Delayed cord clamping practice in the delivery rooms of a regional referral hospital and two lower health centers in Uganda: a facility based cross-sectional study

Background The 2014 World Health Organization (WHO) guidelines on delayed umbilical cord clamping for improved maternal and infant health and nutritional outcomes strongly recommend a delay in umbilical cord clamping of 1–3 minutes after delivery. Delayed cord clamping (DCC) is known to provide an iron load that improves the infant’s iron status up to 6 months after birth. Despite the benefits associated with DCC, only a few countries have set policies regarding this practice. In Uganda, the practice of umbilical cord clamping has not been studied. The purpose of this study is to assess the practice of delayed cord clamping at birth among skilled birth attendants at three different levels of health care system in the Mbale district. Methods This was a descriptive cross-sectional study. A total of 379 births and their skilled birth attendants at Mbale Regional Referral, Namatala Health Centre IV, and Nakaloke Health Centre III were observed. Research assistants used a stopwatch to time the interval from the time the baby was delivered to the time the umbilical cord was clamped. We reported the timing of umbilical cord clamping overall and by skilled birth attendant groups (obstetricians, medical officers, interns, and midwives). Results Almost half (52%, 197/379) (95% CI: 25.7%-46.9%) of the newborns had their cords clamped after at least 60 seconds, a practice of delayed cord clamping (DCC). Approximately half (182/379; 48%) of the newborns had cords clamped before the 60 s (ICC), and approximately one quarter (26.1% (99/379)) of the newborns had their umbilical cords clamped before 30 seconds. The median (5 ^th , 95 ^th percentile) umbilical cord clamping time in seconds was 65 (8.35, 393.79), with variations within the practitioner subgroup. The midwives practised DCCs for 124 (22, 408.71) seconds, whereas the doctors practised ICCs for 22.35 (5.47, 80) seconds and the students practised 56.77 (11.82, 471.96) seconds. Doctors were more likely to clamp the umbilical cord immediately than were midwives and students (COR 33.1; 95% CI: 15.1--72.6). Conclusions The study revealed that only half of health providers practice delayed cord clamping in these delivery rooms. Doctors were more likely not to practice DCC than midwives and students were. This is the first study to guide the timing of umbilical cord clamping in facilities around the Mbale.