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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