The prevalence of harmful traditional umbilical cord care practices and associated factors in newborns: a systematic review and meta-analysis.

Abstract

Background: Harmful umbilical cord care practices remain a major public health concern in various developing countries, contributing significantly to neonatal sepsis, which accounts for approximately 15% of all neonatal deaths globally. Despite known health risks, many caregivers continue to rely on traditional methods. This systematic review and meta-analysis aimed to quantify the national prevalence of such practices and identify associated factors.

Methods: A systematic literature search was conducted using PubMed Central, Cochrane Library, Web of Science, Scopus, and Google Scholar for publications from 2012 to September 2025. The quality of studies was evaluated using the Joanna Briggs Institute (JBI) criteria. Heterogeneity was assessed with I² statistics and Cochran's Q test, and a random-effects model was applied. Publication bias was evaluated using funnel plots and Egger's test, with subgroup analyses conducted to explore heterogeneity among studies.

Results: A total of 15 studies with 15,368 study participants were used for analysis. The overall pooled prevalence of harmful traditional umbilical cord care practices in newborns was 31.63% (95% CI: 25.07, 38.19). Types of harmful substances applied on the cord: the pooled prevalence of butter is 34.24%; Vaseline petroleum jelly, 25.14%; body lotion, 6.64%; ash, 26.28%; food oil, 35.05%; cow dung, 8.81%; and ointment, 42.08%, respectively. Being delivered at home (pooled adjusted odds ratio, AOR = 3.74 (95% CI: 1.33, 7.15)) and uneducated mothers (AOR = 3.22 (95% CI: 2.13, 4.31)) were significantly associated with the prevalence of harmful traditional umbilical cord care practices.

Conclusion and recommendation: The prevalence of harmful traditional cord care was notably high as compared to WHO recommendations. Home delivery and uneducated mothers contribute significantly to the prevalence of harmful traditional cord care practices in the nation. These findings revealed that combating neonatal sepsis requires moving beyond hospital walls; we must bridge the health literacy gap for uneducated mothers and aggressively encourage institutional deliveries to replace lethal traditions with lifesaving cord care.