In last week’s issue of the medical journal The Lancet, researchers reported new evidence that a simple, inexpensive and widely available antiseptic could be key in preventing hundreds of thousands of newborn deaths each year. Mothers in countries such as Nepal and Bangladesh often apply traditional liniments such as mustard seed oil to a newborn’s umbilical cord, but the antiseptic, chlorhexidine, applied even just one time in the hours after birth, makes an enormous difference in preventing infection.
Save the Children‘s Monika Gutestam traveled to Nepal in the fall and took the beautiful photographs in the slideshow that follows. First, though, here’s what Monika had to say about the impact of the chlorhexidine treatment on this vulnerable population:
Each year more than 3 million newborns do not survive their first four weeks of life, and more than one million of these newborns die as a result of serious infection, sepsis. After the baby is born the newly cut umbilical cord is especially vulnerable to infection, particularly in low-income settings where births often take place at home and often under unsanitary conditions.
But now we have a new tool in the fight against infection: cleaning the baby’s umbilical cord with the widely used antiseptic chlorhexidine is a simple, safe and effective way to prevent needless deaths. New studies from Pakistan, Nepal and Bangladesh show that using chlorhexidine on the cord can reduce newborn mortality by more than 23%. That means that more than 200,000 babies every year could be saved in Asia alone if mothers and newborns had access to this product.
In September 2011, I had the chance to visit Nepal and see how frontline community health workers help and teach mothers to use chlorhexidine, and witnessed firsthand the great result the use of this product has had. We travelled to Nepalganj, a town on the border between India and Nepal, where I had the opportunity to join two amazing women who both work as Female Community Health Volunteers. Radha Acharya and Sita Singh are part of a 50,000 strong group of trained health workers, delivering care for mothers and newborns in their communities.
The following slideshow shows the impact of the work women like Radha and Sita do every day to care for mothers and babies at home, and how early detection and cleaning the cord with chlorhexidine can save newborn babies.
Each year 3.1 million newborns, babies that are less than 28 days old, die around the world. Infection is one of the top three causes of newborn death worldwide, claiming more than one million newborn lives each year. A baby’s newly cut umbilical cord can be an entry point for bacteria, which can lead to cord infection and potentially life-threatening sepsis.
In Nepal, the 50,000-strong government health worker cadre known as Female Community Health Volunteers (FCHVs), are credited with helping raise contraceptive rates and reduce child deaths among rural families in Nepal over the last two decades. This community-based health worker force is now learning and teaching mothers how to care for their newborn babies during the most dangerous first days of life, and to prevent umbilical cord infections that often become fatal.
Poor hygiene and lack of antisepsis at birth and in the first week of life increase the risk of deadly but preventable infections. In a visit to Srijana’s home, Female Community Health Volunteer Radha Acharya examines her 9-day old baby boy for danger signs. This is the second time Radha has visited Srijana and her baby at their home since giving birth at a nearby hospital. Radha records the baby’s temperature and respiratory rate, and upon examining the cord, discovers signs of cord infection.
After identifying signs of infection, Female Community Health Volunteer Radha counsels the young mother to seek help at the nearest health post. There, the baby is examined again and the infection is treated with antibiotics.
In some countries, cultural and religious tradition involves frequently putting substances such as mustard oil on the cord stump, in belief that it prevents infection. Unfortunately many of these practices greatly increase exposure to bacteria leading to potentially fatal infections. Following tradition, Srijana had been told by her family to rub mustard oil on her baby’s cord. Fortunately, Srijana sought appropriate care in time, and is welcomed back home by her family after their visit and treatment at the health post.
Most deaths due to infection can be averted by prevention, early detection and treatment. A new preventive measure, chlorhexidine cord care, has been tested in Pakistan, Bangladesh and Nepal, and is effective in reducing exposure to bacteria that cause life-threatening infections. Recent studies published in The Lancet confirm that applying chlorhexidine to the stump prevents infection and saves newborn lives. Female Community Health Volunteer Sita Singh has been trained to use chlorhexidine for cord care, and teaches soon-to-be-mother Bimala how to use chlorhexidine to prevent cord infections.
Sita uses a training doll to show how to apply chlorhexidine properly immediately after cutting the cord. As part of a research trial in Nepal’s Banke district, Female Community Health Volunteers are trained to educate mothers and caregivers about the dangers of infection and to apply chlorhexidine to the cord immediately after cutting. The training doll is dressed in a traditional baby cloth called Bhoto-Suruwal to also teach mothers the importance of avoiding hypothermia.
Mother Rihana Maniyar and her newborn baby have benefited from Sita’s counsel and treatment. Sita helped to deliver Rihana’s baby and soon after birth, she applied chlorhexidine on the baby’s umbilical cord to prevent infection.
In Nepal, chlorhexidine is referred to as kawach, meaning protector or shield. Rihana’s 8 day old baby boy is one of thousands of newborns who have benefited from chlorhexidine cord care. Today, we have the evidence needed to introduce and implement this practice across Asia, in homes and communities where newborns are most vulnerable.
All photos by Monika Gutestam / Save the Children