Cleansing a newborn’s umbilical cord with an antiseptic can reduce the risk of infection and death, revealed a study carried out by the Aga Khan University (AKU)’s Division of Women and Child Health. The research, just published in the leading global medical journal The Lancet, was conducted in 1,300 villages of Dadu district. With 53 deaths per 10,000 live births, Pakistan has one of the highest newborn mortality rates in the world and up to a third are because of infections. Infection risk is greatest in countries where most deliveries take place at home, often attended by unskilled traditional birth attendants (dais) with poor delivery practices.
Unsafe conventions, such as cutting the birth cord with unsterilised instruments, and the application of substances such as ash, surma (lead-based concoctions), oil and even cow dung are practised in many rural areas of Pakistan, and often associated with an increased risk of cord infection and death. Enrolling around 10,000 newborns between January 2008 and June 2009, the study looked at the effectiveness of three interventions. One consisted of birth kits containing 4 per centchlorhexidine (CHX), to be applied to the cord at birth by dais and once daily by family members for up to 14 days, along with soap and educational messages promoting hand washing, the second was CHX alone and the third, hand washing only.
The fourth group was advised to practice standard dry cord care recommended by the World Health Organisation. The study showed that cord cleansing with CHX reduced the risk of infection in children by 42 per cent and deaths by 38 per cent. Hand washing promotion alone appeared to have no effect on infection or mortality risk. “Given the large number of newborn deaths that occur due to severe infection in home settings, our study not only provides the evidence that a simple low-cost solution like chlorhexidine can save lives, but also shows that a delivery strategy through packaging in birth kits works,” said Dr Professor Zulfiqar A. Bhutta, head of the Division of Women and Child Health at the AKU, and principal investigator of the study. “It could be used to scale up coverage of these interventions at birth in both community settings and public sector facilities. These findings also have substantial implications for public health in south Asia, where many areas share similar cultural, social, and economic characteristics.” The researchers propose that this intervention be considered for possible inclusion in the range of interventions available to Leady Health Workers of the National Programme for Family Planning and Primary Care of the Pakistani government.
The trial was carried out in Dadu, a resource-poor rural district in Sindh, with a population of about 1 million, and an infant mortality rate of 90 per 1,000 live births. More than 80 percent deliveries in the district are done at home by dais and almost 90 per cent of households followed the traditional practices of applying surma and other substances on the cord. The study was funded by the Pakistan Initiative for Mothers and Newborns, and John Snow Inc via a grant by the US Agency for International Development.
