newsletter national newborn health program · 2019. 2. 6. · newborn deaths in bangladesh. the...

NewsletterVolume 3 | Issue 2 | April, 2018

National Newborn Health Program

Speaker’s Corner

The News Letter published by National Newborn Health Program (NNHP) is documenting the activities implemented by Directorate General of Health Services and supported by the development partners. Thus encouraging all to achieve Sustainable Development Goals (SDG), NMR 12/1000 live birth and under 5

mortality rate 25/1000 live birth within 2030.

Prof. Abul Kalam AzadDirector General of DGHSMinistry of Health and Family Welfare

Editorial Note

Newborn health is one of the highlighted indicator of the government of Bangladesh to prevent under five morbidity and mortality. The country achieved global appreciation by achieving MDG target 4 well ahead of rime. Now the challenge is to achieve SDGs, where Bangladesh has to bring down newborn mortality to 12 per thousand live birth.

To prioritize the importance of newborn health, the Directorate General of Health Services has redesigned the program as National Newborn Health Program and Integrated Management of Childhood Illness (NNHP & IMCI) in 4th Health Population Nutrition Sector Program. The NNHP & IMCI program with the support from development partners is working hard to fulfill the targets of operational plan.

This issue of the Newsletter documented and dedicated to the program itself and will help the stakeholders to understand the program better.

Dr. Khaleda IslamDirector, PHC&PM, NNHP&IMCI, DGHS

NewsletterNational Newborn Health Program

01

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02

NNHP-context

As a commitment to achieve Sustainable Development Goals (SDGs), Bangladesh is determined to end

preventable newborn deaths by 2030. Though the country showed remarkable success in reduction of

under-five mortality rate (U5MR

46/1000 live births) during last

decade and achieved Millennium

Development Goal (MDG) 4 well

ahead of time yet, the reduction

of neonatal mortality rate (NMR

28/1000 live births) is still very

slow (BDHS 2014). The

4thHealth Nutrition Population

Sector Investment Plan

(HNP-SIP) set the target to

reduce NMR to 18 or below

/1000 live birth by

2022.Therefore in 4th Health

Nutrition Population Sector

Program (HNPSP) the focus on

newborn health has evolved as

“The National Newborn Health

Program (NNHP) and IMCI”

program is strengthened. The objective of NNHP & IMCI is to prevent neonatal and child morbidity and

mortality so that the country can achieve SDG 3.

The major contributors to neonatal

death in Bangladesh are

complications due to prematurity,

birth asphyxia and neonatal infection

or sepsis which are largely

preventable. To address the issues the

program focused the priority

maternal and newborn interventions

identified at ‘The Bangladesh Every

Newborn Action Plan’ (BENAP). Also

the newborn and child health

interventions by level of service

provision, identified at the Essential

Services Package (ESP) are prioritized

for implementation with greater

integration and functional referral

system. Compiling all the service

provisions and high impact

interventions a comprehensive

newborn care package (CNCP) is considered for NNHP.

Bangladesh Achieved MDG 4

133

116

9488

65

5346

48

8782

66 65

5243

38 31

5248

42 4137

32

28 22

0

20

40

60

80

100

120

140

1993 1997 2001 2004 2007 2011 2014 2015

U-5 MR IMRNMR

MDG

Source: BDHS, UN-IAGCME- UN Inter-agency group for Child Mortality Estimation, 2013

Proportion of Neonatal Mortality to U5 Mortality

52 48 42 41 37 32 28

3534

24 2415

1110

46

34

28 23

13

108

1993 1996 1999 2003 2007 2011 2014

Neonatal deaths (0-28 days)Post neonatal deaths (29 to 364 days)Deaths during 1 to 4 years

39 41 45 4757 60 61

0

20

40

60

80

100

1993 1996 1999 2003 2006 2011 2014NMR as proportion of U5MR

Source: BDHS 2014

The National Technical Working Committee (NTWC) is advising and guiding the program through regular coordination meeting under the leadership of Chairperson Prof. Mohammad Shahidullah, Professor of Neonatology (BSMMU), President BPA, President BMDC


03

NNHP & IMCI Program

Vision :

Objectives:

Key Activities:

• All the Newborn and Children of the country will receive high level of essential newborn care where every preventable newborn and child death will be averted.

• Creating awareness among the community and engage them to seek care for their newborn from health facility

• Increase access, availability and utilization of quality services for healthy and sick newborn and children• Improve knowledge, healthy behavior and care seeking practices for newborn and children.

• Community level key activities include multi-sectoral, multi-stakeholder engagement for promoting ENC practice and proper care seeking behavior of the community.

• At facility level:

1) Facility readiness for providing quality and equitable services for newborn is the prime activity which includes capacity development of all staffs and manager on newborn health interventions

2) Ensuring availability of commodities, medical products, job-aids and other supplies at different level of service provision,

3) Uploading monthly report using DHIS 2 platform 4) Quality Improvement Initiatives, monitoring and supportive supervision mechanisms in

place etc.

Photo C

redit: NN

HP

“In recent years Bangladesh has achieved significant success in reducing the newborn death, yet a huge task to be accomplishment to bring down the NMR to its target by 2030. The newborn health newsletter published by National Newborn Health Program (NNHP) will carry the footprint of our activities to improve the country’s newborn health status to achieve SDGs.”

Prof. Mohammad ShahidullahProfessor of Neonatology (BSMMU)

President BPA

President BMDC


04

Goals & Target of NNHP & IMCI

Program Management

At national level along with strong leadership and ownership of Director General of Health Services and functional coordination with different operation plans of DGHS, Directorate General of Family Planning (DGFP) and other units of MNC&AH operation plan the NNHP and IMCI program is implemented by one Program Manager, five Deputy Program Manager (DPM-Admin & Finance; DPM- Newborn Health; DPM- Training and Child Injury; DPM-Monitoring and Data Quality; DPM- Coordination and Logistics). MOH&FW is providing the overall guidance. At District Civil Surgeon, Upazila and below level Upazila Health and Family Planning Officer (UHFPO) with the support of MNH Focal Person will ensure implementation of NNHP & IMCI activities.

The technical assistance of different professional bodies especially Bangladesh Pediatric Association (BPA), Bangladesh Neonatal Forum (BNF), UN organizations (WHO, UNICEF, UNFPA), Development Partners (USAID, Save the Children, ICDDRB, Nutrition International, Plan International etc.) and all other stakeholders is crucial to successful implementation on NNHP and IMCI.

National: Implementation CommitteeNational Technical Committee

DGHS: Line Director Program Manager

DPM

Admin Finance

DPM Newborn Health

DPM Monitoring & Data Quality

DPMCoordinati

on & Logistics

DPM

Training & Child Injury

Division- DirectorDistrict - CS

Upazila - UHFPOUnion – MO & Paramedics

Community – CHCP & Field Staff

DGFPDGNMDPs Professional Associations

Other OPs

CBHCNNSHSMMISBHE

MOH&FW: Steering Committee

The table shows Targets set by MOHFW

Indicators Base line (Year and Data Source)

Projected Target(2022)

U5MR 46(BDHS 2014)

34

NMR28

(BDHS 2014)18

Operational Plan level Indicators (Output/Process):

Middle of theProgram(by June2020)

End of the Program(by June2022)

Baseline (withYear and

Data Source)Indicators

Projected Target

Percentage of newbornreceived essential newborn care

ANC coverage (at least 4 visit)

15% 25%

50 %40%

6.1 %(BDHS,2014)

31.2%(BDHS, 2014)


05

HHNP Implementation Steps

Implementation Strategies

•National Neonatal Health Strategy•National Child Health Strategy

NNHP Intervention package

Community Promotion & Prevention

Awareness

Engagement

Empowerment

PHCCare for All Newborn

Facility Readiness

Capacity Development

Providing quality & equitable services

Specialized CareCare for Small & Sick

Newborn

Preterm & LBW

Perinatal Complication Resuscitation: HBB protocol

Serious Infections

Critically Ill -SCANU

Procurement & supply of 7.1% CHX drugs,

equipment, commodities

SBCCNational Newborn Campaign

Availability of skilled service providers

Capacity building & skill retention

Facility Readiness

Referral &

Routine Data & Monitoring

Quality Improvement

SBCC

Transport


06

Policy and guideline

Training package

Priority activities

Capacity building of health care providers

• National Neonatal Health Strategy• National Child Health Strategy• National guidelines of priority newborn

interventions such as: ChlorhexidineTreatment of Possible Sevier Bactrial Infection (PSBI)Kangaroo Mother Care (KMC)Antenatal Corticosteroid (ACS)

• Special Care Newborn Unit (SCANU) Standard Operating Procedure

• Special Care Newborn Unit (SCANU) Standard• Special Care Newborn Unit (SCANU) Standard • Emergency Triage Assesment and Treatment (ETAT)• Comprehensive Newborn Care Package (CNCP)• Kangaroo Mother Care (KMC)• Health Systems Strengthening

• Training on NNHP Toolkit• Training on revised IMCI protocol focusing

diarrhea and pneumonia• Training on Comprehensive Newborn Care

Package (CNCP)• Training on Kangaroo Mother Care (KMC)• Training on ETAT & Sick Newborn Care• Training on Strengthening of Zinc and ORS use in

treatment of diarrhea for under five children• Ensuring facility readiness to provide essential

newborn care and IMCI at PHC facilities

1) Update/develop standards: • Development of national child health strategy • Revision of national newborn health strategy

2) Interventions that are nationally scaled up – • HBB protocol for resuscitation • ENC with application of 7.1% chx

3) Promote and accelerate other priority newborn interventions

• Expansion of KMC at facility. • Management of sick children at primary care

level facilities • Introduction of ACS for prevention of

complication of prematurity

4) Improved care of sick newborn at facility • Expansion of SCANU at secondary and

tertiary facility • Expansion of NSU at primary facility.

5) Procurement and supply of essential medicine, logistics and job aid of NB care

• Procurement and supply of 7.1% CHX in 64 districts of Bangladesh.

• Procurement and supply of essential medicines for Newborn & Child Health in 64 districts of Bangladesh.

• Procurement and supply of Printing Materials (Registers, Guideline, BCC materials etc)

6) Quality of care • Strengthen training institution • Development of resource pool at national/

district/ upazila. Leverage expertize of professional organization

• Strengthen supervision and monitoring : consultants

• Performance monitoring • Availability of essential commodities at supply

chain

7) Reporting and Database • Incorporation of New Newborn interventions

indicator in DHIS-2 • Dashboard for Newborn interventions • e-MIS of newborn intervention

8) Creating Awareness • National Newborn Campaign • SBCC strategy of NB care

9) Creating awareness among the community people to take care of newborn and children, empowering them with knowledge and information, engaging them to take the responsibility of health.


07

Job Aid

Job Aids - Neonatal Sepsis, KMC, ACS Treatment

Social and Behavioural Change Communication Kits


08

‘National Campaign on Newborn Health’ launching

To improve the knowledge, behavior and practices of people about essential newborn care and related services available in Bangladesh, the program launched the ‘National Campaign on Newborn Health’ on

12November 2017 with support from UNICEF.

The honorable State Minister, Ministry of Health and Family Welfare, Mr. Zahid Maleque, MP; Secretary, Ministry of Health and Family Welfare, Mr. Faiz Ahmed; Director General of Health Services, Prof. Dr. Abul Kalam Azad; representatives from program, development partners, professionals, health experts and media were present at the lunching ceremony.


09

Birth Defects Surveillance in Bangladesh

After sepsis (23%), Birth asphyxia (21%) and prematurity/ LBW (11%); birth defects (8%) contribute the most newborn deaths in Bangladesh. The estimated prevalence of birth defects is 58.6 per thousand live births. NNHP & IMCI program is working closely with Department of Neonatology, BSMMU to address the issue.

Data Capture Using DHIS 2

According to DHIS2 data, newborn care practices have improved considerably in Bangladesh from October 2017. Among institutional births in the last two quarters, the use CHX to the umbilical cord has increased from 70 percent in Oct-Dec 2017 to 75 percent in Jan-Mar 2018. The practice of skin-to-skin care immediately after birth and the initiation of breast-feeding within one hour after birth has also increased between these two quarters.

6170 73

6975 77

0

10

2030

40

50

60

70

80

90

100

No of newborn received skinto skin care immediate after

birth

No. of newborn received 7.1Chlorhexidine in the umbilical

cord

No. of newborn initiatedbreastfeeding within 1 hour

after birth

Perc

ent

October to December 2017 January to March 2018

Figure: Trends in essential newborn care practices, Oct-Dec 2-17 to Jan-Mar 2018 DHIS data


10

According to DHIS2 data, newborn care practices have improved considerably in Bangladesh from October 2017. Among institutional births in the last two quarters, the use CHX to the umbilical cord has increased from 70 percent in Oct-Dec 2017 to 75 percent in Jan-Mar 2018. The practice of skin-to-skin care immediately after birth and the initiation of breast-feeding within one hour after birth has also increased between these two quarters.

Documents develop by using IMCI database

Bangladesh has achieved remarkable reductions in maternal and child mortality in recent years. Successful implementation of high-quality progress requires data for use at all levels of the health systems. The possible steps to ensure monitoring and use of data related to key newborn interventions are as follows:

Agreement upon the set of key newborn indicators needed and subsequently testing to monitor the newly introduced newborn interventions.

Revision of existing tools and introduction of new tools with updated recommended newborn indicators including service registers, reporting forms and database followed by testing.Ensuring systems were in place for data sharing to ensure data quality to use data to drive forward planning and improvements.

The newborn interventions would focus the process taken to periodic update, integrate and successful use of newborn data within the current health information system in order to use in tandem with the NNHP implementation. There is also important to develop the approach and template of the NNHP program monitoring tools.

To monitor newborn interventions effectively, agreement upon the set of key indicators to be collected at each level of the health system is crucial. Agreement upon the newborn indicators and then subsequently indicators and tools monitoring and feedback for program improvement is important to roll out at all level. Training on the use of data and subsequent sharing of data was essential to facilitate data-driven decision-making. District and sub-district level service providers and statisticians should trained for data entry and to facilitate reporting and also repeated field visit to control & monitor over or under reporting.

Dr. Md. Abdul WadudDPM, Monitoring and Data Quality

NNHP&IMCI, DGHS


11

National Newborn and Child Health Cell

National Scale up of 7.1% Chlorhexidine: A mammoth in Public Health history of Bangladesh

With the technical support from Save the Children, Unicef and PHD ‘National Newborn and Child Health Cell’ was establish in MNC&AH of DGHS in June 2015. Science than the ‘Cell’ is supporting NNHP&IMCI program with planning, monitoring and coordination of various scale up activities such as ‘7.1% Chlorhexidine in the newborn umbilical cord’, ‘Use of zinc and ORS in the treatment of diarrhea among 6-59 months children’ and ‘Revisit of Specific Newborn Interventions’. Besides that regular online program reporting were also monitored from the Cell.

This cell is incorporated in the MNC&AH Operational Plan (January 2017 - June 2022) and providing necessary technical support to Line Director and other Programs under MNC&AH operational plan. The Cell also coordinate with the various stakeholders like WHO, Unicef, UNFPA, Save the Children, SIAPS, Ipas, Dnet etc to implement the ongoing activities more effectively. The cell maintains close coordination with DGFP regarding Newborn Health. Thus the Cell supports National Newborn Health Program implementation.

• Application of 7.1% Chlorhexidine for newborn cord care is

recommended as one of the 4 new newborn interventions

and MOH&FW has decided for national scaling-up of this

intervention.

• The vision for this scale-up plan is to achieve 90% coverage

nationally for application of CHX immediately after birth for

all deliveries by 2020.

Procurement and Supply Chain:• NNHP & IMCI program of DGHS has procured 990,000

dropper bottle in 2018

• 500,000 procurement completed and will be distributed by

end of May 2018

• 490,000 procurement and distribution will complete by end

of September 2018

Figure: Category wise orientation on 7.1% Chlorhexidine (July 2015-June 2016)

Picture: Advocacy meeting on 7.1% Chlorhexidine distribution andcommunity awareness on newborn health care -seeking throughCommunity Clinic held on 06th May 2018 in NNHP & IMCI


12

Plan International

CARE

Stakeholders Activitis

IMCI & Eye

Plan International Bangladesh has signed an agreement with National Newborn Health Program (NNHP) & Integrated Management of Childhood Illnesses (IMCI) to execute the assignment of-implementing ‘F-IMCI Training for Sub-Assistant Community Medical Officers (SACMO) and Family Welfare Visitor (FWV) of “Strengthening Health Outcomes for Women and Children (SHOW)” project implementation areas. Under this agreement, training of 1st batch was organized for 24 SACMOs from different upazilas of Nilphamari District between 17th -27th December 2017 at Institute of child and maternal health (ICMH).

CARE partnered with the MOH&FW and UNICEF, through IECMNCH project, to implement and learn about community-based interventions in Khulna district. The coordinated effort aims to improve Effective Coverage of Maternal, New-born and Child Health services funded by KOICA.

Community mobilization and improving MNCH knowledge and service seeking behaviour among community people is one of the key goals of the project and the Community Health Volunteer (CHV) is the integral vehicle for creation of demand for MNCH services in project areas where a total of 730 CHV (9-15 CHV/union) has been working. After completion of series of training (household registration and mapping, MNCH, counselling and community IMCI), CHVs registered 30,474 pregnant women while 27,433 live birth conducted from Jan’17-Dec’17.

Trainning Workshop and Advocacy Meeting on Piloting to integrate referral of pediatric eye cases within IMCI Progranne in Jashore district & Advocacy Meeting with IMCI Group.

Figure: Demonstration of Newborn Care


13

UNICEF

Save the Children

UNICEF is working closely with national newborn Health programme to reduce neonatal mortality and improve newborn Health care. UNICEF focuses on the following priority interventions and support to NNHP.

• Development of Bangladesh Every Newborn Action Plan (BENAP)

• Development of Standard Operating Procedures for facility Based Newborn Care

• Upgrading Facilities with Special Care Newborn Units• Development of Training Modules and Capacity Building

of Service Providers• Procurement and distribution of newborn equipment and

commodities• Strengthen Quality Improvement System for New-born

Health Care• Development of Web-Based MIS for Newborn Care in

Facilities• National Campaign on Newborn Health

Save the Children has been working very close with government. SCi have incorporated the newborn intervention from government operation plan to their work plan and are woking together to achive the SDGs and government commitment in helath sector specially newborn and child helath. The Broad areas of SCI support for NNHP implementation in National level Technical support are National Scale up of NNHP toolkit, National Scale up of CNCP, Training roll out guide and monitoring for NNHP implementation ,Development of national level training center of CNCP implementation, National Neonatal Health Strategy (NNHS) update, SBCC of NNHP, Documentation and sharing of learning of newborn intervention implementation and National scale up of HBB and ENC including 7.1% Chx application.

The district Level support areas are implementation support of HBB and ENC including Chx in SCi supported districts, Demonstration of PSBI and KMC in existing health system, Early implementation of ACS introduction for prematurity, Support for the establishment of SCANU and NSU for sick newborn care at facility, Community engagement for NB intervention and Monitoring and mentoring of NB care (RRQIT).

Picture: Master Trainer’s orientation on NNHP intervention toolkits

Before

After


14

Media Coverage

Save the Children has been working very close with government. SCi have incorporated the newborn intervention from government operation plan to their work plan and are woking together to achive the SDGs and government commitment in helath sector specially newborn and child helath. The Broad areas of SCI support for NNHP implementation in National level Technical support are National Scale up of NNHP toolkit, National Scale up of CNCP, Training roll out guide and monitoring for NNHP implementation ,Development of national level training center of CNCP implementation, National Neonatal Health Strategy (NNHS) update, SBCC of NNHP, Documentation and sharing of learning of newborn intervention implementation and National scale up of HBB and ENC including 7.1% Chx application.

The district Level support areas are implementation support of HBB and ENC including Chx in SCi supported districts, Demonstration of PSBI and KMC in existing health system, Early implementation of ACS introduction for prematurity, Support for the establishment of SCANU and NSU for sick newborn care at facility, Community engagement for NB intervention and Monitoring and mentoring of NB care (RRQIT).

Round table meeting

A roundtable meeting on Essential Newborn Care was held on 6th February, 2018 entitled “every newborn has

to be saved’. The goal of the meeting was to adress the newborn health issue with top priority from policy

making level to every spere of society.

Mr. Zahid Maleque , the honorable state minister of Ministry of Health and Family Welfare

Government of the People's Republic of Bangladesh delivered the inaugural speech. The minister

mentioned the great challenge to meet the target of newborn and child mortality within 2030. He

addressed the importance of availability of facility delivery service, ANC & PNC, Nutrition, vaccination

& initiation of early breast feeding, the infrastructure & environment of service delivery, skilled

manpower and smooth communication system to enhance the newborn and maternal health.

Professor Abul Kalam Azad, DG-DGHS; Professor Mohammad Shahidullah, President BMDC and

President Bangladesh pediatric Association [BPA]; Dr Khaleda Islam, Director PHC, and different

stakeholders were present in the meeting which highlighted some important issues including the

commitment to reduce newborn death should be include in every political party’s election manifesto,

Standard delivery service should be ensured in every facility, and delivery should be performed by skill

midwife, mass awareness should be ensures regarding the most common cause of newborn death,

discrimination between rich and poor should be removed in case of health care service, the pregnant

mother of rural region should be encouraged to visit health facility.

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15

Kangaroo Mother Care: to prevent deaths due to prematurity

Prematurity and low birth weight is one of the main reason for newborn mortality and accounts for 31% total newborn mortality. Evidence based and world recognized Kangaroo Mother Care (KMC) can prevent most of the deaths due to prematurity.

Bangladesh reiterates its commitment to “end preventable child deaths by 2035” through strengthening previous successes achieved for reducing child mortality and adopt to implement evidence based priority newborn health intervention. Kangaroo Mother Care is incorporated in 4th Health, Population, Nutrition Sector Program of Ministry of Health and Family Welfare as priority interventions to implement in all medical college hospital, district hospital and upazilla health complex.

Kangaroo Mother Care (KMC) is functioning in 47 government, autonomous and non-government facilities. Kangaroo Mother Care service is now available in Bangabandhu Sheikh Mujib Medical University, BIRDEM Hospital, Institute of Child and Mother Care (ICMH) and Shahid Shurwardi Medical College Hospital, Mother and Child Health Training Institute (MCHTI), Mohammadpur Fertility Services and Training Center (MFSTC) and district hospital, upazilla health complex and selected Mother and Child Welfare Center (MCWC) of Noakhali, Habiganj, Jalokathi, Lakhmipur, Bhola, Pirojpur, Kushtia district under Directorate General of Health Services and Directorate General of Family Planning.

Presently both Directorate General of Health Services and Directorate General of Family Planning are working to ensure Kangaroo Mother Care service in selected facilities in collaboration with Save the Children, UNICEF

and World Health Organization (WHO). By 2020, government is committed to ensure Kangaroo Mother Care services in 50% of all upazilla health complex and other facilities.

On October 3, 2016, 22 year-old Jesmin from Poschim Lahinipara in Kushtia district delivered a

baby girl, Sharmin, weighing only 1400 gm. She received KMC at Kushtia District Hospital.

Now Sharmin is nine months old and in perfectly good health. Jesmin is thankful to

the doctors and nurses.


16

Case study A Newborn Death Averted in Bhola

For more information please contact:Dr. Khaleda IslamDirector, PHC & PM, NNHP & IMCI, DGHSE-mail: [email protected] [email protected]

Editor in chief - Dr. Khaleda Islam

Editorial board: Dr. Ehtesham KabirDr. Mahfuza AktherDr. Md.Abdul WadudDr. Md. JahurulIslamDr. Md. MoklesurRahmanDr. Sabina Ashrafee Lipi

National Newborn and Child Health Cell

Design & layout : K. M. Munmun Hafiz

Board of advisors: Prof. Abul Kalam AzadProf. Mohammad ShahidullahDr. A.E.Md. Muhiuddin Osmani

Jakir Miah, a farmer from south Rajapur in Bhola district, and his wife Taslima got married in 2003. In 2010 the couple had their second baby boy. The delivery was attended by the village’s traditional birth attendant.

Two days after the birth an infection appeared. The umbilical area became edematous, and there was discharge of pus and water from the cord. The baby’s temperature rose, and he became irritated. The parents took the baby to a village doctor and then to a private doctor. The doctor cleaned the cord ointment and gave medicine. But the baby’s condition remained unchanged for the next 2 weeks. Finally, the parents took the baby to Barisal Medical College and doctors applied an antibiotic therapy, but the attempt was in vain. At the age of 28 days the baby died. In the same way, their fourth baby died on umbilical sepsis.

After losing two children, Jakir began learning about umbilical cord infection. To learn more, hemet a health assistant named Abul Hossain, who taught him about the 7.1% chlorhexidine. Jakir bought this medicine from a local market when his wife was in the eight month of her next pregnancy. “This time I knew that the government had medicine to prevent umbilical infection,” said Jakir. Although the delivery was conducted at home like the previous ones, this time they applied 7.1% chlorhexidine. Jakir said “My baby is now 13 months old. He is well and healthy. I try to let everybody know that nothing should be applied to the cord except chlorhexidine. We are grateful to Abul.” Abul Hossain was trained in the use of 7.1% chlorhexidine through the national scale- conducted by the DGHS and supported by the MaMoni HSS Project.

Photo: Jakir and Taslima with their valuable child