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American Journal of Epidemiology Advance Access published online on October 25, 2006
American Journal of Epidemiology, doi:10.1093/aje/kwj356
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received March 6, 2006
Accepted June 1, 2006

ORIGINAL CONTRIBUTIONS

Risk Factors for Umbilical Cord Infection among Newborns of Southern Nepal

Luke C. Mullany 1 *, Gary L. Darmstadt 1, Joanne Katz 1, Subarna K. Khatry 2, Steven C. LeClerq 3, Ramesh K. Adhikari 4, and James M. Tielsch 1

1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
2 Nepal Nutrition Intervention Project, Sarlahi, Kathmandu, Nepal
3 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Nepal Nutrition Intervention Project, Sarlahi, Kathmandu, Nepal
4 Institute of Medicine, Tribhuvan University, Kathmandu, Nepal

* To whom correspondence should be addressed.
Luke C. Mullany, E-mail: lmullany{at}jhsph.edu


  Abstract

Although umbilical cord infection contributes to neonatal mortality and morbidity and risk can be reduced with topical chlorhexidine, behavioral or other factors associated with cord infection in low-resource settings have not been examined. Data on potential risk factors for omphalitis were collected during a community-based, umbilical cord care trial in Nepal during 2002-2005. Newborns were evaluated in the home for signs of umbilical cord infection (pus, redness, and swelling). Omphalitis was defined as either pus discharge with erythema of the abdominal skin or severe redness (>2 cm extension from the cord stump) with or without pus. Multivariable regression modeling was used to examine associations between omphalitis and maternal, newborn, and household variables. Omphalitis was identified in 954 of 17,198 newborns (5.5%). Infection risk was 29% and 62% higher in infants receiving topical cord applications of mustard oil and other potentially unclean substances, respectively. Skin-to-skin contact (relative risk (RR) = 0.64, 95% confidence interval (CI): 0.43, 0.95) and hand washing by birth attendants (RR = 0.73, 95% CI: 0.64, 0.84) and caretakers (RR = 0.76, 95% CI: 0.60, 0.95) were associated with fewer infections. In this community, unhygienic newborn-care practices lead to continued high risk for omphalitis. In addition to topical antiseptics, simple, low-cost interventions such as hand washing, skin-to-skin contact, and avoiding unclean cord applications should be promoted by community-based health workers.

Keywords: infant, newborn; infection; Nepal; risk factors; umbilical cord.
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 Arch Pediatr Adolesc MedHome page
V. Rhee, L. C. Mullany, S. K. Khatry, J. Katz, S. C. LeClerq, G. L. Darmstadt, and J. M. Tielsch
Maternal and Birth Attendant Hand Washing and Neonatal Mortality in Southern Nepal
Arch Pediatr Adolesc Med, July 1, 2008; 162(7): 603 - 608.
[Abstract] [Full Text] [PDF]


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