CHAPTER ONE

1.1 Introduction

The umbilical cord (UC)which connects the baby and placenta in uterus (the womb) is made up of blood vessels and connective tissues .It is covered by a membrane that is normally bathed in amniotic fluid .After birth, cutting the cord physically separates the mother and the baby. The cord stump dries, falls off and the wound heals. The cord usually separates between 5 and 15 days after birth (Zupan et al., 2004).Before the separation, the remaining stump can be considered to be a healing wound and thus a possible route for infection through the vessels into the baby’s blood stream. Annually about 3.3million neonatal deaths occur around the world; of these, more than 30% are caused by infections .Some of these infections starts as umbilical cord infection. Topically umbilical cord care when performed properly can help to prevent infection and neonatal mortality (Jamlick et al, 2012).World health organisation (WHO, 1998) advocated since 1998 for the use of dry UC care (keeping the cord clean without application of anything or substance in which anything stands for a dye, an antiseptic, or an antibiotic and leaving it exposed to air or loosely covered by a clean cloth, in case it became soiled it is only cleaned with water. In Africa, particularly in the northern Cameroon traditional substances are applied on the cord. Poor umbilical cord care can cause umbilical cord infection. Some of these practices are not washing hands with soap and water before and after contact with the area, the use of unsterile instruments when the umbilical cord should initially be cut, and when the cord is not kept clean and dry it can cause an opening for bacteria and other infectious agents. (In this method we are using a cotton swab to clean generally around the base of cord) and when the cord is not exposed to air or is not covered loosely with clean cloths and the fold diaper is not below the level of the umbilicus (McKinney et al; 2008).This is improper care which can cause umbilical cord infection (original article; mothers knowledge and practice on essential new born care at health facilities in Garoua city ‘Cameroon writing by francisca et al,2018).

1.2 Background

The umbilical cord is a unique tissue, consisting of two arteries and one vein covered by a mucoid connective tissue called whartons’s jelly and a thin mucous membrane. During pregnancy, the placenta supplies all materials for foetal growth and removes waste products. Blood flowing through the cord brings nutrients and oxygen to the foetus and carries away carbon dioxide and metabolic wastes. After birth, until the placenta separates and while the cord is still pulsating, a small volume of blood may be transported from the placenta to the new born .Therefore the cord has to be tied and clamped tightly in order to keep the umbilical vessels occluded and prevent bleeding. The healing of the stump is facilitated by exposure to air. The devitalized tissues of the cord stump can be an excellent medium for bacterial growth, especially if the stump continues to produce small amounts of mucoid materials until complete healing takes place, usually a few days after separation. During this time, the umbilicus is still susceptible to infections although less so than in the first 2 to 3 days. Infection may delay healing, causing the umbilicus to stay moist for longer periods. (david, perlstein, melisa, Conrad and stoppler,2018).The exact incidence of cord infection is unknown, the frequency of umbilical cord infection may be under  reported as babies may be discharged early from the hospital and not being followed at home .The greatest period of risk for umbilical stump colonization is the first three days of life. Risk decreases with time as the umbilicus wound heals and the stump separates. Signs of inflammation (erythema, edema, tenderness) of the tissues surrounding the cord support the diagnoses of Omphalitis. As infection delays or prevents obliteration of the vessels, umbilical bleeding is a common sequele. There may also be a purulent discharge from the stump. However no data are available on the predicative value, sensitivity or these signs for umbilical infections. Associated signs such as fever, lethargy and poor feeding suggest systemic complications. In many instances, the diagnosis of cord infection is uncertain. In normal drying process, they may appear unusual moist and odorous with or without discharge, but with no other signs. The challenges for the care giver are to be able to differentiate between normal process and infection (Dorathy et al; 2018).

Roughly, 135 million live births occur worldwide each year. The majority of these births occur in “less developed countries (US census bureau, 2008). A major cause of death in these undeveloped countries is umbilical cord infections. One such infection is neonatal tetanus that causes about 200,000 infants death each year throughout the world (Zupan, Garnez and Omari 2009). It is important to determine the best practice for umbilical cord care in order to minimise cord infection in the millions of babies born each year

1.3 Statement Of Problem

In placental mammals, the umbilical cord also called navel string is a conduit between the developing foetus and the placenta. After birth, the umbilical cord is cut into two parts, one on the mothers and one towards the new-born. The cord then dries off in the form of a storm. During this period, water is prohibited from coming in contact for longer periods with the storm. At this point, a sponge bath is indicated and the cord kept completely dried afterwards. . The diaper is tied and the storm left open to prevent heating and thus infection. During the infant welfare clinic, the mothers are taught on these methods of prevention of cord infection and cord care. Despite all these measures, the incidence and prevalence of cord infections in neonates is still at a steady rise.

            According to WHO (2021), 21 million cord infections were recorded worldwide which is at a steady rise compared to 15 million cord infections in 2020. Still according to WHO (2021), 8 million of these 21 million are found in Africa. According to Enow et al 2019, 200,000 infants were found to have developed cord infections in Cameroon. Moreover, the investigator while on clinical experience discovered that some post-partum mother came with complications that the stump (Umbilical) has not dried up after three weeks she left the hospital; also, a similar situation was observed at Mount Mary hospital Buea by the investigator when they were on clinical experience. According to Zupan et al; 2004, the umbilical cord usually falls off or separates and get healed between 5-15 days. On examination, it was noticed that, the woman applied Vaseline and other solutions that are not recommended and this cannot permit the umbilical cord to heal normally and this can serve as an entry route for infections, like neonatal sepsis. This thereby, pushed the investigator to carry out a research on proper care of the umbilical cord in new born: the case of mothers attending infant welfare clinic at Bota District Hospital Limbe.

1.4 Research Questions

• How do mothers take care of the umbilical cord?
• What are the complications associated with poor umbilical cord?
• What are some difficulties faced by mothers in caring for the umbilical cord care?

1.5research Objective

GENERAL OBJECTIVES

• The aim of this study is to find out what mothers know on the care of the umbilical cord.

1.6 Specific Objectives

• To asses mothers knowledge on the care of the umbilical cord.
• To find out mothers knowledge on the complications associated with poor umbilical cord care.
• To find out the difficulties faced by mothers in caring for the umbilical cord.