A simple, low-cost antiseptic that may cut the odds of infant illness and death from early infections is one of the Grand Prize winners of the USAID’s 2013 Science and Technology Pioneers Prize. Offered for the first time by the USAID Office of Science and Technology in Washington D.C., the prize recognizes excellence in the use of science, technology, and innovation to solve development challenges.
Until recently, three in every one hundred Nepali babies died before they were 28 days old, often from infections of the newborn navel or umbilical cord stump. In fact, the mortality rate for Nepali newborns did not improve from 2006 to 2011, and deeply rooted cultural practices surrounding the care of the newborn’s umbilical cord were seen as part of the problem.
The World Health Organization has recommended ‘dry care’ of the umbilical cord stump since 1998. ‘Dry care’ means that parents of newborns should ensure that the remaining part of the umbilical cord remains dry and clean. In Nepal, three out of five babies are born at home, sometimes in unhygienic circumstances, and efforts to promote dry cord care were largely unsuccessful. Mothers and grandmothers using information handed down to them for generations would unknowingly contribute to infections in newborns, caused by treating the fresh umbilical stump with turmeric, mustard oil paste, even cow dung or vermillion – a bright red cosmetic that is actually a powdered form of mercury - a highly toxic substance.
2011 saw the successful conclusion of a USAID-funded research in Nepal on the use of Chlorhexidine Digluconate (CHX), the antiseptic lotion used to reduce infections in newborn babies. Working with the National Institutes of Health and the Bill and Melinda Gates Foundation, USAID supported clinical trials of CHX first in liquid form, and then as a gel. The USAID pioneering research project found in trials that applying a single dose of topical gel containing 4 percent CHX to the umbilical cord stump reduced infant mortality by a staggering 34 percent.
USAID Mission Director, Beth Dunford, explained, “Working closely with the Ministry of Health and Population, community-level health volunteers, and other partners, USAID supported the expansion of this pilot and endorsement of Chlorhexidine as part of essential newborn care policy. The scale-up plan, currently being implemented, aims to bring Chlorhexidine to newborns in over three fourth of Nepal’s districts by 2014.”
In their eighth month of pregnancy, expectant mothers now receive a single-dose tube free of cost in the community and at health facilities along with an interactive demonstration about how to apply the gel after cutting the cord.
“Nepal is the first country in the world to begin widespread use of the antiseptic and it has been widely accepted,” said Dr. Leela Khanal, project manager of the Chlorhexidine Navi Care program. She attributes this to vigorous public outreach and education, along with the committed network of 50,000 trained Female Community Health Volunteers.
As part of an innovative USAID partnership with the private sector, the Nepali pharmaceutical manufacturer Lomus Pharmaceuticals stepped in with an early interest in the CHX pilot program and is now exporting the gel tubes to Nigeria, which, after learning of the success in Nepal, is planning its own trials.
Utilizing CHX and other health care services designed to protect mother and infant, Nepal is well on its way to achieving its targets to improve neonatal health across the country.