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Chlorhexidine

Chlorhexidine (CHX) is a topical antiseptic applied to the umbilical cord stump after birth to prevent neonatal sepsis. A simple and inexpensive antiseptic, CHX has been shown to reduce neonatal mortality by 23%.

Unit of interventionper tube

Formulation4% Chlorhexidine (7.1% chlorhexidine digluconate) gel

Target populationNeonates

For information about how PSI is increasing access to chlorhexidine to improve health and save lives, visit our website at:
http://www.psi.org/program/chlorhexidine/

Model Overview

PSI’s chlorhexidine impact model is based on the Lives Saved Tool (LiST). LiST is used to estimate the number of deaths averted with complete coverage of chlorhexidine in select countries over a three year period, representing the projected impact of chlorhexidine. This number of deaths averted at the population level is translated to deaths averted per chlorhexidine tube, using parameters such as the number live births per year, baseline coverage of chlorhexidine, and number of tubes used per live birth. Once we have deaths averted per chlorhexidine tube, we apply data from the 2010 Global Burden of Disease study to estimate the corresponding number of DALYs averted.

Model Outputs (impact metrics)

Estimates of DALYs averted, deaths averted, CYPs provided, and unintended pregnancies averted represent the projected health impact of the intervention. It is projected because it has not been directly measured.

Examples based on distribution of chlorhexidine tubes in Myanmar in 2015 Statement of modeled results, examples:

In 2015, an estimated 8 deaths and 675 DALYs would be averted if 10,000 chlorhexidine tubes were distributed in Myanmar.

For more details about how PSI models the impact of chlorhexidine, see below.

Model Details

Step 1: Running a projection in the Lives Saved Tool (LiST)LiST is a multi-cause mortality model developed by Johns Hopkins Bloomberg School of Public Health that estimates the number of deaths averted (or lives saved) through the scale up of maternal and child health interventions.

PSI begins by running a projection in LiST for select countries. In this projection, access to chlorhexidine is increased from the current, country-specific baseline to 100%. LiST then projects the number of deaths averted among neonates by this increased level of coverage.

Step 1 Output:
Number of additional deaths averted (or lives saved) among neonates if coverage of chlorhexidine increased from baseline to 100% in select countries

Step 2: Estimating deaths averted per chlorhexidine tube PSI uses the step 1 output (deaths averted at 100% coverage of chlorhexidine) to estimate the number of deaths averted by a single chlorhexidine tube. To do this, we divide the number of deaths averted at 100% coverage by the number of chlorhexidine tubes needed to reach 100% coverage among neonates. PSI estimates the number of chlorhexidine tubes needed to reach 100% coverage using a number of parameters including the number live births per year, baseline coverage of chlorhexidine, and the number of tubes used per live birth. We also account for wastage of chlorhexidine in the supply chain, assumed to be 10%.

Step 2 Output:
Deaths averted coefficient

Step 3: Estimating DALYs averted per chlorhexidine tube among neonates A DALY (or disability adjusted life year) includes two components: years of life lost due to premature death (YLL) and years lived with disability (YLD). DALYs averted are in turn comprised of YLLs averted and YLDs averted or, put simply: death and disability that is prevented by PSI interventions.

To estimate YLLs averted per chlorhexidine tube among neonates, PSI first estimates the number of years of life lost per death among neonates due to neonatal sepsis in select countries. This is equal to the life expectancy at the average age of death from neonatal sepsis. Age specific life expectancy is taken from the 2010 Global Burden of Disease study. The number of years of life lost per neonatal sepsis death is then multiplied by the number of deaths averted per chlorhexidine tube among neonates (neonatal deaths averted coefficient), calculated in step 2 above for a selected country. This gives us the YLLs averted per chlorhexidine tube.

To estimate YLDs averted per chlorhexidine tube among neonates, we use a YLD/YLL ratio, based on the 2010 Global Burden of Disease study. This ratio represents the relative number of years lived with disability for every year lost due to death from neonatal sepsis. We apply this ratio to the number of YLLs averted per chlorhexidine tube to estimate the number of YLDs averted per chlorhexidine tube among neonates.

Finally, YLLs averted and YLDs averted are added together to estimate the number of DALYs averted per chlorhexidine tube among neonates.

Step 3 Output:
DALYs averted coefficient