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Impact of Newborn Cord Care Practices on Neonatal Omphalitis Prevention in Nigeria

Abstract

Neonatal omphalitis, an infection of the umbilical cord stump and surrounding tissues, remains an important contributor to neonatal morbidity and mortality in low- and middle-income countries, including Nigeria. Newborns may be exposed to infection through unhygienic delivery conditions, unsafe cord-cutting practices, inappropriate application of substances to the cord stump, poor hand hygiene, and inadequate postnatal care. Omphalitis can lead to local infection, sepsis, prolonged hospitalization, and death if not promptly prevented or treated. Appropriate newborn cord care, including the use of sterile instruments for cord cutting, clean cord-care practices, hand hygiene, and recommended antiseptic application where appropriate, provides an important opportunity to reduce the risk of infection during the neonatal period. However, traditional practices, inadequate awareness, home deliveries, poor access to skilled birth attendants, and limited postnatal education may reduce adherence to recommended cord-care practices in Nigeria. Against this background, this study investigates the impact of newborn cord-care practices on neonatal omphalitis prevention in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and Health Systems Framework. The Health Belief Model explains how caregivers' perceptions of susceptibility to infection, perceived severity of omphalitis, perceived benefits of recommended cord-care practices, perceived barriers, and cues to action may influence cord-care behaviours. The Social Ecological Model emphasizes the influence of individual, family, community, healthcare, cultural, and policy factors on newborn-care practices. The Health Systems Framework emphasizes service delivery, health workforce, health information, availability of essential supplies, financing, governance, and accessibility as important components of effective maternal and newborn healthcare. Collectively, these theoretical perspectives provide a suitable framework for explaining how newborn cord-care practices may influence neonatal omphalitis prevention in Nigeria. The study will adopt a quantitative analytical cohort, cross-sectional, or quasi-experimental research design. The study population will comprise mothers, caregivers, and newborns in selected healthcare facilities and communities in Nigeria. A multistage sampling technique will be used to select states, local government areas, healthcare facilities, communities, households, and eligible mother-newborn pairs. Newborn cord-care practices will be assessed using indicators such as use of sterile instruments for cord cutting, hand hygiene during cord care, application of recommended antiseptic agents where appropriate, dry cord care, frequency of cord cleaning, substances applied to the cord stump, place of delivery, skilled birth attendance, caregiver education, and postnatal counselling on cord care. Neonatal omphalitis prevention will be assessed using indicators such as absence of cord infection, signs of omphalitis, redness, swelling, discharge, foul smell, healthcare visits for cord-related complications, treatment records, hospitalization, and other documented neonatal infection outcomes. Data will be collected using structured questionnaires, observation checklists, maternal and newborn health records, postnatal care records, hospital registers, and community health records. Descriptive statistics will be used to summarize maternal and newborn characteristics, delivery conditions, cord-care practices, and omphalitis-related outcomes. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of newborn cord-care practices on neonatal omphalitis prevention. Where a cohort design is adopted, omphalitis outcomes among newborns receiving recommended cord care may be compared with outcomes among newborns exposed to inappropriate cord-care practices, while relevant maternal, household, and healthcare factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that appropriate newborn cord-care practices have a significant protective impact on neonatal omphalitis prevention in Nigeria. Newborns receiving recommended cord care, including hygienic cord handling, sterile cutting procedures, appropriate antiseptic application where recommended, and avoidance of harmful substances, are expected to have a lower risk of omphalitis than newborns exposed to unsafe practices. Skilled birth attendance and postnatal education are also expected to improve adherence to safe cord-care practices. However, traditional beliefs, home deliveries, inadequate postnatal counselling, poor hygiene, limited access to healthcare services, and low awareness of recommended practices may reduce the effectiveness of prevention efforts. The study therefore expects improved caregiver education, safe delivery practices, appropriate postnatal support, and strengthened newborn-care services to contribute significantly to reducing neonatal omphalitis in Nigeria. The study is expected to contribute to the literature on newborn cord care, neonatal omphalitis, neonatal infections, maternal and newborn health, postnatal care, infection prevention, safe delivery practices, 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, healthcare facilities, maternal and child health programmes, midwives, nurses, community health workers, development partners, and policymakers regarding strategies for strengthening newborn-care services. The study will also provide evidence-based recommendations for promoting recommended cord-care practices, improving caregiver education, strengthening postnatal counselling, improving access to skilled birth attendance, ensuring availability of cord-care supplies, reducing harmful traditional practices, and integrating safe cord care into broader maternal, newborn, and child health programmes across Nigeria.

Keywords: Newborn cord care, neonatal omphalitis, cord-care practices, neonatal infection, newborn health, postnatal care, infection prevention, safe delivery, maternal and child health, Nigeria, public health.