The application of chlorhexidine on a newborn’s umbilical cord soon after birth can greatly reduce the risk of infection. A recent study in The Lancet looked at the application of this simple intervention in Bangladesh and Pakistan. The effectiveness of the intervention was documented in prior study done in Nepal, and these two new studies further confirmed that it could save lives in low resource settings.
Data from 54,000 newborns in these two studies and Nepal, showed an aggregate 23% reduction in neonatal mortality, excluding deaths in the first few hours of life, and a 68% reduction in severe infections when comparing the intervention group to the control group. That is stunning.
Four percent Chlorhexidine (7.1% chlorhexidine digluconate ) is currently in use in Nepal for umbilical cord care, The price of a packaged product is estimated between US $0.11 and $0.43. To ensure uptake, product optimization (packaging and consistency) works are underway. For example, studies show that the gel form of 4% chlorhexidine is preferred in Nepal. On the other hand, a Zambian study indicated a preference for the liquid form.
Easy to apply the product, effectiveness and cheaper price remain the key features of the product. A true win-win-win for global health.
According to the Healthy Newborns Network blog, “Hospitals in the US and other developed countries already use it to prevent umbilical cord infections. But in developing countries, where the majority of births happen at home and in communities where poor hygiene leads to very high newborn infection and death rates, there is little experience with – and evidence for – chlorhexidine cord cleansing. In fact, cord care practices in many developing countries are steeped in cultural and religious traditions, and involve putting a number of different harmful substances on the cord. Unfortunately many of these practices greatly increase exposure of the umbilical cord to bacteria that cause fatal infections.”
Both studies employed a 4% chlorhexidine that PSI believes is destined to be the next “major event” in public health. Presently we are advising PSI platforms to assess the value of the product in their country context and determine appropriateness of incorporating the product into their strategic plan.
“The advantage of the intervention is the ease of application. Community health workers, hospital staff, midwives and even mothers can easily be trained in applying the chlorhexidine ,” said Dr. Abel Irena, PSI Research Advisor on Child Survival. Latest estimates show that neonatal mortality makes up over 40% of global under five child mortality; 29% in Africa and 54% in Southeast Asia.
Presently, the WHO recommends dry cord care unless the umbilical cord clean is tampered with for reasons that include cultural practices. In that case, it suggests the application of a 4% chlorhexidine detergent solution. “I expect the WHO to revise the guidelines in the near future to reflect the findings from the two studies,” said Dr. Irena. He said studies in Sub-Saharan Africa are wrapping up soon, but expects them to largely confirm the findings of the Lancet-published studies.