Chlorhexidine in Bolivia: Preventing Avoidable Infant Death


Infections love newborns. With no ability to fight off infection, newborns are left vulnerable particularly because of open umbilical cords cut immediately after birth. Umbilical cords are an under-appreciated organ in many regards. They provide a vital connection to foster the infant’s growth, but can be a direct entry point for bacteria, viruses, and disease after the child is born.

Due in great part to this fact, neonatal mortality(in the first 28 days) as a result of infection is a major contributor to child mortality in Latin America. In Latin America, newborn death accounts for 60% of infant death(within one year). Infant mortality rates have been decreasing in the region in the last ten years, but neonatal mortality has made almost no progress in that time. One of the most cost effective, simple and safe interventions to reduce neonatal death is the utilization of chlorhexidine cord care. Chlorhexidine is a low risk, high reward intervention that PATH is working to introduce to Latin America.

Trials of chlorhexidine have been so successful in Nepal, Bangladesh and Pakistan that national scale-up for umbilical cord care has been prioritized by these countries. In January 2014, the WHO made a recommendation for cord care using chlorhexidine in all high infant-mortality rate countries.

ChlorhexidinePAHO, UNICEF, USAID, Save the Children, WHO, ACCESS, BASICS, and CORE are currently working with 14 countries in Latin America and the Caribbean to prioritize improvements in maternal and child health. Chlorhexidine is the next step in making the prioritization effective.

Currently Bolivia suffers the highest infant mortality rate in South America, at 32.8deaths/1000 lives births. For substantial and lasting change to be made in preventing infant death due to infection, policy in Bolivia must change to include (or scale-up) chlorhexidine cord cleaning for home births. To give children a fighting chance at life, we need to give infants the time, without infection, to be able to create immunity for the rest of their lives.

More information:

Community Health Workers and Chlorhexidine in Nepal

March 5, 2015 Chlorhexidine article

WHO in Bolivia



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3 Responses to “Chlorhexidine in Bolivia: Preventing Avoidable Infant Death”

  1. drantonioquispe Says:

    I agree with the blog´s author that implementing chlorhexidine would be an important intervention to reduce neonatal mortality in LMIC like Bolivia, but I disagree with her that it should it be implemented alone. The problem of neonatal mortality is a complex problem that must be managed with an integrated strategy including several interventions that by been used together in order to maximize our chances to reduce neonatal mortality effectively. Such interventions should include at least several of the following: a) vaccination with tetanus toxoid of women of child bearing age; b) community-based interventions i.e. clean and skilled care at delivery; newborn resuscitation; exclusive breastfeeding; umbilical cord care and management of infections in newborns; c) supplementary immunization; and, d) safer delivery practices (Khan et al 2013)

    • juliahmoon Says:

      I’m sorry if this came across as suggesting that Chlorhexidine was an effective treatment independently. No intervention is effective in a vacuum, and as you mentioned, integrated packages of treatment are required to improve neonatal and infant health outcomes. Until we prioritize and integrate reproductive health, maternal health care, delivery practices, attendance at birth, general sanitation, and the community based interventions you mentioned, we will not see changes in maternal, neonatal, infant or child health at the scale we would hope for. Chlorhexidine however, is an effective preventive measure against neonatal infections which are the cause of 13% of infant deaths. You are correct that the problem of neonatal mortality is a complex one, but we need to start taking steps to address avoidable deaths we can identify.

  2. lhobbs5 Says:

    Thank you for posting about the potential of Chlorhexidine to prevent infant mortality (particularly in Bolivia). It is staggering to think that approximately 3 million newborns die each year and that 13% of those deaths are caused by infections. I read that the Chlorhexidine Working Group, an international collaboration of organizations that are dedicated to advancing access to and use of 7.1% chlorhexidine, is aspiring to fast-track the introduction and application of chlorhexidine in at least ten countries by 2016. With such marked success during the research trials conducted in Nepal, Bangladesh, and Pakistan, I would like to see the working group set a much more aggressive target. Its ability to lessen the burden of neonatal infection and mortality in Bolivia and other countries hardest hit is momentous. I am curious as to how a culturally acceptable intervention will be developed and implemented in Bolivia. Will Bolivia utilize community-based health workers and/or community-based delivery methods and what measures will be taken to ensure sustainability of chlorhexidine’s application?

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