Over the past 10 years, infant mortality in Nepal has decreased. The number of infants dying before they reach age one has been reduced by more than 50 percent. In 2006, the United Nations Populations Fund ranked Nepal as the most affected by infant and maternal mortality in South Asia. Not many people know what chlorhexidine does for Nepal. However, chlorhexidine is becoming more common in routine care nationwide. Over 1.3 million newborns throughout Nepal benefit from this product.

How Chlorhexidine Helps Nepal

Chlorhexidine is an antiseptic used in hospitals to disinfect the skin before surgery and to sanitize surgical tools. In countries like Nepal, it is used to prevent deadly infections by protecting the umbilical stumps of newborns. It is safe and affordable. Chlorhexidine comes as either a gel or a liquid. It is easy to manufacture and simple to use. Mothers, birth attendants and others with little training in low-resource settings benefit the most from this antiseptic.

Research and Trials

Between November 2002 and March 2005, Nepal Nutrition Intervention Project, Sarlahi (NNIPS) started a community-based trial. The trial hoped to determine the effects of chlorhexidine on newborns. Nepal Health Research Council and the Committee on Human Research of the Johns Hopkins Bloomberg School of Public Health approved the trial. A local female researcher approached women who were six months into pregnancy for enrollment, to explain the procedures and obtain their oral consent.

Education also became a part of the research testing for those in the chlorhexidine trials. Parents in this group received educational messages about clean cord care.

Results

The NNIPS enrolled 15,123 infants into the trials. Of these infants, 268 resulted in neonatal death. Of the surviving infants, researchers found that there is a 24 percent lower risk of mortality among the chlorhexidine group than those who use dry cord-care (no soap and water, chlorhexidine or any other liquid). Also, infant mortality in Nepal was reduced by 34 percent in those enrolled in the trial within the first 24 hours of their birth.

The trial data also provides evidence that cleansing the umbilical cord with chlorhexidine can lessen the risk of omphalitis and other infections. Omphalitis, a cord infection, was reduced by 75 percent when treated with chlorhexidine. The antiseptic was determined to have an overall positive and significant effect on the public health of the country.

Impact in Nepal

In 2009, after results of the trials released, the USAID supported the Government of Nepal to pilot a chlorhexidine program. Saving Lives at Birth: a Grand Challenge for Development, an NGO, included chlorhexidine into routine care nationwide two years later. The Government of Nepal has advocated and promoted the usage of chlorhexidine by packaging the products as a maternal health product. They are now even educating health care workers on the application of the product.

The country received a USAID Pioneers Prize for lowering the neonatal death rate significantly. In 2007 the mortality rate was 43.4 per 1,000. In 2018, it lowered to 27.32 per 1,000.

Global Impact

What chlorhexidine does for Nepal goes beyond its borders. Nepal has also impacted countries such as Nigeria, Pakistan, the Democratic Republic of the Congo and Bangladesh. These countries are now using chlorhexidine to lower the infant mortality rate and create healthier societies.

In 2013, Nigeria started chlorhexidine pilot programs to also lower its neonatal death rate. The infant mortality rate is determined by newborn deaths per 1,000 people born. Nigeria once had the third-highest number of infant deaths (75.3 per 1,000). However, the infant mortality rate now is ranked as the eighth-highest at about 64.6 deaths per 1,000.

Chlorhexidine is reducing infant mortality in Nepal and other countries.

– Francisco Benitez
Photo: Flickr