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Disposable clean delivery kits and prevention of neonatal tetanus in the presence of skilled birth attendants
Author(s) -
Raza Syed A.,
Avan Bilal I.
Publication year - 2013
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2012.07.030
Subject(s) - medicine , tetanus , number needed to treat , neonatal tetanus , confidence interval , odds ratio , toxoid , population , pediatrics , obstetrics , relative risk , environmental health , immunology , vaccination
Objective To determine whether the use of disposable clean delivery kits (CDKs) is effective in reducing neonatal tetanus (NNT) infection, regardless of the skills of birth attendants in resource‐poor settings. Methods A secondary analysis was conducted on data from a matched case–control study in Karachi, Pakistan, involving 140 NNT cases and 280 controls between 1998 and 2001. Conditional logistic regression was performed to assess the independent effect on NNT of CDKs and skilled birth attendants (SBAs). Results After adjustment for socioeconomic factors, both CDKs (adjusted matched odds ratio [mOR] 2.0; 95% confidence interval [CI], 1.3–3.1) and SBAs (adjusted mOR 1.7; 95% CI, 1.1–2.7) were independently associated with NNT. The association with CDKs remained significant when additionally adjusted for SBAs (mOR 2.0; 95% CI, 1.0–3.9; P = 0.05). The population attributable risk for lack of CDK use was 24% in the study setting. Conclusion In the context of resource‐poor settings in low‐income countries with poor coverage of tetanus toxoid immunization, the use of CDKs seems to be an effective strategy for reducing NNT infection, irrespective of the skill levels of birth attendants. Approximately one‐quarter of NNT cases could be prevented in low‐income populations with the use of CDKs.