Chlorhexidine in Nepal

Chlorhexidine Navi Care Program
Chlorhexidine instructional video for community health workers

The first randomized controlled trial, conducted by Johns Hopkins University in Nepal,1 proved the lifesaving potential of early chlorhexidine (CHX) application to the umbilical cord. In 2008/9, JSI conducted two studies in Nepal: an efficacy trial at the main maternity hospital to determine non-inferiority of gel versus aqueous solution; and a community acceptability study (both are summarized in Introducing Chlorhexidine in Nepal). Based on this evidence the MOHP/Nepal approved the use of CHX for umbilical cord care.

In 2011, JSI assisted the Ministry of Health and Population (MOHP) to pioneer the use of CHX for home and health facility deliveries in Nepal through the Chlorhexidine 'Navi' (Cord) Care Program, which is funded by a consortium of donors under the Saving Lives at Birth program. The power of JSI's program comes from its scale: by February 2015, 15,000 trained health facility workers and approximately 35,000 Female Community Health Volunteers in 49 of Nepal's 75 districts ensured that more than 800,000 newborns had CHX applied to their umbilical cord. This intervention is estimated to have prevented 5,500 newborn deaths.

JSI, USAID, and AED worked with Nepal's Lomus Pharmaceuticals Pvt. Ltd. to produce a safe, cost-effective supply of CHX. Lomus has exported CHX to eight other countries in Asia and Africa.

Inspired by Nepal's success, delegates from more than 20 countries have learned from the program, and at least 5 countries have implemented similar interventions. Two of those countries—Nigeria and Madagascar—launched programs that are implemented with JSI technical support.

USAID has highlighted the Chlorhexidine Navi Care program on their digital storytelling site, Extreme Posibilities. View "Nepal's Navel Glazers: How thousands of women, armed with a little tube and lots of heart, are changing minds and saving lives."

More about our work in Nepal:

1. Mullany, L. C., Khatry, S. K., Sherchand, J. B., LeClerq, S. C., Darmstadt, G. L., Katz, J., … Tielsch, J. M. (2008). "A randomized controlled trial of the impact of chlorhexidine skin cleansing on bacterial colonization of hospital-born infants in Nepal." The Pediatric Infectious Disease Journal, 27(6), 505-511. doi:10.1097/INF.0b013