Community Trial of Newborn Skin and Umbilical Cord Cleansing on Neonatal Mortality in Nepal
Community Trial of Newborn Skin and Umbilical Cord Cleansing on Neonatal Mortality in Nepal
Neonatal mortality and morbidity is common in Nepal and the vast majority of women deliver
 babies at home without a skilled birth attendant.

 The purpose of this project is two-fold: 1) to evaluate whether washing a newborn child with
 a dilute antiseptic solution soon after birth can reduce mortality in the first 4 weeks of
 life and 2) to evaluate whether cleaning the umbilical cord and stump with either soap and
 water or an antiseptic solution for the first few days of life can reduce umbilical cord
 infections.
While significant progress has been made in reducing preschool child mortality in developing
 countries over the past 20 years, much less progress has been made in reducing neonatal
 mortality and morbidity. Neonatal mortality rates are high in Nepal; a significant proportion
 of which are due to sepsis. In addition, the vast majority of women deliver babies at home
 without a skilled birth attendant and early neonatal care is routinely used in rural areas.
 Previous hospital-based research in Malawi suggested that newborn cleansing with a dilute
 chlorhexidine solution could reduce early infant mortality. This project evaluates the use of
 a simple intervention at the community level and the impact on neonatal mortality.

 Comparisons: Two nested community-based randomized trials are being conducted. The first
 compares the neonatal mortality rates between newborn infants randomized to receive a whole
 body skin cleansing soon after birth with baby wipes impregnated with 0.25% chlorhexidine
 compared with newborns cleaned with baby wipes with a placebo solution. The second trial
 compares the rates of umbilical cord infections among children assigned to three groups:

 -  education of the mother on clean cord care alone;

 -  education of the mother plus routine washing of the cord and stump with soap and water
 solution for the first 10 days of life; -OR-

 -  education of the mother plus routine washing of the cord and stump with a 4%
 chlorhexidine solution.

 Enrolled infants are visited on a regular basis during the first month of life to record
 vital status and grade the cord for signs of infection.
Inclusion Criteria:

 -  All liveborn infants born in the study area

 Exclusion Criteria:

 -  Newborn infants who died prior to study staff arriving to conduct the interventions