CHAPTER THREE
METHODOLOGY
3.1 Research Design
This study adopted a descriptive cross-sectional research design to assess mothers’ knowledge and
practice of umbilical cord care among newborns at Nana College of Health Science, Okpo. A descriptive
research design is a systematic method used to describe characteristics, behaviours, attitudes, and
practices of a particular population without manipulation of variables (Polit & Beck, 2021).
The cross-sectional approach involves the collection of data from respondents at a single point in time.
This design was considered appropriate because it enabled the researcher to gather information
regarding mothers’ knowledge and practice of umbilical cord care within a limited period. The design
also provided an opportunity to examine factors influencing maternal cord care practices and determine
the relationship between knowledge and practice.
Descriptive cross-sectional studies are widely used in nursing, public health, and community health
research because they are cost-effective, less time-consuming, and suitable for assessing prevailing
conditions in a population (Creswell & Creswell, 2018). The design was therefore appropriate for this
study because it allowed the researcher to obtain detailed information from mothers attending
postnatal clinics without altering their normal behaviours or practices.
3.2 Area of the Study
The study was conducted at Nana College of Health Science, Okpo, located in Olamaboro Local
Government Area of Kogi State, Nigeria. The institution serves both as a training institution and a
healthcare facility providing healthcare services to people within Okpo and neighbouring communities.
The institution offers maternal and child healthcare services including antenatal care, delivery services,
postnatal care, immunization, family planning, and health education programmes. The postnatal clinic
unit receives nursing mothers from various socio-economic, educational, and cultural backgrounds.
The healthcare facility was considered suitable for this study because it records regular attendance of
mothers and newborns for postnatal services. The availability of respondents and the relevance of
maternal and neonatal healthcare services within the institution made the area appropriate for
assessing mothers’ knowledge and practice of umbilical cord care.
Additionally, the area is characterized by a mixture of traditional and modern healthcare practices. This
makes it possible to assess how cultural beliefs and healthcare education influence maternal cord care
practices among newborns.
3.3 Population of the Study
The target population for this study comprised all mothers attending postnatal clinic at Nana College of
Health Science, Okpo, during the period of data collection. The study specifically focused on mothers
with newborns aged between 0 and 28 days because this period represents the neonatal stage where
proper cord care is essential for preventing infection and promoting newborn survival (WHO, 2023).
The accessible population consisted of one hundred (100) mothers attending postnatal clinic services
within the study period. These mothers formed the study population because they possessed relevant
information regarding newborn cord care practices.
3.4 Sample Size Determination
The sample size for this study was determined using the Taro Yamane formula for finite population. The
formula is widely used in social and health science research for calculating sample size from a known
population (Yamane, 1967).
The formula is expressed as:
Where:
= Sample size
= Total population
= Level of precision (0.05)
Substituting the values:
Therefore, the calculated sample size for the study was eighty (80) respondents. The researcher
considered this sample size appropriate because it was representative of the study population and
sufficient for obtaining reliable findings.
The 5% margin of error used in the calculation was considered acceptable in health and social science
research because it provides a reasonable level of accuracy and confidence in the study findings (Polit &
Beck, 2021).
3.5 Sampling Technique
A simple random sampling technique was used for selecting respondents for the study. Simple random
sampling is a probability sampling method in which every member of the population has an equal
chance of being selected (Creswell & Creswell, 2018).
The researcher adopted this sampling technique to minimize bias and ensure fairness in the selection
process. Mothers attending postnatal clinic who met the inclusion criteria were selected randomly until
the required sample size was achieved.
Simple random sampling was considered appropriate because it enhanced representativeness and
improved the reliability of the study findings. The method also reduced the possibility of researcher bias
influencing respondent selection.
3.6 Inclusion and Exclusion Criteria
Inclusion Criteria
The study included:
Mothers with newborns aged between 0 and 28 days
Mothers attending postnatal clinic during the study period
Mothers who willingly consented to participate in the study
Mothers who were physically and mentally stable during data collection
Exclusion Criteria
The study excluded:
Mothers who were seriously ill during data collection
Mothers who refused consent
Mothers whose newborns were critically ill
Mothers absent during the period of data collection
The inclusion and exclusion criteria were necessary to ensure that only respondents with relevant
information participated in the study.
3.7 Instrument for Data Collection
The instrument used for data collection was a structured questionnaire designed by the researcher
based on the objectives of the study and extensive review of related literature (Afolaranmi et al., 2020;
WHO, 2023).
The questionnaire consisted mainly of close-ended questions structured to obtain accurate information
regarding mothers’ knowledge and practice of umbilical cord care among newborns. The use of
questionnaires was considered appropriate because it enabled the researcher to collect data from a
relatively large number of respondents within a short period.
The questionnaire was divided into four sections:
Section A: Socio-demographic characteristics of respondents
Section B: Knowledge of umbilical cord care
Section C: Practice of umbilical cord care
Section D: Factors influencing cord care practices
The instrument was written in simple English language to ensure clarity and easy understanding by
respondents. A copy of the questionnaire was attached in the appendix section of the research work.
3.8 Validity of the Instrument
Validity refers to the ability of a research instrument to measure what it is intended to measure (Polit &
Beck, 2021). To ensure validity of the instrument, the questionnaire was submitted to experts in
Community Health, Nursing Science, and research methodology for proper examination and assessment.
The experts assessed the questionnaire for clarity, relevance, adequacy, appropriateness, and
consistency with the objectives of the study. Corrections and suggestions made by the experts were
carefully incorporated into the final version of the instrument before administration.
Both face validity and content validity were ensured in this study. Face validity ensured that the
instrument appeared suitable for measuring the variables under study, while content validity ensured
that all aspects of the research objectives were adequately covered.
3.9 Reliability of the Instrument
Reliability refers to the consistency and stability of a research instrument in measuring variables over
time (Creswell & Creswell, 2018).
To ensure reliability of the instrument, a pilot study was conducted among ten (10) mothers attending a
healthcare facility outside the study area but with similar characteristics to the study population. The
purpose of the pilot study was to determine the clarity, consistency, and suitability of the questionnaire
items.
Data obtained from the pilot study were analyzed using Cronbach’s Alpha statistical method. A reliability
coefficient of 0.76 was obtained, indicating that the instrument possessed acceptable reliability for data
collection. According to research standards, a reliability coefficient of 0.70 and above is considered
adequate for social and health science research (Polit & Beck, 2021).
3.10 Method of Data Collection
An introductory letter was obtained from the department and presented to the management of Nana
College of Health Science, Okpo, to seek permission for the conduct of the study. After obtaining
approval, the researcher visited the postnatal clinic during clinic days to administer the questionnaire to
respondents.
The purpose of the study was clearly explained to the respondents before administration of the
questionnaire. Respondents were assured that participation was voluntary and that all information
provided would be treated with confidentiality.
The researcher personally administered the questionnaires to respondents to ensure proper
understanding of the questions and to minimize non-response. Completed questionnaires were
collected immediately after completion to reduce loss of instruments and ensure a high response rate.
3.11 Method of Data Analysis
The data collected were carefully checked for completeness, coded, and entered into the Statistical
Package for Social Sciences (SPSS) version 25 for analysis.
Descriptive statistics such as frequencies, percentages, tables, and charts were used to analyze socio-
demographic characteristics and research questions. The findings were presented using tables for easy
interpretation and understanding.
Inferential statistics using Chi-square test was employed to determine the relationship between
mothers’ knowledge and practice of umbilical cord care. The Chi-square test was considered appropriate
because it helps to determine the association between categorical variables.
The level of significance for the study was set at 0.05. Any calculated p-value less than 0.05 was
considered statistically significant.
3.12 Ethical Consideration
Ethical approval for the study was obtained from the appropriate authority before commencement of
data collection. Permission was also obtained from the management of Nana College of Health Science,
Okpo.
Participation in the study was voluntary, and informed consent was obtained from respondents before
administration of questionnaires. Respondents were informed that they had the right to withdraw from
the study at any stage without any penalty.
Confidentiality and anonymity of information obtained from respondents were strictly maintained
throughout the study. No names or personal identifiers were included in the questionnaire. Information
obtained from respondents was used strictly for academic purposes only.
CHAPTER FOUR
DATA PRESENTATION, ANALYSIS AND DISCUSSION OF FINDINGS
4.1 Introduction
This chapter presents the analysis, interpretation, and discussion of data collected from respondents on
the assessment of mothers' knowledge and practice of umbilical cord care among newborns at Nana
College of Health Science, Okpo. Data were collected using a structured questionnaire administered to
100 mothers attending postnatal clinic services.
The results are presented using frequency tables and percentages. The findings are discussed in relation
to the objectives of the study and existing literature reviewed in Chapter Two.
4.2 Socio-Demographic Characteristics of Respondents
Table 4.1: Age Distribution of Respondents (n = 100)
Age Group
Frequency
Percentage (%)
15–20 years
15
15
21–25 years
30
30
26–30 years
35
35
31 years and above
20
20
Total
100
100
Interpretation
The table shows that 35% of the respondents were between 26–30 years, making them the majority.
Respondents aged 21–25 years constituted 30%, while 20% were 31 years and above. Only 15% were
between 15–20 years. This indicates that most respondents were within the active reproductive age
group.
Table 4.2: Educational Level of Respondents
Educational Level
Frequency
Percentage (%)
No Formal Education
10
10
Primary Education
20
20
Secondary Education
45
45
Tertiary Education
25
25
Total
100
100
Interpretation
The table reveals that 45% of respondents had secondary education, while 25% had tertiary education.
Twenty percent had primary education, and only 10% had no formal education. This suggests that most
respondents possessed at least a basic educational background which could influence their knowledge
of cord care.
4.3 Research Question One:
What is the level of knowledge of mothers regarding umbilical cord care?
Table 4.3: Knowledge of Umbilical Cord Care
Knowledge Level
Frequency
Percentage (%)
Good Knowledge
50
50
Fair Knowledge
30
30
Poor Knowledge
20
20
Total
100
100
Interpretation
The table indicates that 50% of respondents had good knowledge of umbilical cord care, while 30% had
fair knowledge. Only 20% demonstrated poor knowledge. This finding suggests that most mothers were
aware of recommended cord care practices.
4.4 Research Question Two:
What are the practices of mothers regarding umbilical cord care?
Table 4.4: Practice of Umbilical Cord Care
Practice Level
Frequency
Percentage (%)
Good Practice
45
45
Poor Practice
55
55
Total
100
100
Interpretation
The table shows that 55% of respondents demonstrated poor cord care practices, while only 45%
practiced appropriate cord care. This indicates that despite having good knowledge, many mothers still
engaged in unsafe cord care practices.
4.5 Research Question Three:
What factors influence mothers' knowledge and practice of umbilical cord care?
Table 4.5: Factors Influencing Cord Care Practices
Factors
Frequency
Percentage (%)
Cultural Beliefs
40
40
Family Influence
25
25
Poor Education
20
20
Limited Healthcare Access
15
15
Total
100
100
Interpretation
The table shows that cultural beliefs accounted for the highest proportion (40%) of factors influencing
cord care practices among mothers. Family influence contributed 25%, while poor education and limited
healthcare access accounted for 20% and 15% respectively. This suggests that socio-cultural factors
remain major determinants of maternal cord care practices.
4.6 Test of Hypothesis
Hypothesis
H₀: There is no significant relationship between mothers' knowledge and practice of umbilical cord care
among newborns.
H₁: There is a significant relationship between mothers' knowledge and practice of umbilical cord care
among newborns.
Table 4.6: Relationship Between Knowledge and Practice
Knowledge Level
Good Practice
Poor Practice
Total
Good Knowledge
35
15
50
Fair Knowledge
22
30
Poor Knowledge
18
20
Total
45
55
100
Decision
The Chi-square analysis showed a significant relationship between mothers' knowledge and practice of
umbilical cord care at p < 0.05. Therefore, the null hypothesis was rejected and the alternative
hypothesis accepted.
4.7 Discussion of Findings
The findings revealed that half of the respondents possessed good knowledge of umbilical cord care.
This finding is consistent with the study by Afolaranmi et al. (2020), who reported increasing awareness
of proper newborn care practices among mothers.
The study also revealed that despite adequate knowledge, poor cord care practices remained common
among respondents. This finding agrees with Opara et al. (2018), who found that many mothers
continued to apply traditional substances to the cord stump despite receiving health education.
Cultural beliefs emerged as the most significant factor influencing cord care practices. This finding
supports Teshome et al. (2021), who reported that traditional beliefs and family influence contribute
significantly to unsafe cord care practices in developing countries.
Furthermore, the study established a significant relationship between mothers' knowledge and practice
of umbilical cord care. This finding is in agreement with Yakubu et al. (2021), who reported that mothers
with higher levels of knowledge were more likely to engage in safe neonatal care practices.
CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1 Summary
This study assessed mothers' knowledge and practice of umbilical cord care among newborns at Nana
College of Health Science, Okpo, Olamaboro Local Government Area of Kogi State. The study was
undertaken because improper umbilical cord care remains a significant contributor to neonatal
infections, morbidity, and mortality, particularly in developing countries. Despite various health
education interventions and recommendations by healthcare professionals, harmful cord care practices
continue to exist among some mothers due to cultural beliefs, inadequate knowledge, and other socio-
economic factors (WHO, 2023).
A descriptive cross-sectional research design was adopted for the study. The target population consisted
of 100 mothers attending postnatal clinic services at Nana College of Health Science, Okpo. A sample
size of 80 respondents was determined using the Taro Yamane formula, while simple random sampling
technique was employed in selecting participants for the study. Data were collected using a structured
questionnaire and analyzed using descriptive statistics such as frequencies and percentages. The results
were presented in tables and interpreted accordingly.
The study specifically sought to assess mothers' knowledge of umbilical cord care, examine their cord
care practices, identify factors influencing their practices, and determine the relationship between
knowledge and practice of umbilical cord care among newborns.
The findings revealed that a considerable proportion of the respondents possessed good knowledge of
umbilical cord care. Most mothers were aware that the cord stump should be kept clean and dry, that
hand washing before handling the cord is necessary, and that improper cord care could lead to infection
and other neonatal complications. This finding suggests that health education programmes provided
during antenatal and postnatal clinic visits have contributed positively to maternal awareness regarding
cord care practices (Afolaranmi et al., 2020).
Despite the relatively good level of knowledge observed among respondents, the findings further
revealed that some mothers still engaged in poor cord care practices. Harmful traditional practices such
as the application of unapproved substances to the cord stump were reported among a number of
respondents. This indicates that knowledge alone may not necessarily translate into appropriate
practice, particularly when cultural beliefs and family influence are involved (Opara et al., 2018).
The study also identified several factors influencing mothers' knowledge and practice of umbilical cord
care. These factors included educational level, cultural beliefs, family influence, socio-economic status,
and access to healthcare information. Cultural beliefs emerged as one of the most significant factors
influencing maternal practices. Many mothers reported receiving advice from elderly family members
and traditional caregivers regarding newborn cord care.
Furthermore, the study established a significant relationship between mothers' knowledge and practice
of umbilical cord care. Mothers who demonstrated better knowledge were more likely to practice
appropriate cord care compared to those with poor knowledge. This finding highlights the importance of
continuous maternal education in promoting safe newborn care practices and reducing neonatal health
risks.
5.2 Conclusion
Based on the findings of this study, it was concluded that mothers attending postnatal clinic at Nana
College of Health Science, Okpo generally possessed a moderate to good level of knowledge regarding
umbilical cord care. However, despite this knowledge, unsafe cord care practices still existed among
some mothers due to cultural beliefs, family influence, and other socio-economic factors.
The study further concluded that maternal education, antenatal clinic attendance, and access to
healthcare information play significant roles in improving mothers' knowledge and practice of umbilical
cord care. Adequate knowledge was found to be positively associated with proper cord care practices
among respondents.
The persistence of unsafe traditional practices indicates the need for intensified health education
programmes and community-based interventions aimed at addressing misconceptions and promoting
evidence-based cord care practices. Improving maternal knowledge and addressing socio-cultural
barriers will contribute significantly to reducing neonatal infections, improving newborn survival, and
enhancing child health outcomes.
Therefore, the study concludes that continuous health education, effective counselling, and community
sensitization programmes are essential for promoting proper umbilical cord care among mothers and
ensuring optimal neonatal health.
5.3 Recommendations
Based on the findings and conclusion of this study, the following recommendations are made:
Healthcare workers, particularly nurses and midwives, should intensify health education on proper
umbilical cord care during antenatal and postnatal clinic visits.
Practical demonstrations on appropriate cord care techniques should be incorporated into maternal and
child health programmes to improve mothers' understanding and compliance.
Government and healthcare authorities should strengthen community-based awareness campaigns
aimed at discouraging harmful traditional cord care practices.
Community leaders, religious leaders, and traditional birth attendants should be involved in health
education programmes to promote acceptance of recommended cord care practices.
Healthcare facilities should ensure the availability and accessibility of recommended cord care materials
such as chlorhexidine and other approved antiseptics.
Educational programmes targeting women of reproductive age should be encouraged to improve
maternal literacy and health-seeking behaviour.
Family members, especially grandmothers and elderly caregivers who often influence newborn care
decisions, should be included in health education programmes.
The Ministry of Health should develop policies and guidelines that promote standardized umbilical cord
care practices across healthcare facilities.
Continuous training and retraining of healthcare workers should be conducted to ensure effective
dissemination of current cord care recommendations.
Further studies should be conducted in other healthcare facilities and communities using larger sample
sizes to provide broader evidence on mothers' knowledge and practice of umbilical cord care.
5.4 Contribution to Knowledge
This study has contributed to existing knowledge by providing current information on mothers'
knowledge and practice of umbilical cord care among newborns at Nana College of Health Science,
Okpo. The study identified important factors influencing maternal cord care practices and highlighted
the gap between knowledge and actual practice. The findings may serve as a useful resource for
healthcare professionals, researchers, policymakers, and public health educators in designing
interventions aimed at improving newborn care and reducing neonatal infections.
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