Assessment of Chlorhexidine use for cord care at Kangundo level 4 Hospital

Abstract

Background: Sepsis continues to be an important cause of morbidity and mortality in neonates. One of the most important portals of entry for infections is the umbilical cord. Proper care of the cord can prevent many of these cases of sepsis and hence reduce neonatal mortality rates. In Kenya, the use of chlorhexidine digluconate (CHX) gel was introduced to scale in 2016 and received with mixed reactions in some hospitals with reports of medication errors and ineffectiveness being received. This study sought to find out the knowledge, practices and attitude on its use in Kangundo Level 4 hospital.Methodology: The study was carried out at Kangundo level 4 hospital between June and August 2019.It was a descriptive cross-sectional study with both quantitative and qualitative components. A questionnaire was used for the quantitative data collection while focus group discussions were held for the qualitative data collection. Ethical approval was sought prior to commencement of data collection.Results: A total of 19 clients and 24 healthcare workers were interviewed and two focus group discussions held. All the 19 clients had delivered in the hospital and only three were first-time mothers. Education on how to use chlorhexidine (CHX) was given to 16/19 (84%) of the clients interviewed. Duration of application varied among clients; 4 days 5/19(26%), 7 days, 12/19 (64%) and until the stump falls off, 2/19 (10%). Twenty of the 24 HCWs (83%) interviewed advised the patients on cleaning the cord prior to application of CHX, frequency of application varied from OD 15/24 ( 62%), BD 3/24 (13%) and TID 6/24( 25%). Two FGDs were held for HCW; lack of training and clear instructions on how to use the gel as major contributors to ineffectiveness of CHX.Conclusion and recommendation: There was poor understanding on the use of CHX among both clients and HCWs at Kangundo level 4 hospital. Cleaning of the stump prior to gel application is important to prevent accumulation of the dry gel and allow contact with the wound. There is need for training and development of a standard operating procedure on use of CHX.

Umbilical Cord Care Knowledge and Practice: What is the Status of National Chlorhexidine Gel Scale-Up in Nnewi Nigeria?

“…However, it is not clear whether its continued use despite chlorhexidine scale up could be attributed to lack of awareness or unacceptability of the later among healthcare workers. A focused group discussion in Uganda, conducted 3 years after chlorhexidine gel was scaled-up, showed that most healthcare workers considered methylated spirit better and moreeffective than chlorhexidine gel and this may affect the information given to clients [26]. Reports from post scale-up Nigerian quasi experimental and small randomized trials indicate that the efficacy of methylated spirit was comparable to chlorhexidine gel and that the later was associated with delayed cord separation which was a source of dissatisfaction for the users [27,28].…”

Enablers and Barriers to Chlorhexidine Use in Umbilical Cord Care: Voices of Care Givers and Healthcare Providers in Selected Counties in Kenya

“…Similarly, a descriptive cross-sectional study on the assessment of chlorohexidine use in Kangundo Level 4 hospital in Kenya showed mixed cord care practices among respondents. Feedback from the focused group discussions indicated that respondents felt the methylated spirit was more effective than CHX, lack of use of the CHX Gel in maternity immediately after birth as recommended and no clear instructions on how to apply the gel coupled with the erratic supply of gel leading healthcare facilities to opt for spirit (Ambale et al, 2019) contributed to minimal uptake. Similarly, a case-control study to assess umbilical care hygiene and neonatal sepsis relationship in a primary healthcare facility in an urban setting found that Chlorhexidine/surgical spirit were used for cord care among 79.2% of caregivers in the control group compared to 35.6% of the cases (Moraa et al, 2019a).…”

“…In 2016, the use of CHX was introduced in healthcare facilities in Kenya (Ambale et al, 2019;Health et al, 2016), and research conducted in Bungoma county shows high acceptability of CHX use among caregivers and healthcare workers (Muriuki et al, 2017). The introduction of CHX was, however met with mixed reactions (Ambale et al, 2019).…”

“…In 2016, the use of CHX was introduced in healthcare facilities in Kenya (Ambale et al, 2019;Health et al, 2016), and research conducted in Bungoma county shows high acceptability of CHX use among caregivers and healthcare workers (Muriuki et al, 2017). The introduction of CHX was, however met with mixed reactions (Ambale et al, 2019). While the use of CHX as a lifesaving commodity in infant cord care is widely documented and strongly supported as a safe, effective, and affordable intervention to prevent neonatal sepsis, awareness of its availability, correct use, and associated benefits is still very limited amongst mothers, caregivers, and healthcare workers.…”