Adoption and factors associated with 7.1% chlorhexidine digluconate cord care standards in public health facilities in Kiambu County, Kenya

Background: The Government of Kenya adopted the practice of 7.1% chlorhexidine digluconate (CHX) application for all newborns. However, challenges in implementation have arisen, as some counties in Kenya do not align with the underlying criteria for this recommendation. Therefore, we aimed to evaluate CHX adoption and associated factors in Kiambu County, Kenya. Methods: A cross-sectional survey was conducted among 434 caregivers attending their 6-week well-child clinics using multistage sampling. Descriptive statistics summarized sociodemographic data and CHX cord care uptake, while logistic regression analyzed associations between variables and CHX uptake. Results: The prevalence of use of CHX in Kiambu county was 41.0%. Twenty-two percent (22%) of the mothers were provided CHX post-delivery and 100% used it. Of the 78% who weren't provided CHX post-delivery, 39% were given prescriptions for CHX. The 61% who were not issued a prescription resorted to the use of surgical spirit (34.8%), dry cord care (9.2%) and saliva (3%). In public facilities, being married [AOR 0.19 (0.11–0.33)] and index use of CHX [AOR 0.17 (0.08–0.35)] were associated with non-adherence. Being employed [AOR 2.46 (1.26–4.77)] and delivering in hospital [COR 3.29 (1.69–7.08)] increased the likelihood of using CHX. Conclusion: Weak prescription and adherence to the CHX cord care policy in Kiambu county has led to women turning to alternative substances for cord care. Quality improvement strategies are necessary to enhance adherence to guidelines, such as refining county-specific recommendations for cord care and providing corresponding patient education, or issuing definitive prescriptions for CHX post-delivery.