Nigeria Journal
Paediatrics 2011; 38(3)104-108
ORIGINAL
Abhulimhen-Iyoha BI
Cord
care practices among mothers
Ofili A,
Ibadin MO
attending immunization clinic at the
University of Benin Teaching Hospital,
Benin City.
Received:19th April
2011
Abstract:
Background: Poor
cord
clamp (22.7%) to
secure
Accepted: 3rd August
2011
care practices
contribute to
haemostasis at the
umbilical stump.
neonatal morbidity and
mortality
Other materials used
include suture
Abhulimhen-Iyoha BI (
)
resulting from neonatal
infections
materials, strips of
cloth, bandage,
Ibadin MO
including tetanus.
Identification of
plaster and rubber
band. Majority of
Department of Child
Health,
negative practices
should
the mothers practiced
hand washing
University of Benin
Teaching
ultimately improve care
and
before (86.9%) and
after (89.3%)
Hospital, Benin
City.
neonatal
outcome.
cord care. The
traditional practices
Email:
Objective : To
evaluate cord
care
of cord care in Benin
City include
drblessing4ever@yahoo.com
practices among mothers
attending
the use of hot compress
(46.1%),
Tel:
+2348059143792.
the Well
Baby/Immunization
menthol-containing
balm, herbs,
Clinic of the
University of Benin
native chalk, petroleum
jelly, palm
Ofili A
Teaching Hospital
(UBTH), Benin
oil, toothpaste ( Close-up ), salt, sand
Department of
Community
City.
and saliva. The most
common
Health, University of
Benin
Subjects
and
Methods:
Four
single agent for cord
treatment was
Teaching Hospital,
Benin City.
hundred and
ninety-seven mothers
alcohol (methylated
spirit).
who brought their
babies to Well
Conclusion:
The attendant
risks
Baby/Immunization
Clinic in
associated with harmful
cord care
UBTH between July and
August
practices remain real
in our
2009 were interviewed.
A
communities. There is
need for
structured, pretested
questionnaire
education of the
public, using the
was used as test
instrument to
mass media and health
talks in
investigate the care of
the
health facilities, to
discourage
umbilical cord of their
infants in
harmful cord care
practices while
their last
deliveries.
reinforcing beneficial
ones.
Results: Harmful
or non-beneficial
cord care practices
were common
Key
Words: Umbilical
cord, Care
(79.5%) among mothers
in Benin
practices, Mothers,
Benin City.
City. Most delivery
units used
Introduction
thread (65.6%) and
plastic cord
Introduction
In developing
countries, individual cases and
epidemics of cord
infections continue to occur, even
in supposedly clean
nurseries for newborns. The
6
Infections account for
an estimated 1·44 million
(36%) deaths, and about
half of deaths in regions with
hazards of poor cord
care are not limited to
high neonatal mortality
rates.
1
A substantial
predisposition to
infections. There is also the risk of
bleeding from the cord
which can be rapidly fatal.
proportion of neonatal
deaths from infection are
Empirical observation
suggests that harmful
traceable to initial
cord infections. Contamination of
2,3
traditional cord care
practices abound in our
the umbilical cord can
lead to omphalitis, which may
community, thus placing
newborn babies at risk of
have an incidence as
high as 77 per 1000 hospital-
morbidity and
mortality. In spite of this, there is
born infants.
4,5
paucity of data on cord
care practices in developing
countries
105
Even when mothers
deliver in health facilities, the
(range 1- 8). The study
group consisted of four major
baby's cord stump
normally falls off between five and
tribes, namely Bini
(39.8%), Igbo (14.4%), Esan
15 days after birth.
Since the majority of mothers
7
(12.9%) and Yoruba
(6.8%). Most of the mothers
with uncomplicated
deliveries with their babies are
were traders 189
(38.0%), housewives 68 (13.7%),
discharged home between
48 and 72 hours post
fashion designers 67
(13.5%) and hair dressers 62
delivery, most of the
cord care is carried out at home.
(12.5%). Majority
(57.3%) of the mothers and 233
Usually, the mother
becomes responsible for taking
(46.9%) fathers had
some form of secondary
care of her baby's
umbilical cord until it separates and
education. Seventy-two
(14.5%) families belonged to
heals. It is,
therefore, desirable to know the cord care
the upper social class
(classes I and II), 192 (38.6%) to
practices amongst
mothers other than what obtains in
the middle class (class
III); and 233 (46.8%) to the
the hospitals.
low socio-economic
group (classes IV and V). The
places used for
antenatal care Table1.
This knowledge, it is
envisaged could assist in
improving the current
practices by way of
Table
1: Place
of Receipt
of Antenatal
Care and
of
discouraging harmful
practices and reinforcing
Delivery of Study
Mothers
beneficial ones.
Place of care
Antenatal care
Delivery
Private
hospitals
252 (5.7)
220 (44.3)
Subjects and Methods
Teaching
hospitals
171 (34.4)
171 (34.4)
Maternity homes
31 (6.2)
14 (2.8)
The study was a
descriptive and cross-sectional one
State hospitals
23 (4.6)
13 (2.6)
carried out at the Well
Baby/Immunization Clinic of
Traditional birth
attendants 5 (1.0)
22 (4.4)
the University of Benin
Teaching Hospital (UBTH),
Church
5 (1.0)
0 (0.0)
Benin City, Edo State;
from July to August 2009.
At home
45 (9.1)
Subjects consisted of
497 consenting mothers of
healthy infants .
The mothers responded
to a
Ten (2.0%) mothers did
not have antenatal care
structured
questionnaire with provision for age,
(ANC) while 12 (2.4%)
delivered in other places -
parity, educational
status, place of antenatal care
churches, chemist,
primary health centre (PHC) and
(ANC) and birth with
particular reference to their last
on the road proceeding
to a hospital.
delivery; and the care
of the umbilical cord of their
infants including the
specifics of all forms of
Materials used in tying
the cord were mainly thread
treatment carried out
on the cord.
(65.6%) and sterile
plastic clamp (22.7%). (Table 2).
The cord care by the
mother was adjudged as
Table 2: Materials
Used in
Tying the
Cord at
Delivery
beneficial when it was
treated with methylated spirit
Materials used in
tying
Frequency (%)
only. Other forms of
treatment to the umbilical cord
the cord
stump were adjudged as
non-beneficial. The socio-
economic status of the
families was classified in
Thread
326 (65.6)
accordance with the
method of Olusanya et
al .
8
Approval was obtained
from the Ethics Committee of
Plastic cord
clamp
113 (22.7)
UBTH and informed
consent gotten from each
Suture material
45 (9.1)
participant.
Cloth
4 (0.8)
Bandage
7 (1.4)
Data collected were
analyzed with the Statistical
Plaster
1 (0.2)
Package for Scientific
Solutions (SPSS) version 16.
Rubber band
1 (0.2)
The results were cross
tabulated as frequency tables,
Total
497
(100.0)
charts and contingency
tables. Means, standard
deviations and ranges
were used as appropriate to
Most [479 (96.4%)] of
the mothers did not notice
describe continuous
variables.
bleeding from the
umbilical cord stump of their
infants. Of the 18
babies who bled from the cord,
three mothers claimed
to have applied herbal mixture,
nine applied methylated
spirit in nine (50.0%), two
Results
reapplied the ligature
and four took no additional
steps.
Of the 497 mothers
studied, 471 (94.8%) were
married while 26 (5.2%)
were single. Their ages
Majority of the mothers
stated that they washed their
ranged between 17 and
42 years, with a mean of 29.10
hands before [423
(86.9%)] and after [444(89.3%)]
± 4.91 years. The mode
of maternal parity was 1.0
cord care.
106
Various substances were
used by mothers to care for
In the current study,
majority of the mothers practiced
the cord of their
babies . Alcohol (methylated spirit)
hand washing before
(86.9%) and after (89.3%) cord
was the most utilized
single agent for umbilical cord
care - a practice that
must be encouraged.
care. Hot compress was
used in combination with
other substances in
over 46.1% of the infants. It was
The fact that 96.4% of
the infants in this study did not
used alone in 0.8% of
the infants. Other substances in
bleed from the
umbilical cord suggests that the
their combinations used
are as contained in Table 3.
materials for ligature
were effective in securing
haemostasis. However,
the materials were usually not
Table 3: Substances/ Materials Used for Cord
Care
sterilized and could
therefore harbour pathogens
by mothers
including tetanus
spores and contribute to the
infection of the
cord.
10
Substances used for
Cord Care
Frequency (%)
Methylated spirit
(alone)
102 (20.5)
The traditional
practices of cord care in Benin City
Mentholatum, Methylated
spirit, Hot
99 (19.9)
include the use of hot
compress (over 46.1%), (that is,
compress
the use of a piece of
cloth soaked in hot water to
Methylated spirit, Hot
compress
71 (14.3)
massage the cord
stump); use of herbs e.g. leaves
Mentholatum, Methylated
spirit
69 (13.9)
(
Ocimum gratissimum ) locally
known as “scent” ,
Mentholatum, Hot
compress
29 (5.9)
native chalk, petroleum
jelly, palm oil, toothpaste
Mentholatum, Methylated
spirit,
12 (2.4)
(
Closeup ), salt, sand and saliva. These practices are
Cicatrin powder, Hot
compress
often harmful, because
these substances are liable to
Herbs, Mentholatum,
Methylated
10 (2.0)
being contaminated with
bacteria and spores, thus
spirit, Hot
compress
increasing the risk of
infection. Our findings are in
consonance with those
of Ambe et
al. Parents use hot
9
Mentholatum, Methylated
spirit,
8 (1.6)
Native chalk, Hot
compress
water fomentation
because they are conscious of the
Mentholatum
7 (1.4)
need to rid the stump
of infection and believe that hot
substances would do
this; but the temperature of such
Hot compress
4(0.8)
Herbs
3 (0.6)
foments is too low to
eradicate microorganisms.
Rather complications
associated with the application
Several substances in
various combinations were
of these agents in
previous studies include the
used in 83 (16.7%)
other infants. These included
development of tetanus,
omphalitis, fever,
septicaemia and
burns.
11-14
menthol-containing balm
( mentholatum ), herbs,
petroleum jelly, native
chalk, sand, toothpaste
(
close-up ), palm oil, salt and saliva.
In the current study,
the most frequently used agent
for cord treatment was
alcohol (methylated spirit).
This may be due to the
fact that in the postpartum/
maternity wards of the
University of Benin Teaching
Hospital, alcohol
swabbing is the standard method of
Discussion
caring for the cord
stump. It was used alone in 20.5%
of the infants and in
combination with other
The umbilical stump
represents a unique but
substances in over
52.1%. Our observation is in
universally acquired
wound in which devitalized
consonance with
findings contained in previous
tissue provides a
medium that could support bacterial
studies that documented
alcohol as the commonest
growth. Thus, the
immediate care of the umbilical
agent for cord
care.
15,16
(With regard to the use
of
cord requires strict
asepsis following healthy
alcohol, the two
earlier Nigerian reports
15,16
alluded to
clamping and severance
of the cord. If these basic
above, had documented
the use of alcohol alone in
conditions are
overlooked, deleterious haemorrhage
59.2 to 82.9% and in
combination with other
or infection may
occur.
6
substances in 14.0 to
37.7%.) Whereas our figure of
20.5% for sole use of
methylated spirit is an
The study reveals that
non-beneficial cord care
improvement on the
results of Ambe et
al
9
that
practices is rampant
(79.5%) among mothers in Benin
obtained 8.5% in Borno
State in 2005, they fall short
City. The respondents
may have used varied and
of those obtained by
Oladokun et
al
15
and Joel-
unhygienic materials
because they were readily
Medewase
et al
16
of 59.2% in Ibadan, Oyo
State in
available or they may
have been influenced by
2002 and 82.9% in
Osogbo, Osun State in 2006
custom or were unaware
of the health risks involved.
respectively. The
mothers in Benin City may prefer or
Our findings are
partially in agreement with those of
believe more in
traditional cord care practices hence
Ambe
et al where as high as 73.3% of
mothers had
9
their low use of
methylated spirit as a sole agent in the
their infants' cord
tied with thread.
care of their babies'
cord stump.
107
The application of
menthol-containing balm (over
In conclusion, the use
of non-beneficial cord care
47.1%) was also noted
in this study and similar
practices is highly
prevalent in Benin City and should
finding had been
reported by Joel-Medewase et al as
16
be discouraged through
health education of the
part of the care given
by the mothers to the cord stump
populace using the mass
media and health talks in
in 22.8% of cases.
However, the danger of its use in
health facilities.
Pregnant women should be taught
our environment is that
such ointment could easily be
beneficial cord care
practices as well as the effects of
contaminated.
Furthermore, menthol is a risk factor
use of harmful
substances in cord care at the antenatal
for haemolysis that
could lead to neonatal jaundice
17
clinics. Newly
delivered mothers should be given
particularly among
glucose-6-phosphate
practical sessions on
beneficial cord care methods
dehydrogenase deficient
newborns.
before discharge from
health facilities and measures
should be put in place
to ensure that mothers deliver in
Majority of the mothers
(84.3%) in this study
orthodox health
facilities.
Delivered in some form
of orthodox health facility.
Our observation is in
contradiction to the trend
reported in other parts
of the country and in some
18
other developing
countries.
19
These other
studies
Acknowledgement
were, however,
community-based, unlike the present
one in which the
mothers had accessed a health
We wish to express our
profound gratitude to the
facility for their
infants' immunization and as such
respondents involved
with this study for their co-
could be influenced in
their responses.
operation. The
assistance of doctors and medical
students in the
Department of Child Health, UBTH in
data collection is also
acknowledged.
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