When the Cord Falls Off Early, We the Mothers Can Come Out of Confinement: Newborn Cord Care Practices in Urban Slums in Accra, Ghana

In Ghana, neonatal deaths account for >60% of infant deaths. Few studies have focused on umbilical cord care in Ghana's urban slums. This paper examines newborn cord care practices among mothers in two large urban slums in Accra, and the data come from a concurrent mixed-methods cross-sectional study. A quantitative survey was conducted among 279 randomly sampled mothers ages 15-49 years with live neonates. The qualitative component was conducted among women ages 15-49 years with live neonates, traditional birth attendants, community leaders, and public health managers who were purposively sampled. Descriptive analyses were used to describe cord care practices. Bivariate and multiple logistic regression analyses assessed factors associated with cord care practices at the 95% confidence level (CI). Qualitative data were analyzed thematically. Overall, the prevalence of appropriate cord care practices was low (28.3%). Despite a policy shift from the use of methylated spirit to chlorhexidine, >81% of mothers reported using methylated spirit for cord management. The adjusted odds of newborns receiving appropriate cord care (AOR: 2.82; 95% CI: 1.13-7.07; P = 0.027) were significantly greater among mothers who had skilled deliveries than among deliveries involving unskilled attendants. Mothers residing within a radius of 3-5 km of the nearest facility were more likely than those living within a 1-2 km radius (AOR: 2.34; 95% CI: 1.14-4.77; P = 0.020) to practice appropriate cord care. Improving cord care in slums requires strengthening antenatal care services and skilled delivery.