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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

Neonatal Mortality Rates in Cohort of 36,404 Newborns April–December 2014.Sokoto State, Nigeria.
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pone.0134040.g005: Neonatal Mortality Rates in Cohort of 36,404 Newborns April–December 2014.Sokoto State, Nigeria.

Mentions: The causes of death in the 124 deaths derived from verbal autopsies are shown in Table 1. The top three causes of death that accounted for 87% of all deaths were stillbirths 76 (61%), neonatal sepsis 19 (15%) and birth asphyxia 14 (11%). The stillbirths, made up of the fresh and macerated, occurred at a ratio of 3.5 fresh stillbirths for every macerated one. The lesser occurring causes recorded included prematurity, acute respiratory infections/pneumonia, severe anemia and malnutrition and congenital causes. In excluding 76 stillbirths from the initially unverified124 neonatal deaths, the confirmed number of live births that suffered mortality in the neonatal period were a total of 48. The principal causes of death in this cohort were neonatal sepsis 19 (40%), birth asphyxia 14 (29%), other unspecified causes 5 (10%) and prematurity 4 (8%) (see Table 2). With stillbirths deducted from the denominator to obtain an adjusted number of 36,328, we obtained an annualized newborn mortality rate of 1.8 per 1,000 live births (Fig 5). This mortality rate was considerably lower than the annualized neonatal mortality rate of 44 deaths per 1,000 live births reported in the North West zone, the closest counterfactual [13], and the neonatal mortality rate of 10.4 per 1,000 live births for 2012 obtained from the Nahuche Demographic Surveillance System (HDSS) based in the Nahuche District of Bungudu LGA, Zamfara State, adjacent to Sokoto State [22].


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)

Neonatal Mortality Rates in Cohort of 36,404 Newborns April–December 2014.Sokoto State, Nigeria.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0134040.g005: Neonatal Mortality Rates in Cohort of 36,404 Newborns April–December 2014.Sokoto State, Nigeria.
Mentions: The causes of death in the 124 deaths derived from verbal autopsies are shown in Table 1. The top three causes of death that accounted for 87% of all deaths were stillbirths 76 (61%), neonatal sepsis 19 (15%) and birth asphyxia 14 (11%). The stillbirths, made up of the fresh and macerated, occurred at a ratio of 3.5 fresh stillbirths for every macerated one. The lesser occurring causes recorded included prematurity, acute respiratory infections/pneumonia, severe anemia and malnutrition and congenital causes. In excluding 76 stillbirths from the initially unverified124 neonatal deaths, the confirmed number of live births that suffered mortality in the neonatal period were a total of 48. The principal causes of death in this cohort were neonatal sepsis 19 (40%), birth asphyxia 14 (29%), other unspecified causes 5 (10%) and prematurity 4 (8%) (see Table 2). With stillbirths deducted from the denominator to obtain an adjusted number of 36,328, we obtained an annualized newborn mortality rate of 1.8 per 1,000 live births (Fig 5). This mortality rate was considerably lower than the annualized neonatal mortality rate of 44 deaths per 1,000 live births reported in the North West zone, the closest counterfactual [13], and the neonatal mortality rate of 10.4 per 1,000 live births for 2012 obtained from the Nahuche Demographic Surveillance System (HDSS) based in the Nahuche District of Bungudu LGA, Zamfara State, adjacent to Sokoto State [22].

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