Incidence and Associated Factors of Cord Infection Among Neonates at Fort Portal and Hoima Regional Referral Hospitals

Abstract

Introduction: Untreated cord infections can result in life-threatening effects including necrotizing fasciitis. In Uganda, these effects due to cord infections are high. Proper cord care is crucial for preventing infections. This study aimed to determine the incidence of cord infection and associated factors among neonates at Fort portal and Hoima Regional Referral Hospitals. Methods: This was a prospective cohort study in which 334 neonates born at FRRH and HRRH and their parents consented to the study were consecutively enrolled and followed up for 14 days. Neonates with abdominal wall defects and those that underwent abdominal surgery were excluded. Cord infection was characterized by the presence of pus discharge accompanied by skin redness around the umbilical area, redness with or without discharge, or a foul-smelling secretion from the cord. To identify significant predictors and assess cord care practices, Poisson regression analysis was conducted using SPSS software. A p-value of less than 0.05 was considered statistically significant. Results: Majority were female 69.5% (232/334), 34.7% (116/334) had low birth weight (<2500g) and 32.9% (110/334) were born preterm. Cord infection was identified in 25/334 of the neonates, representing an incidence of 7.5%. The commonest symptom was foul smelling cord 48.0% (12/25), while the commonest signs were pus discharge 40.0% (10/334) and fever 28.0% (7/25). Not practicing early initiation of breastfeeding (aIRR=1.081, CI=1.009–1.159, P=0.027): not keeping the cord clean and dry (aIRR=1.244, CI=1.074–1.441, P=0.004) and not practicing hand hygiene (aIRR=1.082, CI=1.019–1.150, P=0.010) were significantly associated with cord infection. Conclusion: The incidence of cord infection among neonates was high, where in every 10 neonates approximately one developed cord infection. Community sensitization should be conducted to all mothers to practice proper personal hygiene including handwashing. Mothers should initiate breast feeding within the first hour after delivery and keep the cords of their babies dry and clean.