Use of chlorhexidine digluconate 7.1% gel for umbilical cord care in selected regions in Northern Ghana: qualitative perspectives of key stakeholders.

Abstract

Background: The Government of Ghana in 2017 included chlorhexidine (CHX) digluconate 7.1% gel in the essential medicines list to replace methylated spirit for umbilical cord care. However, there are limited studies around the use of the CHX gel. This paper explores the perspectives of stakeholders in childcare regarding the use of the gel for umbilical cord care in selected regions in Northern Ghana.

Methods: Data for the study were from 42 in-depth interviews and 12 focus group discussions conducted among mothers, caregivers, fathers, traditional birth attendants, and health care providers (including pharmacists and over the counter medicine sellers). The transcribed data was analysed and organized into themes and sub-themes using thematic analysis approach. The data analysis was conducted using NVIVO version 12 analytical software.

Results: CHX gel was used side-by-side with methylated spirit for umbilical cord care in the study areas. Use of methylated spirit for umbilical cord care was found to be common, and in the home setting there was evidence of use of traditional substances such as shea butter, toothpaste, cow dung, herbs and chalk. However, shea butter was regarded as the "golden standard" for cord care among non-health professionals. Co-use of traditional and orthodox cord care substances was also rife. The limited use of the CHX gel was attributable to the fact that some participants, especially health providers were convinced that the gel and methylated spirit were both effective; hence they continued prescribing methylated spirit over the gel for cord care. Evidence on the efficacy of the gel was mixed perhaps a reflection of the limited awareness and knowledge about the CHX gel, and the limited use behaviour / use skills. Additionally, awareness of the inclusion of the CHX gel in the national health insurance was also mixed.

Conclusions: The CHX gel is yet to replace other cord care substances as the use of methylated spirit and traditional substances were still prevalent. Hence, a comprehensive strategy is needed to create awareness and educate providers, significant others, and the community about the gel and its efficacy if it is to replace methylated spirit as the cord care substance.