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JSI Research & Training Institute, Inc. successfully implemented the Nepal Family Health Program II for the U.S. Agency for International Development from 2007 to 2012. For further information on project activites, visit the NFHP II page on


Progress on Chlorhexidine Navi Care Program

There is good evidence that application of chlorhexidine (CHX) to the umbilical cord of a newborn immediately after cord-cutting reduces neonatal mortality.
Based on this evidence, CHX was piloted as a component of maternal and newborn health activities at the community level in three districts: Banke, Jumla and Bajhang, under the leadership of the Family Health Division, with technical and financial support from the Nepal Family Health Program II. A key part of the pilot process was orientation on the use of CHX to all health workers and Female Community Health Volunteers (FCHVs). The objective of the training was to ensure application of CHX for all deliveries, and to make sure that all pregnant women that are visited by FCHVs during their eight month of pregnancy receive CHX along with appropriate counseling on its use.

A household-level survey was carried out in 2011 to measure the coverage and compliance of CHX application as part of cord care management. The results were encouraging, thus helping the Ministry of Health and Population endorse the inclusion of CHX in existing national programs such as the Community Based Newborn Care Program (CB-NCP), use of misoprostol to prevent post-partum hemorrhage at birth, and pre-service and in-service training of skilled birth attendants, as part of essential newborn care.

Chlorhexidine Nave Care Program
”Saving Life at Birth: a Grand Challenge for Development” awarded a 3 year grant to JSI, given the name: Chlorhexidine Navi Care Program (CNCP). Through CNC, JSI is supporting the GoN and working with other partners to scale up use of chlorhexidine to as many districts as possible.
Specifically, the CNCP plans to:
• Implement CB-NCP with CHX in two new districts (Pyuthan and Rupandehi)
• Scale-up CHX in existing CB-NCP districts
• Scale-up CHX in new CB-NCP districts with other partners
• Introduce CHX as part of misoprostol program expansion in non-CB-NCP districts
• Include CHX in pre-service and SBA training curriculum
• Carry out CHX social marketing

• CHX has been integrated into the CB-NCP training package. Health workers and FCHVs were given separate orientations about CHX in existing CB-NCP districts, whereas in the new CB-NCP districts, CHX orientation will be carried out as part of overall CB-NCP orientation.
• CHX for cord care has already been included in the essential medicine list and the CHD has allocated a budget to purchase CHX for at least 45 districts in the upcoming fiscal year. Moreover, PSI Nepal has shown interest to carry out social marketing of CHX.
• To date, CHX has been introduced in 11 districts and will be introduced in at least 63 districts across Nepal before the end of the CNCP project period.

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Chlorhexidine on umbilical cord to prevent new born sepsis

There is good evidence that application of chlorhexidine (CHX) to the cord area of a newborn immediately after cutting the cord reduces neonatal mortality. These findings have generated interest from the Government in introducing this intervention. In preparation for this, NFHP II initiated studies on the optimal preparation of CHX for the Nepal context, and is currently working with the GoN to pilot CHX use in 4 districts.

A 4% aqueous form of CHX was shown to be effective in reducing neonatal mortality risk. NFHP II facilitated a study, conducted at Paropakar Maternity and Women's Hospital that assessed whether CHX in lotion form was at least as effective as an aqueous form, as measured by presence of bacterial colonies on periumbilical cultures 24 hours post application. A community acceptability study done in Banke district showed that there was a clear preference for the lotion preparation. These studies facilitated further discussion on scaling up this intervention.

The CHX intervention is now being piloted in four districts in Nepal with Government approval and support from different partners. The four implementing districts are Banke and Jumla (NFHP II), Bajhang (NFHP and UMN) and Parsa (PLAN/Nepal with technical support from NFHP II). Chlorhexidine has been named as “Kawach” and is being made available, through FCHVs, to pregnant women in late pregnancy along with counseling on its use. CHX is also included in Clean Home Delivery Kits (CHDKs) and local pharmacies in these pilot districts. This represents a successful model of public private partnership.

Chlorhexidine is a cheap compound, free of side-effects or toxicity when applied topically, and it can reduce newborn deaths. If the pilots are successful, national scale-up is expected.

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Calcium for Prevention of the Consequences of Pre-eclampsia/Eclampsia

Calcium supplementation has been shown to be effective in reducing the risk of the complications of pre-eclampsia/eclampsia. The Family Health Division (FHD), MCHIP and NFHP II are jointly implementing a pilot study on the use of calcium to prevent pre-eclampsia/eclampsia in two VDCs of Banke district with approval from Nepal Health Research Council. The main objective of this study is to examine the acceptability and ease use of two different forms of calcium supplements—tablet and powder forms.

As part of this study, a one–day orientation was organized for all FCHVs (38) from both VDCs in Dec 2009. Calcium supplementation started at the end of December 2009. As planned, Udaharapur VDC started with calcium in tablet form, and Titiheria VDC started with the powder form. After one month of supply of calcium in these forms, both VDC switched to the alternate form in January 2010. Technical support visits were conducted in these two VDCs by staff from FHD, NFHP, MCHIP and NHRC during orientation and first supply, and after switching Preparations. A total 97 pregnant women enrolled in this study and are currently taking calcium. The majority of the pregnant women enrolled in the study completed two months of calcium supplementation, and continued from the third month with the preparation of choice. FCHVs provided messages to the pregnant women as per flash cards provided to them during orientation. FCHVs are also distributing the calcium supplements regularly to the women, providing their preparation of choice. The Valley Research Group (VARG) was selected to conduct this study on acceptability of and compliance with calcium supplementation. VARG staff are currently finishing data cleaning, analysis and reporting. Preliminary findings suggest that the majority of women preferred tablet compared to the powder form of supplementation. Women reported minimal side effects due to the intake of calcium in study areas. The study report is being finalized, and will be disseminated in August, 2010.

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