Cord care practices and related outcomes among caregivers in two referral facilities in Ghana: a cross-sectional study.

Background: Neonatal mortality is still high in Ghana and Sub-Saharan Africa though great strides have been made in other parts of the world. Neonatal infection causes a third of neonatal deaths. The umbilical stump can be an entry point for bacteria if not properly cared for, leading to omphalitis and sepsis. The World Health Organisation and Ghana Health Service recommend using 7.1% chlorhexidine digluconate for cord care to reduce the incidence of cord complications. There is however inadequate data on its usage and cord outcomes compared to other cord care methods. This study aimed to assess the risk of cord complications with the various cord care practices in two referral facilities in the Ashanti region, Ghana. Methods: A cross-sectional study with a quantitative approach was conducted from June to December 2023. Simple random sampling was used to select 453 caregivers. We collected data on cord care practices and outcomes using a questionnaire. Stata/SE Version 17.0 was used to analyse the data. Results: Antenatal clinic attendance significantly reduced the odds of cord infection (aOR = 0.03, p-value = 0.018). Babies of caregivers who washed their hands before cord care were at a decreased odds of getting cord infection (aOR = 0.20, p-value = 0.047). Babies were at increased odds (aOR = 42, p-value = 0.010) of cord bleeding if their caregivers received recommendation on cord care from people other than health workers. There was no statistically significant difference in cord complications (i.e. cord bleeding, cord granuloma and cord infection) in the chlorhexidine and the methylated spirit group (p-value > 0.05). Recall bias was a limitation of the study since caregivers of children between one week and one year were required to report cord practices and outcomes in the first few weeks of their babies' lives. Conclusions: The cord outcome differs with the various cord care practices. Antenatal clinic attendance should be encouraged and education on proper cord care practices should be intensified among caregivers. Randomized control trials or cohort studies should be done to compare the cord outcome in chlorhexidine and methylated spirit.