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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

Newborns as Percent of Expected Births, Reached with Chlorhexidine 4% gel in Sokoto State, April–December 2013.
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pone.0134040.g003: Newborns as Percent of Expected Births, Reached with Chlorhexidine 4% gel in Sokoto State, April–December 2013.

Mentions: Fig 3 shows a bar chart of the monthly number of newborns that used chlorhexidine digluconate 7.1% gel throughout Sokoto State from April to December 2013. The number of newborns rose fivefold from 1,061 in April to 5,465 in May, reflecting an improved penetration of services along with awareness of services. The sharp increase also reflected the high, unmet demand for services. Assuming a constant rate of newborns for the nine-month period, 11,536 tubes of chlorhexidine digluconate 7.1% gel would be needed per month to cover all expected births. However, the highest attained level, reached in August, was 5,690 or 49% of expected monthly births. The monthly number of newborns served with chlorhexidine digluconate 7.1% gel remained at around 5,550 (48%) through to a peak of 5,690 in August, and then dropped to 2,445 (21%) in December. The tapering of quantities consumed by more than 50% from the plateau of 5,550 suggests shortages fueled by a combination of an inadequate pipeline of supplies and a problem of mal-distribution of chlorhexidine digluconate 7.1%. The MOLG officials invoked civil service regulations to rationalize on why it limited the purchase of chlorhexidine digluconate 7.1% gel to cover the needs of one quarter at a time, which did not include an adequate filling of the pipeline. In addition, the decision by the MOLG to give equal quantities of chlorhexidine digluconate 7.1% gel to LGAs without regard to population size, more likely aggravated mal-distribution.


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)

Newborns as Percent of Expected Births, Reached with Chlorhexidine 4% gel in Sokoto State, April–December 2013.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0134040.g003: Newborns as Percent of Expected Births, Reached with Chlorhexidine 4% gel in Sokoto State, April–December 2013.
Mentions: Fig 3 shows a bar chart of the monthly number of newborns that used chlorhexidine digluconate 7.1% gel throughout Sokoto State from April to December 2013. The number of newborns rose fivefold from 1,061 in April to 5,465 in May, reflecting an improved penetration of services along with awareness of services. The sharp increase also reflected the high, unmet demand for services. Assuming a constant rate of newborns for the nine-month period, 11,536 tubes of chlorhexidine digluconate 7.1% gel would be needed per month to cover all expected births. However, the highest attained level, reached in August, was 5,690 or 49% of expected monthly births. The monthly number of newborns served with chlorhexidine digluconate 7.1% gel remained at around 5,550 (48%) through to a peak of 5,690 in August, and then dropped to 2,445 (21%) in December. The tapering of quantities consumed by more than 50% from the plateau of 5,550 suggests shortages fueled by a combination of an inadequate pipeline of supplies and a problem of mal-distribution of chlorhexidine digluconate 7.1%. The MOLG officials invoked civil service regulations to rationalize on why it limited the purchase of chlorhexidine digluconate 7.1% gel to cover the needs of one quarter at a time, which did not include an adequate filling of the pipeline. In addition, the decision by the MOLG to give equal quantities of chlorhexidine digluconate 7.1% gel to LGAs without regard to population size, more likely aggravated mal-distribution.

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