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.