Association between Clean Delivery Kit Use,Clean Delivery Practices,and Neonatal Survival: Pooled Analysis of Data from Three Sites in South Asia |
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| Authors: | Nadine Seward David Osrin Leah Li Anthony Costello Anni-Maria Pulkki-Br?nnstr?m Tanja A J Houweling Joanna Morrison Nirmala Nair Prasanta Tripathy Kishwar Azad Dharma Manandhar Audrey Prost |
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| Institution: | 1.UCL, Centre for International Health and Development, Institute of Child Health, United Kingdom;2.UCL, Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, United Kingdom;3.Ekjut, Chakradharpur, Jharkhand, India;4.Perinatal Care Project (PCP), Bangladesh;5.Mother and Infant Research Activities (MIRA), Nepal;Johns Hopkins Bloomberg School of Public Health, United States of America |
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| Abstract: | BackgroundSepsis accounts for up to 15% of an estimated 3.3 million annual neonatal deaths globally. We used data collected from the control arms of three previously conducted cluster-randomised controlled trials in rural Bangladesh, India, and Nepal to examine the association between clean delivery kit use or clean delivery practices and neonatal mortality among home births.Methods and FindingsHierarchical, logistic regression models were used to explore the association between neonatal mortality and clean delivery kit use or clean delivery practices in 19,754 home births, controlling for confounders common to all study sites. We tested the association between kit use and neonatal mortality using a pooled dataset from all three sites and separately for each site. We then examined the association between individual clean delivery practices addressed in the contents of the kit (boiled blade and thread, plastic sheet, gloves, hand washing, and appropriate cord care) and neonatal mortality. Finally, we examined the combined association between mortality and four specific clean delivery practices (boiled blade and thread, hand washing, and plastic sheet). Using the pooled dataset, we found that kit use was associated with a relative reduction in neonatal mortality (adjusted odds ratio 0.52, 95% CI 0.39–0.68). While use of a clean delivery kit was not always accompanied by clean delivery practices, using a plastic sheet during delivery, a boiled blade to cut the cord, a boiled thread to tie the cord, and antiseptic to clean the umbilicus were each significantly associated with relative reductions in mortality, independently of kit use. Each additional clean delivery practice used was associated with a 16% relative reduction in neonatal mortality (odds ratio 0.84, 95% CI 0.77–0.92).ConclusionsThe appropriate use of a clean delivery kit or clean delivery practices is associated with relative reductions in neonatal mortality among home births in underserved, rural populations.
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