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PubMed2002

Impact assessment of mass measles vaccination.

OBJECTIVE: The mass measles vaccination campaign was conducted in the slums of Surat City, in Gujarat State, as a part of urban measles control initiative in India. One dose each of the vaccine was administered to children in the age range of 9-59 months residing in these slums, regardless of their previous vaccination status. METHODS: One year later, (October 2000), the present study was carried out in order to assess the impact of the mass vaccination campaign on the vaccination coverage and on the incidence of measles by comparing the findings with those of the baseline survey carried out in May 98. This was a retrospective study with a recall period of the preceding year. 3,147 children under five were studied in thirty slum clusters selected by the cluster sampling method. The parents/caretakers of these children were interviewed for information on any episode of fever with rash conforming to the case definition. RESULT: The incidence rate for measles declined from 7.7 percent reported in the baseline (May 1998) to 3.5 percent in the impact assessment study. The incidence was 8 times higher in unvaccinated children. The mean and median age at contracting the illness increased from 26 +/- 14.2 months and 26 months in the baseline to 30.9 +/- 14.7 months and 30 months respectively in the impact assessment. The vaccination coverage had improved from 48.3 percent to 73.7 percent following the campaign. CONCLUSION: The compaign increased vaccination coverage decreased disease incidence and caused a shift towards higher age-groups in vaccinated children.

Chi-Square Distribution↗
PubMedDate not supplied

Prevalence and abuse of psychoactive substances in children and adolescents.

The present study has been carried out in the slum areas of Gorakhpur city, covering a population of 10,187 in the four colleges of Gorakhpur. Five hundred and eighty children and adolescents in urban slums, and 750 college students between 10-18 years were studied by means of a questionnaire card for detection of prevalence rate and various others co-relates of abuse of psychoactive substances. Overall, prevalence of abuse of psychoactive substances was 25% in slum areas, and 18% in college students. Abuse of tobacco was most frequent (50.3% & 72.5%) followed by that of alcohol (11.7% & 16.2%) in both the groups respectively. Cannabis was also used by some children (0.6%). More abusers were from Hindu families with low educational status and low family income. Surprisingly no one was found to be abusing tablets and street drugs.

Adolescent↗
PubMed2005

Nasopharyngeal carriage, antimicrobial susceptibility, serotype distribution and clonal relatedness of Streptococcus pneumoniae isolates in healthy children in Malatya, Turkey.

The aims of this study were to assess the nasopharyngeal colonisation rate, serogroup and antibiotic susceptibility patterns of Streptococcus pneumoniae strains isolated from healthy children. Of 848 children, 162 (19.1%) were found to be carriers. The carrier rate was significantly higher in the 7-year-old age group. Children from the slums of the city had higher carriage rate (23.7%) than those in the centre of the city (17.7%), but this was not statistically significant. The number of intermediate penicillin-resistant strains was 17 (10.5%). No high-level penicillin-resistant S. pneumoniae strain was found. The rates of resistance to co-trimoxazole, erythromycin, tetracycline and clindamycin were 11.7%, 4.9%, 4.3% and 3.7%, respectively. All isolates were uniformly susceptible to rifampicin, moxifloxacin, levofloxacin and vancomycin. Fourteen different serogroups were identified. The most prevalent serogroups in descending order were 9, 19, 23, 10, 6 and 18, accounting for 76.3% of the isolates. Arbitrarily primed polymerase chain reaction typing of 105 isolates revealed that 25 (23.8%) of the isolates were clonally indistinguishable. This value was 20.9% in children from the central area and 36.8% in those from the slum of the city. There was no relationship between serogroups and genotypes, i.e. strains within the same serogroup yielded the same or different genotypes, and vice versa. In conclusion, serogrouping results give a preliminary idea about the possible coverage of a future pneumococcal vaccine. Penicillin G is still a suitable agent for the empirical treatment of pneumococcal infections in our population. Living in the slum of the city may lead to both increased carriage and clustering rates of S. pneumoniae among healthy children.

Adolescent↗
PubMed1996

Population-based cohort study of injuries.

A population-based cohort study was done to estimate the incidence of different types of injuries and to evaluate certain risk factors in an urban slum; 4333 slum dwellers in Madras city in India were randomly selected by cluster sampling, of whom 1.7 per cent were lost during the 12 months of follow up. The cumulative injury incidence for 12 months for all injuries was 127 per 1000 persons (95 per cent confidence interval 117-137); for males 137 per 1000 and for females 118 per 1000. Incidence of unintentional injury was 121 per 1000 persons. The incidence for road traffic injury was 16 per 1000 persons, for household injuries 57 per 1000 persons and for injury at place of work 19 per 1000 persons. The relative risk of males to females for traffic injuries was 3.04 and for household injuries was 0.39. The relative risk of traffic injuries among adult males who reported daily alcohol consumption was 2.26. The incidence of injury is high in an urban slum and it is a priority health problem. This study has identified groups of people who are at high risk for injuries and who may need specific protective measures.

Accidents, Home↗
PubMed2003

Parental presence and adolescent reproductive health among the Nairobi urban poor.

PURPOSE: To investigate whether the presence of parents constitute a protective factor against adverse reproductive health outcomes for adolescents living in slums of Nairobi, Kenya. METHODS: The data come from a cross-sectional survey that canvassed a random sample of 4564 households representative of all Nairobi slums in February-June 2000. Structured questionnaires on household census, reproduction and adolescent health were verbally administered to household heads, women of reproductive ages, and adolescents, respectively. We restrict the analysis to a sub-sample of 788 never-married adolescent girls aged 12-19 years. We compare reproductive health outcomes of adolescents who live with neither parent, father only, mother only, and both parents. Data were analyzed using simple descriptive analysis and logistic regression models of three outcome variables: ever sexually active, ever experienced an unplanned pregnancy, and sexually active within the past 4 weeks. For each of the outcome variables, two models, one with and one without a proxy for adolescents' disorderly behavior are presented to establish whether parental presence affects adolescents' reproductive health. RESULTS: When the father is present in the household (i.e., father only or both parents present), adolescent girls are 42% less likely to have ever had sex (p<.05), 45% less likely to have been sexually active in the most recent 4-week period (p<0.1), and 59% less likely to have ever experienced an unwanted pregnancy (p<.05) than when neither parent, or only the mother, is present in the household. CONCLUSIONS: In the slums of Nairobi, father's presence, unlike that of the mother, is associated with stronger resilience among adolescents. When programming for adolescents in these resource-constrained settings, it is important, therefore, to involve parents.

Adolescent↗
PubMed2004

The epidemiology of good nutritional status among children from a population with a high prevalence of malnutrition.

OBJECTIVES: To identify socio-economic demographic and environmental factors that predict better height-for-age for children under 5 years of age in a Dhaka slum population. DESIGN: A panel survey, conducted between 1995 and 1997. A random sample of households was selected. Socio-economic, demographic and environmental variables were collected monthly by questionnaire and nutritional status was assessed. SETTING: Dhaka slums in Bangladesh. SUBJECTS: Three hundred and ninety-two children, surveyed in September-November 1996. MAIN OUTCOME MEASURES: Height-for-age Z-score (HAZ) above -2. RESULTS: Thirty-one per cent of children had HAZ >-2. Logistic regression adjusted for cluster sampling showed that better nourished children were more likely to have taller mothers, to be from female-headed households and from families with higher income, electricity in the home, better latrines, more floor space and living in Central Mohammadpur. Better nourished children were less likely to have fathers who have taken days off from work due to illness. CONCLUSIONS Interest in 'positive deviance' is motivated by the recognition that a focus on the malnourished only--the bottom tail of the distribution--provides indications of how families fail, but not of how they succeed in maintaining child nutrition in the face of adversity. Our analysis provides an alternative perspective on nutrition and vulnerability in an urban slum setting.

Bangladesh↗
PubMed1993

Early child health in Lahore, Pakistan: III. Maternal and family situation.

The family situation for mothers, in three areas differing in degree of urbanization and an upper middle class control group, in Lahore, Pakistan was described. Area differences in socio-economic, family composition, and housing and sanitary conditions were investigated. Data from a longitudinal sample (n = 1476 newborns) were compared with data from a cross-sectional population survey (n = 2998 families). Risk factors for child mortality and morbidity were common in the village and periurban slum area; conditions were somewhat better in the urban slum community. The sample was concluded to be representative of the population in the three areas and also for Pakistan in general. Two indices for cross-study comparisons were proposed, one for socio-economic background and the other for housing standard. The two indices were shown to be related to maternal weight for height at 9 months of pregnancy in the urban slum area; the socio-economic level was also functionally related to the weight for height measure in the village. The lower socio-economic and housing standard level, the lower was the mothers' relative weight just before childbirth. The findings were discussed in terms of risk factors for infant mortality, morbidity and psychological development.

Child Welfare↗
PubMed2000

Health conditions and residential concentration of poverty: a study in Rio de Janeiro, Brazil.

STUDY OBJECTIVES: To establish the geographical relation of health conditions to socioeconomic status in the city of Rio de Janeiro, Brazil. DESIGN: All reported deaths in the municipality of Rio de Janeiro, from 1987 to 1995, obtained from the Mortality Information System, were considered in the study. The 24 "administrative regions" that compose the city were used as the geographical units. A geographical information system (GIS) was used to link mortality data and population census data, and allowed the authors to establish the geographical pattern of the health indicators considered in this study: "infant mortality rate"; "standardised mortality rate"; "life expectancy" and "homicide rate". Information on location of low income communities (slums) was also provided by the GIS. A varimax rotation principal component analysis combined information on socioeconomic conditions and provided a two dimension basis to assess contextual variation. MAIN RESULTS: The 24 administrative regions were aggregated into three different clusters, identified as relevant to reflect the socioeconomic variation. Almost all health indicator thematic maps showed the same socioeconomic stratification pattern. The worst health situation was found in the cluster composed of the harbour area and northern vicinity, precisely in the sector where the highest concentration of slum residents are present. This sector of the city exhibited an extremely high homicide rate and a seven year lower life expectancy than the remainder of the city. The sector that concentrates affluence, composed of the geographical units located along the coast, showed the best health situation. Intermediate health conditions were found in the west area, which also has poor living standards but low concentration of slums. CONCLUSIONS: The findings suggest that social and organisation characteristics of low income communities may have a relevant role in understanding health variations. Local health and other social programmes specifically targeting these communities are recommended.

Adolescent↗
PubMedDate not supplied

Polymerase chain reaction for detection of endocervical Chlamydia trachomatis infection in women attending a gynecology outpatient department in India.

OBJECTIVES: To detect Chlamydia trachomatis infection by polymerase chain reaction (PCR) in symptomatic women attending a gynecology clinic in a city hospital and in randomly selected slum dwellers. STUDY DESIGN: Endocervical specimens were collected from 350 women with genitourinary complaints (group I) and 53 slum dwellers (group II). Samples were analyzed by PCR, direct fluorescence assay (DFA) and Giemsa stain cytology for detection of C trachomatis and compared for their sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS: The prevalence of endocervical C trachomatis infection was 43.1% and 24.5% in groups I and II, respectively. The sensitivity, specificity, PPV and NPV of PCR were 80.0%, 75.0%, 66.6% and 85.7%, respectively, when DFA was considered true positive. The percent increment in detection of C trachomatis by PCR was 15.3%. CONCLUSION: Giemsa stain cytology has low sensitivity and specificity; hence, it cannot be recommended for use as a diagnostic technique. It appears that PCR can be used routinely in Chlamydia diagnosis and in screening selected populations. The high positivity of C trachomatis infection in urban slum dwellers is cause for concern.

Adult↗
PubMed2000

Total energy expenditure & physical activity level in chronically energy deficient Indian males measured by the doubly labelled water technique.

Total energy expenditure (TEE) and basal metabolic rate (BMR) in the free-living state were measured in healthy south Indians, by the doubly labelled water (DLW) method. From these measurements, estimates of physical activity level (PAL) could be calculated. A total of 18 subjects were studied in 3 groups of 6 subjects each: Group I (urban controls), Group II (urban slum, chronically undernourished) and Group III (rural). The urban slum recruits were chronically energy deficient (CED), and had a low BMI (average 17.0 kg/m2), while the rural subjects had an average BMI of 18.1 kg/m2. The TEE measured by the doubly labelled water technique was 11.2, 7.1 and 12.2 MJ/day for Groups I, II and III respectively. The TEE was significantly lower in the urban CED group as obtained by the one way ANOVA. The estimates of TEE by the DLW technique were compared with estimates made by whole body calorimetry, in the urban groups of subjects. The TEE obtained by calorimetry was 10.3 +/- 1.6 and 7.3 +/- 0.2 MJ/day in Groups I and II respectively. There were no significant differences between the TEE measured by the two methods, in both the groups. The two methods also correlated well, and the mean difference between the methods, in both groups was -0.5 +/- 1.1 MJ/day, which was about 6 per cent of the value of TEE measured by the DLW method. The calculated PAL (by using TEE measured by DLW/BMR) was 1.79, 1.54 and 1.90 for Groups I, II and III respectively. The results showed that the activity of chronically energy deficient subjects, in urban slums, was reduced, and that this may be their method of conserving energy to maintain a stable body weight. Rural males had a high activity level, even though they had a low BMI.

Adult↗
PubMed1992

City studies on nutrition: Bangalore, India.

The size of urban population in developing Asian countries grows at a faster rate than in the developed West. Urban cities in India are being crushed by the onslaught of population growth, migration of rural poor and industrialization, the urbanization in turn inducing social and economic changes. During the decade 1972-81, India's population grew by 25%, urban population by over 40% and that of Bangalore city by 76%. The 1991 Census records the population of Bangalore city at 4.1 million, though the decennial growth rate seems to have begun to decline. The current sex ratio is 900 females to 1000 males with nearly 50% of the population literate and the density of population at 2200 per km2. With the rapidly expanding "conurbation" (continuous urbanization), the number of slum settlements have increased with Bangalore having recorded the highest annual growth rate of 27.4% in its slum population accounting for more than 10% of the share of its population in the slums within the corporation limits. 29% of the population in urban areas in the State is under the poverty line and the percentage under the poverty line may be higher in the city. In this situation the nutrition of the mother and child is most vulnerable. The incidence of low birth weight recorded in a Government Hospital in Bangalore was between 30-40% and the IMR at 47/1000 births. Incidence of child mortality was 5% for children under 1 year and 3% for preschool children. The percent distribution of PEM in preschool children was 41, 31 and 1 for Gomez Grades I, II and III respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

Epidemiological study of child & adolescent psychiatric disorders in urban & rural areas of Bangalore, India.

BACKGROUND & OBJECTIVE: There are limited data on child mental health needs in our country. Therefore, an epidemiological study to determine the prevalence rates of child and adolescent psychiatric disorders was initiated as a two-centre (Bangalore and Lucknow) study by the Indian Council of Medical Research. It also aimed to study the psychosocial correlates of the psychiatric disorders. We present here the findings of Bangalore Centre. METHODS: In Bangalore, 2064 children aged 0-16 yr, were selected by stratified random sampling from urban middle-class, urban slum and rural areas. The screening stage was followed by a detailed evaluation stage. The ICD-10 DCR criteria were used to reach a penta-axial diagnosis. RESULTS: The results indicated a prevalence rate of 12.5 per cent among children aged 0-16 yr. There were no significant differences among prevalence rates in urban middle class, slum and rural areas. The psychiatric morbidity among 0-3 yr old children was 13.8 per cent with the most common diagnoses being breath holding spells, pica, behaviour disorder NOS, expressive language disorder and mental retardation. The prevalence rate in the 4-16 yr old children was 12.0 per cent. Enuresis, specific phobia, hyperkinetic disorders, stuttering and oppositional defiant disorder were the most frequent diagnoses. When impairment associated with the disorder was assessed, significant disability was found in 5.3 per cent of the 4-16 yr group. Assessment of felt treatment needs indicated that only 37.5 per cent of the families perceived that their children had any problem. Physical abuse and parental mental disorder were significantly associated with psychiatric disorders. INTERPRETATION & CONCLUSION: Prevalence rates of psychiatric morbidity in 0-16 yr old children in India were found to be lower than Western figures. Middle class urban areas had highest and urban slum areas had lowest prevalence rates. The implications for clinical training, practice and policy initiatives are discussed.

Adolescent↗
PubMed2006

Prevalence of asthma and allergic diseases in Sanliurfa, Turkey, and the relation to environmental and socioeconomic factors: is the hygiene hypothesis enough?

BACKGROUND: The prevalence of asthma and allergic diseases has been reported to be higher in urban than in rural areas between developed and underdeveloped countries and within any given country. Studies in Turkey have yielded different results for different regions. This study aimed to investigate the prevalence of asthma and atopy in Sanliurfa, Turkey, and the influence of environmental factors. MATERIALS AND METHODS: We recruited 1108 children from different areas of Sanliurfa and administered the questionnaire of the International Study of Asthma and Allergies in Childhood. Items asking for socioeconomic data were also included. Skin prick and purified protein derivative tests were performed on the children. Measles antibodies were determined and feces were analyzed for parasites. RESULTS: The total prevalence of atopic diseases was 8.6% (n = 95/1108), asthma 1.9% (n=21/1108), allergic rhinitis 2.9% (n=32/1108), and allergic conjunctivitis 3.8% (n=42/1108). The rate of atopic diseases was 5.6% (n=32/573) in children attending schools in peripheral, less urban, slum areas while it was 11.8% (n=63/535) in those attending city-center schools (OR, 2.2; 95% confidence interval [CI]; 1.4-3.5; P<.001). Skin prick test positivity was observed in 3.9% (n=43/1108) overall; at schools in slum areas it was 1.9% (n=11/573), whereas at central schools the rate was 6% (n=32/535) (OR, 4.08; 95% CI, 2.03-8.20; P<.001). The prevalence of asthma and atopic diseases was significantly higher in children who have a family history of atopy, attend a central school, live in an apartment, have more rooms in their homes, and enjoy better economic conditions. CONCLUSION: We found associations between various factors suggested by the hygiene hypothesis and asthma, and very low rates of prevalence of asthma and atopic diseases both in Sanliurfa in comparison with the more developed western regions and in the peripheral slum areas. The hygiene hypothesis is helpful in explaining these observations.

Adolescent↗
PubMed1990

Dental health in urban and rural areas of central and western Bangladesh.

A survey of the prevalence of dental caries and periodontal disease was carried out in 826 individuals residing in Central and Western Bangladesh. The survey included 6, 12, 18 and 35-45 year olds in privileged and slum urban areas as well as in rural areas. Dmft, DMFT and CPITN indices were used. The results showed that the highest mean dmft-values were found in urban privileged children (5.0). The mean DMFT-values ranged from 1.1 (urban privileged 6 year olds) to 4.7 (rural 34-45 year olds). The percentage of 12 year old children affected by caries was higher than in the 18 and 35-45 year olds in all socioeconomic groups. No statistically significant differences were found in the mean DMFT values within the age groups between urban privileged, urban slum and rural people. There was a high prevalence of bleeding on probing and of calculus in all age groups. Except for the 6 year olds, less than 10% in all age groups had a healthy periodontium. In the 18 year olds, shallow pockets were found in 34% of the urban slum group and in 42% of the rural group, but not in the urban privileged group. Deep pockets (greater than 6 mm) were found in the 18 and 35-45 year olds, except in the urban privileged groups.

Adolescent↗
PubMedDate not supplied

Review of poliomyelitis in Bombay (1982-1989): observations on the improved immunisation coverage.

In Bombay, the immunization coverage with 3 doses of oral polio vaccine in children below 2 years of age has reached 80%. As a result, the high incidence of over 11/100,000 population prevailing in the 6 year period (1982-1987) has declined to around 6 in 1988 and 1989. The decline was observed both in the slum and in the "non-slum" population. The incidence in the slum population has reduced from over 22/100,000 population to around 11. In the morbidity, a subtle "age shift" to older children was noticed in 1988-1989. Average age-specific incidence (for age group below 1 year) was found to be 1.04/1000 children in 1988-89 as against 2.47 in the preceding 6 years. The proportion of "Non-Immunized" cases gradually declined from 65.8% in 1982 to 49.7% in 1989 and conversely, the proportion of fully immunized cases increased from 14.5% in 1982 to 22.7% in 1989. The attack rates per 1000 children below 1 year of age in the inadequately/"Non-Immunized" and the fully immunized children were found to be 2.822 and 0.224 respectively. The sharp peak in the morbidity observed in the 3rd quarter of an year (July to September) has been replaced by almost even distribution of cases in all the quarters of an year. All the three polioviruses were encountered through out the year. Although, poliovirus type 1 was the most predominant of viruses, its proportion was on decline. The portion of isolation of "Non-Polio" viruses has increased from 6.8% in 1982 to 16.2% in 1989.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Health practices and indices of a poor urban population in Indonesia. Part I: Patterns of health service utilization.

This first section in a two-part study of health indices and practices among residents living in a Jakarta slum describes the use of public and private primary health care services in relation to socioeconomic and health status. As problems associated with urban poverty rapidly increase in developing countries, it is important to study the ethnic and economic diversity which exists in slums and shanty towns: results of such studies should inform the development of effective strategies for outreach and service delivery. Through a survey of 690 mothers and 593 children, we found that 1) poorer residents were more likely than relatively affluent ones to rely on local government clinics (posyandus) for primary health care; 2) regular posyandu users were more likely than non-users to be fully immunized and to use ORT correctly; 3) delivery in hospital was common among all residents, but especially among the more affluent; and 4) prevalence of contraception was high and not associated with socioeconomic status or type of primary health care service used. Strengthening primary health care services at the government's local health posts could benefit all groups in the community if wealthier residents participated more in the posyandus. Standards of care in the private sector should also be improved.

Child Welfare↗
PubMed1999

Vitamin A intake and xerophthalmia among Indian children.

OBJECTIVE: To estimate prevalence of xerophthalmia and to assess dietary intake of vitamin A in Indian children aged under 6 y. DESIGN: Cross sectional study. STUDY SETTING: Urban slums under Urban Health Centre affiliated to Department of Preventive and Social Medicine, Government Medical College, Nagpur, India. PARTICIPANTS: The study included 1094 all children under 6 y of age, from two randomly selected urban slums. METHODS: Xerophthalmia was diagnosed on the basis of ocular signs and symptoms (WHO recommendations). Dietary intake of vitamin A was assessed by using one year recall method recommended by International Vitamin A Consultative Group. RESULTS: Prevalence of xerophthalmia was estimated to be 8.7%. Nine hundred and ninety-five (90.9%) study subjects were identified as inhabitants consuming dietary vitamin A at below recommended levels. (UPF score < 210). Five hundred and ninety-three (54.2%) study subjects were consuming dietary vitamin A at approximately less than 200 RE/d (UPF score < 120) while 402 (36.2%) were consuming approximately 200-300 RE/d (UPF score 120-210). The prevalence of xerophthalmia was found to be decreasing as the score of usual pattern of food consumption (UPF) increased. CONCLUSIONS: Children with a dietary intake represented by a UPF score of less than 120 were at high risk of developing xerophthalmia, whereas, those consuming vitamin A equal to a UPF score greater than 120 were at comparatively less risk despite being below the recommended levels.

Child, Preschool↗
PubMed1999

Knowledge, attitudes and practices of mothers and knowledge of health workers regarding care of the newborn umbilical cord.

OBJECTIVE: To determine the knowledge, attitudes and practices (KAP) of mothers and the knowledge of health workers regarding care of the newborn umbilical cord. DESIGN: Cross-sectional survey. SUBJECTS: Mothers with infants less than three months of age attending well child clinics and health workers (HW) in the clinics, maternity and newborn units of public health, facilities serving an urban slum area in Nairobi, Kenya. RESULTS: Of the 307 mothers interviewed, 91% and 28% of mothers knew of the need for hygiene whilst cutting and tying the cord, respectively. Regarding postnatal cord care, 40% had good knowledge and 66% good practice. Fifty-one percent of mothers knew and 54% practised postnatal cord care for the appropriate duration of time. Seventy-nine percent of mothers were afraid of handling an unhealed cord. After multivariate analysis, the following variables showed significant independent association with good maternal KAP; increased level of education (OR 2.3, p < 0.001), living in middle class areas rather than slums (OR 1.5, p < 0.03), increased maternal age (OR 1.8, p < 0.001), acquisition of knowledge from a HW rather than from other sources (OR 1.5, p < 0.001), and living in stone/brick houses rather than mud houses (p = 0.01). Fifty per cent of HW had correct knowledge on type of postnatal cord care, and 79% had correct knowledge on duration required for the same. The knowledge of 50% on type of care was incorrect by international standards, but was in keeping with Nursing Council of Kenya teaching. CONCLUSION: Mothers had good knowledge on the need for hygiene when cutting the cord, had poor knowledge and practice in other aspects of cord care, and were afraid of handling the cord. Poor KAP was associated with young, poor mothers of low education, who had acquired their knowledge from sources other than HW. The knowledge of a large proportion of HW was incorrect and outdated. We recommend that health education on cord care be given at all levels of contact with mothers and that knowledge of all primary HW on cord care be updated.

Adolescent↗