Health care providers’ perspectives regarding the use of chlorhexidine gel for cord care in neonates in rural Kenya: implications for scale-up

Abstract

BackgroundThis paper explores the perspectives of health care providers regarding the use of 7.1% Chlorhexidine Digluconate (CHX) gel that releases 4% chlorhexidine for newborn umbilical cord care under a managed access program (MAP) implemented in Bungoma County of Kenya. Understanding the perspectives of providers regarding CHX is important since they play a key role in the health system and the fact that their views could be influenced by prior beliefs and inconsistent practices regarding umbilical cord care.MethodsData are from in-depth interviews conducted between April and June 2016 with 39 service providers from 21 facilities that participated in the program. The data were transcribed, typed in Word and analyzed for content. Analysis entailed identifying recurring themes based on the interview guides.ResultsUse of CHX gel for cord care in neonates was acceptable to the health care providers, with all of them supporting scaling up its use throughout the country. Their views were largely influenced by positive outcomes of the medication including fast healing of the cord as reported by mothers, minimal side effects, reduced newborn infections based on what their records showed and mothers’ reports, ease of use that made it simple for them to counsel mothers on how to apply it, positive feedback from mothers which demonstrated satisfaction with the medication, and general acceptance of the medication by the community. They further noted that successful scale-up of the medication required community sensitization, adequate follow-up mechanisms to ensure mothers use the medication correctly, addressing issues of staffing levels and staff training, developing guidelines and protocols for provision of the medication, adopting appropriate service delivery approaches to ensure all groups of mothers are reached, and ensuring constant supply of the medication.ConclusionUse of CHX gel for cord care in neonates is likely to be acceptable to health care workers in settings with high prevalence of neonatal morbidity and mortality arising from cord infections. In scaling up the use of the medication in such settings, some of the health systems requirements for successful roll-out can be addressed by programs while others are likely to be a persistent challenge.

Assessment of Chlorhexidine use for cord care at Kangundo level 4 Hospital

“…There have also been unverified reports of an increase in the number of septic cords in the child welfare clinic . This is in contradiction to the findings reported in a study done in 2016 that showed high acceptability of CHX owing to its fast action in cord drop off (22).…”

“…Methylated spirit, normal saline are among the most common products used for cord care (22). The same problem still exists today in our facility with most of the healthcare workers still not sure which product to use despite the guidelines being clear.…”

“…Recommendations by a study that supported the scale up of CHX use have not been fully implemented; These include community sensitization through CHVs, staff training, providing CHX for free and ensuring constant supply of the medication (22).…”

Influence of newborn health messages on care-seeking practices and community health behaviors among participants in the Zambia Chlorhexidine Application Trial

“…Health care providers accepted use of CHX gel and were largely influenced by positive outcomes including ease of use, fast healing of the cord, minimal side effects and reduced infections based on records and mothers’ reports [ 16 ]. The evaluation presented similar results to ZamCAT as mothers and health workers agreed that chlorhexidine should continue to be freely provided through government health facilities and the importance of education and training for mothers and health providers prior to use [ 17 ].…”

“…While there are no reports of chlorhexidine being considered harmful when used appropriately to treat umbilical cord infections, it is important to correct the misperception that there are no risks associated with chlorhexidine use. A controlled managed access program was implemented in Bungoma County, Kenya to evaluate the acceptability of 7.1% chlorhexidine gel for neonatal umbilical cord care among providers and mothers of newborns [ 17 ]. Health care providers accepted use of CHX gel and were largely influenced by positive outcomes including ease of use, fast healing of the cord, minimal side effects and reduced infections based on records and mothers’ reports [ 16 ].…”