Umbilical Cord Hygiene And The Risk Of Neonatal Sepsis Among Neonates Presenting At Kahawa Health Centre In Nairobi County, Kenya

Abstract

Introduction: Neonatal sepsis could be defined as a bacterial, fungal or viral systemic condition characterized by bio-chemical and clinical symptoms and attended by significant morbidity and mortality. Three-quarters of all annual neonatal deaths in developing countries are attributable to neonatal sepsis. In primary care settings, poor cord hygiene due to unclean handling of the infant‟s cord is a major contributor to the occurrence of neonatal sepsis. Objectives: To identify umbilical cord care practices among mothers attending the Kahawa Health Centre (KHC) and assess the relationship between umbilical cord hygiene and neonatal sepsis, its population attributable fraction (PAF), as well as the influence of other neonatal and maternal factors. Methods: A case-control study was conducted at the KHC to assess the umbilical cord-hygiene-neonatal sepsis relationship among neonates presenting to the facility between August and October 2018. All those who were premature, of low birth weight or with congenital anomalies were excluded. All cases were selected, while controls were systematically random-sampled to achieve the required sample size of 312 neonates. Analysis: Exposure variables were summarized using descriptive statistics. A multivariable logistic regression model was fitted to evaluate the association between umbilical cord hygiene and neonatal sepsis adjusting for the effect of potential confounders. Subsequently, a population attributable fraction (PAF) was estimated. Results: Chlorhexidine/surgical spirit were the applied agents by 79.2% of controls‟ compared to 35.6% of the cases‟ caregivers. Other recommended cord care practices were reported more among the control than the case respondents. The proportion of mothers with improper hygiene was 35.3%: 72.1% among the cases and 16.3% among the controls‟ xiv caregivers. The odds of neonatal sepsis were 13 times higher (OR=13.24; 95% CI: [7.5; 23.4]) among infants whose caregivers had improper hygiene compared to those who had proper hygiene. None of the neonatal and maternal covariates confounded the umbilical cord hygiene-neonatal sepsis association. This odds ratio gave a PAF of 66.7% (95% CI: 62.5; 69.03). Conclusions: Improper cord hygiene is prevalent among the population served by KHC showing a strong positive association of improper cord hygiene with neonatal sepsis. The high PAF estimate implies that up to 67% of newborn infections could be prevented by observing proper cord hygiene methods among the caregivers. Recommendations: A proper cord hygiene protocol should be included within the antenatal care package.