Effect of a supportive-educative nursing intervention programme on knowledge of chlorhexidine gel for umbilical cord management amongst mothers in Cross River State, Nigeria

Abstract

The global prevalence of neonatal infection remains high and accounts for one-third of neonatal deaths (1.5 million), with umbilical cord infection as the major risk factor, especially in low-income countries. 1,2 Hospital-based studies in Nigeria revealed that umbilical cord infections account for about 10% -19% of neonatal admissions, resulting in 30% -49% of deaths in neonates. 3 Nigeria therefore ranks the second highest globally, with 276 000 deaths annually resulting from umbilical cord infection. 4,5 In Cross River State, umbilical infection is responsible for 36% of hospital admissions and 45.2% of neonatal deaths. 6 The situation in Nigeria is also typical of other African countries like Tanzania, with neonatal sepsis accounting for 27% -56% of neonatal mortality annually and umbilical cord infection as the major cause of infection. 7 Umbilical cord infection causing about 30% of neonatal mortality was also reported in a related study. 8 Although cord cleansing after delivery is viewed as mainstay of neonatal care, the substances and method of application are not consistent with the best practice guidelines. 9 The increased neonatal mortality rate occasioned by umbilical cord infection has necessitated the recommendation of chlorhexidine (CHX) gel for cord management, which was first introduced by the World Health Organization (WHO) in Geneva on 29 September 2008 but is still poorly used in communities with high neonatal motility. 10 This is particularly indicated for neonates during the first week of life in countries or settings with high neonatal mortality (≥ 30 neonatal deaths per 1000 live births).Background: Umbilical cord infection contributes significantly to neonatal mortality rate in sub-Saharan Africa. Studies have shown low knowledge of chlorhexidine (CHX) gel for umbilical cord management amongst mothers in low-resource settings, including Nigeria.Objective: The objective of this study was to assess the effectiveness of a supportive-educative nursing intervention programme on knowledge of CHX gel amongst mothers in Cross River State, Nigeria. Methods:A quasi-experimental study design was used, and study participants comprised 168 expectant mothers, who were purposely selected and assigned to randomised control and intervention groups. The instrument for data collection was a researcher-developed structured questionnaire. The data were analysed using Statistical Package for Social Sciences version 23 for descriptive and inferential statistics at significant level was set at p < 0.05. Results:The result showed that at post-test the knowledge score of mothers on CHX gel improved significantly in the intervention group (t 77 = 24.394; p < 0.05). The result showed no significant difference between mothers' demographic variables and knowledge of CHX gel. Conclusion:A supportive-educative nursing intervention programme could effectively improve knowledge of CHX gel for umbilical cord management amongst mothers. This underscores the need to improve mothers' knowledge of CHX gel by healthcare personn...

Sociocultural practices, beliefs, and myths surrounding newborn cord care in Bayelsa State, Nigeria: A qualitative study

“…Some believed hospitals were a good option while others felt the use of herbal remedies would take care of any cord-related infections. Concerning the management of cord infections, our findings are similar to those of Osuchukwu, et al [ 31 ] which showed that only a few caregivers visited the hospital when the cords were infected while the majority managed the infections at home with herbs. Muella and Johnson [ 34 ] found that only few mothers treated cord infections in the hospital as against the numerous others that preferred to manage their babies at home.…”

“…Some participants mentioned death of children as one of the complications from improper care of baby's cord. The complications of improper cord care experienced by the participants of this study are similar to those reported among mothers in Calabar in Cross River State, Nigeria by Osuchukwu, et al in 2018 [31]. The women in that study reported symptoms such as fever, red skin around base of cord and foul smell due to cord infection.…”

Predictors of knowledge and practice of newborn care among post-natal mothers attending immunisation clinics in Southeast Nigeria

“…12 In another study, poor knowledge of chlorhexidine gel for cord care in 62.8% of the mothers was found. 13 Similarly, in a study of forty health facilities, no newborn received the full package of essential newborn care. 14 In Ebonyi State, only 56.6% of women of reproductive age who had a live birth five years preceding the latest Demographic Health Survey delivered in a health facility; 58.3% had their deliveries attended by a skilled provider.…”

“… 11 Evidence from Nigeria, suggests suboptimal to moderate levels of knowledge and practice of essential newborn care. 12 , 13 For example in one study, 59.3% practiced immediate skin to skin contact while only 10.1% initiated breastfeeding within 30 minutes of birth. 12 In another study, poor knowledge of chlorhexidine gel for cord care in 62.8% of the mothers was found.…”

Knowledge and use of chorhexidine gel in umbilical cord care among postpartum women at Poly General Hospital, Enugu, Southeast Nigeria: a cross-sectional study

“…It has been affirmed in previous research that a supportive educative nursing intervention programme could effectively improve the knowledge of CHX gel for umbilical cord management among mothers. 36 …”