2
21
time to vary from 3 to 45 days with a mean of 13.9 days.
Oudesluys-Murphy et al found range of 1 to 29 days
cord stump can be an excellent medium for bacterial
growth if the stump is kept moist and unclean sub-
stances are applied to it. However, shea butter if not
refined, is known to contain Vitamin A and E. The vita-
min increases micro-circulation to the skin and acts as
anti-free radical agent; there is nevertheless no known
study that has found it useful in early separation of the
cord or in preventing cord colonization and sepsis
9
3
with a mean of 7.4 (SD 3.3) among 911 babies in the
8
Netherlands. Wilson et al reported a range of 5 to 15
8
days after birth. It could therefore be said that time of
umbilical cord separation is similar among cultures.
8
Wilson et al defined delayed separation of cord as
8
separation occurring after 15 days. In the present study,
1
in the first two weeks of life. Thus by the definition of
Wilson et al only 13 (6.7%) could be classified as de-
layed. Known factors that delay the process of umbilical
separation are the application of antiseptics to the stump,
infection, mode of delivery like caesarean section, and
method of cord care. Delayed cord separation with anti-
septics may be due to destruction of the normal flora
around the umbilicus and a subsequent decrease in the
81(93.3%) of the babies had the cord stump separated
In the present study, complications occurred in 56
(16.9%) of the babies. This is high but is likely to be
higher if not for the fact that the babies evaluated in the
present study were apparently healthy babies brought for
immunization. Very ill infants such as babies with septi-
caemia and tetanus or babies who had severe neonatal
jaundice following exposure to menthol during cord care
may not be known since many of them may have re-
ported directly to the hospitals for treatment. The reason
for the large number of babies with complications could
be inferred from the methods of cord care. Significantly
associated with complications in the present study were
lack of antenatal care, low socioeconomic class of the
mothers and poor cord care. Cord sepsis is a common
finding in many prospec3ti,1v4e-16study and clinical reviews
8
7
number of leucocytes attracted to the cord. These were
not fully evaluated in the present study.
The present study shows various methods of cord care
practised in the area of study. Cord care is an integral
part of newborn care in most cultures. It is interesting to
find how varying agents are used by mothers to care for
the cord of their babies. Many of the methods used are
against the principle of having a dry cord which is more
important in cord care. In fact, many of the methods
could promote bacterial colonization and infection of the
cord. Several mothers used hot water fomentation before
cleaning with methylated spirit. Methylated spirit con-
sists of 2% methanol, less than 6.2 percent water and
over 90 percent of ethanol which is known to be irritant
in developing countries.
Previous study put the
incidence of cord infections in newborns between 0.5%
in term newborns and 2.08% in preterm babies among
those w3 ho were routinely bathed with hexac1h4loro-
phenel; 30/1000 among urban slums in India and
sometimes can be as high as in 47% of infants hospital-
ized with sepsis. Similarly, a study found that 21% of
infants admitted for other reasons had concurrent om-
1
5
phalitis. Though, incidence of cord sepsis may some-
times be bloated due to misdiagnosis because during the
normal process of separation, small amounts of cloudy
mucoid material may collect at the junction; which may
be misinterpreted as pus, and the cord may appear moist,
1
0
to the skin. Alcohol has been shown in many hospital
studies to be ineffective in controlling umbilical coloni-
zation and skin infections. Alcohol also has been shown
3
to delay cord separation when compared to other treat-
3
3
ments. Isopropanol has consi1stently been shown to
sticky or smelly however, babies may not have external
1
lengthen cord separation time. Cases of acute alcohol
signs of infection despite cord sepsis
toxicity in infants up to 21 days old have been reported
4
after alcohol applications to the umbilical stump. Alco-
According to the WHO, even though, there is still no
complete answer to the question of what constitutes the
best cord care; clean cord care in the postnatal period
includes washing hands with clean water and soap be-
fore and after care, and keeping the cord dry and ex-
hol is also known to cause central nervous system de-
pression, convulsions, ataxia and coma if absorbed in
significant quantity. It may also cause pulmonary dam-
age, alteration in gastric secretion, nausea, vomiting and
1
0
3
other gastrointestinal changes. This is however rare
and not observed in the present study probably because
of small quantity used in cord care. Previous studies
have recommended that physicians and nurse practitio-
ners s2hould limit or avoid the use of alcohol for cord
posed to air. The cord should be washed when neces-
sary with clean water and soap (cleaning with alcohol
seems to delay healing), and the napkin should be folded
below the umbilicus. Touching the cord, applying un-
clean substances to it and applying bandages should be
discouraged. Practices that may also reduce the risk of
cord infection is the use of 24-hour rooming-in instead
of nurseries, and skin-to-skin contact with the mother at
birth to promote colonization of the newborn and the
cord with 7non-pathogenic bacteria from the mother's
1
care. This however, is also not adhered to in the area of
study where alcohol as methylated spirit is usually the
main prescription by health workers to mothers for um-
bilical cord care.
1
The cloth used by mothers in the practice of hot fomen-
tation may be dirty and promote infection. It was also
observed that about 36% of the mothers used shea but-
ter. Shea butter (fat from nut of shea tree: Vitellaria
paradoxa) is used in the cosmetics industry as skin and
hair moisturizer. By its qu3ality of increasing wetness, it
skin flora. Early and frequent breast-feeding will pro-
vide the newborn with antibodies especially against the
commensals in the mothers’ skin. There is need for the
health workers and birth attendants to be very conver-
sant on proper cord care so as to adequately educate the
mothers and the need to teach mothers on appropriate
cord care with practical demonstration. They need to
1
may promote cord sepsis. The devitalized tissue of the