(Kawach) in Banke, Jumla and Bajhang Districts - Nepal Family ...

Preface
This document provides results of a survey done in support of a newly introduced
intervention to reduce infant mortality. The current neonatal mortality rate of 33 per 1,000
live births in Nepal translates to around 23,000 neonatal deaths per year. Recent evidence
from controlled trials has suggested that immediate application of 4% Chlorhexidine (CHX)
reduces neonatal mortality by about 23%.
Based on these studies, two preliminary studies were carried out by the USAID funded Nepal
Family Health Program (NFHP) II. The first compared the efficacy of CHX lotion versus
aqueous preparations, and the second examined the acceptability and ease for two different
CHX formulations (liquid vs. lotion) for prophylactic application on freshly cut umbilical
cord stumps. Subsequently, the Department of Health Services endorsed a pilot CHX
program as a component of essential newborn care practices in four districts - Banke,
Bajhang, Jumla and Parsa in 2008-2009. Three of the pilot districts were supported by NFHP
II, and a household level survey was carried out in 2011 to measure the coverage and
compliance of CHX (Kawach) application as part of cord care management.
The survey used a 30 cluster sample design and interviewed six hundred recently delivered
women in each district. The results showed that coverage was two-thirds (67%) in Banke,
nearly three-fifths (58%) in Jumla and nearly one-half (47%) in Bajhang while compliance
was between 68% to 77% in these districts. The results were quite encouraging and this has
helped the Ministry of Health and Population to endorse the inclusion of CHX in national
program. The study also examined other aspects of cord care practices.
The survey was implemented by New ERA with technical support from NFHP II. I
appreciate the technical inputs provided by Mr. Bharat Ban, Specialist, Ms. Sabita Tuladhar
and Mr. Sujan Karki, Sr. Program Officer and Ms. Sarita Yadav-Joshi, Program Assistant, all
from NFHP II M&E; Ms. Leela Khanal, Mr. Ramchandra Silwal and Dr. Jaganath Sharma,
Sr. Program Officers of NFHP II; and Mr. Sunil Acharya, Ms Nira Joshi, Ms. Priti Shrestha
and Mr. Jagat Basnet of New ERA for successfully implementing this survey.
Dr. Robin Houston
Deputy Project Director
Nepal Family Health Program (NFHP) II
March 2012