18 July 2012

Groundbreaking Intervention Will Save Infants' Lives

The application of chlorhexidine on a newborn’s umbilical cord at home and soon after birth can greatly reduce the risk of infection. A recent study in The Lancet looked at the application of this simple intervention in Bangladesh and Pakistan. The effectiveness of the intervention was already known, but the studies confirmed that it could be help save lives in low resource settings.

Data from 54,000 newborns in the two studies and Nepal, where the chlorhexidine solution is already being used showed an aggregate 23% reduction in neonatal mortality, excluding deaths in the first few hours of life, and a 68% reduction in severe infections when comparing the intervention group to the control group. That is stunning.

In Nepal, the price of a packaged product is estimated between US $0.11 and $0.43. Further studies are taking place in Africa to learn more about the behaviors and preferences for the product. For example, studies show that the gel form of chlorhexidine is preferred in Nepal. On the other hand, a Zambian study indicated a preference for the liquid form.

The solution is easy to carry out, effective and cheap. A true win-win-win for global health.

According to the Healthy Newborns Network blog, "Hospitals in the US and other developed countries already use it to prevent umbilical cord infections. But in developing countries, where the majority of births happen at home and in communities where poor hygiene leads to very high newborn infection and death rates, there is little experience with – and evidence for – chlorhexidine cord cleansing. In fact, cord care practices in many developing countries are steeped in cultural and religious traditions, and involve putting a number of different harmful substances on the cord. Unfortunately many of these practices greatly increase exposure of the umbilical cord to bacteria that cause fatal infections."

Both studies employed a 4% chlorhexidine that PSI believes is destined to be the next “major event” in public health. Presently we are advising PSI platforms to assess the value of the product in their country context and determine appropriateness of incorporating the product into their strategic plan.

"The advantage of the intervention is the ease of application. Community health workers, hospital staff, midwives and even mothers can be trained in applying the chlorhexidine solution," said Dr. Abel Irena, PSI Research Advisor on Child Survival. Latest estimates show that neonatal mortality makes up over 40% of global under five child mortality; 29% in Africa and 54% in Southeast Asia.

Presently, the WHO does not recommend the use of 4% chlorhexidine. It says to keep the umbilical cord clean and dry, unless it is tampered with for cultural reasons. In that case, it suggests the application of a 5% chlorhexidine solution. "I expect the WHO to change the guidelines in the near future to reflect the findings from the the two studies," said Dr. Irena. He said studies in Sub-Saharan Africa are wrapping up soon, but expects them to largely confirm the findings of the Lancet-published studies.

Note: I wrote this a few months back for PSI and it got lost in the shuffle. Since I took the time to put this together, I figured it was better late than never.