Singh Kavita, Simmons Elizabeth, Garriga Bliss, Hoover Grace, Ijdi Rashida E, Kc Ashish
Data for Impact (D4I), University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
Matern Health Neonatol Perinatol. 2024 Jun 7;10(1):12. doi: 10.1186/s40748-024-00182-8.
Preventable newborn deaths are a global tragedy with many of these deaths concentrated in the first week and day of life. A simple low-cost intervention, chlorhexidine cleansing of the umbilical cord, can prevent deaths from omphalitis, an infection of the umbilical cord. Bangladesh and Nepal have national policies promoting chlorhexidine use, as well as routinely collected household survey data, which allows for an assessment of coverage and predictors of the intervention.
We used data from the 2017-2018 Bangladesh Demographic and Health Survey and the 2016 Nepal Demographic and Health Survey, two large-scale nationally representative household surveys. We studied coverage of single application of chlorhexidine to the umbilical cord of newborns born in the past year using descriptive, bivariate and multivariable analyses. Key predictors of newborns receiving chlorhexidine cleansing, including socio-economic factors, healthcare related factors and the application of harmful and nonharmful substances, were explored in this study.
Coverage of chlorhexidine cleansing was 15.0% in Bangladesh and 50.7% in Nepal, while the application of a harmful substance was 16.9% in Bangladesh and 22.6% in Nepal. Results from the multivariable analyses indicated that delivery in a health facility was strongly associated with a newborn's receipt of chlorhexidine in both countries (Bangladesh: OR = 2.23, p = 0.002; Nepal: OR = 5.01, p = 0.000). In Bangladesh, delivery by Cesarean section and application of another non-harmful substance were significantly and positively associated with the receipt of chlorhexidine. In Nepal antenatal care was significantly and positively associated with chlorhexidine, while application of a harmful substance was significantly and negatively associated with receipt of chlorhexidine. Maternal education, urban/rural residence, religion and sex were not significant in the multivariable analysis. Wealth was not a significant factor in Bangladesh, but in Nepal newborns in the two highest wealth quintiles were significantly less likely to receive chlorhexidine than newborns in the lowest wealth quintile.
As Bangladesh and Nepal continue to scale-up chlorhexidine for newborn umbilical cord care, additional focus on newborns born in non-facility environments may be warranted. Chlorhexidine cleansing may have the potential to be an equitable intervention, as newborns from the poorest wealth quintiles and whose mothers had less education were not disadvantaged in receiving the intervention in these two settings.
可预防的新生儿死亡是一场全球悲剧，其中许多死亡集中在生命的第一周和第一天。一种简单的低成本干预措施，即使用洗必泰清洁脐带，可预防因脐带感染（脐炎）导致的死亡。孟加拉国和尼泊尔制定了促进使用洗必泰的国家政策，并且有常规收集的家庭调查数据，这使得能够评估该干预措施的覆盖率及其影响因素。
我们使用了2017 - 2018年孟加拉国人口与健康调查以及2016年尼泊尔人口与健康调查的数据，这两项都是具有全国代表性的大规模家庭调查。我们通过描述性、双变量和多变量分析，研究了过去一年中出生的新生儿脐带单次使用洗必泰的覆盖率。本研究探讨了新生儿接受洗必泰清洁的关键影响因素，包括社会经济因素、医疗保健相关因素以及有害和无害物质的使用情况。
孟加拉国洗必泰清洁的覆盖率为15.0%，尼泊尔为50.7%，而孟加拉国使用有害物质的比例为16.9%，尼泊尔为22.6%。多变量分析结果表明，在这两个国家，在医疗机构分娩都与新生儿接受洗必泰密切相关（孟加拉国：比值比[OR]=2.23，p = 0.002；尼泊尔：OR = 5.01，p = 0.000）。在孟加拉国，剖宫产分娩以及使用另一种无害物质与接受洗必泰显著正相关。在尼泊尔，产前护理与洗必泰显著正相关，而使用有害物质与接受洗必泰显著负相关。在多变量分析中，母亲教育程度、城乡居住情况、宗教信仰和性别均无显著影响。财富在孟加拉国不是一个显著因素，但在尼泊尔，最富裕的两个财富五分位数组中的新生儿接受洗必泰治疗的可能性明显低于最贫困财富五分位数组中的新生儿。
随着孟加拉国和尼泊尔继续扩大洗必泰在新生儿脐带护理中的应用，可能有必要额外关注在非医疗机构环境中出生的新生儿。洗必泰清洁有可能成为一种公平的干预措施，因为在这两种情况下，最贫困财富五分位数组的新生儿及其母亲受教育程度较低的新生儿在接受该干预措施方面并未处于劣势。
