Nepal Clean Home Delivery Kit: Evaluation of the Health Impact - Path

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Table 6 shows other birth practices possibly related to infection, such as substances put on the cord immediately after cutting or later, the covering put on the cord, and whether and when the attendant washes her hands. Most attendants put nothing on the cord (67%- 76%). When they did use something, trained attendants were more likely to use Dettol (a common antiseptic) while untrained attendants were more likely to use ash. Mustard oil was the most commonly applied substance later (55%-66%), followed by “nothing” (26%-38%). Kit non-users with trained attendants were the most likely to use herbal preparations later (11% vs. 2-4%). Among kit users, babies delivered by untrained attendants were the most likely to have dirty cloths on the cord stump at the time of the interview (53%), while those with trained attendants were the least likely (42%). Babies delivered by trained and untrained kit non-users were equally likely to have a dirty cloth on the cord stump (47%). Among trained attendants slightly more kit users washed their hands before cutting the cord (96% vs. 90%), but among untrained attendants many more kit users than non-users washed their hands (91% vs. 76%; p< .001). Untrained attendants in both user and non-user cohorts were more likely than trained attendants to wash their hands only after cutting the cord. Table 6. Birth practices possibly related to infection, by cohort Kit User, Kit User, Kit Non-user, Kit Non-user, Trained Untrained Trained Untrained (Col %) (Col %) (Col %) (Col %) Put on cord Nothing 67.1 75.9 68.8 72.6 just after Ash 5.7 12.1 9.9 14.2 Dettol 11.2 6.5 9.9 1.8 Mustard oil 1.9 2.5 3.5 5.0 Antibiotic 2.1 0.5 2.0 0.5 Herbal 2.1 1.0 0.5 3.4 Other 0.7 0.5 0.7 0.9 Don’t know 9.0 1.0 4.7 1.6 Put on cord later Nothing 32.1 26.4 29.0 37.9 Mustard oil 57.6 66.2 56.2 55.3 Herbal 4.3 3.0 10.9 1.8 Antibiotic 3.8 2.5 3.0 1.4 Don’t know 0.5 0 0.2 0.2 Other 1.7 1.8 0.7 3.4 Cord covering Clean 56.3 45.7 48.7 49.0 No cloth 1.5 1.8 4.3 3.8 Dirty cloth 42.3 52.5 47.0 47.1 Wash hands - at all Yes 98.3 90.6 95.4 75.9 -before cord cut Yes 95.8 73.5 89.8 64.9 -only after cord cut Yes 2.4 16.1 5.0 9.4 13 Nepal Delivery Kit Evaluation May 2000
Definition of Infection The determination of cord infection was based on both the mother’s report during the interview (including selection of a photo from an array of color photos of cords) and the interviewer’s observation of the umbilicus at the time of the interview. It is clear from Table 7 that those defined as having “likely” or “possible” infection were substantially different from those defined as not infected. Cord-specific questions differentiate better than general baby symptoms like fever or poor sucking. “Foul smell” was weakly correlated with discharge (r=.323), photo (r=.328) and interviewer observation (r=.296), but discharge and photo were strongly correlated with interviewer observation (r=.521 and .655) and with diagnosis of likely infection (r=.602 and .737). The factor most strongly correlated with diagnosis of likely cord infection was interviewer observation of signs of infection (r=.839). Table 7. Defining features of infection cases Mother’s report: Cord: LIKELY CORD INFECTION POSSIBLE CORD INFECTION None Likely None Possible Col % (n=1389) Col % (n=271) Col % (n=1300) Col % (n=360) Foul smell 2.0 32.9 0.9 28.7 Blood or pus discharge 3.0 55.0 0.5 51.4 Infected (using photo) 5.1 80.8 0.8 77.5 Baby symptoms: None 76.3 63.5 76.7 65.9 Fever 7.2 8.2 7.2 7.8 Spasm, stiff 3.1 9.5 3.1 7.8 Poor suck 6.6 6.9 6.9 6.0 Interviewer observation: Slight redness 3.0 10.0 1.2 14.9 Infection, red, swollen 1.0 78.1 0.0 62.6 Definition of Comparison Groups within Kit Non-users Since so many kit non-users actually used new or boiled blades, it is necessary to define comparison groups that distinguish those using components similar to the kit from those who are not. The strongest associations between various kit components and infection were with the blade used for cutting and the cutting surface. Table 8 shows the infection rates associated with various combinations of blade and surface. There is relatively little difference between those using an old coin or nothing in each blade group (e.g., lightly shaded block for new blade), but the infection is considerably higher if some other cutting Nepal Delivery Kit Evaluation May 2000 14
Page 1 and 2: Nepal Clean Home Delivery Kit Evalu
Page 3 and 4: TABLE OF CONTENTS Executive Summary
Page 5 and 6: • About 70% of all attendants put
Page 7 and 8: I. INTRODUCTION Tetanus and sepsis
Page 9 and 10: encompassing the target number of w
Page 11 and 12: Nepal. After checking the data for
Page 13 and 14: Kit User, Kit User, Kit Non-user, K
Page 15: Table 5. Supplies used at current d
Page 19 and 20: Table 9. Key confounding factors, b
Page 21 and 22: Table 10. Infection rates by confou
Page 23 and 24: elevated risk of infection, while m
Page 25 and 26: ehavior is considered (as in Table
Page 27 and 28: Table 15. Kit awareness and decisio
Page 29 and 30: Table 16. Kit purchase, by district
Page 31 and 32: V. DISCUSSION Immediate Impact Use
Page 33 and 34: washing (they had the highest propo
Page 35 and 36: long as the traditional coin is boi

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