A newborn baby at Lumbini Zonal Hospital in Rupandehi District, Nepal receives a chlorhexidine treatment to its umbilical cord. Photo: Kalpana Chaudhary
This blog was originally published in The Kathmandu Post
Among Nepal’s 50,000 female community health volunteers, Sita is one of the most experienced. She has assisted mothers and newborns during childbirth for 25 years. During the past year, Sita made frequent use of a new, easy-to-use antiseptic ointment called chlorhexidine, which is applied directly to the umbilical cord immediately after birth. Health workers also call this product a kawach—the Nepali word for protector or shield.
In Nepal, about two thirds of births take place at home, often in unhygienic conditions. Many families still apply ash, oil, turmeric paste or other harmful substances to the umbilical cords of newborn babies, which can lead to infection and death.
Assisting a mother named Rihana after one recent childbirth, Sita applied chlorhexidine to the baby’s umbilical cord. Afterwards, the mother was impressed: “I now tell my friends to use kawach since the cord heals sooner.” Mothers in 36 of Nepal’s 75 districts are now being provided the gel, at no cost, to clean the cord immediately after birth to prevent infection. The cost to the government is about Rs 18 per tube and based on recent studies, it appears that the proper use of the gel can reduce neonatal deaths by 15 to 20 percent.
However, chlorhexidine is not a magic bullet that alone can solve the many challenges associated with childbirth. But it is an example of a number of simple, cost-effective intervention that can help reduce newborn mortality. Nepal is committed to reduce newborn deaths using a number of interventions, including chlorhexidine.
Across South Asia, in fact, newborn health is fast becoming a top health priority. Death rates among newborns are declining at much slower rates than deaths among children who survive their first month of life. Indeed, the death toll in South Asia on the first day of life is truly staggering. In 2011, an estimated 423,000 South Asian babies died on the day they were born—including 6,900 babies in Nepal alone.
The risk of dying during the first day of life in South Asia is 11 deaths per 1,000 live births. This means that one baby in every 90 dies on the day he or she is born. In contrast, in some industrialised countries like Sweden and Singapore, the risk is well below one death per 1,000 live births.
First-day mortality rates vary greatly across the region, ranging from a high of almost 13 deaths per 1,000 births in Afghanistan and Pakistan to less than three deaths per 1,000 live births in Maldives and Sri Lanka—a five-fold difference. Nepal is in the upper range with 10 babies dying in the first day for each 1,000 live births.
This past week, health representatives across Asia met in Nepal to focus on ways to improve newborn and maternal health. The meeting is one of a number of consultations scheduled to take place in Africa and Asia this summer and fall to develop a global action plan to save newborn lives. The goal is to expand our ability to save thousands of lives by applying and scaling up evidence-based, cost-effective interventions to address the major killers of newborns: prematurity, low birth weight, severe infections and complications during childbirth.
A decade of research shows that thousands of newborn lives could be saved through simple, cost-effective interventions such as helping women plan healthy pregnancies, providing a skilled attendant at birth, treating newborn infections promptly, helping babies breathe at birth with easy-to-operate resuscitation equipment, encouraging immediate breastfeeding after birth and making more information available about family planning.
Besides strengthening basic health services, simple changes in common home practices—like using chlorhexidine and encouraging mothers to keep their babies warm through skin-to-skin contact—can also have a huge impact in improving newborn health and survival.
While noting the importance of these interventions, we must also acknowledge the real challenges we face in making these interventions available to all mothers and newborns in need. Trained health workers, for example, are in short supply. Appropriate drugs and equipment are often lacking. Even more challenging, most mothers in South Asia still deliver their babies at home.
Helping frontline health volunteers like Sita—especially by providing health workers the training and equipment they need—is an important step to ensuring that the first day of a baby’s life is not their last.