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ORIGINAL ARTICLE
Year : 2015  |  Volume : 18  |  Issue : 3  |  Page : 129-133

Cord care education and its content given to mothers at antenatal clinics in various health facilities in Edo state, Nigeria


Department of Child Health, University of Benin Teaching Hospital, Benin City, Nigeria

Date of Web Publication10-Nov-2015

Correspondence Address:
Blessing I Abhulimhen-Iyoha
Department of Child Health, University of Benin Teaching Hospital Benin City
Nigeria
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DOI: 10.4103/1118-8561.169278

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  Abstract 

Introduction: Hygienic umbilical cord care is necessary for the well-.being of the newborn. Health education is a strong tool for lifestyle modification aimed at healthy living. This ought to extend to mothers who care for their infants' umbilical cord stump in various ways especially after discharge from hospital. The content of health education on cord care given to mothers (if any) at various health institutions which they accessed for antenatal care is thus worth evaluating. Objective: To evaluate the content of health education on cord care given to mothers at various health facilities which served as their places of antenatal care in Benin City, Nigeria. Methods: The study subjects included mothers who brought their babies to Well Baby/Immunization Clinic of the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria. A structured questionnaire was used to assess their biodata, places of antenatal care, whether health education on cord care constituted part of the services received in health facilities and the content of the cord care education. Results: Of the 497 subjects studied, 487 (98.0%) received antenatal care (ANC) in both orthodox and unorthodox facilities. Amongst these, 352 (72.3%) received health education on cord care while 135 (27.7%) did not. Teaching and private hospitals contributed 116 (48.9%) and 103 (43.5%) respectively to the total documentation of the advice concerning use of methylated spirit alone. The relationship between content of health education on cord care and method of cord care practiced by mothers was statistically significant. Conclusion: Health education on cord care is lacking in some of our health facilities and where available, content may not be evidence-.based. We must equip health workers with facts required to enlighten patients. A standard and universal method of cord care should be adopted to reduce or abolish the confusion which mothers presently encounter in caring for their babies' umbilical cords.

Keywords: Content, cord care education, health facilities, Nigeria


How to cite this article:
Abhulimhen-Iyoha BI, Ibadin MO. Cord care education and its content given to mothers at antenatal clinics in various health facilities in Edo state, Nigeria. Sahel Med J 2015;18:129-33

How to cite this URL:
Abhulimhen-Iyoha BI, Ibadin MO. Cord care education and its content given to mothers at antenatal clinics in various health facilities in Edo state, Nigeria. Sahel Med J [serial online] 2015 [cited 2019 Oct 15];18:129-33. Available from: http://www.smjonline.org/text.asp?2015/18/3/129/169278


  Introduction Top


Cord care refers to the handling of the umbilical stump of a newborn at delivery. Hygienic umbilical cord care is important for the well being of the newborn. Health education is a strong tool for lifestyle modification towards healthy living. This ought to extend to mothers who care for their infants' umbilical cord stump in various ways especially after discharge from hospital.[1] At birth, the umbilical cord is mandatorily cut and the umbilical stump so generated represents a unique wound in which devitalized tissues provide medium that could support bacterial growth. Keeping the stump clean and dry is, therefore, very important if a veritable source of infection is to be controlled.[2]

There is no single best method of care of the umbilical cord [2] as various health institutions and cultures adopt different methods of care.[3] While some orthodox health institutions advocate the use of alcohol, others prefer the use of antiseptics such as chlorhexidine and yet some advise no treatment at all but keeping the cord clean and dry. A particular health facility may even advocate change in its practice over time.[3] What is common to all health facilities however, is that the cord be kept clean to prevent infection and thus reduce infant morbidity and mortality.[2]

Contrary to the teachings and practices of orthodox health facilities are the traditional/cultural practices of cord care particularly in developing nations.[1] These practices are mainly done to hasten the separation of the umbilical cord; stimulating its occurrence within the first few days of life despite the fact that studies have revealed normal cord separation time to extend for as long as 28 days in some cases.[4],[5] These practices involve the application of harmful substances such as sand, salt, native chalk, saliva, petroleum jelly, menthol-containing balm, herbs and hot foments on the cord stump.[1] The wide options available in cord care practice as advocated by health facilities as well as the cultural practices which abound do create confusion for mothers.[3] Focused health education could assist in streamlining the content of myriad of practices.

This study aims at highlighting the content of health education on cord care given to mothers at various health institutions which served as their places of antenatal care (ANC) and to bring to the fore benefits, lapses (if any) and recommend the way forward.


  Subjects and Methods Top


The subjects consisted of mothers of healthy infants attending the immunization clinic of the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria; seen between July 16, 2009 and August 27, 2009. This descriptive and cross-sectional study involved the use of structured questionnaire which were researcher-administered with the aim of recording information on the subjects' biodata, places of ANC and whether cord care constituted part of the health education received and the content of such education (if any) at these health facilities. Immunisation clinic is utilised by mothers irrespective of where they had ANC. Methods of cord care were classified as beneficial when it involved the use of methylated spirit alone and nonbeneficial when other substances like herbs, native chalk, sand or menthol-containing balm were used.

Ethical approval was gotten from the Ethics Committee of UBTH and informed consent was obtained from each participant.

Data collected were entered into the Statistical Package for Social Sciences version 16 (SPSS Inc. 233 South Wacker Drive, 11th Floor Chicago, IL, IBM). The results obtained were cross tabulated as frequency and contingency tables. Means, standard deviations and ranges were used as appropriate to describe continuous variables.


  Results Top


A total of 497 respondents were studied. Their mean age was 29.10 ± 4.91 years (range; 17-42 years). Majority (73.4%) of them had only secondary education while 26.6% had tertiary education. Only 1 (0.2%) of the mothers had no formal education.

Of the respondents, 487 (98.0%) received ANC in both orthodox and unorthodox facilities while 10 (2.0%) did not access any form of ANC. Amongst those who received ANC, most 252 (50.7%) had it in private hospitals, followed by teaching hospitals that were accessed by 171 (34.4%); [Table 1]. Of those who accessed ANC, 352 (72.3%) received health education on cord care while 135 (27.7%) did not. The places the mothers accessed ANC and the percentage of mothers who had the privilege of cord care education in the various health facilities are shown in [Table 1].
Table 1: Receipt of health education on cord care and places of ANC accessed by mothers

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Among mothers who were given health education on cord care, 237 (67.3%) claimed that they were taught to clean their infants' umbilical cords with solely methylated spirit [Table 2]. Teaching and private hospitals contributed 116 (48.9%) and 103 (43.5%) respectively to the total documentation of the advice for use of methylated spirit alone. They both also contributed majorly (private 20 (52.6%); teaching 12 (31.6%)) to the teaching of the use of a combination of methylated spirit, hot compress and application of mentholatum ointment (a medicated balm manufactured by The Mentholatum Company Inc.). No traditional birth attendant (TBA) advised the sole use of methylated spirit; both advised its use with medicated balm while one of them added hot compress to this combination [Table 2]. Other substances also advised for use include Dettol (liquid antiseptic which total admixture comprises chloroxylenol 4.8%, with the rest made up by pine oil, isopropanol, castor oil, soap and water) and engine oil.
Table 2: Content of health education on cord care given to mothers at various health facilities

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There was no statistically significant relationship between the receipt of health education on cord care and method of cord care practiced by the mothers (χ2 = 2.591, P = 0.107). Most mothers 271 (55.6%) who received health educationon practiced nonbeneficial cord care methods. Among mothers who claimed that they were advised to use methylated spirit alone to clean the cord, only 77 (32.5%) actually complied whereas those who were advised on other forms of care had 3 (2.6%) mothers cleaning their babies' cords with solely methylated spirit [Table 3]. The relationship between content of health education on cord care and method of cord care practiced by mothers was statistically significant [Table 3].
Table 3: Relationship between content of health education on cord care and method of cord care practiced by mothers

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  Discussion Top


Mothers care for their babies' cords in different ways.[1] Their cord care practices may be beneficial, harmless or harmful to their infants. It is the duty of health professionals or the health educators in the health facilities which they accessed during the antenatal period to enlighten them on best practices regarding umbilical cord care.[6]

The current study revealed that majority of the mothers was advised to use menthylated spirit solely to clean the cord. This method of care is recommended in developing countries [7] where traditional or cultural practices are known to conflict with the general recommendation of just keeping the cord clean.[1] Some cultural practices may be deeply rooted amongst the people that advocating no treatment of the cord may be unacceptable to them. Suggesting the use of safe alternatives such as topical antimicrobial as a transitional measure to help wean the community away from harmful substances may be appropriate in the immediate circumstances.[7]

From the present study, it became apparent that in some cases the content of the health education on cord care provided even in orthodox centres were misleading, inimical and not evidence-based. For instance, some mothers were told to apply hot compress and medicated balm on the cord stump. Newborns with glucose-6-phosphate dehydrogenase deficiency stand the risk of accentuated haemolysis that could result in neonatal jaundice when menthol-containing substances are used.[8] Complications associated with the application of hot water compress include burns, omphalitis and septicaemia as the temperature of warm compress is insufficient to eradicate microbes. The plausible reason for this misinformation could be lack of awareness on the part of the health workers as has been documented by Obimbo et al.[9] in 1999 in Kenyan where they concluded that the knowledge of cord care of a large proportion of health workers was incorrect and outdated. Their study which involved 307 mothers revealed that only 40% of them had good knowledge of postnatal cord care. They therefore, recommended that health education on cord care be given at all levels of contact with mothers and that knowledge of all primary health workers on cord care be updated.

The TBAs in our study seemed to contribute to the misinformation given to mothers. Majority of TBAs are not trained to give the care they provide.[10] They have been a subject of discussion in the provision of maternal and newborn health care, especially in developing countries where there is paucity of trained health personnel. Nevertheless, in sub-Saharan Africa, skilled birth attendants conduct less than 50% of deliveries with an estimated 22.2% of deliveries attended by TBAs.[11] Their clients need to be correctly informed on the care of their infants' cords. So if trained, followed-up, supervised, supplied with relevant materials and motivated, TBAs could fill in the blank spaces in the health care systems.[12] Perhaps this may help reduce infant morbidity and mortality in our bid to achieving the Millennium Development Goal 4.

Although there is no single method of cord care which has been proven to limit umbilical colonization and disease, there is near consensus that the umbilical area must be kept clean and uncovered to promote healing and drying.[2],[13] Preventive treatment of the cord with disinfectants and antimicrobials to limit bacterial colonization and prevent systemic infections evolved from the presumption that the umbilical stump is predisposed to infection. The risks associated with the use of topical antimicrobials include local irritation, chemical burns, sensitization and allergic/contact dermatitis, systemic absorption and toxicity, accidental ingestion and poisoning.[14] Recently however, some studies comparing treatment versus nontreatment of the cord have not demonstrated an increased incidence of infection when the umbilicus was left untreated.[15],[16],[17] Evens et al.[18] in 2004 comparing alcohol versus natural drying for umbilical cord care in preterm infants, documented the potential benefits of natural drying of the umbilical cord to include shorter cord detachment period, prevention of exposure to alcohol and potential skin breakdown in preterm infants, and reduction in umbilical care costs, all without an increase in infection rate. Also, Agrawal et al.[19] in their study involving 5741 singleton live births delivered at home concluded that promoting clean cord care practice among neonates in community-based maternal and newborn care programmes has the potential of improving neonatal survival in rural India and similar other settings. They advocated clean cord care practice.

Whereas health education is important in that it gives information which may modify health behaviour, it is known that knowledge (awareness) does not automatically translate to practice or behavioural change. It therefore implies that factors other than knowledge or awareness (of beneficial cord care) may determine subjects' behaviour in terms of cord care actually practiced.[20] Such determinants must be considered and addressed by the health professional and the health educator.

It is apparent from the current study that some health facilities did not provide avenues to educate mothers on how to care for their babies' cords after delivery. There are no better places and time for mothers to receive evidence-based health education facts and tips than at the various health facilities where they had ANC.


  Conclusion Top


Health education on cord care is lacking in some of our health facilities and where available, some of the content is not evidence-based. Therefore, we must emphasize the need for training of TBAs, health educators and professional health workers [21] including midwives to equip them with facts that they require to enlighten their clients or patients. The mass media (both electronic and print) can also be used to reach a larger audience. The antenatal period using the antenatal clinics as comfortable venues should not be missed as opportunities to health educate mothers with evidence-based, verifiable facts on healthful cord care practice. A standard method of cord care should be adopted to reduce or abolish the confusion which mothers presently encounter.


  Acknowledgments Top


The doctors in the Department of Child Health, UBTH who assisted in data collection are appreciated. Also acknowledged are the mothers recruited for this study for their cooperation.

 
  References Top

1.
Abhulimhen-Iyoha BI, Ofili A, Ibadin MO. Cord care practices among mothers attending immunization clinic at the University of Benin Teaching Hospital, Benin City. Niger J Paediatr 2011;38:104-8.  Back to cited text no. 1
    
2.
Perry DS. The umbilical cord: Transcultural care and customs. J Nurse Midwifery 1982;27:25-30.  Back to cited text no. 2
    
3.
Ireland J, Rennie AM, Hundley V, Fitzmaurice A, Graham W. Cord-care practice in Scotland. Midwifery 2000;16:237-45.  Back to cited text no. 3
    
4.
Oladokun RE, Orimadegun AE, Olowu JA. Umbilical cord separation time in healthy Nigerian newborns. Niger J Paediatr 2005;32:19-25.  Back to cited text no. 4
    
5.
Abhulimhen-Iyoha BI, Ibadin MO. Umbilical cord separation time among infants attending immunization clinic in the University of Benin Teaching Hospital, Benin City. East Afr Med J 2011;88:99-103.  Back to cited text no. 5
    
6.
Cincinnati Children's Hospital Medical Center. Health Topics: Your Baby's Umbilical Cord. Available from: http://www.cincinnatichildrens.org/health/c/cord-care/. [Last accessed on 2013 May 13].  Back to cited text no. 6
    
7.
World Health Organization. Care of the Umbilical Cord: A Review of the Evidence. WHO/RHT/MSM/98. 4th ed. Geneva: World Health Organization; 1999. Available from: http://bvs.per.paho.org/videosdigitales/matedu/ICATT-AIEPI/Data/Care%20of%20the%20umbilical%20cord/fd38a9b4-bfa1-4735-9a9a-e7dbb0faa720.pdf. [Last accessed on 2013 May 11].  Back to cited text no. 7
    
8.
Sodeinde O. Glucose-6-phosphate dehydrogenase deficiency. Baillieres Clin Haematol 1992;5:367-82.  Back to cited text no. 8
[PUBMED]    
9.
Obimbo E, Musoke RN, Were F. Knowledge, attitudes and practices of mothers and knowledge of health workers regarding care of the newborn umbilical cord. East Afr Med J 1999;76:425-9.  Back to cited text no. 9
    
10.
Itina SM. Characteristics of traditional birth attendants and their beliefs and practices in the Offot Clan, Nigeria. Bull World Health Organ 1997;75:563-7.  Back to cited text no. 10
    
11.
Wanyu B, Diom E, Mitchell P, Tih PM, Meyer DJ. Birth attendants trained in "prevention of mother-to-child HIV transmission" provide care in rural Cameroon, Africa. J Midwifery Womens Health 2007;52:334-41.  Back to cited text no. 11
    
12.
Ngala EM. Traditional Birth Attendants: Filling the blank space in rural Cameroon. Available from: http://www.amplifyyourvoice.org/u/elngala/2012/12/11/traditional-birth-attendants-filling-the-blank-space-in-rural-cameroon. [Last accessed on 2013 Aug 28].  Back to cited text no. 12
    
13.
American Academy of Pediatrics, Committee on Fetus and Newborn. Standards and Recommendations for Hospital Care of Newborn Infants. 6th ed. Evanston, IL: American Academy of Pediatrics; 1977. p. 121-2.  Back to cited text no. 13
    
14.
Howard R. The appropriate use of topical antimicrobials and antiseptics in children. Pediatr Ann 2001;30:219-24.  Back to cited text no. 14
    
15.
Shafique MF, Ali S, Roshan E, Jamal S. Alcohol application versus natural drying of umbilical cord. Rawal Med J 2006;31:58-60.  Back to cited text no. 15
    
16.
Dore S, Buchan D, Coulas S, Hamber L, Stewart M, Cowan D, et al. Alcohol versus natural drying for newborn cord care. J Obstet Gynecol Neonatal Nurs 1998;27:621-7.  Back to cited text no. 16
    
17.
Janssen PA, Selwood BL, Dobson SR, Peacock D, Thiessen PN. To dye or not to dye: A randomized, clinical trial of a triple dye/alcohol regime versus dry cord care. Pediatrics 2003;111:15-20.  Back to cited text no. 17
    
18.
Evens K, George J, Angst D, Schweig L. Does umbilical cord care in preterm infants influence cord bacterial colonization or detachment? J Perinatol 2004;24:100-4.  Back to cited text no. 18
    
19.
Agrawal PK, Agrawal S, Mullany LC, Darmstadt GL, Kumar V, Kiran U, et al. Clean cord care practices and neonatal mortality: Evidence from rural Uttar Pradesh, India. J Epidemiol Community Health 2012;66:755-8.  Back to cited text no. 19
    
20.
Abhulimhen-Iyoha BI, Ibadin MO. Determinants of cord care practices among mothers in Benin City, Edo State, Nigeria. Niger J Clin Pract 2012;15:210-3.  Back to cited text no. 20
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21.
Pakenham-Walsh N, Bukachi F. Information needs of health care workers in developing countries: A literature review with a focus on Africa. Hum Resour Health 2009;7:30.  Back to cited text no. 21
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]


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