{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T04:47:26Z","timestamp":1750308446347,"version":"3.41.0"},"reference-count":42,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T00:00:00Z","timestamp":1750204800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIH Fogarty","award":["R 25TW011212"],"award-info":[{"award-number":["R 25TW011212"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Neonatal sepsis (NNS) continues to be a leading cause of neonatal mortality in low-resource settings. NNS can occur secondary to umbilical stump infections (omphalitis) and this requires preventative cord care practices. To address this, the World Health Organization (WHO) issued context-specific recommendations for the use of 7.1% chlorhexidine (CHX) solution in areas with high neonatal mortality. Despite adoption of this policy, monitoring and evaluation of this guidance is lacking. This study describes the experiences of healthcare workers (HCWs) regarding cord care practices in Kiambu County, Kenya.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We employed an exploratory qualitative design. Key informant interviews were conducted with 38 HCWs between October 6th and November 9th 2022 in six healthcare facilities in Kiambu County. Data were analyzed thematically using NVivo software.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>While Ministry of Health guidelines endorse WHO\u2019s recommendation for the nation-wide use of CHX for neonatal cord care, its implementation in Kiambu county remains varied. HCWs continue to favour surgical spirit, and one of the healthcare facilities in our study adopted a facility-based policy of dry cord care. HCWs also relayed that mothers often combined modern and traditional methods. Some HCWs reported high satisfaction with CHX due to its perceived effectiveness, ease of use, and faster stump healing. However, systemic and product-specific barriers to uptake were noted. Systemic issues included frequent CHX stock-outs and high out-of-pocket costs due to inconsistent county-level supply and lack of insurance coverage. Product-specific concerns such as difficulty of application and reported adverse effects (e.g., delayed cord detachment, sepsis, burns) further impeded use. Knowledge gaps and contrary instructions among and between both the HCWs and mothers also undermined CHX use.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Despite CHX being the recommended intervention for cord care in Kenya, its inconsistent use in Kiambu county reflects gaps in policy enforcement, supply chain reliability, and health education. The persistence of outdated or non-recommended cord care practices underscores a critical lack of oversight. To realize CHX\u2019s full public health potential, urgent policy action is needed to ensure consistent availability, enforcement of national neonatal guidelines, and investment into inclusive IEC materials. Bridging the gap between policy and practice is essential for reducing neonatal morbidity and achieving equitable progress towards Kenya\u2019s goal of Universal Health Coverage.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0326506","type":"journal-article","created":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T17:56:23Z","timestamp":1750269383000},"page":"e0326506","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201c...In Kiambu county, there are different things being done\u201d: A qualitative exploration of healthcare workers\u2019 experiences with cord care practices"],"prefix":"10.1371","volume":"20","author":[{"given":"James Maina","family":"Githinji","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4033-7869","authenticated-orcid":true,"given":"Angeline","family":"Chepchirchir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian Ombura","family":"Nyanchoka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7227-7949","authenticated-orcid":true,"given":"Prabhjot Kaur","family":"Juttla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruth","family":"Nduati","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,6,18]]},"reference":[{"key":"pone.0326506.ref001","first-page":"656","volume-title":"Omphalitis. The 5-Minute Pediatric Consult","author":"JP Clarke-Pounder","year":"2022"},{"key":"pone.0326506.ref002","article-title":"Dry care versus chlorhexidine cord care for prevention of omphalitis. Systematic review with meta-analysis","volume":"27","author":"MD L\u00f3pez-Medina","year":"2019","journal-title":"Rev Latino-Am Enfermagem"},{"key":"pone.0326506.ref003","volume-title":"WHO recommendations on maternal and newborn care for a positive postnatal experience","author":"Geneva: World Health Organization","year":"2022"},{"key":"pone.0326506.ref004","volume-title":"The Kenya guideline for the use of chlorhexidine digluconate 7.1% for prevention of newborn umbilical cord infection","author":"Kenya: Ministry of Health","year":"2022"},{"key":"pone.0326506.ref005","article-title":"A Cochrane review on the umbilical cord care and prevention of infections","volume-title":"Antiseptic solutions are not necessary in developed countries but life-saving in developing countries. - PubMed","author":"I Axelsson","year":"2002"},{"issue":"3","key":"pone.0326506.ref006","article-title":"Topical umbilical cord care at birth","volume":"2004","author":"J Zupan","year":"2004","journal-title":"Cochrane Database Syst Rev"},{"key":"pone.0326506.ref007"},{"key":"pone.0326506.ref008","article-title":"G272\u2005Epidemiological trends of neonatal sepsis in a county referral hospital in central Kenya","volume":"101","author":"JL Geyt","year":"2016","journal-title":"Arch Dis Child"},{"issue":"5","key":"pone.0326506.ref009","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-004475","article-title":"Neonatal mortality in Kenyan hospitals: a multisite, retrospective, cohort study","volume":"6","author":"G Irimu","year":"2021","journal-title":"BMJ Glob Health"},{"key":"pone.0326506.ref010","volume-title":"Kenya Demographic and Health Survey 2022 Key Indicators Report","author":"National Bureau of Statistics Nairobi K","year":"2023"},{"issue":"5","key":"pone.0326506.ref011","article-title":"Umbilical cord antiseptics for preventing sepsis and death among newborns","volume":"2013","author":"A Imdad","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"pone.0326506.ref012","volume-title":"National Guidelines for Quality Obstetrics and Perinatal Care","author":"Kenya M of PH and S, Kenya M of MS","year":"2009"},{"issue":"1","key":"pone.0326506.ref013","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1186\/s12884-017-1250-7","article-title":"Umbilical cord-care practices in low- and middle-income countries: a systematic review","volume":"17","author":"PS Coffey","year":"2017","journal-title":"BMC Pregnancy Childbirth"},{"issue":"14","key":"pone.0326506.ref014","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000003207","article-title":"70% Alcohol Versus Dry Cord Care in the Umbilical Cord Care: A Case-Control Study in Italy","volume":"95","author":"R Quattrin","year":"2016","journal-title":"Medicine (Baltimore)"},{"key":"pone.0326506.ref015","volume-title":"Cord care with 7.1% chlorhexidine digluconate saves newborn lives: Chlorhexidine for umbilical cord care: A new, low-cost intervention to reduce newborn mortality 2.95 million","year":"2014"},{"issue":"1","key":"pone.0326506.ref016","doi-asserted-by":"crossref","first-page":"308","DOI":"10.29322\/IJSRP.11.01.2021.p10932","article-title":"Assessment of the Use Of Chlorhexidine Digluconate Gel for Cord Care at Kangundo Level 4 Hospital","volume":"11","author":"C Ambale","year":"2020","journal-title":"IJSRP"},{"key":"pone.0326506.ref017","volume-title":"Kenya: Ministry of Health. Basic Paediatric Protocols","year":"2022"},{"key":"pone.0326506.ref018","doi-asserted-by":"crossref","first-page":"101781","DOI":"10.1016\/j.cegh.2024.101781","article-title":"Adoption and factors associated with 7.1% chlorhexidine digluconate cord care standards in public health facilities in Kiambu County, Kenya","volume":"29","author":"JM Githinji","year":"2024","journal-title":"Clinical Epidemiology and Global Health"},{"issue":"3","key":"pone.0326506.ref019","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0297335","article-title":"Knowledge, attitudes and practices towards COVID-19 among healthcare workers: A cross-sectional survey from Kiambu County, Kenya","volume":"19","author":"PK Juttla","year":"2024","journal-title":"PLoS One"},{"key":"pone.0326506.ref020","volume-title":"A guideline for the use of Chlorhexidine for newborn umbilical cord care in Kenya","year":"2016"},{"key":"pone.0326506.ref021","volume-title":"Chlorhexidine 7,1% digluconate (CHX) aqueous solution or gel (10ml): Reports of serious eye injury due to errors in administration","year":"n.d"},{"key":"pone.0326506.ref022","volume-title":"Kenya Essential Medicines List 2019","author":"Ministry of Health","year":"2019"},{"key":"pone.0326506.ref023","volume-title":"Manual for Procurement & Supply of Quality-Assured Maternal, Newborn and Child Health Commodities","year":"n.d"},{"issue":"5","key":"pone.0326506.ref024","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0304631","article-title":"Comparing labour induction outcomes using misoprostol and dinoprostone in term pregnancies: A retrospective study at Kiambu Level 5 Hospital between 2018 and 2020","volume":"19","author":"M Mwancha-Kwasa","year":"2024","journal-title":"PLoS One"},{"key":"pone.0326506.ref025","doi-asserted-by":"crossref","first-page":"100174","DOI":"10.1016\/j.ijnsa.2024.100174","article-title":"Saturation in qualitative research: An evolutionary concept analysis","volume":"6","author":"S Rahimi","year":"2024","journal-title":"Int J Nurs Stud Adv"},{"issue":"1","key":"pone.0326506.ref026","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1177\/1077800415603395","article-title":"Goodall\u2019s Verbal Exchange Coding","volume":"22","author":"J Salda\u00f1a","year":"2015","journal-title":"Qualitative Inquiry"},{"issue":"01","key":"pone.0326506.ref027","doi-asserted-by":"crossref","first-page":"007","DOI":"10.4103\/2321-0656.140875","article-title":"The second step in data analysis: Coding qualitative research data","volume":"03","author":"H Stuckey","year":"2015","journal-title":"Journal of Social Health and Diabetes"},{"key":"pone.0326506.ref028","article-title":"Don\u2019t blame the software: Using qualitative data analysis software successfully in doctoral research","volume":"17","author":"M Salmona","year":"2016","journal-title":"Forum Qualitative Sozialforschung\/ Forum: Qualitative Social Research"},{"issue":"2","key":"pone.0326506.ref029","doi-asserted-by":"crossref","first-page":"72","DOI":"10.37284\/eajhs.5.2.995","article-title":"Enablers and Barriers to Chlorhexidine Use in Umbilical Cord Care: Voices of Care Givers and Healthcare Providers in Selected Counties in Kenya","volume":"5","author":"Y Opanga","year":"2022","journal-title":"East Afr j health sci"},{"issue":"1","key":"pone.0326506.ref030","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1186\/s12913-017-2262-8","article-title":"Health care providers\u2019 perspectives regarding the use of chlorhexidine gel for cord care in neonates in rural Kenya: implications for scale-up","volume":"17","author":"A Muriuki","year":"2017","journal-title":"BMC Health Serv Res"},{"key":"pone.0326506.ref031","article-title":"Essential medicines lists are for high income countries too","volume":"382","author":"P Brhlikova","year":"2023","journal-title":"BMJ"},{"issue":"1","key":"pone.0326506.ref032","doi-asserted-by":"crossref","first-page":"1699342","DOI":"10.1080\/16549716.2019.1699342","article-title":"Universal access to essential medicines as part of the right to health: a cross-national comparison of national laws, medicines policies, and health system indicators","volume":"13","author":"K Perehudoff","year":"2020","journal-title":"Glob Health Action"},{"key":"pone.0326506.ref033","unstructured":"Kariuki J, Njeru MK, Wamae W, Mackintosh M. African Centre for Technology Studies Local Supply Chains for Medicines and A Working Paper from the Industrial Productivity, Health Sector Performance and Policy Synergies for Inclusive Growth (IPHSP) research project. n.d."},{"key":"pone.0326506.ref034","author":"Health Action International","year":"2018"},{"key":"pone.0326506.ref035","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/1472-698X-13-44","article-title":"Willingness to pay for a 4% chlorhexidine (7.1% chlorhexidine digluconate) product for umbilical cord care in rural Bangladesh: a contingency valuation study","volume":"13","author":"PS Coffey","year":"2013","journal-title":"BMC Int Health Hum Rights"},{"key":"pone.0326506.ref036","volume-title":"Kenya Demographic and Health Survey 2022 Key Indicators Report","author":"National Bureau of Statistics Nairobi K","year":"2023"},{"issue":"11","key":"pone.0326506.ref037","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(16)30223-6","article-title":"Efficacy of chlorhexidine application to umbilical cord on neonatal mortality in Pemba, Tanzania: a community-based randomised controlled trial","volume":"4","author":"S Sazawal","year":"2016","journal-title":"Lancet Glob Health"},{"issue":"11","key":"pone.0326506.ref038","article-title":"Effectiveness of 4% chlorhexidine umbilical cord care on neonatal mortality in Southern Province, Zambia (ZamCAT): a cluster-randomised controlled trial","volume":"4","author":"KEA Semrau","year":"2016","journal-title":"Lancet Glob Health"},{"key":"pone.0326506.ref039","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11908-017-0572-y","article-title":"Infection control in limited resources countries: challenges and priorities","volume":"19","author":"D Vilar-Compte","year":"2017","journal-title":"Curr Infect Dis Rep"},{"issue":"01","key":"pone.0326506.ref040","doi-asserted-by":"crossref","first-page":"20","DOI":"10.4236\/health.2023.151002","article-title":"Umbilical Cord Care Practices and Cord Care Education of Mothers Attending Health Care (Pakistan Prospect)","volume":"15","author":"M Ans","year":"2023","journal-title":"Health"},{"key":"pone.0326506.ref041","volume-title":"Integrating chlorhexidine for cord care into community based newborn care in Ethiopia","author":"Y Tadesse","year":"2019"},{"key":"pone.0326506.ref042","unstructured":"World Health Organization. Universal Health Coverage (UHC). 2025. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/universal-health-coverage-(uhc) [Last accessed: 6\/7\/2025]."}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0326506","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T17:56:40Z","timestamp":1750269400000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0326506"}},"subtitle":[],"editor":[{"given":"Sojib","family":"Zaman","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,6,18]]},"references-count":42,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0326506","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,18]]}}}