Business students are used to thinking about how to sell a new shampoo or a new app for a phone.
Last week they were asked to put their strategic brains to another use: Figuring out the best way to convince health workers and new parents in Nigeria to apply a potentially life-saving antiseptic to the baby's umbilical cord stump.
That was the challenge at a competition at Northwestern University's Kellogg School of Management that drew MBA students from 11 business schools around the country.
In 2015, 34 Nigerian newborns out of every 1,000 died before they were 28 days old, according to the World Bank. That compares to 25 per 1,000 in Haiti, 4 per 1,000 in the U.S, 1 per 1,000 in Japan — and a worldwide average of 19.2 per 1,000.
More than 30 percent of neonatal deaths around the world are the result of infection, according to a Jan. 2013 study in Pediatric Infectious Disease Journal. And lots of those infections start at the newly snipped umbilical cord, where bacteria thrive on the moist stump and have direct access to the blood stream through umbilical vessels.
Stopping those infections at their source is not difficult. "It's easy," says Dr. Tanya Altmann, a pediatrician in Calabasas, Calif. and professor at Mattel Children's Hospital, UCLA. She was not involved in the case competition. "After the cord is clamped and cut, you apply chlorhexidine and you can significantly reduce infant mortality."
The World Health Organization, in 2014, recommended that the topical antiseptic be applied to the infant's umbilical cord stump within 24 hours of birth and for seven days after. That treatment can reduce neonatal deaths by nearly 40 percent, according to studies in Nepal and Pakistan.
And the idea of treating the umbilical cord stump is not foreign to Nigeria. A government report says 88 percent of mothers apply some substance to the cord after their babies are born. But the substances they use — including toothpaste, ash and even animal dung — have not been proven to protect against infection. Fewer than 5 percent of newborns in Nigeria are treated with chlorhexidine.
The challenge for Quingan Zhou, a member of the winning team from the Wharton School at the University of Pennsylvania, was to come up with a plan to bump up that percentage.
The students had a theoretical budget of $10 million — "not enough to target every single person in Nigeria," Zhou says. So they focused on three areas of the country where neonatal mortality is highest. They developed plans to educate mothers, community and religious leaders, pharmacists, midwives, clinicians and nurses.
"We proposed providing free samples to health care facilities and local birthing assistants," she says. The sample of chlorhexidine would only be enough for one application, while WHO recommends using it for a week. "But showing them how to apply it just once would allow the mothers to see how easy it was and promote consumer demand," she says.
And their plan would offer rebates to pharmacists so they'd have an incentive to stock chlorhexidine.
The winning Wharton team, also including MBA students Vikram Srinivasan and Eason Hahm, had to understand the culture of the country where their potential consumers lived.
"For example, one statistic offered in the case was that only 40 percent of women are involved in their own health-care decisions," Zhou says. "Husbands have a lot of influence in decision-making, so we targeted radio ads to men. The ads would feature a male celebrity, and focus on safety, cost effectiveness and protecting family and loved ones."
All this planning, talking and competing is a way to bring business principles to a global health problem. But will it have any effect on the ground?
It's not certain, says Tim Calkins, marketing professor at Kellogg.
Nigeria's health ministry has said that expanding the use of chlorhexidine on newborns' umbilical cords is a top priority — and global foundations and donors have committed $10 million over three years to the effort, Calkins says.
The day after the Kellogg Biotech and Healthcare Competition, one of the judges, Nikki Tyler, who is market access adviser at the U.S. Agency for International Development, was on a plane bound for Nigeria. It was a previously planned trip to meet with local health officials.
While there is no formal application of ideas from the competition, Calkins says: "She left with all those ideas in her head. It's not inconceivable that some of these ideas are being kicked around in Nigeria right now."
And he appears to be right.
In an email from Nigeria, Tyler said: "We will certainly share these ideas with local partners and the Ministry of Health."