Chlorhexidine for facility-based umbilical cord care: EN-BIRTH multi-country validation study

Area of Science:

• Neonatal Health
• Public Health Interventions
• Health Informatics

Background:

• Neonatal sepsis is a leading cause of infant mortality globally.
• The World Health Organization recommends 7.1% chlorhexidine digluconate (CHX) for umbilical cord care, especially in high-mortality settings.
• National policies in Bangladesh and Nepal mandate CHX use for facility births, yet indicator validation is lacking.

Purpose of the Study:

• To assess the measurement validity of CHX cord care indicators.
• To compare the accuracy of exit surveys and routine registers against direct observation of CHX application.
• To identify gaps in coverage and data recording for CHX cord care.

Main Methods:

• An observational study (EN-BIRTH) was conducted in three public hospitals in Bangladesh and Nepal.
• Clinical observers collected time-stamped data on CHX cord application.
• Data from direct observation were compared with women's exit survey reports and routine hospital register data.

Main Results:

• Observer-assessed CHX coverage was high (89.3-99.4%), but exit survey reports significantly underestimated this (0.4-45.9%).
• Routine registers in Bangladesh, particularly with a specific column for CHX, showed good validity (0.9-1.1), while Nepal's register had poorer validity (0.8).
• Exit surveys had poor validity ratios (0.01-0.38) due to underestimation and high "don't know" responses.

Conclusions:

• Exit surveys are unreliable for measuring CHX cord care coverage.
• Routine registers, especially those with dedicated fields for CHX, provide more accurate data on coverage.
• Integrating CHX cord care data into health management information systems is recommended, with further research on optimal register design and data flow.