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A Report of At-Scale Distribution of Chlorhexidine Digluconate 7.1% Gel for Newborn Cord Care to 36,404 Newborns in Sokoto State, Nigeria: Initial Lessons Learned.

Orobaton N, Abegunde D, Shoretire K, Abdulazeez J, Fapohunda B, Lamiri G, Maishanu A, Ganiyu A, Ndifon E, Gwamzhi R, Osborne-Smith M - PLoS ONE (2015)

Bottom Line: We used routine data of chlorhexidine digluconate 7.1% gel utilized by 36,404 newborns delivered by 36,370 mothers, to study lessons associated with at-scale distribution in Sokoto State, North West Nigeria.In tandem with high prevalence of stillborn deaths, delivery, interventions designed to increase mothers' timely and regular use of quality antenatal care, and increased facility-based based delivery, need urgent attention.We call for accelerated investments in community health volunteer programs and the requisite community measurement systems to better track coverage.

View Article: PubMed Central - PubMed

Affiliation: United States Agency for International Development/Targeted States High Impact Project, Sokoto Nigeria; John Snow, Inc. Research & Training Institute, Boston, MA, United States of America.

ABSTRACT

Background: With an annual estimated 276,000 neonatal deaths, Nigeria has the second highest of any country in the world. Global progress in accelerating neonatal deaths is hinged to scaled-up interventions in Nigeria. We used routine data of chlorhexidine digluconate 7.1% gel utilized by 36,404 newborns delivered by 36,370 mothers, to study lessons associated with at-scale distribution in Sokoto State, North West Nigeria.

Methods and findings: Under state government leadership, a community-based distribution system overseen by 244 ward development committees and over 3,440 community-based health volunteers and community drug keepers, was activated to deliver two locally stored medicines to women when labor commenced. Newborns and their mothers were tracked through 28 days and 42 days respectively, including verbal autopsy results. 36,404 or 26.3% of expected newborns received the gel from April 2013 to December 2013 throughout all 244 wards in the State. 99.97% of newborns survived past 28 days. There were 124 pre-verified neonatal deaths reported. Upon verification using verbal autopsy procedures, 76 deaths were stillborn and 48 were previously live births. Among the previous 48 live births, the main causes of death were sepsis (40%), asphyxia (29%) and prematurity (8%). Underuse of logistics management information by government in procurement decisions and not accounting for differences in LGA population sizes during commodity distribution, severely limited program scalability.

Conclusions: Enhancements in the predictable availability and supply of chlorhexidine digluconate 7.1% gel to communities through better, evidence-based logistics management by the state public sector will most likely dramatically increase program scalability. Infections as a cause of mortality in babies delivered in home settings may be much higher than previously conceived. In tandem with high prevalence of stillborn deaths, delivery, interventions designed to increase mothers' timely and regular use of quality antenatal care, and increased facility-based based delivery, need urgent attention. We call for accelerated investments in community health volunteer programs and the requisite community measurement systems to better track coverage. We also advocate for the development, refinement and use of routine community-based verbal autopsies to track newborn and maternal survival.

No MeSH data available.


Related in: MedlinePlus

Coverage of Newborns as a Percent of Expected Births that Received Chlorhexidine Digluconate 7.1% Gel in 23 Local Governments and at State Level, April to December 2013, Sokoto State, Nigeria (N = 36,404).
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pone.0134040.g002: Coverage of Newborns as a Percent of Expected Births that Received Chlorhexidine Digluconate 7.1% Gel in 23 Local Governments and at State Level, April to December 2013, Sokoto State, Nigeria (N = 36,404).

Mentions: To estimate the coverage of newborns that received chlorhexidine digluconate 7.1% gel, we used the number of expected births disaggregated by LGA supplied by the Sokoto State Office of the National Population Commission. There were a total of 184,255 births expected for the calendar year of 2013 [21]. The prorated expected births for a period of nine months between April and December 2013 was estimated at 138,191. As shown on Fig 2, 26.3% of all expected newborns were reached with chlorhexidine digluconate 7.1% gel. The coverage rate ranged from a low 17% in Isa LGA to 50% in Kware LGA. Five LGAs attained a coverage rate of 40% or higher. Thirteen LGA had coverage rates that fell below the 26.3% state average and the remaining 10 were above. The correlation coefficient between population of expected births in LGAs and their coverage rates was -0.71. On average, LGA with larger populations tended to have lower coverage rates and those with smaller populations had higher coverage rates. We compared the coverage rates of urban LGA with rural LGA. Rural-urban classifications of LGA were based on government-supplied information. Urban LGA tended to have lower coverage rates compared to more rural LGA. One argument was that urban LGA had greater access to secondary and tertiary hospitals and so were less likely to use the home delivery services. The coverage rate achieved in rural LGA was 28.8% and it was 20.2% for urban LGA.


A Report of At-Scale Distribution of Chlorhexidine Digluconate 7.1% Gel for Newborn Cord Care to 36,404 Newborns in Sokoto State, Nigeria: Initial Lessons Learned.

Orobaton N, Abegunde D, Shoretire K, Abdulazeez J, Fapohunda B, Lamiri G, Maishanu A, Ganiyu A, Ndifon E, Gwamzhi R, Osborne-Smith M - PLoS ONE (2015)

Coverage of Newborns as a Percent of Expected Births that Received Chlorhexidine Digluconate 7.1% Gel in 23 Local Governments and at State Level, April to December 2013, Sokoto State, Nigeria (N = 36,404).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4520693&req=5

pone.0134040.g002: Coverage of Newborns as a Percent of Expected Births that Received Chlorhexidine Digluconate 7.1% Gel in 23 Local Governments and at State Level, April to December 2013, Sokoto State, Nigeria (N = 36,404).
Mentions: To estimate the coverage of newborns that received chlorhexidine digluconate 7.1% gel, we used the number of expected births disaggregated by LGA supplied by the Sokoto State Office of the National Population Commission. There were a total of 184,255 births expected for the calendar year of 2013 [21]. The prorated expected births for a period of nine months between April and December 2013 was estimated at 138,191. As shown on Fig 2, 26.3% of all expected newborns were reached with chlorhexidine digluconate 7.1% gel. The coverage rate ranged from a low 17% in Isa LGA to 50% in Kware LGA. Five LGAs attained a coverage rate of 40% or higher. Thirteen LGA had coverage rates that fell below the 26.3% state average and the remaining 10 were above. The correlation coefficient between population of expected births in LGAs and their coverage rates was -0.71. On average, LGA with larger populations tended to have lower coverage rates and those with smaller populations had higher coverage rates. We compared the coverage rates of urban LGA with rural LGA. Rural-urban classifications of LGA were based on government-supplied information. Urban LGA tended to have lower coverage rates compared to more rural LGA. One argument was that urban LGA had greater access to secondary and tertiary hospitals and so were less likely to use the home delivery services. The coverage rate achieved in rural LGA was 28.8% and it was 20.2% for urban LGA.

Bottom Line: We used routine data of chlorhexidine digluconate 7.1% gel utilized by 36,404 newborns delivered by 36,370 mothers, to study lessons associated with at-scale distribution in Sokoto State, North West Nigeria.In tandem with high prevalence of stillborn deaths, delivery, interventions designed to increase mothers' timely and regular use of quality antenatal care, and increased facility-based based delivery, need urgent attention.We call for accelerated investments in community health volunteer programs and the requisite community measurement systems to better track coverage.

View Article: PubMed Central - PubMed

Affiliation: United States Agency for International Development/Targeted States High Impact Project, Sokoto Nigeria; John Snow, Inc. Research & Training Institute, Boston, MA, United States of America.

ABSTRACT

Background: With an annual estimated 276,000 neonatal deaths, Nigeria has the second highest of any country in the world. Global progress in accelerating neonatal deaths is hinged to scaled-up interventions in Nigeria. We used routine data of chlorhexidine digluconate 7.1% gel utilized by 36,404 newborns delivered by 36,370 mothers, to study lessons associated with at-scale distribution in Sokoto State, North West Nigeria.

Methods and findings: Under state government leadership, a community-based distribution system overseen by 244 ward development committees and over 3,440 community-based health volunteers and community drug keepers, was activated to deliver two locally stored medicines to women when labor commenced. Newborns and their mothers were tracked through 28 days and 42 days respectively, including verbal autopsy results. 36,404 or 26.3% of expected newborns received the gel from April 2013 to December 2013 throughout all 244 wards in the State. 99.97% of newborns survived past 28 days. There were 124 pre-verified neonatal deaths reported. Upon verification using verbal autopsy procedures, 76 deaths were stillborn and 48 were previously live births. Among the previous 48 live births, the main causes of death were sepsis (40%), asphyxia (29%) and prematurity (8%). Underuse of logistics management information by government in procurement decisions and not accounting for differences in LGA population sizes during commodity distribution, severely limited program scalability.

Conclusions: Enhancements in the predictable availability and supply of chlorhexidine digluconate 7.1% gel to communities through better, evidence-based logistics management by the state public sector will most likely dramatically increase program scalability. Infections as a cause of mortality in babies delivered in home settings may be much higher than previously conceived. In tandem with high prevalence of stillborn deaths, delivery, interventions designed to increase mothers' timely and regular use of quality antenatal care, and increased facility-based based delivery, need urgent attention. We call for accelerated investments in community health volunteer programs and the requisite community measurement systems to better track coverage. We also advocate for the development, refinement and use of routine community-based verbal autopsies to track newborn and maternal survival.

No MeSH data available.


Related in: MedlinePlus