Newborn Umbilical Cord Care: Evaluating a Community-Campaign in Haiti

Presenter: Susan Walsh, University of Illinois at Chicago, WHO Collaborating Center

Background: Newborn cord infections can lead to neonatal sepsis and death, particularly in low-resource countries. Topical application of chlorhexidine to the umbilical cord has shown to reduce infections in neonates born in the community setting.  Chlorhexidine application may be particularly important in Haiti, where unhygienic cord care occurs. Previous research suggests community stakeholders in Haiti recognize susceptibility of newborns to serious cord infection.  They also acknowledged that traditional practices are harmful to newborns and expressed willingness to adopt practices to protect them.  Aim. Evaluate the effects of a community-campaign promoting hygienic newborn cord care based on the World Health Organization recommendations for chlorhexidine (4%) application.

Methods: The community-campaign targeted women who delivered a healthy baby at home with a traditional birth attendant (TBA). At delivery, trained TBAs taught mothers to replace unhygienic substances with chlorhexidine application to neonates’ cords daily. Using a questionnaire, community health workers interviewed mothers 1-4 weeks postpartum about their newborn’s cord care. Data was analyzed by generating descriptive statistics.

Results: Of the 235 participating mothers, 99% applied chlorhexidine as directed.  All but two mothers received instruction for chlorhexidine application only from their TBA, with no previous instructions at a prenatal visit. Although directed to apply nothing but chlorhexidine to the neonate’s cord, 5% of mothers reported applying dirt/dust-powder, 37% applied traditional abdominal/cord coverings. No serious illness in newborns was reported.

Conclusions: Mothers and local caregivers in Haiti are committed to improving neonatal health. Study results demonstrate a high level of acceptability for chlorhexidine use. Results suggest adapting instructions to include a clean gauze/cloth as a substitute for traditional cord/abdominal coverings. Community-campaigns that successfully promote chlorhexidine application in place of unhygienic cord care practices may effectively reduce newborn cord infections, neonatal sepsis and death. Such strategies can also be used for improving other aspects of newborn care.