Umbilical cord care in Ethiopia and implications for behavioral change: a qualitative study

Abstract

BackgroundInfections account for up to a half of neonatal deaths in low income countries. The umbilicus is a common source of infection in such settings. This qualitative study investigates practices and perspectives related to umbilical cord care in Ethiopia.MethodsIn-depth interviews (IDI) were conducted in a district in each of the four most populous regions in the country: Oromia, Amhara, Tigray and Southern Nations, Nationalities and Peoples Region (SNNPR). In each district, one community was purposively selected; and in each study community, IDIs were conducted with 6 mothers, 4 grandmothers, 2 Traditional Birth Attendants and 2 Health Extension Workers (HEWs). The two main questions in the interview guide related to cord care were: How was the umbilical cord cut and tied? Was anything applied to the cord stump immediately after cutting/in the first 7 days? Why was it applied/not applied?ResultsThe study elucidates local cord care practices and the rational for these practices. Concepts underlying cord tying practices were how to stem blood flow and facilitate delivery of the placenta. Substances were applied on the cord to moisturize it, facilitate its separation and promote healing. Locally recognized cord problems were delayed healing, bleeding or swelling. Few respondents reported familiarity with redness of the cord - a sign of infection. Grandmothers, TBAs and HEWs were influential regarding cord care.ConclusionsThis study highlights local rationale for cord practices, concerns about cord related problems and recognition of signs of infection. Behavioral change messages aimed at improving cord care including cleansing with CHX should address these local perspectives. It is suggested that HEWs and health facility staff target mothers, grandmothers, TBAs and other community women with messages and counseling.

Surgical affections of cattle in the milk-shed areas of Bangladesh

“…Newly born calves are also exposed to huge organisms, causing navel ill. The umbilicus is contaminated from wet floors, leading to septicemia in neonates (Amare, 2014). Joint ill is a common condition of calves that can cause 6% mortality in calves of Africa (Wudu et al, 2008).…”

“The cord is the child”: meanings and practices related to umbilical cord care in Central Uganda

“…Underlying most umbilical practices was the desire to have the umbilical cord separate as fast as possible, in order to reduce the period of anxiety but also to ensure wholeness of the body through the closure of the umbilical cord. The desire of mothers to have the umbilical cord separate quickly has been reported in a number of studies from Uganda, Zambia, Ethiopia and other parts of Africa [2,6,[34][35][36][37]. The umbilical cord also produced secretions which mothers were uncomfortable with.…”

Dry care versus chlorhexidine cord care for prevention of omphalitis. Systematic review with meta-analysis

“…Depending on where the birth takes place, the UC cutting technique is performed with the use of a new or boiled razor blade 35 - 36 , and this, together with the lack of hand washing before the intervention 35 increases the risk of infection, especially in home deliveries. Researchers are aware that efforts to promote hand washing, cut the umbilical cord with the use of clean instruments and avoid unclean domestic interventions can reduce exposure to infectious agents and improve neonatal outcomes 37 .…”