Nigeria Journal Paediatrics 2011; 38(3)104-108
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
Objective : To evaluate cord care
of cord care in Benin City include
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
and saliva. The most common
Health, University of Benin
single agent for cord treatment was
Teaching Hospital, Benin City.
hundred and ninety-seven mothers
alcohol (methylated spirit).
who brought their babies to Well
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
thread (65.6%) and plastic cord
In developing countries, individual cases and
epidemics of cord infections continue to occur, even
in supposedly clean nurseries for newborns. The
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.
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
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.
paucity of data on cord care practices in developing
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
(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),
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
326 (65.6)
accordance with the method of Olusanya et al .
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)
4 (0.8)
7 (1.4)
Data collected were analyzed with the Statistical
1 (0.2)
Package for Scientific Solutions (SPSS) version 16.
Rubber band
1 (0.2)
The results were cross tabulated as frequency tables,
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
reapplied the ligature and four took no additional
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.
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.
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,
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
Mentholatum, Methylated spirit,
8 (1.6)
Native chalk, Hot compress
water fomentation because they are conscious of the
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
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.
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
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.
(With regard to the use of
cord requires strict asepsis following healthy
alcohol, the two earlier Nigerian reports
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.
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
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
and Joel-
unhygienic materials because they were readily
Medewase et al
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
their low use of methylated spirit as a sole agent in the
their infants' cord tied with thread.
care of their babies' cord stump.
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
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
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
other developing countries.
These other studies
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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