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

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

doi:10.1371/journal.pmed.1001180

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

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

King's College London

UCL Institute of Child Health, London, UK; Department of Histopathology, UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK.

Research output: Contribution to journal › Article › peer-review

59 Citations (Scopus)

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.

Original language	English
Pages (from-to)	e1001180
Journal	PLoS Medicine
Volume	9
Issue number	2
DOIs	https://doi.org/10.1371/journal.pmed.1001180
Publication status	Published - Feb 2012

Keywords

Bangladesh/epidemiology
Cluster Analysis
Delivery, Obstetric
Female
Health Knowledge, Attitudes, Practice
Home Childbirth/instrumentation
Humans
India/epidemiology
Infant Mortality
Infant, Newborn
Midwifery/instrumentation
Nepal/epidemiology
Pregnancy
Rural Population
Sepsis/epidemiology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1371/journal.pmed.1001180

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Seward, N., Osrin, D., Li, L., Costello, A., Pulkki-Brännström, A.-M., Houweling, T. A. J., Morrison, J., Nair, N., Tripathy, P., Azad, K., Manandhar, D., & Prost, A. (2012). Association between clean delivery kit use, clean delivery practices, and neonatal survival: pooled analysis of data from three sites in South Asia. PLoS Medicine, 9(2), e1001180. https://doi.org/10.1371/journal.pmed.1001180

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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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Seward, N, Osrin, D, Li, L, Costello, A, Pulkki-Brännström, A-M, Houweling, TAJ, Morrison, J, Nair, N, Tripathy, P, Azad, K, Manandhar, D & Prost, A 2012, 'Association between clean delivery kit use, clean delivery practices, and neonatal survival: pooled analysis of data from three sites in South Asia', PLoS Medicine, vol. 9, no. 2, pp. e1001180. https://doi.org/10.1371/journal.pmed.1001180

TY - JOUR

T1 - Association between clean delivery kit use, clean delivery practices, and neonatal survival

T2 - pooled analysis of data from three sites in South Asia

AU - Seward, Nadine

AU - Osrin, David

AU - Li, Leah

AU - Costello, Anthony

AU - Pulkki-Brännström, Anni-Maria

AU - Houweling, Tanja A J

AU - Morrison, Joanna

AU - Nair, Nirmala

AU - Tripathy, Prasanta

AU - Azad, Kishwar

AU - Manandhar, Dharma

AU - Prost, Audrey

PY - 2012/2

Y1 - 2012/2

N2 - 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.

AB - 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.

KW - Bangladesh/epidemiology

KW - Cluster Analysis

KW - Delivery, Obstetric

KW - Female

KW - Health Knowledge, Attitudes, Practice

KW - Home Childbirth/instrumentation

KW - Humans

KW - India/epidemiology

KW - Infant Mortality

KW - Infant, Newborn

KW - Midwifery/instrumentation

KW - Nepal/epidemiology

KW - Pregnancy

KW - Rural Population

KW - Sepsis/epidemiology

U2 - 10.1371/journal.pmed.1001180

DO - 10.1371/journal.pmed.1001180

M3 - Article

C2 - 22389634

SN - 1549-1277

VL - 9

SP - e1001180

JO - PLoS Medicine

JF - PLoS Medicine

IS - 2

ER -

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

Abstract

Keywords

UN SDGs

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