Effectiveness of Chlorhexidine, Alcohol, and Dry Practices of Umbilical Cord Care Among Neonates: a Framework for Prevention of Omphalitis in Nakuru County Hospital

Abstract

Introduction: Every year, the vast majority of approximately 2.7 million neonatal deaths worldwide occur in low- and middle-income countries, with infections, especially those affecting the umbilical cord (omphalitis), accounting for roughly one-third of these fatalities. Infants with omphalitis have a 46% higher chance of overall mortality compared to those unaffected. While studies in Asia and Sub-Saharan Africa have explored the effectiveness of multiple applications of 4% chlorhexidine (CHX) for at least 7 days in reducing omphalitis risk, research on the impact of a single CHX application at birth, particularly in African settings, remains limited. Objective: To address this gap, our study examines the comparative effects of a single CHX application at birth versus dry cord care on omphalitis and severe neonatal illness among infants born in Nakuru County Hospital. Our study aimed to compare these three cord care methods in terms of cord separation time (CST) and the incidence of omphalitis, sepsis, and neonatal mortality in order to develop a guiding framework for the prevention of omphalitis at Nakuru County Hospital, as well as at other medical facilities that can benefit from the insights gained through this study. Method: Different methods and steps were employed to examine and gather information. Information was gathered through a structured questionnaire, swabs taken for bacterial analysis, and subsequent evaluations to monitor infection indicators. The data was then entered into SPSS version 20 for analysis. Both descriptive and inferential statistics were utilized for examination. A 95% confidence interval was employed to assess the relationship between various factors. Statistical significance was defined at a p value of 0.05. The study findings were presented in tables, graphs, charts and narrative. Findings: The incidence of omphalitis was 23.1%, and this varied significantly in the different intervention groups (p=0.023). The incidence was higher among the dry cord care group (27.0%) and the alcohol group (26.8%) which appeared to have the same rate compared to the chlorhexidine group (15.8%). Among infected neonates, common bacteria were Escherichia coli (36.6%) and Staphylococcus aureus (32.1%). Conclusion: The application of 4% chlorhexidine topically to the umbilicus of neonates born in health facilities significantly decreases the risk of omphalitis compared to both dry cord.....................................