The World Health Organization recommends dry cord care for newborns but this recommendation may
not be optimal in low resource settings where most births take place in an unclean environment and infections account
for up to half of neonatal deaths. A previous trial in Nepal indicated that umbilical cord cleansing with 4.0% chlorhexidine
could substantially reduce mortality and omphalitis risk, but policy changes await additional community-based data.
Methods: The Projahnmo Chlorhexidine study was a three-year, cluster-randomized, community-based trial to assess
the impact of three cord care regimens on neonatal mortality and omphalitis. Women were recruited mid-pregnancy,
received a basic package of maternal and neonatal health promotion messages, and were followed to pregnancy outcome.
Newborns were visited at home by local village-based workers whose areas were randomized to either 1) single- or 2)
7-day cord cleansing with 4.0% chlorhexidine, or 3) promotion of dry cord care as recommended by WHO. All mothers
received basic messages regarding hand-washing, clean cord cutting, and avoidance of harmful home-base applications to
the cord. Death within 28 days and omphalitis were the primary outcomes; these were monitored directly through home
visits by community health workers on days 1, 3, 6, 9, 15, and 28 after birth.
Discussion: Due to report in early 2010, the Projahnmo Chlorhexidine Study examines the impact of multiple or single
chlorhexidine cleansing of the cord on neonatal mortality and omphalitis among newborns of rural Sylhet District,
Bangladesh. The results of this trial will be interpreted in conjunction with a similarly designed trial previously conducted
in Nepal, and will have implications for policy guidelines for optimal cord care of newborns in low resource settings in
Asia.
The World Health Organization recommends dry cord care for newborns but this recommendation maynot be optimal in low resource settings where most births take place in an unclean environment and infections accountfor up to half of neonatal deaths. A previous trial in Nepal indicated that umbilical cord cleansing with 4.0% chlorhexidinecould substantially reduce mortality and omphalitis risk, but policy changes await additional community-based data.Methods: The Projahnmo Chlorhexidine study was a three-year, cluster-randomized, community-based trial to assessthe impact of three cord care regimens on neonatal mortality and omphalitis. Women were recruited mid-pregnancy,received a basic package of maternal and neonatal health promotion messages, and were followed to pregnancy outcome.Newborns were visited at home by local village-based workers whose areas were randomized to either 1) single- or 2)7-day cord cleansing with 4.0% chlorhexidine, or 3) promotion of dry cord care as recommended by WHO. All mothersreceived basic messages regarding hand-washing, clean cord cutting, and avoidance of harmful home-base applications tothe cord. Death within 28 days and omphalitis were the primary outcomes; these were monitored directly through homevisits by community health workers on days 1, 3, 6, 9, 15, and 28 after birth.Discussion: Due to report in early 2010, the Projahnmo Chlorhexidine Study examines the impact of multiple or singlechlorhexidine cleansing of the cord on neonatal mortality and omphalitis among newborns of rural Sylhet District,Bangladesh. The results of this trial will be interpreted in conjunction with a similarly designed trial previously conductedin Nepal, and will have implications for policy guidelines for optimal cord care of newborns in low resource settings inAsia.
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