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dc.contributor.authorSeward, Nen_US
dc.contributor.authorProst, Aen_US
dc.contributor.authorCopas, Aen_US
dc.contributor.authorCorbin, Men_US
dc.contributor.authorLi, Len_US
dc.contributor.authorColbourn, Ten_US
dc.contributor.authorOsrin, Den_US
dc.contributor.authorNeuman, Men_US
dc.contributor.authorAzad, Ken_US
dc.contributor.authorKuddus, Aen_US
dc.contributor.authorNair, Nen_US
dc.contributor.authorTripathy, Pen_US
dc.contributor.authorManandhar, Den_US
dc.contributor.authorCostello, Aen_US
dc.contributor.authorCortina-Borja, Men_US
dc.coverage.spatialUnited Statesen_US
dc.date.accessioned2017-09-21T01:41:00Z
dc.date.available2015en_US
dc.date.available2015-07-31en_US
dc.date.available2017-09-21T01:41:00Z
dc.date.issued2015en_US
dc.identifierhttps://www.ncbi.nlm.nih.gov/pubmed/26295838en_US
dc.identifierPONE-D-14-23718en_US
dc.identifier.citationPLoS One, 2015, 10 (8), pp. e0136152 - ?en_US
dc.identifier.urihttp://hdl.handle.net/10179/11892
dc.description.abstractBACKGROUND: Globally, puerperal sepsis accounts for an estimated 8-12% of maternal deaths, but evidence is lacking on the extent to which clean delivery practices could improve maternal survival. We used data from the control arms of four cluster-randomised controlled trials conducted in rural India, Bangladesh and Nepal, to examine associations between clean delivery kit use and hand washing by the birth attendant with maternal mortality among home deliveries. METHODS: We tested associations between clean delivery practices and maternal deaths, using a pooled dataset for 40,602 home births across sites in the three countries. Cross-sectional data were analysed by fitting logistic regression models with and without multiple imputation, and confounders were selected a priori using causal directed acyclic graphs. The robustness of estimates was investigated through sensitivity analyses. RESULTS: Hand washing was associated with a 49% reduction in the odds of maternal mortality after adjusting for confounding factors (adjusted odds ratio (AOR) 0.51, 95% CI 0.28-0.93). The sensitivity analysis testing the missing at random assumption for the multiple imputation, as well as the sensitivity analysis accounting for possible misclassification bias in the use of clean delivery practices, indicated that the association between hand washing and maternal death had been over estimated. Clean delivery kit use was not associated with a maternal death (AOR 1.26, 95% CI 0.62-2.56). CONCLUSIONS: Our evidence suggests that hand washing in delivery is critical for maternal survival among home deliveries in rural South Asia, although the exact magnitude of this effect is uncertain due to inherent biases associated with observational data from low resource settings. Our findings indicating kit use does not improve maternal survival, suggests that the soap is not being used in all instances that kit use is being reported.en_US
dc.format.extente0136152 - ?en_US
dc.languageengen_US
dc.rights© 2015 Seward et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_US
dc.subjectAdulten_US
dc.subjectBangladeshen_US
dc.subjectCross-Sectional Studiesen_US
dc.subjectDelivery, Obstetricen_US
dc.subjectHand Disinfectionen_US
dc.subjectHome Childbirthen_US
dc.subjectHumansen_US
dc.subjectIndiaen_US
dc.subjectLogistic Modelsen_US
dc.subjectMaternal Mortalityen_US
dc.subjectMidwiferyen_US
dc.subjectNepalen_US
dc.subjectOdds Ratioen_US
dc.subjectPuerperal Infectionen_US
dc.subjectRandomized Controlled Trials as Topicen_US
dc.subjectRural Populationen_US
dc.titleUsing Observational Data to Estimate the Effect of Hand Washing and Clean Delivery Kit Use by Birth Attendants on Maternal Deaths after Home Deliveries in Rural Bangladesh, India and Nepal.en_US
dc.typeJournal Article
dc.citation.volume10en_US
dc.identifier.doi10.1371/journal.pone.0136152en_US
dc.identifier.elements-id380019
dc.relation.isPartOfPLoS Oneen_US
dc.citation.issue8en_US
dc.identifier.eissn1932-6203en_US
dc.description.publication-statusPublished onlineen_US
pubs.organisational-group/Massey University
pubs.organisational-group/Massey University/College of Health
pubs.organisational-group/Massey University/College of Health/Centre for Public Health Research
dc.identifier.harvestedMassey_Dark
pubs.notesNot knownen_US
dc.subject.anzsrcMD Multidisciplinaryen_US


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