Academic journal article Journal of Health Population and Nutrition

Impact of Clean Delivery-Kit Use on Newborn Umbilical Cord and Maternal Puerperal Infections in Egypt

Academic journal article Journal of Health Population and Nutrition

Impact of Clean Delivery-Kit Use on Newborn Umbilical Cord and Maternal Puerperal Infections in Egypt

Article excerpt


Each year, an estimated four million neonatal deaths occur globally (1). Infections account for 36% of these deaths (1). Serious systemic infections, including sepsis, meningitis, and pneumonia, account for 26% of neonatal deaths while neonatal tetanus and diarrhoea account for 7% and 3% respectively (1). Although precise data on the relationship between cord infections and sepsis are lacking, a substantial proportion of neonatal sepsis and meningitis may stem from infections of the umbilical cord (2-5), and cord infections are associated with increased risk for mortality (6). Furthermore, puerperal sepsis causes an estimated 15% of all maternal deaths, or approximately 75,000 deaths per year worldwide, most of which occur in developing countries (7-9).

In most developing countries, almost half of all births take place in the home, and an untrained birth attendant is present at one in every four births (9,10). A major factor contributing to neonatal and maternal infections is delivery in the home under unhygienic conditions, increasing the likelihood of pathogenic microorganisms entering the cord-stump of the neonate or birth-canal of the mother (8,11). Tetanus toxoid immunization for pregnant women is an effective means of reducing neonatal and maternal deaths due to tetanus but a large number of babies and mothers continue to die due to bacterial infections transmitted during unclean deliveries (12).

The importance of infection as a cause of neonatal death varied whether defined based on Wigglesworth classification (7%), World Health Organization (WHO) estimates (13%), or a panel of two Egyptian neonatologists (20%) (13). A study to explore neonatal care-practices conducted in three Governorates of Egypt found umbilical stump-oozing, redness, and tenderness during the first week of life in 4%, 6%, and 7% of newborns respectively (14). In Nepal (15) and Tanzania (16), 1-15% and 1-12% of newborns respectively were found to have omphalitis, depending on the combination of clinical signs used to define the condition.

Infection ranks third among the direct causes of maternal mortality in Egypt, accounting for 8% of all deaths (17). Substandard home-delivery practices of daya [traditional birth attendant (TBA)] were identified as significant risk factors associated with mortality due to sepsis (17,18).

Research by the WHO suggests that pre-assembled clean delivery-kits (CDKs), with instructions for use, can be a vital component in improving hygiene at delivery, particularly for deliveries conducted by unskilled care providers (19). The CDK promotes and supports the use of clean delivery practices, specifically the 'cleans' defined by the WHO, i.e. clean hands, perineum, delivery surface, cord-cutting surface, cord-cutting, and tying instruments (20).

Studies have been conducted in several countries on the use and impact of CDKs (20-25). In Tanzania, Mosha et al. concluded that the use of a CDK, when coupled with an educational intervention about the 'six cleans', was strongly associated with lower incidences of umbilical cord infection and puerperal sepsis (25). In Nepal, Tsu found that infections of the umbilical cord were reduced by more than half among users of the clean blade and clean-cutting surface provided in CDKs (23).

In recent years, significant resources have been invested in promoting safe and hygienic delivery care by health professionals in facilities equipped to provide basic essential obstetric care. While this approach is sound, there is concern that it may be inadequate, particularly in settings, such as rural areas of Middle and Upper Egypt, where almost 50% of all births still take place in the home and almost 40% of which are typically attended to by a daya or a family member (26). In 1998, in an effort to improve delivery care in all settings, the Egyptian Ministry of Health and Population (MoHP) introduced CDKs through existing primary healthcare facilities in certain Governorates across the country. …

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