Clean Delivery Kits May Be Attributed to a Decline in Neonatal Deaths in South Asia

The results of a study published this week found that the use of clean delivery kits could lead to a decline in neonatal (newborn) deaths in South Asia.

The facts:

  • There are approximately 3.3 million neonatal deaths around the world each year, 15% of which are due to sepsis, a systematic bacterial infection in the blood stream that leads to organ damage, which is harmful to developing babies.
  • Thirty to forty percent of the time sepsis is contracted during delivery.
  • 65% of deliveries occur at home in South Asia without a trained birth attendant
  • The largest absolute number of newborn deaths occurs in South Asia, with India contributing a quarter of the world total.

The use of each additional kit of the 2,885 distributed, resulted in a 16% relative reduction of neonatal deaths. The delivery kit and clean delivery practices include soap for hand washing, use of sterilized blade, use of boiled thread and plastic sheet, and a clean string to tie the umbilical cord. The idea to distribute clean delivery kits works to stand in for one of the most important factors that contributes to neonatal deaths, the lack of trained birth attendants. In the bigger scheme of things, this would hopefully help us reach Millennium Development Goal 4, which is to reduce deaths in children under 5 years by two-thirds by 2015.

The costs of the kits are relatively low; $0.44, $0.40, and $.27 (in US dollars), in India, Nepal and Bangladesh respectively. While this is moderately affordable, the poorest of women would not be able to purchase the kits. Sepsis at the moment is either treated at home or in a hospital, which I fear would not be as effective if the family cannot get to a hospital, pay for medical bills or obtain the intensive care kit for the home. Other research into treatment has failed in the past 20-30 years. This highlights the importance of education and prevention of disease, rather than investing time in treatment that might not be effective.

The issue of cultural practice arises as some mothers that received the delivery kit did not use it. Mothers from Nepal were interviewed after the trial and expressed their opinions regarding the inability to understand the instructions on the kit. Few even bothered to read them. The promotion of these kits and other clean practices, as well as postnatal practices such as breastfeeding, needs to be developed on a cultural basis. We cannot assume that in the moment an untrained birth attendantĀ  can adopt and understand Western medical practices. One suggestion from the study is that group-based community interventions that promote safe, effective and beneficial practices, such as one in Pakistan called the Lady Health Workers, can help.

Further studies must be conducted regarding what else should be included in the kits. For example, the World Health Organization recommends dry umbilical cord care, but the current study showed that this led to higher neonatal death in Bangladesh and India. The kit does not contain an antiseptic to clean the cord, which would otherwise reduce infection. Additionally, a limitation to the study suggests that postnatal care practices may contribute to the reduction of risk of death, rather than the kits themselves.

While this study is not exactly saying that clean delivery kits will absolutely led to a decline in neonatal deaths, it is possible and a worthwhile cause for those in communities with limited access to health care. Further research will hopefully fill in the gaps and provide us with a better picture of the methods in which we can work towards reducing the number of children that die before they reach the age of 5.

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