Plan International

Bhagawan Das Shreshta, Harpreet Anand, Vidya Sampath

May 2, 2012 – Core Group Spring Meeting

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Promising Futures,Community by Community

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?

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Promising Futures,Community by Community

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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Promising Futures,Community by Community

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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Promising Futures,Community by Community

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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Promising Futures,Community by Community

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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Promising Futures,Community by Community

“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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Promising Futures,Community by Community

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Promising Futures,Community by Community

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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Promising Futures,Community by Community

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Promising Futures,Community by Community

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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Promising Futures,Community by Community

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Promising Futures,Community by Community

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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Promising Futures,Community by Community

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Promising Futures,Community by Community

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Promising Futures,Community by Community

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Promising Futures,Community by Community

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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Promising Futures,Community by Community

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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Promising Futures,Community by Community

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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Promising Futures,Community by Community

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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Promising Futures,Community by Community

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_care.html

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