Opportunity to reduce Pakistan’s high newborn death rate

Karachi

Karachi: Cleansing a newborn’s umbilical cord with an antiseptic can reduce risk of infection and death, said a study carried out by Aga Khan University’s Division of Women & Child Health. The research, just published in leading global medical journal The Lancet, was conducted in Dadu district of Sindh in 1,300 villages.

With 53 deaths per 10,000 live births, Pakistan has one of highest newborn mortality rates in the world and up to a third are because of infections.

Infection risk is greatest in countries where most deliveries take place at home, often attended by unskilled traditional birth attendants (dais) with poor delivery practices. Unsafe conventions, such as cutting birth cord with unsterilized instruments, and application of substances such as ash, surma (lead-based concoctions), oil and even cow dung are practised in many rural areas of Pakistan, and often associated with an increased risk of cord infection and death.

Enrolling around 10,000 newborns between January 2008 & June 2009, study looked at effectiveness of three interventions. One consisted of birth kits containing 4 per cent chlorhexidine (CHX), to be applied to the cord at birth by dais and once daily by family members for up to 14 days, along with soap and educational messages promoting hand washing, second was CHX alone and third, hand washing only. Fourth group were advised to practice standard dry cord care recommended by World Health Organization.

The study showed that cord cleansing with CHX reduced risk of infection in children by 42 per cent and deaths by 38 per cent. Hand washing promotion alone appeared to have no effect on infection or mortality risk. “Given large number of newborn deaths that occur due to severe infection in home settings, our study not only provides evidence that a simple low-cost solution like chlorhexidine can save lives, but also shows that a delivery strategy through packaging in birth kits works,” said Dr Professor Zulfiqar A. Bhutta, head Division of Women & Child Health at AKU, and principal investigator of study.

“It could be used to scale up coverage of these interventions at birth in both community settings and public sector facilities. These findings also have substantial implications for public health in south Asia, where many areas share similar cultural, social, and economic characteristics.”

Researchers propose that this intervention be considered for possible inclusion in range of interventions available to Leady Health Workers of National Program for Family Planning & Primary Care of Pakistan Government.

Trial was carried out in Dadu, a resource-poor rural district in Sindh, with population of about 1 million, and an infant mortality rate of 90 per 1,000 live births. More than 80 per cent deliveries in the district are done at home by dais and almost 90 per cent of households followed traditional practices of applying surma and other substances on the cord. Study was funded by Pakistan Initiative for Mothers & Newborns (PAIMAN), and John Snow Inc. via a grant by US Agency for International Development (USAID).

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