Niger J Paed 2014; 41 (3):218 –222  
Adebami OJ  
Evaluation of home care  
management of umbilical cord  
stumps by mothers at Ilesa,  
Southwestern Nigeria  
Accepted: 6th April 2014  
Abstract: Background: Umbilical  
umbilical cord care are cleaning  
with methylated spirit, hot water  
formentation and the application of  
shea butter. None of the mothers  
had appropriate cord care practice  
of hand-washing before and after  
cord care, washing the cord with  
clean water and soap, keeping the  
cord dry and exposed to air. How-  
ever, 225 (68.0%) had fair cord  
care while 106 (32.0%) had poor  
cord care. Fifty six (16.9%) of the  
331 babies had various localized  
complications of the umbilicus.  
These were purulent discharge/  
umbilical sepsis, bleeding, umbili-  
cal granuloma, periumbilical cellu-  
litis and omphalitis. Associated  
factors to poor cord care and com-  
plications were no antenatal care  
and lower social class of the moth-  
ers. p =0.000.  
cord care is an integral part of neo-  
natal care in all communities and  
cultures and appropriate cord care  
reduces the risk of infection in the  
newborn infant.  
Objective: The present study as-  
sessed the home care management  
of the umbilical stump by the  
mothers at Ilesa, Southwestern  
Subjects and methods: The sub-  
jects were newborn babies brought  
for routine immunization in health  
facilities at Ilesa, Nigeria. Informed  
consent was obtained from the  
mothers and permission sought  
from the nurses in charge of the  
immunization centres. Data col-  
lected were entered into a research  
proforma designed for the study.  
The babies had complete physical  
examination with special emphasis  
on the umbilical cord stump for  
any abnormality or complications  
resulting from care.  
Adebami OJ  
Department Paediatrics & Child Health,  
College of Health Sciences,  
Ladoke Akintola University of  
Technology, Osogbo, Nigeria  
Email: ojadebami@lautech.edu.ng;  
Conclusions: It is concluded that  
improved antenatal care, improved  
social class and training on appro-  
priate cord care during antenatal  
care visit will improve incidence  
of cord complications.  
Results: Of 331 babies aged 0 to 28  
days assessed, 194 (58.6%) were  
males and 137 (41.4%) females.  
The age range at dropping of the  
cord was 3 to 25 days with a mean  
and standard deviation of 8.64 ±  
Key words: Evaluation, Home  
Care, Umbilical cord stump care,  
.55 days. Common methods of  
and dry is therefore very important if infection is to be  
prevented. In many cultures, some substances are ap-  
plied to the cord stump. Some of such substances are  
Umbilical cord care is an integral part of neonatal care  
in all communities and cultures and appropriate cord  
care reduces the risk of infection in the newborn infant.  
The umbilical cord is an important bacterial colonization  
site, which may occasionally lead to fatal neonatal infec-  
tion such as omphalitis. Appropriate umbilical cord care  
ashes, oil, butter, spice pastes, herbs and mud . These  
substances are often contaminated with bacteria and  
bacterial spores and thus increase the frequency of com-  
plications like cord sepsis, septicaemia, umbilical cord  
granuloma, excessive bleeding, omphalitis and tetanus.  
These conditions contribute significantly to neonatal  
is important to prevent infections in newborn .  
Approriate cord care in the postnatal period includes  
hand-washing before and after cord care, washing the  
cord with clean water and soap, keeping the cord dry  
and exposed to air. The napkin/diaper should also be  
folded below the umbilicus. Keeping the stump clean  
morbidity and mortality . Appropriate cord care there-  
fore, contributes largely to the well being of the new-  
Joel Medewase et al in 2006 reported poor cord care  
practices in 17.1% of 193 mothers of babies seen in  
State hospital Osogbo (about 40 kilometers from Ilesa.  
However, none of the babies who had poor cord care  
experienced any medical complication - a finding ex-  
plained on the basis of the cross sectional design of the  
study. Nevertheless, anecdotal comments and clinical  
experience suggest that the frequency of complications  
especially infections may be profound. Therefore, in  
view of the complications and deaths which may be as-  
sociated with poor cord care, there is a need to review  
the present status of mothers’ current practice and the  
associated complications so that this aspect of child sur-  
vival and child health can be improved.  
Gender, places of antenatal care and birth of the babies  
Three hundred and thirty one babies aged 0 to 28 days  
were studied. They consisted of 194 (58.6%) males and  
137 (41.4%) females (Male: Female ratio of 1.4:1) as  
shown in Table 1. Two hundred and ninety seven  
(89.7%) were term and 34(10.3%) preterm babies.  
Two hundred and seventy five (83.1%) of the mothers  
had antenatal care while 56 (16.9%) had no antenatal  
care. Of the 275 mothers who had antenatal care, 109  
(39.6%) were told about umbilical cord care during the  
antenatal period. This was mainly instruction to wash  
hand before cord care, clean the cord with methylated  
spirit and expose to air-dry.  
The aim of the present study therefore, was to assess the  
home management of the umbilical cord stump by the  
mothers at Ilesa, Southwestern Nigeria.  
One hundred and two (30.8%) of the babies were deliv-  
ered at government maternity /health centres, 72  
21.7%) at state hospitals, 48 (14.5%) at private hospi-  
tals, 47 (14.2%) at teaching hospitals, 35 (10.6%) at  
mission houses, and 27 (8.2%) home/traditional birth  
Subjects and Methods  
Newborn babies brought by their mothers for routine  
immunization in one secondary and ten primary health  
facilities at Ilesa, Osun State, Southwestern Nigeria were  
studied. Informed consent was obtained from the moth-  
ers and permission was sought from the nurses in charge  
of the immunization centres. The babies were recruited  
consecutively over a period of three months (March to  
May 2013). Data collected were entered into a research  
proforma designed for the study. Structured question-  
naires were administered and additional oral questioning  
of the mothers on the care of their babies was done.  
Also, places of antenatal care, whether information  
about umbilical cord care during antenatal care was  
given, birth and educational status of the mothers were  
recorded. The socio-economic classes of the mothers  
were derived from the educational attainments6and occu-  
pations of the parents as described by Oyedeji.  
Table 1: Age and sex distribution of 331 study subjects  
Age (days)  
– 7  
5 -21  
2 – 28  
179 (54.1)  
84 (25.4)  
41 (12.4)  
27 (8.2)  
137 (41.4)  
331 (100)  
x = 1.41, p = 0.23  
Separation of umbilical cord  
The umbilical stumps of 135 (40.8%) of the 331 babies  
were still present whilst 196 (59.2%) stumps had  
dropped off. Figure I shows the gender and the age of  
separation of umbilical cord stumps among 196 babies  
whose stump had fallen off  
The age range at dropping of the cord was 3 to 25 days  
babies had their cords separated in the first two weeks of  
Mean ± SD = 8.64 ± 3.55 days). 181(93.3%) of the  
The babies had complete physical examination with  
special emphasis on the umbilical cord stump; noting the  
position of the stump in relation to the diaper, oils/  
creams, powder or any agent on the cord and examined  
for any abnormality or complications resulting from the  
care including odour, discharges, bleeding, differential  
skin colour or granuloma. Appropriate cord care is taken  
as hand wash before and after cord care, cord stump air-  
dry and above the napkin/diaper. Cord stump stocked  
into the napkin/diaper or with use of methylated spirit  
and expose to air-dry is taken as fair care while formen-  
tations, application/detection of oils, creams, powder  
and any other agent is taken as poor cord care. Mothers  
were counseled when inappropriate methods of care  
were detected and babies who had problems were re-  
ferred to the hospital for appropriate medical treatment.  
Fig 1: Age at dropping of the umbilical stump among 196  
7 to 14  
15 to 21  
22 to 28 days  
The data generated were entered into HP personal  
computer and analyzed with the Statistical Package for  
the Social Sciences (SSPS version 15). Simple frequen-  
cies and chi-square test of significance were calculated.  
The level of significance was taken as p <0.05.  
Care of umbilical cord stump by the mothers  
The frequency of different umbilical cord care practices  
by mothers is shown in Table 2. None of the mothers  
had appropriate cord care practice of hand-washing  
before and after cord care, washing the cord with clean  
water and soap, keeping the cord dry and exposed to air.  
However, 225 (68.0%) had fair cord care while 106  
social class IV and V. For example, 134 (80.2%) of the  
167 mothers compared to 91(55.5%) of the 164 mothers  
had fair cord care x = 23.3, p=0.000. Also, significant  
proportion of mothers in lower social class has more  
babies with umbilical cord complications: 11 (6.6%) of  
32.0%) had poor cord care. Common methods of um-  
bilical cord care were cleaning with methylated spirit,  
hot water formentation, hot/warm cloth formentation,  
shea butter application, mentholatum application, olive  
oil and dusting powder application. Two hundred and  
thirty six (71.3%) mothers used a single method of  
cleaning or applied a single cleaning agent, 52 (15.7%)  
used two methods while 43(13.0%) used more than two  
methods in cord care. Therefore, 95 (28.7%) of the  
mothers used multiple methods at the same time and  
sometimes on different days. Also, 219 (79.6%) of the  
167 mothers compare to 45 (27.4%) of 164 mothers X  
= 25.6, p=0.000 as in Table 5.  
Table 3: Relationship between maternal social class and as-  
sessment of umbilical cord care of their babies  
Assessment of maternal cord  
Social class care in their babies  
Good Fair  
n = 225  
n = 106  
T+ otal N (%)  
75 mothers who had antenatal care had fair cord care  
15 (83.3)  
69 (79.3)  
65 (58.0)  
26 (50.0)  
3 (16.7)  
12 (19.4) 62 (18.7)  
18(20.7) 87 (26.3)  
47 (42.0) 112 (33.8)  
26 (50.0) 52 (15.7)  
and used single agent.  
Table 2: Methods of cord care employed by mothers  
Method of umbilical cord  
Frequen+cy of usage (n =+ 331)  
Always Sometimes Never  
n (%) n (%) n (%)  
331 (100.0)  
Figures in parenthesis are percentages of total in the row  
Figures in parenthesis are percentages of total in the column  
Hot water fomentation  
Hot/warm cloth fomentation  
Methylated spirit  
84 (25.4)  
98 (29.6)  
53 (16.0)  
166 (50.2)  
30 (9.1)  
Table 4: Relationship between assessment of umbilical cord  
Shea butter  
Engine oil  
Olive oil  
Dusting powder  
Breast milk  
45 (13.6)  
11 (3.3)  
22 (6.6)  
35 (10.6)  
56 (16.9)  
15 (4.5)  
5 (1.5)  
17 (5.1)  
31 (9.4)  
0 (0)  
76 (23.0)  
35 (10.6)  
67 (20.2)  
39 ((11.8)  
45 (13.6)  
21 (6.3)  
24 (7.3)  
56 (16.9)  
0 (0)  
210 (63.4)  
285 (86.1)  
242 (73.1)  
230 (69.5)  
305 (92.1)  
290 (87.6)  
244 (73.7)  
0 (0)  
care and complications in the babies  
Good Fair  
N = 331  
n = 225 n = 106  
Periumbilical cellu-  
4 (1.8)  
6 (2.7)  
5 (4.7)  
14 (13.2) 20 (6.0)  
6 (5.7) 7(2.1)  
9 (2.7)  
Camphor water  
Cord Bandaging on abdomen  
Local herb preparation  
Distilled water only  
Ordinary water only  
Animal dung  
Purulent discharge/  
umbilical sepsis  
16 (15.1) 19 (5.7)  
0 (0)  
0 (0)  
0 (0)  
0 (0)  
0 (0)  
0 (0)  
0 (0) 14 (6.2) 41 (38.7) 56 (16.9)  
Multiple agents were used by mothers at same time and at different  
x =54.9, p =0.000  
Umbilical disorders observed  
Table 5: Relationship between social class of mothers and  
development of umbilical complications  
There was no umbilical abnormality seen among 285  
86.1%) babies. However, 56 (16.9%) of the 331 babies  
Maternal Social  
class group  
No whose babies had  
umbilical complication  
n (%) of 56  
n (%) of 331  
had various localized complications in and around the  
umbilical stump. These were purulent discharge/ umbili-  
cal sepsis in 19 (5.7%) babies, bleeding in 20 (6.0%)  
umbilical granuloma in 9 (2.7%), periumbilical cellulitis  
in 7 (2.1%) and omphalitis in 1 (0.3%) baby. Table 3  
shows the relationship between assessment of umbilical  
cord care and complications in the babies. Significant  
higher proportions of mothers with poor cord care had  
complications. For example, while 14 (6.2%) of the 225  
mothers with fair cord care had various complications,  
62 (18.7)  
87 (26.3)  
112 (33.8)  
52 (15.7)  
331 (100.0)  
Comparing complications between maternal social class I-III  
with IV-V, =25.6, p =0.000  
complications =54.9, p =0.000.  
1 (38.7%) of the 106 mothers with poor cord care had  
Maternal Social class and umbilical cord care  
The mean age of babies at umbilical cord dropping in  
the present study was 8.60 (SD 3.54) days and ranged  
from 3 t7o,825 days. This is similar to the findings of other  
Table 4 shows the relationship between maternal social  
class and assessment of umbilical cord care in their  
babies. Significantly, higher proportion of the mothers  
in social classs I to III had fair cord care compared to  
workers For instance, Novack et al found separation  
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  
with a mean of 7.4 (SD 3.3) among 911 babies in the  
Netherlands. Wilson et al reported a range of 5 to 15  
days after birth. It could therefore be said that time of  
umbilical cord separation is similar among cultures.  
Wilson et al defined delayed separation of cord as  
separation occurring after 15 days. In the present study,  
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  
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-  
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,  
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  
to delay cord separation when compared to other treat-  
ments. Isopropanol has consi1stently been shown to  
sticky or smelly however, babies may not have external  
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  
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  
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  
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.  
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  
may promote cord sepsis. The devitalized tissue of the  
emphasize clean and dry cord than encouraging the use  
of alcohol as observed in the present study.  
Conflict of Interest: None  
Funding: None  
Also, application of human milk to the cord stump  
which is one of the cultural cord care practices as prac-  
ticed in Turkey, could be beneficial in view of the anti-  
bacterial factors present in the breast milk but its use in  
the care of umbilical cord may have its own challenges  
of cultural acceptability, it may make the cord messy  
and wet thereby negating the dry cord care that is being  
encouraged. The present study also showed that better  
antenatal care attendance and improved social status of  
the mothers will have better cord care practices and  
overall survival of the babies.  
The support of the mothers, nurses and other health  
workers at the immunization centres of the primary and  
secondary health facilities in Ilesa, Southwestern Nigeria  
is hereby acknowledged.  
Jellard J. Umbilical cord as reser-  
voir of infection in a maternity  
hospital. Br Med J 2002;21:925-  
6. Oyedeji GA. Socio-economic and  
12. Howard, R. The appropriate use of  
topical antimicrobials and antisep-  
tics in children. Pediatr Ann  
cultural background of hospital-  
ized children in Ilesa. Nig J Paedi-  
atr 1985;12:111-7  
7. Novack AH, Mueller B and Ochs  
H. Umbilical cord separation in  
the normal newborn. Am J Dis  
Child. 1988;142: 220-3  
8. Wilson CB, Ochs HD, Almquist J,  
Dassel S, Mauseth R and Ochs  
VH. When is umbilical cord sepa-  
ration delayed? J Pediatr  
Traverso HP, Bennett JV, Kahn  
AJ, Agha SB, Rahim H, Kamil S,  
Lang MH. Ghee applications to  
the umbilical cord: a risk factor for  
neonatal tetanus. Lancet  
13. Masters ET, Yidana JA and Lovett  
P. Reinforcing sound management  
through trade: Shea tree products  
in Africa. Uansylva 2004;55:46-51  
14. Singhal PK, Mathur GP, Mathur S  
and Singh YD. Neonatal morbidity  
and mortality in ICDS urban  
World Health Organization, Care  
of the umbilical cord: A review of  
the evidence, Reproductive Health  
slums. Indian Pediatr,  
(Technical Support), Maternal and  
9. Oudesluys-Murphy AM, Eilers  
GA and de Groot CJ. The time of  
separation of the umbilical cord  
Eur J Pediatr 1987;146:387-9.  
10. Manufacturer's Material Safety  
Data Sheet D: Chem Alert Report  
on Methylated spirit and phenon  
inhalation.htm. Date last updated  
February 21, 2010. Accessed July  
25, 2013.  
11. Covas MC, Alda E, Medina MS,  
Ventura S, Pezutti O, Paris de  
Baeza A, Sillero J and Esandi ME.  
Alcohol versus bath and natural  
drying for term newborns’ umbili-  
cal cord care: a prospective ran-  
domized clinical trial. Arch Argent  
Pediatr 2011;109:305-13.  
15. Faridi MM, Rattan A, Ahmad SH.  
Omphalitis neonatorum. J Indian  
Med Assoc 1993;91:283-285.  
16. Antia-Obong OE, Ekanem EE,  
Udo JJ, Utsalo SJ. Septicaemia  
among neonates with tetanus. J  
Trop Pediatr 1992; 38:173-175.  
17. Mapata S, Djauhariah A, Dasril D.  
A study comparing rooming-in  
with separate nursing. Paediatr  
Indones 1988; 28:116-123.  
Newborn Health / Safe Mother-  
hood. Geneva 1999. WHO/RHT/  
Ebtsam SM, Mirret MD, Soheir  
AD, Ibrahim M and Sayed FA.  
Topical application of human milk  
reduces umbilical cord separation  
time and bacterial colonization  
compared to ethanol in newborns.  
Translational Biomedicine iMed-  
Pub Journals 2012; 3; 1 http://  
www.imedpub.com. Accessed  
July 25, 2013.  
Joel-Medewase VI, Oyedeji OA,  
Elemile PO and Oyedeji GA. Cord  
care practices of Southwestern  
Nigerian mothers. Int J Trop Med