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

Abstract

Neonatal sepsis contributes to increased rates of mortality among newborns during their first month of life. Chlorhexidine (CHX) has proven effective in the prevention of neonatal sepsis due to umbilical stump infection after birth. Despite shifting from dry cord care techniques to CHX use, there is still a high prevalence of improper cord care in low-resource settings in Kenya. This study sought to explore barriers and enablers to CHX use in Kwale, Vihiga and Machakos counties in Kenya. We adopted mixed methods cross-sectional survey with 582 women of reproductive age with a young child less than one year as respondents to the quantitative survey. Qualitative data entailed thirty (30) key informant interviews with healthcare workers and national policymakers. Six (6) focus group discussions with mothers, caregivers, community health volunteers (CHVs) and traditional birth attendants were conducted. An observation checklist was used to assess the availability of CHX services and supplies in fourteen (14) health facilities was conducted. Results indicated variation in umbilical cord care practices for newborns across counties. Of 582 caregivers, only 1.3% reported having ever used CHX. Majority mentioned using methylated spirits (41.6%), other antiseptics (23.3%) and salty water (11.3%). Other substances used for cord care included plain water, herbal extracts, cow dung, soil, and breast milk. Despite 100% awareness of CHX among health workers, only a third of caregivers (38.7%) had heard of CHX. About 76.9% of participants preferred the gel formulation and 8.9% did not know where to get the product. Drivers of CHX use included faster cord healing, infection control in hospitals, ease of use, cost implications, ease of access, influence from key decision makers and preferred CHX formulation. Barriers included minimal awareness among caregivers, cultural practices and taboos on cord care, inadequate capacity building of CHVs on CHX, unclear CHX user guidelines for caregivers, prolonged stockouts and inadequate knowledge of CHX in communities. Healthcare workers highlighted poor dissemination of CHX guidelines by the Ministry of Health, unavailability in the Kenya Medical Supplies Authority (KEMSA) and Mission for Essential Drugs and Supplies logistic management information system making it difficult to procure. There is a need for advocacy to promote the uptake of CHX in facilities and increase knowledge of communities on CHX as well as manage the supply chain to increase CHX availability

Knowledge and use of chorhexidine gel in umbilical cord care among postpartum women at Poly General Hospital, Enugu, Southeast Nigeria: a cross-sectional study

“… 28 A 2022 study in Kenya revealed that only 1.3% used chlorhexidine gel for cord care, which is a much lower percentage compared with the current study. 30 The findings of this study revealed that parity of the women was not significantly associated with utilisation of chlorhexidine gel (p=0.736). The utilisation was almost the same for different parities.…”

“…In a similar study among healthcare providers, it was reported that with the application of chlorhexidine gel to the umbilical stump, the cord takes longer to heal because it leaves the cord wet, which delays the healing process, and that they prefer to use the spirit. 30 …”

“…The study, however, highlighted that to overcome this barrier, community mobilisation and testimonials from mothers who reported fast cord healing and infection control should be implemented. 30 This is because perception of increased separation time might negatively affect the likelihood of widespread acceptance of the intervention in subsequent scaling up activities.…”

Determinants of cord care practices among caregivers in a level 5 facility in Kenya

“…Similarly, a study conducted in Kenya found that cultural beliefs and taboos were barriers to the implementation of chlorhexidine use for cord care. 23 In the African context, diverse cultural beliefs exist regarding cord care practices. Strategies to overcome negative beliefs especially in culturally endowed communities like Kenya, regarding cord care should be explored.…”