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CBK Info: Kits Effective in Tanzanian Study

From J Midwifery Womens Health. 2007 Jan-Feb;52(1):37-43.“Use of a clean delivery kit and factors associated with cord infection and puerperal sepsis in Mwanza, Tanzania.” Winani S, Wood S, Coffey P, Chirwa T, Mosha F, Changalucha J. Source: Ministry of Health, Republic of Tanzania.

Here’s the abstract of a study done in Tanzania, 3262 women were surveyed and their babies cord stumps checked.  Here’s what they found:

Newborns whose mothers used the delivery kit were 13.1 times less likely to develop cord infection than infants whose mothers did not use the kit. Furthermore, women who used the kit for delivery were 3.2 times less likely to develop puerperal sepsis than women who did not use the kit. Women who bathed before delivery were 2.6 times less likely to develop puerperal sepsis than women who did not bathe, and their infants were 3.9 times less likely to develop cord infection. Single-use delivery kits, when combined with education about clean delivery, can have a positive impact on the health of women and their newborns by significantly decreasing the likelihood of developing puerperal sepsis or cord infection.

CBK Info: Notes from PATHs “Basic Delivery Kit Guide”

LOVE these chapters from PATH’s “Basic Delivery Kit Guide.”  Such a great resource for anyone looking to do this work:

I started taking notes on Sections 2 & 3.

http://www.path.org/files/MCHN_BDKG_Section_2.pdf

http://www.path.org/files/MCHN_BDKG_Section_3.pdf

Here are some notes paraphrased from Section 3:

General things for me to keep in mind:  The CBK program should be added to and strengthen existing maternal and child health MCH programs.  Examples of good places that would be a good fit include traditional birth attendants (TBAs) or medical provider trainings and antenatal care clinics.

Overall project goals:

• contributing to the decrease in maternal and neonatal mortality and morbidity caused by puerperal sepsis, cord infection, and tetanus;

•  improving clean delivery practices of delivering women and trained and

untrained birth attendants; and

• establishing a sustainable basic delivery kit project as one component of a clean delivery program

Sustainable…hmmm. I am assuming sustainable means kits produced in-country and sold to pay for inputs/wages.  This is a must I know and I want to do it.  But it will have to be phase two.  I will start with the pilot.  And then see what is possible on the ground.

Specific Goals:

• annual number of kits produced;

• number of assembly sites established;

• number of assemblers hired and trained;

• number of promotional channels, and number of potential users reached per year;

• number of distribution channels;

• number of kits distributed, types of users receiving the kit, and areas reached;

• number of kit outlets (such as retail stores, voluntary women’s groups, NGOs, and health posts); and

• number of TBAs, midwives, and community health workers who use the kit during all deliveries by an established date

Very simple questions to ask when determinig whether to do this, paraphrased:

Do they need CBKs?  Are CBKs available already?

Would that fit in with their program?

Do they have regularly scheduled trainings where the CBKs could be introduced?

And from Section 2 more questions to ask:

Births per year.

Numbers of deliveries conducted at home;

Persons helping with delivery;

Traditional delivery process;

Understanding of “cleanliness” among TBAs and pregnant women;

Types of TBAs;

How women delivering alone prepare for the birth;

Availability of basic equipment such as cord-cutting instruments, cord ties,

water, and facilities to boil water;

Traditional equipment used in delivery;

Feasibility of introducing delivery kits — Specific contents.

Availability of locally assembled kits or United Nations (UN) kits.

Community involvement

Maternal Health: Key steps for maternal and newborn health care in Humanitarian Crisi

This is a WHO guide for ” maternal and newborn health experts as well as reproductive health experts coordinating and assisting with emergency care during the humanitarian crisis.”

The document emphasizes the need for clean birth practices and identifies these specifics for birthing kits for “self delivery”:

Reproductive Health Sub kit 2. Clean delivery

This kit is composed of 200 individual packets containing material and a pictorial instruction sheet for self delivery plus material for birth attendants. They are designed for 10,000 people for 3 months and are for use at the community level.

These packets have two parts

Part A: To be distributed to all women more than six months pregnant.

Part B: Equipment for birth attendants (for universal precautions)

Considering a birth rate of 4%, 100 deliveries will occur in 3 months for a population of 10,000

Number needed: 200 for a population of 10,000: 100 kits for those delivering in the initial 3 monthperiod, and another 100 kits for deliveries in the subsequent 3 month period.

Note: no oxytocin is available. If a skilled attendant is providing childbirth care, 400 ampoules of oxytocin, syringes, needles and antiseptic swabs should be added.

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