Implementation outcomes of the national scale up of chlorhexidine cord cleansing in Bangladesh’s public health system

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dc.contributor.authorCallaghan-Koru, Jennifer A
dc.contributor.authorKhan, Marufa
dc.contributor.authorIslam, Munia
dc.contributor.authorSowe, Ardy
dc.contributor.authorIslam, Jahurul
dc.contributor.authorBillah, Sk Masum
dc.contributor.authorMannan, Imteaz Ibne
dc.contributor.authorGeorge, Joby
dc.contributor.authorThe Bangladesh Chlorhexidine Scale Up Study Group
dc.date.accessioned2019-11-04T17:03:54Z
dc.date.available2019-11-04T17:03:54Z
dc.date.issued2019
dc.description.abstractBackground Chlorhexidine (CHX) cleansing of the umbilical cord stump is an evidence-based intervention that reduces newborn infections and is recommended for high-mortality settings. Bangladesh is one of the first countries to adopt and scale up CHX nationally. This study evaluates the implementation outcomes for the CHX scale up in Bangladesh and identifies and describes key milestones and processes for the scale up. Methods We adapted the RE-AIM framework for this study, incorporating the WHO/ExpandNet model of Scale Up. Adoption and incorporation milestones were assessed through program documents and interviews with national stakeholders (n = 25). Provider training records served as a measure of reach. Implementation was assessed through a survey of readiness to provide CHX at public facilities (n = 4479) and routine data on the proportion of all live births at public facilities (n = 813 607) that received CHX from December 2016 to November 2017. Six rounds of a rolling household survey with recently-delivered women in four districts (n = 6000 to 8000 per round) measured the effectiveness and maintenance of the scale up in increasing population-level coverage of CHX in those districts. Results More than 80 000 providers, supervisors, and managers across all 64 districts received a half-day training on CHX and essential newborn care between July 2015 and September 2016. Seventy-four percent of facilities had at least 70% of maternal and newborn health providers with CHX training, while only 46% had CHX in stock on the day of the assessment. The provision of CHX to newborns delivered at facilities steadily increased from 15 059 newborns (24%) in December 2016 to 71 704 (72%) in November 2017. In the final household survey of four districts, 33% of newborns were reported to receive CHX, and babies delivered at public facilities had 5.04 times greater odds (95% CI = 4.45, 5.72) of receiving CHX than those delivered at home. Conclusions The scale up of CHX in Bangladesh achieved sustained national implementation in public health facilities. Institutionalization barriers, such as changes to supply logistics systems, had to be addressed before expansion was achieved. For greater public health impact, implementation must reach deliveries that take place at home and in the private sector.en_US
dc.description.sponsorshipThis study was conducted as a part of MaMoni Health Systems Strengthening (HSS) Project with generous support of the American people through the United States Agency for International Development (USAID); Associate Cooperative Agreement No. AID-338-LA-13-00004. The views expressed in this article are solely the views of the authors and do not reflect the views of the United States Agency for International Development or the United States Government.en_US
dc.description.urihttp://www.jogh.org/documents/issue201902/jogh-09-020410.htmen_US
dc.format.extent13 pagesen_US
dc.genrejournal articlesen_US
dc.identifierdoi:10.13016/m2kuss-ffug
dc.identifier.citationCallaghan-Koru, Jennifer A; Khan, Marufa; Islam, Munia; Sowe, Ardy; Islam, Jahurul; Billah, Sk Masum; Mannan, Imteaz Ibne; George, Joby; The Bangladesh Chlorhexidine Scale Up Study Group; Implementation outcomes of the national scale up of chlorhexidine cord cleansing in Bangladesh’s public health system; Journal of Global Health; https://doi.org/10.7189/jogh.09.020410en_US
dc.identifier.urihttps://doi.org/10.7189/jogh.09.020410
dc.identifier.urihttp://hdl.handle.net/11603/16028
dc.language.isoen_USen_US
dc.publisherJournal of Global Healthen_US
dc.relation.isAvailableAtThe University of Maryland, Baltimore County (UMBC)
dc.relation.ispartofUMBC Sociology and Anthropology Department Collection
dc.relation.ispartofUMBC Faculty Collection
dc.rightsThis item is likely protected under Title 17 of the U.S. Copyright Law. Unless on a Creative Commons license, for uses protected by Copyright Law, contact the copyright holder or the author.
dc.rightsAttribution 4.0 International (CC BY 4.0)*
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/*
dc.subjectChlorhexidineen_US
dc.subjectnewborn infectionsen_US
dc.subjectpublic health facilitiesen_US
dc.subjectevidence-based interventionen_US
dc.titleImplementation outcomes of the national scale up of chlorhexidine cord cleansing in Bangladesh’s public health systemen_US
dc.typeTexten_US

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