Delivery Kits for Home Birth May Increase Neonate Survival

Using clean delivery kits during home births and encouraging other clean delivery practices could help reduce deaths in rural areas with limited access to healthcare, according to a new study.

Researchers at University College London (United Kingdom), the Perinatal Care Project (PCP, Dhaka, Bangladesh), and other organizations explored the association between neonatal mortality and clean delivery kit use and delivery practices in 19,754 home births in India, Bangladesh, and Nepal, controlling for confounders common to all study sites. Both the contents of the kit (boiled blade and thread, plastic sheet, gloves, hand washing, and appropriate cord care), and the combined association between mortality and four specific clean delivery practices (boiled blade and thread, hand washing, and plastic sheet) were evaluated.

The researchers found that kit use was associated with combined 48% lower odds of the newborn dying within 28 days. 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. However, based on interviews with the mothers, the kits were only used in 18.4% of deliveries in India and Bangladesh, and 5.7% of those in Nepal.

“The kits were inexpensive; at the time of the trials, from 2000 to 2008, the costs of a kit ranged from USD 0.27-0.44,” said lead author Nadine Seward, MSc, of UCL, and colleagues. “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.”

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.

Related Links:
University College London
Perinatal Care Project Bangladesh