Effect of cleansing the birth canal with antiseptic solution on maternal and newborn morbidity and mortality in malawi: clinical trial

Taha, Taha E.; Biggar, Robert J.; Broadhead, Robin L.; Mtimavalye, Laban A.R.; Justesen, Aafke; Liomba, George N.; Chiphangwi, John D.; Miotti, Paolo

doi:10.1136/bmj.315.7102.216

Cited by 143 publications

(70 citation statements)

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“…A study of the impact of chlorhexidine cleansing was undertaken in Malawi at an urban hospital, at a cost of $0.10 for each maternal-infant pair treated (Table 25). 427,428 Cleansing of the maternal vaginal canal and the newborn skin with a 0.25% chlorhexidine solution resulted in significant reductions in serious postpartum maternal infections (P ϭ .02), neonatal admissions (OR: 0.8; CI: 0.79 -0.97), neonatal sepsis (OR: 0.5; CI: 0.32-0.76), overall neonatal mortality (28.6 vs 36.9 per 1000; P Ͻ .05), and neonatal mortality due to infections (OR: 0.5; CI: 0.29 -0.88; 2.4 vs 7.3 per 1000; P Ͻ .005). 428 Among women with rupture of membranes for Ͼ4 hours, the HIV transmission rate was decreased by 40% (OR: 0.6; CI: 0.4 -0.9).…”

Section: )mentioning

confidence: 99%

“…427,428 Cleansing of the maternal vaginal canal and the newborn skin with a 0.25% chlorhexidine solution resulted in significant reductions in serious postpartum maternal infections (P ϭ .02), neonatal admissions (OR: 0.8; CI: 0.79 -0.97), neonatal sepsis (OR: 0.5; CI: 0.32-0.76), overall neonatal mortality (28.6 vs 36.9 per 1000; P Ͻ .05), and neonatal mortality due to infections (OR: 0.5; CI: 0.29 -0.88; 2.4 vs 7.3 per 1000; P Ͻ .005). 428 Among women with rupture of membranes for Ͼ4 hours, the HIV transmission rate was decreased by 40% (OR: 0.6; CI: 0.4 -0.9). In another study in Kenya comparing intrapartum vaginal lavage with 0.2% and 0.4% chlorhexidine, there was no overall effect on transmission of HIV, but risk of transmission was significantly reduced (OR: 0.1; CI: 0.0 -0.9) in the subgroup that had not had rupture of membranes before treatment.…”

Section: )mentioning

confidence: 99%

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Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

et al. 2005

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ABSTRACT. Background. Infant and under-5 childhood mortality rates in developing countries have declined significantly in the past 2 to 3 decades. However, 2 critical indicators, maternal and newborn mortality, have hardly changed. World leaders at the United Nations Millennium Summit in September 2000 agreed on a critical goal to reduce deaths of children <5 years by two thirds, but this may be unattainable without halving newborn deaths, which now comprise 40% of all under-5 deaths. Greater emphasis on wide-scale implementation of proven, cost-effective measures is required to save women's and newborns' lives. Approximately 99% of neonatal deaths take place in developing countries, mostly in homes and communities. A comprehensive review of the evidence base for impact of interventions on neonatal health and survival in developingcountry communities has not been reported.Objective. This review of community-based antenatal, intrapartum, and postnatal intervention trials in developing countries aimed to identify (1) key behaviors and interventions for which the weight of evidence is sufficient to recommend their inclusion in communitybased neonatal care programs and (2) key gaps in knowledge and priority areas for future research and program learning.Methods. Available published and unpublished data on the impact of community-based strategies and interventions on perinatal and neonatal health status outcomes were reviewed. Evidence was summarized systematically and categorized into 4 levels of evidence based on study size, location, design, and reported impact, particularly on perinatal or neonatal mortality. The evidence was placed in the context of biological plausibility of the intervention; evidence from relevant developed-country studies; health care program experience in implementation; and recommendations from the World Health Organization and other leading agencies.Results. A paucity of community-based data was found from developing-country studies on health status impact for many interventions currently being considered for inclusion in neonatal health programs. However, review of the evidence and consideration of the broader context of knowledge, experience, and recommendations regarding these interventions enabled us to categorize them according to the strength of the evidence base and confidence regarding their inclusion now in programs. This article identifies a package of priority interventions to include in programs and formulates research priorities for advancing the state of the art in neonatal health care.Conclusions. This review emphasizes some new findings while recommending an integrated approach to safe motherhood and newborn health. The results of this study provide a foundation for policies and programs related to maternal and newborn health and emphasizes the importance of health systems research and evaluation of interventions. The review offers compelling support for using research to identify the most effective measures to save newborn lives. It also may facilitate dialogue with policy...

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confidence: 99%

Section: )mentioning

confidence: 99%

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

et al. 2005

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“…5 Intral l partum use of chlorhexidine, coupled with communitylbased interventions to improve hygiene (such as handlwashing and clean delivery) and neonatal care practices (clean cord cutting and care, skin care) may reduce the incidence of neonatal infections. 6,38,44,45 Later deaths from infections including tetanus can be strongly linked to environmental exposures and practices during home delivery and care. 6 Neonatal tetanus can be prevented through maternal tetanus immunization, as well as clean cord care.…”

Section: 6mentioning

confidence: 99%

“…33 Recent evidence suggests that iml l proved care of preterm or LBW infants can substantially improve survival. 5,6 Early postnatal vitamin A dosing; 34 promotion of early and exclusive breastl l feeding; 6,35 hypothermia prevention and management, including skinltolskin care; 36,37 topical skin cleansing with chlorhexidine; 38,39 and topical emollient treatment for hospitalized infants 40,41 may also reduce mortality and morbidity in LBW or preterm neonates. 5,42,43 Furl l thermore, the substantial proportion of early deaths that occurred in the absence of distinct symptoms suggests that prol l grammes to reduce neonatal mortality should also focus on routine, preventive care for all newborn babies in addition to responding to carelseeking for perceived presence of danger signs.…”

Section: 6mentioning

confidence: 99%

Rates, timing and causes of neonatal deaths in rural India: implications for neonatal health programmes

Baqui

Darmstadt

Williams

et al. 2006

Bull World Health Organ

190

175

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Objective To assess the rates, timing and causes of neonatal deaths and the burden of stillbirths in rural Uttar Pradesh, India. We discuss the implications of our findings for neonatal interventions. Methods We used verbal autopsy interviews to investigate 1048 neonatal deaths and stillbirths. Findings There were 430 stillbirths reported, comprising 41% of all deaths in the sample. Of the 618 live births, 32% deaths were on the day of birth, 50% occurred during the first 3 days of life and 71% were during the first week. The primary causes of death on the first day of life (i.e. day 0) were birth asphyxia or injury (31%) and preterm birth (26%). During days 1-6, the most frequent causes of death were preterm birth (30%) and sepsis or pneumonia (25%). Half of all deaths caused by sepsis or pneumonia occurred during the first week of life. The proportion of deaths attributed to sepsis or pneumonia increased to 45% and 36% during days 7-13 and 14-27, respectively. Conclusion Stillbirths and deaths on the day of birth represent a large proportion of perinatal and neonatal deaths, highlighting an urgent need to improve coverage with skilled birth attendants and to ensure access to emergency obstetric care. Health interventions to improve essential neonatal care and care-seeking behavior are also needed, particularly for preterm neonates in the early postnatal period.Bulletin of the World Health Organization 2006;84:706-713.Voir page 711 le résumé en français. En la página 712 figura un resumen en español. IntroductionEvery year, there are an estimated 4 mill l lion neonatal deaths, accounting for all l most 40% of deaths in children younger than 5 years.1,2 About a quarter of global neonatal deaths occur in India, which has a neonatal mortality of 43 per 1000 live births. 1,3 Therefore, interventions to address neonatal mortality are crucial if child mortality is to be reduced globally and in India. 2,4l6 Globally, the main causes of neonal l tal deaths are thought to be preterm birth (28%), sepsis or pneumonia (26%), and birth asphyxia (23%).1,2 In the Southl East Asia Region, WHO has attributed 30% of neonatal deaths to preterm birth, 27% to sepsis or pneumonia, 23% to birth asphyxia, 6% to congenital abnorl l malities, 4% to tetanus, 3% to diarrhoea and 7% to other causes. 7 However, most stillbirths or neonatal deaths occur at home and vital registration systems are incomplete, 3,4,8 and as such current estimates have been generated from a limited set of data.2,9,10Verbal autopsies, which are interl l views with caregivers, 11,12 have been used to establish causes of neonatal deaths. 8,[13][14][15][16][17][18][19][20][21] Data on timing and causes of neonatal deaths are very important for the design of interventions to reduce mortality, yet only one study with a small sample size (n = 40) has previously described causes of neonatal deaths by day. 13 Here, we describe the rates, causes and timing of 1048 neonatal deaths and stillbirths in a rural population in Uttar Pradesh, India, where the neonatal mortality...

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“…Following this landmark study, different ART regimens have demonstrated variable impact in the reduction of HIV-1 vertical transmission rates (Dabis et al 1999, Guay et al 1999, Shaffer et al 1999, Wiktor et al 1999, PST 2002, Lallemant et al 2004, Read et al 2007). In addition to ART, other interventions have contributed to the reduction of HIV-1 vertical transmission, such as elective cesarean section (C-section) (IPHIVG 1999, EMDC 1999, vaginal cleaning during the intrapartum period (Taha et al 1997), vitamin A supplementation (Semba 1997), and avoidance of breastfeeding (Nduati et al 2001, RoUsseau et al 2004.…”

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Determinants and trends in perinatal human immunodeficiency virus type 1 (HIV-1) transmission in the metropolitan area of Belo Horizonte, Brazil: 1998 - 2005

Kakehasi

Pinto

Romanelli

et al. 2008

Mem. Inst. Oswaldo Cruz

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Effect of cleansing the birth canal with antiseptic solution on maternal and newborn morbidity and mortality in malawi: clinical trial

Cited by 143 publications

References 10 publications

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

Rates, timing and causes of neonatal deaths in rural India: implications for neonatal health programmes

Determinants and trends in perinatal human immunodeficiency virus type 1 (HIV-1) transmission in the metropolitan area of Belo Horizonte, Brazil: 1998 - 2005

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