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Abstract
BackgroundChlorhexidine topical cord application is recommended to prevent umbilical cord infections in newborns delivered at home in low-resource settings. A community campaign introducing chlorhexidine for the first time in Haiti was developed. Traditional birth attendants (TBAs) were identified as implementers since they typically cut newborns’ cords. TBAs were trained to apply chlorhexidine to the cord and demonstrate this procedure to the mother. Concurrently TBAs explained reasons for using chlorhexidine exclusively instead of traditional cord care practices. The campaign’s effectiveness was evaluated 7–10 days post-delivery using a survey administered by community health workers (CHWs) to 198 mothers.ResultsNearly all mothers heard about chlorhexidine use and applied it as instructed. Most mothers did not initially report using traditional cord care practices. With further probing, the majority reported covering the cord but few applied an unhygienic substance. No serious cord infections were reported.ConclusionThe campaign was highly successful in reaching mothers and achieving chlorhexidine use. In this study, the concomitant use of traditional cloth coverings or bindings of the cord did not appear harmful; however more research is needed in this area. This campaign provides a model for implementing chlorhexidine use, especially where trained TBAs and CHWs are present.
Highlights
Chlorhexidine topical cord application is recommended to prevent umbilical cord infections in newborns delivered at home in low-resource settings
Three of the 198 women (1.5%) said they had not been told to apply chlorhexidine to the baby’s cord. Of those who had been told to apply chlorhexidine, 98.4% of mothers reported that the traditional birth attendant (TBA) advised them about chlorhexidine use at the time of delivery and 8.4% were told by the community health worker (CHW)
Most women had not heard about chlorhexidine use prenatally (Table 2)
Summary
Chlorhexidine topical cord application is recommended to prevent umbilical cord infections in newborns delivered at home in low-resource settings. In response to the WHO’s call to action, several reviews have sought evidence to support antiseptic use for neonatal cord care in both facility and in the community setting where unhygienic delivery is likely [8, 14, 15]. Despite these WHO recommendations, chlorhexidine 7.1% (delivering 4%) is not on the Haitian List of Essential Medicines. Chlorhexidine for cord care use has not been initiated in Haiti, among many other countries, where its benefits may be important due to high rates of poverty, neonatal mortality and home deliveries. More than 90% of women in Haiti receive at least one antenatal visit, approximately 64% of deliveries occur at home [16]
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