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7/28/2019 Khanal: Better Cord Care Saves Babies' Lives_ CHX Program in Nepal
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B e t t e r c o r d c a
r e s a v e s b a b i e s ’ l i v e s :
C h l o r h e x i d i n e N a v i ( c o r d ) C a r e P r o g r a m i n
N e p a l 1
D r . P u r u
s o t a m R a j S h e d a i n , M i n i s t r y o f H e a l t h
a n d
P o p u l a t i o n , N e p a
l
L e e l a
K h a n a l , P r o j e c t M a n a g e r , C N C P , N e p
a l
7/28/2019 Khanal: Better Cord Care Saves Babies' Lives_ CHX Program in Nepal
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1 5
3
1 1 8
9 1
6 1
5 4
5 4
1 0
2
7 9
6 4
4 8
4 6
3 4
4 6
5 0
3 9
3 3
3 3
1 6 *
1 9 9 1
1 9 9 6
2 0 0 1
2 0 0 6
2 0 1 1
2 0 1 5
0 2 0
4 0
6 0
8 0
1 0 0
1 2 0
1 4 0
1 6 0
1 8 0
U n d e r f i v e m o r t a l i t y r a t e
I n f a n t m o r t a l i t y r a t e
N e o n a t a l m o r t a l i t y r a t e
T h e N e p a l C o n t e x t - C h i l d M o r t a l i t y
S o u r c e : N D H S & N H S P *
2
M a r k e d d e c l i n e i n i n f a n t a n d
c h i l d m o r t a l i t y
L e s s i m p r o v e m e n t w i t h n e o n a t a l
m o r t a l i t y a n d n o c h
a n g e f r o m 2 0 0 6 - 2 0
1 1
7/28/2019 Khanal: Better Cord Care Saves Babies' Lives_ CHX Program in Nepal
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S e v e r e
i n f e c t i o n s
4 2 %
I n j u r y
1 9 %
B i r t h A s p h y x i a
1 5 %
P r e t e r m / L B W
6 % C o n g e n i t a l
A n o m a l y
8 %
O
t h e r
1 0 %
C a u s e s o f N e o n a t a l D e a t h
s N e p a l
P e r
h o u r 3 - 4
n e o n a t e s
d i e i n
N e p a
l
N e o n a t a
l m o r t a
l i t y -
6 1 %
o f t h e u
n d e r
f i v e m o r t a l i t y a n
d
7 5 %
o f i n
f a n
t
m o r t a
l i t y S o u r c e : N D H S ,
2 0 0 6
7/28/2019 Khanal: Better Cord Care Saves Babies' Lives_ CHX Program in Nepal
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6
3 % d
e l i v e r i e
s a t h o m e
8 2 % u
s e d c l e a n d e l i v e r y k i t o r n e w / b
o i l e d
b l a d e
4
1 % o f b a b i e s h a d s o m e m
a t e r i a l o n s t u
m p .
T h e N e p a l
C o n t e x t - D
e l i v e r y S
o u r c e :
N D H S ,
2 0 1 1
7/28/2019 Khanal: Better Cord Care Saves Babies' Lives_ CHX Program in Nepal
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E x p a n s i o n
o f c o m m u n i t y - b a s e d n e o n a t a l
c a r e p r o g r a
m a n d r o l e o f
c o m m u n i t y l e v e l
h e a l t h w o r k e r s
P r o m o t e i n
s t i t u t i o n a l d e l i v e r y a n d S k i l l e d
B i r t h A t t e n
d a n t
N e p a l C
o n t e x t – P o
l i c y
5
S t r a t e g i e s t o r e
d u c e n e o n a t a l m o r t a l i t y
7/28/2019 Khanal: Better Cord Care Saves Babies' Lives_ CHX Program in Nepal
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W h y 7 . 1 %
w / v C h l o r h e x i d i n e N a v i ( C o r d ) C a r e ?
A n e s t i m
a t e d 1 i n 6 n e
o n a t a l d e a t h s
c o u l d b e a v e r t e d
w i t h C h l o r h e x i d i n e c o r d c a r e .
A s i m p l e
t e c h n o l o g y w
i t h p o t e n t i a l t o p r e v e n t 5 0 0 , 0 0 0
g l o b a l n e
o n a t a l d e a t h s
a n n u a l l y .
S o u r e : H o d g i n s
e t . a l ( 2 0 1 3 )
A p p l i c a t i o n o f 7 . 1
% w
/ v c h l o r h e x i d i n e d i g l u c o n a t e i n
f r e s h l y c u t u m b i l i c a l c o r d s t u m p c a n
r e d u c e n e o n
a t a l
m o r t a l i t y b y 2 3 %
6 8 % r e d
u c t i o n i n s e r i o u s i n f e c t i o n
S o u r c e : M u l l a n y ( 2 0 1 1 ) .
7/28/2019 Khanal: Better Cord Care Saves Babies' Lives_ CHX Program in Nepal
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W h y N e p a l A c c e p t e d C h l o r h e x i d i n e C o r d
C a r e
A d d r e s s i n g
a p r o b l e m w i t h h i g h p o p u l a t i o n h e a l t h b
u r d e n
E f f i c a c y
L o w c o s t
S i m p l i c i t y
S a f e t y
A c c e p t a b i l i t y
L o w r e g u l a
t o r y r e q u i r e m
e n t s
H e a l t h s y s t
e m c o m p a t i b i l i t y
S c a l a b i l i t y
C o m m e r c i a l v i a b i l i t y
7
7/28/2019 Khanal: Better Cord Care Saves Babies' Lives_ CHX Program in Nepal
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2 0 0 7
• 1 s t c o n s u l t a t i v e m e e t i n g i n
N e p a l
2 0 0 8 - 0 9
• N o n - i n f e r i o r i t y t r i a l o f C H X
g e l c o m p a r e
d t o
a q u e o u s
• G e l v e r s u s a q u e o u s c o m m u n i t y a c c e p t a b i l i t y
s t u d y
2 0 0 9 - 1
1 • P i l o t p r o g r a m
i n f o u r d i s t r i c t s
N e p a l : A L i v i n g U n i v e r
s i t y f o r C h l o r h e x i d i n e C
o r d
C a r e
7/28/2019 Khanal: Better Cord Care Saves Babies' Lives_ CHX Program in Nepal
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2 0 0 9 - 1 1
•
C o v e r a g e a n d c o m p l i a n c e s t u d y
•
C H X i n t e r n a
t i o n a l m e e t i n g a t B a n k e ,
N e p a l g u n j
•
A p p r o v a l f r o m
M o H P f o r n a t i o n a l l e v e l
s c a l e u p
•
S a v i n g L i v e s
a t B i r t h : a G r
a n d C h a l l e n g e f o r
D e v e l o p m e n t – B e t t e r C o r d C a r e S a v e s
B a b i e s ’ L i v e s , T h r e e y e a r p
r o j e c t b y J S I
t o
s u p p o r t s c a l e
u p C H X a s a
n a t i o n a l p r o g
r a m .
N e p a l : A l i v
i n g u n i v e r s i t y f o r C h l o r
h e x i d i n e c o r d c a r e
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2 0 1 2
O n w a r d s •
P r o v i d i n g t e c h n i c a l a n d p r o d u c t
s u p p o r t t o n e i g h b o r i n g
A s i a n a n d
s e v e r a l A f r i c a n c o u n t r i e
s f o r d o i n g
f o r m a t i v e w
o r k a n d p r e p a r i n g t o p i l o t
•
P r o v i d i n g a
l e a r n i n g p l a t f o r m t o
m a n y i n t e r n
a t i o n a l v i s i t o r s
•
P r o v i d i n g t e c h n i c a l s u p p o r t t o o t h e r
i m p l e m e n t i n g p a r t n e r s
•
P r o v i d i n g t e c h n i c a l a n d p r o d u c t
s u p p o r t t o n e i g h b o r i n g
A s i a n a n d
s e v e r a l A f r i c a n c o u n t r i e
s f o r d o i n g
f o r m a t i v e w
o r k a n d p r e p a r i n g t o p i l o t
•
P r o v i d i n g a
l e a r n i n g p l a t f o r m t o
m a n y i n t e r n
a t i o n a l v i s i t o r s
•
P r o v i d i n g t e c h n i c a l s u p p o r t t o o t h e r
i m p l e m e n t i n g p a r t n e r s
N e p a l : A L i v i n g U n i v e r
s i t y f o r C h l o r h e x i d i n e C
o r d
C a r e
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P i l o t - 4
d i s t r i c t s
P l a n n e d f o r 2 0 1 3 - 1 3 d i s t r i c t s
C
e n t r a l R e g i o n
E a
s t e r n R e g i o n
M i d - W e s t e r n R e g i o n
F a r - W e s t e r n R e g i o n
W e s t e r n R e g i o n
H u m l a
D a r c h u l a
B a i t a d i
D a d e l d h u r a
K a n c h a n p u r
K a i l a l i
D o t i
B a j h a n g A c
h h a m
M u g u
M u s t a n g
M a n a n g
R a s u w
a
K a l i k o t
D a i l e k h
S u r k h e t
J u m l a
J a j a r k o t
B a n k e
R u k u m
S a l y a n
R o l p a
P y u t h a n
M y a g d i
B a g l u n g
G u l m i
K a p i l v a s t u
A r g h a k h a n c h i
K a s k i
S y a n g h a
R
u p a n d e h i
P a l p a
L a m j u n g
T a n a h u
G o r k h a
C h i t w a n
D h a d i n g
N u w a k o t
M a k w a n p u r
N a w a l p a r a s i
P a r s a
B a r a
R a u t a h a t *
T a p l e j u n g
S o l u k h u m b u
S a n k h u w a s
a v a
S i n d h u p a l c h o w k
S a r l a h i
D h a n u s h a
S i r a h a
S a p t a r i
S i n d h u l i
K a v r e
D o l a k h a
R a m e c h h a p
O k h a l d h u n g a
U d a y a p u r
M o r a n g
J h a p a
I l a m
K h o t a n g
B h o j p u r
D h a n
k u t a
KL
B
N
M a h o t t a r i
D a n g
C o m p l e
t e d - 2 8 d i s t r i c t s i n c l u d i n g p i l o t
O n g o i n g - 9 d i s t r i c t s
C h l o r h e x i d i n e
I m p l e m e n t
a t i o n S t a t u s
S c a l e u p a t n a t i o n a l l e v e l b y 2 0
1 5
I
m p l e m e n t i n g p a r t n e r s
C h l o r h e x i d i n e N
a v i C a r e P r o g r a m
U N I C
E F
S a v e t h e C h i l d r e n
O n e H e a r t W o r l
d w i d e
N F H P I I
P l a n N e p a l
C a r e N e p a l
H e a l t h R i g h t
I n t e r n a t i o n a l
1 1
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S t r a t e
g i c A p p r o a
c h
I n t e g r a t e
C h l o r h e x i d i n e a s a
p a
r t o f o n g o i n g
g o v e r n m e n t p r o g r a m
C o m m u n i t y
b a s e d
n e o n a t a l
c a r e
p r o g r a m
U s e
C h l o r h e x i d i n e
i n h e a l t h
f a c i l i t y
d e l i v e r y
S
k i l l b i r t h
a
t t e n d a n t
t r a i n i n g
c u
r r i c u l u m
C
h l o r h e x i d i n e
w i t h
M i s o p r o s t o l
S
o c i a l
m a r k e t i n g
1 2
7/28/2019 Khanal: Better Cord Care Saves Babies' Lives_ CHX Program in Nepal
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O r i e n t a t i o n t o
s e r v i c e
p r o v i d e r s o f a l l l e v e l
O r i e n t a t i o n t o F C H
V s
I m p
l e m e n t a t i o n a p p r o a c h
C h l o r h e x i d i n
e o r i e n t a t i o n t o
s t a k e h o l d e r s a n d s t a f f
o f D P H O / D
H O
F C H V s d i s t r i b u t e s C H X t o
p r e g n a n t m o t h e r a t 8 t h m o
n t h
o f p r e g n a n c y a f t e r c o u n s e
l i n g
S e r v i c e d e l i v e
r y
a t h o s p i t a l a n d
p e r i p h e r a l
h e a l t h f a c i l i t y
A v a i l a
b i l i t y o f
s e r v
i c e a t
h o m
e b i r t h 1
3
M o n i t o r i n g a n d q u a l i t y a s s u r a n c e
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K
e y t o P r o g r
a m S u c c e s s
i n N e p a l
B e n e f i t o f
c o n d u c t i n g t h e f i r s t R C T
i n N e p a l
G o v e r n m e n t l e a d e r s h i p s i n c e i n c e p t i o n o f t h e p r o g r a m
L o c a l m a n u f a c t u r e r ( L
o m u s P h a r m a
c e u t i c a l ) p r o d
u c i n g
a g o o d - q u a l i t y p r o d u c t
G r a n d C h
a l l e n g e f o r D
e v e l o p m e n t a w a r d t o J S I R
& T
t o s u p p o r t
G o N t o s c a l e
u p c h l o r h e x i d i n e N a v i C a r e
p r o g r a m a s a n a t i o n a l p r o g r a m
P a r t n e r s a n d p r o f e s s i o
n a l o r g a n i s a t i o n i n v o l v e m
e n t i n
s c a l i n g u p
N e p a l – m e m b e r o f g l o b
a l C h l o r h e x i d
i n e w o r k i n g g
r o u p
m e m b e r
1 4
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S u p p l y o f 7 . 1 % w / v
C h l o r h e x i d i n e
i n N e p
a l
3 g r a m o f 7
. 1 % C h l o r h e x
i d i n e
d i g l u c o n a t e
g e l t u b e - N e
p a l i b r a n d n a m e
K a w a c h .
P i c t o r i a l i n
s t r u c t i o n i n s i d e b o x .
C u r r e n t p r i c e i s R s . 1 8 ( $
0 . 2 3 ) f o r
G o v e r n m e n
t .
S u p p l y i s e n s u r e d t h r o u g h t h e
g o v e r n m e n
t l o g i s t i c s s u p p l y s y s t e m .
J o b a i d t o c o u n s e l
m o t h e r
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D o l l a
s a I n t e r p e r s o n a l C o m m u n i c a t i o n T o o l
E v e r y F C H
V a n d H F r e c
e i v e d b a b y
d o l l a s a I P
C t o o l t o t e a c
h m o t h e r
a n d f a m i l y
a b o u t C h l o r h
e x i d i n e
a p p l i c a t i o n p r o c e d u r e a
n d o t h e r
e s s e n t i a l n e w b o r n c a r e
T h i s i s b e i n
g a c e n t e r f o r
a t t r a c t i o n
– i n s o m e d i s t r i c t k n o w
a s P u t a l i ( d
o l l ) P r o g r a m
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E n s u r i n
g S u s t a i n a b
i l i t y
C h l o r h e x i d i n e a d d e d i n E
s s e n t i a l D r u g L i s t o f N e p a l
C h l o r h e x i d i n e c o r d c a r e i s a p a r t o f a n
e s s e n t i a l n e w b o r n
c a r e
G o v e r n m e n
t o f N e p a l i n c
l u d e d C h l o r h e x i d i n e p r o c u r e m e n t
i n m u l t i - y e
a r p r o c u r e m e n t p l a n
I n c l u d e d i n
r o u t i n e h e a l t h i n f o r m a t i o n s y s t e m f o r
r e c o r d i n g a n d r e p o r t i n g
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L e s s
o n s L e a r n e
d
R a p i d s c a l e
u p i s p o s s i b l e t h r o u g h t h e
e x i s t i n g
g o v e r n m e n t h e a l t h s y s t e
m
T r a d i t i o n a l h a r m f u l p r a c
t i c e s o f c o r d c a r e c a n b e r e p l a c e d
M u l t i p l e p o
s s i b l e d i s t r i b
u t i o n c h a n n e
l s – f o r h i g h
c o v e r a g e a n
d p o t e n t i a l f o r d i r e c t c o n s u m e r u s e
H i g h l y a c c e
p t a b l e a n d f u
n c t i o n a l t h r o u g h c o m m u n
i t y
m o b i l i z a t i o n
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C
h a l l e n g e s
W H O p o s i t i o n ( 1 9 9 8 ) u n d e r s t o o d t o b e
a g a i n s t a n t i s e p t i c
u s e
P r o g r a m s h i f t i n g f o r c o r d
c a r e m a y c r e
a t e c o n f u s i o n
i n
s e r v i c e p r o v i d e r a n d e v e n i n p o l i c y m a
k e r s f o r t r a n s i t i o n
p e r i o d
P r o d u c t a v a
i l a b i l i t y
E n s u r i n g q u
a l i t y o f r o l l - o
u t v s . g o v e r n m e n t o w n e r s h
i p
C o n t i n u i n g
i m p a c t a t s c a l e - S u p p l y c h a i n , H
M I S
( C o v e r a g e t r a c k i n g , o n g o
i n g p e r f o r m a n c e m a n a g e m e n t
( e . g . r e v i e w
m e e t i n g s )
7/28/2019 Khanal: Better Cord Care Saves Babies' Lives_ CHX Program in Nepal
http://slidepdf.com/reader/full/khanal-better-cord-care-saves-babies-lives-chx-program-in-nepal 20/21
R e f e r e n c e s :
2 0
H o d g i n s S , P r a
d h a n Y V , K
h a n a l L , U p r e t t i S , K
C N P . C h l o r h e x i d i n e f o r u m b i l i c a l c o r d
c a r e : g a m e - c h a
n g e r f o r n e w b o r n s u r
v i v a l ? G l o b H e a l t h S
c i P r a c t . 2 0 1 3 ; 1 ( 1 ) : 5 - 1 0 .
h t t p : / / d x . d o i . o r
g / 1 0 . 9 7
4 5 / G H S P - D - 1 2 - 0 0 0 1 4
M u l l a n y , L ( 2
0 1 1 ) C h l o r h e x i d i n e C
o r d C l e a n s i n g . S u m m
a r y a n d M e t a A n a l y s
i s o f
S o u t h A s i a n T r
i a l s
M i n i s t r y o f H e a l t h a n d P o p u l a t i o n ( M O H P ) [ N e p a l ] , N e w
E R A , a n d I C F I n t e r n a t i o n a l
I n c . 2 0 1 2 . N e p a l D e m o g r a p h i c a n d H e a l t h S u r v e y 2 0 1 1 . K a t h m a n d u ,
N e p a l : M
i n i s t r y
o f H e a l t h a n d P
o p u l a t i o n , N e w E R A
, a n d I C F I n t e r n a t i o n
a l , C a l v e r t o n , M a r y l a
n d .
7/28/2019 Khanal: Better Cord Care Saves Babies' Lives_ CHX Program in Nepal
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T h a
n k Y o u
2 1