UK - Delivery Kits for Home Birth May Up Survival

Using clean delivery kits during home births -- and encouraging other clean delivery practices -- could help reduce neonatal deaths in rural areas with limited access to healthcare, an analysis of South Asian studies showed.

The kits -- which included soap, a razor for cutting the umbilical cord, clean string for tying the cord, and a plastic sheet -- were associated with 48% lower odds of the newborn dying within 28 days (OR 0.52, 95% CI 0.39 to 0.68), according to Nadine Seward, MSc, of University College London, and colleagues.

Also, independent of the use of a kit, using more clean delivery practices -- including handwashing, use of a sterilized blade, use of boiled thread, and use of a plastic sheet -- was associated with a reduction in neonatal mortality, the researchers reported online in PLoS Medicine.

"Further research should explore the context of kit use in order to develop and test locally appropriate promotion strategies, as well as examine the potential of kits to improve neonatal survival in the context of increasing institutional delivery rates," they wrote.

Each year, an estimated 3.3 million newborns around the world die within a month, nearly all of whom are born in low- and middle-income countries. Up to 15% of the deaths are related to sepsis.

Although childhood mortality rates have dropped over the past few decades in South Asia, rates remain high in India, Bangladesh, and Nepal, where most deliveries occur at home because of limited access to formal care and institutional deliveries.

One strategy to deal with high rates of neonatal mortality in these areas is the use of clean delivery kits and other clean delivery practices.

To evaluate the kits' effectiveness, Seward and colleagues analyzed data from three cluster-randomized controlled trials that were completed in India, Bangladesh, and Nepal. The analysis included 19,754 home births from the control arms of the trials.

In addition to the basic kit elements, the kits in Nepal also included a plastic disc against which the umbilical cord could be cut.

Based on interviews with the mothers, the kits were used in 18.4% of deliveries in India and Bangladesh and 5.7% of those in Nepal. Although clean delivery practices were more likely to be used when the kits were used, the kits did not guarantee use of the practices.

The association between kit use and reduced neonatal mortality remained significant after adjustment for potential confounders and did not differ between the three study sites.

Data from India indicated that kit use was associated with reduction in mortality from sepsis (OR 0.28, 95% CI 0.12 to 0.65) and from prematurity and birth asphyxia (OR 0.51, 95% CI 0.35 to 0.76).

Using a plastic sheet during delivery, a boiled blade to cut the umbilical cord, a boiled thread to tie the cord, and antiseptic to clean the cord were each associated with lower neonatal mortality rates, regardless of the use of a clean delivery kit.

For four specific clean delivery practices -- hand washing, use of a sterilized blade, use of a boiled thread, and use of a plastic sheet -- each additional practice used was associated with a 16% decrease in neonatal mortality (OR 0.84, 95% CI 0.77 to 0.92).

The kits were inexpensive; at the time of the trials -- from 2000 to 2008 -- the costs of a kit ranged from $0.27 to $0.44 in U.S. money.

But, the authors noted, "while the kit can be considered a low-cost intervention, there have been no studies on willingness to pay for kits, and these costs may still be prohibitive for the poorest women."

Seward and colleagues noted that the study was limited by the possibility of residual confounding, recall bias, and social desirability bias.

Todd Neale

MedPage Today

Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.

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