The Bangladesh Ministry of Health and Family Welfare (MOHFW) implemented a policy in 2014 that supported universal cleaning of the umbilical cord stump at the time of delivery using chlorhexidine digluconate (CHX), a broad spectrum antiseptic. Prior to introduction of this policy, the recommendation from the MOHFW was to keep the cord dry, but common practice in Bangladesh was to apply various substances to the umbilical cord that were not medically recommended, risking newborn infection and mortality. In the years since policy introduction, efforts by the MOHFW and their partners have resulted in Bangladesh becoming one of the first countries to scale-up universal CHX cord cleansing.
Since 2015, Bangladesh has been producing CHX solution in a dropper bottle to ensure distinction from lotion or gel. This was implemented as part of the ‘National Scale-up of 7.1% Chlorhexidine in the Newborn Umbilical Cord’ initiative. Despite a national policy for CHX distribution in communities by community health workers to pregnant women, the MOHFW initially took precaution and did not encourage home-based use of CHX after there were reported incidents of misuse & eye injury in another country. Initially, Bangladesh supplied CHX in facilities only (from February 2016). Though CHX was widely distributed at community level in two districts (Kushtia and Lakshmipur) during this time along with proper counseling, a leaflet of messages and strong monitoring. Not a single occurrence of misuse or morbidity was reported.
Bangladesh has been able to prevent any misuse of the dropper bottle form of CHX due to preventative efforts by MOHFW and partners. For example, instructions to the manufacturer* were clear that the bottle should look different, with the cap being purple in color to differentiate from other available eye or nasal drops. The National Technical Working Committee for Newborn Health then recommended the manufacturer make the cap of the bottle more innovative to differentiate it from any other dropper bottle and minimize any confusion. As a result, the cap of the CHX bottle was made flattened – but remains the same purple color – to make more unique in presentation. In addition, manufacturers were asked to include a pictorial message in the label of the bottle regarding use in the newborn umbilicus. An additional advantage is that there is no program for eye drop or eye ointment for newborns in Bangladesh.
As part of the national scale- up, Bangladesh has made CHX available in private pharmacies as an over the counter product with pictorial messages provided to the consumer. So far, Bangladesh does not have any reported incidents of CHX-misuse resulting in eye injury or other adverse outcome in focused project areas or in other districts.