ABSTRACT
In Nigeria, just like in other developing countries, umbilical cord infections contribute significantly to neonatal morbidity and mortality. The increasing number of mothers returning to the health care facility with umbilical cord complications especially omphalitis in newborns makes this study in the state necessary. The study determined the factors influencing umbilical cord care practices of mothers attending infant welfare clinic in selected primary health care centres in Jos-North Local Government Area, Plateau State.
A descriptive cross – sectional design involving one hundred and seventy (170) respondents selected using simple random method, self-developed questionnaire and interview guide (Explanatory method) were used. The validated instrument (Cronbach’s alpha of .760) was filled voluntarily by the respondents and returned. Data collected were analyzed and presented as descriptive and inferential statistics using SPSS v21 at critical value of 0.05 as the level of significance.
Findings of the study revealed that majority of the respondents 66(38.8%) were between 20-29 years, 102(60%) were Christians, 100(58.8%) had monthly income below 10,000, 90(52.9%) had 4-6 number of children, 151(88.8%) were Hausa, and 100(58.8) had primary education. Majority of the respondents (90.5%) had adequate knowledge with mean score of = 1.1647 had good practice with mean score of = 1.2059 and majority of the respondents 121(71.2%) cover the umbilical cord loosely with clean cloths and 96(56.5%) practice two hourly cord care. Regarding substance/materials used by mothers, majority (75.9%) of mothers used methylated spirit and cotton wool, (58.8%) used string of cloth, (54.1%) used herbal solution and (45.3%) used new blade for cord care. There is significant relationship between maternal monthly income (p-value .001), level of education (p-value .000) and cultural and traditional beliefs (p-value .037) while occupation (p-value .460) and maternal parity (.054)does not influence umbilical cord care practice with variation of 16.8% and positive correlation of 0.410. Maternal income and level of education with negative low correlation of (-0.218, p-value of 0.016) and (-0.296, p-value of 0.000) is likely to reduce good core practice.
In conclusion, it is necessary to empower women so as to help them make decisions and become independent as maternal monthly income, level of education and knowledge influence umbilical cord care practices. Based on the findings, the study recommends that health care personnel should organize health education programs for women during antenatal postnatal visit and also training and re-training of Traditional Birth Attendants (TBAs) on hygienic cord care practices as well as monitoring and supervision of their delivery practices. Introduction and use of chlorhexidine gel for cord care in health care facilities by health care personnel. Government should ensure that public enlightenment program on hygienic cord care practices, the importance of tetanus vaccine to all child bearing age women, advantages of hospital delivery and the implication of cultural practices on health are carried out also regular and continuous provision of health facilities, logistics, equipment and skilled manpower to facilitate access to mothers.
Keywords: Practice, Mothers, Umbilical Cord Care, Assess, Newborn
Word Count: 474
v
TABLE OF CONTENTS
Content Page
Title page i
Certification ii
Dedication iii
Acknowledgements iv
Abstract v
Table of Contents vi
List of Tables vii
List of Figures viii
Appendices ix
CHAPTER ONE: INTRODUCTION
1.1 Background to the Study 1
1.2 Statement of the Problem 2
1.3 Objective of the Study 3
1.4 Research Questions 3
1.5 Hypotheses 4
1.6 Scope of the Study 4
1.7 Significance of the Study 4
1.8 Justification to the Study 4
iv
Content Page
1.9 Operational Definition of Terms 5
CHAPTER TWO: REVIEW OF LITERATURE
2.0 Introduction 6
2.1 Umbilical cord care overview 6
2.2 Determinant of umbilical cord practices 6
2.3 Types of substances used for umbilical cord care 8
2.4 Possible problems of umbilical cord stump 8
2.5 World Health Organization (WHO) recommendations 9
2:6:0 Related literatures to umbilical cord care practices 10
2:6:1 Knowledge of mother regarding newborn umbilical cord care 11
2:6:2 Practice of mothers regarding newborn umbilical cord care 12
2:6:3 General management of umbilical cord infection 15
2.1 Ramona Mercer: Maternal Role Attainment Conceptual Model 16
CHAPTER THREE: METHODOLOGY
3.0 Introduction 18
3.1 Research Design 18
3.2 Population 18
3.3 Sample size and Sampling Technique 18
3.4 Research Instrument 19
3.5 Reliability and Validity of Instrument 20
v
Content Page
3.6 Method of Data Collection 20
3.7 Method of Data Analysis 20
3.8 Ethical Consideration 21
CHAPTER FOUR: DATA ANALYSIS, RESULTS
AND DISCUSSION OF FINDINGS
4.0 Introduction 22
4.1 Socio-demographic information of respondents 22
4.2 Analysis of Research Questions 27
4.3 Hypothesis Testing 32
4.4 Discussion of Findings 35
CHAPTER FIVE: SUMMARY, CONCLUSION
AND RECOMMENDATIONS
5.0 Introduction 39
5.1 Summary 39
5.2 Conclusion 40
5.3 Recommendations 40
5.4 Limitation of the Study 40
5.5 Suggestion for Further Studies 40
REFERENCES 41
APPENDICES vi 47
LIST OF TABLES
Table Page
4.1 Socio-demographic data of the respondents 23
4.2 Interview guide on knowledge toward umbilical cord care 25
4.3 Interview guide on umbilical cord care practice 26
4.4 Mother’s knowledge on umbilical cord cares 27
4.5 Umbilical cord care practices of mothers 27
4.6 Substances/materials used for umbilical cord care 28
4.7 ANOVA table for factors influencing cord practice 29
4.8 Model summary for factors influencing cord practice 29
4.9 Coefficient table for factors influencing cord practice 29
4.10 Relationship between mother’s knowledge and practice of umbilical care 30
4.11 Correlations of knowledge and practice 30
4.12 Mean and standard deviation of knowledge and practice 31
4.13 Relationship between umbilical cord care practice and maternal parity 31
4.14 Correlations of maternal parity and practice 31
4.15 Hypothesis One 32
4.16 Correlation of practice and income 32
4.17 Hypothesis Two 33
4.18 Hypothesis Three 34
vii
LIST OF FIGURE
Figure Page
2.1 Maternal Role Attainment Model by Mercer 17
Viii
APPENDICES
Appendix Page
Inform Consent Form 46
Questionnaire used for this study 47
Ethical Clearance Certificate 50
Letter of Introduction 51
Evidence of Anti-plagiarism 52
CHAPTER ONE
INTRODUCTION
- Background to the Study
The first 28days in the infant’s life is a period of great significance as the newborn is fragile and susceptible to infection; hence they need to be handled carefully so as to prevent neonatal death or permanent deformity. Mothers as the primary care providers have very important role to play to ensure that these newborns develop optimally as the new born health and survival is dependant on the essential care received before, during and after delivery (Joel-Medewase, Oyedeji, Elemile, & Oyedeji, 2008).
Neonatal infection is a major cause of neonatal deaths as the mortality rate could be as high as 44 per thousand life-births in the north-east zone of Nigeria. Neonatal deaths, cord infection and sepsis can be prevented with good umbilical cord practices especially in areas where home deliveries are done. In developing countries such as Nigeria, umbilical cord infection accounts for significant number neonatal morbidity and mortality, this accounts for 276,000 neonatal deaths annually the second highest deaths in the world and in Nigeria alone it accounts for about 33% of neonatal mortality (Jabbi, Shoretire, Ojile, Maishanu & Orobaton, 2014; Soofi, Cousens, Imdad, Bhutto, & Ali, 2012; Orobaton, Abegunde, Abdulazeez, Akomolafe & Ganiyu, 2015; Osuchukwu, 2014).
The umbilical cord is a tissue that has a vein and two arteries of which at term is about 56cm in length and extends normally from the center of the placenta to the umbilicus of the unborn baby. During pregnancy, the umbilical cord connects the fetus to the mother through the placenta. The umbilical cord is responsible for the supply of blood rich in nutrients and oxygen from the mother to the fetus and the removal of carbon dioxide and other metabolites away from the fetus to the mother. Umbilical cord care is one of the most essential cares given to umbilical stump of newborns in the first few days of extra uterine life before the fall-off of the cord and immediately after its fall (Fraser & Cooper, 2009).
The availability of tetanus vaccine for pregnant women and topical application of antimicrobial agents should help reduce bacterial infection hence newborn deaths and improve the newborn health and wellbeing. Aside cleaning and drying of the umbilical cord stump, daily application of chlorhexidine 7.1% chlorhexidine digluconate aqueous solution or gel to the umbilical cord stump during the first week of life is strongly recommended for newborns who are born at home in settings with high neonatal mortality (30 or more neonatal deaths per 1000 live births) Chlorhexidine digluconate 7.1% gel was used by 36,404 newborns delivered by 36,370 mothers to help reduce such neonatal deaths in Sokoto State, North West Nigeria, this low cost but highly effective gel used for the prevention of newborn sepsis should be made available in all delivery settings so as to reduce umbilical cord infection and then neonatal death (Enang, Ushie, Arikpo, Osonwa, Esu, Odey, et al., 2013; Mullany, Darmstadt & Tielsch, 2003; Orobaton et al., 2015).
Unqualified personnel provide health care services to majority of women especially during pregnancy, child birth and after child birth as there is lack of skilled personnel, needed resources and availability of essential drugs that has increased neonatal and childhood deaths. To achieve a healthy and productive society it is important to pay attention to the health and wellness of the newborn as this will help reduce neonatal and newborn mortality and morbidity. In 2013, in Johannesburg, South Africa, an International Conference on Maternal, Newborn and Child Health was held so as to bring about concrete actions for improving MNCH in Africa. Maternal and child care during pregnancy, child birth and post partum is a major strategy to improve child survival as low socio-cultural barriers to care, weak health care system and poor socio-economic development influence maternal and child health (Ezechi & David, 2012)
- Statement of the Problem
The future of any nation lies on the present generation, their health and welfare can be altered by activities that occur either before, during or after delivery. Newborn health and survival is partly dependent on the mother’s decisions on where to deliver and actions or activities taken after delivery. In most rural communities, deliveries and child care activities are mostly managed at home where about 69.8% of care providers used unhygienic and harmful materials for cord care (Osuchukwu, 2014).
In Nigeria, cases of umbilical cord infections are under documented and reported. But for some studies conducted in the hospital, in Port Harcourt, omphalitis constitute 10% reasons of neonatal admissions and 30% of neonatal deaths. In Ibadan it constitute about 18% of neonatal deaths while in Calabar, 49% of neonatal deaths were linked to omphalitis. Neonatal death every year in Nigeria is about 241,000 making it the highest neonatal death rate in African. In Africa, annually about 600,000 infants die of neonatal tetanus. Global annual neonatal deaths constitute about 4million (3.1%) and about (25%) of these deaths are due to umbilical infection. Similar studies have been conducted in other part of the country so the researcher intends to explore the factors influencing umbilical cord care Plateau state, due to the increasing number of mothers returning to the health care facility with umbilical cord complications especially omphalitis in newborns (Federal Ministry of Health, 2009; Osuchukwu, 2014).
1.3 Objective of the study
The general objective is to assess the factors influencing umbilical cord care practices among mothers attending infant welfare clinic in selected primary health care centres in Jos-North Local Government Area, Plateau State. The specific objectives are to:
- determine the level of knowledge of mothers on umbilical cord care;
- assess cord care practices among mothers attending infant welfare clinic;
- identify the substances/materials used for umbilical cord care by mothers;
- determine the factors that influence umbilical cord care practices of mothers;
- identify the association between mother’s knowledge and practice of umbilical cord care and
- assess the association between umbilical cord care practice and maternal parity.
1.4 Research Questions
- What is the level of mother’s knowledge on umbilical cord care?
- What are the umbilical cord care practices of mothers attending infant welfare clinic?
- What are the substances/materials used by mothers for umbilical cord care?
- What factors influence umbilical cord care practices?
- What is the relationship between mother’s knowledge and practice of umbilical care?
- What is the relationship between umbilical cord care practice and maternal parity?
1.5 Hypotheses (at 0.05 level of significance)
Ho: Maternal monthly income is not significantly related to their cord care practices.
Ho: Maternal level of education is not significantly related to their cord care practices.
Ho: There is no significant difference among mother’s ethnicity and their practice of umbilical cord care.
1.6 Scope of the Study
This study was limited to nursing mothers who are attending infant welfare clinic in selected primary health care centres in Jos-North Local Government Area, Plateau state.
1.7 Significance of the Study
The findings of this study might be used to educate pregnant women and mothers on the importance of good umbilical cord care practices, as well as health care providers and TBAs to buttress the need for hygienic umbilical cord care practices and enlighten the general public on the harmful effect of some substances used by mothers.
1:8 Justification for the Study
Newborns’ are susceptible to infections because the neonates have low immunity and the presence of the raw site of the remains of the umbilical cord. Mothers who are the primary care givers must have the appropriate knowledge about this care and using the correct interventions. In 2011 report, it was discovered that nearly 7 million children died before age five every year. Most of these deaths were preventable and two-third of it occurred from infectious disease (UNICEF, 2014). Infection accounts for about 1.5 million newborn deaths occurring in the first 28 days of life worldwide annually and for such infections umbilical cord infection is one. Poor knowledge and incorrect umbilical cord care practices increase the risk for neonatal infections such as sepsis and tetanus which accounts for 37% of neonatal death (WHO, 2013). Neonatal infections pose a serious threat to every new born and even the mother who might spend ample periods of her postnatal period in the hospital environment and still have to meet financial obligations. In most developing countries, Neonatal tetanus is still deadly despite the availability of vaccine to prevent such disease. There is still high prevalence rate of NNT in 2013 of about 28.815% in the northern part of Nigeria. Apart from been delivered by an unskilled health provider, unhygienic delivery and umbilical cord care practices in Nigeria contribute to the high rate of neonatal morbidity and mortality rate (Saleh, Nemecek & Jones, 2015).
1.9 Operational Definition of Terms
Practice: Any substance applied to the umbilical cord.
Cord care: cleaning the cord of a newborn to keep it clean and aid healing.
Mothers: a female adult left with the responsibility of caring for newborn.
Newborn: an infant less than 6 months of life.
Assess – getting information on umbilical cord care knowledge and practice
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