Redistributing Medical Gel to Curb Newborn Infections in Nigeria

Ginika Nniekwe holding 2-month-old Raymond.

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July 19, 2023

Ginika Nniekwe, a 32-year-old housewife and mother of four, lives in the Okputimo-Onunkwuago community near Abakaliki in Ebonyi State, Nigeria. She received antenatal care at a health clinic in her community and recalled listening to a health worker discuss the benefits of chlorhexidine 4% gel (CHX) for newborn cord care. Ginika and the other women were told that CHX could help prevent neonatal sepsis, a life-threatening medical emergency in children caused by unhygienic cord care practices like applying toothpaste, mixed leaves, and hot water compress on the umbilical stump which are ineffective in preventing infection. CHX is a low-cost, over-the-counter medicine the World Health Organization recommends for preventing neonatal sepsis, which accounts for one-third (31.4%) of all newborn deaths in Nigeria. Unfortunately, access to CHX is limited and not entirely accepted as a replacement for traditional cord care practices, even among health workers.

In 2021, USAID donated over 200,000 tubes of CHX as seedstock to the Drug Revolving Fund (DRF) schemes of Bauchi and Sokoto States. The DRF is a cost recovery system that sells healthcare commodities at cost plus a predetermined markup. Because the scheme is capitalized with seedstock and the proceeds from sales replenish inventory, it provides a sustainable means of ensuring access to medicines, such as CHX, in supported health facilities.

However, the low utilization of the donated CHX in Bauchi and Sokoto States was observed by supply chain managers during the routine monitoring of consumption trends on the National Health Logistics Management Information System and confirmed by the biannual End Use Verification survey conducted in February 2022. The low utilization put over 122,000 CHX tubes at risk of expiry. To avert expiry and waste, the USAID Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) project worked with state teams to retrieve excess quantities of CHX from health facilities and warehouses and pooled them to the central warehouses. As a result, 122,049 CHX tubes were retrieved from Bauchi and Sokoto States and redistributed to 16 states and the Federal Capital Territory in July 2022.

Mrs Blessing Nniekwe, mother of a two months old child talking to a health officer on her experience using chlorhexidine on her child at Nkwegu Model PHC in Ebonyi state

Ginika Nniekwe holding 2-month-old Raymond. Photo Credit: GHSC-PSM in Nigeria

Ominyi Juliet, the Officer in-charge at Nkwegu Model Primary Health Center, Ebonyi administering CHX to the umbilical cord of a newborn. Photo Credit: GHSC-PSM in Nigeria

Ginika benefitted from the redistribution as she received CHX for her fourth child, Raymond, who is now two months old and has no infection to his umbilical cord. "I am glad I used CHX on my son's cord. The cord healed and dried quickly, and there was no pus. It was my first time using CHX, and I have no regrets. I recommend that all mothers use it for their newborn children to prevent infections," Ginika enthused.

CHX Tube Distribution Graphic

USAID redistributed 122,049 CHX tubes to 16 states and the Federal Capital Territory

Similarly, Aliyah Ahmed, the Reproductive Health Coordinator for Jigawa State, stated, "Jigawa had not had CHX for several years, and the delivery of CHX tubes came when we most needed it. We applaud USAID for this effort, which will fill an unmet need and reduce cord sepsis in Jigawa State." The CHX redistribution is projected to protect over 122,000 newborns from sepsis and save over $73,000 that would have been lost due to expiries. USAID continues to support the Government of Nigeria to improve access to maternal, newborn and child health commodities by strengthening the State's capacity in health commodity logistics management, financing, sourcing, procurement, inventory management and warehousing.

*Daily application of chlorhexidine on the umbilical cord stump in the first week after birth is recommended only in settings where harmful traditional substances (e.g. animal dung) are commonly used on the umbilical cord. For more information see WHO recommendations on maternal and newborn care for a positive postnatal experience.

*WHO has issued an alert on multiple recent reports of eye injury, including blindness, with the use of chlorhexidine gluconate 7.1%. This product may cause serious harm if mistakenly applied to the eyes. Read the alert here.

*WHO has issued an alert on multiple recent reports of eye injury, including blindness, with the use of chlorhexidine gluconate 7.1%. This product may cause serious harm if mistakenly applied to the eyes. Read the alert here.

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