SEATTLE — In 2016, Nepal experienced 12,000 newborn fatalities. This is a small number compared to the 2.6 million newborns who die every year before reaching one month of age. Globally, 15 percent of newborn deaths are caused by infection, but Nepal has an even higher occurrence at 35 percent. These deaths are caused by severe infections that can easily be prevented with inexpensive treatments. One new treatment that has seen real results in recent years and has been widely used to prevent newborn deaths in Nepal is called chlorhexidine (CHX).
What is CHX and How Does It Work?
Chlorhexidine is an antiseptic that comes in gel or liquid form and is easy to use, make and purchase. It is often used to clean medical tools in hospitals or clean skin before surgery, but in developing countries it is now being used as a form of protection for umbilical stumps on newborn babies to prevent infection. Newborns are at risk of contracting severe infections through newly cut umbilical cords, making cord care extremely important.
This antiseptic has previously been used in hand sanitizers and mouthwash, but its new formulation, with a higher makeup of active CHX ingredients, has been a literal lifesaver in countries like Nepal. Severe infections such as these occur more frequently and cause newborn deaths in Nepal mainly because of the traditions involved with home births and are far more common in low-resource countries. Some of these traditions involve cutting cords with unclean tools from around the house and using turmeric or cow manure to treat the stump.
CHX is a life-changing treatment for newborns, with studies showing that using this treatment one time can decrease the potential for infection by 68 percent and newborn fatalities by 23 percent. It is also used and considered essential to newborn health in many countries in sub-Saharan Africa and South Asia. These improvements and successes could not have been possible without the teamwork and dedication of several important groups.
Who Is Working to Prevent Newborn Deaths in Nepal?
USAID started researching and using CHX more widely in developing countries in 2002. After seeing studies on how effective this antiseptic is, Nepal led a CHX program supported by USAID in 2009, and within two years it became part of routine care throughout the nation. The government of Nepal worked hard to increase the use of CHX and included it in packages for maternal and child health, acquired materials and training for healthcare providers and has advocated strongly for its use.
This treatment was also promoted by the Chlorhexidine Working Group, made up of people from different organizations around the world starting in 2012 and hosted by PATH. Success is also due in part to the work of the Chlorhexidine Navi Care Program, led by John Snow Inc. This group, along with USAID and the government of Nepal, documented the successes and failures in the scale-up program. A combination of local production capabilities, market research, advocacy, policy work and government and private sector cooperation made this wide-scale usage possible.
Within 10 years’ time, CHX was being used throughout the country, saving nearly 10,000 lives and benefiting 1.3 million babies. The speed and effectiveness with which CHX was implemented to decrease newborn deaths in Nepal was rather unprecedented, with studies showing that it normally takes decades to achieve this level of success in low-income countries. This success story is being applied to other countries in the hope that similar programs using CHX will save more newborns and prevent life-threatening infections.
– Alexandra Eppenauer