ABSTRACT
In
Nigeria, just like in other developing countries, umbilical cord infections
contribute significantly to neonatal morbidity and mortality. The increasing
number of mothers returning to the health care facility with umbilical cord
complications especially omphalitis in newborns makes this study in the state
necessary. The study determined the factors influencing umbilical cord care
practices of mothers attending infant welfare clinic in selected primary health
care centres in Jos-North Local Government Area, Plateau State.
A descriptive cross – sectional
design involving one hundred and seventy (170) respondents selected using
simple random method, self-developed questionnaire and interview guide
(Explanatory method) were used. The validated
instrument (Cronbach’s alpha of .760) was filled voluntarily
by the respondents and returned. Data collected were analyzed and
presented as descriptive and inferential statistics using SPSS v21 at critical value of 0.05 as the level of significance.
Findings
of the study revealed that majority of the respondents 66(38.8%) were between
20-29 years, 102(60%) were Christians, 100(58.8%) had
monthly income below 10,000, 90(52.9%) had 4-6 number of children, 151(88.8%)
were Hausa, and 100(58.8) had primary education. Majority of the respondents
(90.5%) had adequate knowledge with mean scoreof = 1.1647 had good practice with mean score of = 1.2059 and majority of the
respondents 121(71.2%) cover the umbilical cord loosely with clean cloths and
96(56.5%) practice two hourly cord care. Regarding substance/materials used by
mothers, majority (75.9%) of mothers used methylated spirit and cotton wool,
(58.8%) used string of cloth, (54.1%) used herbal solution and (45.3%) used new
blade for cord care. There is significant
relationship between maternal monthly income (p-value .001), level of education
(p-value .000) and cultural and traditional beliefs (p-value .037) while occupation (p-value .460) and maternal
parity (.054)does not influence umbilical cord care practice with
variation of 16.8% and positive correlation of 0.410. Maternal income and level of education with negative
low correlation of (-0.218, p-value of 0.016) and (-0.296, p-value of 0.000) is
likely to reduce good core practice.
In conclusion, it is necessary to empower women
so as to help them make decisions and become independent as maternal monthly income, level of
education and knowledge influence umbilical cord care practices. Based on the findings, the study recommends thathealth care personnel
should organize health education programs for women during antenatal postnatal
visit and also training and re-training of Traditional Birth Attendants (TBAs)
on hygienic cord care practices as well as monitoring and supervision of their
delivery practices. Introduction and use of chlorhexidine gel for cord care in
health care facilities by health care personnel. Government should ensure that
public enlightenment program on hygienic cord care practices, the importance of
tetanus vaccine to all child bearing age women, advantages of hospital delivery
and the implication of cultural practices on health are carried out also
regular and continuous provision of health facilities, logistics, equipment and
skilled manpower to facilitate access to mothers.
CHAPTER
ONE
INTRODUCTION
1.1 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)
1.2 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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