The use of Chlorhexidine in umbilical cord cleansing to prevent infections in newborns in Uganda.
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, chlorhexidineapplication 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 Science and the Centre for Interaitonal Health, University of Bergen.