Supply kits for antenatal and childbirth care: a systematic review

Abstract

IntroductionIt is critical to increase the uptake of interventions proven to be effective to improve maternal and perinatal outcomes. Supply kits have been suggested to be a feasible strategy designed to ensure timely availability and effective follow-up of care.ObjectiveWe conducted a systematic review to summarize the evidence on the uptake, effectiveness and safety of supply kits for maternal care.Search strategyMEDLINE, the Cochrane Pregnancy and Childbirth Group’s Trials Register, Campbell Collaboration, Lilacs, Embase and unpublished studies were searched.Selection criteriaStudies that reported the efficacy, safety and use of supply kits for maternal healthcare were eligible. Participants were pregnant women or in childbirth. Supply kits were defined as a collection of medicines, supplies or instruments packaged together with the aim of conducting a healthcare task.Data collection and analysisTwo reviewers independently performed the screening, data extraction, and methodological and quality assessment.Main results24 studies were included: 4 of them were systematic reviews and 20 primary studies. Eighteen studies evaluated a so-called “clean delivery kit”. In all but two studies, the kits were used by more than half of the participants. A meta-analysis was deemed inappropriate due to the heterogeneity in study design, in the components of the interventions implemented, in the content of the kits, and in outcomes. Nine studies assessed neonatal outcomes and found statistically significant reductions in cord infection, sepsis and tetanus-related mortality in the intervention group. Three studies showed evidence of reduced neonatal mortality (OR 0.52, 0.60 and 0.71) with statistically significant confidence intervals in all cases. Four studies reported odd ratios for maternal mortality, but only one showed evidence of a statistically significant decrease in this outcome but it was ascribed to hand washing prior to childbirth and not with the use of kits.ConclusionThis review suggests potential benefits in the use of supply kits to improve maternal and neonatal health. However, the observational nature of the studies, the heterogeneity and the use of kits incorporated within complex interventions limit the interpretation of the findings.Electronic supplementary materialThe online version of this article (10.1186/s12978-017-0436-9) contains supplementary material, which is available to authorized users.

Associations between birth kit use and maternal and neonatal health outcomes in rural Jigawa state, Nigeria: A secondary analysis of data from a cluster randomized controlled trial

“…In previous literature, reported use of birth kits ranges from 15–100% [10]. Our findings are broadly consistent with a study analyzing data from a cRCT promoting birth kit use in Nepal, India, and Bangladesh: kits were used in 18.4% of home births in India, 18.4% in Bangladesh, and 5.7% in Nepal [17].…”

“…Second, the existing evidence almost exclusively focuses on interventions in which birth kits are distributed to health facilities, skilled birth attendants, or stores for purchase [12]. There is little existing evidence analyzing how uptake of birth kits may vary with respect to the identity of the recipient (health worker or pregnant woman) [10]. Accordingly, this paper provides a novel contribution to the literature by examining the effects of an intervention that provided kits directly to pregnant women.…”

“…Despite these recommendations, there is limited evidence around the impact of clean delivery kits on health outcomes, including neonatal sepsis and neonatal mortality [10–12]. The most recent systematic review of safe birth kit research found that only 18 studies reported results of an intervention including birth kits; all of these were observational studies except for one randomized controlled trial, and almost all were unable to separately identify the effects of birth kits compared to other interventions [10].…”

“…Conceptually, there are at least two important factors that may limit the effectiveness of birth kits. First, utilization rates of the kits themselves may be low outside of formal health care settings; the existing evidence almost exclusively focuses on interventions in which birth kits are distributed to health facilities or skilled birth attendants [10, 12], although an estimated 52 million women give birth at home without a skilled provider each year [20]. In what Hart deems the law of inverse care, women who are most vulnerable are generally characterized by the lowest rates of service utilization [21].…”

Maternal critical care in resource-limited settings. Narrative review

“…Supply kits (packaged supplies targeting patient, healthcare provider or health facility requirements) have been proposed to be a simple and low-cost intervention that can address various challenges routinely encountered in RLS. 72 In the area of maternal and newborn health, supply kits have been designed to focus on issues ranging from timely availability of effective treatment in emergency situations and avoidance of stock-outs for routine care. 73 Leligdowicz and colleagues have recently published the results from their critical care unit resource assessment survey in RLS.…”