Nurses' perspectives on factors influencing the use of chlorhexidine gel in newborn umbilical cord care in Ghana

BACKGROUND: Neonatal umbilical cord infection is a significant contributor to neonatal sepsis, a leading cause of newborn mortality, particularly in sub-Saharan Africa and southern Asia. The World Health Organization recommends the use of 7.1% chlorhexidine digluconate gel for newborn umbilical cord care to reduce infection risks. In Ghana, this recommendation has been adopted by the Ministry of Health. However, uptake and adherence to this recommendation are inconsistent. AIM: To explore nurses' perspectives on the factors influencing the use of chlorhexidine gel in newborn umbilical cord care in a tertiary referral hospital in Ghana. METHOD: A qualitative, exploratory, descriptive design was adopted using purposive sampling to recruit 15 nurses with at least six months' experience in neonatal care. Semi-structured, face-to-face interviews were conducted and data were analysed using content analysis to identify the main themes and subthemes. FINDINGS: Two main themes and seven subthemes emerged from the analysis. While participants showed good awareness of chlorhexidine gel, there were inconsistencies in their knowledge of its application, largely due to inadequate training. Maternal socioeconomic status and cultural beliefs influenced adherence to use of the gel, with some mothers opting to use traditional substances such as herbal preparations, cow dung and toothpaste instead. Low maternal health literacy and affordability concerns further affected the uptake of chlorhexidine gel. Participants identified the need for structured training programmes and policy interventions to enhance the uptake of chlorhexidine gel. CONCLUSION: Limited knowledge among healthcare providers, maternal socioeconomic barriers, cultural influences and misconceptions about chlorhexidine gel hinder its widespread adoption for newborn umbilical cord care. Addressing these challenges requires targeted training for nurses, culturally sensitive maternal education and policy interventions such as cost waivers for chlorhexidine gel to promote equitable access. Furthermore, research comparing the effectiveness of the gel versus its aqueous form is recommended to improve acceptance and use in Ghana.