristic (N=168) Categories Frequency(n) Percentage
(%)
Age of caregivers (yrs) <20 13 7.74
21 – 30 89 52.98
31- 40 66 45.28
>40
Caregivers’ education level None 21 12.50
Primary 62 36.90
Secondary 48 28.57
Tertiary 37 22.03
Occupation of caregivers Peasant 69 41.07
Salaried / Employed 41 24.40
Business / Trader 58 34.53
Religion of caregivers Catholic 69 41.07
Protestant 57 33.93
Moslem 07 4.17
Pentecostal 35 20.83
Mothers’ Marital status Single 49 29.17
Married 102 60.71
Divorced / Separated 17 10.12
Occupation of caregiver’s spouse Peasant 51 30.36
Salaried/ Formally 28 16.67
employed
Business / Trader 73 43.45
Other 16 9.52
Type of family Monogamous 141 83.93
Polygamous 27 16.07
Attended Antenatal care in the last pregnancy Yes 168 100.0
No 0 0
Parity Para 1 49 29.17
Para 2-3 106 63.10
≥4 13 7.73

Majority of the mothers 124 (73.81%) have heard about standard umbilical cord care while 44 (26.91%) where oblivious of standard
umbilical cord care, whereas only 21 (12.50%) have had a health education about the subject with majority 147 (87.5%) having never
had such an education.Majority of the mothers 109 (64.88%) considered Tying, cutting, and cleaning the cord with methylated
spirit as the standard procedure of cord care while 38 (22.62%) considered use of herbsonly and 11 (6.55%) allowed the cord to dry on
its own. Methylated spirit is known by mothers asthe most appropriate substance for cord cleaning 117 (69.64%) while 23 (13.69%)
knew salt solution as the most appropriate substance and 22 (13.10%) picked herbal preparation with a fraction of 06 (3.57%)
knowing hot water as the appropriate as shown in Table 2.
 Table 2: Showing Knowledge of cord care among the mothers interviewed for the study

Characteristic (N=168) Categories Frequenc Percentage

y (n) (%)
Have you ever heard about Yes - 124 73.81 Page |
standard umbilical cord care? 46
No - 44 26.91
Ever attended any health Yes - 21 12.50
educationon cord care
No - 147 87.5
What are the standard of Use of herbs on cord only - 38 22.62
componentsof standard cord
care
Keep baby away to visitors- 03 1.79
Tying, cutting, and cleaning with methylated 109 64.88
spirit -
Allow cord to dry on its own - 11 6.55
Others - 07 4.16
What substances are used for Salt solution - 23 13.69
cordcare
Methylated spirit - 117 69.64
Hot water - 06 3.57
Herbal preparation - 22 13.10
Do not know -
Others -
What are the benefits of cord Quick cord separation - 53 31.55
care
To prevent infection - 115 68.45
To prevent abdominal pain -

Level of Score of the Level of Good - 126 75.0

knowledge of care

Poor - 42 25.0

88.10% of the mothers at KIU-TH use Cord clamp to the tie the umbilical cord after delivery while11.90% of them have used a string
of cloth. Majority of the mothers 69.66% of them used methylated spirit for cord cleaning while herbal preparations where
preferred by 18.45% of the mothers as 10.7% and 1.19% used salt solution and hot water respectively. Cord stump cleaning was the
most practiced method by mothers at 51.19% while 24.40% cleaned the cord base beforestump as 12.50% cleaned the material used
to tie the cord and 11.91% cleaned surrounding skin only.
 Table 3: Showing practices of cord care among mothers interviewed

Characteristic (N=168) Categories Frequency(n) Percentage

(%)
Material used in tying Cord clamp 148 88.10
cordafter delivery
String of cloth 20 11.90 Page |
Tailor’s thread 0 0 47

Substance (s) used for Salt solution 18 10.7

cordcleaning

Hot water 02 1.19

Herbal preparation 31 18.45
Methylated spirit 117 69.66
Care of the hands during Wash hands with water 28 16.67
cord care

Wash hands with soap and water 130 77.38

Clean hands on cloth/wrapper 03 1.79
Clean hands with clean handkerchief 07 4.16
Method of cord cleaning Clean cord base before stump 41 24.40
Clean cord stump only 86 51.19
Clean the material used to tie the cord 21 12.50
Clean surrounding skin only 20 11.91
Frequency of cord Morning, afternoon, evening 94 68.11
cleaning
Once daily 0 0
After each nappy is changed 07 4.17
Several times a day 67 27.72
Level of practice Good 91 54.17
Poor 77 45.83

Table 4: Relationship between maternal knowledge on postnatal cord care with education andincome source

Characteristic Good knowledge Poor knowledge (%) P - value

(%)
Mother’s education
None 31.7 68.3 <0.001
Primary 50.1 49.9
Secondary 53.8 46.2
Tertiary 55.3 44.7
Parity
Para 1 39.3 60.7 0.02
Para 2-3 35.6 64.4
≥4 35.9 64.1
Age of mother
<20 49.3 50.7 0.01
21 - 30 63.1 36.9
31- 40 73.8 26.2
 DISCUSSION
This study presents a view of cord-care knowledge and practices of mothers attending KIU-TH. The desire to care for the umbilical
cord of an infant appears to be universal in all cultures. Of interest was the description of the knowledge and a range of practices
applied to the newly cut cord and the substances applied to the umbilical cord to infants born at the facility. The study population
was largely made up of middle-aged mothers between 21 – 30yrs (52.98%),with majority having obtained Primary level education at
36.90% and 41.07% of peasantry background with majority of para 2-3 (63.10%). This demographic outlook is similar to that observed
by [13]. Majority of the mothers 124 (73.81%) have heard about standard umbilical cord care while 44 (26.91%) where oblivious of
standard umbilical cord care, whereas only 21 (12.50%) have had a health education about the subject with majority 147 (87.5%)
Page |
having never had such an education.Majority of the mothers 109 (64.88%) considered Tying, cutting, and cleaning the cord with 48
methylated spirit as the standard procedure of cord care while 38 (22.62%) considered use of herbsonly and 11 (6.55%) allowed the cord
to dry on its own. Methylated spirit is known by mothers asthe most appropriate substance for cord cleaning 117 (69.64%) while 23
(13.69%) knew salt solution as the most appropriate substance and 22 (13.10%) picked herbal preparation with a fraction of 06 (3.57%)
knowing hot water as the appropriate. The study observes a disconnect where most mothers have heard about standard umbilical
cord care albeit with a low education level about the same subject of only 12.5%. This observation is similar that of [14]. in a systemic
review of cord care knowledge in low-income countries. The study also observes majority of mothers knowing methylated spirit as
the most appropriate substance of cord care cleaning, however with majority (41.07%) being of a peasant background. Therein is a
challenge of cost versus need to use disparity as also observed by [15] in a similar study of a rural Uganda setting. Mothers at KIU-
TH applied a range of practices caring for the umbilical cord of their babies, with88.10% of them use Cord clamp to the tie the umbilical
cord after delivery while 11.90% of them have used a string of cloth, a 69.66% majority of them used methylated spirit for cord
cleaning while herbal preparations were preferred by 18.45% of the mothers as 10.7% and 1.19% used saltsolution and hot water
respectively. Cord stump cleaning was the most practiced method by mothers at 51.19% while 24.40% cleaned the cord base before
stump as 12.50% cleaned the material used to tie the cord and 11.91% cleaned surrounding skin only. Similar findings have been
previously reported in other settings among adolescent mothers and among women of the general reproductive age group in Uganda
by [16-20]. The study has been able to observe that maternal knowledge on umbilical cord care improved withincreased education
and better source of income (peasant, salary employment or business). After logistic regression analysis, maternal education (OR 2.5,
95% CI 2.1 – 2.9, p=0.04) and income source or mother’s occupation (OR 1.5, 95% CI 0.5 – 2.4, P=0.04) showed significant independent
association with good knowledge on postnatal umbilical code care. Maternal knowledge of cord care improved with increasing age
of the mother and the number of times she has given birth (parity). After logistic regression, all the 3 variables maintainedindependent
significant association with maternal knowledge of cord care (maternal education level OR 1.7, 95% CI 1.4 – 3.2, p<0.001; parity
OR 1.5, 95% CI 0.3 – 3.3, p=0.02; Age OR 1.3, 95% CI 1.2 – 3.1, p=0.01). The study was able to also show that maternal application
of good care practices improved with age and number of times a mother gave birth. Logistic analysis shows that all the three variables
remained independently significant associated with appropriate cord care (maternal education level OR 1.5, 95% CI 1.2 – 2.8, p<0.001;
parity OR 1.2, 95% CI 0.1 – 2.8, p=<0.001; Age OR 1.4, 5% CI 1.1 – 2.6, p=<0.001).
CONCLUSION
Findings from this study have been able to reveal that mothers attending KIU-TH have optimal knowledge of umbilical cord care
for new born babies, however the level is limited by lack of sufficient education about the subject. The study has also established that
Umbilical cord care practices by mothers at KIU-TH are not standardized with different materials and methods of care preferred by
different mothers althoughthe preferences are determined by a range of social and economic factors.
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