TABLE 0F CONTENTS Page
TITLE PAGE                                                                           i                        Â
APPROVAL                                                            ii                                                    Â
CERTIFICATION iii
DEDICATION
iv
ACKNOWLEDGEMENT
v
TABLE OF CONTENTS vi
LIST OF TABLES                                                                 vii              Â
ABSTRACT                                             viii   Â
CHAPTER ONE: INTRODUCTION
Background to the Study                                                    1              Â
Statement of Problem                                            3         Â
Purpose of Study 4
Objectives of the Study 4
Research Questions                                                       5     Â
Significance of the Study 5
Scope of the Study 6
Operational Definition of Terms 6
CHAPTER TWO: LITERATURE REVIEW
Conceptual Review of Umbilical Cord                                           8
Management of Umbilical Cord               9                            Â
Knowledge of Standard Cord care and Sources                               10      Â
Material for Cord Management                                                 11 Â
Reasons for Choice of Substance for Cord Management        12
Techniques of Cord Care                                                        14
Factors Influencing Umbilical Stump Management                         15
Cord Infections 16
Cord Separation Time                                                                 20 Â
Theoretical Review 20
Conceptual Model of the Study                                                23
Empirical Review                                                                           24     Â
Summary of Literature Review                                                 34
CHAPTER THREE: RESEARCH METHOD
Research Design                                                                      36
Area of Study 36
Population of Study                                                                     37    Â
Sample 37
Sampling Procedure                                                                   38
Instrument for Data Collection                           40                                     Â
Validity of the Instrument                                                             40
Reliability of the Instrument                                                       41
Ethical Consideration                                                                  41  Â
Procedure for Data Collection                                                            41
Method of Data Analysis 42
CHAPTER FOUR: DATA PRESENTATION
Demographic Data of Respondents                                            43
Research Questions                                                                       45
Summary of major Findings                         60                                        Â
CHAPTER FIVE: DISCUSSION OF FINDINGS
Discussion of Major Findings                                                             61       Â
Implication to Nursing                                                            67         Â
Limitations of the Study                                                           68
Suggest for further studies                                                            68
Summary                                                                                            69       Â
Conclusion                                                                                       70
Recommendations                                                                               72
REFERENCES Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 72Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â
APPENDICES Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 77Â Â Â
LIST OF TABLES Page
Table 1:          The Number of Sample for Each Clan                    39
Table 2:         Demographic Characteristics of Respondents              43
Tables 3-8       Knowledge of Standard Cord Care and Source             45
Table 9:          Materials Used by Mothers for Core Care   51                                         Â
Table 10:       Reasons for Choice of Material for Cord Care         53
Table 11:        Techniques Used by Mothers in Umbilical Care        54
Tables 12       Management outcome of umbilical care  56       Â
Table 16: Correlation Test of Association between Age and cord management 57
Table 17: Correlation Test of Association between educational Attainments 58
Cord Management
Table 18: Correlation Test of Association between income and Cord Management 59
LIST OF FIGURE
Figure 1:                                  Conceptual Model of the study              23
LIST OF APPENDICES
Appendix 1:                                  Questionnaire                         77        Â
Appendix 2:                                  Calculation of Sample Size       85Â
Appendix 3:                                  Reliability Test Result                    86
Appendix 4                                   Identification Letter                  88
Appendix 5                                   Ethical Clearance Certificate      89
Appendix 6:                                  Letter of Approval                    90
Appendix 7                                   Information Letter                     91Â
Appendix 8                                   Informed Consent                         93 Â
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). In conclusion, there was poor
knowledge of standard cord care among the respondents in this study. Unhygienic
materials were used in the care of umbilical cord by most of the respondents.
Based on the findings, the study recommends that there should be increased home
visits and education of the mothers by the health personnel to reduce the
consequences of poor cord management after delivery.
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
