Pathogenesis and prevention
The recently-cut umbilical cord is an entry point for bacteria that can cause newborn sepsis and death. Bacteria rapidly colonize the moist cord stump and have direct access to the bloodstream through umbilical vessels that remain patent for the first few days after birth. In addition, bacterial colonization may lead to cord infection (omphalitis) with potential spread to the surrounding tissues and blood stream. Ensuring optimal cord care at birth and in the first week of life (including use of chlorhexidine), especially in settings with poor hygiene, is a crucial strategy to prevent life- threatening sepsis and cord infections, and avert preventable ne- onatal deaths.
Countries moving forward
Annual number of newborn deaths1
Hundreds of thousands
Potential annual number of newborn lives saved globally from widespread chlorhexidine use3
In late 2011, Nepal became the first country to introduce chlorhexidine at scale for umbilical cord care. The Govern- ment of Nepal approved the use of chlorhexidine as part of essential newborn care for both home and facility births. The product is now included in the national essential drug list and is provided by a local pharmaceutical company.
Scale-up involves the integration of chlorhexidine into ongoing government services and incorporation into pre-service and in-service training curricula for professionally qualified birth attendants.
Countries in sub-Saharan Africa have also begun to move forward with chlorhexidine for umbilical cord care. Recently, chlorhexidine was introduced for cord care in the Nigerian state of Sokoto through community-based distribution. As a result of this successful effort, the Nigerian Ministry of Health has made 7.1% chlorhexidine diglu- conate a priority commodity for newborn health and has committed to scaling it na- tionally. Efforts to establish local production capacity in the country are also under- way. Both Liberia and Madagascar have completed formative research and are now beginning pilot introduction programs of 7.1% chlorhexidine digluconate for umbili- cal cord care. Further, the adoption of chlorhexidine for umbilical cord care is under earnest consideration by the ministries of health in several other countries in sub- Saharan Africa and South Asia.