Department of Comprehensive Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
PLoS One. 2024 Oct 24;19(10):e0310471. doi: 10.1371/journal.pone.0310471. eCollection 2024.
The umbilical cord (UC) serves as the main pathway for bacteria to reach the neonate's body, potentially causing local and severe infections, sepsis, and even death. Consequently, neonatal mortality remains a significant public health concern, particularly in Ethiopia. The World Health Organization (WHO) recommends that the umbilical cord stump be kept clean and dry, with the exception of applying topical antiseptics. However, various harmful substances are still applied to the umbilical cord of neonates. Data on the geographical distribution and risk factors for harmful umbilical cord stump (UCS) care are scarce. Therefore, this study aims to fill this gap.
A secondary data analysis of the Ethiopian Demographic Health Survey (EDHS 2016) was conducted using a weighted sample of 7,168 live births. ArcGIS version 10.7.1 software was utilized to visualize the spatial distribution of harmful umbilical cord stump (UCS) care practices in Ethiopia. Additionally, a Bernoulli probability model-based spatial scan statistic was applied using Kulldorff's SaTScan version 9.6 software to identify significant clusters of harmful UCS care. A multilevel logistic regression model was used to determine the factors associated with UCS care practices in Ethiopia. Statistical significance was declared at a two-sided P-value of < 0.05.
Overall, the prevalence of harmful UCS care in Ethiopia was 15.09% (95% CI: 13.9-16.3), with significant spatial heterogeneity across geographical areas. The hotspot areas of harmful US care were observed in the eastern (Somali) and northern (Tigray and Amhara) parts of Ethiopia. In spatial scan analysis, the most likely primary clusters were observed in South Nation Nationalities and Peoples region (SNNPR), secondary clusters in the Somali, tertiary clusters in Tigray, and the next clusters in the Amhara regions, respectively. In the final multilevel model, maternal age (Adjusted odds ratio/AOR 1.07, 95% CI: 1.02-1.12), institutional delivery (AOR 0.64, 95% CI: 0.42-0.97), female neonates (AOR 1.31, 95% CI: 1.04-1.61), rural residence (AOR 2.18, 95% CI: 1.05-4.52), living in Tigray region (AOR 3.79, 95% CI: 1.38-9.38), living in Somali region (AOR, 2.95% CI: 1.02-8.52), and living in Harari region (AOR 3.51, 95% CI: 1.28-9.60) were identified as a significant factors of harmful US care practice in Ethiopia.
In Ethiopia, the distribution of harmful UCS care practices is non-random and highly clustered in the SNNPR, Somalia, Tigray, and Amhara regions. Both individual and community-level factors were significantly associated with the practice. Special emphasis needs to be provided for neonates from those hot-spot areas and to address the identified predictors of harmful umbilical cord stump care practices.
脐带是细菌进入新生儿体内的主要途径，可能导致局部和严重感染、败血症，甚至死亡。因此，新生儿死亡率仍然是一个重大的公共卫生问题，特别是在埃塞俄比亚。世界卫生组织（WHO）建议保持脐带残端清洁干燥，除了使用局部防腐剂外。然而，各种有害物质仍被应用于新生儿的脐带。关于有害脐带残端（UCS）护理的地理分布和危险因素的数据仍然很少。因此，本研究旨在填补这一空白。
使用 7168 名活产儿的加权样本，对埃塞俄比亚人口与健康调查（EDHS 2016）进行二次数据分析。使用 ArcGIS 版本 10.7.1 软件可视化埃塞俄比亚有害脐带残端（UCS）护理实践的空间分布。此外，使用 Kulldorff 的 SaTScan 版本 9.6 软件，应用 Bernoulli 概率模型空间扫描统计，识别有害 UCS 护理的显著集群。使用多水平逻辑回归模型确定与埃塞俄比亚 UCS 护理实践相关的因素。统计显著性以双侧 P 值 < 0.05 表示。
总体而言，埃塞俄比亚有害 UCS 护理的流行率为 15.09%（95%CI：13.9-16.3），地理区域之间存在显著的空间异质性。有害 US 护理的热点区域出现在埃塞俄比亚东部（索马里）和北部（提格雷和阿姆哈拉）地区。在空间扫描分析中，观察到最有可能的主要集群在南国家民族和人民地区（SNNPR），次要集群在索马里，三级集群在提格雷，下一个集群在阿姆哈拉地区。在最终的多水平模型中，产妇年龄（调整后的优势比/AOR 1.07，95%CI：1.02-1.12）、机构分娩（AOR 0.64，95%CI：0.42-0.97）、女性新生儿（AOR 1.31，95%CI：1.04-1.61）、农村居民（AOR 2.18，95%CI：1.05-4.52）、居住在提格雷地区（AOR 3.79，95%CI：1.38-9.38）、居住在索马里地区（AOR，95%CI：1.02-8.52）和居住在哈拉里地区（AOR 3.51，95%CI：1.28-9.60）被确定为埃塞俄比亚有害 US 护理实践的重要因素。
在埃塞俄比亚，有害 UCS 护理实践的分布是非随机的，在 SNNPR、索马里、提格雷和阿姆哈拉地区高度集中。个体和社区层面的因素都与这一实践显著相关。需要特别关注那些热点地区的新生儿，并解决有害脐带残端护理实践的确定预测因素。
