**7.5 Hygiene at birth and after birth**

Preterm neonates have a heightened risk for sepsis usually because of poor cord care and unhygienic conditions during and after birth [3]. Mothers continue to have home births under unhygienic conditions; health systems need to acknowledge this and be able to provide clean birth kits at community level for births that are likely to take place at home. Awareness needs to be created among mothers and close relatives about hand washing prior to handling a neonate and avoid separating mother and baby especially when there is no need.

Different communities in developing countries apply different substances at the cord and different cultural beliefs are attached to the practice. Chlorhexidine has been proven to be effective in preventing neonatal cord sepsis and there are suggestions that a policy of using it at community level might eliminate use of harmful products.

#### **7.6 Resuscitation**

About 5–10% of all babies will need support to initiate breathing at birth and fortunately 80% of these can survive with just basic resuscitation with a bag and a mask [23]. Traditionally this has been a function of health facilities but whether resuscitation training can be conducted to birth attendants plus CHWs at community level to equip them with skills to identify infants with apnea and how to stimulate and perform basic manual ventilation needs further study. Considering that many mothers continue to give birth at home, basic ventilation with bags and face masks at community level is a skill worth considering at that level.
