Innovation in cord care saves newborn lives in Nepal

Over the past decade Nepal experienced a decline in infant and child mortality. However, neonatal mortality remained the same. In fact, every hour three to four newborns die in Nepal and the leading cause is infection. The 2011 Demographic and Health Survey showed that 63% of deliveries occur in the home and unhygienic cord-care practices are common. The objective of the Chlorhexidine ‘Navi' Care Program, funded by the Saving Lives at Birth Grand Challenge and implemented by JSI, is to reduce newborn deaths by preventing sepsis through scaling up the use of chlorhexidine for umbilical cord-care. Methods: The Program developed a model to orient district supervisors, hospital providers, health workers and community health volunteers on the benefits and use of chlorhexidine. Through partnership with a local private pharmaceutical company, a reliable supply of 7.1% chlorhexidine gel is secured. Female Community Health Volunteers provide chlorhexidine tubes to pregnant women at the 8 month of pregnancy following family counseling. Chlorhexidine is being introduced in health facilities as a part of essential newborn care. Chlorhexidine is included on the essential drug list and is being incorporated into newborn care nationwide by government of Nepal and CNCP support. Results: The use of chlorhexidine has been introduced in 40% of districts as a component of the essential newborn care package and the Safe Motherhood Program. Achievement of national scale-up is expected by 2014. Recommendations: Nepal's Chlorhexidine ‘Navi' Care Program is a living university for countries to learn program implementation aspects from introduction to national scale-up.