Global neonatal mortality stands at 22 per 1000 live births and about 41% of deaths in
children under 5 years old occur in the neonatal period. In Kenya, neonatal mortality was
22 deaths per 1000 live births between the years 2004 and 2008 and 60 % of infant deaths
in Kenya occur during the first month of life. Neonatal sepsis is the leading cause (15%)
of all neonatal deaths worldwide. Umbilical infections are an important cause of neonatal
morbidity and mortality in developing countries with incidence rates as high as 55-197
per 1000 live births in community-based studies. Poor cord care practices may
predispose to poor cord outcomes. The findings of this study will be used to make
relevant recommendations on cord care and will probably trigger other researchers to
study the subject of cord care and eventually influence cord care policies, guidelines and
practices targeting reduction in morbidity and mortality related to umbilical cord
infections and other umbilical cord conditions (prolonged cord separation and umbilical
granulomas). The broad objective of the study was to determine the relationship between
cord care practices and cord outcomes among neonates attending Meru Teaching and
Referral Hospital, Meru County, Kenya. The study population was 132
mothers/caregivers and baby pairs of neonates. A case control design was used to
compare cord care factors (sterility of cord cutting tools, application of substances on the
umbilicus, hand washing before substance application, method of bathing, skilled birth
attendance and source of advice on cord care) and cord outcomes. A focused group
discussion and three key informant interviews provided secondary data. Cases were
neonates presenting with omphalitis, tetanus, prolonged cord separation and umbilical
granuloma while controls were neonates without the aforementioned conditions. A
sample of 132 neonates (66 cases and 66 controls) was recruited. Data was collected
using interviewer administered questionnaires, Key Informant Interview guides and a
Focus Group Discussion guide. Data was analyzed using SPSS 20.0. Logistic regression
was used to predict the probability of the outcomes of interest relative to the independent
variables. P values and confidence intervals were used as inferential statistics. Thematic
content analysis was used in analysis of qualitative data. P value of <0.05 was considered
significant. Dry cord care was associated with omphalitis (p=0.000, OR 15) but was
protective for prolonged cord separation (p=0.015, OR 0.18). Home delivery, unskilled
birth attendance and receiving advice on cord care from a non-health care worker were
associated with neonatal omphalitis (p=0.001 for the three variables, OR 8.1 for home
delivery and unskilled birth attendance and OR 7 for advice from a non-health care
worker) and prolonged cord separation (p=0.000 for both variables, OR 13.6 and 10.8
respectively). Immersion bathing was associated with omphalitis (p=0.001, OR 5.7).
From the FGD, it was reported that following most home deliveries, non-sterile cord
cutting tools were often used and hand washing was not practiced before substance
application to the umbilical cord. In conclusion, findings of the study indicate that dry
cord care was significantly associated with neonatal omphalitis and use of antiseptics was
significantly associated with delayed cord separation. Recommendations made include
promotion of use of antiseptics for cord care and nationwide dissemination of current
Ministry of Health Kenya guidelines on cord care to health care workers in order to
harmonize cord care practice.