Made in Nepal panacea to umbilical cord sepsisThirty-five-year-old Gita Parajuli, a female health care volunteer at Ugratara village development committee in Kavre, was demonstrating the application of the gel on a newborn baby doll
At Dhulikhel Hospital, the nurse in charge, Indira Shrestha, applied the product on a three-hour-old baby.
Chlorhexidine is a chemical compound usually found in disinfectants. Since 2009 the antiseptic has been manufactured and used in Nepal in its gel form to prevent umbilical cord infections in neonates. Through the national network of around 52,000 female health care volunteers like Parajuli, the antiseptic currently reaches newborns in 41 districts, slashing neonatal deaths by 23 percent— a feat the administrator of the US Agency for International Development (USAID), Rajiv Shah, who was on a two-day visit of the country, formally recognised on Wednesday.
At an event organised in the Capital, Shah presented the USAID Pioneers Prize to the Secretary of Ministry of Health and Population, Praveen Mishra. Impressed with the results delivered by the collective efforts of the Ministry, Lomus Pharmaceuticals which produces the gel, the community of female volunteers and the USAID, Shah said, "Ending preventable child deaths is achievable, but it requires all of our efforts."
Nepal has a high neonatal mortality at 33 per 1,000 births, according to the 2011 Nepal Demographic and Health Survey. The rate has not changed since 1996.
With umbilical cord sepsis causing most of the deaths, a randomised control trial was conducted in Sarlahi in 2005, with support from the USAID. The test results showed that around 6,000 babies can be saved every year if chlorhexidine is applied on the navel immediately after the cord is severed. Subsequently in 2011, the government approved to extend the project to 65 districts by 2015.
By the next three years, partners in the project plan to reach newborns in all 75 districts.
"Since two-thirds of the deliveries occur at home and the rest at unhygienic birthing centres, most babies in Nepal develop umbilical cord infections," said Leela Khanal, Project Manager of Chlorhexidine Navi Cord Care Project. She explained traditional application of turmeric and mustard oil paste, vermillion powder, ashes, or cow dung would
only increase chances of navel sepsis instead of preventing it.
Studies carried out at the Thapathali maternity hospital and in Banke between 2008-2009 show that the benefits of the chlorhexidine gel lie in its efficacy: low cost (Rs 18 for a 3-gram tube) and high communal acceptability. The product, manufactured locally by Lomus, has to be applied only once, the sooner the better. It also sticks to baby's skin, without getting absorbed, so that bathing the newborn
will not reduce the antiseptic's effect. And it does not cause any side effects on infants, such as skin rashes often induced by other antiseptic lotions.
The role of the gel in saving neonatal lives has been so phenomenal that Lomus now supplies chlorhexidine tubes to Nigeria, Liberia and Madagascar. "Since 2012, we have shipped 240,000 tubes outside of Nepal," said Prajwal Jung Pandey, marketing director at Lomus.