Clean birth and postnatal care practices to reduce neonatal deaths from sepsis and tetanus: a systematic review and Delphi estimation of mortality effect

This paper published in 2011 provides estimates of the effect of clean birth and postnatal care practices on all-cause neonatal mortality, sepsis and tetanus mortality, and infection-related morbidity.Neonatal infections are recognised to be a leading cause of newborn mortality globally. Every year over 520,000 newborns die from neonatal sepsis, and 60,000 more from tetanus. In addition, newborns are at an increased risk of contracting infections at the time of birth or shortly after. 30-40% of infections resulting in sepsis-related mortality are transmitted at the time of childbirth and have early onset of symptoms. There is therefore a need to investigate the role of hygienic practices at birth and during the postnatal period in preventing the transmission of neonatal infections, with a focus on sepsis and tetanus.The researchers searched various databases (PubMed, EMBASE, Cochrane Libraries, and WHO Regional Databases) for studies of clean birth and postnatal practices for the prevention of neonatal sepsis and tetanus mortality and morbidity (1980-2010). Data were entered into standard tables and assessed. For interventions with low quality evidence, the researchers sought expert consensus via the Delphi method.Key findingsOverall, the literature reviews suggested positive outcomes of clean birth and postnatal care practices on all-cause neonatal mortality, and sepsis- and tetanus-related mortality. However, evidence quality was often low or very low. In response to the low quality of evidence, expert consensus via the Delphi method was sought. 30 experts agreed that:

• Clean birth practices contributed towards a reduction of neonatal sepsis deaths both at home (15%) and in a facility (27%), and clean postnatal care practices contributed towards a reduction of neonatal sepsis by 40%.
• Clean birth practices reduced neonatal tetanus mortality at home (30%) and in a facility (38%), while clean postnatal care practices reduced it by 40%.

This suggests that clean birth and more particularly postnatal care practices play an important role in reducing newborn deaths from sepsis and tetanus.To read this paper for free, click here!Read the Evidence for Action Facts and Figures on Water, Sanitation and Hygiene here>Blencowe, H., Cousens, S., Mullany, L.C., Lee, A.C.C., Kerber, K., Wall, S., Darmstadt, G.L., & Lawn, J.E. (2011). Clean birth and postnatal care practices to reduce neonatal deaths from sepsis and tetanus: a systematic review and Delphi estimation of mortality effect. BMC Public Health, 11(Suppl 3): S11.