Assessment of determinants of umbilical cord infection among newborns at Pumwani Maternity Hospital

Abstract

Background: The umbilical vessels remain patent for a few days following birth which provides direct access to the bloodstream. The cord stump can therefore be an excellent medium for bacteria. Infections are the single most important cause of neonatal mortality and it is estimated that 300 000 infants die annually from tetanus and 460 000 die because of severe bacterial infections, of which umbilical cord infection is a major precursor. Objectives: The broad objective was to assess the determinants of umbilical cord infection among neonates aged 3 to 28 days attending Pumwani Maternity Hospital. Methodology: This was a cross sectional descriptive design and 178 mothers with neonates of 3-28 days were selected using systematic sampling method. The data was collected using pre-tested semi-structured questionnaire. Descriptive analysis using means, frequency and proportions was computed. Chi-square test (p<0.05) and odds ratio with corresponding 95% confidence interval was used to determine the association between dependent and independent variables. Binary logistic regression analysis was performed to determine the independent factors associated with cord infection. Results: The findings of the study revealed that the prevalence of umbilical cord infection among neonates was 37.6%. Of these, 49.3% presented with redness and 37.3% with pus discharge while13.4% presented with swelling. The stepwise logistic regression revealed that being female was at [AOR=2.68; 95%CI=1.19-6.04; P=0.017], mothers who had primary school education were at [AOR=7.21; 95%CI=1.62-32.13; P=0.026] and those who had secondary school education [AOR=6.00; 95%CI=1.49-24.20; P=0.010] than those who had college/university education respectively, households getting water through handcart [AOR=8.19; 95%CI=1.37-48.94; P=0.021 ] compared to those getting piped water, primipara mothers [AOR=10.38; 95%CI=2.35-45.97; P=0.002], babies who initiated breastfeeding after one hour of delivery [AOR=2.61 ; 95%CI=1.11-6.11; P=0.027]. Babies who bathed with hand/body soap or Dettol [AOR=3.07; 95%CI=1.24-7.58; P=0.015] were factors independently associated with cord infection. Conclusion: The prevalence of cord infection among neonates was high, indicating that it is a major public health problem. Baby‟s sex, maternal level of education, parity, source of water, breast-feeding initiation and adding hand/body or Dettol to the baby‟s bath water were the independent predictors of umbilical cord infection. Recommendations: More campaigning and sensitization on the contributing factors should be tailored among mothers during ANC visits so as to avoid umbilical cord infections.