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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 - October 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.

5-424 FRA Presentation5-424 Townhall Meeting
The team meets with the community and invites them to participate in their study (photos courtesy of Dr. Ara).

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: 

During the reporting period from April to June , the intervention phase has been completed at the project site, Dangdhora Union, and the post intervention period will begin in July 2018 at both Dangdhora and Hativanga Unions. Two Town Hall Meetings, 21 community meetings and 10,923 door-to-door visits were carried out at the Dangdhora Union, where the intervention was a Social and Behavioral Change Communication (SSBC). The second Town Hall Meeting, where the chief guest was the Chairman of Dangdhora Union was conducted, and the third Town Hall Meeting at Joyanerchar Sarkerpara Government primary school was organized where Headmaster of the school was the chief guest. The number of attendants of these 2 town hall meetings was 100 and 120 respectively. During the Town Hall meetings, the research team asked the community to participate in the study by using 7.1% chlorhexidine to prevent umbilical cord infections. There were a total of 512 participants who were reached through community meetings. The pregnant women, their mothers and mother-in-laws, the husbands, fathers and father-in-laws, grandmothers and grandfathers were the participants. Posters were displayed mentioning the advantages of using 7.1% Chlorhexidine among newborn. In the door to door visits, the field research assistants (FRAs) discussed the advantages and the proper use of 7.1% Chlorhexidine for umbilical cord care with pregnant women, their family members, and other community members of the area. The pharmacists were also visited by the project research physician (PRP) to sensitize them about 7.1% Chlorhexidine. This communication was intended to ensure its regular supply in this area.

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