Neonatal mortality is still high in Pakistan at 55 neonatal deaths per 1000 live births (PDHS 2012–13). Approximately 671 babies will die each day before reaching their first month (UNICEF 2013). The majority of these newborn deaths are from preventable or treatable causes: infections, complications at birth and complications of prematurity.
The second most common killer of newborn is infections; sepsis (blood infection), pneumonia (lung infection) and meningitis (infection of lining of brain).
Every three minutes a newborn baby dies in Pakistan. Most of these deaths are in the first week of life and are preventable.
7.1% Chlorhexidine digluconate (delivering 4% chlorhexidine) is a low-cost, broad-spectrum antiseptic that is safe and effective for reducing bacterial colonization on the skin and umbilical stump of newborn babies. Research evidence shows that application of 7.1% CHX on the umbilical cord immediately after cord cutting helps prevent infection by 68% and reduces neonatal mortality by 23%.
In November 2014, Ministry of National Health Services Regulations & Coordination, Government of Pakistan approved following recommendations on use and scale up of Chlorhexidine for umbilical cord care in Pakistan.
PPHI Sindh introduced usage of 7.1% Chlorhexidine Digluconate (CHX) at its HFs.
Initially, the supply of CHX came from MCHIP/ USAID funded project but later on, PPHI started procuring through regular supplies and ensured its availability at almost every BHU plus for facility-based deliveries followed by home application by mother for seven days.
- Application of Chlorhexidine in gel form for umbilical cord care:
a) All newborn babies should receive Chlorhexidine in gel form for application on the umbilical cord within 24 hours of birth (preferably within one hour of birth), regardless of place of birth or mode of delivery;
b) Once-a day application of Chlorhexidine gel should be continued for up to seven days after birth or separation of cord, whichever comes first;
c) The person applying Chlorhexidine gel must adequately wash and dry his/her hands as per standard recommendations for hand washing;
d) Mothers must be properly educated not to apply anything else on the cord, other than Chlorhexidine, under any circumstances;
e) Mothers should be instructed to immediately contact their LHW or healthcare provider if any sign of cord infection appears;
- Provincial Departments of Health:
Provincial Departments of Health will ensure the distribution of Chlorhexidine gel to all pregnant women delivering in health facilities or at home (through LHWs and clean delivery kits, preferably during third trimester of pregnancy)
PDHS (2017-18). Pakistan Demographic Heath Survey.
- 2 United Nations Inter-agency Group for Child Mortality Estimation (UNICEF, WHO, United Nations Population Division and the World Bank).
3. Role of 7.1% Chlorhexidine Digluconate in Prevention of Newborn sepsis. One-Day Orientation for Skilled Birth Attendants (SBAs) and Lady Health Workers LHWs)