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Effect of Umbilical Cord Care Education on Safe Cord-Care Practices among Mothers of Newborns in Nigeria

Abstract

Umbilical cord care is an essential component of newborn care because inappropriate cord-care practices may increase the risk of local infection, delayed cord separation, neonatal sepsis, and other preventable complications. Mothers of newborns in Nigeria may receive different information about cord care from healthcare providers, family members, traditional birth attendants, and informal sources, which may contribute to practices that are not consistent with recommended newborn-care guidance. Limited knowledge, cultural beliefs, application of unverified substances, poor hand hygiene, inadequate access to skilled postnatal education, and misconceptions about keeping the umbilical cord clean and dry may further affect safe cord-care practices. Umbilical cord care education provides an opportunity to improve mothers' knowledge and practical skills regarding hygienic cord handling, appropriate cord cleaning where indicated, keeping the cord dry, avoiding harmful substances, recognizing signs of infection, and seeking timely healthcare when complications occur. Against this background, this study investigates the effect of umbilical cord care education on safe cord-care practices among mothers of newborns in Nigeria. The study will be anchored on the Health Belief Model, Social Cognitive Theory, and Social Ecological Model. The Health Belief Model explains how mothers' perceptions of newborn infection risks, perceived severity of cord-related complications, perceived benefits of appropriate cord care, perceived barriers, self-efficacy, and cues to action may influence their cord-care practices. Social Cognitive Theory emphasizes observational learning, practical demonstration, behavioural modelling, self-efficacy, reinforcement, and social support in developing safe newborn-care behaviours. The Social Ecological Model highlights the influence of mothers, family members, healthcare providers, cultural practices, socioeconomic conditions, household hygiene, community resources, and health systems on newborn cord-care practices. Collectively, these theoretical perspectives provide a suitable framework for explaining how umbilical cord care education may influence safe cord-care practices among mothers of newborns in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise mothers of newborns aged 0–28 days residing in selected urban, semi-urban, and rural communities across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, communities, households, healthcare facilities, and eligible mothers. Umbilical cord care education will be assessed using indicators such as exposure to educational sessions, frequency and duration of education, hand hygiene before cord handling, appropriate cord-care procedures, keeping the cord clean and dry, appropriate cleaning practices where recommended, avoidance of unverified substances, recognition of normal cord separation, recognition of signs of cord infection, appropriate newborn bathing and cord protection, safe diaper positioning, and appropriate healthcare-seeking for concerning cord changes. Safe cord-care practices will be assessed using indicators such as handwashing before cord handling, clean and appropriate handling of the umbilical cord, keeping the cord dry where appropriate, avoidance of harmful substances, appropriate cleaning practices, safe diaper placement, avoidance of unnecessary manipulation, recognition of redness, swelling, foul-smelling discharge, bleeding, fever, or other concerning signs, and timely consultation with qualified healthcare professionals when complications are suspected. Data will be collected using structured questionnaires, newborn-care knowledge assessment tools, standardized cord-care practice checklists, direct observation where ethically and practically appropriate, healthcare records where available, and pre-test and post-test assessments where a quasi-experimental intervention is adopted. Descriptive statistics will be used to summarize mothers' demographic and socioeconomic characteristics, newborn characteristics, sources of cord-care information, previous education, and cord-care practices. Inferential statistical techniques, including chi-square tests, paired and independent t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of umbilical cord care education on safe cord-care practices. Where a quasi-experimental design is adopted, cord-care practice scores before and after the educational intervention may be compared with those of a comparison group to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that umbilical cord care education has a significant positive effect on safe cord-care practices among mothers of newborns in Nigeria. Mothers exposed to structured, practical, evidence-based, and culturally appropriate cord-care education are expected to demonstrate safer practices than mothers without comparable exposure. Education may improve mothers' ability to maintain appropriate hand hygiene, handle the umbilical cord safely, keep the cord clean and dry, avoid potentially harmful substances, recognize signs of infection, and seek timely professional care when concerning symptoms occur. Practical demonstrations may also improve mothers' confidence and reduce reliance on unverified traditional substances or practices. However, family influence, cultural beliefs, misinformation, limited access to clean water and sanitation, inadequate postnatal support, financial constraints, and limited availability of trained healthcare personnel may reduce the effectiveness of education alone. The study therefore expects accessible, practical, culturally sensitive, and sustained umbilical cord care education, supported by appropriate postnatal and newborn-health services, to contribute significantly to improved safe cord-care practices among mothers of newborns in Nigeria. The study is expected to contribute to the literature on umbilical cord care, newborn care, neonatal infection prevention, maternal and child health, postnatal care, maternal health education, practical newborn-care skills, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospitals, maternity facilities, primary healthcare centres, nurses, midwives, community health workers, maternal and newborn health programmes, development partners, and policymakers regarding strategies for improving essential newborn-care practices. The study will also provide evidence-based recommendations for integrating umbilical cord care education into antenatal and postnatal services, strengthening practical newborn-care demonstrations, improving maternal access to skilled counselling, addressing harmful cultural practices, strengthening community-based newborn-health education, improving referral and follow-up systems, and developing sustainable maternal and newborn-health programmes that promote safe umbilical cord care practices across Nigeria.

Keywords: Umbilical cord care education, safe cord-care practices, mothers of newborns, newborn care, neonatal infection prevention, postnatal care, maternal and child health, maternal health education, newborn hygiene, Nigeria, public health.