Using 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.

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dc.citation.issue8
dc.citation.volume10
dc.contributor.authorSeward N
dc.contributor.authorProst A
dc.contributor.authorCopas A
dc.contributor.authorCorbin M
dc.contributor.authorLi L
dc.contributor.authorColbourn T
dc.contributor.authorOsrin D
dc.contributor.authorNeuman M
dc.contributor.authorAzad K
dc.contributor.authorKuddus A
dc.contributor.authorNair N
dc.contributor.authorTripathy P
dc.contributor.authorManandhar D
dc.contributor.authorCostello A
dc.contributor.authorCortina-Borja M
dc.coverage.spatialUnited States
dc.date.available2015
dc.date.available2015-07-31
dc.date.issued2015
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.
dc.description.publication-statusPublished online
dc.format.extente0136152 - ?
dc.identifierhttps://www.ncbi.nlm.nih.gov/pubmed/26295838
dc.identifierPONE-D-14-23718
dc.identifier.citationPLoS One, 2015, 10 (8), pp. e0136152 - ?
dc.identifier.doi10.1371/journal.pone.0136152
dc.identifier.eissn1932-6203
dc.identifier.elements-id380019
dc.identifier.harvestedMassey_Dark
dc.languageeng
dc.relation.isPartOfPLoS One
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.
dc.subjectAdult
dc.subjectBangladesh
dc.subjectCross-Sectional Studies
dc.subjectDelivery, Obstetric
dc.subjectHand Disinfection
dc.subjectHome Childbirth
dc.subjectHumans
dc.subjectIndia
dc.subjectLogistic Models
dc.subjectMaternal Mortality
dc.subjectMidwifery
dc.subjectNepal
dc.subjectOdds Ratio
dc.subjectPuerperal Infection
dc.subjectRandomized Controlled Trials as Topic
dc.subjectRural Population
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.
dc.typeJournal article
pubs.notesNot known
pubs.organisational-group/Massey University
pubs.organisational-group/Massey University/College of Health
pubs.organisational-group/Massey University/College of Health/Research Centre for Hauora and Health
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