Chlorhexidine

The use of Chlorhexidine to disinfect the umbilical cord stump to prevent newborn infections

Ninety-eight percent of the approximately 2.7 million deaths in the first 28 days of life occur in low and middle income countries (LMICs), yearly. A third of themse are associated with infections and this proportion rises in areas where at least half of the births occur at home like Uganda. Infection of the umbilical cord stump (omphalitis) is a major contributor to these infections. The umbilical cord is cut after birth and the remaining cord stump generally dries and falls off within 5-15 days. Before it detaches, the stump provides dead tissue, and acts as an easy entry point for micro-organisms into the newborn.

Several interventions have been recommended to combat newborn infections including full body skin cleansing with antiseptics like chlorhexidine, hand washing with soap and water and use of clean birth kits. But the effects of these interventions on the incidence of infection and death in newborns are unclear. Of the applications that could be used to lower the risk of newborn infections and death through appropriate cord care in LMICs, chlorhexidine application shows the most promise. The World Health Organization (WHO), recognizing the importance of cord care, recommends chlorhexidineit for babies born at home but not for those born at health facilities in LMICs. For these children, WHO recommends dry cord care (applying nothing to the cord but washing it with clean water when it is soiled) which is questionable given the lack of proper evidence. Moreover, there are substantial challenges in achieving appropriate hygienic practices within facilities and children born in these facilities are quickly discharged into the same community conditions as children born at home.

This trial will therefore assess the effect of a single washing of the umbilical cord stump with 4% chlorhexidine in facility settings on omphalitis and severe infections. The trial enrolls 4,760 children. Receiving the bulk of its funding from the Research Council of Norway’s GLOBVAC program, it will be undertaken by researchers at the Makerere University, College of Health Sciences and the Center for International Health, University of Bergen.

Project Management Team

Principal Investigator
VICTORIA NANKABIRWA is a senior lecturer in the Department of Epidemiology & Biostatistics, School of Public Health, Makerere University and a researcher at the Center for International Health, University of Bergen. She holds a doctorate degree (PhD) from the University of Bergen. In the past, she has worked at the Norwegian Institute of Public Health (NIPH) as a researcher, at ICAP, Columbia University, New York as an analyst, at Nsambya hospital as a medical doctor and at Mulago national referral hospital. Her research and interests lie in the fields of maternal and child health, perinatal epidemiology, vaccination, core epidemiologic methods, randomized controlled trials and implementation research. Victoria Nankabirwa, Makerere University
Co-Principal Investigator
HALVOR SOMMERFELT is Professor in epidemiology and global health at the University of Bergen, Director of CISMAC, and senior consultant at the Norwegian Institute of Public Health. Through international collaborative ventures with research groups in South Asia, sub-Saharan Africa, Europe and the U.S. he has participated in or coordinated front-line research aimed at improving management and prevention of important childhood illnesses and promoting childhood nutrition. Sommerfelt has (co-)authored more than 100 scientific papers, holds lectures at research institutions in Norway, elsewhere in Europe, India, South Africa, and the US, and he has organized international scientific meetings on maternal and child health and vaccination research. Sommerfelt is also member of the Independent Assessment Committee of Advance Market Commitment for vaccines.

RESEARCHERS

 

PHD CANDIDATES

 

 

Grace Ndeezi

Makerere

Josephine Tumuhamye

UiB/Makerere

James K Tumwine

Makerere

David Mukunya

UiB/Makerere

Thorkild Tylleskär

UiB

 

 

Usha Dhingra

Center for Public Health Kinetics

 

 

Country: Uganda