Abstract: Neonatal sepsis Neonatal sepsis remains a leading cause of neonatal morbidity and mortality in sub-Saharan Africa, with Kenya reporting 21 deaths per 1,000 live births in the first month of life. Unsafe umbilical cord care remains an avoidable source of neonatal infection, while chlorhexidine (CHX) cord care is recommended by WHO and Kenya Ministry of Health for prevention. However, correct use depends on mothers’ practices and adherence. This study assessed the association between CHX cord care practices and presentation of neonatal sepsis in Vihiga County, Kenya. An analytical cross-sectional study using mixed methods was conducted among 378 mothers with newborns. Data were collected using structured questionnaires and key informant interviews. Odds ratios were determined and logistic regression was used to examine associations. Neonatal sepsis prevalence was 21.7%. Correct practices were protective, including once-daily application (OR=0.2, p<.001) and hand hygiene (OR=0.3, p=.01). Application for less than 7 days increased risk (OR=2.3, p=.006), while cultural practices significantly increased risk (OR=3.7, p<.001). Awareness alone was not protective. The study concludes that correct and consistent CHX use, rather than awareness alone, is critical in reducing neonatal sepsis. It recommends behaviour-focused interventions to improve CHX application. Findings are expected to inform neonatal sepsis prevention policy in Kenya.