The effect of cord cleansing with chlorhexidine on neonatal mortality in rural Bangladesh: a community-based, cluster-randomised trial

Arifeen, Shams El; Mullany, Luke C.; Shah, Rasheduzzaman; Mannan, Ishtiaq; Rahman, Syed Moshfiqur; Talukder, Mohammad Radwanur Rahman; Begum, Nazma; Al-Kabir, Ahmed; Darmstadt, Gary L.; Santosham, Mathuram; Black, Robert E.; Baqui, Abdullah H

doi:10.1016/s0140-6736(11)61848-5

Cited by 161 publications

(170 citation statements)

References 20 publications

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“…The demographic characteristics were not significantly different among the six groups ( Table 1). The cord separation time was significantly shorter in the dry care group (7 [6-7] days) compared to other groups (p < 0.001).In the post-hoc analysis, the cord separation time in both 4% chlorhexidine groups (group 3: 10 [7][8][9][10][11][12] days; group 6: 10 [8-12] days) was significantly longer than that in groups 1, 2, and 5 (p < 0.001), but there was no statistically significant difference when compared with the povidone-iodine group. The cord separation time was found to be 7 (6-10) days, 8 (6-11) days, and 7 (6-10) days in groups 2, 4, and 5, respectively, without any statistical differences (Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…A Cochrane review by Zupan et al 6 reported studies mainly conducted in hospitals in high-income countries; the results cannot be generalized to community settings in low-income countries, where achieving clean and dry cord care is difficult [7][8][9][10]. A recent meta-analysis that included studies from both developing and developed countries reported that 4% chlorhexidine significantly reduced omphalitis in community settings 11.…”

Section: Introductionmentioning

confidence: 99%

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Impact of different antiseptics on umbilical cord colonization and cord separation time

Özdemir

Bilgen

Topuzoğlu

et al. 2017

J Infect Dev Ctries

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Introduction: There is still some uncertainty on cord care practices all around the world, especially in developing countries. The aim of our study was to investigate the effects of six different umbilical cord care practices on the rate of colonization and cord separation time. Methodology: A total of 516 newborns were randomly allocated to the following six umbilical cord care groups: group 1 received dry care; groups 2-4 received a single application of 70% alcohol, 4% chlorhexidine, or povidon-iodine in the delivery room, respectively, which were discontinued thereafter; groups 5 and 6 received a single application of 70% alcohol or 4% chlorhexidine, respectively, starting in the delivery room and continuing every six hours until discharge. Umbilical cords were examined on the second and third days and between the fifth and seventh day for signs of omphalitis. Swab cultures were taken on the second or third day from all cases. Results: Cord separation time (median [interquartile range]) was the shortest for group 1 (7 [6-7] days) and the longest for group 3 (10 [7-12] days) and group 6 (10 [8-12] days) (p < 0.001). The cord colonization in the swab cultures was significantly lower in groups 3 and 6 (p < 0.001). Omphalitis was detected in eight (1.5%) patients among the study population, and there was no significant difference between the groups. Conclusions: Our study showed that chlorhexidine application was the most effective agent in decreasing colonization, though it increased cord separation time significantly in both groups.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of different antiseptics on umbilical cord colonization and cord separation time

Özdemir

Bilgen

Topuzoğlu

et al. 2017

J Infect Dev Ctries

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“…This low rate compares favorably to chlorhexidine application trials conducted in south Asia (5% lost to follow-up in Bangladesh, and 2.5% lost to follow-up in Nepal) and newborn health trials in Africa. 7,8,22,23 Structural barriers. In Zambia, like many African countries, rural communities are widely dispersed, and families often travel great distances to reach primary health centers.…”

Section: Resultsmentioning

confidence: 99%

“…The use of 4% chlorhexidine as a topical umbilical antiseptic has been recently shown to reduce omphalitis and all-cause neonatal mortality in southern Nepal, Bangladesh, and Pakistan. [5][6][7][8] The choice of 4% chlorhexidine was based on the safety of this concentration and its efficacy in reducing cord colonization. 9,10 At the time of our study initiation in 2010, only one of these studies (Nepal) had been completed.…”

Section: Introductionmentioning

confidence: 99%

Engagement of the Community, Traditional Leaders, and Public Health System in the Design and Implementation of a Large Community-Based, Cluster-Randomized Trial of Umbilical Cord Care in Zambia

Hamer¹,

Herlihy²,

Musokotwane³

et al. 2015

The American Journal of Tropical Medicine and Hygiene

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Abstract. Conducting research in areas with diverse cultures requires attention to community sensitization and involvement. The process of community engagement is described for a large community-based, cluster-randomized, controlled trial comparing daily 4% chlorhexidine umbilical cord wash to dry cord care for neonatal mortality prevention in Southern Province, Zambia. Study preparations required baseline formative ethnographic research, substantial community sensitization, and engagement with three levels of stakeholders, each necessitating different strategies. Cluster-specific birth notification systems developed with traditional leadership and community members using community-selected data collectors resulted in a post-natal home visit within 48 hours of birth in 96% of births. Of 39,679 pregnant women enrolled (93% of the target of 42,570), only 3.7% were lost to follow-up or withdrew antenatally; 0.2% live-born neonates were lost by day 28 of follow-up. Conducting this trial in close collaboration with traditional, administrative, political, and community stakeholders facilitated excellent study participation, despite structural and sociocultural challenges.

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“…23,24 Although the scope and methodologies of these reviews differed, all 4 stratified results according to the study setting, distinguishing results reported from communities with high proportions of births at home and high neonatal mortality rates from those obtained in hospitals and settings with low neonatal mortality rates. These analyses concluded that 3 studies (including >44 000 subjects) in community settings in South Asia with a high neonatal mortality rate 3,25,26 24 No other cord-management strategies have been evaluated systematically in such settings, but the application of traditional materials (eg, ash, herbal or other vegetal poultices, and human milk) may provide a source of contamination with pathogenic bacteria, including C tetani. 27 In contrast, the meta-analyses found little evidence of benefit from topical treatments for infants born in hospitals.…”

Section: Evidence-based Practicementioning

confidence: 99%

Umbilical Cord Care in the Newborn Infant

Stewart¹,

Benitz²,

Newborn³

2016

Pediatrics

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Postpartum infections remain a leading cause of neonatal morbidity and mortality worldwide. A high percentage of these infections may stem from bacterial colonization of the umbilicus, because cord care practices vary in refl ection of cultural traditions within communities and disparities in health care practices globally. After birth, the devitalized umbilical cord often proves to be an ideal substrate for bacterial growth and also provides direct access to the bloodstream of the neonate. Bacterial colonization of the cord not infrequently leads to omphalitis and associated thrombophlebitis, cellulitis, or necrotizing fasciitis. Various topical substances continue to be used for cord care around the world to mitigate the risk of serious infection. More recently, particularly in high-resource countries, the treatment paradigm has shifted toward dry umbilical cord care. This clinical report reviews the evidence underlying recommendations for care of the umbilical cord in different clinical settings.

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The effect of cord cleansing with chlorhexidine on neonatal mortality in rural Bangladesh: a community-based, cluster-randomised trial

Cited by 161 publications

References 20 publications

Impact of different antiseptics on umbilical cord colonization and cord separation time

Impact of different antiseptics on umbilical cord colonization and cord separation time

Engagement of the Community, Traditional Leaders, and Public Health System in the Design and Implementation of a Large Community-Based, Cluster-Randomized Trial of Umbilical Cord Care in Zambia

Umbilical Cord Care in the Newborn Infant

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