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Plan International  Bhagawan Das Shreshta, Harpreet Anand, Vidya Sampath  May 2, 2012 – Core Group Spring Meeting02 May  2...
   What does the Science tell us?   What did the Nepal Government want to do?   What was Plan International’s role in t...
   Recently-cut cord is common portal of entry    for bacteria   Causes newborn sepsis and death from serious    infecti...
   4% CHX ointment reduces:    - severe cord infection (by 65%)  - neonatal mortality (by 23.5%; 34% if          applied ...
   Current neonatal mortality rate: 33 deaths per    1000 live births/23,000 neonatal deaths every    year;   72% of inf...
   Global organization, established in 1937, that    works side by side with communities in 50    developing countries to...
   “Local Innovation for Better Outcomes for    Neonates” (2006-2011);   Key factors for success: Pregnant Women’s    Gr...
Promising Futures,Community by Community                         05/07/12   8
   FCHV role:-   Motivate women to utilize MCH services;-   Distribute pre-natal medicines;-   Present at childbirth and ...
Promising Futures,Community by Community                         05/07/12   10
   Measure the coverage and compliance in the    application of CHX at the community level;   CHX supplied in a tube mar...
Promising Futures,Community by Community                         05/07/12   12
   Coverage rate: 82.7% of newborns had CHX    applied to their umbilical cord;   Compliance rate: 66.4% (of above) appl...
Promising Futures,Community by Community                         05/07/12   14
Promising Futures,Community by Community                         05/07/12   15
Promising Futures,Community by Community                         05/07/12   16
   Women who belong to PWGs were 1.3 times more    likely to have correctly applied CHX, than those    who were not;   N...
   Plan Nepal, through its organizational funds,    continues the CHX program by integrating it with    Community Based N...
   The 4% CHX lotion is listed in the essential drugs    list of Ministry of Health and Population of Nepal;   CHX lotio...
   WHO recommendation: “dry cord care is    general recommendation, but when adequate    hygiene cannot be assured in hou...
   CHX Working Group:    http://www.healthynewbornnetwork.org/topic/chlorhexidine   USAID Technical Brief:     www.usaid...
02 May  2012   22
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CSHGP Special Studies in Nepal and Ethiopia_Sampath_Gannon_5.2.12

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CSHGP Special Studies in Nepal and Ethiopia_Sampath_Gannon_5.2.12

  1. 1. Plan International Bhagawan Das Shreshta, Harpreet Anand, Vidya Sampath May 2, 2012 – Core Group Spring Meeting02 May 2012 1
  2. 2.  What does the Science tell us? What did the Nepal Government want to do? What was Plan International’s role in this? What are the policy implications and next steps?Promising Futures,Community by Community 05/07/12 2
  3. 3.  Recently-cut cord is common portal of entry for bacteria Causes newborn sepsis and death from serious infection Bacteria can enter bloodstreamPromising Futures,Community by Community 05/07/12 3
  4. 4.  4% CHX ointment reduces: - severe cord infection (by 65%)  - neonatal mortality (by 23.5%; 34% if applied on day of delivery) - incidence of severe infection of umbilicus stump (by 70 - 80%) [source: Mullany et. al, 2006]Promising Futures,Community by Community 4
  5. 5.  Current neonatal mortality rate: 33 deaths per 1000 live births/23,000 neonatal deaths every year; 72% of infant deaths; 61% of U5 deaths; Umbilical cord infection is about 62% of local bacterial infection; Pilot CHX programs in four districts: Banke, Bajhang, Jumla, and Parsa.Promising Futures,Community by Community 05/07/12 5
  6. 6.  Global organization, established in 1937, that works side by side with communities in 50 developing countries to end the cycle of poverty for children; In Nepal since 1978 15 districts 2 million people Four CSHGP grants (1997 – 2011)Promising Futures,Community by Community 6
  7. 7.  “Local Innovation for Better Outcomes for Neonates” (2006-2011); Key factors for success: Pregnant Women’s Groups (PWGs), facilitated by Female Community Health Volunteers (FCHVs); 10-12 pregnant women in each group, facilitated by 1 FCHV;Promising Futures,Community by Community 7
  8. 8. Promising Futures,Community by Community 05/07/12 8
  9. 9.  FCHV role:- Motivate women to utilize MCH services;- Distribute pre-natal medicines;- Present at childbirth and immediate care of neonate;- Home visits after birth (1st, 3rd, 7th & 29th days);- Diagnoses and Referrals.Promising Futures,Community by Community 05/07/12 9
  10. 10. Promising Futures,Community by Community 05/07/12 10
  11. 11.  Measure the coverage and compliance in the application of CHX at the community level; CHX supplied in a tube marketed under the brand name “Kawach”; Participants were informed on proper usage.Promising Futures,Community by Community 05/07/12 11
  12. 12. Promising Futures,Community by Community 05/07/12 12
  13. 13.  Coverage rate: 82.7% of newborns had CHX applied to their umbilical cord; Compliance rate: 66.4% (of above) applied CHX correctly; 97% used full tube of CHX; 2% partial tube.Promising Futures,Community by Community 05/07/12 13
  14. 14. Promising Futures,Community by Community 05/07/12 14
  15. 15. Promising Futures,Community by Community 05/07/12 15
  16. 16. Promising Futures,Community by Community 05/07/12 16
  17. 17.  Women who belong to PWGs were 1.3 times more likely to have correctly applied CHX, than those who were not; None of the women in PWGs reported using harmful substances on stump, as per usual local practice, such as cow dung, oil, or turmericPromising Futures,Community by Community 05/07/12 17
  18. 18.  Plan Nepal, through its organizational funds, continues the CHX program by integrating it with Community Based Newborn Care Program (CBNCP) in Rautahat district; As of April 30, 2012: - 8 districts completed CHX integration with CBNCP - 7 districts ongoing - Planning has commenced to add on 5 more - By June 2013, total CHX coverage goal: 45 out of 75 districts in Nepal.Promising Futures,Community by Community 05/07/12 18
  19. 19.  The 4% CHX lotion is listed in the essential drugs list of Ministry of Health and Population of Nepal; CHX lotion is free of cost; CHX will be scaled up and integrated with CBNCP all over Nepal The CBNCP training manual and reporting formats have been revised to include CHX components.Promising Futures,Community by Community 05/07/12 19
  20. 20.  WHO recommendation: “dry cord care is general recommendation, but when adequate hygiene cannot be assured in household environment, CHX should be used”; USAID brief: “there is sufficient evidence to recommend introduction of 4% chx cord cleansing, in place of dry cord care, as a strategy to reduce neonatal mortality in settings of high neonatal mortality and poor hygiene”Promising Futures,Community by Community 05/07/12 20
  21. 21.  CHX Working Group: http://www.healthynewbornnetwork.org/topic/chlorhexidine USAID Technical Brief: www.usaid .gov/our_work/global_health/mch/.../chx_issuebrief.pdf Johns Hopkins page on CHX: http://www.jhsph.edu/publichealthnews/press_releases/2012/baqui_cordPromising Futures,Community by Community 05/07/12 21
  22. 22. 02 May 2012 22

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