Evaluating the Use of Chlorhexidine Gel in the Management of Newborns' Umbilical Cord in the Greater Accra Regional Hospital
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University of Ghana
Abstract
Introduction: Good umbilical cord care is paramount in the reduction of incidences of neonatal
tetanus and omphalitis. Various public health interventions have demonstrated effectiveness in
reducing the incidence and fatalities from these infections. The use of chlorhexidine gel
decreased the incidence of omphalitis by an appreciable 75% and reduced overall neonatal
mortality by 26% as compared to dry cord care. Despite this, the uptake and application of the
gel in the management of the umbilical cord are less known, especially in Ghana and other SSA
countries.
Objective: This study evaluated the use of chlorhexidine gel in managing the umbilical cords of
newborns in the Greater Accra Regional Hospital.
Methods: This study adopted an exploratory case study design to determine the use of
chlorhexidine gel in newborns at Greater Accra Regional Hospital. A purposive sampling
technique was used to identify and select the participants. The data were collected until
saturation was attained. The study population, hence, comprised 8 midwives, 2 nurses, and 8
post-natal mothers. In-depth interviews were conducted by the principal investigator using an
interview guide and audio-recorded with permission from the study participants. The audio
recorded interviews were transcribed verbatim and analyzed using the ATLAS software.
Thematic analysis was done, and quotations were used to illustrate the results.
Results: All the midwives and nurses confirmed that Ridge Hospital has instituted guidelines
and conducts workshops for the use of chlorhexidine gel which addresses the prevention of
sepsis and other neonatal infections by advocating for a sterile procedure and providing details
on the steps to follow in applying the gel. Also, on the comparison of the use of the Methylated
spirit and Chlorhexidine gel, the midwives and nurses stated that the gel is the preferred method of cord care due to its antibacterial properties and reduced risk of infection, however, it has a
slower drying time. In this regard, some post-natal mothers stated that they prefer the use of the
spirit to the gel as the spirit makes the cord heal faster. Further, the majority of the care providers
indicated that the use of methylated spirit has been phased out and replaced with Chlorhexidine
gel as the primary method of cord care. While the benefits of the chlorhexidine gel over
methylated spirit are well established as the gel contains antibiotics, which reduces the risk of
infection in newborns, some post-natal mothers maintained that the use of the gel leads to cord
infections. Other side effects with regards to the use of the gel as stated by both healthcare
providers and post-natal mothers include; delayed cord drying off, cord stump, delayed cord fall
off, and adverse reactions when the gel touches other parts of the baby. On the side of the
midwives and nurses, they explained that cord infections resulting from the use of the gel arise
from improper use of the gel and excessive gel application. Some symptoms of an infected
umbilical cord as revealed by this study include redness and swelling, the base of the cord may
also be warm to the touch a strong, unpleasant odour coming from the umbilical cord, and other
discharges coming from the cord.
Conclusion: There is a perception that the use of Chlorhexidine gel for cord care in the Greater
Accra Regional Hospital in Ghana is an effective method of reducing the risk of neonatal
infections. There are, however, some setbacks associated with the use of Chlorhexidine gel, such
as delayed cord drying time and a higher rate of stumps, these are outweighed by its benefits in
reducing the risk of infection. It is, therefore, recommended that the hospital consider educating
mothers on the benefits of Chlorhexidine gel and the potential drawbacks to alleviate any
concerns they may have. Additionally, continuous monitoring of the use of Chlorhexidine gel
and evaluate its long-term effects on the health of newborns.
Description
MPH. Monitoring and Evaluation