{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T21:32:03Z","timestamp":1775079123885,"version":"3.50.1"},"reference-count":98,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    In Ghana, neonatal deaths account for &gt;60% of infant deaths. Few studies have focused on umbilical cord care in Ghana\u2019s urban slums. This paper examines newborn cord care practices among mothers in two large urban slums in Accra, and the data come from a concurrent mixed-methods cross-sectional study. A quantitative survey was conducted among 279 randomly sampled mothers ages 15\u201349 years with live neonates. The qualitative component was conducted among women ages 15\u201349 years with live neonates, traditional birth attendants, community leaders, and public health managers who were purposively sampled. Descriptive analyses were used to describe cord care practices. Bivariate and multiple logistic regression analyses assessed factors associated with cord care practices at the 95% confidence level (CI). Qualitative data were analyzed thematically. Overall, the prevalence of appropriate cord care practices was low (28.3%). Despite a policy shift from the use of methylated spirit to chlorhexidine, &gt;81% of mothers reported using methylated spirit for cord management. The adjusted odds of newborns receiving appropriate cord care (AOR: 2.82; 95% CI: 1.13\u20137.07;\n                    <jats:italic>P<\/jats:italic>\n                    = 0.027) were significantly greater among mothers who had skilled deliveries than among deliveries involving unskilled attendants. Mothers residing within a radius of 3\u20135 km of the nearest facility were more likely than those living within a 1\u20132 km radius (AOR: 2.34; 95% CI: 1.14\u20134.77;\n                    <jats:italic>P<\/jats:italic>\n                    = 0.020) to practice appropriate cord care. Improving cord care in slums requires strengthening antenatal care services and skilled delivery.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.24-0706","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T15:35:31Z","timestamp":1771947331000},"page":"756-766","source":"Crossref","is-referenced-by-count":0,"title":["When the Cord Falls Off Early, We the Mothers Can Come Out of Confinement: Newborn Cord Care Practices in Urban Slums in Accra, Ghana"],"prefix":"10.4269","volume":"114","author":[{"given":"Edward Akolgo","family":"Adimazoya","sequence":"first","affiliation":[{"name":"Center for Communication Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John Kumuuori","family":"Ganle","sequence":"additional","affiliation":[{"name":"Department of Population, Family and Reproductive Health, College of Health Sciences, School of Public Health, University of Ghana, Legon, Ghana;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmanuel","family":"Asampong","sequence":"additional","affiliation":[{"name":"Department of Social and Behavioural Sciences, College of Health Sciences, School of Public Health, University of Ghana, Legon, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franklin","family":"Glozah","sequence":"additional","affiliation":[{"name":"Department of Social and Behavioural Sciences, College of Health Sciences, School of Public Health, University of Ghana, Legon, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip Baba","family":"Adongo","sequence":"additional","affiliation":[{"name":"Department of Social and Behavioural Sciences, College of Health Sciences, School of Public Health, University of Ghana, Legon, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","article-title":"Newborns: Improving Survival and Well-Being.","year":"2020"},{"key":"b2","article-title":"Levels and Trends in Child Mortality: Report 2020.","year":"2020"},{"key":"b3","series-title":"Lancet","first-page":"347","article-title":"Can available interventions end preventable deaths in mothers, newborn babies, and still births, and at what cost?","volume":"384","author":"Bhutta","year":"2014"},{"key":"b4","series-title":"Lancet","first-page":"189","article-title":"Every Newborn: Progress, priorities, and potential beyond survival","volume":"384","author":"Lawn","year":"2014"},{"key":"b5","series-title":"Lancet","first-page":"957","article-title":"Global, regional, and national levels of neonatal, infant, and under5 mortalities during 1990\u20132013: A systematic analysis for the Global Burden of Disease Study 2013","volume":"384","author":"Wang","year":"2014"},{"key":"b6","article-title":"Pregnancy, Childbirth, Postpartum and Newborn Care: A Guide for Essential Practice.","year":"2006"},{"key":"b7","author":"Narayanan","year":"2014"},{"key":"b8","article-title":"Essential Newborn Care: Report of a Technical Working Group (Trieste, 25-29 April 1994).","year":"1996"},{"key":"b9","year":"1998"},{"key":"b10","series-title":"J Perinatol","first-page":"572","article-title":"Advancing newborn health and survival in developing countries: A conceptual framework","volume":"22","author":"Marsh","year":"2002"},{"key":"b11","series-title":"Lancet","first-page":"430","article-title":"Global, regional and national causes of child mortality in 2000\u20132013, with projections to inform post 2015 priorities: An updated systematic analysis","volume":"385","author":"Liu","year":"2015"},{"key":"b12","series-title":"BMC Public Health","first-page":"S15","article-title":"The effect of umbilical cord cleansing with chlorhexidine on omphalitis and neonatal mortality in developing country communities: A meta-analysis","volume":"13","author":"Imdad","year":"2013"},{"key":"b13","series-title":"Am J Obstet Gynecol","first-page":"113","article-title":"The preterm birth syndrome: Issues to consider in creating a classification system","volume":"206","author":"Goldenberg","year":"2012"},{"key":"b14","series-title":"Lancet","first-page":"1029","article-title":"Topical application of Chlorhexidine to neonatal umbilical cords for prevention of omphalitis and neonatal mortality in a rural district of Pakistan: A community-based, cluster randomised trial","volume":"379","author":"Soofi","year":"2012"},{"key":"b15","series-title":"BMC Pregnancy Childbirth","first-page":"54","article-title":"Newborn care practices among slum dwellers in Dhaka, Bangladesh: A quantitative and qualitative exploratory study","volume":"9","author":"Moran","year":"2009"},{"key":"b16","series-title":"J Trop Pediatr","first-page":"24","article-title":"Avoiding neonatal death: An intervention study of umbilical cord care","volume":"40","author":"Garmer","year":"1994"},{"key":"b17","series-title":"Western Pac Surveill Response J","first-page":"40","article-title":"Three cases of neonatal tetanus in Papua New Guinea sets ground for development of national plan for maternal and neonatal tetanus elimination","volume":"4","author":"Datta","year":"2013"},{"key":"b18","series-title":"J Nurse Midwifery","first-page":"25","article-title":"The umbilical cord care: Transcultural care and customs","volume":"27","author":"Perry","year":"1982"},{"key":"b19","series-title":"J Obstet Gynecol Neonatal Nurs","first-page":"262","article-title":"Non institutional births and newborn care practices among adolescent mothers in Bangladesh","volume":"40","author":"Rahaman","year":"2011"},{"key":"b20","series-title":"Soc Sci Med","first-page":"675","article-title":"Cow dung, rock salt, and medical innovation in the Hindu Kush of Pakistan: The cultural transformation of neonatal tetanus and iodine deficiency","volume":"30","author":"Mull","year":"1990"},{"key":"b21","series-title":"J Perinatol","first-page":"182","article-title":"Household knowledge and practices of newborn and maternal health in Haripur District","volume":"28","author":"Khaddurri","year":"2008"},{"key":"b22","series-title":"Acta Pediatr","first-page":"546","article-title":"Impact of topical oils on the skin barrier; possible implications for neonatal health in developing countries","volume":"91","author":"Darmstardt","year":"2002"},{"key":"b23","series-title":"Pediatr Infect Dis J","first-page":"719","article-title":"Topically applied sunflower seed oil prevents invasive bacterial infections in preterm infants in Egypt: A randomised, controlled clinical trial","volume":"23","author":"Darmstadt","year":"2004"},{"key":"b24","series-title":"Trop Med Int Health","first-page":"283","article-title":"Neonatal home care practices in rural Egypt during the first week of life","volume":"12","author":"Darmstadt","year":"2007"},{"key":"b25","series-title":"J Pediatr Infect Dis","first-page":"1004","article-title":"Improving hygiene in home deliveries in rural Ghana","volume":"29","author":"Hill","year":"2010b"},{"key":"b26","series-title":"BMC Pediatr","first-page":"173","article-title":"Prevalence and determinants of essential newborn care practices in the Lawra District of Ghana","volume":"18","author":"Saaka","year":"2018"},{"key":"b27","series-title":"J Neonatal Perinatal Med","first-page":"1","article-title":"Newborn care practices in urban slums: Evidence from central India","volume":"2","author":"Agarwal","year":"2009"},{"key":"b28","author":"Marah","year":"2011"},{"key":"b29","series-title":"BMC Pregnancy Childbirth","first-page":"50","article-title":"Clean delivery practices in rural northern Ghana: A qualitative study of community and provider knowledge, attitudes, and beliefs","volume":"12","author":"Moyer","year":"2012"},{"key":"b30","year":"2019"},{"key":"b31","series-title":"J Trop Pediatr","first-page":"82","article-title":"Traditional massage of newborns in Nepal: Implications for trials of improved practice","volume":"51","author":"Mullany","year":"2005"},{"key":"b32","series-title":"Sampling Techniques","author":"Cochran","year":"1977"},{"key":"b33","series-title":"Indian J Community Med.","article-title":"Newborn care practices in urban slums of Lucknow City, UP","volume":"35","author":"Gupta","year":"2010"},{"key":"b34","article-title":"2012 Population and Housing Census: Summary Report of Final Results. GSS, Accra. Macro.","year":"2012"},{"key":"b35","series-title":"Int J Equity Health","first-page":"186","article-title":"Family Planning for urban slums in low- and middle-income countries: A scoping review of interventions\/service delivery models and their impact","volume":"20","author":"Ganle","year":"2021"},{"key":"b36","series-title":"Field Methods","first-page":"59","article-title":"How many interviews are enough? An experiment with data saturation and variability","volume":"18","author":"Guest","year":"2006"},{"key":"b37","series-title":"Psychol Health","first-page":"1229","article-title":"What is an adequate sample size? Operationalising data saturation for theory-based interview studies","volume":"25","author":"Francis","year":"2010"},{"key":"b38","series-title":"ECTJ","first-page":"75","article-title":"Criteria for assessing the trustworthiness of naturalistic inquiries","volume":"29","author":"Guba","year":"1981"},{"key":"b39","series-title":"Interpreting Qualitative Data: Methods for Analysing Talk, Text and Interaction","author":"Silverman","year":"2001"},{"key":"b40","series-title":"Research Design: Qualitative, Quantitative, and Mixed Methods Approaches","author":"Creswell","year":"2009"},{"key":"b41","series-title":"Open J Prev Med","first-page":"43","article-title":"Determinants of cord care practices among mothers in Abakaliki, Ebonyi State, South East, Nigeria","volume":"9","author":"Asiegbu","year":"2019"},{"key":"b42","series-title":"J Health Popul Nutr","first-page":"479","article-title":"Delivery practices of traditional birth attendants in Dhaka slums","volume":"25","author":"Fronczak","year":"2007"},{"key":"b43","article-title":"Ghana Multiple Indicator Cluster Survey 2018.","year":"2018"},{"key":"b44","series-title":"Reprod Health","first-page":"162","article-title":"Essential newborn care practices and associated factors among home delivered mothers in Damot pulasa Woreda, southern Ethiopia","volume":"15","author":"Chichiabellu","year":"2018"},{"key":"b45","series-title":"Indian J Public Health","first-page":"20","article-title":"Delivery practices in west Uttar Pradesh","volume":"40","author":"Nandan","year":"1996"},{"key":"b46","series-title":"BMJ","first-page":"1063","article-title":"Cross sectional community based study of care for newborn infants in Nepal","volume":"325","author":"Osrin","year":"2002"},{"key":"b47","series-title":"Soc Sci Med","first-page":"911","article-title":"Newborn care practices in low socioeconomic settlements of Karachi, Pakistan","volume":"60","author":"Fikree","year":"2005a"},{"key":"b48","series-title":"J Health Popul Nutr","first-page":"375","article-title":"Causes of neonatal deaths in a rural subdistrict of Bangladesh: Implications for intervention","volume":"28","author":"Chowdhury","year":"2010"},{"key":"b49","series-title":"PLoS One","first-page":"e0237820","article-title":"Assessment of knowledge and quality of essential newborn care practices in La Dade Kotopon Municipality, Ghana","volume":"15","author":"Ayete-Nyampong","year":"2020"},{"key":"b1","article-title":"Newborns: Improving Survival and Well-Being.","year":"2020"},{"key":"b2","article-title":"Levels and Trends in Child Mortality: Report 2020.","year":"2020"},{"key":"b3","series-title":"Lancet","first-page":"347","article-title":"Can available interventions end preventable deaths in mothers, newborn babies, and still births, and at what cost?","volume":"384","author":"Bhutta","year":"2014"},{"key":"b4","series-title":"Lancet","first-page":"189","article-title":"Every Newborn: Progress, priorities, and potential beyond survival","volume":"384","author":"Lawn","year":"2014"},{"key":"b5","series-title":"Lancet","first-page":"957","article-title":"Global, regional, and national levels of neonatal, infant, and under5 mortalities during 1990\u20132013: A systematic analysis for the Global Burden of Disease Study 2013","volume":"384","author":"Wang","year":"2014"},{"key":"b6","article-title":"Pregnancy, Childbirth, Postpartum and Newborn Care: A Guide for Essential Practice.","year":"2006"},{"key":"b7","author":"Narayanan","year":"2014"},{"key":"b8","article-title":"Essential Newborn Care: Report of a Technical Working Group (Trieste, 25-29 April 1994).","year":"1996"},{"key":"b9","year":"1998"},{"key":"b10","series-title":"J Perinatol","first-page":"572","article-title":"Advancing newborn health and survival in developing countries: A conceptual framework","volume":"22","author":"Marsh","year":"2002"},{"key":"b11","series-title":"Lancet","first-page":"430","article-title":"Global, regional and national causes of child mortality in 2000\u20132013, with projections to inform post 2015 priorities: An updated systematic analysis","volume":"385","author":"Liu","year":"2015"},{"key":"b12","series-title":"BMC Public Health","first-page":"S15","article-title":"The effect of umbilical cord cleansing with chlorhexidine on omphalitis and neonatal mortality in developing country communities: A meta-analysis","volume":"13","author":"Imdad","year":"2013"},{"key":"b13","series-title":"Am J Obstet Gynecol","first-page":"113","article-title":"The preterm birth syndrome: Issues to consider in creating a classification system","volume":"206","author":"Goldenberg","year":"2012"},{"key":"b14","series-title":"Lancet","first-page":"1029","article-title":"Topical application of Chlorhexidine to neonatal umbilical cords for prevention of omphalitis and neonatal mortality in a rural district of Pakistan: A community-based, cluster randomised trial","volume":"379","author":"Soofi","year":"2012"},{"key":"b15","series-title":"BMC Pregnancy Childbirth","first-page":"54","article-title":"Newborn care practices among slum dwellers in Dhaka, Bangladesh: A quantitative and qualitative exploratory study","volume":"9","author":"Moran","year":"2009"},{"key":"b16","series-title":"J Trop Pediatr","first-page":"24","article-title":"Avoiding neonatal death: An intervention study of umbilical cord care","volume":"40","author":"Garmer","year":"1994"},{"key":"b17","series-title":"Western Pac Surveill Response J","first-page":"40","article-title":"Three cases of neonatal tetanus in Papua New Guinea sets ground for development of national plan for maternal and neonatal tetanus elimination","volume":"4","author":"Datta","year":"2013"},{"key":"b18","series-title":"J Nurse Midwifery","first-page":"25","article-title":"The umbilical cord care: Transcultural care and customs","volume":"27","author":"Perry","year":"1982"},{"key":"b19","series-title":"J Obstet Gynecol Neonatal Nurs","first-page":"262","article-title":"Non institutional births and newborn care practices among adolescent mothers in Bangladesh","volume":"40","author":"Rahaman","year":"2011"},{"key":"b20","series-title":"Soc Sci Med","first-page":"675","article-title":"Cow dung, rock salt, and medical innovation in the Hindu Kush of Pakistan: The cultural transformation of neonatal tetanus and iodine deficiency","volume":"30","author":"Mull","year":"1990"},{"key":"b21","series-title":"J Perinatol","first-page":"182","article-title":"Household knowledge and practices of newborn and maternal health in Haripur District","volume":"28","author":"Khaddurri","year":"2008"},{"key":"b22","series-title":"Acta Pediatr","first-page":"546","article-title":"Impact of topical oils on the skin barrier; possible implications for neonatal health in developing countries","volume":"91","author":"Darmstardt","year":"2002"},{"key":"b23","series-title":"Pediatr Infect Dis J","first-page":"719","article-title":"Topically applied sunflower seed oil prevents invasive bacterial infections in preterm infants in Egypt: A randomised, controlled clinical trial","volume":"23","author":"Darmstadt","year":"2004"},{"key":"b24","series-title":"Trop Med Int Health","first-page":"283","article-title":"Neonatal home care practices in rural Egypt during the first week of life","volume":"12","author":"Darmstadt","year":"2007"},{"key":"b25","series-title":"J Pediatr Infect Dis","first-page":"1004","article-title":"Improving hygiene in home deliveries in rural Ghana","volume":"29","author":"Hill","year":"2010b"},{"key":"b26","series-title":"BMC Pediatr","first-page":"173","article-title":"Prevalence and determinants of essential newborn care practices in the Lawra District of Ghana","volume":"18","author":"Saaka","year":"2018"},{"key":"b27","series-title":"J Neonatal Perinatal Med","first-page":"1","article-title":"Newborn care practices in urban slums: Evidence from central India","volume":"2","author":"Agarwal","year":"2009"},{"key":"b28","author":"Marah","year":"2011"},{"key":"b29","series-title":"BMC Pregnancy Childbirth","first-page":"50","article-title":"Clean delivery practices in rural northern Ghana: A qualitative study of community and provider knowledge, attitudes, and beliefs","volume":"12","author":"Moyer","year":"2012"},{"key":"b30","year":"2019"},{"key":"b31","series-title":"J Trop Pediatr","first-page":"82","article-title":"Traditional massage of newborns in Nepal: Implications for trials of improved practice","volume":"51","author":"Mullany","year":"2005"},{"key":"b32","series-title":"Sampling Techniques","author":"Cochran","year":"1977"},{"key":"b33","series-title":"Indian J Community Med.","article-title":"Newborn care practices in urban slums of Lucknow City, UP","volume":"35","author":"Gupta","year":"2010"},{"key":"b34","article-title":"2012 Population and Housing Census: Summary Report of Final Results. GSS, Accra. Macro.","year":"2012"},{"key":"b35","series-title":"Int J Equity Health","first-page":"186","article-title":"Family Planning for urban slums in low- and middle-income countries: A scoping review of interventions\/service delivery models and their impact","volume":"20","author":"Ganle","year":"2021"},{"key":"b36","series-title":"Field Methods","first-page":"59","article-title":"How many interviews are enough? An experiment with data saturation and variability","volume":"18","author":"Guest","year":"2006"},{"key":"b37","series-title":"Psychol Health","first-page":"1229","article-title":"What is an adequate sample size? Operationalising data saturation for theory-based interview studies","volume":"25","author":"Francis","year":"2010"},{"key":"b38","series-title":"ECTJ","first-page":"75","article-title":"Criteria for assessing the trustworthiness of naturalistic inquiries","volume":"29","author":"Guba","year":"1981"},{"key":"b39","series-title":"Interpreting Qualitative Data: Methods for Analysing Talk, Text and Interaction","author":"Silverman","year":"2001"},{"key":"b40","series-title":"Research Design: Qualitative, Quantitative, and Mixed Methods Approaches","author":"Creswell","year":"2009"},{"key":"b41","series-title":"Open J Prev Med","first-page":"43","article-title":"Determinants of cord care practices among mothers in Abakaliki, Ebonyi State, South East, Nigeria","volume":"9","author":"Asiegbu","year":"2019"},{"key":"b42","series-title":"J Health Popul Nutr","first-page":"479","article-title":"Delivery practices of traditional birth attendants in Dhaka slums","volume":"25","author":"Fronczak","year":"2007"},{"key":"b43","article-title":"Ghana Multiple Indicator Cluster Survey 2018.","year":"2018"},{"key":"b44","series-title":"Reprod Health","first-page":"162","article-title":"Essential newborn care practices and associated factors among home delivered mothers in Damot pulasa Woreda, southern Ethiopia","volume":"15","author":"Chichiabellu","year":"2018"},{"key":"b45","series-title":"Indian J Public Health","first-page":"20","article-title":"Delivery practices in west Uttar Pradesh","volume":"40","author":"Nandan","year":"1996"},{"key":"b46","series-title":"BMJ","first-page":"1063","article-title":"Cross sectional community based study of care for newborn infants in Nepal","volume":"325","author":"Osrin","year":"2002"},{"key":"b47","series-title":"Soc Sci Med","first-page":"911","article-title":"Newborn care practices in low socioeconomic settlements of Karachi, Pakistan","volume":"60","author":"Fikree","year":"2005a"},{"key":"b48","series-title":"J Health Popul Nutr","first-page":"375","article-title":"Causes of neonatal deaths in a rural subdistrict of Bangladesh: Implications for intervention","volume":"28","author":"Chowdhury","year":"2010"},{"key":"b49","series-title":"PLoS One","first-page":"e0237820","article-title":"Assessment of knowledge and quality of essential newborn care practices in La Dade Kotopon Municipality, Ghana","volume":"15","author":"Ayete-Nyampong","year":"2020"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/114\/4\/article-p756.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/114\/4\/article-p756.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/114\/4\/article-p756.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T19:21:41Z","timestamp":1775071301000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/114\/4\/article-p756.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":98,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.24-0706","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]}}}