FACTORS INFLUENCING UMBILICAL CORD CARE PRACTICES AMONG MOTHERS ATTENDING INFANT WELFARE CLINIC IN SELECTED PRIMARY HEALTH CARE CENTRES IN JOS-NORTH LOCAL GOVERNMENT AREA, PLATEAU STATE

CHAPTER ONE

INTRODUCTION

• Background to the Study

The first 28days in the infant’s life is a period of great significance as the newborn is fragile and susceptible to infection; hence they need to be handled carefully so as to prevent neonatal death or permanent deformity. Mothers as the primary care providers have very important role to play to ensure that these newborns develop optimally as the new born health and survival is dependant on the essential care received before, during and after delivery (Joel-Medewase, Oyedeji, Elemile, & Oyedeji, 2008). 

Neonatal infection is a major cause of neonatal deaths as the mortality rate could be as high as 44 per thousand life-births in the north-east zone of Nigeria. Neonatal deaths, cord infection and sepsis can be prevented with good umbilical cord practices especially in areas where home deliveries are done. In developing countries such as Nigeria, umbilical cord infection accounts for significant number neonatal morbidity and mortality, this accounts for 276,000 neonatal deaths annually the second highest deaths in the world and in Nigeria alone it accounts for about 33% of neonatal mortality (Jabbi, Shoretire, Ojile,  Maishanu & Orobaton, 2014; Soofi, Cousens, Imdad, Bhutto, & Ali, 2012; Orobaton, Abegunde, Abdulazeez, Akomolafe & Ganiyu, 2015; Osuchukwu, 2014).

The umbilical cord is a tissue that has a vein and two arteries of which at term is about 56cm in length and extends normally from the center of the placenta to the umbilicus of the unborn baby. During pregnancy, the umbilical cord connects the fetus to the mother through the placenta. The umbilical cord is responsible for the supply of blood rich in nutrients and oxygen from the mother to the fetus and the removal of carbon dioxide and other metabolites away from the fetus to the mother. Umbilical cord care is one of the most essential cares given to umbilical stump of newborns in the first few days of extra uterine life before the fall-off of the cord and immediately after its fall (Fraser & Cooper, 2009).

The availability of tetanus vaccine for pregnant women and topical application of antimicrobial agents should help reduce bacterial infection hence newborn deaths and improve the newborn health and wellbeing. Aside cleaning and drying of the umbilical cord stump, daily application of chlorhexidine 7.1% chlorhexidine digluconate aqueous solution or gel to the umbilical cord stump during the first week of life is strongly recommended for newborns who are born at home in settings with high neonatal mortality (30 or more neonatal deaths per 1000 live births) Chlorhexidine digluconate 7.1% gel was used by 36,404 newborns delivered by 36,370 mothers to help reduce such neonatal deaths in Sokoto State, North West Nigeria, this low cost but highly effective gel used for the prevention of newborn sepsis should be made available in all delivery settings so as to reduce umbilical cord infection and then neonatal death (Enang, Ushie, Arikpo, Osonwa, Esu, Odey, et al., 2013; Mullany, Darmstadt & Tielsch, 2003; Orobaton et al., 2015).

Unqualified personnel  provide health care services to majority of women especially during pregnancy, child birth and after child birth as there is lack of skilled personnel, needed resources and  availability of essentialdrugs that has increased neonatal and childhood deaths. To achieve a healthy and productive society it is important to pay attention to the health and wellness of the newborn as this will help reduce neonatal and newborn mortality and morbidity. In 2013, in Johannesburg, South Africa, an International Conference on Maternal, Newborn and Child Health was held so as to bring about concrete actions for improving MNCH in Africa. Maternal and child care during pregnancy, child birth and post partum is a major strategy to improve child survival as low socio-cultural barriers to care, weak health care system and poor socio-economic development influence maternal and child health (Ezechi & David, 2012)

• Statement of the Problem

The future of any nation lies on the present generation, their health and welfare can be altered by activities that occur either before, during or after delivery. Newborn health and survival is partly dependent on the mother’s decisions on where to deliver and actions or activities taken after delivery. In most rural communities, deliveries and child care activities are mostly managed at home where about 69.8% of care providers used unhygienic and harmful materials for cord care (Osuchukwu, 2014).

In Nigeria, cases of umbilical cord infections are under documented and reported. But for some studies conducted in the hospital, in Port Harcourt, omphalitis constitute 10% reasons of neonatal admissions and 30% of neonatal deaths. In Ibadan it constitute about 18% of neonatal deaths while in Calabar, 49% of neonatal deaths were linked to omphalitis. Neonatal death every year in Nigeria is about 241,000 making it the highest neonatal death rate in African. In Africa, annually about 600,000 infants die of neonatal tetanus. Global annual neonatal deaths constitute about 4million (3.1%) and about (25%) of these deaths are due to umbilical infection. Similar studies have been conducted in other part of the country so the researcher intends to explore the factors influencing umbilical cord care Plateau state, due to the increasing number of mothers returning to the health care facility with umbilical cord complications especially omphalitis in newborns (Federal Ministry of Health, 2009; Osuchukwu, 2014).

1.3 Objective of the study

The general objective is to assess the factors influencing umbilical cord care practices among mothers attending infant welfare clinic in selected primary health care centres in Jos-North Local Government Area, Plateau State. The specific objectives are to:

1. determine the level of knowledge of mothers on umbilical cord care;
2. assess cord care practices among mothers attending infant welfare clinic;
3. identify the substances/materials used for umbilical cord care by mothers;
4. determine the factors that influence umbilical cord care practices of mothers;
5. identify the association between mother’s knowledge and practice of umbilical cord care and
6. assess the association between umbilical cord care practice and maternal parity.

1.4 Research Questions

1. What is the level of mother’s knowledge on umbilical cord care?
2. What are the umbilical cord care practices of mothers attending infant welfare clinic?
3. What are the substances/materials used by mothers for umbilical cord care?
4. What factors influence umbilical cord care practices?
5. What is the relationship between mother’s knowledge and practice of umbilical care?
6. What is the relationship between umbilical cord care practice and maternal parity?

1.5 Hypotheses (at 0.05 level of significance)

Ho: Maternal monthly income is not significantly related to their cord care practices.

Ho: Maternal level of education is not significantly related to their cord care practices.

Ho: There is no significant difference among mother’s ethnicity and their practice of umbilical cord care.

1.6 Scope of the Study

This study was limited to nursing mothers who are attending infant welfare clinic in selected primary health care centres in Jos-North Local Government Area, Plateau state.

 1.7 Significance of the Study

The findings of this study might be used to educate pregnant women and mothers on the importance of good umbilical cord care practices, as well as health care providers and TBAs to buttress the need for hygienic umbilical cord care practices and enlighten the general public on the harmful effect of some substances used by mothers.

1:8 Justification for the Study

Newborns’ are susceptible to infections because the neonates have low immunity and the presence of the raw site of the remains of the umbilical cord. Mothers who are the primary care givers must have the appropriate knowledge about this care and using the correct interventions. In 2011 report, it was discovered that nearly 7 million children died before age five every year. Most of these deaths were preventable and two-third of it occurred from infectious disease (UNICEF, 2014). Infection accounts for about 1.5 million newborn deaths occurring in the first 28 days of life worldwide annually and for such infections umbilical cord infection is one. Poor knowledge and incorrect umbilical cord care practices increase the risk for neonatal infections such as sepsis and tetanus which accounts for 37% of neonatal death (WHO, 2013). Neonatal infections pose a serious threat to every new born and even the mother who might spend ample periods of her postnatal period in the hospital environment and still have to meet financial obligations.  In most developing countries, Neonatal tetanus is still deadly despite the availability of vaccine to prevent such disease. There is still high prevalence rate of NNT in 2013 of about 28.815% in the northern part of Nigeria. Apart from been delivered by an unskilled health provider, unhygienic delivery and umbilical cord care practices in Nigeria contribute to the high rate of neonatal morbidity and mortality rate(Saleh,  Nemecek & Jones,  2015).

1.9 Operational Definition of Terms

Practice: Any substance applied to the umbilical cord.

Cord care: cleaning the cord of a newborn to keep it clean and aid healing.

Mothers: a female adult left with the responsibility of caring for newborn.

Newborn: an infant less than 6 months of life.

Assess – getting information on umbilical cord care knowledge and practice

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