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Cycle 5 (2016 Deadline)

Community intervention to promote Chlorhexidine for reducing umbilical cord infections in Jamalpur district, Bangladesh

PI: Lutfe Ara (, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
U.S. Partner: Eben Kenah, University of Florida
Project dates: March 2017 - February 2019

Project Overview:

The effectiveness of applying 7.1% chlorhexidine digluconate (delivering 4% chlorhexidine) on the umbilical cord stump to prevent umbilical cord sepsis and neonatal death has been proven through community‚Äźbased clinical trials in Bangladesh, Nepal, and Pakistan. In Bangladesh, however, chlorhexidine is not widely used in the rural areas, as most deliveries are performed by untrained birth attendants, who apply unhygienic substances such as turmeric, boric powder, mustard oil, ash, coconut oil, ginger, chewed rice, and even cow dung on the umbilical cord stump. It is necessary to build awareness and motivate pregnant mothers, their family members, community members, and traditional birth attendants (TBAs) to change these practices in order to prevent neonatal umbilical cord sepsis. No community intervention has been implemented to train and motivate the above mentioned groups to use chlorhexidine for neonatal umbilical cord care. To address this gap, the research team will conduct a pretest/post-test quasi-experimental study for 18 months in Jamalpur, Bangladesh. It will include a baseline survey, community intervention, and a post-intervention. The rate of chlorhexidine use; rate of umbilical cord sepsis; and knowledge, attitudes, and practices of the respondents will be assessed during the baseline survey. Awareness building and knowledge development intervention will occur through household and community Behavioral Change Communication (BCC) activities. After the intervention, data on the post-intervention rate of chlorhexidine use; rate of neonatal umbilical cord infections; and knowledge, attitude, and practices of the respondents on neonatal umbilical cord care and cord sepsis will be collected through survey. The sources of chlorhexidine distribution in the community will also be assessed during the survey.

The study will build awareness among pregnant mothers, their family members, other community members, TBAs, and pharmacy personnel on umbilical cord infections and the effectiveness of using 4% chlorhexidine to prevent sepsis. These interventions will eventually help in achieving development goals for child health by reducing under-five mortality. The anticipated outcomes will be improved awareness on neonatal umbilical cord care in the selected rural Bangladeshi community and increased utilization of chlorhexidine in the community for neonatal umbilical cord care. The study will result in community mobilization by engaging the community stakeholders, leaders, and TBAs to prevent umbilical cord sepsis by using chlorhexidine for newborn cord care. Involving the TBAs in the intervention will cover both formal and informal healthcare providers for a multifaceted developmental approach.

Summary of Recent Activities: 

Bangladesh has faced one of the most catastrophic floods in its history during the period of August-September 2017. The flood hit over one-third of the districts of the country; the northern and northeastern districts were the most affected regions. Being a district of this part, our study site Jamalpur also experienced heavy flooding. Communication in Jamalpur was suspended as roads and railway lines had been severely damaged at several points. One of our project sites, Dangdhora union, was partially submerged while the other one, Hativanga union, was completely under water. Under the above circumstances, the team was compelled to delay the scheduled visit to the project sites. As a result, field site activities at Hativanga and Dangdhora Unions started in September 2017. The PEER project has already enrolled 363 study participants out of 374 needed. Additionally, the team hired a Project Research Physician (PRP), Data Management Assistant (DMA), and Field Research Assistants (FRAs) during this quarter.

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