Integrating Chlorhexidine for Cord Care into Community Based Newborn Care in Ethiopia
ntroduction: Ensuring adequate cord care at birth and in the first week of life is crucial to prevent sepsis and cord infections, and to reduce preventable neonatal deaths. WHO recommends application of 7.1% chlorhexidine digluconate daily to the umbilical cord stump during the first week of life for newborns born at home in settings with high neonatal mortality.
Objective: This article describes the introduction of chlorhexidine for cord care in Ethiopia using the Community-Based Newborn Care (CBNC) platform and early lessons.
Methods: Data related to chlorhexidine introduction inputs and processes from minutes, reports, and related documents from 2013 to 2017 were assessed and described using steps from the three phases to ensure sustainable implementation introduced in a recent guideline from the Global Chlorhexidine Working Group.
Results: Chlorhexidine was included as one of the components in CBNC after consensus building, and it was manufactured locally. Current implementation status in four zones is described. Early lessons include the fact that chlorhexidine for cord care is feasible and acceptable in Ethiopia. Critical gaps in knowledge, practice, and attitude on the service providers’ and mothers’ sides were observed. In addition, product availability was limited outside of facilities. Poor documentation and parallel supply-chain management also require further attention.
Conclusion: Government leadership and integration within the existing platform were key to the introduction of chlorhexidine for cord care in Ethiopia. Issues that require further attention include synchronization, behavior change communication, monitoring, and evaluation, as well as financing for sustainable product availability.