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Wednesday, August 23, 2017

Why new antiseptic strikes a cord with mothers in Bungoma

Nursing officer Herbert Magati applying Chlorhexidine gel to new born Ivan Kimutai at Kopsiror Health center, Mt.Elgon sub county, Bungoma county on 7th March 2017./RHODA ODHIAMBO
Nursing officer Herbert Magati applying Chlorhexidine gel to new born Ivan Kimutai at Kopsiror Health center, Mt.Elgon sub county, Bungoma county on 7th March 2017./RHODA ODHIAMBO

At about 7.30am on a cold, chilly morning, I make my way to one of the largest subcounties in Bungoma county, Mt Elgon.

Up the slopes of this mountain, one cannot fail to see children playing by the roadside. Breathtaking views are what one can see on the way up.

As the birds chirrup in the trees, herein lies a deeper secret on the life of newborn babies.

At Chepyuk ward, I meet 30-year-old Esther Jesor, who gave birth to five children at home. Esther, a mother of six, says she gave birth to only one of her children in a public hospital.

She decided to give birth at home because of the distance between her home and the nearest hospital, about 45 minutes to an hour by vehicle. It might seem close to her home but the topography in this area makes it twice as hard for expectant women to deliver in hospitals. The only available mode of transport is boda bodas, and the operators charge between Sh300 and Sh500.

Soil treatment

The five other times she was pregnant, she feared that if she walked down to the hospital, she would not have made in time to deliver her babies.

“I thank God that my deliveries at home did not have any complication. However, I had one problem. All my babies did not have proper umbilical cord care,” Esther says.

As is the norm to learn about motherhood from our grandparents, Esther’s grandmother gave her the "traditional way" of taking care of a newly cut umbilical cord.

“Since I did not have time to go to hospital, I asked my grandmother for advice and she told me to ground the soil outside my house until it was fine and put it on the baby’s cord.

The remedy, however, did not help in ensuring the cord healed faster.

“I used to put soil on my babies’ cords for two weeks and nothing changed. The only thing everyone noticed without looking at the cord was the foul smell coming from it each time they carried the baby," Esther says.

On her sixth pregnancy, Esther made sure she went and delivered in a hospital. She took a boda boda down the slope to Kospiro Health Centre.

After delivery, Esther says she was given quality care by the health care providers, who gave her a gel to apply on the newly cut umbilical cord to prevent the baby from getting an infection and fasten cord healing.

“After giving birth the doctor gave me a gel and told me to apply it on the baby’s cord stump for seven days. I am happy that this medicine worked. The cord healed faster than the traditional options and my baby did not have any odour coming from the newly cut cord,” she says.

How antiseptic works

The gel Esther was given to apply after she gave birth to her baby is known as the Chlorhexidine gel. This gel, an antiseptic used to prevent umbilical cord infections in newborn babies during the first 28 days of life, was developed from a mouthwash product known as Corsodyl, which is manufactured by GlaxoSmithKline.

Pauline Williams, head of GSK’s research and development for maternal and neonatal health, is the brains behind the idea, after reading a UN report over a glass of wine. The report identified chlorhexidine as an overlooked “life-saving commodity” with the potential to save 422,000 lives over five years if made more widely available across poor parts of Africa and Asia.

“There was a call for manufactures in 2012 to formulate the liquid into a suitable gel that would withstand high humidity and heat, and so it made sense that GSK would be the company that makes that mouthwash to reformulate it into an antiseptic gel that could save thousands of lives in developing countries,” Williams says.

In 2016, the European Medicines Agency approved the reformulation of chlorhexidine gel.

Chlorhexidine for umbilical cord care has a concentration of 7.1 per cent chlorhexidine digluconate, which delivers 4 per cent chlorhexidine. It is specifically formulated for umbilical cord care and is safe and effective in reducing neonatal sepsis due to bacterial exposure through the fresh umbilical stump.

The gel was given to newborn babies in Kopsiro Health Centre, Mt Elgon, following GSK’s partnership with Save the Children to reduce neonatal deaths.

The nursing officer at the hospital, Herbert Magati, says since they received the first batch of chlorhexidine in April last year, newborn deaths in the health centre have drastically reduced.

“Our newborn death rate at the hospital has reduced from 9 per cent to 2 cent. The deaths were mainly as a result of cord infections, but since the introduction of the antiseptic, cord care practices have improved,” Magati said.

The hospital has a catchment area of 25,857 people.

Angela Muruiki, head of child survival at Save The Children, says the programme was rolled in four sub counties in Bungoma namely, Kimilili, Mt Elgon, Kanduyi and Cheptais, mainly because they have a larger population.

“We realised there are counties such as Bungoma that you would think are doing well until you look at the data on newborn deaths, which paints a different picture,” Muriuki says.

Problems faced

The Kenya National Bureau of Statistics in 2015 indicated that the infant mortality rate in Bungoma county is 65 per 1,000 live births, which is higher than the national average of 39 per 1,000 live births.

“When we were looking at ways of reducing new born deaths, it was stated that the chlorhexidine gel would be recommended for use in regions that have more than 30 per 1,000 neonatal deaths, and Bungoma qualified,” Williams said.

Muruiki also pointed out the delays expectant mothers in Mt Elgon subcounty experience before they deliver.

The first delay is at the home level. If they deliver there, they would not get proper care for the unborn child. Traditional birth attendants would use the peel of a dry sugar cane or even their nails to cut the umbilical cord. After cutting the cord, they would tie it with old sweaters or grass.

The social cultural practices do not also have a proper guideline on cord care, as mothers applied cow dung, lizard faeces (the white part), soot and soil on the newly cut umbilical cord.

The second delay is the fact the areas’ geography is not friendly to expectant women. Some live hours away from the hospital, which if they were to make their way to the hospital they would have to have enough money to get a boda boda that would take them to hospital or if they have enough energy to walk down or up the hill to the nearest health facility.

The third delay is at the health centre. Some do not operate for 24 hours, which forces these women to wait until the next day to access medical services. Others opt not to go because of the distance.

Study findings

A study carried out by Population Council and Save The Children in 2015 showed that 99 per cent of mothers who used the gel said it reduced cord infections and it healed faster when compared to traditional methods.

Ninety seven per cent said their babies did not have any adverse reaction to it.

Out of 475 people sampled, only 13 mothers reported a delay in cord separation. Nine reported that the substance was irritating the baby, four noted that the gel changed the colour of the cord, while two said blood was coming out from the cord after use.

The study was titled 'The acceptability of the use of chlorhexidine gel on neonates under the managed access programme.'

“Cord care practices have been changing and this study was also trying to help understand how mothers would react to this new practice, especially those who have experienced different practices after every birth,” Muruiki said.

There have been some changes on how umbilical cords are supposed to be cared for to avoid infections. Before the dry cord care, medics would clean the cord and apply a topical agent, such as spirit, on it.

On October 31 last year, a circular was issued to by the Health ministry to Health executives in all counties on cord care after developing guidelines on its use.

The circular, signed by Health PS Nicholas Muraguri, stated that the government had adopted the use of chlorhexidine digluconcate 7.1 per cent for umbilical cord care in April 2013 and has included it in the list of essential medicines for neonates.

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