Use of antiseptic for cord care and its association with neonatal mortality in a population-based assessment in Bihar State, India

OBJECTIVES Dry cord care is recommended for all births by the Health Ministry in India. We report prevalence of antiseptic cord care in the context of neonatal mortality in the Indian state of Bihar. DESIGN Population-based cross-sectional study with multistage stratified random sampling. SETTING Households in 1017 clusters in Bihar. PARTICIPANTS A representative sample of 12 015 women with a live birth in the last 12 months were interviewed from all 38 districts of Bihar (90.7% participation) in 2014. PRIMARY AND SECONDARY OUTCOME MEASURES Use of antiseptic cord care at birth and its association with neonatal mortality using multiple logistic regression. RESULTS Topical application of any material on cord was reported by 6534 women (54.4%; 95% CI 53.5% to 55.3%). Antiseptic cord care prevalence was 49.7% (95% CI 48.8% to 50.6%), the majority of which was gentian violet (76.4%). The odds of antiseptic use for cord care were higher in facility births (OR 1.46; 95% CI 1.27 to 1.69) and for deliveries by a qualified health provider (OR 1.44; 95% CI 1.26 to 1.66), but were lower for births that occurred before the expected delivery date (OR 0.77; 95% CI 0.61 to 0.96). A total of 256 (2.1%) newborns died during the neonatal period. The odds of neonatal death were significantly higher for live births with no reported antiseptic use (OR 1.53; 95% CI 1.18 to 1.99), and this association persisted when live births in health facilities were considered separately. CONCLUSIONS Even though dry cord care is recommended by health authorities in India, half the women in this study reported use of antiseptic for cord care mainly with gentian violet; and its use had beneficial effect on neonatal mortality. These findings suggest that the application of readily available gentian violet for cord care in less developed settings should be assessed further for its potential beneficial influence on neonatal mortality.