(Page last updated November 22, 2013)
Welcome to the Chlorhexidine for Umbilical Cord Care Technical Resource Page. This page provides the latest information on the use of chlorhexidine for umbilical cord care—a safe and effective intervention to prevent neonatal infection. This intervention is low cost and can be integrated into existing newborn care programs or platforms.
Severe infection is one of the top three causes of newborn deaths worldwide, claiming approximately 13% of all neonatal deaths each year (Liu et al. 2012). In resource-poor, high-mortality settings, infections can account for over half of the neonatal deaths. A baby's newly cut umbilical cord can be an entry point for bacteria, which can lead to cord infection and potentially life-threatening sepsis. Poor hygiene and lack of antisepsis at birth and in the first week of life increases the risk of deadly but preventable infections.
Evidence supports 7.1% chlorhexidine digluconate (delivering 4% chlorhexidine) for cord cleansing as an efficacious, acceptable, feasible and cost-effective strategy to reduce neonatal mortality in settings where poor hygiene and high neonatal mortality are issues.
The following information is aimed to support program managers, policymakers and stakeholders in countries where early implementation is possible. For questions or information not found on this resource page, please email the Chlorhexidine Working Group at email@example.com.
- Overview & Advocacy Documents
- Policy & Guidelines
- Research & Evidence
- Product Supply
- Programmatic Experience
- Chlorhexidine Working Group Terms of Reference (June 2013)
- Chlorhexidine Technical Brief: Umbilical Cord Cleansing Saves Newborn Lives (September 2013)
- Chlorhexidine Technical Brief in French: La chlorhexidine pour les soins du cordon ombilical: Une nouvelle intervention à faible coût pour réduire la mortalité néonatale (March 2013)
- Frequently Asked Questions About Chlorhexidine for Umbilical Cord Care (Updated June 2013).
- Frequently Asked Questions in French: Foire aux questions (FAQ) concernant l’utilisation du digluconate de chlorhexidine à 7,1 % pour les soins du cordon ombilical (Updated June 2013)
- Summary of the Evidence, Policy, Product Availability, and Global Introduction Efforts (Updated November 2013).
- Chlorhexidine for umbilical cord care: a game-changer for newborn survival? Global Health: Science and Practice (March 2013).
- Chlorhexidine for umbilical cord care - report prepared for the UN Commission on Life-Saving Commodities for Women and Children (July 2012).
- Evidence Base and the Way Forward: Regional dissemination meeting in Nepalgunj, Nepal, 2011. Read the meeting report (PDF).
- WHO Model List of Essential Medicines for Children (2013).
- Topical umbilical cord care at birth: RHL Commentary - Capurro. H. Topical umbilical cord care at birth: RHL commentary. The WHO Reproductive Health Library; Geneva: World Health Organization. (last revised 30 September, 2004)
- View the 1998 WHO Cord Care Guidelines (1998)
Chlorhexidine is a well-known antiseptic with an excellent safety record. Since its introduction in the 1950s, chlorhexidine has been used regularly as a pre-surgical scrub and skin antiseptic and carefully studied for safety and efficacy. The CWG has compiled a Chlorhexidine Bibliography that lists the evidence supporting chlorhexidine digluconate for cord care.
Chlorhexidine for Umbilical Cord Care: Selected Bibliography (Updated November 2013)
Recent community‐based randomized trials in rural areas in Bangladesh, Nepal, and Pakistan confirm that applying 7.1% chlorhexidine digluconate (delivering 4% chlorhexidine) to the umbilical cord prevents infection and saves newborn lives. The results of these trials showed a reduction of neonatal mortality from 20% to 38%, and eliminates up to three-quarters of serious umbilical infections (omphalitis). Additionally, operational studies in Bangladesh and Nepal demonstrated that both liquid and gel forms of 7.1% chlorhexidine digluconate were acceptable to families, and that families were typically able to use the product as recommended. (Lancet registration required for full access)
- Nepal: 24% reduction in newborn mortality when community health workers applied 7.1% chlorhexidine digluconate (delivering 4% chlorhexidine) to the cord during home visits. Cord cleansing with 7.1% chlorhexidine digluconate can be successfully incorporated into maternal and newborn care programs using existing cadre of female community health volunteers.
- Pakistan: When 7.1% chlorhexidine digluconate (delivering 4% chlorhexidine) was recommended and provided by traditional birth attendants to families, risk of newborn infection dropped 42%, and neonatal mortality reduced by nearly 40%.
- Bangladesh: 7.1% chlorhexidine digluconate (delivering 4% chlorhexidine) cord cleansing on the first day of birth reduced newborn death by as much as 20%, but continuing the treatment for 7 days, although showing fewer signs of infection when compared to dry cord care, did not see a significant reduction in newborn mortality.
- Safety and Impact of Chlorhexidine Antisepsis Interventions for Improving Neonatal Health in Developing Countries. LC Mullany, GL Darmstadt, JM Tielsch. The Pediatric Infectious Disease Journal, August 2006.
- Chlorhexidine Gel Versus Aqueous for Preventive Use on Umbilical Stump: A Randomized Noninferiority Trial. S Hodgins, K Thapa, L Khanal, et al. The Pediatric Infectious Disease Journal, November 2010.
There are two available sources for purchase of 7.1% chlorhexidine digluconate for umbilical cord care at this time:
- Lomus Pharmaceuticals in Nepal (http://www.lomus.com.np/about_us.htm). They require a minimum lead time of 25 days.
- UNICEF Supply Division catalogue, product number S1531515 (https://supply.unicef.org/).
Exploring Local Production
The CWG believes that local production is one of the production strategies for producing chlorhexidine for cord care - locally owned manufacturers, multi-national companies based in low-resource countries, or regional manufacturers, as appropriate. 7.1% chlorhexidine digluconate (delivering 4% chlorhexidine) is relatively easy to manufacture and local production allows low-resource countries to build local drug production capacity.
- Production Strategy: 7.1% Chlorhexidine Digluconate for Umbilical Cord Care (2013)
- Production Strategy in French: Stratégie de production: le digluconate de chlorhexidine à 7,1 % pour les soins du cordon ombilical (2013)
- Market sizing tool - Utilizing market size estimates (2012)
- Market sizing tool - Utilizing user estimates (2012)
In addition to large-scale clinical effectiveness trials, extensive formative research and programmatic piloting has been conducted to establish and confirm the acceptability, feasibility, impact, and cost‐effectiveness of introducing a 7.1% chlorhexidine digluconate (delivering 4% chlorhexidine) product for umbilical cord care. In order to provide an overview of programmatic experiences to date, we have created a summary of chlorhexidine for umbilical cord care implementation in five countries.
- Summary of Chlorhexidine for Umbilical Cord Care in Selected Countries (Updated May 28, 2013)
- Summary in French: Résumé concernant la chlorhexidine destinée aux soins du cordon ombilical dans les pays sélectionnés (June 18, 2013)
Market Shaping for Chlorhexidine for Umbilical Cord Care:
A brief summary of efforts to introduce and scale-up chlorhexidine for umbilical cord care in selected countries.
- Democractic Republic of the Congo (October 2013)
- Liberia (October 2013)
- Madagascar (October 2013)
- Nepal (October 2013)
- Nigeria (October 2013)
More specifc Information and resources from programmatic experience in Nepal, Nigeria, Bangladesh, and India are provided below.
- Chlorhexidine in Nepal: A Public-Private Partnership Case Study (July 2013)
- Video! Nepal: Reducing Newborn Death Through Better Cord Care (November 2012)
- Better Cord Care Saves Babies' Lives in Nepal: Presentation to UNCoLSC in Abuja, Nigeria (October 2012)
- Video! Better Cord Care Saves Babies' Lives (August 2012)
- A Study on Cord Care Practices in Bardiya District (April 2007)
- Survey tools
- Semi Structured Interview with Recently Delivered Women
- Semi Structured Interview with Mothers in Law
- Semi Structured Interview with TBAs/FCHVs
- Semi Structured Interview with Cord Cutting Occupational Groups
- Focus Group Discussion with Recently Delivered Women
- Focus Group Discussion with Mothers in Law
- Focus Group Discussion with Ocuupational Castes
- Formative Research: Operations Research Draft Report and Presentation (2010)
- Chlorhexidine Product Attribute Study (2008)
- Operations Research Phase II Instructions for Use (2009)
Access additional resources and coverage on chlorhexidine for umbilical cord care:
We can save thousands
For less than fifty cents a dose, chlorhexidine could save an estimated 422,000 babies over the next five years.
Chlorhexidine Working Group (CWG)
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 is the Secretariat for the CWG, and participants include individuals representing:
- Bill & Melinda Gates Foundation
- Boston University
- John Snow, Inc. (JSI)
- Johns Hopkins Bloomberg School of Public Health
- Lomus Pharmaceuticals Pvt. Ltd.
- Maternal and Child Health Integrated Program
- Promoting the Quality of Medicines Program/United States Pharmacopeia
- Population Services International (PSI)
- Save the Children/Saving Newborn Lives program
- Systems for Improved Access to Pharmaceuticals and Services Program/Management Sciences for Health
- United Nations Children’s Fund Programme Division
- United Nations Children’s Fund Supply Division
- United States Agency for International Development (USAID)
- Venture Strategies Innovations
- World Health Organization (WHO)
For more information, please contact firstname.lastname@example.org.
Leading experts from the Chlorhexidine Working Group representing JSI, PATH and Save the Children held a discussion on chlorhexidine programming in Madagascar, Nepal and Nigeria. Watch the video to get an overview of the event, held in Washington, DC in January. >> Watch the Video
Chlorhexidine Use in Nepal
As part of a research trial in Nepal’s Banke district, Female Community Health Volunteers (FCHVs) are trained to educate mothers and caregivers about the dangers of cord infection and to apply chlorhexidine to the cord immediately after cutting. Follow two dedicated FCHVs as they counsel women and teach them to use chlorhexidine on their newborn's umbilical cords.
>> Launch photo gallery