The neonatal mortality rate in Nepal is 23 per 1,000 live births and major cause of neonatal death is infection. Among newborns, exposure of the freshly cut cord stump to pathogens through hands instruments, cloths etc. may lead to infection and death.
Chlorhexidine is a broad-spectrum antiseptic that is safe and effective for reducing bacterial colonization on the skin and umbilical stump of newborns. Pooled analysis of studies including study of 2006 in Sarlahi, Nepal has shown that immediate cleansing of the umbilical cord with 4% chlorhexidine (equivalent to 7.1% Chlorhexidine Digluconate w/v) reduces mortality risk by about 23%. After this a study was conducted in Maternity hospital, Thapathali and demonstrated that a gel preparation was as effective as an aqueous preparation. Another study on acceptability was done at the community level and demonstrated a clear preference for a gel preparation. Then a pilot was done in four districts (Bajhang, Jumla, Banke and Parsa) to determine the coverage and compliance in the Nepalese context and within the existing public health service delivery system.
Based on the encouraging results of all studies conducted in Nepal, the government of Nepal approved the use of 4% chlorhexidine for umbilical cord care as part of essential newborn care on 23rd December, 2011 (2068 Poush 8, BS).