Prevalence and factors associated with use of unrecommendable cord care substances among women 15-49 years in Uganda; a retrospective cross-sectional study

Abstract

In 2021, globally, 2.3 million neonates aged 0-28 days died, amounting to approximately 6,400 deaths per day, with Uganda accounting for 81 daily deaths. Sepsis, partly caused by poor cord care, is responsible for 18.2% of these deaths, contributing to over 700,000 neonatal deaths annually. Therefore, adhering to recommended cord care practices is critical for preventing newborn infections. Despite various guidelines, the extent of compliance with these recommendations in Uganda remains unclear. Objective: This study aimed to estimate the prevalence of using non-recommended substances for cord care, document the various substances used, and assess the factors associated with the use of non-recommended substances among women of reproductive age in Uganda. Methods: A retrospective cross-sectional study was conducted among 19835 women aged 15-49 years. Women were included if they had given birth within the past year prior to the survey. Data on cord care practices, socio-demographic factors, cultural factors, maternal factors, health service utilization, and health system factors were collected. The prevalence of using non-recommended substances for cord care was computed using weighted samples while adjusting for clustering. Modified Poisson models from the generalized linear models (GLM) family with log link function and clustered standard errors were used to determine factors associated with the use of nonrecommended substances for umbilical cord care, using Stata version 15. Results: The prevalence of using non-recommended substances for cord care was 14% [95% confidence interval (CI: 13.40%, 14.35%)]. Significant factors associated with the use of nonrecommended substances included young maternal age (adjusted prevalence ratio [aPR]=2.2, 95% CI: 1.1-4.5 for mothers aged 15-19 years); religion (aPR=2.3, 95% CI: 1.2-4.2 for Anglicans, and aPR=0.5, 95% CI: 0.4-0.7 for Muslims); and postnatal care attendance (aPR=0.4, 95% CI: 0.2- 0.7). Conclusion: The prevalence of using non-recommended substances for cord care in Uganda was high. Key factors associated with this practice included teenage motherhood, and poor postnatal care attendance. Enhancing maternal education on proper cord care during antenatal and postnatal care visits could reduce the use of non-recommended substances, thereby lowering the risk of neonatal sepsis and mortality in Uganda.