Impact of Promoting Waterless Hand Cleansing with Chlorhexidine on Hand Cleansing Behavior During the Neonatal Period: Findings From a Randomized Controlled Trial in Rural Bangladesh

Presentation at the Global Maternal Newborn Health Conference, October 19, 2015

One-quarter of neonatal deaths are attributable to infections, which may be prevented by maternal handwashing.  Handwashing is difficult to increase among mothers in the neonatal period.  In a randomized controlled trial, we tested the impact of a chlorhexidine-based waterless hand cleansing promotion on behavior of mothers and other household members.  We identified pregnant women at 32-34 weeks gestation and randomized them to intervention or control. Behavior change communicators promoted chlorhexidine hand cleansing to pregnant women and household members in the intervention arm, and provided a bottle of 4% chlorhexidine lotion.  Using data from structured observations, we compared hand cleansing with chlorhexidine or handwashing with soap before baby care among mothers and household members in the intervention arm to those in the control.  Hand cleansing before baby care was observed 5.6 times more frequently among 130 mothers in the intervention arm, compared to 128 controls (95% CI 4.0 – 7.7).  Hand cleansing was observed at 34% of baby care events among women other than the mother in the intervention arm and 3% in the control arm (RR 10.9, 95% CI 5.1 – 23.1).   Girls in the intervention arm cleansed hands before baby contact 37.0 times more frequently than those in the control arm (95% CI 5.2 – 263.7).  Men cleansed hands before 29% and boys cleansed before 44% of baby care events in the intervention arm, compared to 0% for each in the control arm.    A waterless hand cleansing option using chlorhexidine resulted in substantial increases in hand cleansing behavior among mothers who have greatest contact with neonates. Other household members, particularly children who may introduce new organisms to the neonate’s environment, had far greater increases in hand cleansing in the intervention arm than mothers.  The impact of chlorhexidine hand cleansing among mothers and other household members on neonatal infections should be evaluated.