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

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egardless of what the absolute rate is in the specific setting is. The relative risk is more useful for general analysis, since the underlying rates may be affected by many other factors and vary widely from one setting to another. All factors which had a significant relationship with both kit use and cord infection were initially included in the logistic regression models. Only those factors which had significant independent risks in the model (i.e., whose 95% confidence intervals did not include 1.0) were retained in the final model. For example, DISTRICT was no longer significant when INTERVIEWER was included in the model and was, therefore, dropped from the model. Similarly, a variable that grouped birth attendants into four categories (trained TBA, untrained TBA, family or neighbor, health worker) was initially included in the model. There were no real differences among the first three groups (once other more specific variables were accounted for), and the elevated infection risk associated with health workers (RR=1.6, 95% C.I. of 0.78-3.4) was not statistically significant. The relative risks, as adjusted for the confounding factors of week of interview, month, and interviewer, are shown in Table 11. Table 11. Kit use and other risk factors for cord infection Risk Factor Relative Risk 1 95% Confidence Interval Kit vs. new blade, coin/nothing 1.3 (0.81, 1.9) Kit vs. new blade, other surface 0.74 (0.22, 2.5) Kit vs. boiled blade, coin/nothing 0.96 (0.63, 1.5) Kit vs. boiled blade, other surface; other 2 blade, any surface 0.45 (0.25, 0.81) Put on cord just after (vs. nothing): Mustard oil 0.31 (0.07, 1.3) Ash 1.4 (0.90, 2.2) Herbals 0.78 (0.22, 2.8) Dettol 0.67 (0.35, 1.3) Antibiotic 0.93 (0.25, 3.4) Other 3.8 (0.96, 15.1) Don’t know 0.56 (0.24, 1.3) Clean or no cloth vs. Dirty one 2 0.60 (0.43, 0.82) Hands washed with soap before cutting 2 cord vs. not washed 0.58 (0.40, 0.84) Hands washed with water before cutting cord vs. not washed 0.78 (0.44, 1.4) 1 Adjusted for interview week, month, and interviewer. 2 p
elevated risk of infection, while mustard oil (n=54) seems to offer some protective value (although not statistically significant). Dettol and herbals also appear to be somewhat protective, but this could be due to chance (since the numbers are relatively small and the confidence intervals are large). As expected, a clean cloth or no covering on the umbilicus at the time of the interview was significantly associated with reduced infection (by 40%), when compared with a dirty cloth. Infection is reduced by about 40% (OR=0.58) when the birth attendant washes her hands with soap before cutting the cord. Those who washed with water but no soap (n=183) had some reduction in risk compared to those who did not wash at all (OR=0.78), but it is not significant. In families where they did not know whether the attendant washed her hands or not, the difference in risk is not statistically significant (OR=0.84; 95% C.I. of 0.47-1.5). Based on these relative risks and the prevalence of the various practices among the population, an unclean blade and cutting surface accounted for about 8% of the infection among kit non-users (population attributable risk percent), the dirty cloth accounted for about 24%, not washing hands before cutting accounted for about 11%, putting ash on the cord accounted for about 4%, and putting other substances on the cord accounted for about 2% of the infections. Nepal Delivery Kit Evaluation May 2000 20
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 and 16: Table 5. Supplies used at current d
Page 17 and 18: Definition of Infection The determi
Page 19 and 20: Table 9. Key confounding factors, b
Page 21: Table 10. Infection rates by confou
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

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

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