UMBILICAL CORD CARE AND MANAGEMENT OUTCOME AMONG MOTHERS IN CALABAR SOUTH LOCAL GOVERNMENT AREA, CROSS RIVER STATE, NIGERIA

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ABSTRACT 

Umbilical cord remains the major means for the transmission of infection after birth and constitutes 33% of neonatal mortality in Nigeria. Most of the cord care in Nigeria is home based as two third of the delivery takes place at home. The purpose of this study was to determine the umbilical cord care and management outcome among mothers in Calabar South Local Government Area of Cross River State, Nigeria. The research method was a cross – sectional descriptive survey design. Four hundred and fifty (450) respondents were selected using a snow ball (networking) method. Data were collected using a researcher developed questionnaire. The instrument was validated by the supervisor, two lecturers in the Department of Nursing Sciences who are experts in child health and three neonatologists. The reliability was established using a test re-test method at interval of two weeks. The scores obtained were correlated using Pearson product correlation coefficient to obtain coefficient reliability of 0.993 – 0.99 at 0.05 level of significance. Data collected were analyzed using mean, simple percentage and standard deviation to answer the research questions. Findings revealed that 201 (44.7%) of the respondents had good knowledge of standard cord care and their major sources of information was from mothers / mothers-in-laws. Three hundred and fourteen (69.8%) used unhygienic and harmful materials for cord care. The major reason for choice of materials was mainly to wade away evil spirit which the respondents belief causes neonatal deaths. The technique for cord care was poor as only 92 (20.4%) cleaned the base of the cord before cleaning the surrounding skins. The management outcome was poor as 338 (75.1%) of respondents reported signs of umbilical infections in their neonates and only 5 (4.1%) reported the problem to the health facilities within 24hours of onset of problem. There was a significant association between age, educational level, income and cord management (p=<0 .05="" after="" among="" and="" based="" be="" by="" care="" conclusion="" consequences="" cord="" delivery.="" education="" findings="" health="" home="" in="" increased="" knowledge="" management="" materials="" most="" mothers="" o:p="" of="" on="" personnel="" poor="" recommends="" reduce="" respondents.="" respondents="" should="" standard="" study.="" study="" that="" the="" there="" this="" to="" umbilical="" unhygienic="" used="" visits="" was="" were="">

TABLE 0F CONTENTS

TITLE PAGE
TABLE OF CONTENTS
LIST OF TABLES
ABSTRACT

CHAPTER ONE: INTRODUCTION
Background to the Study
Statement of Problem
Purpose of Study
Objectives of the Study
Research Questions
Significance of the Study
Scope of the Study
Operational Definition of Terms

CHAPTER TWO:  LITERATURE REVIEW
Conceptual Review of Umbilical Cord
Management of Umbilical Cord
Knowledge of Standard Cord care and Sources
Material for Cord Management
Reasons for Choice of Substance for Cord Management
Techniques of Cord Care
Factors Influencing Umbilical Stump Management
Cord Infections
Cord Separation Time
Theoretical Review
Conceptual Model of the Study
Empirical Review
Summary of Literature Review

CHAPTER THREE:  RESEARCH METHOD
Research Design
Area of Study
Population of Study
Sample
Sampling Procedure
Instrument for Data Collection
Validity of the Instrument
Reliability of the Instrument
Ethical Consideration
Procedure for Data Collection
Method of Data Analysis

CHAPTER FOUR:  DATA PRESENTATION
Demographic Data of Respondents
Research Questions
Summary of major Findings

CHAPTER FIVE:  DISCUSSION OF FINDINGS
Discussion of Major Findings
Implication to Nursing
Limitations of the Study
Suggest for further studies
Summary
Conclusion
Recommendations
REFERENCES
APPENDICES

CHAPTER ONE
                                                           INTRODUCTION
Background to the Study                                                                                                    
In developing countries umbilical cord infections constitute a major cause of neonatal morbidity and pose significant risk for mortality (WHO, 2009). Cord management introduced to mothers in both developed and developing countries to reduce exposure of the cord to infectious pathogens include clean cord cutting, hygienic cleaning and washing of hands before and after cord care (Garner, 2008; Basil, Kayode, Mark & Mbe, 2009).

The umbilical cord is a unique tissue consisting of two arteries and one vein which at term is about 56cm in length and extends normally from the centre of the placenta to the umbilicus of the unborn baby (Abba, 2008). During pregnancy, the umbilical cord connects the fetus to the mother through the placenta. The blood flowing through the cord brings nutrients and oxygen from the mother to the fetus and carries away carbon dioxide and other metabolites from the fetus (World Health Organisation, 2009; Bello & Omotara, 2010; Ezenduka & Eze, 2002).

After the delivery of the baby, the cord should be clamped firmly and cut with sterile instrument to separate the baby from the placenta attached to the mother’s uterus leaving about 6cm with the baby. The instrument used in cutting the cord cuts across the living tissues and the blood vessels which are still connected to the baby. In view of the fact that this time the umbilical cord is wet with an open surface wound and blood vessels still patent, they provide a nutritive culture medium for bacterial growth. These require that some degree of hygiene practices must be adopted to prevent infection, which may present as yellow discharge from the cord, foul smelling, red skin around the base of the cord, pain when touched the skin around the stump and excessive crying.  These strengthen the need for standard cord management among mothers (Bemor & Uta, 2011).

Methods of caring for the umbilical cord vary greatly between communities depending on their cultural and religious beliefs, level of education and resources. In the developing countries most deliveries occur at home where health care services may not be available. Sometimes materials used to tie the cord include strings, thread and strips of cloth, scissors and sharp stone (Obuekwe & Obuekwe, 2008). The risk of cord infection is increased by unhygienic cutting of the cord and application of unclean substances such substances sand from door post mixed with saliva, herbal preparations and lantern wax. Even babies delivered in hospitals may be affected by traditional practices after discharge which most times lead to umbilical cord infection and dead among the neonates (Sreeramaraddy, Josh, Sreekumaran & Giri, 2006).

 The use of alcohol daily and as often as each diaper is changed has been recommended by the World Health Organisation (WHO) as standard care. With standard care the cord usually falls off between five to fifteen days after birth (WHO, 2007). Where clean cord care is not practiced, the cord is readily colonized and infected by pathogenic organisms (Bennet & Adetunde, 2010; WHO, 2007). Therefore, mothers who adopt clean cord management will by implication contribute to the survival of the neonates and prevent neonatal death from infections such as omphalitis, neonatal tetanus and septicaemia (Bemor &Uta, 2011; Bennet &Adetunde, 2010; WHO,2007).

Globally, neonatal tetanus accounts for 7% of neonatal deaths, but accounts for more than 48% in Africa (Peter & Johnson 2010).   Nigeria has one of the highest infant mortality rates of 94 deaths/1,000 live births (WHO, 2009). According to the report, 26% was due to umbilical infection (Peter & Johnson 2010; WHO, 2009). In Calabar South Local Government Area of Cross River State, umbilical infection is responsible for 49% of neonatal deaths (Antai & Effiong, 2009). This study therefore addressed umbilical cord care and management outcome among mothers in Calabar South Local Government Area of Cross River State, Nigeria.


Statement of Problem
Globally, about 130million babies are delivered annually, 4million (3.1%) die within the first 4 weeks of life (Peter & Johnson, 2010). Twenty- five percent (25%) of these deaths are as a result of umbilical infection (Peter & Johnson, 2010). In developing countries, most of the cord care is home based since two third of births take place at home (WHO, 2009). Peter and Johnson (2010) reported that, globally, about 150,000 neonates die annually from omphalitis. Each year some 600,000 infants die of neonatal tetanus in Africa; in untreated cases, case fatality rate approach 100% and a further 460,000 die as a consequence of other severe bacterial infections (Peter & Johnson, 2010).
 In Nigeria, several hospital-based studies have reported cases of umbilical cord infections. For instance, in Port Harcourt, umbilical cord infection accounted for 10% of neonatal admissions and 30% of neonatal deaths (Antai & Effiong, 2009).  A review of umbilical infection in Ibadan showed that it accounts for 18% of neonatal deaths (Bennet & Adetunde, 2010). In Calabar South Local Government of Cross River State, 49% of neonatal deaths were due to umbilical cord infection while the condition was responsible for 19% of all newborn admissions (Antai & Effiong, 2009). Many of the neonatal deaths occur at home and therefore unseen and unaccounted for in official statistics (Ambe, Bello, Yahaya &  Omotara, 2010; Green, Udoh & Peters, 2006; Garner, 2008). According to the reports, many of these neonates are brought in for admission in very bad state, consequently resulting in neonatal deaths. Unfortunately, these...... 

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