Zambia Chlorhexidine Application Trial (ZamCAT)

Project Description

Each year nearly 4 million children die before 4 weeks of age, with one-third of these deaths due to infection. Contamination of the umbilical stump poses a significant risk of infection and death during the first 28 days of life, especially among home births, which are common in rural Zambia. Effective interventions that can be carried out at the household level are critically needed to reduce neonatal infections and mortality. Between November 2009 and December 2013, the CGHD worked in partnership with the Zambia Ministry of Health to implement the Zambia Chlorhexidine Application Trial (ZamCAT). The aim of the study is to demonstrate whether chlorhexidine, a simple antiseptic wash applied to the umbilical stump of newborns, will reduce infection and thus improve infant survival rates.

Almost 40,000 pregnant Zambian women were recruited for the study. Half of them used the topical antiseptic daily for a period of a week to ten days postpartum, and half cared for their newborns based on the standard practice—dry cord care. The study seeks to determine whether community-based health workers and mothers themselves can implement this effective and sustainable home-based program in a rural African setting, where neonatal mortality rates are high.

Before launching the project, the study team conducted formative research to identify community-specific behaviors and practices related to umbilicus care through focus group discussions and in-depth interviews in Zambia’s Southern Province, where the trial took place. The results of this qualitative research have informed the design and implementation of a culturally acceptable intervention.

The trial is now in the data analysis phase, with over 39,787 mother baby pairs having completed the data collection follow-up.

The anticipated outcome of this study will be a proven, simple method to reduce neonatal mortality. Similar research in Nepal found that the neonatal mortality rate was reduced by 25% and up to 34% in children who had the first chlorhexidine application within 24 hours of birth. The intervention—which costs pennies—would be a cheap, effective method to protect newborns in the first 28 days of life in Zambia and has the potential to be applied in other settings in the developing world.

View local staff in Lusaka and Choma on the Zambia Country Program Contact List.

Project Details

Principal Investigator Davidson Hamer, Katherine Semrau
Boston University Co-Investigators Julie Herlihy, William MacLeodDeborah Maine, Arthur MazimbaJonathon Simon, Donald Thea, Kojo Yeboah-Antwi
Country(ies) Zambia
Dates of Research 2009–2013
Donor/Funder Gates_foundation_logo_150The Bill & Melinda Gates Foundation