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CBK Info: WHO Showcase Supports CBKs

Review of WHO’s “Innovation Showcase” featuring Clean Birth Kits.  The findings  here  are positive:

From Pledges to Action, New Delhi, India, 13-14 November 2010

 Innovation Showcase

Cleaner, safer births

Cleaner births

The need

More than 350 000 women die each year due to pregnancy and childbirth related complications. 1 About 10 to 12% of these maternal deaths and 26% of the newborn deaths are due to severe infections.2 Many of these are a result of unhygienic practices during childbirth. For example, nearly 46% of the home births in developing countries happen without a skilled attendant and expose women to these risks if clean practices are not followed. Conflict and emergencies can also expose women to unclean surroundings during childbirth. Simple cleanliness and hygienic delivery practices by a trained birth attendant can prevent life-threatening infections.

The innovation

Clean birth includes ‘six cleans’: clean hands, clean perineum, clean delivery surface, clean cord cutting, clean cord tying and clean cord care. A clean birth kit has items to address these: soap, a plastic sheet, a clean blade and clean thread.

Has it helped?

Clean birth kits are already used in several countries. When pregnant women and birth attendants are educated about it and use it, birth kits have a significant effect on reducing death rates. A review of 30 studies on clean birth kits estimated that if clean practices were followed in 90% of all home births, then the lives of 6,300 women and 102,000 newborns could be saved each year.2 In Tanzania, clean birth kits were given to pregnant women and the use of each item was explained. This helped to reduce both cord infection and high-fever from infections (sepsis).3 In Egypt, too clean delivery kits were distributed through primary health centres after training and similar results were found.4 Since the mid-1990s, women and traditional birth attendants in Nepal have been encouraged to use a locally produced birth kit. This improved clean birth practices particularly when it was accompanied with training and education for women.2

1 WHO (2010). “Trends in maternal mortality 1990 – 2008.” (PDF). http://whqlibdoc.who.int/publications/2010/9789241500265_eng.pdf
2 Ronsmans, C. and W.J. Graham, Maternal mortality: who, when, where, and why. Lancet, 2006. 368(9542): p. 1189-200.
3 Mosha F et al (2005) Evaluation of the effectiveness of a clean delivery kit intervention in preventing cord infection and puerperal sepsis among neonates and their mothers in rural Mwanza Region, Tanzania. Tanzan Health Res Bull. 2005 Sep;7(3):185-8.
4 Darmstadt GL et al (2009) Impact of Clean Delivery-kit use on Newborn Umbilical Cord and Maternal Puerperal Infections in Egypt, J Health Popul Nutr. 2009 December; 27(6): 746–754.

CBK Info: Clean Birth Effective in Reducing Neonatal Mortality

The conclusion of  “Clean birth and postnatal care practices to reduce neonatal deaths from sepsis and tetanus: a systematic review and Delphi estimation of mortality effect,”Blencowe et al, BMC Public Health 2011, 11(Suppl 3):S11, April 13, 2011 (abstract here) supports clean birthing.  The conclusion from the abstract:

According to expert opinion, clean birth and particularly postnatal care practices are effective in reducing neonatal mortality from sepsis and tetanus. Further research is required regarding optimal implementation strategies.

CBK Info: HNN Jan 2011 CBK Working Group

Another full article post on the CBK Working Group in Jan 13, 2011. Interesting.   According to the Group there is “substantial, high-quality evidence” to support the inclusion of Misoprostol as an add-on to the standard kit (soap, plastic sheet, blade, cord tie and clamp, picture instructions) when oxytocin is not available.

Conclusion, as reported by Claudia Morrissey of Healthy Newborn Network, “there is more work to do.”

 

CBK Info: HNN’s Summary on Three CBK Meetings

I know that it’s a lazy blogger’s tool to post the whole article but you need to read this article by Claudia Morrissey of Save the Children on the Healthy Newborn Network.  Great info on what great minds are thinking about the efficacy of CBKs.

Dialog and debate are at the heart of consensus building. Sometimes neutral space needs to be created to facilitate evidence-informed discussion around contentious public health issues and interventions. Save the Children, Immpact, and the Maternal Health Task Force are collaborating to create that space for dialog on the role of mother-held, prevention-focused clean birth kits (CBKS) in promoting clean delivery practices in low-resource settings.

Throughout 2010, five meetings are planned to achieve the following objectives:

  1.  Assess the evidence-base on the effects of clean birth practices and kits for both mother and newborn
  2.  Review implementation experiences, including clean birth kit content and methods of distribution
  3.  Translate the evidence and experience with CBKs into recommendations for policy, programs and advocacy, within the wider context of MNCH interventions
  4.  Identify remaining priority evidence gaps and design options for addressing these
  5.  Create a collaborative maternal and newborn health technical network to review the evidence and reach consensus on the role of CBKs

The first meeting was held in London, March 25 and 26, to examine the existing evidence-base on the impact of clean birth practices and CBKs (as one approach to promote the uptake of clean practices) on maternal and newborn deaths due to infection. Findings from two systematic reviews and a Delphi exercise were presented. Informed by those findings and deliberations during the meeting, a policy brief, “Clean Birth Kits—Potential to Deliver? Evidence, Experience, Estimated Lives Saved and Cost”was produced.

Based on the extant evidence, the brief concludes:

  • Clean birth practices are important contributors to realizing the basic right of mothers and newborns to a safe delivery
  • Clean delivery practices must be promoted alongside other proven interventions such as universal access to skilled attendance and to life-saving emergency obstetric and newborn care should complications arise.
  • Mother-held, prevention-focused CBKs are a highly cost-effective approach to promoting clean delivery practices
  • CBKs should be considered appropriate in conflict or humanitarian emergencies or in settings where there is currently low coverage of facility birth.

An important evidence gap remained: do CBKs act as a disincentive to facility delivery? If implementation experiences do not support this concern, wider promotion of mother-held CBKs would be justifiable. Answering this question has become a key focus for the group’s efforts.

The second event in this exploration was a debate held at the Women Deliver conference on the motion “This house believes women-held birth kits are a diversion from achieving facility delivery for all.” Speakers pro and con introduced the topic and then the session was opened to comments from the floor. After a robust discussion, a vote was taken; the motion did not carry. The majority of the participants, many of whom were from developing countries, felt that CBKs do have a role to play in promoting clean delivery practices in situations were facility delivery is not available or due to concerns about quality, value for money, or cultural sensitivity, is unacceptable.

The third meeting, June 10th and 11th, focused on implementation experiences to better understand the positioning and promotion of CBKs in the over 50 countries where they are currently being used. Findings from a survey on implementation that was fielded to Save the Children/Saving Newborn Lives and USAID MCHIP country offices were presented along with the results from an inventory of CBK add-ons such as Chlorhexidine and Misoprostol. Participants committed to developing an implementation decision-making tool that would provide guidance to policy-makers and programmers on whether CBK introduction and distribution are appropriate. A working group will also be mining existing databases to better understand the relationship between CBK distribution and the use of facility deliveries.

Additional meetings are planned to coincide with the Maternal Health Task Force and the PMNCH meetings this fall. We invite you to become part of the maternal and newborn health Community of Practice that is examining the use of CBKs as one approach to increase clean birth practices in low-resource settings. We hope, by the end of this year, to have reached greater global consensus on the answer to the question: To use or not to use?

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