Chlorhexidine Adoption in Nigeria

Abstract

It is January 2017, and Nikki Tyler, market access advisor at the U.S. Agency for International Development’s Center for Accelerating Innovation and Impact, must recommend an actionable strategy for how to use the $10 million contributed by global donors and foundations to scale up the use of chlorhexidine in Nigeria. It was clear that chlorhexidine, a substance applied to newborns’ umbilical cord stumps to prevent infection, could reduce infant mortality significantly. However, changing behavior would be an enormous challenge. This case gives students an appreciation for the importance and complexity of global health issues, along with an understanding of key analytic techniques for approaching a complex market situation. Students quickly learn that there are no easy answers to encouraging chlorhexidine’s greater use. To develop a plan, it is essential to complete detailed analyses, study insights and motivations, and ultimately compare different possible solutions, considering efficiency and efficacy.

This case was prepared for inclusion in Sage Business Cases primarily as a basis for classroom discussion or self-study, and is not meant to illustrate either effective or ineffective management styles. Nothing herein shall be deemed to be an endorsement of any kind. This case is for scholarly, educational, or personal use only within your university, and cannot be forwarded outside the university or used for other commercial purposes.

2024 Sage Publications, Inc. All Rights Reserved

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Resources

Exhibit 1: Neonatal Mortality Rates in Selected Nations, 2015

Country

Deaths Within First 28 Days of Life per 1,000 Live Births

Australia

2

Bangladesh

23

Botswana

22

Canada

3

Chad

39

Haiti

25

Japan

1

Nepal

22

Nigeria

34

Senegal

21

Swaziland

14

United States

4

Source: The World Bank, “Mortality Rate, Neonatal (Per 1,000 Live Births),” http://data.worldbank.org/indicator/SH.DYN.NMRT (accessed January 12, 2017).

Exhibit 2: Top Causes of Neonatal Mortality in Nigeria

Causes

% of Deaths Within First 28 Days of Life

Preterm birth complications

32.9

Intrapartu

27.3

Infection/sepsis

20.6

Pneumonia

8.7

Congenital abnormalities

4.4

Other conditions

6.0

Source: Child Health Epidemiology Reference Group (CHERG), “Underlying Causes of Child Death,” http://cherg.org/projects/underlying_causes.html (accessed January 12, 2017).

Exhibit 3: Population, Birth, and Mortality Rates in Nigeria

2006 Population

Births

Neonatal Mortality, 2013 (Deaths per 1,000 Live Births)

Infant Mortality, 2013 (Deaths per 1,000 Live Births)

National

140,431,790

7,028,000

37

69

Zone

    North Central

20,339,956

999,000

35

66

    North East

18,984,299

1,100,000

43

77

    North West

35,915,467

2,206,000

44

89

    South East

16,431,555

716,000

37

82

    South South

21,044,081

840,000

32

58

    South West

27,722,432

1,167,000

39

61

Sources: Nigeria Federal Ministry of Health, “Nigeria State Data Profiles: An Accountability Tool for Maternal Newborn and Child Health in Nigeria,” http://www.mamaye.org/sites/default/files/evidence/MoH%20NG_2014_Nigeria%20State%20Profiles.pdf (for 2006 population and number of births), and Nigeria National Population Commission, “Nigeria Demographic & Health Survey 2013,” Table 8.2, https://dhsprogram.com/pubs/pdf/FR293/FR293.pdf (for neonatal and infant mortality).

Exhibit 4: Place of Delivery of Newborns in Nigeria (%)

Public Health Facility

Private Health Facility

Total Health Facility

Home

National

22.6

13.2

35.8

63.1

Zone

    North Central

30.0

15.7

45.7

52.9

    North East

18.4

1.2

19.6

79.3

    North West

11.0

0.5

11.5

87.5

    South East

33.9

44.2

78.1

19.9

    South South

35.7

14.3

50.0

48.7

    South West

35.4

39.6

75.0

24.2

Source: Nigeria National Population Commission, “Nigeria Demographic & Health Survey 2013,” Table 9.5, https://dhsprogram.com/pubs/pdf/FR293/FR293.pdf.

Exhibit 5: ANC Visits

% Attending at Least One Visit

% Attending at Least Four Visits

National

64.4

50.7

Zone

    North Central

70.2

56.6

    North East

51.8

39.5

    North West

41.8

21.9

    South East

91.5

80.5

    South South

73.5

61.2

    South West

90.8

84.9

Source: Nigeria National Population Commission, “Nigeria Demographic & Health Survey 2013,” Table 9.1, https://dhsprogram.com/pubs/pdf/FR293/FR293.pdf.

Exhibit 6: Person Assisting Birth in Nigeria (%)

Total Skilled Health Provider

Doctor

Nurse/Midwife

Traditional Birth Attendant

Relative/Other

None

National

38.1

10.2

27.9

22.0

25.0

13.4

Zone

    North Central

46.5

12.4

34.1

3.6

35.4

6.5

    North East

19.9

3.3

16.6

26.0

39.0

9.7

    North West

12.3

3.5

8.8

34.0

23.6

27.8

    South East

82.2

13.7

68.5

7.4

5.1

1.5

    South South

55.4

13.7

41.6

29.7

9.6

1.8

    South West

82.5

30.4

52.1

7.4

7.1

1.3

Place of delivery

Facility

95.8

27.4

68.4

0.4

0.3

0.1

Home

6.1

0.7

5.4

34.6

35.8

21.1

Source: Nigeria National Population Commission, “Nigeria Demographic & Health Survey 2013,” Table 9.7, https://dhsprogram.com/pubs/pdf/FR293/FR293.pdf.

Exhibit 7: Type of Substance Applied on Stump, When a Substance Was Applied

Substance Applied

%

Oil

31

Methylated spirits

30

Toothpaste

13

Ash

8

Ointment/powder

7

Detol

4

Animal dung

2

Other

11

Don’t know

2

Source: Nigeria National Population Commission, “Nigeria Demographic & Health Survey 2013,” Figure 9.4, https://dhsprogram.com/pubs/pdf/FR293/FR293.pdf.

Exhibit 8: Source of Information for Antenatal and Postnatal Care

Source of Information

%

Doctor/nurse

34

Radio

25

TV

19

Female relative

7

Wife of religious head

3

Source: PATH Market Research in four states: Kano, Nassarawa, Osun, and Cross Rivers, November 2014.

Exhibit 9: Cord Care Purchase Behavior: Timing

Timing

%

Before delivery, during ANC

44.2

Before delivery, not during ANC

24.8

At time of delivery

21.3

Source: PATH Market Research in four states: Kano, Nassarawa, Osun, and Cross Rivers, November 2014.

Exhibit 10: Cord Care Purchase Behavior: Place of Purchase

Place of Purchase

%

PPMV/chemist

39

Market/shop

23

Pharmacy

16

Healthcare facility

10

Other

12

Source: PATH Market Research in four states: Kano, Nassarawa, Osun, and Cross Rivers, November 2014.

Exhibit 11: The States of Nigeria, Listed by Zone

Nigerian State

Zone

Benue

North Central

Kogi

North Central

Kwara

North Central

Nasarawa

North Central

Niger

North Central

Plateau

North Central

Federal Capital Territory

North Central

Adamawa

North East

Bauchi

North East

Borno

North East

Gombe

North East

Taraba

North East

Yobe

North East

Jigawa

North West

Kaduna

North West

Kano

North West

Katsina

North West

Kebbi

North West

Sokoto

North West

Zamfara

North West

Abia

South East

Anambra

South East

Ebonyi

South East

Enugu

South East

Imo

South East

Akwa Ibom

South South

Cross River

South South

Bayelsa

South South

Rivers

South South

Delta

South South

Edo

South South

Ekiti

South West

Lagos

South West

Ogun

South West

Ondo

South West

Osun

South West

Oyo

South West

This case was prepared for inclusion in Sage Business Cases primarily as a basis for classroom discussion or self-study, and is not meant to illustrate either effective or ineffective management styles. Nothing herein shall be deemed to be an endorsement of any kind. This case is for scholarly, educational, or personal use only within your university, and cannot be forwarded outside the university or used for other commercial purposes.

2024 Sage Publications, Inc. All Rights Reserved

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