Comparative Evaluation of 7.1% Chlorhexidine Digluconate Gel and Methylated Spirit for Neonatal Umbilical Cord Care in Two Ghanaian Hospitals

Abstract

Background: Umbilical cord infection is an avoidable contributor to neonatal morbidity and mortality, particularly where harmful cord applications, inconsistent hygiene and limited postnatal follow-up persist. Ghana recommends 7.1% chlorhexidine digluconate gel for newborn cord care, but methylated spirit remains common in routine practice. Context-specific comparative evidence is needed to support implementation and caregiver counselling. Objective: The objective of this study was to compare 7.1% chlorhexidine digluconate gel with methylated spirit under routine practice in two Ghanaian hospitals with respect to umbilical cord separation time, clinical signs of cord infection, local umbilical complications and maternal satisfaction. Methods: A prospective, facility-based, non-randomised comparative study was conducted among 160 hospital-born neonates and their mothers between January and March 2023. Exposure was determined by routine facility practice: neonates delivered at Ahafo Ano North Municipal Hospital received 7.1% chlorhexidine digluconate gel, whereas those delivered at Janie Speaks A.M.E. Zion Hospital received methylated spirit. Outcomes were cord separation time, a prespecified composite of clinical signs of cord infection, local umbilical complications and maternal satisfaction. Maternal satisfaction was assessed using a single structured satisfied/not-satisfied item at follow-up. Data were summarised using descriptive statistics, chi-square or Fisher's exact tests and Student’s t-test at a 5% significance level. Results: Of 160 neonates, 75 received chlorhexidine gel and 85 received methylated spirit. Mean cord separation time was longer in the chlorhexidine group than in the methylated spirit group (6.57 ± 1.99 versus 5.74 ± 1.15 days; p = 0.0013). The frequency of clinical signs or symptoms of cord infection was lower in the chlorhexidine group than in the methylated spirit group (12.0% versus 37.6%; RR 0.32, 95% CI 0.16-0.62; p < 0.001). No local umbilical complication was recorded in the chlorhexidine group, compared with 15.3% in the methylated spirit group (p < 0.001). Satisfaction was high in both groups and did not differ significantly (84.0% versus 82.4%; p = 0.781). Conclusion: In these two Ghanaian hospitals, chlorhexidine gel was associated with fewer clinical signs of cord infection and fewer local umbilical complications than methylated spirit, although cord separation was modestly longer. Because cord-care agent was determined by facility rather than randomisation, the findings should be interpreted as pragmatic comparative associations rather than definitive causal effects. Implementation should be accompanied by caregiver counselling, reliable supply, staff training and continued evaluation.