The purposes of this project were to a) initiate aseptic birth interventions using disposable clean delivery kits to pregnant women in under-resourced areas of Monrovia, Liberia, b) assess for umbilical cord infection in their infants for 28 days following birth, and c) facilitate an educational program for assessing the signs for neonatal infection of the umbilical cord site of infants. The project was conducted in partnership with the University of Liberia School of Nurse Midwifery, UNICEF, and the Liberia Ministry of Health.
Thirty pregnant women who have received a tetanus-toxoid immunization, as documented by the UNICEF vaccination coordinator of the West and Central Africa regions, along with their newborn infants were recruited from clinics and a hospital serving under-resourced areas of Monrovia, Liberia.
Given that contamination with tetanus spores can occur when the umbilical cord is cut by an unsterile instrument, the study's participating expectant mothers and their attending midwives were given an aseptic birth kit for use at the time of delivery. The items in the birth kits were consistent with the WHO's 'six cleans' model which supports a clean and sanitary mode of delivery. Each birth kit came in a pink purse and contained a pair of sterile gloves, a clean delivery surface by means of a blue chux pad, a clean cord clamp, a pair of umbilical cord scissors, a wiping cloth to clean and dry the baby after delivery, and a bar of ayurvedic soap to clean the mother's perineum. Since prior research has shown that not all of the items in clean birth kits are used in the under-resourced areas of developing countries, documentation of the utilization/non-utilization of each of the 6 contents of the birth kit was noted on participant's data collection sheets.
The infants of the participating mothers were followed and assessed for umbilical cord infection (neonatal omphalitis) for 28 days post-delivery. Specifically, the infants were assessed for swelling and redness around the umbilical cord, the presence of pus at the umbilical cord site, and temperature at 12 time-points over the first 28 days following birth.
Lastly, an educational program containing digital photo algorithms that detail the distinct stages of neonatal umbilical cord infection and neonatal omphalitis was provided to all midwives, local health workers, students and mothers at the participating and surrounding clinics, hospitals, and villages as an educational resource. As there is a fine line between umbilical cord healing and the development of infection, the algorithm helped all to recognize both early and active signs of infection and to seek early clinical intervention.
Descriptive analysis including frequencies was used to describe the use of the individual items in the clean birth kit and the occurrence of umbilical cord infection in the infants. The project was consistent with the fundamental objectives of The Ministry of Health's Committee on Child's Survival which holds to the constitutional goal of preparing a comprehensive National Child Survival Strategy and Implementation for the reduction of under-five mortality.