Factors Influencing the Prevalence of Umbilical Cord Sepsis Among Newborn Babies at the China-Uganda Friendship Hospital Naguru

Scientific Essay, 2015

11 Pages, Grade: 21.00

MPH Vanice Petwa (Author)

Free online reading


Petwa, K.W., Callender-Carter, S.T., Ndungutse, D., and SamuelBiraro,

A descriptive cross sectional study research design was used to assess factors, prevalence and how it was influenced by associated factors at China Uganda Friendship Hospital-Naguru. Both quantitative and qualitative methods were used; a sample of 258 mothers of newborns and 4 key informants and records were used. The Statistical Package for Social Scientists (SPSS) and thematic content analysis methods were used for quantitative and qualitative data respectively. Parity was (UOR, 2.04, p-value, 0.001) attendance of cord care talk (UOR, 2.96, p-value, 0.04), knowledge about cord care (UOR, 2.07, p-value 0.003) were maternal factors influencing neonatal cord sepsis. Cultural and environmental factors; cord care at hospital (UOR, 1.05, p-value 0.008), and at home(UOR, 3.76, p-value 0.003), application of substances to the cord (UOR, 2.95, p-value 0.001), occasions for washing hands while caring for new born (UOR, 2.05, p-value 0.009), influencing prevalence of cord sepsis, the prevalence of cord sepsis was at (24.0%) and was positively influenced by associated factors. It was concluded that parity, attendance of cord care talk, knowledge and occasions for washing hands (Maternal factors), cord care at hospital and home, application of substances (Cultural factors) influenced cord sepsis, the prevalence was high and associated factors had a positive influence. The study recommended that health workers should increase health education talks about umbilical cord care.

Keywords: neonatal cord sepsis, maternal factors, cultural factors, prevalence


Severe cord sepsis is one of the top three causes of newborn death worldwide, causing 13% of all neonatal deaths (WHO & UNICEF 2012). In developing countries it was found that umbilical cord infections can account for more than half of all neonatal deaths (Mullany et al 2006). A study in Nepal revealed 16% prevalence of cord infection and in Egypt 8.2% (Black et al 2008). Six percent, 0.521 million deaths occurred in five countries of India, Nigeria, Democratic Republic of Congo, Pakistan and China (Black et al 2008). According to Bugaje et al (2013) and Mullany et al (2006), umbilical cord sepsis (omphalitis) is defined as either pus discharge with erythema of the abdominal skin or severe redness >2 cm extension from the cord stump with or without pus (Mullany et al 2006).

Globally infections account for 36% of neonatal mortality (Lawn, Cousens &Zupan, 2005) of which, sepsis and meningitis claimed 5.2% in a period between 2000-2010 (Liu et al 2012), majority cases were from the least developed and developing countries whereas developed countries registered small prevalence of approximately 0.2-0.7% (Bugaje, Ameh, Mchoney&Lakhoo 2013).

Cord sepsis has been identified as one of the neonatal infections which can cause severe illness for example neonatal tetanus which causes about two hundred thousand infant deaths each year throughout the world (Zupan, Garner & Omari, 2004).

Sub-Saharan Africa contributes 67% to the global under-five mortality and also affirmed that the prevalence is even higher in communities that practice application of non-sterile home remedies to the cord (Bugaje et al 2013). In Pemba Island, Zanzibar and Tanzania, omphalitis occurred in 954 (5.5%) out of 17,198 infants within seven days of age (Mullany et al 2009). In another assessment, out of 1653 infants, the proportion of these affected ranged from 16 (1.0%) with moderate to severe redness with pus discharge to 199 (12.0%) pus and foul odor while single signs were observed in < 20% of infants (Mir et al, 2007).

In developing countries little is known about risk factors of umbilical cord infection, although unhygienic practices around the time of birth may be likely determinant of disease (Bernnett, Macia, Traverso, et al, 2006). According to Achiro, (2001), there is no information about factors that influence this high prevalence. A study by Triza, et al (2011), found that age, educational level, socio economic status influenced maternal knowledge and practice of umbilical cord care.

In Uganda, neonatal sepsis contributes 45.0% to infant mortality rate. In 2013 the status was 27 per 1,000 live births and the target for 2015 is 20 per 1000 live births (Annual Health Sector Performance Report for Financial Year 2013/2014). The death toll per day due to neonatal sepsis stands at 120 (Uganda Demographic Health Survey-UDHS 2011). The ministry of health 2014 report states that one of the major causes of newborn mortality is sepsis (Ministry of Health Report 2014).

It has been noted at China Uganda Friendship Hospital-Naguru, that there was high prevalence of neonatal sepsis. In a period of three months, 39/1000 live births were admitted at the hospital with neonatal sepsis in their first week of life (Inpatient Registers and Health Management Information System (HMIS 108 2014) almost the level of national prevalence rate of neonatal sepsis in Uganda which was at 27/1000 live births (UDHS 2011). Factors explaining the high prevalence in Naguru were not yet studied. I suspect that factors like maternal, neonatal, and social cultural and environmental could contribute to the problem. Scholars have pointed out some so that’s why it was important to ascertain and document what were the factors at Naguru Hospital the purpose of this study was to investigate factors influencing high prevalence of umbilical cord sepsis at Naguru.

A descriptive cross sectional study research design was used to assess factors, prevalence and how it was influenced by associated factors at China Uganda Friendship Hospital-Naguru. Both quantitative and qualitative methods were used; a sample of 258 mothers of newborns and 4 key informants and records were used.

The study found that significant maternal factors influencing neonatal umbilical cord sepsis were: Parity (UOR, 1.0; p-value, 0.001), attendance of health talks on cord care. (UOR, 1.03; p-value, 0.04), knowledge about cord care (UOR, 1.07; p-value 0.003) and occasions of hand washing (UOR, 1.09, p-value, 0.009).

Also the study found that cultural factors that influenced prevalence of umbilical cord sepsis were: the person who took care of the cord at the hospital before discharge (UOR, 1.05, p-value 0.008), the person who takes care of the cord while at home (1.76, p-value 0.003 and application of substances at the cord (UOR, 1.97, p-value 0.001).

Qualitative data showed that several factors are responsible for neonatal umbilical cord sepsis among newborns which included; failure to observe infections control measures, absence of health education regarding cord care and ignorance of mothers among others.

Regarding prevalence of cord sepsis, the study showed that 24.0% newborns developed cord sepsis and majority of mothers of these babies, sought for health care from health facilities especially China Uganda Friendship Hospital-Naguru.

Associated factorswereinfluential on theprevalenceofcordsepsisasindicatedbytheincreaseforthenumberofchildren (newborn) withthisproblemovertheyearsasbased on thedataextractedfrom China Uganda Friendship Hospital Naguru for the years 2012-2014.


In relationtothefindingsandthediscussionmade in chapterfourabove, itcanbeconcludedthat; parity, cord care talkattendance,knowledge and practiceaboutumbilicalcord care andoccasion for washing handwerethematernalfactorsinfluencingtheprevalenceofumbilicalcordsepsisamongnewbornbabies. This isbecausetheformerincreasesskillsandcapabilitiesofmonitoring a baby’shealthconditionsincludinghygienefortheumbilicalcorduntilit falls off.

Cordcare at hospital and home, applicationofsubstancestobaby’scordwereculturalfactorsinfluencingtheprevalenceofumbilicalcordsepsisamongnewbornbabies. This isworsenedbytheculturalbeliefsamongpeople in communityregardingwelcoming a newborn in thecommunitywheresanitationandhygienearecompromised.

Occasionsofhandwashingis an environmental factorinfluencingtheprevalenceofumbilicalcordsepsisamongnewbornbabies atChina Uganda Friendship Hospital-Naguru. Failuretowashhandsbeforehandlingthebabyincreaseschancesoftransitinggermstothecord.

The prevalence of umbilical cord sepsis was high at (24.0%) due to several factors that influenced existence of sepsis among newborn attending care from China Uganda Friendship Hospital-Naguru.

Associated factors have a positive influence on the prevalence of neonatal umbilical cord sepsis among newborn babies attending Naguru Hospital. These increase the prevalence of sepsis everyday at this health facility.

Statistically, maternal factors outweighed cultural factors.


According to the study results mothers’ knowledge was an important factor in the prevalence of sepsis therefore, it is recommended that healthworkers at thefacilitiesshouldincrease health talks and demonstrations on cord care at thehealthfacilities, community level orthroughthemedia. This will increasemothers’ knowledgeandskillson cord care thus reducing the prevalence of sepsis. This hasbeenrecommendedbecauseresultsofthisstudyhaveshownthatfewmothershadhealthtalkregardingcord care this is in line with what key informant 2 complained about.

More public health nurses and midwives should be trained and employed to provide health facility and home-based cord care since results of this study have shown that babies who were cared for by health workers at hospital and at home stood higher changes of not developing sepsis.

Special in servicetrainingandmentoringprogramfor all midwivesregarding proper umbilicalcord care shouldbedevelopedandimplementedbyMinistryof Healthandpartnerstopreventneonatalsepsiswhichis on theincrease. This is in regardtothecommentmadebykeyinformants.

MinistryofHealthshouldrevisetheantenatalcardtoinclude all importanthealtheducationtalks a mothershouldattendduringantenatalperiodandshortly after deliverybeforedischarge so that mothers demand for this information or these talks in case they are not given.

Mothersshould continue seeking for antenatal care deliverfromhealthfacilities and post-natal care becausethiscanoffer them a chancetoobtaincord care relatedinformationunlikewhentheydeliverfrom traditional birthattendantsandvisitthehealthfacility after theirbabiesdevelopcordcomplications and this is in regard to key informant 3.

Environmental sanitationshouldbeimproved at householdandcommunitylevelshouldbeimprovedbymothersand care-takers. This is in relationtothefindingsofthisstudy in relationofoccasionsofhandwashing.

Infection prevention and control in hospitals should be improved by training and mentoring health workers and sanitation staff. More hospitals should be constructed and equipped with facilities to reduce overcrowding in maternity units which exposes mothers and infants to infections as observed by the key informant four who noted that failure to observe infection control increases umbilical cord sepsis in hospitals.

Itisrecommendedthat a studyisconductedregardingtheinfluenceofhealthfacilityfactorsandcordsepsisamongnewborn in Uganda. This will offerinformationtohealthfacilityadministratorregardingsepsis in Uganda.

A study to find out reasons why some health workers do not explain and demonstrate proper cord care to mother before discharge is recommended.

In relation to secondary data, a study about factors contributing to neonatal sepsis is recommended because it was found that there was higher prevalence of neonatal sepsis among newborn.


Abhulimhen-Iyoha, B. I, &W Ibadin, M O.(2012). Determinants of cord care practices among mothers in Benin City, Edo State, Nigeria. Nigeria Journal Clinical Practice 2012; 15:210-3210-3 Doi 10.4103/1119-3077, 97320.

Achiro, (2001) . knowledge Gaps Identified among Mothers on Appropriate Umbilical Cord Care duration. Uganda.

Akani, N.A., Oruamabo, R.S Nig& J Pediatric, (2004). Neonatal Tetanus in Nigeria: One Social Scourge too many! Nigeria.

Association of Women’s Health, Obstetric and Neonatal Nurses. (2007). Neonatal Skin Care: Evidence –Based Clinical Practice Guideline (2nd Ed); Washington D. C.

Baltimore, Maternal and Neonatal Health program. (2001), Birth preparedness and compilation of readiness is a matrix of shared responsibilities during pregnancy.

Black RE, Morris SS, and Bryce J.(2008). where and why are 10 million Children dying every year? Essentials of global health pg 145 Google books results

Blencowe, Hannah. (2011). Estimates of effects of clean birth and postnatal practices.National center for biotechnology information, united staes national library of medicine.

Bugaje, E.A. Ameh, M.M, &Kokila L.(2013). Umbilical cord infection (omphalitis) is uncommon in developed countries with an prevalence of 0.2-0.7 percent.

Collin,&Bonsall A. (2013). Prevalence of Sexually Transmitted Diseases from Mother to Child , 843 version24, Cochrane Database of Systematic Reviews (3) doi: 10.1002/14651858CD001057.pub2.

Dachew, B.A &Bifftu, B.B. (2014). Breastfeeding practice and associated factors among female nurses and midwives at North Gondar Zone, Northwest Ethiopia: A cross-sectional institution based study; College of Medicine and Health Science, Department of Nursing, University of Gondar, Gondar, Ethiopia.

Dawodu, A.(1998). Neonatology in developing countries; problems, practices and prospects. Ann Trop Paediatr1998; 18:S73–S79.

Devkota, MD & Bhatta, M.R. (2011). Newborn Care Practices of Mothers in a Rural Community in Baitadi, Nepal, India.

Dore, S., Buchan, D., Coulas, S., Hamber, L., Stewart, M., Cowan, D., Jamieson, L. (2006). Alcohol versus natural drying in newborn cord care. Journal of Obstetric, Gynaecologic and Neonatal Nursing, 27 (6), 621-627.

Enkin (2000). Rooming in a practice that protects babies from harmful micro organisms

Evens, K., George, J., Angst D., & Schweig, L. (2004). Does umbilical cord care in preterm infants influence cord bacterial colonization or detachment ? Journal of Perinatology (24), 100-104.

Garner P , Lai, D, Baea M, Edwards, K, & Heywood P.(2009). Avoiding Neonatal Death: An intervention Study of Umbilical Cord Care. J Trop Pediatr. 1994; 40: 24 – 28

Ghaffari, V, VahidShahi, K, &Taleshi B. knowledge and attitude assessment of neonatal Infection among postnatal mothers in sari: Journal of Mazandaran University of Medical Sciences .2005:92-97.

Ghana Demographic Health Survey. (2009) In Ghana mortality rate were 43 per 1000 live births 2004 while in 2008 it was 31 per 1000 live births.

Gul et al. (2014). Newborn care knowledge and practices among mothers attending pediatric outpatient clinic of a hospital in Karachi, Pakistan,Baqai Medical University, and Karachi, Pakistan.

Herbst, K.K (2007). Time between membrane rupture and delivery and septicemia in term neonates; Department of Obstetrics and Gynecology, Clinical Sciences, and Thornblad Institute, Lund University, Lund, Sweden.

Harnagle, R, & Chawla P.S.(2013). A study of knowledge, attitude and practices (KAP) of lactating mothers on breast feeding, weaning immunization and dietary practices at Jabalpur cantonment, India; Department of Community Medicine, AFMC, Pune, India.

Herlihy, JM; Shaikh, A, Mazimba, A, Gagne, N, Grogan ,C, et al. (2013). Local Perceptions, Cultural Beliefs and Practices That Shape Umbilical CordCare: A Qualitative Study in Southern Province, Zambia. PLoS ONE 8(11): e79191. doi:10.1371/journal.pone.0079191.

Hoque, M. M, Mohammad FaizulHaque Khan,,Jotsna Ara Begum, MAK Azad Chowdhury;Lars Ake Perssonet al (2011 ). Neonatal mortality accounts for 2/3 of infants due to poor maternal knowledge of identifying sickness in Bangladesh (http://wwwmnhijhpiego.org/resources bpc matrix, accessed (29Jan 2005).

Janssen, P, Selwood, B, Dobson S, Peacock D, & Thiessen P. To dye or not to dye: a randomized, clinical trial of a triple dye/alcohol regime versus dry cord care. Pediatrics. 2003; 111: 15 – 20

Jelliffe, D, B, Stanfield, J, P, Edward Arnold (publisher) (1978). Woodruff AW, EI Bashir E,

Joy, E.Lawn, Simon Cousens, &JelcaZupan (2013). Four Million Neonatal Deaths: When? Where? Why? Imdad A, Bautista RM, Senen KA, Uy ME, Mantaring JB 3rd, Bhutta ZA(2013): Umbilical Cord Antiseptics for Preventing Sepsis And Death Among Newborns. Cochrane Database Systems Review. 2013 May 31; 5:CD008635. doi: 10.1002/14651858.CD008635.pub2.

Kakhobwe, Itara. (2011)(Kamayashi 2005) Kami K Ikeda M, Kishi M, Murashiqe Y, Tanosaki N, Mozi R, Takave S, (2005)

Klieg man, RM, & Arvin AM (1996). Routine Delivery Room care. Philadelphia: WB Saunders company1996:437–439

Lawn et al, (2001). Factors like household practices and social cultural beliefs contribute to cord infection. Selected Newborn Lives Publication- Save The Children Ghana.www.savethechildren.org

Ladewig, P.W., Ball, J.W., &Bindler, R.C. (2007). Maternal & Child Nursing Care (2nd Ed ). Pearson: Upper Saddle River.

Liu, L , Johnson, HL, Cousens, S, Perin, J, Scott, S, Lawn, JE, Rudan, I, Campbell H, Cibulskis R, Li

MMathers C, Black RE(2012); Child Health Epidemiology Reference Group of WHO and UNICEF . Global, Regional and National Causes of Childhood Mortality.

Mangwi, et al (2013). Exploring the focus of prenatal information offered to pregnant mothers regarding newborn care in rural Ug anda; Mulago Hospital Complex, Makerere University School of Public Health, Kampala, Uganda.

McConnell, T.P., Lee, C.W, Couillard, M., & Sherrill, W.W. (2004). Trends in umbilical cord care:Scientific evidence for practice. Newborn and Infant Nursing Reviews (4), 211-222.

McKinney, E.S., James, S.R., Murray, S.S., &Ashwill, J.W. (2009). Maternal – Child nursing (3rd ed ). Elsevier: St. Louis.

Mercer, R. T. &Ferketich, S. L. (1995).Experienced and Inexperienced Mothers’ Maternal Competence during Infancy. Research in Nursing and Health 18 (4), 333-343. doi:10.1002/nur.4770180407

Ministry of health and medical education.(2002). Population and health in lran, 2000, health office of family and population of Tehran. Tehran: Estila pub.

Ministry of Health Uganda, annual health sector performance report for financial year 2013/2014, October, 2014

Ministry of Health.(2007). Situation analysis of newborn health in Uganda; Current status and opportunities to improve care and survival; Kampala, Uganda.

Mir et al (2007). Assessment on prevalence of umbilical cord sepsis Mohamad Asifpadiyath, vishnu Bhat B, heswariEkambaram, knowledge assessment of neonatal care among postnatal mothers.

Monebrenimp, et al (1980). mothers are not knowledgeable on danger signs and have poor practice on new born care. Mug ford (1980) a practice often forgotten is nothing other than keep the cord clean and dry without applying anything.

Mullany et al, (2006). Risk factors surrounding newborn umbilical cord infection, in developing countries umbilical cord sepsis account for more than all neonatal deaths. Among Newborn of Southern Nepal.

Obimbo E, Musoke, R.N. (2010). Mothers Knowledge on the Need for Hygiene When Cutting the Cord Care and Pathogens Associated With Sepsis In Newborns and Young Infants in Developing Countries.

Onah, S, Chidiebere D I O, Ebenebe J, Ezechukwu C, Uchenna E &Ndukwu, (2014) Infant feeding practices and maternal socio-demographic factors that influence practice of exclusive breastfeeding among mothers in Nnewi South-East Nigeria: A cross-sectional and Analytical study; 1Department of Pediatrics, NnamdiAzikiwe University teaching Hospital, Nnewi, Anambra state, Nigeria.

Opara, PI, Jaja, T &Okari, TG (2012). Newborn cord care practices amongst mothers in Port Harcourt, Nigeria.

Omar (2009). Major causes of neonatal deaths Pediatric infectious Diseases Journal (2009 Jan 28):S3-9 a review of evidence from Community Based Studies.

Sharan, M. (2004). Determinants of safe motherhood and newborn care behaviours in ruralIndia . (PhD thesis) John Hopkins University

Save the Children. (2013 ). New born Health; Save the Children, Newborn Health Factsheet.

Solomons, N, &Rosant, C, (2011). Knowledge and attitudes of nursing staff and mothers towards kangaroo mother care in the eastern sub-district of Cape Town; Division of Dietetics, South Africa.

Suliman, A . (2007). Triple dye plus alcohol versus triple dye alone for newborn umbilical cord care. Pennsylvania State Milton S. Hershey Medical Center, ClinicalTrials.gov identifier: NCT00127699.

Taghavi M. The mortality rate if 23 provinces of country in 2005 Tehran: The ministry of health and medical education; 2005.

ThaverD.Zaidi, AK, (2009). Burden of Neonatal Infections in Developing Countries: The Lancet : Volume .365, No.9462 (2005), pages 891-900 Traverso HP et al. Ghee applications to the umbilical cord: a risk factor for neonatal tetanus.

Triza, T &Kakhobwe, I. (2011). Knowledge Levels Of Mothers in Zimbabwe (8):S10-8PMID:19106757.

Tuladhar, S. (2010). The Determinants of Good Newborn Care Practices In The Rural Areas of Nepal;University of Canterbury.

United Nations Population Fund (UNDP). State of the World’s Population 2005 (Geneva UNFPA, 2005)

US census Bureau (2008) The rate of decline in under five mortality of 4.4million, is insufficient to reach 2015 Millennium Development Goals target especially in the low income countries.

Vural, G. &Kisa, S. (2006). Umbilical cord care: A pilot study comparing topical human milk, povidone – iodine, and dry ca re. Journal of Obstetrics, Gynecology and Neonatal Nursing (35), doi: 10.1111/J.15526909.2006.00012.

Waiswa P, PetersonS, Thomson, G et al (2010). Place of Birth In Relation to the YaminiDurani, New Born Infections MD October 2012

Waiswa, P. (2010). Understanding Newborn Care in Uganda-Towards Future Interventions. Thesis for doctoral degree, (PhD) Stockholm, Sweden.

Wojcicki, J. M, Gugig, R, Camtran, Suganya, K, Holbrook, K &Heyman, MB.(2010). Early Exclusive Breastfeeding and Maternal Attitudes towards Infant Feeding in a Population of New Mothers in San Francisco, California.

World Health Organization. (1998). Care of the umbilical cord: A review of the evidence. Geneva (1998). Retrieved from Http:// www.who.int/reproductiveHealth/publications/MSM_98_4

WHO-Guideline, (2014). Delayed umbilical cord clamping for improved maternal and infant health and nutrition outcomes. Geneva: World Health Organization; 2014.

World Health Organization, (1996). Essential Newborn care: A Report of Technical Working Group. Geneva

Yugusuk A, Grant J, Baya EI, Suni A (1984). Neonatal tetanus: Mode of infection, prevalence and prevention in Southern Sudan. Lancet; 1:378–379

Zupan, J, Garner, P. & Omari, A.A.A. (2004). Topical umbilical cord care at birth. Cochrane data base of systematic review 2004, issue 3.

11 of 11 pages


Factors Influencing the Prevalence of Umbilical Cord Sepsis Among Newborn Babies at the China-Uganda Friendship Hospital Naguru
Master of Public Health Thesis Research
Catalog Number
File size
506 KB
neonatal cord sepsis, maternal factors, cultural factors, prevalence
Quote paper
MPH Vanice Petwa (Author)Dr. Sylvia T. Callender-Carter (Author), 2015, Factors Influencing the Prevalence of Umbilical Cord Sepsis Among Newborn Babies at the China-Uganda Friendship Hospital Naguru, Munich, GRIN Verlag, https://www.grin.com/document/307433


  • No comments yet.
Read the ebook
Title: Factors Influencing the Prevalence of Umbilical Cord Sepsis Among Newborn Babies at the China-Uganda Friendship Hospital Naguru

Upload papers

Your term paper / thesis:

- Publication as eBook and book
- High royalties for the sales
- Completely free - with ISBN
- It only takes five minutes
- Every paper finds readers

Publish now - it's free