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

Blencowe, Hannah; Cousens, Simon; Mullany, Luke C; Lee, Anne CC; Kerber, Kate; Wall, Steve; Darmstadt, Gary L; Lawn, Joy E

doi:10.1186/1471-2458-11-S3-S11

Table 4

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

		Quality Assessment						Summary of Findings
					Generalisability			Intervention		Control
No of studies (ref)	Intervention	Design	Limitations	Consistency	To population of interest	To intervention of interest	GRADE of evidence	No. events	No. births	No. events	No. births	Effect size (95% CI)
Neonatal Mortality (Tetanus Deaths):
No studies identified
*Neonatal Mortality (Sepsis Deaths):*
3 (67, 68, 70)	Chlorhexidine vaginal and baby wipes	1 RCT, 2 Before and after	Hospital based studies	Heterogeneity	S.Africa, Malawi, Egypt	Yes	Moderate	21	10108	55	9612
1 (73)	Chlorhexidine to cord (day 1)	cRCT ˇ	Single study		Nepal	Yes	Moderate		3134		3179	RR = 0.69 (0.40 - 1.18)
*Neonatal Mortality (All Cause):*
1 (73)	Chlorhexidine to cord	cRCT	Single study		Nepal	Yes	Moderate	72	4924	98	5082	RR = 0.78 (0.57 - 1.07)*
1 (73)	Chlorhexidine to cord (day 1)	cRCT ˇ	Single study		Nepal	Yes	Moderate	45	3134	69	3179	RR = 0.66 (0.46 - 0.95)
1 (72)	Chlorhexidine wipes to baby	cRCT	Single study		Nepal	Yes	Moderate	264	860	263	8880	RR = 1.04 (0.87 - 1.24)
1 (72)	Chlorhexidine wipes to baby	cRCTˇ	Single study		Nepal	Low birth weight babies only	Moderate	83	2448	117	2491	RR = 0.72 (0.55 - 0.95)
1 (71)	Chlorhexidine vaginal and baby wipes	1 RCT	Single study		Pakistan	Yes	Moderate	55	2505	56	2503	RR = 0.98 (0.68 - 1.41)
*Neonatal Sepsis incidence:*
2 (70,71)	Chlorhexidine vaginal and baby wipes	2 RCT	Hospital based studies	Consistent	S. Africa, Pakistan	Yes	Moderate	179	6,577	188	6,560	RR = 0.95^ (0.76 - 1.14)
*Cord infection/oomphalitis*
1 (73)	Chlorhexidine to cord	cRCT	Single study		Nepal	Yes	Moderate	438	4703	638	4859	RR = 0.68** (0.58 - 0.80)

ˇsub-group analysis *adjusted for ethnic group, literacy, topical mustard oil applications ^based on pooled analysis **oomphalitis defined as redness extending to the skin at the base of the umbilical stump

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ISSN: 1471-2458

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