Umbilical Cord Care among Women 15-49 Years in Uganda; a National Cross Sectional Study

Background Globally, 203000 children die of neonatal sepsis annually. Neonatal Sepsis, partly caused by poor umbilical cord hygiene, is responsible for 18.2% of neonatal deaths in Uganda. While the national newborn care includes cord care practices, the extent of compliance with these recommendations in Uganda remains unclear.

This study aimed at estimating the prevalence of applying non-recommended substances for umbilical cord care, identify substances used, and assess factors associated with use of non-recommended substances.

A secondary data analysis was conducted among 19835 women 15-49 years using data from the 2023 Uganda Situation Analysis of Newborn health. Women were included if they had a live birth within the past one year prior to the survey. Data on substances used for cord care, socio-demographic factors, maternal factors, and healthcare service utilization was abstracted using a pretested data abstraction tool. Modified Poisson models from generalized linear models family with log link function and clustered standard errors were used to determine factors associated with use of non-recommended substances for umbilical cord care, using Stata version 15.

The prevalence of using non-recommended substances for umbilical cord care was 14%. Some of the non-recommended substances used in this context included body ointments, body powder, ash and various types of oils. The analysis revealed that maternal age 15-19 (aPR=2.2, 95% CI: 1.1-4.5), religion; protestant (aPR=2.3, 95% CI: 1.2-4.2) and Muslim (aPR=0.5, 95% CI: 0.4-0.7), not attending postnatal care (aPR=0.4, 95% CI: 0.2-0.7), were significantly associated with using non-recommended substances for umbilical cord care.

The prevalence of applying non-recommended substances for umbilical cord care in Uganda was moderately high. Enhancing maternal education on proper cord care during postnatal care visits could reduce the use of non-recommended substances for umbilical cord care. Educating teenage mothers about recommendable cord care should be prioritized during postnatal care sessions. Competing Interest Statement The authors have declared no competing interest. Funding Statement No funding was received for this work Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Makerere University School of Medicine Research Ethics Committee, Makerere University Uganda. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability Data is available upon reasonable request to the Principle Investigor of the parent study. List of abbreviations - ANC - Antenatal Care - aPR - adjusted prevalence ratios - BCmCH - Bachelors of Clinical Medicine and Community Health - cPR - Crude prevalence ratio - CI - Confidence interval - C.tetani - Clamydia tetani - DE - Design Effect - DHS - Demographic Health Survey - EDHS - Ethiopia Demographic Health Survey Data - EMNCC - Essential Maternal and Newborn Clinical Care Guidelines - FGDs - Focused Group Discussions - HBM - Health Belief Model - KIU - Kampala International University - KIU-TH - Kampala International University Teaching Hospital - MNCH - Maternal Newborn and Child Health - MOH - Ministry Of Health - NM - Neonatal Mortality - NMR - Neonatal Mortality Rate - NPA - National Planning Authority - PNC - Postnatal Care - SDG - Sustainable Development Goal - SOMREC - School Of Medicine Research Ethics Committee - TBAs - Traditional Birth Attendants - TBA - Traditional Birth Attendant - UN - United Nations - UNICEF - United Nations Children’s Fund - UN SDG3 - United Sustainable Development Goal 3 - UDHS - Uganda Demographic and Health Survey - WHO - World Health Organization