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Background: Globally, newborn deaths have declined from 5 million in 1990 to 2.4 million in 2019; however, the risk of death in the first 28 days is high. Harmful umbilical cord care contributes to neonatal infection, which accounts for millions of neonatal deaths. This study assessed determinants of potentially harmful traditional cord care practices in Ethiopia using data from a nationally representative survey. Materials and methods: Secondary data analyses were employed using data from the 2016 Ethiopian Demographic and Health Survey. Weighted samples of 4,402 mothers who gave birth in the last 3 years prior to the survey were included in the analysis. Binary logistic regression was fitted to identify associations of outcome variables with explanatory variable analysis, and the results were presented with an adjusted odds ratio (AOR) at a 95% confidence interval (CI), declaring statistical significance at a p-value < 0.05 in all analyses. Results: About 13.70% (95% CI: 12.7%, 14.7%) of mothers practice harmful traditional umbilical cord care. Maternal age (25–34 years, AOR = 1.77, 95% CI: 1.36, 2.31, 35–49 years, AOR = 1.53, 95% CI: 1.07, 2.19), maternal education (primary: AOR = 0.54, 95% CI: 0.41, 0.70 and secondary and above: AOR = 0.61, 95% CI: 0.40, 0.94), parity (para two, AOR = 0.71, 95% CI: 0.55, 0.92), and place of delivery (home delivery, AOR = 1.96, 95% CI: 1.51, 2.56) were factors associated with potentially harmful traditional umbilical cord care practices. Conclusion: Maternal educational status, parity, maternal age, and place of delivery were associated with harmful traditional cord care practices. Thus, improving mothers’ education, strengthening antenatal and postnatal care (PNC), and utilization of institutional delivery would help to reduce harmful traditional cord care practices.
This study was conducted in Ethiopia, which is located in the horn of Africa. The country has nine regions [Afar; Tigray; Amhara; Oromia; Somali; Southern Nations, Nationalities, and People’s Region (SNNPR); Benishangul-Gumuz; Gambella; and Harari] and two administrative cities (Addis Ababa and Dire Dawa). The study utilized data extracted from the 2016 Ethiopian Demographic and Health Survey (EDHS). Ethiopian Demographic and Health Survey collected data on basic health, demographic, and socioeconomic indicators across the nine administrative regions and two city administrations. The survey was conducted by the Central Statistical Agency (CSA) together with the Ministry of Health (MoH) and the Ethiopian Public Health Institute. The United States Agency for International Development (USAID) funded the survey. The data collection period was from 18 January 2016 to 27 June 2016 (26). A total of 16,583 eligible women were included in the survey, 15,683 women (15–49 years) completed the interview (26). We extracted data of all mothers who gave birth in the last 3 years prior to the survey. All mothers who gave birth to alive neonates were included. Weighted samples of 4,402 mothers were included in the final analysis. Details about the DHS sampling techniques and sample size are available at http://www.dhsprogram.com/. Any substances applied to the cord except for 4% of chlorhexidine are considered potentially harmful substances (16). This study included sex of the child (male and female), maternal education (no education, primary education, secondary, and higher education), age of the mother (15–24, 25–34, and 35–49 years), place of residence (urban and rural), and employment status (employed and unemployed), the number of the antenatal clinic (ANC) visits was also categorized into no ANC visits, 1–3 ANC visits, four or more ANC visits, and places of delivery (categorized as a health facility or home). Parity was also categorized into para one, para two, para three, or more. In this study, the 11 regions of Ethiopia were categorized into three contextual regions: pastoralist, agrarian, and city (which were defined on the basis of the socioeconomic and cultural backgrounds of their populations) (27). Wealth indexes (categorized as poorest, poorer, middle, richer, and richest) were used to indicate a household’s wealth status. The wealth index was constructed using data on a household’s ownership of selected assets, such as television and bicycles, materials used for housing construction, and types of water access and sanitation facilities (26). Analyses were performed using STATA version 14. Descriptive statistics, such as frequency and proportion, were used to describe the characteristics of the data. To assess the association between explanatory variables and potentially harmful umbilical cord care practices of mothers with children aged 0–12 months, a binary logistic regression model was fitted. First, each variable was entered into a binary logistic regression model. Second, variables, which were significant at a p-value of less than or equal to 0.25, were fitted into a multivariable logistic regression model to identify independent factors of harmful umbilical cord care practices among mothers with children aged 0–12 months in Ethiopia. Statistical significance was declared at a p-value < 0.05 in all analyses. The results from the logistic regression analyses are presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs).
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