Ensuring optimal cord care at birth and during the first week of life, including use of chlorhexidine, especially in settings having poor hygiene, is a crucial strategy to prevent life-threatening sepsis and cord infections and avert preventable neonatal deaths.
Chlorhexidine digluconate is a broad spectrum antiseptic that is available in a range of concentrations and has been safely used for over 40 years for a variety of health-related applications; but its specific use for umbilical cord care was uniquely tested in three clinical trials in Nepal, Bangladesh, and Pakistan, in the form of 7.1% chlorhexidine digluconate (CHX). Given the promising results of the trials, in 2013 the World Health Organization (WHO) added CHX to its Model List of Essential Medicines for Children; and in 2014 the WHO issued a new guideline on umbilical cord care, which included a formal recommendation on the use of chlorhexidine.
This webpage is maintained by the Chlorhexidine Working Group (CWG). It was developed to help policy makers, program managers, and donors facilitate the introduction of 7.1% chlorhexidine digluconate into existing essential newborn care services in low- and middle-income countries. The webpage consists of three phases, Get Ready, Plan, and Execute, and is based on the experiences of the CWG partners in introducing chlorhexidine in various countries. Each phase is composed of activities that facilitate introduction and scale-up. The phases do not necessarily occur in a sequential manner; however, as some activities/components across the three phases may occur simultaneously while others are dependent upon the results of activities from a previous phase.
Newborn lives are claimed every year across the world
Of the deaths are caused by sepsis
Reduction in neonatal mortality when 7.1% chlorhexidine digluconate was used on the first day of life, as demonstrated by the clinical trials conducted in South Asia.
Successful program implementation requires the coordinated effort of the key stakeholders and alignment of policies and guidelines. The first step is to gain consensus through consultations with various key stakeholders, such as different departments within ministries of health, skilled providers, professional organizations, manufacturers, and distributors in the public and private sectors. Further evidence for implementation may need to be generated if stakeholders believe that gaps in operational evidence exist. The final component of coordinating the effort is to align policies and guidelines for chlorhexidine implementation.
Once consensus has been gained among key stakeholders, any needed operational data has been generated, and policies and guidelines have been updated, the next phase should be to plan for initial implementation. Key components of implementation planning include: developing demand generation strategies, orientation and training of service providers, considering product manufacturing and distribution options, developing a monitoring and evaluation plan, and developing a financing strategy.
The final phase is to execute the CHX implementation plan and continuously monitor how it is being implemented to determine if the desired outcomes are being achieved. Data from the initial phase of implementation should be disseminated to key stakeholders within the country. If the program is not being implemented as planned, corrective action should be taken. Ministries of Health or key stakeholders may wish to disseminate data about the progress of CHX implementation in their country through international conferences or publications to help other countries accelerate implementation of CHX.
- Chlorhexidine for umbilical cord care presentations at the Global Maternal Newborn Health Conference (October 2015):
- Introduction of Chlorhexidine in Sindh, Pakistan (MCHIP)
- Introduction de la Chlorhexidine Digluconate 7,1% dans les soins ombilicaux en RDC (MSH/SIAPS)
- Saving the Pair –Integrated Scale-up of Chlorhexidine and Misoprostol for Newborns and Mothers in Rural Madagascar (JSI Research and Training Institute)
- Institutionalizing Chlorhexidine Program and Maintaining Coverage Chlorhexidine Cord Care Program in Nepal (JSI Research and Training Institute)
- Nepal progress towards program sustainability (timeline)
- National Strategy For Scale-Up Of Chlorhexidine in Nigeria
Activity 1: Gaining Consensus
- Chlorhexidine for umbilical cord care: game-changer for newborn survival?
- PATH chlorhexidine stability data
- CWG Bibliography [update in progress]
- DRC Technical Working Group structure and outline (français)
- DRC Résumé sur les évidences scientifiques de l’utilisation de la Chlorhexidine(CHX) digluconate 7.1% (français) [DRC scientific evidence presentation]
Activity 2: Building Evidence for Implementation
- Bangladesh operations research report and presentation
- Bangladesh product attribute study
- India (Uttar Pradesh) formative research results and end-to-end analysis
Activity 3: Aligning Policies and Guidelines
- DRC Élaboration d’une politique nationale concernant l’introduction de la chlorhexidine à 7,1 % pour les soins du cordon ombilical (français) [DRC national policy development plan]
Component 1: Integrating Demand Generation
- Madagascar Stratégie de communication (français) [Madagascar communication strategy for AroFoitra]
Component 2: Orientation/Training
- Madagascar formation des agents de sante (français) [Madagascar health worker training materials]
- Madagascar job aid (Malagasy)
- Nepal job aid
- Sindh Province (Pakistan) training materials
- Aqueous solution (liquid) instructions for use
Component 3: Product Manufacturing and Distribution
Component 4: Monitoring and Evaluation (M&E)
- Demographic and Health Surveys (DHS) newborn module
Component 5: Financing
The Chlorhexidine Working Group (CWG) is an international collaboration of organizations committed to advancing the use of 7.1% chlorhexidine digluconate (delivering 4% chlorhexidine) for umbilical cord care through advocacy and technical assistance. PATH serves as the Secretariat of the CWG.
To contact the Chlorhexidine Working Group, please email: email@example.com
- PATH [Secretariat]
- Bill & Melinda Gates Foundation
- Boston University
- Burnet Institute
- Centre for Infectious Disease Research in Zambia
- Clinton Health Access Initiative
- Drugfield Pharmaceuticals Ltd. (Nigeria)
- Duke University
- GSK (UK)
- Global Health Action
- John Snow, Inc.
- Johns Hopkins Bloomberg School of Public Health
- Johnson & Johnson (USA)
- Lomus Pharmaceuticals Pvt. Ltd. (Nepal)
- Maternal and Child Survival Program
- Ministry of Health, DRC (Reproductive Health)
- Ministry of Health, Ethiopia (Maternal & Child Health)
- Ministry of Health, Kenya (Child & Adolescent Health)
- Ministry of Health, Liberia (Family Health)
- Ministry of Health, Malawi (Reproductive Health)
- Ministry of Health, Mozambique (Child Health)
- Promoting the Quality of Medicines/United States Pharmacopeia
- Save the Children/Saving Newborn Lives
- SHOPS Plus/Abt Associates
- Systems for Improved Access to Pharmaceuticals and Services/Management Sciences for Health
- United Nations Children’s Fund
- United States Agency for International Development
- Universal Corporation Ltd. (Kenya)
- University of Illinois at Chicago
- University Research Corporation
- World Health Organization