A Systematic Review of the Effectiveness of Existing Umbilical Cord Care Interventions in Preventing Omphalitis and Reducing Neonatal Mortality in Sub-saharan Africa

Background Neonatal mortality remains a major public health concern in Sub-Saharan Africa, with umbilical cord infections accounting for a substantial proportion of these deaths. This systematic review seeks to synthesise existing evidence on the effectiveness of existing umbilical cord care strategies in preventing omphalitis and lowering infant mortality Sub-Saharan Africa using a narrative approach. Methods 1309 studies were identified through a thorough search of electronic databases such as PubMed, European PMC, and Google Scholar between 2014 and 2024. Studies were screened according to predetermined inclusion and exclusion criteria. Data was extracted using Microsoft Excel, In addition, the quality of the selected studies was assessed using the CASP checklist. Due to the heterogeneity of the selected studies the synthesis of data synthesis was performed using narrative synthesis Results The review includes six papers, including randomised controlled trials, observational research, and qualitative investigations. The included trials covered a wide range of therapies, such as chlorhexidine application, dry cord care, alcohol application, and clean birth kits. The combined findings demonstrate the efficacy of chlorhexidine treatment in lowering omphalitis incidence and neonatal mortality rates. Comparative assessments of various cord care methods reveal variable effects on infant health outcomes. Implementation obstacles, such as adherence issues and healthcare system barriers, were observed in multiple studies. In addition, the review looked into the relationship between cord care interventions and maternal and newborn health outcomes, health equity, accessibility, cost-effectiveness, scalability, causality, and mortality rates. Conclusion This systematic review sheds light on the current evidence basis for umbilical cord care interventions in Sub-Saharan Africa. Despite differences in study techniques and outcomes, the review emphasises the need to tackle newborn mortality and omphalitis through focused interventions and health-system strengthening initiatives. Future research should focus on overcoming implementation barriers, improving health equity and accessibility, and assessing the long-term impact and scalability of cord care interventions in various contexts across the area. Manuscript PROSPERO registration number [CRD42024540612]