Report writing

Awareness about Practices used to clean Umbilical Cord

Group-3
Submitted to Mam Fuldisia
Submitted by:
Talat Mushtaq
Hasnain Qayyum
Mehwish Khan
Zohra Bibi
Mishal Arshad
Iqra Rehman
Introduction
Mortality among children especially between 5 and 15 days after birth. Where

newborns has become one of the global clean cord care is not practiced, the cord is

concerns. It is known that neonatal mortality colonized and infected by pathogenic

and morbidity have remained high in many organisms. The umbilical cord is an

settings but the situation is worse in important bacterial colonization site. A

developing countries. The World Health possible consequence of bacterial

Organization reported that the vast majority colonization is cord stump infection, a factor

of newborn deaths take place in developing that can greatly increase morbidity and

countries where access to health care is low mortality. Tracking bacteria along the

and the main causes of newborn deaths are umbilical vessels may lead to septicemia,

prematurity, low birth weight, infections, which can result in neonatal morbidity and

asphyxia and birth trauma. Consequently, mortality. The risk of infection increases

improving newborn survival is a global until the stump detaches (López-Medina et

priority (Mallick et al., 2019). The umbilical al., 2020). The risk of cord infection is

cord, which connects the baby and placenta increased by unhygienic cutting of the cord

in the uterus, is made of blood vessels and and application of unclean substances such

connective tissue. It is covered by a as sand mixed with saliva, herbal

membrane that is normally bathed in preparations, and lantern wax. Even babies

amniotic fluid. After birth, cutting the cord delivered in hospitals may be affected by

physically and symbolically separates the traditional practices after discharge which

mother and her baby. The cord stump dries most times lead to umbilical cord infection

and falls off, and the wound heals. With and death among the neonates. Little is

standard care, the cord usually falls off known on the risk factors for umbilical cord
infection especially in the developing medicine, and cow dung These practices

countries. However, some of the common often take place under unsterilized

risk factors for the development of neonatal conditions; hence, they increase the risk of

omphalitis include low birth weight, umbilical infection and neonatal tetanus

prolonged rupture of membrane, umbilical (Merga et al., 2022). It is imperative to

catheterization, and chorioamnionitis. Some assess the knowledge of UCC and its

harmful traditional practices such as the use practices among women at the lowest level

of old razor blade, an old knife, sharp of care (Mallick et al., 2019). As cord

stones, sewing threads, herbs preparation, infections are preventable in most cases, it is

palm oil, salt, sand, and saliva were also important to identify the best cord care

reported to increase the risk of cord practice to reduce neonatal mortality and

infection (Ango et al., 2021). morbidity and offer an alternative to

widespread potentially harmful traditional

Poor umbilical cord care (UCC) practices
practices. The practice of standard umbilical
have been linked with infections and
cord care (UCC) among mothers in
mortality in newborns. Some mothers use
developing and developed countries reduces
multiple agents in umbilical cord care
the exposure of the umbilical cord to
(Mallick et al., 2019). Many evidences of
infectious pathogens such as bacteria,
studies from low-and middle-income
viruses, and fungi. Clean umbilical cord care
countries have shown that mothers apply
involves washing hands with soap and water
substances, such as butter, hot fermentation,
before delivery, tying and cutting the
lantern wax, fish bone, toothpaste, ash,
umbilical cord with a sterile instrument, and
charcoal, oils, vaseline, saliva, red sand,
finally laying the baby on a clean surface
menthol-containing balm, traditional
(Ango et al., 2021). National Strategy for the baby’s current and future survival, as

Newborn and Child Survival has identified well as the household’s survival and well-

chlorhexidine for cord care as one of the being. In the care of the umbilical cord,

high impact interventions to reduce the high people other than the mother, such as elder

neonatal mortality. The use of female relatives, played a big role (Abua et

chlorhexidine, especially in setting with al., 2023).

poor hygiene, is set as a crucial strategy to

Literature Review:
prevent life-threatening sepsis and cord

infections and to avert preventable neonatal Cord care is important for a newborn. It has

deaths (Merga et al., 2022). Umbilical cord- certain steps and that is needed to be

care techniques are frequently culturally followed in order to protect a newborn from

regulated beliefs that serve as spiritual any kind of infection. (Zupan, j 2022) A

controls over the infant’s, mothers, and newly cut neonatal umbilical stump is a

community’s well-being. In some countries potential portal of pathogen entry leading to

it is believed that in newborn care, the omphalitis. Neonatal sepsis can complicate

umbilical cord played a symbolic role. The omphalitis, but good cord care practices can

way it was viewed and handled had far- reduce this risk. (Shwe, D., et al 2023) A

reaching implications for the baby’s survival major factor contributing to neonatal deaths

and well-being. The umbilical cord was a is home deliveries in rural areas. In

source of worry, a potential portal to illness, developing countries majority of the

a test of fatherhood, and a symbol of deliveries occur at home through untrained

parental duty5. As a result, the umbilical birth attendant and in unhygienic conditions

cord and how it was handled had a role in this can create a pathway for the entry of

pathogens.(Mullany ,et al 2019)World

Health Organization recommended basic infection may enter to the blood stream may

principle of umbilical cord care is to keep it cause omphalitis and can become systemic.

clean and dry, these recommendation can (Chizoma MN, et al 2020) Substances that

contribute to rapid healing.(2022)Young many people uses on cord can correlate

mothers’ knowledge and practice have a with the increase the risk of omphalitis and

significant impact on the health of the neonatal deaths.(Mullany LC,et al 2019)

neonate, with mothers who are Umbilical cord care is the aseptic activities needed

to be ensure immediate after delivery including

knowledgeable about standard cord care
clamping of the cord, cutting with blade and
being more likely to practice good cord care.
cleaning of the stump with 4% chlorhexidine or
(Udosen E, et al ,2019)Harmful practices
using methylated spirit in order to ensure cord
can be a leading cause of neonatal sepsis,
healing and falls off completely to reduce the risk
rate of sepsis and mortality rate is highest in
of omphalitis.( Herlihy JM,2023) In low and
developing countries where harmful
middle income countries traditional practices used
practices are high.(Mallick L,2019) WHO by mothers usually apply different kinds of

recommended chlorhexidine daily (7.1% substances such as ( butter, hot fermentation,

chlorhexidine Di gluconate aqueous solution lantern wax, fish bone, toothpaste, ash,

or gel, delivering 4% chlorhexidine) to the charcoal, oils, Vaseline, saliva, red sand,

umbilical cord stumps in the first week after menthol-containing balm, traditional

birth in those areas where materials like medicine, and cow dung.(Turyasiima M,et al

(animal dung) are commonly used that is 2020) According to WHO neonatal umbilical cord

very useful to prevent life-threatening infection can be identified with certain signs such

neonatal umbilical cord infections and also as the presence of umbilical

in reducing mortality rate.(WHO,2022)Cord discharge,erythma,swelling.(2020) Umbilical cord

infection is the infection of the umbilicus and the

surrounding tissues occurring primarily in the practice proper handwashing in order

neonatal period. (Painter,k et al 2019) The risk of prevent the pathway of infections.

umbilical cord infection is higher in those who (Turyasiima M, et al 2020) The use of
usually used topical substances specifically of
antiseptic is typically not used by the
uncleaned substances other risk factors are
developed countries. Antiseptic is effective
unplanned home birth or septic delivery, low
in reducing the risk of neonatal conditions.
birth weight, prolonged rupture of
Apart from that antiseptic has negative
membranes, umbilical catheterization,
effects such as iodine and mercury
chorioamnionitis , lack of knowledge on
compound that can be absorbed in to the
cord care, twin’s delivery and prematurity.
blood and having neurotoxic effects.
(Steward,D et al 2016) In developing
(BAN,N,et al 2022) It is reported that
countries, where most deliveries take place
antiseptic can delay the separation time of
at home, some traditional practices such as
umbilical cord and if the separation time is
applying unclean substances to the cord
delayed then it can increase risk for
stump, conflict with principles of cleanliness
infections.( SÖYLEMEZ, N 2022)
and greatly increase the risk of cord
Ttraditional practices of cutting with
infection and tetanus. These substances have
unclean objects are still found. For example,
included plant extracts, raisins, coins, cow
in Nepal the umbilical cord is sometimes cut
dung, colostrum, and, more recently,
against a rupee, called a “good luck coin ”.
antibiotics in the form of powders, solutions,
(Mallick, et al 2019) Around the world
and/or sprays. (Coffee, et al 2017) Hand
traditional substances used to heal the
washing is the simplest and most effective
stump, prevention of the pain, bleeding,
way to prevent contamination of the
infection and also to keep out the evil spirits
umbilical cord. A mother must have to
or cold air. (Coffey,PS et al 2017) Due to (Chizoma MN, et al 2022) Neonatal sepsis is

unsanitary cord care practices, cord brought on by microorganisms that enter the

infections are more common and prevalent bloodstream through the umbilical with and

in developing countries.(Mohammad AU,et without the appearance of omphalitis. Due

al 2021) Neonatal sepsis is the third leading to home deliveries' 6 times higher neonatal

cause of neonatal mortality in in the first mortality incidence, the majority of these

month of life accounting for 15% of fatalities occur in low- and middle-

neonatal deaths worldwide.(Dessalegn, N et income nations. (Inayat et al 2022)

al 2022) Traditional practices is the major Regardless of their educational and social

concerns of public health and to address the status, mothers demonstrated low levels of

neonatal sepsis it is important to understand knowledge and poor practises because they

the behavioural intentions behind traditional were opposed to providing colostrum as the

cord care practices in low and middle baby's first feed and were unaware of the

income countries.(Dagnaw,y et al 2022) In aseptic technique for handling the umbilical

many underdeveloped nations where cord. As a result, the baby's first

deliveries are carried out by inexperienced breastfeed was delayed. (Kausar, S et al

personnel, recommendations for umbilical 2022) However, the umbilical cord is

cord care are rarely followed despite efforts handled differently by various organisations

to improve those practises. Mothers and civilizations. Despite the fact that some

reportedly apply items like mustard oil, conventional health organisations suggest

turmeric, cow dung, and antiseptic lotion on drinking alcohol, some advice using

the cord stump, according to numerous antiseptics like chlorhexidine, and still

research conducted in impoverished nations. others advise taking no medication at all and
merely keeping the chord dry and clean, individuals from the Bari Imam Community

these recommendations are not universal. located in Islamabad, Pakistan was taken.

(Hsieh, L. Y et al 2022) Salted water, soot, The sample was selected to be 250

banana ash, herbs, surgical spirit, powder, participants. Openepi.com was used to

ghee, papyrus reeds, saliva, water, butter, calculate the sample size. For the research

and petroleum jelly are a few substances that data bases Google scholar, CINAHL and

are frequently administered to the cord. Pub Med were used. A consent form and

(Hsieh, L. Y et al 2022) questionnaire for the interview was

developed by our group and finalized by the

cord separation times were found to be
faculty at Shifa College of Nursing, Shifa
extended in premature babies, low-birth-
Tameer-e-Millat University, few
weight infants, infants given antibiotics for
modifications were given according to
infections, and male infants,
which the questionnaire was modified. The
according to reports. (Juliati et al., 2021)
consent form was developed following the
There is varying data on gender differences,
guidelines mentioned in Polit and Beck,
with some studies indicating that male
Editon 10, 2021. The consent form was
infants tend to experience earlier umbilical
written in English at first, then it was
cord detachment. Additionally, research has
translated and printed in Urdu, as it was the
demonstrated that breastfeeding can
language of the target population. Before the
expedite the separation of the cord. (Merter,
interview the participants were asked to sign
O et al 2023).
the consent. Questionnaires were developed,
Methodology: which were modified from a tool developed

For this study, we used a cross-sectional by Letuka 18. Formal permission for tool

conventional study design; a sample of 250

use was taken via email. The validity of the about the practice used to clean the

tool was checked by Pilot Testing. It was a umbilical cord in Bari Imam Community.

structured questionnaire. Interviewer The statistical analysis was performed by

administered tool consisting of close ended using SPSS version 25. The descriptive

questions, the participants were given statistical analysis was utilized for

options for their answers. No Jargon's were computing this study mean finding,

mentioned in the questionnaire. All percentages, and frequency. The data was

participants answered all the components collected via questionnaire developed by the

given in the questionnaire. The interview did team. It was a convenient sample.

not take more than 10 minutes, the expected Result:

interventions were explained to the

participants. No false assurances given. The The result was presented by utilizing
result statements, graphs, and tables.
participants were all above 17 years in age.

Pilot testing was done before taking final

data collectons.30 participants were

involved in Pilot testing after which

questionnaire was modified. After selection

of final questionnaire, we have taken the

data of 250 participants. A questionnaire

consists of 29 questions. It was divided into

three parts first part was about consent form

the second was about demographic data and

the third part include questions that were

The result shows that out of 216 participants, only 63.43% participants were aware of the practices to
clean umbilical cord and 36.57% participants were not aware.

The graph shows that out of 216 participants, 65.74% participants had heard of practices
involving various materials for tying the umbilical cord and 34.26% participants did not hear
about those practices.
The results show that out of 216 participants, 52.78% participants agreed that olive oil is best to
clean the umbilical cord and 47.22% participants did not agree.

This graph shows that out of 216 participants, 50% of the participants had informed about avoid
using the harsh substances on umbilical cord stump and 50% participants did not inform.
This graph shows that out of 216 participants, only 28.24% participant’s children experienced
umbilical cord infection and 71.76% children did not experience it

The result shows out of 216 participants, 55.56% participants knows that how many times they
should clean the cord in a day and 44.4% did not know.
The graph shows the co-relation between number of children of the participants and how many

of them have used the cord clamp to tie the umbilical cord. In the chi-square the p-value is

greater than 0.05, so result is being insignificant.

The graph shows the co-relation between formal education of the participants and their feelings

about educating mothers for cleaning the umbilical cord. In the chi-square the p-value is greater

than 0.05, so result is being insignificant.

The graph shows the co-relation between formal education of the participants and the use of

methylated spirit for cleaning the cord. In the chi-square the p-value is greater than 0.05, so

result is being insignificant.

The graph shows the co-relation between formal education of the participants and if

chlorhexidine solution helps in the reduction in incidence of omphalitis. In the chi-square the p-

value is less than 0.05, so result is being significant

.
Discussion: substances used could be due to Different

cultural or familial habits.

The study's findings revealed that more than
According to the findings of this study,
half of mothers (54.1%) had good
mothers who had not received proper
knowledge in terms of umbilical cord care
education were in greater number (27.4%)
ability. Similar to research done in Tabora,
on the list of participants who lacked
East Africa, which revealed that 62.2% of
knowledge regarding umbilical cord care,
mothers had strong understanding of
highlighting education as a key component
umbilical cord care. However, a study was
of having extensive understanding of cord
conducted in Calabar which reported that
care. Lack of formal education increased the
only 40.2% of mothers have sufficient
likelihood of having little information. This
understanding of cord care. This variation
is to be anticipated because those with lower
may be accounted to the varying populations
levels of education are less likely to be able
under study and environmental factors.
to gain knowledge on their own, whereas
Similar to the study conducted in Ethiopia,
people with more education may be able to
where 54.7% of the participants were
find information on cord care on pamphlets,
identified to be using unnecessary
stamps, or wall boards in healthcare
substances including butter and Vaseline to
institutions. This result is consistent with a
the cord, over half (53.2%) of the
study done in Ethiopia, which similarly
respondents in this study stated that they had
found that those with more education had
applied unnecessary substances to the cord,
2.46 times more chances of being well-
including oil ash and mud. which can be a
informed than people with less education. A
source of infection. The variation in the
study carried out in Ghana discovered that
cord care behaviors were strongly correlated knowledge and mentioned cleaning the cord

with the educational status of mothers. As base before the stump as the most

maternal education expanded, more appropriate method during umbilical cord

effective cord care techniques were used. care.

This study also assessed mothers' knowledge During the study,75% of the mothers also

regarding chlorhexidine in umbilical cord reported washing their hands before and

care. It was found that 90.3% of participants after umbilical cord care which was similar

had inadequate knowledge regarding to the findings of the research done in

chlorhexidine while 46.3% of participants Nigeria(66.1%).

did not know methylated spirit usage in

Conclusion:
umbilical cord care. The results showed a

greater percentage of participants compared In conclusion, this study aimed to assess the

to a recent study, in which Mohammed et al. knowledge and practices of umbilical cord

revealed that 35.1% of participants had care among mothers in the Bari Imam

inadequate understanding of standard cord Community in Islamabad, Pakistan. The

care, involving the use of methylated spirit results of our study show several crucial

and chlorhexidine gel. things.

According to this study, 40.7% of the A sizeable percentage of participants

participants were unaware of cleaning cord showed variable degrees of knowledge on

base before stump when performing caring for the umbilical cord. While some

umbilical cord care which was opposite to mothers showed an excellent understanding

the findings of a study done in African of appropriate cord care techniques, some

setting where 73.2% of the mother had

women lacked critical information in this behavior surrounding umbilical cord care.

area. Such initiatives might reduce neonatal

infections and enhance the general health of

A worrisome percentage of mothers reported
newborns.
applying mud, ash, and oils on the umbilical

cord. There is a chance of infection and The wellbeing of babies in the

consequences from this technique. Mothers' community may be improved with more

knowledge and practices regarding cord care study and initiatives in this area. In the end,

appeared to be significantly influenced by lowering the rates of newborn death and

their formal educational background. morbidity is a global objective that must be

accomplished.
Many participants were unaware of the use

of methylated spirit and chlorhexadine for

cord care, indicating the need for education

and awareness efforts about these efficient

therapies.

Positive evidence of infection prevention

comes from the participants' reports of

practicing hand cleanliness before and after

cord care, which is heartening.

These results make it clear that focused

education and awareness campaigns are

required within the Bari Imam Community

to enhance mothers' understanding of and

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