MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES SCHOOL OF NURSING TO ASSESS LEVEL OF KNOWLEDGE ABOUT CORD CARE OF NEWBORN AMONG POST DELIVERY WOMEN WHO DELIVERED AT AMANA HOSPITAL IN 2018/2019

MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES
SCHOOL OF NURSING

TO ASSESS LEVEL OF KNOWLEDGE ABOUT CORD CARE OF NEWBORN AMONG POST DELIVERY WOMEN WHO DELIVERED AT AMANA HOSPITAL IN 2018/2019.

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AUTHOR: NICHOLAUS MAGIDA
REG: 2015-04-08600
BACHELOR OF SCIENCE IN NURSING
SUPERVISOR: DR. LILIAN MSELLE
COORDINATOR: DR. LILIAN MSELLE
18th JUNE, 2018
Table of contentsContents
TOC o "1-3" h z u HYPERLINK l "_Toc518569881" Table of contents PAGEREF _Toc518569881 h ii
HYPERLINK l "_Toc518569882" 1. Introduction PAGEREF _Toc518569882 h 1
HYPERLINK l "_Toc518569883" 2. Problem statement PAGEREF _Toc518569883 h 2
HYPERLINK l "_Toc518569884" 3. Broad objective PAGEREF _Toc518569884 h 3
HYPERLINK l "_Toc518569885" 4. Specific objective PAGEREF _Toc518569885 h 3
HYPERLINK l "_Toc518569886" 5. Specific research questions PAGEREF _Toc518569886 h 3
HYPERLINK l "_Toc518569887" 6. Hypothesis PAGEREF _Toc518569887 h 3
HYPERLINK l "_Toc518569888" 7. Conceptual framework PAGEREF _Toc518569888 h 3
HYPERLINK l "_Toc518569889" 8. Literature review PAGEREF _Toc518569889 h 5
HYPERLINK l "_Toc518569890" Reference PAGEREF _Toc518569890 h 7

1. Introduction
Cord care is the series of steps applied in handling of the umbilical cord after delivery of the new born. Globally, an estimated 4 million deaths occur annually within the first 4 weeks of life and 1.5 million of these deaths are attributable to infectionsADDIN CSL_CITATION { "citationItems" : { "id" : "ITEM-1", "itemData" : { "author" : { "dropping-particle" : "", "family" : "Zuwaira I. Hassan, Ofakunrin O. Akinye", "given" : "Sarah S. Sule and Matthew U. Malete.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } , "id" : "ITEM-1", "issued" : { "date-parts" : "2018" }, "page" : "16", "publisher" : "Tolulope O. Afolaranmi", "publisher-place" : "Nigeria", "title" : "Frontiers _ Cord Care Practices A Perspective of Contemporary African Setting _ Public Health", "type" : "article" }, "uris" : "http://www.mendeley.com/documents/?uuid=5671193d-ed86-4361-95cf-4cea9f05809c" } , "mendeley" : { "formattedCitation" : "(Zuwaira I. Hassan, Ofakunrin O. Akinye, 2018)", "manualFormatting" : "(Hassan & Akinye, 2018)", "plainTextFormattedCitation" : "(Zuwaira I. Hassan, Ofakunrin O. Akinye, 2018)", "previouslyFormattedCitation" : "(Zuwaira I. Hassan, Ofakunrin O. Akinye, 2018)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }(Hassan & Akinye, 2018). Umbilical cord care is taken by mothers and grandmothers, some allow the cord to dry without any application but others apply different harmful substance depending on culture of the place.
In India, 25 million babies are born every year, which accounts for 20% of global births, and 1 million die before completing the first 4 weeks of life. This accounts for nearly 25% of the total 3.9 million neonatal deaths worldwide. Causes of neonatal deaths reported to include sepsis as resulting from unhealthier cord care practice among post-delivery womenADDIN CSL_CITATION { "citationItems" : { "id" : "ITEM-1", "itemData" : { "ISSN" : "2249-9571", "abstract" : "Background: A human infant from the time of birth up to 28th day of life is called a newborn. Nearly 27 million babies are born in India each year. Every year 4 million babies die in the first month of life in the world and quarter of these takes place in India. Newborns most frequent caretaker is their own mothers and it is mothers knowledge and practices that shapes the future of the new born. Objective: To assess the knowledge and practices of mother in relation to newborn care. Materials and methods: This cross-sectional study was carried out from August 2014 to September 2014 at Sir Sunderlal Hospital BHU, Varanasi. A total of 87 postnatal mothers who were having the infants in the age group of 0-3 months and attending the out patients department for any reasons during the study period were included in the study. A semi structured, pre tested questionnaire was used. All participants were informed regarding the purpose of study and their consent was obtained for data collection. Results: The data collected from 87 samples were analyzed using descriptive statistics. Only 26.4% of the deliveries took place at home and 52.2% were conducted by untrained birth attendant. 65.2% mothers initiated breast-feeding within 24 hrs of birth and 34.8% initiated after 1 day. 34.8% mothers had not given colostrums to their newborn, prohibition by family customs and elderly member was most common reason stated for this. The result of study showed that many harmful and un-indicated neonatal practices were prevalent in the community Conclusion: Practices regarding newborn care were unsatisfactory and knowledge was incomplete among mothers and this should be promoted through improved coverage with existing health services.", "author" : { "dropping-particle" : "", "family" : "Kumar", "given" : "Avadhesh", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Srivastava", "given" : "Manushi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ahmad", "given" : "Shamshad", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Upadhyay", "given" : "O P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } , "container-title" : "International Journal of Health Sciences & Research (www.ijhsr.org) International Journal of Health Sciences and Research", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : "2015" }, "page" : "38-44", "title" : "Knowledge & Practices of Newborn Care among Postnatal Mothers in Tertiary Care Hospital of Varanasi", "type" : "article-journal", "volume" : "385" }, "uris" : "http://www.mendeley.com/documents/?uuid=07d86e53-9755-405b-868f-e576c9d71a8d" } , "mendeley" : { "formattedCitation" : "(Kumar, Srivastava, Ahmad, & Upadhyay, 2015)", "plainTextFormattedCitation" : "(Kumar, Srivastava, Ahmad, & Upadhyay, 2015)", "previouslyFormattedCitation" : "(Kumar, Srivastava, Ahmad, & Upadhyay, 2015)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }(Kumar, Srivastava, Ahmad, & Upadhyay, 2015).

In Nigeria, studies have reported umbilical cord infections accounting for between 10 and 19% of neonatal admissions and resultant estimated 30–49% neonatal deaths. Hence, this study was conducted to assess the knowledge and practice of cord care within a contemporary settingADDIN CSL_CITATION { "citationItems" : { "id" : "ITEM-1", "itemData" : { "author" : { "dropping-particle" : "", "family" : "Zuwaira I. Hassan, Ofakunrin O. Akinye", "given" : "Sarah S. Sule and Matthew U. Malete.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } , "id" : "ITEM-1", "issued" : { "date-parts" : "2018" }, "page" : "16", "publisher" : "Tolulope O. Afolaranmi", "publisher-place" : "Nigeria", "title" : "Frontiers _ Cord Care Practices A Perspective of Contemporary African Setting _ Public Health", "type" : "article" }, "uris" : "http://www.mendeley.com/documents/?uuid=5671193d-ed86-4361-95cf-4cea9f05809c" } , "mendeley" : { "formattedCitation" : "(Zuwaira I. Hassan, Ofakunrin O. Akinye, 2018)", "plainTextFormattedCitation" : "(Zuwaira I. Hassan, Ofakunrin O. Akinye, 2018)", "previouslyFormattedCitation" : "(Zuwaira I. Hassan, Ofakunrin O. Akinye, 2018)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }( Zuwaira I. Hassan, Ofakunrin O. Akinye, 2018).
Trend of cord infection is higher in low income countries compared to high income countries because in low income countries majority of women deliver at home with low knowledge on cord careADDIN CSL_CITATION { "citationItems" : { "id" : "ITEM-1", "itemData" : { "author" : { "dropping-particle" : "", "family" : "Opara", "given" : "Peace Ibo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jaja", "given" : "Tamunopriye", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dotimi", "given" : "Doris Atibi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Alex-hart", "given" : "Balafama Abinye", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } , "id" : "ITEM-1", "issue" : "January", "issued" : { "date-parts" : "2012" }, "page" : "22-27", "title" : "Newborn Cord Care Practices amongst Mothers in Yenagoa Local Government Area , Bayelsa State , Nigeria", "type" : "article-journal", "volume" : "2012" }, "uris" : "http://www.mendeley.com/documents/?uuid=9c08276b-9847-4017-af22-5a44bd8cfcab" } , "mendeley" : { "formattedCitation" : "(Opara, Jaja, Dotimi, & Alex-hart, 2012)", "plainTextFormattedCitation" : "(Opara, Jaja, Dotimi, & Alex-hart, 2012)", "previouslyFormattedCitation" : "(Opara, Jaja, Dotimi, & Alex-hart, 2012)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }( Opara, Jaja, Dotimi, & Alex-hart, 2012). In low income countries estimated risk of umbilical cord infection range between 2 and 77 per 1000 live birth in hospital environment with mortality rate 1% to 15% based on characteristics used. Also Study done in Pemba, Tanzania shows that 1% to 12% found to have umbilical cord infectionADDIN CSL_CITATION { "citationItems" : { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1186/1471-2393-14-173", "ISBN" : "1471-2393 (Electronic)\r1471-2393 (Linking)", "ISSN" : "14712393", "PMID" : "24885689", "abstract" : "BACKGROUND: Deaths during the neonatal period account for almost two-thirds of all deaths in the first year of life and 40 percent of deaths before the age of five. Most of these deaths could be prevented through proven cost-effective interventions. Although there are some recent data from sub-Saharan Africa, but there is paucity of qualitative data from Zanzibar and cord care practices data from most of East Africa. We undertook a qualitative study in Pemba Island as a pilot to explore the attitudes, beliefs and practices of the community and health workers related to delivery, newborn and cord care with the potential to inform the main chlorhexidine (CHX) trial.\n\nMETHODS: 80 in-depth interviews (IDI) and 11 focus group discussions (FGD) involving mothers, grandmothers, fathers, traditional birth attendants and other health service providers from the community were undertaken. All IDIs and FGDs were audio taped, transcribed and analyzed using ATLAS ti 6.2.\n\nRESULTS: Poor transportation, cost of delivery at hospitals, overcrowding and ill treatment by hospital staff are some of the obstacles for achieving higher institutional delivery. TBAs and health professionals understand the need of using sterilized equipments to reduce risk of infection to both mothers and their babies during delivery. Despite this knowledge, use of gloves during delivery and hand washing before delivery were seldom reported. Early initiation of breastfeeding and feeding colostrum was almost universal. Hospital personnel and trained TBAs understood the importance of keeping babies warm after birth and delayed baby's first bath. The importance of cord care was well recognized in the community. Nearly all TBAs counseled the mothers to protect the cord from dust, flies and mosquitoes or any other kind of infections by covering it with cloth. There was consensus among respondents that CHX liquid cord cleansing could be successfully implemented in the community with appropriate education and awareness.\n\nCONCLUSION: The willingness of community in accepting a CHX cord care practice was very high; the only requirement was that a MCH worker needs to do and demonstrate the use to the mother.\n\nTRIAL REGISTRATION: ClinicalTrials.gov: NCT01528852.", "author" : { "dropping-particle" : "", "family" : "Dhingra", "given" : "Usha", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gittelsohn", "given" : "Joel", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Suleiman", "given" : "Atifa M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Suleiman", "given" : "Shekhia M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dutta", "given" : "Arup", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ali", "given" : "Said M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gupta", "given" : "Shilpi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Black", "given" : "Robert E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sazawal", "given" : "Sunil", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } , "container-title" : "BMC Pregnancy and Childbirth", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : "2014" }, "page" : "1-11", "title" : "Delivery, immediate newborn and cord care practices in Pemba Tanzania: A qualitative study of community, hospital staff and community level care providers for knowledge, attitudes, belief systems and practices", "type" : "article-journal", "volume" : "14" }, "uris" : "http://www.mendeley.com/documents/?uuid=ad701bec-e2d7-48d7-93bd-d13816885007" } , "mendeley" : { "formattedCitation" : "(Dhingra et al., 2014)", "manualFormatting" : "( Dhingra et al., 2014)", "plainTextFormattedCitation" : "(Dhingra et al., 2014)", "previouslyFormattedCitation" : "(Dhingra et al., 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }( Dhingra et al., 2014).

Education on umbilical cord care will help mother to avoid applications of unwanted material on umbilical cord and hence reduce mortality rate associated with sepsis. There was statistically significant association between the mother’s knowledge with the age, education and family type at P=;0.05, P=;0.001 and P=;0.01 respectively. There was no significant association between the mother’s knowledge with the religion, monthly income, type of hospital visit, gravid, mode of delivery and source of health information. There was no statistically significant association between the mother’s practices with the any of the demographic variables in the current study ADDIN CSL_CITATION { ;citationItems; : { ;id; : ;ITEM-1;, ;itemData; : { ;author; : { ;dropping-particle; : ;;, ;family; : ;Missiriya;, ;given; : ;Sahbanathul;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; } , ;container-title; : ;Int. J. Pharm. Sci. Rev. Res.;, ;id; : ;ITEM-1;, ;issue; : ;18;, ;issued; : { ;date-parts; : ;2016; }, ;page; : ;89-93;, ;title; : ;Research Article Knowledge and Practice of Postnatal Mothers Regarding Personal Hygiene and Newborn Care;, ;type; : ;article-journal;, ;volume; : ;40; }, ;uris; : ;http://www.mendeley.com/documents/?uuid=9cd1445b-bfc9-4a8c-a4f0-6016caeb318b; } , ;mendeley; : { ;formattedCitation; : ;(Missiriya, 2016);, ;plainTextFormattedCitation; : ;(Missiriya, 2016);, ;previouslyFormattedCitation; : ;(Missiriya, 2016); }, ;properties; : { ;noteIndex; : 0 }, ;schema; : ;https://github.com/citation-style-language/schema/raw/master/csl-citation.json; }(Missiriya, 2016).

2. Problem statementCord care is the series of steps applied in handling of the umbilical cord after delivery of the new born. Globally, an estimated 4 million deaths occur annually within the first 4 weeks of life and 1.5 million of these deaths are attributable to infectionsADDIN CSL_CITATION { ;citationItems; : { ;id; : ;ITEM-1;, ;itemData; : { ;author; : { ;dropping-particle; : ;;, ;family; : ;Zuwaira I. Hassan, Ofakunrin O. Akinye;, ;given; : ;Sarah S. Sule and Matthew U. Malete.;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; } , ;id; : ;ITEM-1;, ;issued; : { ;date-parts; : ;2018; }, ;page; : ;16;, ;publisher; : ;Tolulope O. Afolaranmi;, ;publisher-place; : ;Nigeria;, ;title; : ;Frontiers _ Cord Care Practices A Perspective of Contemporary African Setting _ Public Health;, ;type; : ;article; }, ;uris; : ;http://www.mendeley.com/documents/?uuid=5671193d-ed86-4361-95cf-4cea9f05809c; } , ;mendeley; : { ;formattedCitation; : ;(Zuwaira I. Hassan, Ofakunrin O. Akinye, 2018);, ;manualFormatting; : ;( Zuwaira I. Hassan, Ofakunrin O. Akinye, 2018);, ;plainTextFormattedCitation; : ;(Zuwaira I. Hassan, Ofakunrin O. Akinye, 2018);, ;previouslyFormattedCitation; : ;(Zuwaira I. Hassan, Ofakunrin O. Akinye, 2018); }, ;properties; : { ;noteIndex; : 0 }, ;schema; : ;https://github.com/citation-style-language/schema/raw/master/csl-citation.json; }( Zuwaira I. Hassan, Ofakunrin O. Akinye, 2018). Umbilical cord care is taken by mothers and grandmothers, some allow the cord to dry without any application but others apply different harmful substance depending on culture of the place.

Also the application of non sterile agents like charcoal, baby powder, and dust for drying the cord are great risk to infant during that time. Not only that but also the use of lubricant agent like Vaseline, cooking oils and motor oils. All those cause infections to infant during post natal as the umbilical cord is the major entry point for bacteria in newborn.
A study done in Pemba, Tanzania shows that 1% to 12% found to have umbilical cord infection during caring of the umbilical cord ADDIN CSL_CITATION { ;citationItems; : { ;id; : ;ITEM-1;, ;itemData; : { ;DOI; : ;10.1186/1471-2393-14-173;, ;ISBN; : ;1471-2393 (Electronic)\r1471-2393 (Linking);, ;ISSN; : ;14712393;, ;PMID; : ;24885689;, ;abstract; : ;BACKGROUND: Deaths during the neonatal period account for almost two-thirds of all deaths in the first year of life and 40 percent of deaths before the age of five. Most of these deaths could be prevented through proven cost-effective interventions. Although there are some recent data from sub-Saharan Africa, but there is paucity of qualitative data from Zanzibar and cord care practices data from most of East Africa. We undertook a qualitative study in Pemba Island as a pilot to explore the attitudes, beliefs and practices of the community and health workers related to delivery, newborn and cord care with the potential to inform the main chlorhexidine (CHX) trial.\n\nMETHODS: 80 in-depth interviews (IDI) and 11 focus group discussions (FGD) involving mothers, grandmothers, fathers, traditional birth attendants and other health service providers from the community were undertaken. All IDIs and FGDs were audio taped, transcribed and analyzed using ATLAS ti 6.2.\n\nRESULTS: Poor transportation, cost of delivery at hospitals, overcrowding and ill treatment by hospital staff are some of the obstacles for achieving higher institutional delivery. TBAs and health professionals understand the need of using sterilized equipments to reduce risk of infection to both mothers and their babies during delivery. Despite this knowledge, use of gloves during delivery and hand washing before delivery were seldom reported. Early initiation of breastfeeding and feeding colostrum was almost universal. Hospital personnel and trained TBAs understood the importance of keeping babies warm after birth and delayed baby;s first bath. The importance of cord care was well recognized in the community. Nearly all TBAs counseled the mothers to protect the cord from dust, flies and mosquitoes or any other kind of infections by covering it with cloth. There was consensus among respondents that CHX liquid cord cleansing could be successfully implemented in the community with appropriate education and awareness.\n\nCONCLUSION: The willingness of community in accepting a CHX cord care practice was very high; the only requirement was that a MCH worker needs to do and demonstrate the use to the mother.\n\nTRIAL REGISTRATION: ClinicalTrials.gov: NCT01528852.;, ;author; : { ;dropping-particle; : ;;, ;family; : ;Dhingra;, ;given; : ;Usha;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Gittelsohn;, ;given; : ;Joel;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Suleiman;, ;given; : ;Atifa M.;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Suleiman;, ;given; : ;Shekhia M.;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Dutta;, ;given; : ;Arup;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Ali;, ;given; : ;Said M.;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Gupta;, ;given; : ;Shilpi;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Black;, ;given; : ;Robert E.;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Sazawal;, ;given; : ;Sunil;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; } , ;container-title; : ;BMC Pregnancy and Childbirth;, ;id; : ;ITEM-1;, ;issue; : ;1;, ;issued; : { ;date-parts; : ;2014; }, ;page; : ;1-11;, ;title; : ;Delivery, immediate newborn and cord care practices in Pemba Tanzania: A qualitative study of community, hospital staff and community level care providers for knowledge, attitudes, belief systems and practices;, ;type; : ;article-journal;, ;volume; : ;14; }, ;uris; : ;http://www.mendeley.com/documents/?uuid=ad701bec-e2d7-48d7-93bd-d13816885007; } , ;mendeley; : { ;formattedCitation; : ;(Dhingra et al., 2014);, ;plainTextFormattedCitation; : ;(Dhingra et al., 2014);, ;previouslyFormattedCitation; : ;(Dhingra et al., 2014); }, ;properties; : { ;noteIndex; : 0 }, ;schema; : ;https://github.com/citation-style-language/schema/raw/master/csl-citation.json; }(Dhingra et al., 2014). Umbilical cord infections cost the government to spend more money for antibiotics in order to treat this neonatal sepsis, also mothers spend their time during hospitalization of their neonates and other lost their babies. It is important to know how much mothers know and how much they not know about umbilical cord care.

Many literature suggesting the problem of poor cord care practice mostly high in developing country, although the problem resulting from unhealthier cord care practice being declining gradually as the result of improved health care,( trained staff, assessable health care ,free maternal service, community based health services and education to peopleADDIN CSL_CITATION { ;citationItems; : { ;id; : ;ITEM-1;, ;itemData; : { ;ISSN; : ;2349-6126;, ;abstract; : ;Vol 2 | Issue 2 | Apr – Jun 2015 Indian J Child Health 83 Purani et al. KAP study on postnatal care Short Communication Knowledge, awareness, and practice of postnatal care among mothers Charul Purani, Purvi Patel, Kirti Gupta, K M Mehariya, Ahesanali Holda Department of Pediatrics, B.J. Medical College, Civil Hospital, Ahmedabad, Gujarat, India Correspondence to: Dr. Charul Purani, A/201, Akash-4, Opposite Pavan Party Plot, Ankur, Naranpura, Ahmedabad – 380 013, Gujarat, India. Tel.: +(0)079-27430630. E-mail: [email protected] Received – 29 November 2015 Initial Review – 17 December 2014 Published Online – 30 May 2015 Abstract Objective: The objective was to study the knowledge, awareness, and practices regarding the postnatal care among the mothers. Design and Setting: A pre-structured and pre-tested questionnaire was used to evaluate knowledge and awareness of postnatal care in mothers at a tertiary care center. The questionnaire was given after stabilization between 1 and 5 days of the postnatal period. Materials and Methods: Totally, 200 postnatal mothers (18-35 years) out of 540 mothers who were given antenatal and postnatal education in our antenatal care center were selected. Study Period: June 2013-September 2013. Results: Knowledge of mothers regarding breastfeeding practices (78%), thermal care (89%), skin and eye care (72%) was good. They have poor knowledge regarding dangers of pre-lacteal feeds (45%), timing of first bath after birth (60%), umbilical cord care (60%), and vaccination (36%). About 32% of them are practicing oil instillation into nostrils while 44% of mothers were intended to use gripe water for infantile colic. Conclusion: The study highlights that there is vital need to improve the knowledge and awareness in the society regarding communitybased newborn care. We should also strive toward helping removing myths and wrong practices, which are rampant in the community. Key words: Postnatal care, Knowledge attitude, and practices, newborn care, maternal education;, ;author; : { ;dropping-particle; : ;;, ;family; : ;Purani;, ;given; : ;Charul;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Patel;, ;given; : ;Purvi;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Gupta;, ;given; : ;Kirti;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Mehariya;, ;given; : ;K M;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Holda;, ;given; : ;Ahesanali;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; } , ;container-title; : ;Indian Journal of Child Health;, ;id; : ;ITEM-1;, ;issue; : ;2;, ;issued; : { ;date-parts; : ;2015; }, ;page; : ;83-85;, ;title; : ;Knowledge, awareness, and practice of postnatal care among mother;, ;type; : ;article-journal;, ;volume; : ;2; }, ;uris; : ;http://www.mendeley.com/documents/?uuid=1ee192c3-f00c-43c9-869d-0b5d5e7fb4d6; }, { ;id; : ;ITEM-2;, ;itemData; : { ;DOI; : ;10.1016/j.apnr.2017.11.018;, ;ISSN; : ;08971897;, ;abstract; : ;Aim Researchers used descriptive study design to examine the traditional practices of women in relation to maternal and newborn care in the postpartum period. Methods 523 postpartum women included who were between 15 and 49 years of age, had at least one child, and had no medical complications that affect the mother-infant health. A questionnaire was used to collect data. Comparisons were made between the responses about the women;s knowledge of traditional practices and other variables. Results We found that women widely used traditional practices such as putting Koran (Holy book for Muslims) and packing needle under the mother;s pillow to prevent mother from u201cal basmasu0131u201d, pouring lead in a cup over the head of the newborn to repel evil spirits, and covering the baby;s face with a piece of yellow cloth to prevent neonatal jaundice. The rate of using postpartum traditional practices increased with age and number of pregnancies and decreased with education (p ; 0.05). Conclusion Educational activities are recommended to increase awareness of harmful traditional practices in the field of reproductive health for nurses and midwives. Health professionals should pay special attention to less educated, older and primiparous women from rural areas enable them to reinforce positive cultural practices, and discourage them from using harmful ones by providing non-critical scientific explanations.;, ;author; : { ;dropping-particle; : ;;, ;family; : ;Zeynelou011flu;, ;given; : ;Simge;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Ku0131sa;, ;given; : ;;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; } , ;container-title; : ;Applied Nursing Research;, ;id; : ;ITEM-2;, ;issue; : ;September 2017;, ;issued; : { ;date-parts; : ;2018; }, ;page; : ;148-153;, ;title; : ;Traditional practices for maternal and newborn care among Turkish postpartum women;, ;type; : ;article-journal;, ;volume; : ;39; }, ;uris; : ;http://www.mendeley.com/documents/?uuid=d665a58e-05c9-4905-a381-a34bbbec3452; }, { ;id; : ;ITEM-3;, ;itemData; : { ;DOI; : ;10.1186/1471-2393-14-173;, ;ISBN; : ;1471-2393 (Electronic)\r1471-2393 (Linking);, ;ISSN; : ;14712393;, ;PMID; : ;24885689;, ;abstract; : ;BACKGROUND: Deaths during the neonatal period account for almost two-thirds of all deaths in the first year of life and 40 percent of deaths before the age of five. Most of these deaths could be prevented through proven cost-effective interventions. Although there are some recent data from sub-Saharan Africa, but there is paucity of qualitative data from Zanzibar and cord care practices data from most of East Africa. We undertook a qualitative study in Pemba Island as a pilot to explore the attitudes, beliefs and practices of the community and health workers related to delivery, newborn and cord care with the potential to inform the main chlorhexidine (CHX) trial.\n\nMETHODS: 80 in-depth interviews (IDI) and 11 focus group discussions (FGD) involving mothers, grandmothers, fathers, traditional birth attendants and other health service providers from the community were undertaken. All IDIs and FGDs were audio taped, transcribed and analyzed using ATLAS ti 6.2.\n\nRESULTS: Poor transportation, cost of delivery at hospitals, overcrowding and ill treatment by hospital staff are some of the obstacles for achieving higher institutional delivery. TBAs and health professionals understand the need of using sterilized equipments to reduce risk of infection to both mothers and their babies during delivery. Despite this knowledge, use of gloves during delivery and hand washing before delivery were seldom reported. Early initiation of breastfeeding and feeding colostrum was almost universal. Hospital personnel and trained TBAs understood the importance of keeping babies warm after birth and delayed baby;s first bath. The importance of cord care was well recognized in the community. Nearly all TBAs counseled the mothers to protect the cord from dust, flies and mosquitoes or any other kind of infections by covering it with cloth. There was consensus among respondents that CHX liquid cord cleansing could be successfully implemented in the community with appropriate education and awareness.\n\nCONCLUSION: The willingness of community in accepting a CHX cord care practice was very high; the only requirement was that a MCH worker needs to do and demonstrate the use to the mother.\n\nTRIAL REGISTRATION: ClinicalTrials.gov: NCT01528852.;, ;author; : { ;dropping-particle; : ;;, ;family; : ;Dhingra;, ;given; : ;Usha;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Gittelsohn;, ;given; : ;Joel;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Suleiman;, ;given; : ;Atifa M.;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Suleiman;, ;given; : ;Shekhia M.;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Dutta;, ;given; : ;Arup;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Ali;, ;given; : ;Said M.;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Gupta;, ;given; : ;Shilpi;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Black;, ;given; : ;Robert E.;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Sazawal;, ;given; : ;Sunil;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; } , ;container-title; : ;BMC Pregnancy and Childbirth;, ;id; : ;ITEM-3;, ;issue; : ;1;, ;issued; : { ;date-parts; : ;2014; }, ;page; : ;1-11;, ;title; : ;Delivery, immediate newborn and cord care practices in Pemba Tanzania: A qualitative study of community, hospital staff and community level care providers for knowledge, attitudes, belief systems and practices;, ;type; : ;article-journal;, ;volume; : ;14; }, ;uris; : ;http://www.mendeley.com/documents/?uuid=ad701bec-e2d7-48d7-93bd-d13816885007; }, { ;id; : ;ITEM-4;, ;itemData; : { ;author; : { ;dropping-particle; : ;;, ;family; : ;Missiriya;, ;given; : ;Sahbanathul;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; } , ;container-title; : ;Int. J. Pharm. Sci. Rev. Res.;, ;id; : ;ITEM-4;, ;issue; : ;18;, ;issued; : { ;date-parts; : ;2016; }, ;page; : ;89-93;, ;title; : ;Research Article Knowledge and Practice of Postnatal Mothers Regarding Personal Hygiene and Newborn Care;, ;type; : ;article-journal;, ;volume; : ;40; }, ;uris; : ;http://www.mendeley.com/documents/?uuid=9cd1445b-bfc9-4a8c-a4f0-6016caeb318b; } , ;mendeley; : { ;formattedCitation; : ;(Dhingra et al., 2014; Missiriya, 2016; Purani, Patel, Gupta, Mehariya, ; Holda, 2015; Zeynelou011flu ; Ku0131sa, 2018);, ;manualFormatting; : ;( Dhingra et al., 2014; Missiriya, 2016; Purani, Patel, Gupta, Mehariya, ; Holda, 2015; Zeynelou011flu ; Ku0131sa, 2018);, ;plainTextFormattedCitation; : ;(Dhingra et al., 2014; Missiriya, 2016; Purani, Patel, Gupta, Mehariya, ; Holda, 2015; Zeynelou011flu ; Ku0131sa, 2018);, ;previouslyFormattedCitation; : ;(Dhingra et al., 2014; Missiriya, 2016; Purani, Patel, Gupta, Mehariya, ; Holda, 2015; Zeynelou011flu ; Ku0131sa, 2018); }, ;properties; : { ;noteIndex; : 0 }, ;schema; : ;https://github.com/citation-style-language/schema/raw/master/csl-citation.json; }( Dhingra et al., 2014; Missiriya, 2016; Purani, Patel, Gupta, Mehariya, ; Holda, 2015; Zeynelo?lu ; K?sa, 2018).

It is very important to conduct this study in Tanzania in order to come out with the concrete view on the level of knowledge of post delivery women about umbilical cord care. This also help to visualize the extent of knowledge about cord care among women in Tanzania setting as many study reveals the high percentage of cord care related problem occurs in developing country. Study design variation among literature necessitates this study to be conducted by using cross section study design.
3. Broad objective
To assess the level of knowledge about cord care, among post delivery women at Amana hospital from November 2018 to March 2019.

4. Specific objectiveTo identify the source of knowledge on cord care among post delivery women at Amana hospital.

To assess the level knowledge on the signs and symptoms of cord infection of among post delivery women at Amana Hospital.

5. Specific research questionsWhat do post delivery women know about cord care?
Where do post delivery women obtain knowledge about cord care?
Do the post delivery women know the signs and symptoms of umbilical cord infection?
6. HypothesisPost delivery women who get knowledge about cord care from hospital are likely to have good knowledge on cord care than those who do not get information from hospital.

7. Conceptual frameworkThis conceptual framework has been constructed with reference to different literatures that explain on the factors associated with knowledge of cord care among post delivery women. Several factors can have both positive and negative influences on cord care as shown in a simplified conceptual framework below
Conceptual frame work

Age

Knowledge of post-delivery women about cord care of their new born

Education level

Source of information

ANC visit

Parity

Belief

Description of the conceptual framework of the study
The figure above shows both dependent and independent variables of the study, the dependent variable is knowledge about cord care. The independent variables are age, education level, source of information, parity and belief. Therefore, the independent variables have a direct influence on the dependent variable. Whenever the independent variables are friendly to the mothers, umbilical cord care would be appropriate and reduce the problem of umbilicus infection among new born or totally preventedADDIN CSL_CITATION { ;citationItems; : { ;id; : ;ITEM-1;, ;itemData; : { ;author; : { ;dropping-particle; : ;;, ;family; : ;Adib-hajbaghery;, ;given; : ;Mohsen;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Khosrojerdi;, ;given; : ;Zahra;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; } , ;id; : ;ITEM-1;, ;issue; : ;2;, ;issued; : { ;date-parts; : ;2017; }, ;page; : ;33-41;, ;title; : ;Knowledge of mothers about post-discharge newborn care;, ;type; : ;article-journal;, ;volume; : ;4; }, ;uris; : ;http://www.mendeley.com/documents/?uuid=d2c91aa3-3845-4b81-bf4a-96472d3f9521; } , ;mendeley; : { ;formattedCitation; : ;(Adib-hajbaghery ; Khosrojerdi, 2017);, ;manualFormatting; : ;( Adib-hajbaghery ; Khosrojerdi, 2017);, ;plainTextFormattedCitation; : ;(Adib-hajbaghery ; Khosrojerdi, 2017);, ;previouslyFormattedCitation; : ;(Adib-hajbaghery ; Khosrojerdi, 2017); }, ;properties; : { ;noteIndex; : 0 }, ;schema; : ;https://github.com/citation-style-language/schema/raw/master/csl-citation.json; }( Adib-hajbaghery ; Khosrojerdi, 2017).

8. Literature reviewKnowledge on cord care
The umbilical cord is the cord like structure that forms the connecting link between the fetus and the placenta through which the fetal blood flows to and from the placenta. This cord extends from the fetal umbilicus to the fetal surface of the placenta. The cord is clamped immediately after birth. The cord clamp is removed once the stump has started drying and is no longer bleeding, typically in 24 hours. The goal of cord care is to prevent or decrease the risk of hemorrhage and infection. The umbilical cord stump is an excellent medium for bacterial growth and can easily become infected. Also the application of non sterile agents like charcoal, baby powder, and dust for drying the cord are great risk to infant during that time. Not only that but also the use of lubricant agent like Vaseline, cooking oils and motor oils. All those cause infections to infant during post natal
Data on the incidence of infection of umbilicus in low-income countries is generally difficult to find. The available data estimate the risk to range between 2 and 77 per 1000 live births in hospital settings, with fatality rates of between 1% and 15% depending on the umbilical cord infection. Community-based data show even higher infection rates: for example, 105 per 1000 live births in Nepal, 217 per 1000 live births in Pakistan and about 197 per 1000 live births in India. This problem is still big among neonatesADDIN CSL_CITATION { ;citationItems; : { ;id; : ;ITEM-1;, ;itemData; : { ;abstract; : ;Background ; Objectives;, ;author; : { ;dropping-particle; : ;;, ;family; : ;Chhetri;, ;given; : ;Mamta Khatri;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Mehta;, ;given; : ;Yogendra Prasad;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Prakash;, ;given; : ;Satyam;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; } , ;container-title; : ;BAOJ Med Nursing Knowledge Regarding Neonatal Sepsis among Postnatal Mother at Selected Hospitals of Biratnagar, Nepal. BAOJ Med Nursing;, ;id; : ;ITEM-1;, ;issue; : ;4;, ;issued; : { ;date-parts; : ;2017; }, ;title; : ;BAOJ Medical and Nursing Knowledge Regarding Neonatal Sepsis among Postnatal Mother at Selected Hospitals of Biratnagar, Nepal;, ;type; : ;article-journal;, ;volume; : ;4; }, ;uris; : ;http://www.mendeley.com/documents/?uuid=8d499b6d-73ab-45ab-b380-cd4b335fe61a; } , ;mendeley; : { ;formattedCitation; : ;(Chhetri, Mehta, ; Prakash, 2017);, ;manualFormatting; : ;( Chhetri, Mehta, ; Prakash, 2017);, ;plainTextFormattedCitation; : ;(Chhetri, Mehta, ; Prakash, 2017);, ;previouslyFormattedCitation; : ;(Chhetri, Mehta, ; Prakash, 2017); }, ;properties; : { ;noteIndex; : 0 }, ;schema; : ;https://github.com/citation-style-language/schema/raw/master/csl-citation.json; }( Chhetri, Mehta, ; Prakash, 2017).before discharge from Hospital ,the mother got all information about caring of her newborn, including umbilical cord care.

Knowledge on signs and symptoms of umbilical cord infection to neonatal among postnatal women
Neonatal sepsis resulted from umbilical cord infection is the single most important cause of neonatal death in the community which causes increase in neonatal high mortality and morbidity rateADDIN CSL_CITATION { ;citationItems; : { ;id; : ;ITEM-1;, ;itemData; : { ;abstract; : ;Background ; Objectives;, ;author; : { ;dropping-particle; : ;;, ;family; : ;Chhetri;, ;given; : ;Mamta Khatri;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Mehta;, ;given; : ;Yogendra Prasad;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Prakash;, ;given; : ;Satyam;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; } , ;container-title; : ;BAOJ Med Nursing Knowledge Regarding Neonatal Sepsis among Postnatal Mother at Selected Hospitals of Biratnagar, Nepal. BAOJ Med Nursing;, ;id; : ;ITEM-1;, ;issue; : ;4;, ;issued; : { ;date-parts; : ;2017; }, ;title; : ;BAOJ Medical and Nursing Knowledge Regarding Neonatal Sepsis among Postnatal Mother at Selected Hospitals of Biratnagar, Nepal;, ;type; : ;article-journal;, ;volume; : ;4; }, ;uris; : ;http://www.mendeley.com/documents/?uuid=8d499b6d-73ab-45ab-b380-cd4b335fe61a; } , ;mendeley; : { ;formattedCitation; : ;(Chhetri et al., 2017);, ;manualFormatting; : ;( Chhetri et al., 2017);, ;plainTextFormattedCitation; : ;(Chhetri et al., 2017);, ;previouslyFormattedCitation; : ;(Chhetri et al., 2017); }, ;properties; : { ;noteIndex; : 0 }, ;schema; : ;https://github.com/citation-style-language/schema/raw/master/csl-citation.json; }( Chhetri et al., 2017) Trend of cord infection is higher in low income countries compared to high income countries because in low income countries majority of women deliver at home with low knowledge on cord care ADDIN CSL_CITATION { ;citationItems; : { ;id; : ;ITEM-1;, ;itemData; : { ;author; : { ;dropping-particle; : ;;, ;family; : ;Opara;, ;given; : ;Peace Ibo;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Jaja;, ;given; : ;Tamunopriye;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Dotimi;, ;given; : ;Doris Atibi;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Alex-hart;, ;given; : ;Balafama Abinye;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; } , ;id; : ;ITEM-1;, ;issue; : ;January;, ;issued; : { ;date-parts; : ;2012; }, ;page; : ;22-27;, ;title; : ;Newborn Cord Care Practices amongst Mothers in Yenagoa Local Government Area , Bayelsa State , Nigeria;, ;type; : ;article-journal;, ;volume; : ;2012; }, ;uris; : ;http://www.mendeley.com/documents/?uuid=9c08276b-9847-4017-af22-5a44bd8cfcab; } , ;mendeley; : { ;formattedCitation; : ;(Opara et al., 2012);, ;plainTextFormattedCitation; : ;(Opara et al., 2012);, ;previouslyFormattedCitation; : ;(Opara et al., 2012); }, ;properties; : { ;noteIndex; : 0 }, ;schema; : ;https://github.com/citation-style-language/schema/raw/master/csl-citation.json; }(Opara et al., 2012). In low income countries estimated risk of umbilical cord infection range between 2 and 77 per 1000 live birth in hospital environment with mortality rate 1% to 15% based on characteristics used. Also Study done in Pemba, Tanzania shows that 1% to 12% found to have umbilical cord infection ADDIN CSL_CITATION { ;citationItems; : { ;id; : ;ITEM-1;, ;itemData; : { ;DOI; : ;10.1186/1471-2393-14-173;, ;ISBN; : ;1471-2393 (Electronic)\r1471-2393 (Linking);, ;ISSN; : ;14712393;, ;PMID; : ;24885689;, ;abstract; : ;BACKGROUND: Deaths during the neonatal period account for almost two-thirds of all deaths in the first year of life and 40 percent of deaths before the age of five. Most of these deaths could be prevented through proven cost-effective interventions. Although there are some recent data from sub-Saharan Africa, but there is paucity of qualitative data from Zanzibar and cord care practices data from most of East Africa. We undertook a qualitative study in Pemba Island as a pilot to explore the attitudes, beliefs and practices of the community and health workers related to delivery, newborn and cord care with the potential to inform the main chlorhexidine (CHX) trial.\n\nMETHODS: 80 in-depth interviews (IDI) and 11 focus group discussions (FGD) involving mothers, grandmothers, fathers, traditional birth attendants and other health service providers from the community were undertaken. All IDIs and FGDs were audio taped, transcribed and analyzed using ATLAS ti 6.2.\n\nRESULTS: Poor transportation, cost of delivery at hospitals, overcrowding and ill treatment by hospital staff are some of the obstacles for achieving higher institutional delivery. TBAs and health professionals understand the need of using sterilized equipments to reduce risk of infection to both mothers and their babies during delivery. Despite this knowledge, use of gloves during delivery and hand washing before delivery were seldom reported. Early initiation of breastfeeding and feeding colostrum was almost universal. Hospital personnel and trained TBAs understood the importance of keeping babies warm after birth and delayed baby;s first bath. The importance of cord care was well recognized in the community. Nearly all TBAs counseled the mothers to protect the cord from dust, flies and mosquitoes or any other kind of infections by covering it with cloth. There was consensus among respondents that CHX liquid cord cleansing could be successfully implemented in the community with appropriate education and awareness.\n\nCONCLUSION: The willingness of community in accepting a CHX cord care practice was very high; the only requirement was that a MCH worker needs to do and demonstrate the use to the mother.\n\nTRIAL REGISTRATION: ClinicalTrials.gov: NCT01528852.;, ;author; : { ;dropping-particle; : ;;, ;family; : ;Dhingra;, ;given; : ;Usha;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Gittelsohn;, ;given; : ;Joel;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Suleiman;, ;given; : ;Atifa M.;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Suleiman;, ;given; : ;Shekhia M.;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Dutta;, ;given; : ;Arup;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Ali;, ;given; : ;Said M.;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Gupta;, ;given; : ;Shilpi;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Black;, ;given; : ;Robert E.;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Sazawal;, ;given; : ;Sunil;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; } , ;container-title; : ;BMC Pregnancy and Childbirth;, ;id; : ;ITEM-1;, ;issue; : ;1;, ;issued; : { ;date-parts; : ;2014; }, ;page; : ;1-11;, ;title; : ;Delivery, immediate newborn and cord care practices in Pemba Tanzania: A qualitative study of community, hospital staff and community level care providers for knowledge, attitudes, belief systems and practices;, ;type; : ;article-journal;, ;volume; : ;14; }, ;uris; : ;http://www.mendeley.com/documents/?uuid=ad701bec-e2d7-48d7-93bd-d13816885007; } , ;mendeley; : { ;formattedCitation; : ;(Dhingra et al., 2014);, ;plainTextFormattedCitation; : ;(Dhingra et al., 2014);, ;previouslyFormattedCitation; : ;(Dhingra et al., 2014); }, ;properties; : { ;noteIndex; : 0 }, ;schema; : ;https://github.com/citation-style-language/schema/raw/master/csl-citation.json; }(Dhingra et al., 2014). The sign and symptoms of umbilical cord infection which might be notified by the mother of health care include redness, discharge(yellowish or pus),swollen, bleeding of the umbilical cord areaADDIN CSL_CITATION { ;citationItems; : { ;id; : ;ITEM-1;, ;itemData; : { ;abstract; : ;Background ; Objectives;, ;author; : { ;dropping-particle; : ;;, ;family; : ;Chhetri;, ;given; : ;Mamta Khatri;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Mehta;, ;given; : ;Yogendra Prasad;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; }, { ;dropping-particle; : ;;, ;family; : ;Prakash;, ;given; : ;Satyam;, ;non-dropping-particle; : ;;, ;parse-names; : false, ;suffix; : ;; } , ;container-title; : ;BAOJ Med Nursing Knowledge Regarding Neonatal Sepsis among Postnatal Mother at Selected Hospitals of Biratnagar, Nepal. BAOJ Med Nursing;, ;id; : ;ITEM-1;, ;issue; : ;4;, ;issued; : { ;date-parts; : ;2017; }, ;title; : ;BAOJ Medical and Nursing Knowledge Regarding Neonatal Sepsis among Postnatal Mother at Selected Hospitals of Biratnagar, Nepal;, ;type; : ;article-journal;, ;volume; : ;4; }, ;uris; : ;http://www.mendeley.com/documents/?uuid=8d499b6d-73ab-45ab-b380-cd4b335fe61a; } , ;mendeley; : { ;formattedCitation; : ;(Chhetri et al., 2017);, ;manualFormatting; : ;( Chhetri et al., 2017);, ;plainTextFormattedCitation; : ;(Chhetri et al., 2017);, ;previouslyFormattedCitation; : ;(Chhetri et al., 2017); }, ;properties; : { ;noteIndex; : 0 }, ;schema; : ;https://github.com/citation-style-language/schema/raw/master/csl-citation.json; }( Chhetri et al., 2017). Education on umbilical cord care will help mother to avoid applications of unwanted material on umbilical cord and hence reduce mortality rate associated with sepsis Therefore it’s important for the mother to know all these sign before living the hospital setting.

ReferenceADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY Adib-hajbaghery, M., & Khosrojerdi, Z. (2017). Knowledge of mothers about post-discharge newborn care, 4(2), 33–41.

Chhetri, M. K., Mehta, Y. P., & Prakash, S. (2017). BAOJ Medical and Nursing Knowledge Regarding Neonatal Sepsis among Postnatal Mother at Selected Hospitals of Biratnagar, Nepal. BAOJ Med Nursing Knowledge Regarding Neonatal Sepsis among Postnatal Mother at Selected Hospitals of Biratnagar, Nepal. BAOJ Med Nursing, 4(4).

Dhingra, U., Gittelsohn, J., Suleiman, A. M., Suleiman, S. M., Dutta, A., Ali, S. M., … Sazawal, S. (2014). Delivery, immediate newborn and cord care practices in Pemba Tanzania: A qualitative study of community, hospital staff and community level care providers for knowledge, attitudes, belief systems and practices. BMC Pregnancy and Childbirth, 14(1), 1–11. https://doi.org/10.1186/1471-2393-14-173
Kumar, A., Srivastava, M., Ahmad, S., & Upadhyay, O. P. (2015). Knowledge & Practices of Newborn Care among Postnatal Mothers in Tertiary Care Hospital of Varanasi. International Journal of Health Sciences & Research (Www.ijhsr.org) International Journal of Health Sciences and Research, 385(8), 38–44. Retrieved from http://www.ijhsr.org/IJHSR_Vol.5_Issue.8_Aug2015/7.pdf
Missiriya, S. (2016). Research Article Knowledge and Practice of Postnatal Mothers Regarding Personal Hygiene and Newborn Care. Int. J. Pharm. Sci. Rev. Res., 40(18), 89–93.

Opara, P. I., Jaja, T., Dotimi, D. A., & Alex-hart, B. A. (2012). Newborn Cord Care Practices amongst Mothers in Yenagoa Local Government Area , Bayelsa State , Nigeria, 2012(January), 22–27.

Purani, C., Patel, P., Gupta, K., Mehariya, K. M., & Holda, A. (2015). Knowledge, awareness, and practice of postnatal care among mother. Indian Journal of Child Health, 2(2), 83–85. Retrieved from http://atharvapub.net/index.php/IJCH/article/view/197/160
Zeynelo?lu, S., & K?sa. (2018). Traditional practices for maternal and newborn care among Turkish postpartum women. Applied Nursing Research, 39(September 2017), 148–153. https://doi.org/10.1016/j.apnr.2017.11.018
Zuwaira I. Hassan, Ofakunrin O. Akinye, S. S. S. and M. U. M. (2018). Frontiers _ Cord Care Practices A Perspective of Contemporary African Setting _ Public Health. Nigeria: Tolulope O. Afolaranmi.