1. Plan International
Bhagawan Das Shreshta, Harpreet Anand, Vidya Sampath
May 2, 2012 – Core Group Spring Meeting
02 May
2012 1

2.  What does the Science tell us?
 What did the Nepal Government want to do?
 What was Plan International’s role in this?
 What are the policy implications and next
steps?
Promising Futures,
Community by Community
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3.  Recently-cut cord is common portal of entry
for bacteria
 Causes newborn sepsis and death from serious
infection
 Bacteria can enter bloodstream
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Community by Community
05/07/12 3

4.  4% CHX ointment reduces:
- severe cord infection (by 65%)
- neonatal mortality (by 23.5%; 34% if applied on
day of delivery)
- incidence of severe infection of umbilicus
stump (by 70 - 80%)
[source: Mullany et. al, 2006]
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5.  Current neonatal mortality rate: 33 deaths per
1000 live births/23,000 neonatal deaths every
year;
 72% of infant deaths; 61% of U5 deaths;
 Umbilical cord infection is about 62% of local
bacterial infection;
 Pilot CHX programs in four districts: Banke,
Bajhang, Jumla, and Parsa.
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6.  Global organization, established in 1937, that
works side by side with communities in 50
developing countries to end the cycle of
poverty for children;
 In Nepal since 1978
 15 districts
 2 million people
 Four CSHGP grants
(1997 – 2011)
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7.  “Local Innovation for Better Outcomes for
Neonates” (2006-2011);
 Key factors for success: Pregnant Women’s
Groups (PWGs), facilitated by Female
Community Health Volunteers (FCHVs);
 10-12 pregnant women in each group,
facilitated by 1 FCHV;
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9.  FCHV role:
- Motivate women to utilize MCH services;
- Distribute pre-natal medicines;
- Present at childbirth and immediate care of
neonate;
- Home visits after birth (1st, 3rd, 7th & 29th
days);
- Diagnoses and Referrals.
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10. Promising Futures,
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11.  Measure the coverage and compliance in the
application of CHX at the community level;
 CHX supplied in a tube marketed under the
brand name “Kawach”;
 Participants were informed on proper usage.
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12. Promising Futures,
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13.  Coverage rate: 82.7% of newborns had CHX
applied to their umbilical cord;
 Compliance rate: 66.4% (of above) applied
CHX correctly;
 97% used full tube of CHX; 2% partial tube.
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Community by Community
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17.  Women who belong to PWGs were 1.3 times more
likely to have correctly applied CHX, than those
who were not;
 None of the women in PWGs reported using
harmful substances on stump, as per usual local
practice, such as cow dung, oil, or turmeric
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Community by Community
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18.  Plan Nepal, through its organizational funds,
continues the CHX program by integrating it with
Community Based Newborn Care Program
(CBNCP) in Rautahat district;
 As of April 30, 2012:
- 8 districts completed CHX integration with CBNCP
- 7 districts ongoing
- Planning has commenced to add on 5 more
- By June 2013, total CHX coverage goal: 45 out of 75
districts in Nepal.
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Community by Community
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19.  The 4% CHX lotion is listed in the essential drugs
list of Ministry of Health and Population of Nepal;
 CHX lotion is free of cost;
 CHX will be scaled up and integrated with CBNCP
all over Nepal
 The CBNCP training manual and reporting formats
have been revised to include CHX components.
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Community by Community
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20.  WHO recommendation: “dry cord care is
general recommendation, but when adequate
hygiene cannot be assured in household
environment, CHX should be used”;
 USAID brief: “there is sufficient evidence to
recommend introduction of 4% chx cord
cleansing, in place of dry cord care, as a
strategy to reduce neonatal mortality in
settings of high neonatal mortality and poor
hygiene”
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Community by Community
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21.  CHX Working Group:
http://www.healthynewbornnetwork.org/topic/chlorhexidine
 USAID Technical Brief: www.usaid
.gov/our_work/global_health/mch/.../chx_issuebrief.pdf
 Johns Hopkins page on CHX:
http://www.jhsph.edu/publichealthnews/press_releases/2012/baqui_cord
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