title: The use of chlorhexidine to reduce maternal and neonatal mortality and morbidity in low-resource settings.
abstract: Of the 4 million neonatal deaths and 500,000 maternal deaths that occur annually worldwide, almost 99% are in developing countries and one-third are associated with infections. Implementation of proven interventions and targeted research on a select number of promising high-impact preventative and curative interventions are essential to achieve Millennium Development Goals for reduction of child and maternal mortality. Feasible, simple, low-cost interventions have the potential to significantly reduce the mortality and severe morbidity associated with infection in these settings. Studies of chlorhexidine in developing countries have focused on three primary uses: 1) intrapartum vaginal and neonatal wiping, 2) neonatal wiping alone, and 3) umbilical cord cleansing. A study of vaginal wiping and neonatal skin cleansing with chlorhexidine, conducted in Malawi in the 1990s suggested that chlorhexidine has potential to reduce neonatal infectious morbidity and mortality. A recent trial of cord cleansing conducted in Nepal also demonstrated benefit. Although studies have shown promise, widespread acceptance and implementation of chlorhexidine use has not yet occurred. This paper is derived in part from data presented at a conference on the use of chlorhexidine in developing countries and reviews the available evidence related to chlorhexidine use to reduce mortality and severe morbidity due to infections in mothers and neonates in low-resource settings. It also summarizes issues related to programmatic implementation.
authors.affiliation: Department of Statistics and Epidemiology, RTI International, Durham, NC 27709, USA. mcclure@rti.org
authors.forename: E M
authors.initials: EM
authors.lastname: McClure
authors.forename: R L
authors.initials: RL
authors.lastname: Goldenberg
authors.forename: N
authors.initials: N
authors.lastname: Brandes
authors.forename: G L
authors.initials: GL
authors.lastname: Darmstadt
authors.forename: L L
authors.initials: LL
authors.lastname: Wright
authors.forename: Deborah
authors.initials: D
authors.lastname: Armbruster
authors.forename: Robert
authors.initials: R
authors.lastname: Biggar
authors.forename: Joyce
authors.initials: J
authors.lastname: Carpenter
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Free
authors.forename: Donald
authors.initials: D
authors.lastname: Mattison
authors.forename: Matthews
authors.initials: M
authors.lastname: Mathai
authors.forename: Nancy
authors.initials: N
authors.lastname: Moss
authors.forename: Luke C
authors.initials: LC
authors.lastname: Mullany
authors.forename: Stephanie
authors.initials: S
authors.lastname: Schrag
authors.forename: James
authors.initials: J
authors.lastname: Tielsch
authors.forename: Jorge
authors.initials: J
authors.lastname: Tolosa
authors.forename: Stephen N
authors.initials: SN
authors.lastname: Wall
authors.forename: Anne
authors.initials: A
authors.lastname: Schuchat
authors.forename: Abdelkrim
authors.initials: A
authors.lastname: Smine
mesh_terms: D000349:Africa / Q000453:epidemiology; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D001211:Asia, Western / Q000453:epidemiology; D002710:Chlorhexidine / Q000627:therapeutic use*; D003906:Developing Countries; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods*; D008428:Maternal Mortality; D011247:Pregnancy; D011645:Puerperal Infection / Q000401:mortality / Q000517:prevention & control*; D018805:Sepsis / Q000517:prevention & control
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine