An Integrated Health Systems Approach to Increase the Use of Chlorhexidine for Newborn Care in Madagascar
An Integrated Health Systems Approach to Increase the Use of Chlorhexidine for Newborn Care in Madagascar
While Madagascar has made progress in reducing its newborn mortality rate from 31 deaths within the first 28 days of life per 1,000 live births in 2000 to 24 in 2020, more efforts are needed to improve newborn survival by addressing underlying causes of newborn mortality, including preventable infections and sepsis, which account for around 7% of these newborn deaths. Umbilical cord care with the application of 7.1% Chlorhexidine Digluconate (CHX) is recommended by the World Health Organization (WHO) to reduce risk of infection and prevent life-threatening cases of sepsis, particularly in areas with high neonatal mortality, where poor hygiene at birth or use of harmful umbilical cord care practices (i.e., application of alcohol to the umbilical cord) are prevalent.
In Madagascar, this standard was adopted by the Ministry of Public Health (MOPH) in 2017, but implementation has been hindered by certain cultural traditional practices and health system bottlenecks. Faced with low and stagnating rates of CHX administration in health facilities, over several months and ending in November 2020, the USAID-funded ACCESS program supported the MOPH to identify root causes behind low uptake of this high-impact practice. After the root cause analysis exercise, ACCESS, the MOPH, and other partners worked together to identify context-specific solutions and issued a series of recommended programmatic interventions.