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chlorhexidine reduces neonatal mortality
Although the neonatal mortality rate across the globe has been consistently decreasing, neonatal death is still common in many regions. According to the World Health Organization (WHO), annual infant deaths were at an all-time low of 4.1 million deaths in 2017, decreasing from 8.8 million in 1990. However, the death rate in Africa is over six times higher than it is in Europe, illustrating a severe disparity. As such, there is still much more that people can do to lower neonatal mortality rates. One potential solution is chlorhexidine, which reduces neonatal mortality.

How Chlorhexidine Reduces Neonatal Mortality

To combat mortality rates, Save the Children and governments in Nepal and Nigeria have implemented chlorhexidine, an antiseptic found in mouthwash. When used to clean the umbilical cord as soon as possible after birth, chlorhexidine reduces neonatal mortality by preventing infection in newborns, which is among the top drivers of neonatal deaths across the globe. Save the Children and pharmaceutical company GlaxoSmithKline (GSK) partnered to create a chlorhexidine gel to distribute in wrapped pouches. Save the Children noted that this gel “was developed to be suitable for use in high temperatures, useful in sub-Saharan Africa and [South] Asia where the risk of newborn infections is high and temperatures are hot.”

Chlorhexidine gel has become wildly popular in Nepal, where USAID created the Chlorhexidine “Navi” Care Program to distribute chlorhexidine gel. In Nepal, around half of deliveries happen at home, making newborns even more exposed to infection if they are not delivered in a clean environment. In fact, a large majority of deaths in Nepal occur within the first month of life. Moreover, infections cause half of those deaths. In Nepal, chlorhexidine has reduced neonatal mortality by 24% and decreased the rate of infections in newborns by 68%. The Chlorhexidine “Navi” Care program’s objective aims to distribute chlorhexidine gel to all 75 districts of Nepal.

The Lifesaving Effects of Chlorhexidine

Nepal is not the only country to see chlorhexidine reduce neonatal mortality rates. Nigeria, one of the most populous countries in Africa, has also seen success. Its neonatal mortality rate has dropped from 48 deaths per 1,000 births in 2003 to 37 deaths per 1,000 live births in 2013. According to many estimates, infections cause at least one-third of newborn mortalities in Nigeria. In March 2016, Nigeria created a plan to scale-up the use of chlorhexidine to lower neonatal mortality rates. If this program succeeds, it will save 55,000 infants. Although this scaling up program started slowly, the Nigerian government has committed to continuing the use of chlorhexidine to prevent infection and fatalities. To do so, it has a plan in place to help local governments achieve their goals.

Across the globe, there are large imbalances in neonatal mortality rates. Countries like Pakistan, Afghanistan and Somalia have a much higher neonatal death rate than countries such as Australia, Canada or China. In developing countries where poverty rates are higher, neonatal death skyrockets due to a lack of resources. This simple, cheap and over-the-counter chlorhexidine gel is saving lives across the globe. As chlorhexidine becomes even more accessible to every community, it is hopeful that neonatal deaths will continue to decrease.

Hannah Kaufman
Photo: Flickr

USAID Saves Thousands of BabiesRoughly 2.76 million newborns die each year, with preventable infections causing at least 15% of those deaths. For instance, a baby’s cut umbilical cord could allow bacteria to enter their body, leading to life-threatening newborn sepsis. To avoid neonatal deaths like this, cord stump care at birth is critical, particularly in settings with poor hygiene. Thankfully, with national assistance, USAID saves thousands of babies in Nepal and other countries around the world.

There is a low-cost, easily manufactured and easily distributed life-saving solution that the World Health Organization (WHO) recognized in 1998 as a suitable antiseptic for cord care. Commonly found in mouth wash and hand sanitizers, chlorhexidine is an antiseptic gel that USAID helped produce for nations with the greatest need since 2002. Nepal was the first nation to adopt chlorhexidine on a large scale. USAID’s efforts, as well as cooperation with the Government of Nepal and its private sector, are responsible for lowering the infant mortality rate significantly. USAID saves thousands of babies around the world.

Chlorhexidine “Navi” Care Program

USAID’s Chlorhexidine “Navi” Care Program, implemented by John Snow Inc. (JSI), provides technical assistance to the Government of Nepal to scale up the use of chlorhexidine through resources and education. The six-year, $3.9 million program had two phases. The first phase occurred from October 2011 to September 2014 in 49 out of 75 of Nepal’s districts. Phase two started in October 2014 and brought chlorhexidine to all districts. The program found funding as a part of USAID’s “Saving Lives at Birth: A Grand Challenge for Development.”

The Nepali government strongly advocated for this scale-up. The administration incorporated single-use chlorhexidine tubes into its maternal and child health packages. In addition, it also trained health care workers for use of the antiseptic. Nurses began to use chlorhexidine at birthing centers across the country. They apply the antiseptic to the umbilical stump immediately after the cut. Its use in Nepal decreased newborn infections by 68% and decreased newborn deaths by 24%. Chlorhexidine for cord care thus became an integral part of maternal and infant health programs. Through the implementation of its new programs like this, USAID saves thousands of babies.

According to the Bill & Melinda Gates Foundation, Dalberg Global Development Advisors and the Boston Consulting Group, it usually takes more than a decade for global health innovations to develop in low and middle-income nations. In Nepal, it took around five years.

The success of USAID’s Navi Care Program is attributed to its partnering with the Government of Nepal and various organizations. USAID’s partners include MoHP, Save the Children, Plan International, Health For Life (USAID), UNICEF, One Heart Worldwide and PSI. Future initiatives should replicate USAID’s coordinated effort due to this program’s monumental success.

Nepal’s Success Serves as a Model for Others

Other nations have taken notice of Nepal’s health improvements and how USAID saves thousands of babies. Many nations sent their leaders and officials to speak with those who worked on the program to expand the use of chlorhexidine in their own countries. Following Nepal as a model, these nations have planned trials with the antiseptic gel. All program-related materials are public, supporting the global trend. As a result, Nigeria, Bangladesh, Pakistan and the Democratic Republic of Congo have begun the process of scaling up chlorhexidine to reduce newborn death rates. In particular, Nigeria has made substantial progress.

USAID’s efforts to lower infant mortality rates yielded fruitful results from a single and simple solution. As a result, it inspired efficient innovation elsewhere. This program was a tremendous global success, as USAID saves thousands of babies and makes the world a healthier place. USAID’s programs will hopefully continue to work with the governments and organizations in low- and middle-income nations to achieve the optimal adoption of healthcare initiatives.

Mia McKnight
Photo: Wikimedia Commons

 

Infant Mortality and Chlorhexidine in Liberia When applied to the umbilical cord and stump, the antiseptic chlorhexidine has been shown to reduce neonatal deaths by preventing infection. Liberia, which has high rates of infant mortality, has included chlorhexidine in its national health policy. As health is closely linked to poverty, this is an important measure in improving both the health and prosperity of Liberians. Chlorhexidine and infant mortality in Liberia represent a global health success story.  

Liberia and Public Health: A Brief Background 

Liberia is a country in western Africa with a population of around five million and a per capita income of $710. The country faces a variety of public health crises. For instance, life expectancy in Liberia is 64 years for women and 62 years for men, and the infant mortality rate was 50 per 1,000 live births as of 2018. Neonatal disorders are the third most common cause of death, exceeded only by malaria and diarrheal diseases, which also commonly affect infants and young children.

Chlorhexidine

Around the world, 21% of neonatal deaths are caused by severe bacterial infection. This amounts to over 500,000 neonatal deaths annually. Fortunately, simple and affordable interventions can greatly reduce the occurrence of neonatal infection. Chlorhexidine is a prime example. It is an affordable antiseptic that is easy to manufacture and use. Hospitals often use chlorhexidine as a preoperative skin disinfectant, as well as for sterilizing surgical instruments.

When chlorhexidine is applied to the umbilical cord stumps of newborns, it can prevent infection and the complications of infection. Studies demonstrate that using chlorhexidine on newborns can decrease the risk of severe infection by 68% and can decrease the risk of neonatal mortality by 23%. Chlorhexidine is now used in neonates in several countries around the world, including the Democratic Republic of the Congo, Malawi, Madagascar, Afghanistan, Pakistan, Nepal and Bangladesh.

Using Chlorhexidine in Liberia

In Liberia, the newborn mortality rate was 26 per 1,000 live births in 2013. Neonatal deaths accounted for 35% of deaths of children under the age of five, and severe infections were the cause of 28% of neonatal deaths. To address this problem, Liberia adopted a chlorhexidine policy in 2013 requiring the application of chlorhexidine. The Liberian Ministry of Health and Social Welfare stated, “Henceforth 7.1% chlorhexidine digluconate (4% free chlorhexidine) will be applied to the tip of the [umbilical] cord, the stump and around the base of the stump cord of all babies delivered in Liberia immediately after cutting the cord as with repeat application once daily until the cord separates.” The policy follows WHO guidelines for infants born in areas of high neonatal mortality. Chlorhexidine was also added to Liberia’s essential medicines list.

Liberia has benefitted from the support of the U.S. Agency for International Development (USAID) Maternal and Child Survival Program and NGO partners like Save the Children. These organizations have helped Liberian healthcare to implement chlorhexidine use, train health workers and ensure supply and intake. The policy reduced infant mortality in Liberia by 2.2% annually.

The Ministry of Health and various organizations have made important strides in reducing the rates of infant mortality in Liberia. Using chlorhexidine in Liberia is a powerful example of how simple interventions can effectively improve health, save lives and help to end poverty. 

 

– Isabelle Breier

Photo: Flickr

ChlorhexidineAn estimated 390,000 babies die within their first months of life annually due to severe infections. For the past decade or so, USAID has been combating this number with a low-cost yet highly effective antiseptic called Chlorhexidine. The chemical is typically used in hospitals to either disinfect the skin before a surgery or to sterilize surgical equipment, but USAID says that the antiseptic “can also be used to protect the umbilical stumps of newborns to prevent life-threatening complications from an infection.” These infections, USAID explains, can in part be a regular consequence of the traditional home birthing practices found in poorer countries. After conducting multiple studies, it has been shown that even a “one-time chlorhexidine treatment can lower the risk of severe infection [in infants] by 68 percent and infant death by 23 percent.”

Countries Adopting Chlorhexidine

Because it is relatively cheap, easy to manufacture and proven to be effective, around 30 nations throughout Africa and Asia either expressed interest in the antiseptic or have begun working with USAID to integrate the antiseptic into their healthcare system over the past several years.

Case Study: Nepal

Nepal was the first nation to implement the treatment back in 2011. It has since reduced the likelihood of infant illness and mortality by 34 percent. The success in Nepal is what inspired a chain-reaction that lead to the antiseptic being adopted into a variety of different countries—but the success of the disinfectant did not come without its challenges.

Before Chlorhexidine was initiated into their health system, the World Health Organization (WHO) recommended that the nation adopt a dry care system to treat the umbilical cord; this system required that the mother keep her child’s umbilical stump clean and dry until the stump fell off on its own while she kept an eye out for any signs of infection.

Due to cultural barriers, this suggestion was not followed. USAID said that mothers in Nepal had been used to routinely applying unsanitary substances such as turmeric, ash, cow dung or a mercury-based red cosmetic powder used by Hindu women to the umbilical stump by hand. Thankfully Nepal has been impressed with the results Chlorhexidine has supplied but the earlier setbacks in treatment shed an important light for USAID and its partners on how complex assimilating a scientifically safe treatment into impoverished nation’s culture can actually be.

Today, both single-dose tubes of the antiseptic are freely distributed to all expecting mothers in their eighth month of pregnancy and a one-on-one training session explaining how to safely apply the gel after cutting the umbilical cord.

Case Study: Pakistan

Pakistan implemented the treatment in 2014. Pakistan reportedly has the third-highest newborn mortality rate in the world, with umbilical cord infections serving as the second leading cause of death to Pakistani newborns. Seeing as Pakistan is a much larger and complex country, it faced a different set of challenges than Nepal when it came to making the antiseptic widespread.

There were some cultural barriers to overcome in Pakistan as well—many Pakistani women used to treat umbilical cords with surma, a lead-based concoction)—but the main challenge the nation had to overcome was to bring together all the government and private offices working towards a Chlorhexidine treatment program independently. To convene all of these health offices together and collaborate on an implementation plan was no small feat and took around a full year, and then the plans were formally adopted another year later, in 2016.

Of course, Chlorhexidine comes with its own set of risks. Although it has been found to reduce infections, it has also been discovered to cause rashes and burns on some skin types. Even so, the use of Chlorhexidine in both Nepal and Pakistan shows that although the process of assimilating treatment is not always easy or quick, it yields hopeful results that encourage nations in the surrounding areas to adopt the life-saving drug as well.

– Haley Hiday
Photo: Flickr

Infant Mortality in NepalOver 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

Chlorhexidine Maternal Health Infant Mortality Happy African Child
Despite declining mortality rates for children under five, deaths that occur within the first month of life are on the rise. Infections caught through the cutting of umbilical cords are a factor in nearly 13 percent of neonatal deaths worldwide and more than 50 percent in developing nations. A simple, affordable solution is presented by the antiseptic solution chlorhexidine.

Chlorhexidine has already been around for more than 50 years, and can be found in a variety of products, like hand sanitizers and mouth washes, both of which are available in the United States and Europe. The type of chlorhexidine that would be used specifically to treat and prevent umbilical cord infections is 7.1 percent chlorhexidine digluconate. It would potentially prevent over 200,000 deaths a year in South Asia alone. Up to 75 percent of serious umbilical cord infections are eliminated through its use as well. According to PATH, the cost of providing chlorhexidine would be less than fifty or even thirty cents a dose.

In July, the World Health Organization (WHO) listed 7.1 percent chlorhexidine digluconate on its Essential Medicines for Children. More instructions on how chlorhexidine will be used are coming later this year. Despite chlorhexidine’s supposed effectiveness, progress is slow to distribute it. At the moment, there are only two sources for purchasing 7.1 percent chlorhexidine digluconate for umbilical cord use: Lomus Pharmaceuticals in Nepal and UNICEF Supply Division.

PATH, the secretariat of the Chlorhexidine Working Group, is working to spread the word about the low cost and high effectiveness of 7.1 percent chlorhexidine in order to see it used in more locations and countries where it is needed most, particularly in African countries.

– The Borgen Project

Sources: Huffington PostPATHHealthy Newborn Network, Trust
Photo: The Script Lab