Enabling demand generation for 7.1% chlorhexidine for umbilical cord care in Togo

Abstract

Background A novel newborn umbilical cord care product, 7.1% chlorhexidine digluconate, which delivers 4% free chlorhexidine (CHX), is being introduced in Togo. Although the policy framework for this product introduction has been in place since 2017, product use appears to be limited. The overall aim of this mixed methods study was to understand how to generate demand for an umbilical cord care product among (i) pregnant women and/or women who recently birthed and (ii) providers in Togo. The specific study objectives were to understand current cord care practices and identify willingness and rationale to use CHX and preferred product pricing and source. Methods We collected data in December 2019 via 13 focus group discussions (FGDs) with 60 pregnant women and 38 women who recently birthed and through semi-structured interviews with 39 providers in 13 randomly selected facilities that provide essential newborn care services in all six regions of the country. Results Most of the FGD participants were unaware of this novel cord care product. FGD participants reported high hypothetical acceptability of the product due to its aesthetic presentation, ease of use, ease of storage, and provider recommendation. Actual use was contingent on positive product performance in terms of time to heal the wound, fast cord separation, and absence of pain in the infant. Almost 70% of the providers were aware of CHX and all of them were supportive of its use. Because CHX availability was very limited in-country, providers recommended alcohol or other skin disinfectants for cord cleaning. Both FGD participants and providers viewed the effect of CHX use on time to cord separation as a key determinant of product uptake. Pricing of FCFA 500–800 was considered affordable for most families. Conclusions To generate demand, providers could prescribe CHX as an essential item at the time of delivery. The CHX product should be available for sale at pharmacies and health facilities as a key component of an integrated birthing kit. A tiered pricing strategy could extend coverage to both facility-based and home-based births.