14-20 March 2014 #698

Belly-gazing

An ointment applied on newborns’ navels could prevent one out of four neonatal deaths
Sunir Pandey in KAVRE

SUNIR PANDEY
APPLY ONCE: Gita Parajuli (centre) and Ganeshmaya Ranjitkar (left), female community health volunteers from Ugratara, Kavre, demonstrate how to apply the chlorhexidine ointment on a newborn’s umbilical cord.
On a warm morning in March, the maternity ward Dhulikhel Hospital is abuzz with activity as doctors and nurses move from one room to another helping with deliveries and checking up on the newborns and their mothers. The hospital delivers around eight babies everyday and resident doctor Anjana Dangol is in charge of all cases.

Just hours ago she delivered a boy to Sangita Shrestha, 18, of Sindhupalchok. One of the first things she did after cutting off his umbilical cord was to get a nurse to squeeze out a tube of Navi Malam and apply it on the stump.

Navi Malam is a colourless, odourless gel that contains the disinfectant chlorhexidine. When applied correctly to a new-born baby’s umbilical cord stump, it binds to the skin and closes the open wound on the infant’s belly and repels water and other traditional ointment. “The easiest way to prevent infections is by keeping the naval area dry and untouched until the stump falls off,” explains Dangol. “But since most of our patients return home a day after delivery, we give them the cream.”

Almost 750,000 babies are born every year in Nepal and up to two thirds of all deliveries take place at home in the absence of skilled birth attendants. Four out of 10 newborns will have their cords treated in the customary manner – hacked off with a hasiya and a mixture of turmeric, ash, and mustard oil applied on the remainder.

Lack of healthcare services and superstitions surrounding child-rearing mean that Nepal has one of the worst neo-natal mortality rates in Asia (see chart). Forty per cent of deaths occur because of infections.

In 2005, a study conducted by the Nepal Nutritional Innovation Program Sarlahi found that cleansing the umbilical cord stump with a chlorihexidine solution would reduce neo-natal deaths by 23 per cent. Similarly, a pilot study undertaken between November 2008 and May 2009 in Banke by the Ministry of Health and Population, supported by USAID and JSI Research and Study Institute, found that families preferred using gel on their newborn whose texture was consistent with the mustard-turmeric paste.

Over the next two years, the government worked closely with Saving Lives at Birth partners (USAID, Bill & Melinda Gates Foundation, Grand Challenges Canada, and the World Bank) and a local pharmaceutical company Lomus to develop such an the ointment. Lomus now produces up to 10,000 tubes of Navi Malam a day at its Gothatar factory. The tube is available for Rs 18 as part of the government’s National Safe Motherhood Program.

“We didn’t want our ‘intervention’ to seem out of place, so we stuck to a formula that locals were most comfortable with,” says Shanda L Steimer, director of USAID’s Office of Health and Family Planning.

Since it was first introduced in 2011, ‘Navi Malam’ has been adopted in 41 out of Nepal’s 75 districts, thanks to the role played by Nepal’s Female Community Health Volunteers. Established in 1988, the 52,000 strong force has been instrumental in convincing new mothers and especially their families, that the ointment really shields their baby from infections.

SOURCE: WHO (2013)

“First you take off the cap, wash your hands, apply the entire contents, wrap the baby with a shawl, and leave the cord to dry for around seven minutes,” instructs Gita Parajuli, an FCHV since seven years, to a group of new mothers at Ugratara, Kavre.

When Parajuli had her first baby at 18, the ointment wasn’t available and her husband’s family did what everyone else did – massage the baby with mustard oil. Now, except for some who still want to take care of their children in the old-fashioned way, most expecting parents ask volunteers for the ointment themselves.

Last month, USAID awarded the Nepali government with the pioneers prize for its exceptional support and leadership in the chlorhexidine cord care program. Inspired by our success, 11 other countries like Nigeria and Kenya are looking to promote chlorhexidine as a effective method of reducing neo-natal mortality. 

Read also:

Born to live, ROBIN GIRI

Sixty minutes, DAN TOOLE

Narrowing the gap, ROBERT TIMMONS

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