TABLE 0F CONTENTS Page
TITLE PAGE i
APPROVAL ii
CERTIFICATION iii
DEDICATION
iv
ACKNOWLEDGEMENT
v
TABLE OF CONTENTS vi
LIST OF TABLES vii
ABSTRACT viii
CHAPTER ONE: INTRODUCTION
Background to the Study 1
Statement of Problem 3
Purpose of Study 4
Objectives of the Study 4
Research Questions 5
Significance of the Study
5
Scope of the Study 6
Operational Definition of Terms 6
CHAPTER TWO: LITERATURE REVIEW
Conceptual Review of Umbilical Cord 8
Management of Umbilical Cord 9
Knowledge of Standard Cord care and Sources 10
Material for Cord Management 11
Reasons for Choice of Substance for Cord Management 12
Techniques of Cord Care 14
Factors Influencing Umbilical Stump Management 15
Cord Infections
16
Cord Separation Time 20
Theoretical Review 20
Conceptual Model of the Study 23
Empirical Review 24
Summary of Literature Review 34
CHAPTER THREE: RESEARCH METHOD
Research Design 36
Area of Study 36
Population of Study 37
Sample 37
Sampling Procedure 38
Instrument for Data Collection 40
Validity of the Instrument 40
Reliability of the Instrument 41
Ethical Consideration 41
Procedure for Data Collection 41
Method of Data Analysis 42
CHAPTER FOUR: DATA PRESENTATION
Demographic Data of Respondents 43
Research Questions 45
Summary of major Findings 60
CHAPTER FIVE: DISCUSSION OF
FINDINGS
Discussion of Major Findings 61
Implication to Nursing 67
Limitations of the Study 68
Suggest for further studies 68
Summary 69
Conclusion 70
Recommendations 72
REFERENCES 72
APPENDICES 77
LIST OF TABLES
Page
Table 1: The Number of Sample for Each Clan 39
Table 2: Demographic Characteristics of Respondents 43
Tables 3-8 Knowledge of Standard Cord Care and Source 45
Table 9: Materials Used by Mothers for Core Care 51
Table 10: Reasons for Choice of Material for Cord Care 53
Table 11: Techniques Used by Mothers in Umbilical Care 54
Tables 12 Management outcome of umbilical care 56
Table 16: Correlation Test of Association between Age and cord
management 57
Table 17: Correlation Test of Association between educational
Attainments 58
Cord Management
Table 18: Correlation Test of Association between income and Cord
Management 59
LIST OF FIGURE
Figure 1: Conceptual Model of the study 23
LIST OF APPENDICES
Appendix 1: Questionnaire 77
Appendix 2: Calculation of Sample Size 85
Appendix 3: Reliability Test Result 86
Appendix 4 Identification Letter 88
Appendix 5 Ethical Clearance Certificate 89
Appendix 6: Letter of Approval 90
Appendix 7 Information Letter 91
Appendix 8 Informed Consent 93
ABSTRACT
Umbilical cord remains the major
means for the transmission of infection after birth and constitutes 33% of
neonatal mortality in Nigeria. Most of the cord care in Nigeria is home based
as two third of the delivery takes place at home. The purpose of this study was
to determine the umbilical cord care and management outcome among mothers in
Calabar South Local Government Area of Cross River State, Nigeria. The research
method was a cross – sectional descriptive survey design. Four hundred and
fifty (450) respondents were selected using a snow ball (networking) method.
Data were collected using a researcher developed questionnaire. The instrument
was validated by the supervisor, two lecturers in the Department of Nursing
Sciences who are experts in child health and three neonatologists. The
reliability was established using a test re-test method at interval of two
weeks. The scores obtained were correlated using Pearson product correlation
coefficient to obtain coefficient reliability of 0.993 – 0.99 at 0.05 level of
significance. Data collected were analyzed using mean, simple percentage and
standard deviation to answer the research questions. Findings revealed that 201
(44.7%) of the respondents had good knowledge of standard cord care and their
major sources of information was from mothers / mothers-in-laws. Three hundred
and fourteen (69.8%) used unhygienic and harmful materials for cord care. The
major reason for choice of materials was mainly to wade away evil spirit which
the respondents belief causes neonatal deaths. The technique for cord care was
poor as only 92 (20.4%) cleaned the base of the cord before cleaning the
surrounding skins. The management outcome was poor as 338 (75.1%) of respondents
reported signs of umbilical infections in their neonates and only 5 (4.1%)
reported the problem to the health facilities within 24hours of onset of
problem. There was a significant association between age, educational level,
income and cord management (p=<0.05). In conclusion, there was poor
knowledge of standard cord care among the respondents in this study. Unhygienic
materials were used in the care of umbilical cord by most of the respondents.
Based on the findings, the study recommends that there should be increased home
visits and education of the mothers by the health personnel to reduce the
consequences of poor cord management after delivery.
CHAPTER ONE
INTRODUCTION
Background to the Study
In
developing countries umbilical cord infections constitute a major cause of
neonatal morbidity and pose significant risk for mortality (WHO, 2009). Cord management
introduced to mothers in both developed and developing countries to reduce
exposure of the cord to infectious pathogens include clean cord cutting,
hygienic cleaning and washing of hands before and after cord care (Garner, 2008;
Basil, Kayode, Mark & Mbe, 2009).
The
umbilical cord is a unique tissue consisting of two arteries and one vein which
at term is about 56cm in length and extends normally from the centre of the
placenta to the umbilicus of the unborn baby (Abba, 2008). During pregnancy,
the umbilical cord connects the fetus to the mother through the placenta. The
blood flowing through the cord brings nutrients and oxygen from the mother to
the fetus and carries away carbon dioxide and other metabolites from the fetus
(World Health Organisation, 2009; Bello & Omotara, 2010; Ezenduka &
Eze, 2002).
After
the delivery of the baby, the cord should be clamped firmly and cut with
sterile instrument to separate the baby from the placenta attached to the
mother’s uterus leaving about 6cm with the baby. The instrument used in cutting
the cord cuts across the living tissues and the blood vessels which are still
connected to the baby. In view of the fact that this time the umbilical cord is
wet with an open surface wound and blood vessels still patent, they provide a
nutritive culture medium for bacterial growth. These require that some degree
of hygiene practices must be adopted to prevent infection, which may present as
yellow discharge from the cord, foul smelling, red skin around the base of the
cord, pain when touched the skin around the stump and excessive crying. These strengthen the need for standard cord
management among mothers (Bemor & Uta, 2011).
Methods
of caring for the umbilical cord vary greatly between communities depending on
their cultural and religious beliefs, level of education and resources. In the
developing countries most deliveries occur at home where health care services
may not be available. Sometimes materials used to tie the cord include strings,
thread and strips of cloth, scissors and sharp stone (Obuekwe & Obuekwe,
2008). The risk of cord infection is increased by unhygienic cutting of the
cord and application of unclean substances such substances sand from door post
mixed with saliva, herbal preparations and lantern wax. Even babies delivered
in hospitals may be affected by traditional practices after discharge which
most times lead to umbilical cord infection and dead among the neonates
(Sreeramaraddy, Josh, Sreekumaran & Giri, 2006).
The use of alcohol daily and as often as each
diaper is changed has been recommended by the World Health Organisation (WHO)
as standard care. With standard care the cord usually falls off between five to
fifteen days after birth (WHO, 2007). Where clean cord care is not practiced,
the cord is readily colonized and infected by pathogenic organisms (Bennet
& Adetunde, 2010; WHO, 2007). Therefore, mothers who adopt clean cord
management will by implication contribute to the survival of the neonates and
prevent neonatal death from infections such as omphalitis, neonatal tetanus and
septicaemia (Bemor &Uta, 2011; Bennet &Adetunde, 2010; WHO,2007).
Globally,
neonatal tetanus accounts for 7% of neonatal deaths, but accounts for more than
48% in Africa (Peter & Johnson 2010). Nigeria has one of the highest infant
mortality rates of 94 deaths/1,000 live births (WHO, 2009). According to the
report, 26% was due to umbilical infection (Peter & Johnson 2010; WHO,
2009). In Calabar South Local Government Area of Cross River State, umbilical
infection is responsible for 49% of neonatal deaths (Antai & Effiong, 2009).
This study therefore addressed umbilical cord care and management outcome among
mothers in Calabar South Local Government Area of Cross River State, Nigeria.
Statement of Problem
UMBILICAL CORD CARE AND MANAGEMENT OUTCOME AMONG MOTHERS IN CALABAR SOUTH LOCAL GOVERNMENT AREA, CROSS RIVER STATE, NIGERIA
