The authors, led by Nadine Seward and Audrey Prost from the Institute of Child Health at University College London, analysed data from three previous studies to investigate the links between neonatal mortality, the use of clean delivery kits, and individual clean delivery practices in almost 20 000 home births in rural areas of India, Nepal, and Bangladesh. The researchers found that use of the birth kits was linked to a dramatic drop (48%) in neonatal mortality with a further drop (16%) in neonatal mortality with each additional clean delivery practice used. These results reinforce the importance of clean delivery practices such the use of a boiled blade to cut the umbilical cord, antiseptic to clean the cord, a boiled thread to tie the cord, and a plastic sheet for a clean delivery surface.
The authors say: "The use of kits may not always be accompanied by clean delivery practices, and the latter should be emphasised when promoting them."
Costs of such kits are low (0.44 USD in India, 0.40 USD in Nepal, and 0.27 USD in Bangladesh although these costs may still be prohibitive for the poorest women) and given the impact of clean delivery kits and clean delivery practices in reducing neonatal practices, the authors argue that such strategies should be widely promoted by the international community.
The authors say: "Many governments and nongovernmental organisations encourage the use of clean delivery kits, both with and without accompanying promotion programmes. Our study shows that distributing kits, even with instructions, does not guarantee that life-saving clean delivery practices will be used."
The authors add: "Further research should explore the context of kit use in order to develop and test locally appropriate promotion strategies, as well as examine the potential of kits to improve neonatal survival in the context of increasing institutional delivery rates."