Better Cord Care Saves Babies' Lives in Nepal

JSI Research & Training Institute, Inc.
Organization Location: 
Boston, MA USA

In Nepal, despite recent efforts to increase deliveries attended by a skilled provider, fewer than 20 percent are reached with such care. Much of the population faces significant geographic barriers to care, and a large proportion of newborns are exposed to poor hygiene conditions over their first few days of life. Nearly 70 percent of infant deaths occur within the first month of life, the most common cause being infection. A trial in Nepal has shown that risk of death can be reduced by 24 percent with application of the antiseptic chlorhexidine (CHX) to the umbilical cord stump. Operations research in Nepal has demonstrated that latent demand is high, and there are distribution channels available which can reach a large proportion of deliveries. In four pilot districts, JSI has tested and shown successful a multi-channel distribution approach, relying primarily on a nationwide cadre of female community health volunteers (FCHV) who already provide other antenatal care (ANC) support. CHX was also distributed through ANC visits. JSI has worked with a Nepali pharmaceutical firm, which manufactures the product, to sell CHX through the firm, which manufactures the product, to sell CHX through the firm’s usual wholesale/ retail network in pilot districts. JSI proposes scaling up these approaches as a realistic strategy to rapidly and sustainably achieve high coverage of CHX application to the newborn cord stump, nationwide. No other intervention has equal potential for rapidly reducing newborn mortality in such settings. With support from Grand Challenge and with the government and in-country partners, JSI expects to achieve rapid national scale-up.