FACTORS INFLUENCING PREVALENCE OF UMBILICAL CORD SEPSIS AMONG NEWBORN BABIES AT CHINA UGANDA FRIENDSHIP HOSPITAL- NAGURU
Petwa, K.W., Callender-Carter, S.T., Ndungutse, D., and SamuelBiraro,
A descriptive cross sectional study research design was used to assess factors, prevalence and how it was influenced by associated factors at China Uganda Friendship Hospital-Naguru. Both quantitative and qualitative methods were used; a sample of 258 mothers of newborns and 4 key informants and records were used. The Statistical Package for Social Scientists (SPSS) and thematic content analysis methods were used for quantitative and qualitative data respectively. Parity was (UOR, 2.04, p-value, 0.001) attendance of cord care talk (UOR, 2.96, p-value, 0.04), knowledge about cord care (UOR, 2.07, p-value 0.003) were maternal factors influencing neonatal cord sepsis. Cultural and environmental factors; cord care at hospital (UOR, 1.05, p-value 0.008), and at home(UOR, 3.76, p-value 0.003), application of substances to the cord (UOR, 2.95, p-value 0.001), occasions for washing hands while caring for new born (UOR, 2.05, p-value 0.009), influencing prevalence of cord sepsis, the prevalence of cord sepsis was at (24.0%) and was positively influenced by associated factors. It was concluded that parity, attendance of cord care talk, knowledge and occasions for washing hands (Maternal factors), cord care at hospital and home, application of substances (Cultural factors) influenced cord sepsis, the prevalence was high and associated factors had a positive influence. The study recommended that health workers should increase health education talks about umbilical cord care.
Keywords: neonatal cord sepsis, maternal factors, cultural factors, prevalence
Severe cord sepsis is one of the top three causes of newborn death worldwide, causing 13% of all neonatal deaths (WHO & UNICEF 2012). In developing countries it was found that umbilical cord infections can account for more than half of all neonatal deaths (Mullany et al 2006). A study in Nepal revealed 16% prevalence of cord infection and in Egypt 8.2% (Black et al 2008). Six percent, 0.521 million deaths occurred in five countries of India, Nigeria, Democratic Republic of Congo, Pakistan and China (Black et al 2008). According to Bugaje et al (2013) and Mullany et al (2006), umbilical cord sepsis (omphalitis) is defined as either pus discharge with erythema of the abdominal skin or severe redness >2 cm extension from the cord stump with or without pus (Mullany et al 2006).
Globally infections account for 36% of neonatal mortality (Lawn, Cousens &Zupan, 2005) of which, sepsis and meningitis claimed 5.2% in a period between 2000-2010 (Liu et al 2012), majority cases were from the least developed and developing countries whereas developed countries registered small prevalence of approximately 0.2-0.7% (Bugaje, Ameh, Mchoney&Lakhoo 2013).
Cord sepsis has been identified as one of the neonatal infections which can cause severe illness for example neonatal tetanus which causes about two hundred thousand infant deaths each year throughout the world (Zupan, Garner & Omari, 2004).
Sub-Saharan Africa contributes 67% to the global under-five mortality and also affirmed that the prevalence is even higher in communities that practice application of non-sterile home remedies to the cord (Bugaje et al 2013). In Pemba Island, Zanzibar and Tanzania, omphalitis occurred in 954 (5.5%) out of 17,198 infants within seven days of age (Mullany et al 2009). In another assessment, out of 1653 infants, the proportion of these affected ranged from 16 (1.0%) with moderate to severe redness with pus discharge to 199 (12.0%) pus and foul odor while single signs were observed in < 20% of infants (Mir et al, 2007).
In developing countries little is known about risk factors of umbilical cord infection, although unhygienic practices around the time of birth may be likely determinant of disease (Bernnett, Macia, Traverso, et al, 2006). According to Achiro, (2001), there is no information about factors that influence this high prevalence. A study by Triza, et al (2011), found that age, educational level, socio economic status influenced maternal knowledge and practice of umbilical cord care.
In Uganda, neonatal sepsis contributes 45.0% to infant mortality rate. In 2013 the status was 27 per 1,000 live births and the target for 2015 is 20 per 1000 live births (Annual Health Sector Performance Report for Financial Year 2013/2014). The death toll per day due to neonatal sepsis stands at 120 (Uganda Demographic Health Survey-UDHS 2011). The ministry of health 2014 report states that one of the major causes of newborn mortality is sepsis (Ministry of Health Report 2014).
It has been noted at China Uganda Friendship Hospital-Naguru, that there was high prevalence of neonatal sepsis. In a period of three months, 39/1000 live births were admitted at the hospital with neonatal sepsis in their first week of life (Inpatient Registers and Health Management Information System (HMIS 108 2014) almost the level of national prevalence rate of neonatal sepsis in Uganda which was at 27/1000 live births (UDHS 2011). Factors explaining the high prevalence in Naguru were not yet studied. I suspect that factors like maternal, neonatal, and social cultural and environmental could contribute to the problem. Scholars have pointed out some so that’s why it was important to ascertain and document what were the factors at Naguru Hospital the purpose of this study was to investigate factors influencing high prevalence of umbilical cord sepsis at Naguru.
A descriptive cross sectional study research design was used to assess factors, prevalence and how it was influenced by associated factors at China Uganda Friendship Hospital-Naguru. Both quantitative and qualitative methods were used; a sample of 258 mothers of newborns and 4 key informants and records were used.
The study found that significant maternal factors influencing neonatal umbilical cord sepsis were: Parity (UOR, 1.0; p-value, 0.001), attendance of health talks on cord care. (UOR, 1.03; p-value, 0.04), knowledge about cord care (UOR, 1.07; p-value 0.003) and occasions of hand washing (UOR, 1.09, p-value, 0.009).
Also the study found that cultural factors that influenced prevalence of umbilical cord sepsis were: the person who took care of the cord at the hospital before discharge (UOR, 1.05, p-value 0.008), the person who takes care of the cord while at home (1.76, p-value 0.003 and application of substances at the cord (UOR, 1.97, p-value 0.001).
Qualitative data showed that several factors are responsible for neonatal umbilical cord sepsis among newborns which included; failure to observe infections control measures, absence of health education regarding cord care and ignorance of mothers among others.
Regarding prevalence of cord sepsis, the study showed that 24.0% newborns developed cord sepsis and majority of mothers of these babies, sought for health care from health facilities especially China Uganda Friendship Hospital-Naguru.
Associated factorswereinfluential on theprevalenceofcordsepsisasindicatedbytheincreaseforthenumberofchildren (newborn) withthisproblemovertheyearsasbased on thedataextractedfrom China Uganda Friendship Hospital Naguru for the years 2012-2014.
In relationtothefindingsandthediscussionmade in chapterfourabove, itcanbeconcludedthat; parity, cord care talkattendance,knowledge and practiceaboutumbilicalcord care andoccasion for washing handwerethematernalfactorsinfluencingtheprevalenceofumbilicalcordsepsisamongnewbornbabies. This isbecausetheformerincreasesskillsandcapabilitiesofmonitoring a baby’shealthconditionsincludinghygienefortheumbilicalcorduntilit falls off.
Cordcare at hospital and home, applicationofsubstancestobaby’scordwereculturalfactorsinfluencingtheprevalenceofumbilicalcordsepsisamongnewbornbabies. This isworsenedbytheculturalbeliefsamongpeople in communityregardingwelcoming a newborn in thecommunitywheresanitationandhygienearecompromised.
Occasionsofhandwashingis an environmental factorinfluencingtheprevalenceofumbilicalcordsepsisamongnewbornbabies atChina Uganda Friendship Hospital-Naguru. Failuretowashhandsbeforehandlingthebabyincreaseschancesoftransitinggermstothecord.
The prevalence of umbilical cord sepsis was high at (24.0%) due to several factors that influenced existence of sepsis among newborn attending care from China Uganda Friendship Hospital-Naguru.
Associated factors have a positive influence on the prevalence of neonatal umbilical cord sepsis among newborn babies attending Naguru Hospital. These increase the prevalence of sepsis everyday at this health facility.
Statistically, maternal factors outweighed cultural factors.
According to the study results mothers’ knowledge was an important factor in the prevalence of sepsis therefore, it is recommended that healthworkers at thefacilitiesshouldincrease health talks and demonstrations on cord care at thehealthfacilities, community level orthroughthemedia. This will increasemothers’ knowledgeandskillson cord care thus reducing the prevalence of sepsis. This hasbeenrecommendedbecauseresultsofthisstudyhaveshownthatfewmothershadhealthtalkregardingcord care this is in line with what key informant 2 complained about.
More public health nurses and midwives should be trained and employed to provide health facility and home-based cord care since results of this study have shown that babies who were cared for by health workers at hospital and at home stood higher changes of not developing sepsis.
Special in servicetrainingandmentoringprogramfor all midwivesregarding proper umbilicalcord care shouldbedevelopedandimplementedbyMinistryof Healthandpartnerstopreventneonatalsepsiswhichis on theincrease. This is in regardtothecommentmadebykeyinformants.
MinistryofHealthshouldrevisetheantenatalcardtoinclude all importanthealtheducationtalks a mothershouldattendduringantenatalperiodandshortly after deliverybeforedischarge so that mothers demand for this information or these talks in case they are not given.
Mothersshould continue seeking for antenatal care deliverfromhealthfacilities and post-natal care becausethiscanoffer them a chancetoobtaincord care relatedinformationunlikewhentheydeliverfrom traditional birthattendantsandvisitthehealthfacility after theirbabiesdevelopcordcomplications and this is in regard to key informant 3.
Environmental sanitationshouldbeimproved at householdandcommunitylevelshouldbeimprovedbymothersand care-takers. This is in relationtothefindingsofthisstudy in relationofoccasionsofhandwashing.
Infection prevention and control in hospitals should be improved by training and mentoring health workers and sanitation staff. More hospitals should be constructed and equipped with facilities to reduce overcrowding in maternity units which exposes mothers and infants to infections as observed by the key informant four who noted that failure to observe infection control increases umbilical cord sepsis in hospitals.
Itisrecommendedthat a studyisconductedregardingtheinfluenceofhealthfacilityfactorsandcordsepsisamongnewborn in Uganda. This will offerinformationtohealthfacilityadministratorregardingsepsis in Uganda.
A study to find out reasons why some health workers do not explain and demonstrate proper cord care to mother before discharge is recommended.
In relation to secondary data, a study about factors contributing to neonatal sepsis is recommended because it was found that there was higher prevalence of neonatal sepsis among newborn.
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