Clean birth kits to improve birth practices: development and testing of a country level decision support tool

BMC Pregnancy and Childbirth

Wendy J Graham³  Haris Ahmed¹  Bilal I Avan⁴  Vanora A Hundley² 

[1] Pathfinder International, Islamabad, Pakistan;NMAHP Research Unit, University of Stirling, Stirling, FK9 4LA, UK;Immpact, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK;Department of Disease Control, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK

关键词: Decision support tool;    Birth kits;    Clean birth practices;   

Others  :  1151423
DOI  :  10.1186/1471-2393-12-158

 received in 2012-06-27, accepted in 2012-12-13,  发布年份 2012

【 摘 要 】

Background

Clean birth practices can prevent sepsis, one of the leading causes of both maternal and newborn mortality. Evidence suggests that clean birth kits (CBKs), as part of package that includes education, are associated with a reduction in newborn mortality, omphalitis, and puerperal sepsis. However, questions remain about how best to approach the introduction of CBKs in country. We set out to develop a practical decision support tool for programme managers of public health systems who are considering the potential role of CBKs in their strategy for care at birth.

Methods

Development and testing of the decision support tool was a three-stage process involving an international expert group and country level testing. Stage 1, the development of the tool was undertaken by the Birth Kit Working Group and involved a review of the evidence, a consensus meeting, drafting of the proposed tool and expert review. In Stage 2 the tool was tested with users through interviews (9) and a focus group, with federal and provincial level decision makers in Pakistan. In Stage 3 the findings from the country level testing were reviewed by the expert group.

Results

The decision support tool comprised three separate algorithms to guide the policy maker or programme manager through the specific steps required in making the country level decision about whether to use CBKs. The algorithms were supported by a series of questions (that could be administered by interview, focus group or questionnaire) to help the decision maker identify the information needed. The country level testing revealed that the decision support tool was easy to follow and helpful in making decisions about the potential role of CBKs. Minor modifications were made and the final algorithms are presented.

Conclusion

Testing of the tool with users in Pakistan suggests that the tool facilitates discussion and aids decision making. However, testing in other countries is needed to determine whether these results can be replicated and to identify how the tool can be adapted to meet country specific needs.

【 授权许可】

   
2012 Hundley et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Khan KS, Wojdyla D, Say L, Metin Gülmezoglu A, Van Look PFA: WHO analysis of causes of maternal death: a systematic review. Lancet 2006, 367(9516):1066-1074.
• [2]Bryce J, Boschi-Pinto C, Shibuya RE, Black RE, WHO Child Health Epidemiology Reference Group: WHO estimates of the causes of death in children. Lancet 2005, 365(9465):1147-1152.
• [3]Seale AC, Mwaniki M, Newton CRJC, Berkley JA: Maternal and early onset neonatal bacterial sepsis: burden and strategies for prevention in sub-Saharan Africa. Lancet 2009, 9:428-438.
• [4]Blencowe H, Cousens S, Mullany LC, Lee ACC, Kerber K, Wall S, Darmstadt GL, Lawn JE: Clean birth and postnatal care practices to reduce neonatal deaths from sepsis and tetanus: a systematic review and Delphi estimation of mortality effect. BMC Publ Health 2011, 11(S3):S11. Available at: http://www.biomedcentral.com/1471-2458/11/S3/S11 webcite
• [5]Graham W, Braunholtz D, Islam M, Mathai M, Yoshida S, Kits for Quality Facility Births (Panel 2): Global Campaign for The Health MDGs: First Year Report 2008. 2008, 51. Available at: http://www.immpact-international.com/uploads/files/global_campaign_health_mdgs_report_2008.pdf webcite
• [6]World Health Organization, Department of Reproductive Health and Research: Essential Newborn Care: Report of a Technical Working Group. Geneva: WHO; 1996. WHO/FRH/MSM/96.13
• [7]World Health Organization, Division of Reproductive Health (Technical Support): Care of the Umbilical Cord: A review of the evidence. Geneva: WHO; 1998. WHO/RHT/MSM/98.4
• [8]Hundley V, Avan B, Braunholtz D, Graham WJ: Are birth kits a good idea? A systematic review of the evidence. Midwifery 2012, 28(2):204-215.
• [9]WHO, UNICEF, UNFPA and the World Bank: Trends in maternal mortality: 1990 to 2008. Geneva: WHO; 2010.
• [10]National Institute of Population Studies (NIPS) [Pakistan], and Macro International Inc: Pakistan. Demographic and Health Survey 2006–07. Islamabad, Pakistan: National Institute of Population Studies and Macro International Inc; 2008.
• [11]World Health Organization: Pakistan: Health Profile. Geneva: WHO; 2011. Available at: http://www.who.int/gho/countries/pak.pdf webcite
• [12]Hassan H, Jokhio AH, Winter H, MacArthur C: Safe delivery and newborn care practices in Sindh, Pakistan: a community-based investigation of mothers and health workers. Midwifery 2012, 28:466-471.
• [13]Ayaz A, Saleem S: Neonatal mortality and prevalence of practices for newborn care in a squatter settlement of Karachi, Pakistan: a cross-sectional study. PLoS ONE 2010, 5(11):e13783.
• [14]Jehan I, Harris H, Salat S, Zeb A, Mobeen N, Pasha O, McClure EM, Moore J, Wright LL, Goldenberg RL: Neonatal mortality, risk factors and causes: a prospective population-based cohort study in urban Pakistan. Bull World Health Organ 2009, 87(2):130-138.
• [15]Hundley V, Avan B, Braunholtz D, Fitzmaurice A, Graham W: Lessons regarding the use of birth kits in low resource countries. Midwifery 2011, 27(6):e222-e230.
• [16]Hundley V, Avan B, Graham W, Blencowe H, Lawn J: CBK Country Level Decision Support Tool. Aberdeen: Immpact; 2012. Available at: http://www.immpact-international.org/uploads/files/Clean%20Birth%20Kit_%20Decision%20Tool_Revised.pdf webcite
• [17]Holloway I, Wheeler S: Qualitative research in nursing and health care. 3rd edition. New-Jersey: Wiley-Blackwell; 2009.
• [18]van Teijlingen ER, Pitchforth E: Focus group research in family planning and reproductive health care. J Fam Plan Reprod H 2006, 32(1):30-32.
• [19]van Teijlingen ER, Hundley V: Pilot studies in family planning and reproductive health care. J Fam Plan Reprod H 2005, 31(3):219-221.
• [20]Forrest Keenan K, van Teijlingen E, Pitchforth E: The analysis of qualitative research data in family planning and reproductive health care. J Fam Plan Reprod H 2005, 31(1):40-43.
• [21]World Health Organization and Global Health Workforce Alliance: Pakistan’s Lady Health Worker Programme. Geneva: WHO; 2008. Available at: http://www.who.int/workforcealliance/knowledge/case_studies/CS_Pakistan_web_en.pdf webcite
• [22]USAID: Sustaining health gains – building systems. Health systems report to Congress. Washington DC: USAID; 2009.
• [23]Cameron A, Ewen M, Ross-Degnan D, Ball D, Laing R: Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis. Lancet 2009, 373(9659):240-249.
• [24]Harding A (Chair) Partnerships with the Private Sector in Health: What the International Community Can Do to Strengthen Health Systems in Developing Countries. Washington DC: Center for Global Development; 2009. Available at: http://www.cgdev.org/files/1423350_file_CGD_PSAF_Report_web.pdf webcite
• [25]UN Commission on Life-Saving Commodities: Commission Concept Note. 2012. Available at: http://www.everywomaneverychild.org/images/Concept_Note_Commission_on_Commod webcite
• [26]Soofi S, Cousens S, Imdad A, Bhutto N, Ali N, Bhutta ZA: Topical application of chlorhexidine to neonatal umbilical cords for prevention of omphalitis and neonatal mortality in a rural district of Pakistan: a community-based, cluster-randomised trial. Lancet 2012, 379:1029-1036.
• [27]Raven J, Hofman J, Adegoke A, van den Broek N: Methodology and tools for quality improvement in maternal and newborn health care. Int J Gynecol Obstet 2011, 114:4-9.
• [28]Nyamtema A, Urassa DP, van Roosmalen J: Maternal health interventions in resource limited countries: a systematic review of packages, impacts and factors for change. BMC Pregnancy and Childbirth 2011, 11:30. BioMed Central Full Text