Opportunity to reduce Pakistan’s high newborn death rate
Cleansing a newborn’s umbilical cord with an antiseptic can reduce the risk of infection and death said a study carried out by the Aga Khan University’s Division of Women and Child Health. The research, just published in the leading global medical journal The Lancet, was conducted in the Dadu district of Sindh in 1,300 villages.
With 53 deaths per 10,000 livebirths, 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 cent chlorhexidine (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 handwashing, the second was CHX alone and the third, hand washing only. The fourth group were advised to practice standard dry cord care recommended by the World Health Organization.
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 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 Government of Pakistan. 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 livebirths. More than 80 per cent 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 Pakistan Initiative for Mothers and Newborns (PAIMAN), and John Snow Inc. via a grant by the US Agency for International Development (USAID). A separate study in rural Bangladesh, conducted by researchers from the Johns Hopkins Bloomberg School of Public Health, and funded by USAID and Save the Children’s Saving Newborn Lives programme, which also appears in the current issue of The Lancet, found that cleansing the birth cord with chlorhexidine can reduce an infant’s risk of infection and death during the first weeks of life by as much as 20 per cent.
via AKU-Press, AKU