Targeted States High Impact Project (TSHIP), JSI Research & Training Institute, Inc., Bauchi, Bauchi State, Nigeria.
JSI Research & Training Institute, Inc, Boston, USA.
BMC Pregnancy Childbirth. 2017 Nov 9;17(1):368. doi: 10.1186/s12884-017-1551-x.
Neonatal infections caused by unsafe umbilical cord practices account for the majority of neonatal deaths in Nigeria. We examined the trends in umbilical cord care practices between 2012 and 2015 that coincided with the introduction of chlorhexidine digluconate 7.1% gel in Bauchi and Sokoto States.
We obtained data from three rounds of lot quality assurance samples (LQAS) surveys conducted in 2012, 2013 and 2015. Households were randomly sampled in each round that totaled 1140 and 1311 households in Bauchi and Sokoto States respectively. Mothers responded to questions on cord care practices in the last delivery. Coverage estimates of practice indicators were obtained for each survey period. Local Government Area (LGA) estimates for each indicator were obtained with α ≤ 5%, and β ≤20% statistical errors and aggregated to State-level estimates with finite sample correction relative to the LGA population.
Over 75 and 80% of deliveries in Bauchi and Sokoto States respectively took place at home. The proportion of deliveries in public facilities reported by mothers ranged from 19% in 2012 to 22.4% in 2015 in Bauchi State and from 12.9 to 13.2% in 2015 in Sokoto State. Approximately 50% of deliveries in Bauchi and more than 80% in Sokoto States were assisted by traditional birth attendants (TBAs) or relatives and friends, with little change in the survey periods. In Bauchi and in Sokoto States, over 75% and over 80% of newborn cords were cut with razor blades underscoring the pervasive role of the TBAs in the immediate postpartum period. Use of chlorhexidine digluconate 7.1% gel for cord dressing significantly increased to the highest level in 2015 in both States. Health workers who attended deliveries in health facilities switched from methylated spirit to chlorhexidine. There were no observable changes in cord care practices among the TBAs.
Unsafe umbilical cord care practices remained prevalent in Bauchi and Sokoto States of Nigeria, although a recent introduction of chlorhexidine digluconate 7.1% gel positively changed the cord care practices toward safer practices among public health providers. TBAs, friends and relatives played the strongest immediate postpartum roles and mostly retained the unsafe cord care practices such as use of ash, cow dung and hot compress. We recommend that existing TBAs are retrained and refocused to forge stronger links between communities and the primary health centers to increase mothers' access to skilled birth attendants.
尼日利亚不安全的脐带处理方式导致的新生儿感染，导致了大多数新生儿死亡。我们调查了 2012 年至 2015 年间脐带护理实践的趋势，当时在包奇州和索科托州引入了氯己定葡萄糖酸 7.1%凝胶。
我们从 2012 年、2013 年和 2015 年进行的三轮批量质量保证样本（LQAS）调查中获取了数据。在每一轮中，家庭都被随机抽样，包奇州和索科托州分别有 1140 户和 1311 户家庭。母亲在最近一次分娩时回答了脐带护理实践的问题。每个调查期间都获得了实践指标的覆盖估计数。在统计误差为α≤5%，β≤20%的情况下，获得了每个地方政府区（LGA）的指标估计数，并使用有限样本校正法将其汇总到州一级的估计数，以反映 LGA 人口的情况。
在包奇州和索科托州，分别有超过 75%和 80%的分娩是在家中进行的。母亲报告的公共设施分娩比例从 2012 年的 19%上升到 2015 年的 22.4%，在包奇州，2015 年的比例为 13.2%。在包奇州，约有 50%的分娩是由传统助产士（TBAs）或亲戚朋友协助进行的，而在调查期间，这一比例变化不大。在包奇州和索科托州，超过 75%和超过 80%的新生儿脐带是用剃刀剪断的，这突出了 TBAs 在产后即刻阶段的普遍作用。氯己定葡萄糖酸 7.1%凝胶在这两个州都被用于脐带护理，使用率在 2015 年达到最高水平。在卫生设施中分娩的卫生工作者从使用酒精转向使用氯己定。TBAs 的脐带护理实践没有观察到变化。
尽管最近引入了氯己定葡萄糖酸 7.1%凝胶，但不安全的脐带护理实践在尼日利亚的包奇州和索科托州仍然很普遍，在公共卫生提供者中，这种做法正向更安全的做法转变。TBAs、朋友和亲戚在产后即刻阶段发挥了最强的作用，并且大多保留了不安全的脐带护理实践，如使用灰烬、牛粪和热敷。我们建议对现有的 TBAs 进行再培训和重新定位，以加强社区和初级保健中心之间的联系，增加母亲获得熟练助产士的机会。
