Maternal and Birth Attendant Hand Washing and Neonatal Mortality in Southern Nepal

Overview

Journal Arch Pediatr Adolesc Med

Publisher American Medical Association

Specialty Pediatrics

Date 2008 Jul 9

PMID 18606930

Citations 44

Authors

Victor Rhee

Luke C Mullany

Subarna K Khatry

Joanne Katz

Steven C LeClerq

Gary L Darmstadt

James M Tielsch

Affiliations

Soon will be listed here.

Abstract

Background: More than 95% of neonatal deaths occur in developing countries, approximately 50% at home. Few data are available on the impact of hand-washing practices by birth attendants or caretakers on neonatal mortality.

Objective: To evaluate the relationship between birth attendant and maternal hand-washing practices and neonatal mortality in rural Nepal.

Design: Observational prospective cohort study.

Setting: Sarlahi District in rural southern Nepal.

Participants: Newborn infants were originally enrolled in a community-based trial assessing the effect of skin and/or umbilical cord cleansing with chlorhexidine on neonatal mortality in southern Nepal. A total of 23,662 newborns were enrolled and observed through 28 days of life.

Main Exposures: Questionnaires were administered to mothers on days 1 and 14 after delivery to identify care practices and risk factors for mortality and infection. Three hand-washing categories were defined: (1) birth attendant hand washing with soap and water before assisting with delivery, (2) maternal hand washing with soap and water or antiseptic before handling the baby, and (3) combined birth attendant and maternal hand washing.

Outcome Measures: Mortality within the neonatal period.

Results: Birth attendant hand washing was related to a statistically significant lower mortality rate among neonates (adjusted relative risk [RR] = 0.81; 95% confidence interval [CI], 0.66-0.99), as was maternal hand washing (adjusted RR = 0.56; 95% CI, 0.38-0.82). There was a 41% lower mortality rate among neonates exposed to both hand-washing practices (adjusted RR = 0.59; 95% CI, 0.37-0.94).

Conclusions: Birth attendant and maternal hand washing with soap and water were associated with significantly lower rates of neonatal mortality. Measures to improve or promote birth attendant and maternal hand washing could improve neonatal survival rates.

Citing Articles

Hand hygiene for the prevention of infections in neonates.

Kuti B, Ogunlesi T, Oduwole O, Oringanje C, Udoh E, Bello S Cochrane Database Syst Rev. 2023; 6:CD013326.

PMID: 37278689 PMC: 10243182. DOI: 10.1002/14651858.CD013326.pub4.

Impact on childhood mortality of interventions to improve drinking water, sanitation, and hygiene (WASH) to households: Systematic review and meta-analysis.

Sharma Waddington H, Masset E, Bick S, Cairncross S PLoS Med. 2023; 20(4):e1004215.

PMID: 37079510 PMC: 10118100. DOI: 10.1371/journal.pmed.1004215.

Interventions promoting uptake of water, sanitation and hygiene (WASH) technologies in low- and middle-income countries: An evidence and gap map of effectiveness studies.

Chirgwin H, Cairncross S, Zehra D, Sharma Waddington H Campbell Syst Rev. 2023; 17(4):e1194.

PMID: 36951806 PMC: 8988822. DOI: 10.1002/cl2.1194.

A controlled before-and-after study of a multi-modal intervention to improve hand hygiene during the peri-natal period in Cambodia.

Nalule Y, Pors P, Samol C, Ret S, Leang S, Ir P Sci Rep. 2022; 12(1):19646.

PMID: 36385113 PMC: 9666993. DOI: 10.1038/s41598-022-23937-9.

Diarrhoea among Children Under Five Years of Age Residing in a Village Development Committee: A Descriptive Cross-sectional Study.

Mishra R, Acharya A, Yadav A, Shreewastav R JNMA J Nepal Med Assoc. 2022; 60(249):425-429.

PMID: 35633243 PMC: 9252218. DOI: 10.31729/jnma.7322.

References

Won S, Chou H, Hsieh W, Chen C, Huang S, Tsou K . Handwashing program for the prevention of nosocomial infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 2004; 25(9):742-6. DOI: 10.1086/502470. View

Roberts L, Jorm L, Patel M, Smith W, Douglas R, McGilchrist C . Effect of infection control measures on the frequency of diarrheal episodes in child care: a randomized, controlled trial. Pediatrics. 2000; 105(4 Pt 1):743-6. DOI: 10.1542/peds.105.4.743. View

Mullany L, Darmstadt G, Katz J, Khatry S, LeClerq S, Adhikari R . Risk factors for umbilical cord infection among newborns of southern Nepal. Am J Epidemiol. 2006; 165(2):203-11. PMC: 2362499. DOI: 10.1093/aje/kwj356. View

Velema J, van Wijnen G, Bult P, van Naerssen T, Jota S . Typhoid fever in Ujung Pandang, Indonesia--high-risk groups and high-risk behaviours. Trop Med Int Health. 1997; 2(11):1088-94. DOI: 10.1046/j.1365-3156.1997.d01-179.x. View

Mullany L, Darmstadt G, Khatry S, Katz J, LeClerq S, Shrestha S . Topical applications of chlorhexidine to the umbilical cord for prevention of omphalitis and neonatal mortality in southern Nepal: a community-based, cluster-randomised trial. Lancet. 2006; 367(9514):910-8. PMC: 2367116. DOI: 10.1016/S0140-6736(06)68381-5. View

Gorter A, Sandiford P, Pauw J, Morales P, Perez R, Alberts H . Hygiene behaviour in rural Nicaragua in relation to diarrhoea. Int J Epidemiol. 1999; 27(6):1090-100. DOI: 10.1093/ije/27.6.1090. View

Luby S, Agboatwalla M, Painter J, Altaf A, Billhimer W, Keswick B . Combining drinking water treatment and hand washing for diarrhoea prevention, a cluster randomised controlled trial. Trop Med Int Health. 2006; 11(4):479-89. DOI: 10.1111/j.1365-3156.2006.01592.x. View

Roberts L, Smith W, Jorm L, Patel M, Douglas R, McGilchrist C . Effect of infection control measures on the frequency of upper respiratory infection in child care: a randomized, controlled trial. Pediatrics. 2000; 105(4 Pt 1):738-42. DOI: 10.1542/peds.105.4.738. View

Peterson E, Roberts L, Toole M, Peterson D . The effect of soap distribution on diarrhoea: Nyamithuthu Refugee Camp. Int J Epidemiol. 1998; 27(3):520-4. DOI: 10.1093/ije/27.3.520. View

10.

Black R, Dykes A, Anderson K, Wells J, Sinclair S, Gary Jr G . Handwashing to prevent diarrhea in day-care centers. Am J Epidemiol. 1981; 113(4):445-51. DOI: 10.1093/oxfordjournals.aje.a113112. View

11.

Khan M . Interruption of shigellosis by hand washing. Trans R Soc Trop Med Hyg. 1982; 76(2):164-8. DOI: 10.1016/0035-9203(82)90266-8. View

12.

Luby S, Agboatwalla M, Feikin D, Painter J, Billhimer W, Altaf A . Effect of handwashing on child health: a randomised controlled trial. Lancet. 2005; 366(9481):225-33. DOI: 10.1016/S0140-6736(05)66912-7. View

13.

Lawn J, Cousens S, Zupan J . 4 million neonatal deaths: when? Where? Why?. Lancet. 2005; 365(9462):891-900. DOI: 10.1016/S0140-6736(05)71048-5. View

14.

Lawn J, Cousens S, Darmstadt G, Paul V, Martines J . Why are 4 million newborn babies dying every year?. Lancet. 2004; 364(9450):2020. DOI: 10.1016/S0140-6736(04)17511-9. View

15.

Curtis V, Cairncross S . Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. Lancet Infect Dis. 2003; 3(5):275-81. DOI: 10.1016/s1473-3099(03)00606-6. View

16.

Darmstadt G, Bhutta Z, Cousens S, Adam T, Walker N, De Bernis L . Evidence-based, cost-effective interventions: how many newborn babies can we save?. Lancet. 2005; 365(9463):977-88. DOI: 10.1016/S0140-6736(05)71088-6. View

17.

Gasem M, Dolmans W, Keuter M, Djokomoeljanto R . Poor food hygiene and housing as risk factors for typhoid fever in Semarang, Indonesia. Trop Med Int Health. 2001; 6(6):484-90. DOI: 10.1046/j.1365-3156.2001.00734.x. View

18.

Darmstadt G, Syed U, Patel Z, Kabir N . Review of domiciliary newborn-care practices in Bangladesh. J Health Popul Nutr. 2007; 24(4):380-93. PMC: 3001142. View

19.

Curtis V, Cousens S, Mertens T, Traore E, Kanki B, Diallo I . Structured observations of hygiene behaviours in Burkina Faso: validity, variability, and utility. Bull World Health Organ. 1993; 71(1):23-32. PMC: 2393438. View

20.

Shahid N, Greenough 3rd W, Samadi A, Huq M, Rahman N . Hand washing with soap reduces diarrhoea and spread of bacterial pathogens in a Bangladesh village. J Diarrhoeal Dis Res. 1996; 14(2):85-9. View