Low Cost Effective Affordable and Easy to Use Intervention to Prevent Cord Infections and Saves Lives

BHECO with support from Ministry of Health and Government of South Sudan launched a pilot study aimed at promoting newborn health at community level. The launched study was used to make chlorhexidine gel available for cord care for mothers.  To easy distribution, the chlorhexidine gel was bundled into safe delivery kit (SDK). BHECO seek to increases the use of low technology gel, when applied, reduces cord infections and reduces newborn deaths. Report by UN agencies in South Sudan using data modeling for 2018 indicated that newborn deaths account for 40% of the overall death of which 20% is attributed to infections.

Although, there are other common causes of newborn death in South Sudan more than infections such as premature births, asphyxia and pneumonia, infection of the cord is frequent and serious among the community births yet preventable. Application of CHX gel to the newborn umbilical cord in high risky setting has shown to reduce severe infection by 75% and mortality by 23%.

This could potentially save a lot of newborn lives in South Sudan. Chlorhexidine is an evidence based, cost effective and low cost intervention that can significantly reduce newborn deaths in republic of South Sudan. BHECO started working on testing the effectiveness of integration of CHX Gel for community distribution under leadership of Director General, Directorate of Reproductive Health at Ministry of Health.

This was funded through Grand Challenges Canada under Stars in Global health. The need for practical strategy and implementation plan for scale up of this life saving, low cost commodity in South Sudan is enormous. During the pilot phase, BHECO worked with United Nation Children Fund (UNICEF) and World Health Organization (WHO) to support this initiative. BHECO is playing a role in drafting the national scale up plan to implement the integrated CHX gel buddle into Safe Delivery Kit Says the project Lead for Grand Challenges Canada(GCC) for innovation Dr. Vunni Draiko.

The current goal of Ministry of Health and Government is to ensure that 40% of the newborn receive CHX gel distributed through the health facility and community (Health promoters) after the second year of implementation strategy of three year costed plan which is anticipated to be led by government with support from BHECO and other implementing   partners. It is expected that the strategy will save 0.48 million newborns if successfully implemented.

The costed national strategy of integrating chlorhexidine gel into safe delivery kit which is now at validation stage proposes making CHX gel + SDK available for use all across the continuum of care for cord application. Chlorhexidine is one of the 13 lifesaving commodities for women and children. South Sudan has introduced some of the lifesaving commodities but not chlorhexidine. With the success of the pilot study, South Sudan Ministry is quickly adopting the use of chlorhexidine gel Bundled into safe Delivery Kit.

The national scale up plan consists of procurement and distribution, market and user, coordination, policy advocacy and financing, leadership, accountability and operational research. The national strategy for scale up does not only look at the resources for achieving the targets enshrined in the three-year plan but also development of operational plans at national, state and county level as form of decentralizing   the scale up for sustainability.

Changes that is expected over time: The introduction of Chlorhexidine gel bundled into Safe Delivery Kit was first introduced in 2018. Over the project period, the use of chlorhexidine gel for cord care increase among the communities and the old rudimentary cord care decreased by two folds. The successful introduction and implementation of the pilot project was due to the result of close coordination with the government leaders, community leaders, training of health workers and community health workers. The bundled Chlorhexidine gel with safe Delivery Kit was purchased directly from Kampala Pharmaceutical Industries(KPI) through one time purchase at reasonable price.

This new medicine is very good, I used it on my newborn baby umbilical cord. “It is very easy to use compared to the salt water, and cowdug we used to apply on the babies’ cord. The medicine makes the cord looks good and dries quickly within seven days. We have been checked regularly by the community health workers (TBAs). I will encourage all mothers to use this special medicine on their babies’ cord. Says, Keji a mother of two children from Nesitu community.

The development of the national scale up plan is building on the success of the pilot study from the community. The success is attributed to the good level of coordination, willingness of the mothers to try new method, training of the community leaders and ongoing coordination with the partners in RMNCAH technical working groups that promoted early engagement and buy in for integrating the scale up with the existing maternal and newborn programs priorities. Notably indicators for the national scale up will be tracked using the existing HMIS. The scale up will work through the Boma Health Initiative(BHI). We also anticipated that involvement of community will make it work successfully.

Reaping the impact:  The high level of newborn deaths in South Sudan requires implementation and scale up of life saving innovative product. For the past one year, BHECO introduced and piloted chlorhexidine gel through conducting a clinical trial (Quasi experimental), creating awareness, involvement of the community leaders advocating for inclusion of CHX +SDK into the Essential Medicine List of Republic of South Sudan and having technical working group to support MOH in coordinating the national scale up. The pilot phase contributed to the reduction of cord infections of newborn) to 17%(Intervention) and mortality to 6.5%(Intervention). To show how CHX gel is effective, the infections rate among newborn receiving dry cord care was at 38.7% and mortality reduction was 14.3%

In 2019, BHECO supported national scale up strategy for CHX integrated into safe delivery kit leveraging success from the pilot phase conducted in South Sudan with main focus on demand and supply and activities at state and county level. Based on the result of the pilot study, BHECO team and MOH pride themselves to develop and launch the national scale up plan outlining clearly the responsibilities of the Ministry, implementing partner’s donors and resources needed for the scale up at state and national level.

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