FACTORS INFLUENCING UMBILICAL CORD CARE PRACTICES AMONG MOTHERS ATTENDING INFANT WELFARE CLINIC IN SELECTED PRIMARY HEALTH CARE CENTRES IN JOS-NORTH LOCAL GOVERNMENT AREA, PLATEAU STATE

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TABLE OF CONTENTS

Content                                                                                                               Page

Title page                                                                                                         i

Certification                                                                                                             ii

Dedication                                                                                                       iii

Acknowledgements                                                                                         iv

Abstract                                                                                                               v

Table of Contents                                                                                     vi

List of Tables                                                                                     vii

List of Figures                                                                                viii

Appendices                                                                                             ix

CHAPTER ONE: INTRODUCTION               

1.1       Background to the Study                                                            1

1.2       Statement of the Problem                                                                         2

1.3       Objective of the Study                                                                 3

1.4       Research Questions                                                                          3

1.5       Hypotheses                                                                                        4         

1.6       Scope  of the Study                                                                        4

1.7       Significance of the Study                                                                   4

1.8      Justification to the Study                                                               4

1.9       Operational Definition of Terms                                                        5

CHAPTER TWO: REVIEW OF LITERATURE

2.0       Introduction                                                                                       6

2.1       Umbilical cord care overview                                                        6

2.2Determinant of umbilical cord practices                                  6

2.3     Types of substances used for umbilical cord care                             8

2.4        Possible problems of umbilical cord stump                                       8

2.5      World Health Organization (WHO) recommendations                 9

2:6:0 Related literatures to umbilical cord care practices                              10

2:6:1 Knowledge of mother regarding newborn umbilical cord care     11

2:6:2 Practice of mothers regarding newborn umbilical cord care12

2:6:3 General management of umbilical cord infection                 15

2.1Ramona Mercer: Maternal Role Attainment Conceptual Model                                 16

CHAPTER THREE: METHODOLOGY

3.0       Introduction                                                                                      18

3.1       Research Design                                                                          18

3.2       Population                                                                              18

3.3       Sample size and Sampling Technique                                        18

3.4       Research Instrument                                                                       19

3.5 Reliability and Validity of Instrument                                           20

3.6    Method of Data Collection                                                      20

3.7       Method of Data Analysis                                                                   20

3.8       Ethical Consideration                                                           21

CHAPTER FOUR: DATA ANALYSIS, RESULTS

AND DISCUSSION OF FINDINGS

4.0       Introduction                                                                                        22

4.1       Socio-demographic information of respondents            22

4.2       Analysis of Research Questions                                                         27

4.3       Hypothesis Testing                                                           32

4.4       Discussion of Findings                                                             35

CHAPTER FIVE: SUMMARY, CONCLUSION

AND RECOMMENDATIONS

5.0       Introduction                                                                   39

5.1       Summary                                                                                                         39

5.2       Conclusion                                                                                                      40

5.3      Recommendations                                                              40       

5.4       Limitation of the Study                                                            40

5.5       Suggestion for Further Studies                                                           40

REFERENCES                                                                                                    41

APPENDICES                                           47

LIST OF TABLES

Table                                                                                                                  Page

4.1 Socio-demographic data of the respondents                                              23

4.2 Interview guide on knowledge toward umbilical cord care                   25

4.3 Interview guide on umbilical cord care practice                               26

4.4 Mother’s knowledge on umbilical cord cares                               27

4.5Umbilical cord care practices of mothers                                              27

4.6 Substances/materials used for umbilical cord care                        28

4.7 ANOVA table for factors influencing cord practice                         29

4.8 Model summary for factors influencing cord practice                            29

4.9 Coefficient table for factors influencing cord practice             29

4.10Relationship between mother’s knowledge and practice of umbilical care                     30

4.11 Correlations of knowledge and practice                                                 30

4.12 Mean and standard deviation of knowledge and practice                   31

4.13 Relationship between umbilical cord care practice and maternal parity             31

4.14 Correlations of maternal parity and practice                           31

4.15Hypothesis One                                                                          32

4.16 Correlation of practice and income                                                 32

4.17 Hypothesis Two                                                          33

4.18 Hypothesis Three                                                                             34

LIST OF FIGURE

Figure                                                                                                        Page

2.1       Maternal Role Attainment Model by Mercer                                 17

APPENDICES

Appendix                                                                                                Page

Inform Consent Form                                                                                   46

Questionnaire used for this study                                                       47

Ethical Clearance Certificate                                                         50

Letter of Introduction                                                                                51

Evidence of Anti-plagiarism                                                                        52

CHAPTER ONE

INTRODUCTION

  • Background to the Study

The first 28days in the infant’s life is a period of great significance as the newborn is fragile and susceptible to infection; hence they need to be handled carefully so as to prevent neonatal death or permanent deformity. Mothers as the primary care providers have very important role to play to ensure that these newborns develop optimally as the new born health and survival is dependant on the essential care received before, during and after delivery (Joel-Medewase, Oyedeji, Elemile, & Oyedeji, 2008)

Neonatal infection is a major cause of neonatal deaths as the mortality rate could be as high as 44 per thousand life-births in the north-east zone of Nigeria. Neonatal deaths, cord infection and sepsis can be prevented with good umbilical cord practices especially in areas where home deliveries are done. In developing countries such as Nigeria, umbilical cord infection accounts for significant number neonatal morbidity and mortality, this accounts for 276,000 neonatal deaths annually the second highest deaths in the world and in Nigeria alone it accounts for about 33% of neonatal mortality (Jabbi, Shoretire, Ojile,  Maishanu & Orobaton, 2014; Soofi, Cousens, Imdad, Bhutto, & Ali, 2012; Orobaton, Abegunde, Abdulazeez, Akomolafe & Ganiyu, 2015; Osuchukwu, 2014).

The umbilical cord is a tissue that has a vein and two arteries of which at term is about 56cm in length and extends normally from the center of the placenta to the umbilicus of the unborn baby. During pregnancy, the umbilical cord connects the fetus to the mother through the placenta. The umbilical cord is responsible for the supply of blood rich in nutrients and oxygen from the mother to the fetus and the removal of carbon dioxide and other metabolites away from the fetus to the mother. Umbilical cord care is one of the most essential cares given to umbilical stump of newborns in the first few days of extra uterine life before the fall-off of the cord and immediately after its fall (Fraser & Cooper, 2009). 

The availability of tetanus vaccine for pregnant women and topical application of antimicrobial agents should help reduce bacterial infection hence newborn deaths and improve the newborn health and wellbeing. Aside cleaning and drying of the umbilical cord stump, daily application of chlorhexidine 7.1% chlorhexidine digluconate aqueous solution or gel to the umbilical cord stump during the first week of life is strongly recommended for newborns who are born at home in settings with high neonatal mortality (30 or more neonatal deaths per 1000 live births) Chlorhexidine digluconate 7.1% gel was used by 36,404 newborns delivered by 36,370 mothers to help reduce such neonatal deaths in Sokoto State, North West Nigeria, this low cost but highly effective gel used for the prevention of newborn sepsis should be made available in all delivery settings so as to reduce umbilical cord infection and then neonatal death (Enang, Ushie, Arikpo, Osonwa, Esu, Odey, et al., 2013; Mullany, Darmstadt & Tielsch, 2003; Orobaton et al., 2015).

Unqualified personnel  provide health care services to majority of women especially during pregnancy, child birth and after child birth as there is lack of skilled personnel, needed resources and  availability of essentialdrugs that has increased neonatal and childhood deaths. To achieve a healthy and productive society it is important to pay attention to the health and wellness of the newborn as this will help reduce neonatal and newborn mortality and morbidity. In 2013, in Johannesburg, South Africa, an International Conference on Maternal, Newborn and Child Health was held so as to bring about concrete actions for improving MNCH in Africa. Maternal and child care during pregnancy, child birth and post partum is a major strategy to improve child survival as low socio-cultural barriers to care, weak health care system and poor socio-economic development influence maternal and child health (Ezechi & David, 2012)

  • Statement of the Problem

The future of any nation lies on the present generation, their health and welfare can be altered by activities that occur either before, during or after delivery. Newborn health and survival is partly dependent on the mother’s decisions on where to deliver and actions or activities taken after delivery. In most rural communities, deliveries and child care activities are mostly managed at home where about 69.8% of care providers used unhygienic and harmful materials for cord care (Osuchukwu, 2014).

In Nigeria, cases of umbilical cord infections are under documented and reported. But for some studies conducted in the hospital, in Port Harcourt, omphalitis constitute 10% reasons of neonatal admissions and 30% of neonatal deaths. In Ibadan it constitute about 18% of neonatal deaths while in Calabar, 49% of neonatal deaths were linked to omphalitis. Neonatal death every year in Nigeria is about 241,000 making it the highest neonatal death rate in African. In Africa, annually about 600,000 infants die of neonatal tetanus. Global annual neonatal deaths constitute about 4million (3.1%) and about (25%) of these deaths are due to umbilical infection. Similar studies have been conducted in other part of the country so the researcher intends to explore the factors influencing umbilical cord care Plateau state, due to the increasing number of mothers returning to the health care facility with umbilical cord complications especially omphalitis in newborns (Federal Ministry of Health, 2009; Osuchukwu, 2014).

1.3 Objective of the study

The general objective is to assess the factors influencing umbilical cord care practices among mothers attending infant welfare clinic in selected primary health care centres in Jos-North Local Government Area, Plateau State. The specific objectives are to:

FACTORS INFLUENCING UMBILICAL CORD CARE PRACTICES AMONG MOTHERS ATTENDING INFANT WELFARE CLINIC IN SELECTED PRIMARY HEALTH CARE CENTRES IN JOS-NORTH LOCAL GOVERNMENT AREA, PLATEAU STATE