Delayed Cord Clamping Practice in the Delivery Rooms of a Regional Referral Hospital and Two Lower Health Centres in Uganda: A Facility-Based Cross-Sectional Study.
Winfred Mutaki, Vivian Mutaki, Francis Mbolwa, Jacob Otile, Patrick James Kalanga, Moses Mawanda, James Ditai
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引用次数: 0
Abstract
Background: World Health Organization (WHO) recommends delayed umbilical cord clamping (DCC) by 1-3 minutes to improve infant iron status and reduce anaemia. Few countries have adopted policies on this practice. We assessed the practice of DCC among skilled birth attendants in resource-limited delivery rooms at three levels of the health care system in Mbale district, Uganda.
Methods: This facility-based, analytical cross-sectional study directly observed 379 births and their skilled birth attendants at Mbale Regional Referral, Namatala Health Centre IV, and Nakaloke Health Centre III in Mbale, eastern Uganda. Research assistants used a stopwatch to record the delivery-to-cord-clamping interval. Timing was compared overall and by birth attendant category (Doctors, midwives, and students) and mode of delivery.
Results: Overall, half (52.0%, 197/379) (95% CI: 46.9% - 57.0%) of newborns had their cords clamped after at least 60seconds, a practice of delayed cord clamping (DCC). The remaining half (182/379; 48.0%) were clamped before 60s, and about a quarter (26.1%; 99/379) were clamped before 30s. The median (5th, 95th percentile) cord clamping time was 65seconds (8.35, 393.79) overall, but varied within the birth attendant category: 124.0 (22, 408.7) s for midwives, 22.45 (5.5, 80) s for doctors, and 56.8 (11.8, 471.7) s for students. The prevalence of DCC was far higher among midwives (crude PR 9.2; 95% CI:4.7-18.0) and students (crude PR 5.7; 95% CI:2.8-11.7) than doctors; this attenuated to non-significance after adjusting for mode of delivery (adjusted PR 2.1 for both, p=0.061).
Conclusion: Only about half of newborns received DCC in these delivery rooms. The large crude difference between doctors and midwives reflected doctors performing nearly all caesarean sections, where ICC predominated, rather than provider practice alone. This study describes the timing of cord clamping among skilled birth attendants in resource-limited delivery rooms.
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