KARACHI: A project assisted by international health care organisations has been launched in 10 ‘hard-to-reach’ districts of Sindh to reduce neonatal deaths in the province, it emerged on Thursday.

Umbilical cord infection is the cause of death of 23 per cent children who die in the first month of their life in Pakistan, according to health officials. The ratio is said to be higher in rural areas where medical facilities are scarce and pregnancy is treated by unqualified birth attendants. Officials in the Sindh health department said unskilled births resulted into sepsis at the time of delivery; hence it had sent a request to USAID to help diagnose and suggest remedy.

“The McHIP, implementation partners of the USAID, is assisting to provide training and an initial consignment of Chlorhexidine tubes to the harder-to-reach districts and areas,” said an official.

Sindh was the first province to implement recommendations on chlorhexidine application, the official said, adding the training had already started in 10 districts.

“The solution lies in enhancing skilled birth attendants. Just constructing dispensaries or hospitals may not resolve this issue,” another official said.

Pakistan has the worst ratio of neonatal deaths in South Asia, which is 55 neonatal deaths out of 1,000 births. This is worse than the war-torn Afghanistan where the situation has improved with 36 neonatal deaths in every 1,000.

Bangladesh and Nepal have the better ratio of 24/1,000 while it is 31/1,000 in India. Sri Lanka’s performance is best with 12/1,000.

The Sindh health department believed that chlorhexidine cord cleansing reduced neonatal mortality substantially and trimmed down neonatal mortality by 24pc. It said neonatal mortality could be reduced by 34pc if Chlorhexidine was applied within 24 hours of birth. Besides, it added, the medicine moderately reduced severe omphalitis (inflammation of umbilical cord stump in the neonatal newborn period) and cord bacterial colonization.

The health officials said Sindh had already procured around 50,000 tubes of the medicine, weighing three grams, from Nepal on experimental grounds. They said the medicine was being used in the 10 targeted districts where hundreds of lady health workers were being trained. However, they said Sindh needed around 3.8 million tubes of the medicine for newborns in a year.

The officials said all the provinces in Pakistan had sent their summaries to Islamabad for procurement of Chlorhexidine.

The government, said an official, was busy negotiating with some pharmaceutical company to ensure that such medicine could be manufactured locally.

WHO recommends daily chlorhexidine application to the umbilical cord stump during the first week of life for newborns who are at home in settings with high neonatal mortality. Use of chlorhexidine in these situations may be considered only to replace application of a harmful traditional substance such as cow dung to the cord stump.

Published in Dawn, December 19th, 2014