Nepalese Newborns and Chlorhexidine: Match Made in Heaven
Every year, thousands of Nepalese newborns die due to various life-threatening infections contracted early on that go unaddressed. Currently, one in 19 Nepalese children dies before they reach the age of five and half of that number die before reaching even 28 days of life.

Finding successful ways to nurse newborns to health in Nepal has been a challenge for decades. Navel Glazers, a simple topical application of chlorhexidine digluconate (CHX), are helping to pave the way to a brighter future for Nepalese children.

The application of CHX has been used in health care settings to reduce the development and transmission of infections for a number of years now. However, due to limited support regarding its effectiveness in reducing newborn umbilical cord infections, it is not a widely known practice.

Per the recommendation of the World Health Organization (WHO) more studies have been done to assess the navel-glazing strategy, specifically in high-risk environments like Nepal.

Country-wide clinical trials of CHX application post-birth were rolled out in Nepal through the support of the National Institutes of Health, the Bill and Melinda Gates Foundation and USAID.

It was found that applying a 4 percent chlorhexidine solution to the umbilical cord after birth significantly reduced neonatal mortality.

“This is very important because, after its implementation, the number of infected umbilical cord cases in my facility declined,” explains Birendra Ghale, a health worker in charge of this peripheral-level health facility in Banke, Nepal. “I have also seen that fewer babies are dying in my VDC [village development committee].”

For a long time, cultural barriers kept the implementation of the newly-found, life-saving technique from being used. Nepalese mothers are accustomed to applying substances like turmeric, ash, cow dung or vermilion to their child’s umbilical cord post-birth.

Now, single-dose tubes are freely distributed to all expectant mothers in their eighth month of pregnancy. They also receive a one-on-one educational session to explain how to apply the gel after cutting the cord as well.

Chlorhexidine has rolled out to 26 of 75 districts in Nepal as of July 2012. The country’s government has committed to incurring the full expense of buying the commodity as well as other program costs from its own resources. They are even using a local manufacturer to help with a production of a high-quality product, and distribution continues to rapidly expand — mainly through community health workers.

Delegates from more than 20 countries learned from Nepal and its implementation of the program. At least five of those countries have implemented similar interventions.

According to the Healthy Newborn Network (HNN), the application of CHX is recognized as being successful, acceptable, feasible and cost-effective newborn care intervention. The widespread practice of CHX cord cleansing, or navel glazing, could prevent more than 200,000 newborn deaths each year in South Asia.

Keaton McCalla

Photo: Flickr