Umbilical Cord Care Practices in the Volta Region of Ghana: A Cross Sectional Study

Purpose: In developing countries such as Ghana, care of the umbilical cord is a major concern because it is one of the leading sources of neonatal sepsis (Black et al., 2010).  Most women and sometimes healthcare workers including Traditional Birth Attendants (TBAs) lack the necessary knowledge and skills to care for the umbilical cords of the new newborns (Asif Padiyath, Bhat, & Ekambaram, 2010).  Few studies across developing countries show that various substances including cow dung, mustard oil, ash, mud, breast milk, saliva, water,  ash, mud, rat feces, turmeric, oil and shea butter are commonly applied on the umbilical wound to promote healing (Mullany et al., 2007; Soofi et al., 2012).  These practices are associated with an increased risk for omphalitis which is directly associated with increased neonatal mortality.  The purpose of this study was to investigate the knowledge of health workers and mothers in the Volta region of Ghana and to learn about the current practices in this community.  This study was conducted in collaboration with the Volta Regional Health Directorate of Ghana Health Service

Methods: This was a cross sectional study of 102 mothers and 66 health workers in 11 health centers and hospitals in the Volta region of Ghana. Health workers in this study included nurses and midwives who provided prenatal, intra partum and postnatal care to the mothers.  Survey data were collected through face-to-face semi-structured interviews.  Data collected from mothers included their socio-demographic characteristics, the cord care treatment they used for the most recent child, and their sources of information regarding the treatment method. Healthcare workers were asked about their education and credentials, and their recommendations for cord care. Descriptive statistics were used to summarize the survey findings.

Results: The most commonly used practice was methylated spirit (68%).  While majority of the study participants used methylated spirit (68%) the recommended practice, a significant number of mothers used non-recommended practices including shea butter (18%), toothpaste (4%), oil (2%), water (2%) and 6% used nothing.  Overall 79% of the mothers surveyed received recommendation from healthcare workers on the best medical practice.  Mothers residing in the southern Volta region or in urban areas and those with higher education levels were most likely to follow recommended best practices for cord care. Distrust in healthcare workers and low education levels were found to be the main barriers for adherence to the recommended practices.  Health workers reported they were knowledgeable and confident in cord care practices (61%) and most (97%) supported medically recommended practices for cord care.  Nurses and midwives were taught best practices of newborn cord care during their pre-licensure training.

Conclusion: More than one in five mothers are not following the recommended practices in newborn cord care. This study has public health and policy implications in addressing child mortality especially from neonatal sepsis.  Public health interventions are needed to promote best practices for cord care especially in the northern Volta, in rural areas and among women with low education levels. Further studies will focus on education intervention that will inform the community on best practices in cord care.