1 practice of nursing mothers towards umbilical cord care

PRACTICE OF NURSING MOTHERS TOWARDS UMBILICAL CORD CARE IN 1

CALABAR METROPOLIS, CROSS RIVER STATE 2

3

Abstract 4

Aim:This study assessed the practice of nursing mothers towards umbilical cord care. 5

Methods:The study was a descriptive and cross sectional in design. 388 respondents were 6

randomly selected using multistage sampling technique. Data was collected using a validated 7

semi-structured questionnaire which was self-administered after a Cronbach-Alpha test was 8

carried out giving a result on 0.713. It was analyzed using the statistical package for social 9

science (SPSS) version 21 to generate descriptive (frequency tables, charts) and inferential 10

statistics (Pearson’s chi-square). 11

Results:The practice level showed that most mothers 380 (97.9%) clean the cord of their babies, 12

however most mothers 59 (15.2%) did not clean the cord whenever they changed the diaper of 13

the baby. Hand hygiene was poor within the nursing 88 (22.7%) washed their hands with soap 14

and water and air dried. Only 217 (55.9%) of the respondents cleaned the base of the cord before 15

the surrounding skin. The materials used in cutting the cord were razor 186 (47.9%) while cord 16

clamp 373 (96.1%) of the respondents believed cord clamp was used to tie the cord. a few 17

mothers 131 (22.8%) used chlorhexidine on the cord, 116 (29.9%) still used herbs on the cord. 18

there is a significant relationship between level of education, income, number of children on cord 19

care practice. (P=0.00, 0.00, 0.019). 20

Conclusion: Chlorhexidine should be recommended during counselling and on media so has to 21

replace application of a harmful traditional substance because it has an excellent safety record 22

and is an acceptable, feasible, and cost-effective intervention. Also, There was significant 23

relationship between income, level of education, number of children and cord care practice. 24

Key words: Chlorhexidine, practice, nursing mothers, umbilical cord and care. 25

26

27

28

1. Introduction 29

The umbilical cord or funis is also referred to as the navel string, when fully developed is about 30

1.3-1.9cm in diameter and about 56 cm in length. It begins at the umbilicus of the embryo and is 31

inserted into the central region of the placenta. The cord contains three blood vessels - two 32

umbilical arteries and one umbilical vein. The umbilical cord is a unique tissue consisting of two 33

(2) arteries and one (vein) covered by a connective tissue called Wharton’s Jelly a gelatinous 34

substance formed from mesoderm. The whole cord is covered in a layer of amnion continuous 35

with that covering the placenta which is thin and mucoid in nature [1]. During pregnancy, the 36

placenta supplies all material for fetal growth and removes waste products. Blood flows through 37

the umbilical cord from the placenta and brings all nutrients and oxygen to the fetus and carries 38

away carbon dioxide and metabolic wastes [1,2,3,4]. After delivery of the infant and after the 39

placenta has separated from the mother’s womb, the umbilical cord is cut using a sterile 40

technique, and the newborn must make the essential transition to extra-uterine life, [1]. 41

The umbilical cord must be cut and clamped (or tied tightly) in order to keep the 42

umbilical vessels occluded to prevent bleeding. Once the umbilical cord is cut the cord stump 43

which is the distal end of the cord is suddenly deprived of its oxygen blood supply and it begins 44

to dry, turning black and stiff in appearance stiff (dry gangrene). The umbilical vessels are still 45

patent for a few days following birth which provides direct access to the bloodstream. The 46

devitalized tissue of the cord stump can be an excellent medium for bacteria, especially if the 47

stump is kept moist or if unclean substances are applied to it [1,5,6,3,7,8,9,10,11]. 48

The umbilical cord is a common route of entry for systemic infection in the newborn 49

infant, keeping the cord clean is therefore imperative if infection is to be prevented [11]. 50

In Nigeria, A study carried out by [12] stated that various materials have been used by 51

mothers and other care givers for umbilical cord care in developing countries. These range from 52

varieties of tools used to cut the cord to substances applied. These tools are usually items that are 53

available in the home, such as scissors, knives, broken glass, sharp stones or used razorblades 54

which are rarely clean or boiled before use [12]. Thus it is important to know that approaches to 55

cord care differ and have been evaluated in terms of their impact on timing of cord separation, 56

bacterial colonization and infection. 57

Practice is a habit that has been formed by an individual depending on the knowledge 58

they have acquired which then becomes something a person becomes used to if otherwise 59

changed. This research viewed literature on practice nursing mothers had regarding umbilical 60

cord care. A qualitative study in northern Ghana showed that a wide variety of tools were used in 61

cord cutting, the most commonly used being razor blades or scissors. That study reported that a 62

wide variety of materials were applied while the cord was dressed, traditional materials used 63

were shea butter, ground shea nuts, herbs, local oil and red earth [13]. These unhygienic birth 64

practices with low rates of mother being immunized against tetanus accounts for the high 65

incidence of neonatal tetanus in Nigeria [14]. [15], in a study in Bangladesh observed that more 66

than 80% of women delivered at home. In 6% of cases, blades from a clean-delivery kit (CDK) 67

were used to cut the cord; in 90% of cases, the blades used were from another source; in 4% of 68

cases, other instruments such as bamboo strips and scissors were used to cut the cord. In 51% of 69

cases, a substance (e.g. antibiotic powder/ointment, alcohol/spirit, mustard oil with garlic, boric 70

powder, turmeric, and chewed rice) was applied to the stump after the cord was cut. A study 71

carried out by [16] indicated the material used on the umbilical cord; 279 (62 %) used cord 72

clamp to tie the umbilical cord, 187 (41.6%) used sterile scissors/surgical blades to sever the 73

cord and 224 (49.8%) of the respondents used Methylated spirit to clean the cord. However, a 74

large percentage of 69.8% added other substances other than methylated spirit to the umbilical 75

cord. With regards to various materials added, “Ndodop’’ was commonly used by the 76

respondents accounting for 33.3%. Tooth paste “Close Up” was used by 16 (3.6%) of the 77

respondents. 78

There is a common practice carried out by mothers in rural setting where they used cattle 79

dung to treat umbilical cord stump of children. Some use soil, ash, and other types of concoction. 80

In a study carried out in Port Harcourt by Opara, Jaja, Okari, One hundred and fifty nine (75.5%) 81

mothers cleaned the cord at least four times daily. A study carried out by [17] showed that 63.33 82

% wash hands before handling stump and wash and clean napkins after each motion. 83

Another study carried out in India by Shalini Hajela, showed that with regards to 84

umbilical cord care, 83.6% of the participants used for the study had correct Knowledge, 85

Attitude and Practice regarding cutting of umbilical cord and 52.4% had correct knowledge of 86

care of umbilical cord even though this figure is a little more than half it still shows the need to 87

emphasis effective cord care procedures. Cord care practice by mothers in south-western Nigeria, 88

Showed that the care given by mothers to the cord of 160 infants (82.9%) was considered fair, 89

while that of 33 (17.1%) was poor. The poor treatment consisted of the use of hot water 90

fermentation, menthol containing substance M, hot lantern application. [18] carried out a study 91

on cord care practices in a rural community in Nigeria. The researchers used a cross sectional 92

design and 2000 mothers who brought their sick neonates to the clinic were interviewed using a 93

structured questionnaire. The findings revealed that 60% of the neonates had umbilical infection. 94

About 68.3% managed the cord stump based on culturally recommended therapies such as 95

herpes, salt and saliva, breast milk and sand from door post. The researchers therefore, concluded 96

that there is a strong need to give appropriate education and counseling to caregiver on standard 97

cord care hence the need for this research. 98

A study carried out by [19] showed that Fikree, Ali, Durocher, and Rahbar reported that 99

low socio-economic mothers in settlements applied different substances to the cord such as 100

surma, ghee and powder (not known what is this powder), which might cause a tetanus infection. 101

Also the study reported that another practice of cord care that has been found in this study, either 102

in combination with using antibiotic or as a separate practice, was wiping the umbilical cord and 103

the stump with alcohol. The informants noticed that alcohol is as useful as sulpha in hastening 104

the cord healing process. A study carried out by [20] showed that the practice carried out by 105

nursing mothers was the use of warm water and cotton, Oil and at times nothing to the umbilical 106

cord. Another study carried out by [21] showed that Two hundred (95.3%) used methylated spirit 107

to 108

clean the cord but 69 (32.4%) applied other substances after cleaning with methylated spirit also 109

one hundred and fifty nine (75.5%) mothers cleaned the cord at least four times daily. 60.9% of 110

methylated spirit and 25.3% used hot compress. [22]. 111

Furthermore, Studies conducted in Nepal, Bangladesh and Pakistan have shown that 112

cleansing the cord with Chlorohexidine(CHX) a widely used antiseptic, significantly reduces 113

incidence of omphalitis and mortality in newborns. A formative study on the potential for the use 114

of CHX for cord care in Ethiopia, only one respondent out of all depressed willingness to use a 115

product that would prevent infection of the cord, this showed a strong potential for promoting 116

CHX in Ethiopia [23]. [24] carried out a study in Konduga local Government Area of Borno 117

State, Nigeria on practices of cord care in the area Findings revealed that substances used by 118

mothers in cord care include, the application of hot fermentation, use of rag and lantern wax, use 119

of Vaseline, ash, charcoal, groundnut oil, palm oil, mangrove oil, use of powder and red sand 120

indicating that the practice level was low. 121

In Nigeria and particularly Cross River State, little or no studies has been done on 122

knowledge, attitude and practice of nursing mothers towards umbilical cord care majority are on 123

incidence of neonatal deaths which is related to umbilical infections in the newborn. Most of the 124

literature reviewed were based on evidence gotten from the hospital setting this research seeks to 125

carry out its study on a community level thereby bridging the gap towards cord care practice. 126

This study will also provide a foundation on which behavior change communication programme 127

can be designed and may be implemented by policy makers in the country and the state as a 128

whole to ensure proper cord care is practiced nationwide. The few studies mentioned show the 129

need for nursing mother’s knowledge attitude and practice should be looked in order to improve 130

proper cord care practice. This will go a long way in reducing the morbidity or mortality in the 131

newborns and thereby improve their knowledge, attitude and practice. 132

133

2. Research Methods 134

2.1. Research Design 135

This study was a descriptive cross-sectional in design. 136

2.2. Description of Study Area 137

The area of study will be Calabar metropolis in Calabar, Cross River State, Nigeria. Calabar is 138

also called “Canaan City”. The original name for Calabar was Akwa Akpa. Administratively the 139

city is divded into Calabar Municipal and Calabar South LGAs. It has asn area pf 406 square 140

Kilometers (157 sq mi) and had a population of 371,022 at the 2006 census.The first study 141

population will be in Calabar Municipal. It is also called efik eburutu and Kalabar. 142

2.3. Study Population 143

The study population for this research work were Nursing mothers who visit Ikot Ansa health 144

center in Calabar Municipality and also mothers who visit the health center in Ekpo Abasi in 145

Calabar South which is within Calabar metropolis, irrespective of their tribe, religious belief and 146

level of education. This study population was chosen because of availability of information and 147

participation is guaranteed. The entire population of Ikot Ansa is 87,461 according to the 2006 148

census. The number of women of reproductive age who visit Ikot Ansa health center is 12,500 a 149

year this figure is based on the number of nursing mothers who visit the health center on a daily 150

basis. The entire population of Calabar South Local Government Area is 191,630. The number of 151

women who visit Ekpo Abasi yearly is 14,000. These figures are based on the number or nursing 152

mothers who visit the Health center on a daily basis for their antenatal care needs. 153

154

2.4. Sample Size Determination 155

The formula of Armitage and Berry, 1994 was used to determine the sample size because the 156

study population is more than 10,000 and it gives you more precise estimates of population 157

parameters and their differences and gives more powerful statistical test. This formula can be 158

used to achieve a degree of precision or power though it does not guarantee absence of bias. 159

The sample size will be calculated using this formula; 160

1.96 0.5 0.50.05

384.16

n ≈ 400 161

The sample size for this research was approximately 400. This is to accommodate no response 162

within the study population. 163

Where n = Minimum sample size 164

Z = Standard normal deviation set at 1.96 165

P = Proportion of persons in the population with factors under study, 0.5 166

d2 = Degree of accuracy desired, 0.05 167

q= proportion of persons in the population without factors under study (q=1-P) 168

The inclusion criteria will be: 169

• Mothers aged between 15 and 49. 170

• Mothers who have been discharged after child birth and visiting Ikot Ansa and Ekpo Abasi 171

Health care centers at the time of the study 172

173

2.5. Sample Technique 174

The sampling technique adopted for this research was a multistage sampling technique. Below 175

are the different stages used for the sampling. 176

First Stage: cluster sampling was used because the study population who visit Ikot Ansa and 177

Ekpo Abasi health center are nursing mothers and so this possible because the population is 178

homogenous and approximately the same size. 179

Second Stage: A purposive sampling technique was used. This is due the fact that purposive 180

sampling represents judgment one makes as well as selective or subjective sampling carried out. 181

This sampling technique allowed the researcher to believe that they have the ability to obtain a 182

high representative sample of the population based on sound judgment which is Ikot Ansa and 183

Ekpo Abasi, this will inversely save time and money. 184

Third Stage: Random sampling technique was used to select the Nursing mothers who 185

participated in the research by using Balloting technique where numbers were written on a piece 186

of paper. Mothers who randomly pick odd numbers were selected for the study. This helped to 187

remove bias and gave every nursing mother an equal chance of being selected for the study. The 188

respondents for this study were nursing mothers who attend the antenatal clinic weekly at Ikot 189

Ansa and Ekpo Abasi Health center. 190

2.6. Data Collection Method/ Instrument For Data Collection Quantitative method of data 191

collection was used to collect data from the respondents who were nursing mothers. 192

A 36 – itemed semi structured questionnaire was used to collect data from the nursing mothers 193

and the questions were asked in the sections described below. The questionnaire had four 194

sections. The sections are: 195

Section A- This section is titled Socio-Demographic information of the participants. 196

Section B- The knowledge of Umbilical cord care carried out by mothers. 197

Section C- Attitude of the Nursing Mothers towards Cord Care. 198

Section D- Practice of the Nursing Mothers towards Cord Care. 199

Section E- Materials used by Nursing Mothers towards Cord Care. 200

201

2.7. Validity and Reliability of Instrument 202

Validity: Face and content validity of the instrument (questionnaire) was carried out through the 203

Judgment and supervision of the project supervisor. Corrections and suggestions were made by 204

the supervisor of the research which was incorporated and drafted before the research became 205

effective. Face validity viewed the extent to which the research instrument covered the concepts 206

relating to knowledge, attitude and practice of nursing mothers towards umbilical cord care, 207

content validity tested the extent to which the research instrument applied conceptual models in 208

assessing these variables and the construct validity assessed how the variables in the study were 209

connected in explaining knowledge, attitude and practice of umbilical cord care among nursing 210

mothers. 211

212

Test-retest was used to ensure reliability of the study. A pilot study (pre-test) was conducted at 213

Okon ene by distributing twenty (20) copies of the questionnaire to nursing mothers in the town, 214

this was done to determine the relevance of content, clarity of statement, this tested the ability of 215

the respondents to respond properly to the questions. Questions which were not appropriately 216

answered were reviewed in the final questionnaire. Nursing mothers in Ikot Ansa and Ekpo 217

Abasi was chosen so as to ensure the integrity of the questionnaire when used for the main 218

research study in Calabar metropolis, Calabar. Cronbach’s coefficient Alpha was used to test for 219

internal consistency of the questionnaire of the pretest done, the research instrument scored 220

0.713. This meant that contents of the questionnaire were at least 71.3% appropriate/ reliable for 221

this study. 222

Table 1: Reliability statistics 223

Cronbach’s Alpha N of items

.713 56

224

2.8. Data Collection Procedure 225

The researcher administered the questionnaires with the helpn4 research assistants (1 female and 226

3 males), this was done under a time frame of 6 days (11th-17th of February, 2017). The 227

researcher ensured that the assistants were debriefed on how the questionnaires should be shared 228

and answered. 229

230

For each day used about 64 questionnaires were gotten from the research assistants. Monitoring 231

of sharing the questionnaires was done by each of the research assistants based on instructions 232

from the researcher. 233

234

A total of 400 questionnaires were shared. The questionnaires were shared every morning at the 235

beginning of antenatal and postnatal days and informed consent was sought from each 236

respondent. After the questionnaires were retrieved from the respondents only 388 were turned at 237

the end of the distribution. 238

239

2.9. Data Analysis 240

The data collected was analyzed using a developed coding guide in order to facilitate data entry. 241

Each questionnaire was coded and entered into a computer facilitated by a developed coding guide. 242

The Statistical Package for Social Sciences (SPSS) version 21.0 software package was used for 243

statistical analysis. The data collected were subjected to provide descriptive and inferential statistics 244

using the information obtained and were summarized and presented into tables and charts and 245

Pearson’s Chi square. 246

Knowledge Score 247

Knowledge scores were computed using 1 for the correct answer and 0 for the wrong answers for 248

each of the knowledge questions on a 24- point scale. For each questions, two answers were 249

available; Yes and No. the maximum score obtainable was 24 while the minimum was 0. An 250

addition of the knowledge score was done by adding together individual knowledge scores. The 251

scores were then classified into two categories by taking the mean of the highest and lowest scores 252

and a value of 20.06 was gotten. This was used to classify respondents into high, average and low 253

levels of knowledge. Scores between 0-6 were low, 7-12 as moderate and 13-24 as high level of 254

knowledge. 255

Attitude Scores 256

Attitude scores were computed by awarding a mark for each correct answer to 6 statements which 257

assessed respondents’ attitudes to towards umbilical cord care on a 30 point scale. For each item, 258

there were four responses: Strongly Agree, Agree, Disagree, Strongly Disagree and undecided. A 259

composite attitude score was compiled by adding together the individual attitude scores. The scores 260

were then classified into two categories by taking the mean of the highest and lowest scores and a 261

value of 19.7 was obtained. This was used to classify into poor, fair and good levels of attitude. 262

Scores from 0-6 were low attitude and scores from 7-12 as moderate attitude and 13-24 were 263

regarded as high attitude. 264

265

2.1.0. Ethical Consideration 266

Ethical approval to carry out the study was obtained from Babcock University Health Research 267

and Ethics Committee (BHREC). The purpose of the study was explained to the respondents and 268

a signed consent was obtained from each of the respondents. The respondents wishes and rights 269

was respected at all times, including right to discontinue with the study at any time. 270

271

Informed consent: informed consent forms were shared to the participants during the study and 272

anyone that signed was included in the study. Privacy and respect for human dignity was 273

considered to ensure confidentiality. 274

275

Freedom from harm: only those who agreed to sign the informed consent form was included in 276

the study. Every participant was assured that their response will be anonymous and they will be 277

free from any harm. Participants who wished to opt out of the study was be free to do so at any 278

stage of the study without allowing their decision to affect them. 279

3. Results 280

281

Practice of Nursing Mothers During Umbilical Cord Care Treatment 282

Table 2 showed that nursing mothers carry out various practice when it comes to care for the 283

cord, this study showed that almost the entire respondents (97.9%) had cleaned the cord of their 284

babies, similarly most if not all (98.5%) of the mothers cleaned the cord with methylated spirit. 285

However, most of the respondents who cleaned the cord cleaned it 3 times daily (43.8%). 286

Results from the study showed that mothers agreed that it was necessary to wash hands before 287

attending to the cord (83.2%) but they also indicated in their response that they didn’t wash their 288

hands with soap and water and air dry at all times (22.7%). Only (42.3%) of nursing mothers 289

cleaned the cord base before the surrounding skin. See Table 2 290

291

292

293

294

295

296

297

298

299

300

Table 2a: Nursing mothers Practice during Umbilical Cord Care 301

302

FREQUENCY N% How often do you clean the umbilical cord Which substance do you use to clean the umbilical cord Which of the cleaning methods do you adopt when cleaning the umbilical cord

3 times daily Once daily No cleaning at all After the nappy is changed Whenever it is necessary Methylated spirit Water Herbs Nothing Cleaning cord base before surrounding skin Cleaning cord and surrounding skin at the same time Cleaned cord stump only Cleaned the surrounding skin only Cleaned only the material used in tying the cord stump

170 (43.8%) 5 (1.3%) 1 (0.3%) 59 (15.2%) 153 (39.4%) 382 (98.5%) 6 (1.5%) (0%) (0%) 164 (42.2%) 217 (55.9%) 3 (0.8%) 3 (0.8%) 1 (0.3%)

303

304

305

306

307

308

309

Table 2b: Nursing mothers Practice during Umbilical Cord Care 310

VARIABLE FREQUENCY (N%) FREQUENCY( N%) YES NO 311

312

Have you ever 380 (97.9%) 8 (2.1%) 313

cleaned your baby’s 314

umbilical cord? 315

316

What do you do to 317

your hands before 318

caring for the umbilical cord 319

It is not necessary to 320

wash hands attending 65 (16.8%) 323 (83.2%) 321

to the cord 322

323

Wash hands with 324

Water only before 101 (26%) 287 (74%) 325

attending to the cord 326

327

Wash hands with soap 154 (39.7%) 234 (60.3%) 328

and water 329

330


and water and air dry 332

333


and water and clean 335

336

with mother’s clothing 4 (1%) 384 (99%) 337

Clean hands with baby’s 338

wipes 339

340

341

60.80%

39.20%

Respondents level of Practice towards Umbilical cord care

Good

Poor

Table 3 342

The level of practice of respondents towards umbilical cord care was good 60.8% with a rating 343

scale of 13 and items of 5. Using a mean score of 14.8 and a standard deviation of 2.0. 344

345

Level Frequency N=388 Percentage % X(SD)

Good 236 60.8% 14.8(±2.0)

Poor 152 39.2%

Total 388 100

346

347

348

349

350

351

352

353

354

355

356

357

358

359

360

Figure 1: Respondent level of practice toward umbilical cord care 361

Materials Nursing Mothers Use for Care of The Umbilical Cord 362

Table 4. revealed that majority of the mothers received antenatal care from the General hospital 363

(63.4%), over half of the respondents (59.3%) delivered their last baby at the hospital while 364

(37.9%) delivered at health care centers, however (1.3%) of the respondents had their delivery at 365

the prayer house. Almost the entire number (96.1%) of the mothers responded that cord clamp 366

was used to tie the cord while (47.9%) and (35.8%) of the respondents observed the use of razor 367

blade and sterile scissors respectively to separate the baby from them after delivery. See Table 4 368

369

Table 4a: Materials used by mothers in caring for the umbilical cord 370

VARIABLES FREQUENCY N (%) Where did you receive antenatal care Where did you deliver your last baby Which of the following was used in tying the cord after delivery What was used to separate your baby from you after delivery

Primary Health Care Center General Hospital Teaching Hospital Traditional Birth Attendants Church Prayer House Hospital Health Care Center At Home Thread String of cloth Cord Clamp I don’t know Razor blade Sterile scissors I don’t know

73 246 66 3 6 1 230 147 4 5 8 373 2 186 139 63

(18.8%) (63.4%) (17%) (0.8%) (1.5%) (1.3%) (59.3%) (31.9%) (1.0%) (1.3%) (2.1%) (96.1%) (0.5%) (47.9%) (35.8%) (16.2%)

371

372

Table 4b: Materials used by mothers in caring for the umbilical cord 373

VARIABLE Yes% No% What materials do you apply after cleaning the cord

Dusting powder Engine oil Palm oil Cow dung Sand Breast milk Salt Iodine Palm wine Vaseline Dettol Methylated Spirit with cotton wool Warm water Herbs Chlorhexidine digluconate Nothing

14(3.6%) 58(14.9%) 88(22.7%) 37(9.5%) 143(36.9%) 72(18.6%) 87(22.4%) 73(18.8%) - 72(18.6%) 9(2.3%) 204(52.6%) 132(34%) 116(29.9%) 131(22.8%) 97(25%)

374(96.4%) 330(85.1%) 300(77.3%) 351(90.5%) 245(63.1%) 316(81.4%) 301(77.6%) 315(81.2%) 388(100%) 316(81.4%) 379(97.7%) 184(47.4%) 256(66%) 272(70.1%) 257(66.2%) 291(75%)

374

375

376

377

378

379

380

381

382

383

384

385

386

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

∙ Cord clamp ∙ Thread from cloth

Elastic band

79.40%

20.10%

0.50%

Materials used for care of the umbilical cord 387

388

389

390

391

392

393

394

395

396

397

398

399

400

Figure 2: Materials used for care of the umbilical cord 401

402

403

404

405

406

407

408

409

410

411

412

413

414

415

3.1. Summary of Descriptive Statistics 416

The mean score for knowledge with standard deviation is (20.06±1.7) using a rating score of 24; 417

0 as minimum, maximum score 24 (0-24 points). The mean scores show that they respondents 418

have average knowledge regarding standard cord care. 419

The mean score for attitude with a standard deviation is (19.7±3.9). This was done using a 420

maximum and minimum scale of 0-30 points using a 5 Likert scale (SA-5, A-4, U-3, SD-2, D-1) 421

with a sum of 6 items. 422

With regards to practice, the mean score and standard deviation is (14.8 ±2.0). This result was 423

gotten using a maximum and minimum scale of 0-13 items. 424

425

426

Table 5: Descriptive Summary 427

Mean Standard deviation

Knowledge 20.06 ±1.70 Attitude 19.7 ±3.9 Practice 14.8 ±2.0

428

The mean age for nursing mothers in this study is 29.7 429

430

431

432

433

434

435

436

437

438

439

440

3.2. Test of Hypothesis 441

Decision rule: These rules will be used for deciding which hypothesis to accept after the tests 442

statistics at the 0.05 level of significance (Sig). Note: Ho = Null Hypothesis and Hi= alternative 443

hypothesis 444

Using P-value 445

If P-value< 0.05, reject Ho and accept Hi 446

If P-value> 0.05, reject Hi and accept Ho 447

448

449

Null Hypothesis –Ho 450

H1 There is no significant relationship between number of children and umbilical cord care 451

practice. 452

H2 There is no significant relationship between income and umbilical cord care practice. 453

H3 There is no significant relationship between educational level and umbilical cord care 454

practice. 455

456

Alternative hypothesis-Hi 457

H1 There is significant relationship between numbers of children and umbilical cord care practice 458

H2 There is significant relationship between income and umbilical cord care practice 459

H3 There is significant relationship between educational level and umbilical cord care practice. 460

461

462

463

464

465

466

467

468

Table 6: Correlation between Respondents number of children and umbilical care practice 469

Number of children

Umbilical cord care practice Pearson correlation

Sig. (2-tailed)

N

.488

0.00

388

470

**. Correlation is significant at the 0.01 level (2-tailed). 471

*. Correlation is significant at the 0.05 level (2-tailed). 472

473

474

475

476

Table 7: Correlation between Respondents income per month and umbilical cord care 477

practice 478

Income per month

Knowledge Pearson correlation

Sig. (2-tailed)

N

.587

.000

388

479



482

483

484

485

486

487

Table 8: Correlation between Respondents level of Education and practice towards 488

umbilical cord care 489

Level of Education

Knowledge Pearson correlation

Sig. (2-tailed)

N

-.119**

.019

388

490



493

The tables above revealed a significant relationship between age, level of education, income per 494

month, number of children and the practice of umbilical cord care in Calabar metropolis, Cross 495

River State. The calculated p-value and r respectively for age=0.000 < 0.05, and 0.284<1; for 496

number of children= 0.000 < 0.05 and 0.488<1; for income per month= 0.000 < 0.05, and 497

0.587<1 and for educational level= 0.019 < 0.05 and -0.119<1 were significant at 5% (95% level 498

of confidential interval). Therefore, the relationship between age, income earn per month, number 499

of children, educational level and umbilical cord care practice among nursing mothers in Calabar 500

metropolis, Cross River State were statistically significant. Hence, null hypothesis in this finding 501

was rejected. 502

4. Discusssion 503

The study showed that respondent’s level of practice towards umbilical cord care was good. 504

More than half of the mothers cleaned the cord with methylated spirit which is in consonant 505

with the study carried out by [16] where most of the respondents used Methylated spirit to 506

clean the cord. Also a study carried out in Port Harcourt by Opara, Jaja, Okari, Two hundred 507

(95.3%) of the mothers used methylated spirit to clean the cord. With regards to the 508

technique used to clean the cord, most of the nursing mothers cleaned the cord base and the 509

surrounding skin at the same time this practice can create a medium through which pathogens 510

can make its way into the umbilical stump and thus can lead to the spread of infection. These 511

findings may not be linked to source of knowledge of cord care where a good percentage of 512

the respondents had knowledge of cord care from the Nurses/Doctors. 513

On cleaning of the umbilical stump, majority of the mothers cleaned the cord stump only 3 514

times a day this is not in accordance with [25] which recommends on the average, that the cord 515

should be cleaned often as each diaper is changed. If this is not done it can pose a risk and lead 516

to the base of the cord being moist providing a nutritive culture medium for bacterial growth if it 517

is cleaned only once a day or even three times daily. 518

With regards to cleaning the hands before caring for the cord, the study revealed that 519

most mothers did not wash their hands with soap and water and air dry, this low percentage 520

which has been identified by the respondents on clean hand during cord management showed 521

evidence of unhygienic cord care. This finding is contrary to [25] recommendation on hand care 522

which is washing before and after cord care to prevent cord infection particularly neonatal 523

tetanus and omphalitis. A study carried out by [17] showed that 63.33 % wash hands before 524

handling stump and wash and clean napkins after each motion. This finding is in variance with 525

the finding from the study. 526

Findings from the study showed that cord clamp was used to tie the umbilical cord of the 527

infant as well as the use of sterile blade and surgical scissor to cut the cord. Methylated spirit was 528

the major substance used on the cord while cleaning by mothers. This signified good cord care 529

practice being carried out. This could be linked to the fact that most mothers received antenatal 530

care from the hospitals as well as the fact that most mothers delivered their babies in the hospital 531

thus influencing the material used; this might have had a role to play in the materials used for 532

cord care. A few respondents from the study used harmful materials on the umbilical cord after 533

discharge from the hospital this be due to the fact of the respondents had their delivery at a 534

prayer house or at home, this practice places the baby at risk of umbilical cord infection. This is 535

because the devitalized tissue of the cord stump can be an excellent medium for bacteria 536

especially if it is moist and unclean substances are applied to it [11]. 537

These findings are in coherence with a study carried out by [16] who clearly indicated the 538

material used on the umbilical cord; 279 (62 %) used cord clamp to tie the umbilical cord, 187 539

(41.6%) used sterile scissors/surgical blades to sever the cord and 224 (49.8%) of the 540

respondents used methylated spirit to clean the cord. 541

542

For the respondents who use unsafe/unhygienic materials on the cord, These findings are in 543

agreement with [26] who documented that babies delivered in hospitals may be affected by 544

traditional practices after discharge as care of the cord during neonatal period is provided by 545

mother and mother in-law. This finding is in line with the report from [24] carried out a study in 546

Konduga local Government Area of Borno State, Nigeria on practices of cord care in the area 547

Findings revealed that substances used by mothers in cord care include, the application of hot 548

fermentation, , use of Vaseline, palm oil. Indicating that the practice level was low. This was 549

done in a semi urban setting similar to the area used for the study. 550

Studies conducted in Nepal, Bangladesh and Pakistan have shown that cleansing the cord with 551

Chlorohexidine(CHX) a widely used antiseptic, significantly reduces incidence of omphalitis and 552

mortality in newborns. This finding is similar to the study where a few mother acknowledge 553

knowing about chlorhexidine and less than half of this mothers actually applied it on the 554

umbilical cord of their babies and majority of them idnt know it can be used to prevent infection. 555

The more educated the respondents, the more clean cord care would be adopted. 556

The higher the income, the cleaner cord care will be practiced. 557

The more children the mothers have, the inclination to carry out clean cord care practice based 558

on the experience they have. 559

560

561

5. Conclusion 562

In conclusion, There was significant relationship between income, level of education, number 563

of children and cord care practice. 564

565

COMPETING INTERESTS 566

Authors have declared no competing interests. 567

568

569

REFERENCE 570

[1] London, M.L., Ladewig, P.W., Ball, J.W., & Bindler, R.C. (2007). Maternal & Child 571

Nursing Care (2nd ed). Upper Saddle River: Pearson. 572

573

[2] Association of Women’s Health, Obstetric and Neonatal Nurses. (2007). Evidence based 574

clinical practice guideline: Cord care. Neonatal Skin Care: Evidence-Based 575

clinical Practice Guideline (2nd ed). Washington D.C. AWHONN. 576

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[3] McKinney, E.S., James, S. R., Murray, S.S. & Ashwill, J.W. (2009). Maternal – Child 578

Nursing (3rd ed). St. Louis: Elsevier. 579

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[4] Abba, K. T. (2008). Management of Puberty and Child Birth. Philadelphia: Saunders. P 25-581

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District, Bangladesh: Implication for Promotion of Umbilical Cleansing with 583

Topical Chlorhexidine. Biomedical Journal 17(8): 13 -16. 584

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[5] Evens, K., George, J., Angst, D., & Schweig, L. (2004). Does umbilical cord care in preterm 586

infants influence cord bacterial colonization or detachment? Journal of perinatology (24), 100-587

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[6] McConnell, T.P., Lee, C.W., Couillard, M. & Sherrill, W.W. (2004). Trends in 591

umbilical cord care: Scientific evidence from practice. Newborn and Infant Nursing 592

Reviews, (4), 211-222. 593

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[7] Suliman, A. (2007). Triple dye plus alcohol versus triple dye alone for newborn umbilical 595

cord care. Pennsylvania State Milton S. Hershey Medical Center, Clinical Trials.gov identifier: 596

NCT00127699. 597

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[8] Trotter, S. (2004). Care of the newborn: Proposed new guidelines. British Journal of 599

Midwifery, 12(3), 152-157. 600

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[9] Vural, G. & Kisa, S. (2006). Umbilical cord care: A pilot study comparing topical human 602

milk, povidone - iodine, and dry care. Journal of Obstetrics, Gynecology and Neonatal Nursing 603

(35), doi: 10.1111?J.15526909.2006.00012. 604

605

[10] Zupan, J. Garner, P. Omari, A. (2004). Topical umbilical cord care at birth. Cochrane 606

Database of Systematic Reviews (3), doi: 10.1002/14651858CD001057,pub2. 607

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[11] Bemor, F & Uta, D. (2011). Saving Newborn Lives in Nigeria: Integrated Health Strategy. 610

Global Journal 74(6): 21-26. 611

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[12]Obuekwe, T. R. & Obuekwe, E. (2008). Identifying Indigenous Health Technology Used By 613

women in a Rural Community in Nigeria on the Stumps of Newborns: An Increase in 614

Cord Infection and Neonatal Tetanus. Clinical Pediatr 36:648-652. 615

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[13] Moyer C. A., Aborigo R. A., Logonia G., Affah G., Rominski S., Adongo P. B., Williams J., 617

Hodgson A., Engmann C. (2012). Clean delivery practices in rural northern Ghana: a qualitative 618

study of community and provider knowledge, attitudes, and beliefs. BMC Pregnancy 619

Childbirth.doi: 10.1186/1471-2393-12-50 620

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[14] Eregie C. O., Ofovwe G. (1993). Cluster survey on neonatal tetanus mortality in Nigeria: 622

observation on some clinical aspects. Journal of Tropical Pediatrics, 39(6):372-3. 623

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[15] Andrews J. Y. and DalalK . (2011). Umbilical cord-cutting practices and place of delivery 626

in Bangladesh. International Journal Gynaecology and Obstetrics,114(1):43-6. Epub 2011 May 627

14. 628

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[16] Osuchukwu, Easter Chukwudi (2014). Umbilical cord care and management outcome 630

among mothers in Calabar south local government area, Cross river state, Nigeria. 631

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[17] Saraswati Sharma, Paudyal (2016). Knowledge and Practice of Postnatal Mothers on 633

Newborn Care at Hospital Setting. ARC Journal of Nursing and Healthcare (AJNH) 634

Volume 2, Issue 1, 2016, PP 25-30 ISSN 2455-4324. 635

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[19] Jamila, Abuidhail (2004). Rural Jordanian Mothers; Beliefs, Knowledge and Practices of 637

Postnatal Care. Quality in Primmary Care; 22 (6): 285-9 638

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[18] Mueller, H. & Johnson, M. (2009) Avoiding Neonatal Deaths: An Intervention Study of 641

Umbilical Cord management. Journal of Tropical Pediatrics 23 (4): 50 – 54 642

643

[20] Yadav, M. K. (2013). A Study to Assess the Knowledge, Practices and Attitude of 644

Primigravida Mothers on Newborn Care at JJR Maternity Centre. Karnataka, Bangalore, India. 645

646

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[21] Opara, P. I., Jaja, T., Dotimi, A. D., & Alex Hart, B. A. (2011). Newborn Cord Care 648

Practices amongst Mothers in Yenogoa Local Governmental Area, Bayelsa State, Nigeria. 649

International Journal of Clinical Medicine , 22 - 27. 650

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[22] M Mukhtar-Yola, Z Iliyasu, BJ Wudil (2011). Survey of Umbilical cord care and separation 653

time in healthy newborns in Kano. Nigerian Journal of Paediatrics: vol38, No4. 654

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[23] Mullany, L.C., Darmstadt, G.L., Katz, J., Khatry, S.K., LeClerq, S.C., Adhikari, R.K., et al. 656

(2009) Risk of Mortality Subsequent to Umbilical Cord Infection among New-Borns of Southern 657

Nepal: Cord Infection and Mortality. The Pediatric Infectious Disease Journal, 28, 17-20. 658

http://dx.doi.org/10.1097/INF.0b013e318181fb4c 659

660

661

[24] Ambe, J., Bello, M., Yahaya, S. & Omotora, B. (2010). Umbilical Cord Practices in 662

Konduga Local Government Area of Bornu State, North East Nigeria. Journal of 663

Tropical Medicine 9 (6): 87 – 92. 664

665

[25] World Health Organization (2007). Review of Evidence on Cord Care Practices. 666

Available At http://www.who.int Accessed Jan 18. 2010 667

668

[26] Sreeramaraddy, C. T., Josh, I. Sreekumaran & Giri (2006). Newborn Care among Urban 669

Women in Western Nepal. Clinical Pediatr. 19 (71): 34 – 38. 670

671

672

673

674

675

QUESTIONNAIRE 676

677

Dear Respondents, 678

679

I am Udosen Idorenyin a final year student of Babcock University in 400l. As a requirement for 680

completion of my degree, I am required to carry out a research. My research topic will be on 681

PRACTICE OF NURSING MOTHERS TOWARDS UMBILICAL CORD CARE. This 682

questionnaire is designed to study and determine the umbilical cord care among mothers in 683

Calabar metropolis, Cross River State. Nigeria. The questionnaire is purely designed for 684

academic purpose and all the information collected will be kept strictly and treated with optimum 685

confidentiality. The researcher will appreciate genuine, specific and clear answers. 686

Thanks for your time and cooperation. 687

688

SECTION A: DEMOGRAPHIC VARIABLE 689

Instruction: Instruction: Please tick ( ) the appropriate response to the following questions 690

1. Age at last birthday……………………………………………… 691

2. Tribe (ethnicity): A. Igbo ( ) B. Yoruba ( ) C. Hausa ( ) D. Efik ( ) E. Ibibio ( ) 692

3. Marital status: A. Married ( ) B. Single ( ) C. Separated ( ) D. Divorced ( ) E. Widowed ( ) 693

4. Number of children 694

A. 1 ( ) B. 2 ( ) C. 3 ( ) D. 4 ( ) E. 5 and above ( ) 695

5. Age of infant………………………………………………………… 696

6. Religion: A. Christianity ( ) B. Muslim ( ) C. Traditionalist ( ) 697

7. Highest Educational attainment 698

A. No schooling ( ) B. primary ( ) C. Secondary ( ) D. Tertiary ( ) E. Post-graduate ( ) 699

8. Occupation: A. Farming ( ) B. Hair dressing ( ) C. Petty trading ( ) D. House wife ( ) 700

E. Student ( ) F. Civil servant ( ) 701

9. Income per Month: A. Less than N18, 000.00 ( ) B. N19, 000.00 - N30, 000.00 ( ) 702

C. More than N31, 000.00 ( ) D. No salary 703

704

SECTION B: KNOWLEDGE VARIABLE TOWARDS UMBILICAL CORD CARE 705

Instruction: Please tick ( ) the appropriate response to the following questions 706

10. Have you ever heard of umbilical cord care? Yes ( ) No ( ) 707

11. Where did you hear about umbilical cord care A. Nurse/Doctor ( ) B. Traditional Birth 708

Attendants ( ) C. Mother/Mother-in-law ( ) D. Friends ( ) 709

12. What does umbilical cord care mean? 710

A. not applying anything to the cord till it falls off ( ) 711

B. use of herbal preparations 712

C. tying, cutting and cleaning with methylated spirit and a cotton bud ( ) 713

D. keeping the baby away from family members ( ) 714

13. What substance should be used in cleaning the umbilical cord? 715

A. The use of methylated spirit only while cleaning the cord ( ) 716

B. Apply nothing until the cord falls off ( ) 717

C. Place herbs on the Umbilical cord care ( ) 718

D. Use of hot water ( ) 719

14. After cleaning the umbilical cord, should it be left exposed by folding the diaper under the 720

umbilical cord? Yes ( ) No ( ) 721

15. Instruction: Please tick ( ) the appropriate response to the following questions 722

S/N Which of the following can lead to cord infection?

YES NO

A When the umbilical stump is moist. B When unhygienic materials are placed on

the cord. e.g. herbs, palm oil.

C When the baby is given a sponge bath. D Placing the baby completely in water

when giving the baby a bath.

723

16. Have you heard about Chlorhexidine diglumate (ointment)? Yes ( ) No ( ) 724

17. Can Chlorhexidne diglumate be used to prevent umbilical cord infection? Yes ( ) 725

No ( ) 726

18. What materials should be used to tie the umbilical cord? 727

Please tick ( ) the appropriate response to the following questions 728

S/N MATERIALS RESPONSE

A Cord clamp

B Thread from cloth

C Elastic band

D Hair strand E Narrow tapes 729

730

19. How long does it take the umbilical cord to detach? 731

A. 3-4 days ( ) B. 5-15 days ( ) C. 4 weeks ( ) D. 5 weeks and above ( ) 732

20. Why is it important to care for the umbilical cord? 733

A. to prevent infection 734

B. to prevent evil spirits 735

C. to prevent abdominal pain 736

D. I don’t know 737

738

SECTION C: ATTITUDE VARIABLE TOWARDS UMBILICAL CORD CARE 739

Instruction: Please tick () the appropriate response to the following questions. Where SA-740

STRONGLY AGREE, A-AGREE, SD-STRONGLY DISAGREE, D-DISAGREE , 741

UNDECIDED-U. 742

S/N Attitude nursing mothers have towards umbilical cord care A SA U D SD 21 Baby’s umbilical cord requires special care 22 The appearance of the umbilical cord is scary which

prevents me from cleaning it

23 I am scared to clean the umbilical cord when it is shrinking. 24 I clean the cord only when it is has an offensive odor.

25 I clean the umbilical cord only when I change my baby’s diaper.

26 My cultural belief influences the way in which I clean the umbilical cord.

743

SECTION D: PRACTICE VARIABLE ON UMBILICAL CORD CARE. 744

Instruction: Please tick ( ) the appropriate response to the following questions. 745

27. Have you ever cleaned your baby’s umbilical cord? 746

Yes ( ) No ( ) 747

28. How often do you clean the umbilical cord? 748

A. 3 times daily ( ) 749

B. Once daily ( ) 750

C. No cleaning done at all ( ) 751

D. After the nappy is changed ( ) 752

E. Whenever it is necessary ( ) 753

29. What do you do to your hands before caring for the umbilical cord? 754

S/N METHOD RESPONSE A It is not necessary to wash hands before attending to the

cord

B Wash hands with water only before attending to the cord C Wash hands with soap and water D Wash hands with soap and water and air dry E Wash hands with soap and water and clean with mothers

wrapper

F Clean hands with baby’s wipes 755

30. Which substance do you use to clean the umbilical cord? 756

A. Methylated spirit ( ) B. Water ( ) C. Herbs ( ) D. Nothing ( ) 757

758

759

31. Which of the cleaning methods do you adopt when cleaning the umbilical cord? 760

A. Cleaning cord base before surrounding skin ( ) 761

B. Cleaning cord and surrounding skin at the same time ( ) 762

C. cleaned cord stump only ( ) 763

D. cleaned the surrounding skin only ( ) 764

E. cleaned only the material used in tying the cord stump ( ) 765

766

SECTION E: Materials used for cord care. Instruction: Please tick ( ) the appropriate 767

response to the following questions. 768 769

32. Where did you receive antenatal care? 770

A. Primary health care center ( ) B. General Hospital ( ) 771

C. Teaching hospital ( ) D. Traditional birth attendants 772

33. Where did you deliver your last baby? 773

A. Church ( ) B. prayer house ( ) C. Hospital ( ) D. health care center ( ) E. at Home ( ) 774

F. Traditional Birth Attendant ( ) 775

34. Which of the following was used in tying the umbilical cord after delivery? 776

A. Twine ( ) B. String of cloth ( ) C. Cord clamp ( ) D. I don’t know ( ) 777

35. What was used to separate your baby from you after delivery? 778

A. knife ( ) B. Razor blade ( ) C. Sterile scissors ( ) D. I don’t know ( ) 779

36. What materials do you apply after cleaning the cord? 780

(Instruction: You can tick ( ) more than one response) 781

S/N MATERIALS RESPONSE A Dusting powder B Engine oil C Palm oil D Cow dung E Sand F Breast milk G Salt H Iodine I Palm wine J Vaseline K Dettol L Methylated spirit with cotton wool M warm water N Herbs O Chlorhexidine diglumate P Nothing 782 783

784

785

786

1 practice of nursing mothers towards umbilical cord care

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