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Randomized Controlled Trial
. 2012 Feb;9(2):e1001180.
doi: 10.1371/journal.pmed.1001180. Epub 2012 Feb 28.

Association between clean delivery kit use, clean delivery practices, and neonatal survival: pooled analysis of data from three sites in South Asia

Nadine Seward  1 , 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
Affiliations
Randomized Controlled Trial

Association between clean delivery kit use, clean delivery practices, and neonatal survival: pooled analysis of data from three sites in South Asia

Nadine Seward et al. PLoS Med. 2012 Feb.

Abstract

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.

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Conflict of interest statement

David Osrin is on the Editorial Board of PLoS Medicine. All other authors declare no competing interests.

Figures

Figure 1
Figure 1. Location of study sites.
See this image and copyright information in PMC

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