Chlorhexidine for facility-based umbilical cord care: EN-BIRTH multi-country validation study

BMC Pregnancy and Childbirth

EN-BIRTH Study Group¹  Nahya Salim²  Ashish KC³  Ahmed Ehsanur Rahman⁴  Shafiqul Ameen⁴  Sojib Bin Zaman⁴  Tazeen Tahsina⁴  Abu Bakkar Siddique⁴  Shams El Arifeen⁴  Qazi Sadeq-ur Rahman⁴  Barbara Rawlins⁵  Patricia S. Coffey⁶  Rejina Gurung⁷  Nishant Thakur⁷  Kimberly Peven⁸  Louise T. Day⁸  Joy E. Lawn⁸  Harriet Ruysen⁸ 

[1] ;Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences;Department of Women’s and Children’s Health, Uppsala University;Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b);Maternal and Child Survival Program, jhpiego;PATH;Research Division, Golden Community;The Maternal, Adolescent, Reproductive, & Child, Health (MARCH) Centre, London School of Hygiene & Tropical Medicine;

关键词: Birth;    Newborn;    Coverage;    Validity;    Survey;    Hospital records;   

DOI  :  10.1186/s12884-020-03338-4

来源: DOAJ

【 摘 要 】

Abstract Background Umbilical cord hygiene prevents sepsis, a leading cause of neonatal mortality. The World Health Organization recommends 7.1% chlorhexidine digluconate (CHX) application to the umbilicus after home birth in high mortality contexts. In Bangladesh and Nepal, national policies recommend CHX use for all facility births. Population-based household surveys include optional questions on CHX use, but indicator validation studies are lacking. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) was an observational study assessing measurement validity for maternal and newborn indicators. This paper reports results regarding CHX. Methods The EN-BIRTH study (July 2017–July 2018) included three public hospitals in Bangladesh and Nepal where CHX cord application is routine. Clinical-observers collected tablet-based, time-stamped data regarding cord care during admission to labour and delivery wards as the gold standard to assess accuracy of women’s report at exit survey, and of routine-register data. We calculated validity ratios and individual-level validation metrics; analysed coverage, quality and measurement gaps. We conducted qualitative interviews to assess barriers and enablers to routine register-recording. Results Umbilical cord care was observed for 12,379 live births. Observer-assessed CHX coverage was very high at 89.3–99.4% in all 3 hospitals, although slightly lower after caesarean births in Azimpur (86.8%), Bangladesh. Exit survey-reported coverage (0.4–45.9%) underestimated the observed coverage with substantial “don’t know” responses (55.5–79.4%). Survey-reported validity ratios were all poor (0.01 to 0.38). Register-recorded coverage in the specific column in Bangladesh was underestimated by 0.2% in Kushtia but overestimated by 9.0% in Azimpur. Register-recorded validity ratios were good (0.9 to 1.1) in Bangladesh, and poor (0.8) in Nepal. The non-specific register column in Pokhara, Nepal substantially underestimated coverage (20.7%). Conclusions Exit survey-report highly underestimated observed CHX coverage in all three hospitals. Routine register-recorded coverage was closer to observer-assessed coverage than survey reports in all hospitals, including for caesarean births, and was more accurately captured in hospitals with a specific register column. Inclusion of CHX cord care into registers, and tallied into health management information system platforms, is justified in countries with national policies for facility-based use, but requires implementation research to assess register design and data flow within health information systems.

【 授权许可】

Unknown