EARTHQUAKE in NEPAL: Need for rapid scale up of Chlorhexidine for cord care

Chlorhexidine is a simple, cheap and effective antiseptic that works against a broad spectrum of bacteria as well as some viruses. Chlorhexidine application to the freshly cut umbilical cord reduces neonatal death by 23% (Imdad, 2013). Nepal is a world leader in introducing the use of chlorhexidine for cord care from research to national level scale-up. To date, more than 1.3 million babies have received chlorhexidine, resulting in at least 8,000 lives saved. Scale-up is integrated with existing maternal and child health policy, programs, information systems, and logistics management of the government. Use of chlorhexidine is essential where newborn mortality is high, infection prevention practice is inadequate, home delivery is highly prevalent, early discharge from institutions of mothers and neonates is common practice, and prevalence of use of harmful materials is high. The initial plan was to implement the gradual scale up and reach at national level by 2017. Following the devastating earthquake of April 2015, thousands of pregnant women compelled to live in tents or temporary shelters. The massive destruction of health facilities resulted compromised service delivery, including poor hygienic conditions and infection prevention practices. Babies were born in the temporary shelters and tents with limited facilities. Rapid introduction of chlorhexidine for cord care, as part of a more comprehensive health kit in the affected area, prevented deaths and infections among neonates. More than 1500 frontline health workers and about 1400 female community health volunteers were trained to distribute and use the chlorhexidine for cord care. Key Words Crisis, newborn, earthquake, Chlorhexidine Key Message Rapid scale up the use of chlorhexidine is possible using the existing health service delivery system even in crisis. Use of Chlorhexidine for cord care is more important during crisis to save lives of newborns. Use of chlorhexidine for cord care can prevent neonatal sepsis and death during a crisis.

Penelope (PENNY) Dawson

JSI Research & Training Institute Inc. (JSI)

I am a Canadian physician and have worked in developing countries for more than 35 years in various fields of public health, from “hands-on” clinical practice in a remote, rural hospital in the Himalayas to implementation of integrated programs on a national scale. In Nepal, I have contributed to the expansion of several community-based (CB) child health initiatives including vitamin A distribution, pneumonia/diarrhea treatment which evolved into CB-IMNCI, neonatal health initiatives (including use of chlorhexidine for umbilical cord care) and programs to improve rational commodity management and distribution. During my career I have worked in Canada, India, Nepal, Ethiopia, Pakistan, Namibia, Madagascar and Myanmar. I am currently Sr. Technical Advisor for JSI based in Kathmandu, Nepal and provide technical support to the Chlorhexidine Navi (Cord) Care Program.