Trial of improved practices approach to explore the acceptability and feasibility of different modes of chlorhexidine application for neonatal cord care in Pemba, Tanzania

Usha Dhingra, Sunil Sazawal, Pratibha Dhingra, Arup Dutta, Said Mohammed Ali, Shaali Makame Ame, Saikat Deb, Atifa Mohammed Suleiman, Robert E Black

Research output: Contribution to journalArticle

Abstract

Background: Infections are responsible for 30-40 % of 4 million neonatal deaths annually. Use of chlorhexidine (CHX), a broad-spectrum topical antiseptic with strong residual activity, for umbilical cord cleansing has been shown to reduce infections during the neonatal period. However, the challenge remains with regard to selection of best mode of CHX delivery. As a part of formative research, we undertook a qualitative study in Pemba Island as a pilot to explore the attitudes; beliefs and practices of the community and health workers related to delivery, newborn and cord care. During the second phase of formative research, we used Trials of Improved Practices (TIPs) methodology to explore the acceptance and impediments, for the three possible modes of chlorhexidine application- 100 ml bottle with cotton swab, 10 ml single use dropper bottle and 3 g single application squeeze tube containing gel, as an umbilical cord care intervention. Methods: In this pilot study, 204 mother-newborn pairs were enrolled from hospital and community setting in Pemba, Tanzania using a randomized three period crossover design. Mothers/guardians, Trained Birth Attendants (TBA)/ medical staff and community health workers (CHWs) were requested to try three different modes of CHX application for cord cleaning. All participants were demonstrated the method of cord cleaning using all three modes of delivery; each delivery mode was used for 3 days and an interview was conducted on day 10 to collect summary of their experience. Acceptance and preference scores were calculated based on feedback from the participants. Results: Of 204 mother-newborn pairs, 27 were lost to follow up. 177 mothers performed the intervention and applied CHX to the newborn cord for all 9 days. Mothers rated 10 ml dropper bottle (49.7 %) as most convenient in terms of ease and application. They selected 10 ml dropper bottle (44.6 %) as their first choice; gel tube (33.9 %) and 100 ml bottle (21.5 %) as their second and third choice. TBAs, medical staff and CHWs also preferred 10 ml dropper bottle (43.3 %) over 100 ml bottle (12.9 %) and gel (38.8 %). Conclusions: Overall acceptability of CHX application for cord cleansing was high. 10 ml single use dropper bottle was given highest preference for CHX application. An understanding of the attitudes, beliefs and cultural practices in the community and selection of the most acceptable mode of CHX delivery is essential to the design and implementation of the intervention trials examining the efficacy of CHX cord care in reducing neonatal mortality and subsequent implementation in the programs. Trial registration: ClinicalTrials.gov NCT01528852Registered February 3, 2012

Original languageEnglish (US)
Article number354
JournalBMC Pregnancy and Childbirth
Volume15
Issue number1
DOIs
StatePublished - Dec 28 2015

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Indian Ocean Islands
Chlorhexidine
Tanzania
Mothers
Newborn Infant
Umbilical Cord
Gels
Medical Staff
Local Anti-Infective Agents
Lost to Follow-Up
Infant Mortality
Infection
Research
Islands
Cross-Over Studies
Parturition
Interviews

Keywords

  • Chlorhexidine
  • Cord care
  • Trials of Improved Practices (TIPs)

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Trial of improved practices approach to explore the acceptability and feasibility of different modes of chlorhexidine application for neonatal cord care in Pemba, Tanzania. / Dhingra, Usha; Sazawal, Sunil; Dhingra, Pratibha; Dutta, Arup; Ali, Said Mohammed; Ame, Shaali Makame; Deb, Saikat; Suleiman, Atifa Mohammed; Black, Robert E.

In: BMC Pregnancy and Childbirth, Vol. 15, No. 1, 354, 28.12.2015.

Research output: Contribution to journalArticle

Dhingra, Usha ; Sazawal, Sunil ; Dhingra, Pratibha ; Dutta, Arup ; Ali, Said Mohammed ; Ame, Shaali Makame ; Deb, Saikat ; Suleiman, Atifa Mohammed ; Black, Robert E. / Trial of improved practices approach to explore the acceptability and feasibility of different modes of chlorhexidine application for neonatal cord care in Pemba, Tanzania. In: BMC Pregnancy and Childbirth. 2015 ; Vol. 15, No. 1.
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abstract = "Background: Infections are responsible for 30-40 {\%} of 4 million neonatal deaths annually. Use of chlorhexidine (CHX), a broad-spectrum topical antiseptic with strong residual activity, for umbilical cord cleansing has been shown to reduce infections during the neonatal period. However, the challenge remains with regard to selection of best mode of CHX delivery. As a part of formative research, we undertook a qualitative study in Pemba Island as a pilot to explore the attitudes; beliefs and practices of the community and health workers related to delivery, newborn and cord care. During the second phase of formative research, we used Trials of Improved Practices (TIPs) methodology to explore the acceptance and impediments, for the three possible modes of chlorhexidine application- 100 ml bottle with cotton swab, 10 ml single use dropper bottle and 3 g single application squeeze tube containing gel, as an umbilical cord care intervention. Methods: In this pilot study, 204 mother-newborn pairs were enrolled from hospital and community setting in Pemba, Tanzania using a randomized three period crossover design. Mothers/guardians, Trained Birth Attendants (TBA)/ medical staff and community health workers (CHWs) were requested to try three different modes of CHX application for cord cleaning. All participants were demonstrated the method of cord cleaning using all three modes of delivery; each delivery mode was used for 3 days and an interview was conducted on day 10 to collect summary of their experience. Acceptance and preference scores were calculated based on feedback from the participants. Results: Of 204 mother-newborn pairs, 27 were lost to follow up. 177 mothers performed the intervention and applied CHX to the newborn cord for all 9 days. Mothers rated 10 ml dropper bottle (49.7 {\%}) as most convenient in terms of ease and application. They selected 10 ml dropper bottle (44.6 {\%}) as their first choice; gel tube (33.9 {\%}) and 100 ml bottle (21.5 {\%}) as their second and third choice. TBAs, medical staff and CHWs also preferred 10 ml dropper bottle (43.3 {\%}) over 100 ml bottle (12.9 {\%}) and gel (38.8 {\%}). Conclusions: Overall acceptability of CHX application for cord cleansing was high. 10 ml single use dropper bottle was given highest preference for CHX application. An understanding of the attitudes, beliefs and cultural practices in the community and selection of the most acceptable mode of CHX delivery is essential to the design and implementation of the intervention trials examining the efficacy of CHX cord care in reducing neonatal mortality and subsequent implementation in the programs. Trial registration: ClinicalTrials.gov NCT01528852Registered February 3, 2012",
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AU - Sazawal, Sunil

AU - Dhingra, Pratibha

AU - Dutta, Arup

AU - Ali, Said Mohammed

AU - Ame, Shaali Makame

AU - Deb, Saikat

AU - Suleiman, Atifa Mohammed

AU - Black, Robert E

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N2 - Background: Infections are responsible for 30-40 % of 4 million neonatal deaths annually. Use of chlorhexidine (CHX), a broad-spectrum topical antiseptic with strong residual activity, for umbilical cord cleansing has been shown to reduce infections during the neonatal period. However, the challenge remains with regard to selection of best mode of CHX delivery. As a part of formative research, we undertook a qualitative study in Pemba Island as a pilot to explore the attitudes; beliefs and practices of the community and health workers related to delivery, newborn and cord care. During the second phase of formative research, we used Trials of Improved Practices (TIPs) methodology to explore the acceptance and impediments, for the three possible modes of chlorhexidine application- 100 ml bottle with cotton swab, 10 ml single use dropper bottle and 3 g single application squeeze tube containing gel, as an umbilical cord care intervention. Methods: In this pilot study, 204 mother-newborn pairs were enrolled from hospital and community setting in Pemba, Tanzania using a randomized three period crossover design. Mothers/guardians, Trained Birth Attendants (TBA)/ medical staff and community health workers (CHWs) were requested to try three different modes of CHX application for cord cleaning. All participants were demonstrated the method of cord cleaning using all three modes of delivery; each delivery mode was used for 3 days and an interview was conducted on day 10 to collect summary of their experience. Acceptance and preference scores were calculated based on feedback from the participants. Results: Of 204 mother-newborn pairs, 27 were lost to follow up. 177 mothers performed the intervention and applied CHX to the newborn cord for all 9 days. Mothers rated 10 ml dropper bottle (49.7 %) as most convenient in terms of ease and application. They selected 10 ml dropper bottle (44.6 %) as their first choice; gel tube (33.9 %) and 100 ml bottle (21.5 %) as their second and third choice. TBAs, medical staff and CHWs also preferred 10 ml dropper bottle (43.3 %) over 100 ml bottle (12.9 %) and gel (38.8 %). Conclusions: Overall acceptability of CHX application for cord cleansing was high. 10 ml single use dropper bottle was given highest preference for CHX application. An understanding of the attitudes, beliefs and cultural practices in the community and selection of the most acceptable mode of CHX delivery is essential to the design and implementation of the intervention trials examining the efficacy of CHX cord care in reducing neonatal mortality and subsequent implementation in the programs. Trial registration: ClinicalTrials.gov NCT01528852Registered February 3, 2012

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