Components of clean delivery kits and newborn mortality in the Zambia Chlorhexidine Application Trial (ZamCAT): An observational study

Neonatal infection, a leading cause of neonatal death in low- and middle-income countries, is often caused by pathogens acquired during childbirth. Clean delivery kits (CDKs) have shown efficacy in reducing infection-related perinatal and neonatal mortality. However, there remain gaps in our current...

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Bibliographic Details
Published in:PLoS medicine 2021-05, Vol.18 (5), p.e1003610-e1003610
Main Authors: Park, Jason H, Hamer, Davidson H, Mbewe, Reuben, Scott, Nancy A, Herlihy, Julie M, Yeboah-Antwi, Kojo, Semrau, Katherine E A
Format: Article
Language:English
Subjects:
Biology and Life Sciences
Birth weight
Births
Chlorhexidine
Clinical trials
Community
Cyclin-dependent kinase
Diseases
Gestational age
Health facilities
Infant mortality
Infants (Newborn)
Infection control
Infections
Medicine and Health Sciences
Methods
Mortality
Neonates
Observational studies
Patient outcomes
Pediatric research
Perineum
Physical Sciences
Prenatal care
Prevention
Sepsis
Stillbirth
Vagina
Womens health
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Summary:Neonatal infection, a leading cause of neonatal death in low- and middle-income countries, is often caused by pathogens acquired during childbirth. Clean delivery kits (CDKs) have shown efficacy in reducing infection-related perinatal and neonatal mortality. However, there remain gaps in our current knowledge, including the effect of individual components, the timeline of protection, and the benefit of CDKs in home and facility deliveries. A post hoc secondary analysis was performed using nonrandomized data from the Zambia Chlorhexidine Application Trial (ZamCAT), a community-based, cluster-randomized controlled trial of chlorhexidine umbilical cord care in Southern Province of Zambia from February 2011 to January 2013. CDKs, containing soap, gloves, cord clamps, plastic sheet, razor blade, matches, and candle, were provided to all participants (pregnant women). Field monitors made a home-based visit to each participant 4 days postpartum, during which CDK use and newborn outcomes were ascertained. Logistic regression was used to study the association between different CDK components and neonatal mortality rate (NMR). Of 38,579 deliveries recorded during the study, 36,996 newborns were analyzed after excluding stillbirths and those with missing information. Gloves, cord clamps, and plastic sheets were the most frequently used CDK item combination in both home and facility deliveries. Each of the 7 CDK components was associated with lower NMR in users versus nonusers. Adjusted logistic regression showed that use of gloves (odds ratio [OR] 0.33, 95% CI 0.24-0.46), cord clamp (OR 0.51, 95% CI 0.38-0.68), plastic sheet (OR 0.46, 95% CI 0.34-0.63), and razor blade (OR 0.69, 95% CI 0.53-0.89) were associated with lower risk of newborn mortality. Use of gloves and cord clamp were associated with reduced risk of immediate newborn death (
ISSN:1549-1676
1549-1277
1549-1676
DOI:10.1371/journal.pmed.1003610