Factors influencing chlorhexidine application for prevention of cord infection in District Tando Allahyar Sind

The neonatal mortality trends are reducing globally but the mortality trends are high in Pakistan. One fifth of newborn deaths occur due to infection; mostly related to unhygienic cord practices and umbilical cord sepsis contributing to 13% of these deaths. Most of these deaths can be averted by maintaining good hygienic practices at the household level. The simple application of chlorhexidine (CHX) for umbilical cord care within 24 hours of birth is proven to have reduced neonatal mortality. Yet mothers being under influence of the old traditional home practices and ancient health beliefs of applying surma (lead powder), oil, ash and other various substances on umbilical cord, often leading to cord sepsis; thereby contributing to increased incidences of neonatal mortality. Hence it requires critical emphasis to explore and gather knowledge on factors influencing chlorhexidine application for prevention of cord infection in district Tando Allahyar Sindh. Research Objectives: The study was aimed to explore the cord care practices and the factors influencing chlorhexidine application for prevention of cord infection in district Tando Allahyar Sindh. Methodology: The exploratory qualitative research design was used in this study, participants for study were recruited through purposive sampling technique and data was collected using mixed methods. The qualitative part comprised 12 in-depth interviews (IDIs) with mothers and skilled birth attendants, 3 key informant interviews (K11) with district stakeholders and 4 focus group discussions (FGD\u27s) were conducted with grandmothers TBA\u27s and with LHWs. The observation checklist was used to assess the skills of SBA\u27s at secondary care hospital. Qualitative content analysis was used to interpret the textual information, whereas descriptive frequency was calculated for skill checklist. The duration of study was three months from July to September, 2017. Results: Based on the evidence collected through interviews, factors supporting topical CHX application, and major constraints were identified. Findings of the study revealed common usage of cord clamp and using new razors for cord excision indicated as healthy practice. Study identified that the SBA\u27S were well versed with the recommended guidelines of newborn cord care in hospital settings in contrast to mothers and grandmothers who practiced the same cultural practices of appliing surrna and oil on cord in home based deliveries. The findings also revealed that some mothers were reluctant initially to use CHX wondering on its real benefits and fears for its possible side effects. However the study findings revealed that the CHX application acceptability for cord care among mothers especially in rural settings was maximized through awareness sessions carried out in the communities in Tando Allahyar. The study identified unavailability of CHX gel, irregularities in LHW\u27s visiting households, lack of monitoring and supervision of CHX gel distribution, home based deliveries and cultural beliefs as major factors influencing CHX gel application in Tando Allahyar. Conclusion: The study demonstrated general acceptance of CHX among all stakeholders, and their opinions influenced a great deal due to feedback on positive results of the gel application. The study identified unavailability of CHX, lack of monitoring and supervision in CHX application and distribution, cultural practices in LHW\u27s uncovered area, low standard practices in home based deliveries as main constraints for implementation of CHX application. The study recommends that, this needs to be addressed through local manufacturing of CHX gel and its distribution through both Government and social marketing channels. It was also learnt from the study, that involvement of media and BCC approach was the most crucial step for creating awareness regarding significance of CHX application. The study emphasized the need for a strong mechanism of monitoring and supervision for CHX distribution both at health facilities and in the communities through DHMT. The study findings contribute in providing insights to the policy makers to devise interventions to scale up CHX application for cord care in rest of the country. The study also highlighted challenges and areas of focus for future research