Umbilical Cord Cleansing for the Prevention of Newborn Infections in Uganda

Ninety-eight percent of the approximately 3.3 million deaths in the first 28 days of life occur in low and middle income countries (LMICs), yearly. A third of these 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, suitable for pathogen colonization 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 on the incidence of infection and death in newborns are unclear. Of the potential applications that could be used to lower newborn infections and death through appropriate cord care in LMICs, chlorhexidine shows the most promise.

The World Health Organization (WHO), recognizing the importance of cord care, recommends it for cord care among 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 except water when it is soiled) which is questionable given the inadequate evidence on which it is based. 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 study will therefore assess the effect of 4% chlorhexidine in facility settings on newborn infections and deaths. It will be undertaken under a partnership between Makerere University, College of Health Sciences and the Center for International Health, University of Bergen.