Document Detail

Association between clean delivery kit use, clean delivery practices, and neonatal survival: pooled analysis of data from three sites in South Asia.
MedLine Citation:
PMID:  22389634     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Sepsis 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 FINDINGS: Hierarchical, 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).
CONCLUSIONS: The 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.
Nadine Seward; David Osrin; Leah Li; Anthony Costello; Anni-Maria Pulkki-Brännström; Tanja A J Houweling; Joanna Morrison; Nirmala Nair; Prasanta Tripathy; Kishwar Azad; Dharma Manandhar; Audrey Prost
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2012-02-28
Journal Detail:
Title:  PLoS medicine     Volume:  9     ISSN:  1549-1676     ISO Abbreviation:  PLoS Med.     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-03-05     Completed Date:  2012-06-26     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  101231360     Medline TA:  PLoS Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e1001180     Citation Subset:  IM    
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MeSH Terms
Bangladesh / epidemiology
Cluster Analysis
Delivery, Obstetric
Health Knowledge, Attitudes, Practice*
Home Childbirth / instrumentation*,  methods,  standards
India / epidemiology
Infant Mortality*
Infant, Newborn
Midwifery / instrumentation*,  methods,  standards
Nepal / epidemiology
Rural Population
Sepsis / epidemiology,  mortality,  prevention & control*
Grant Support
091561//Wellcome Trust; G0601941//Medical Research Council; //Wellcome Trust

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