TY - JOUR
T1 - Chlorhexidine for facility-based umbilical cord care
T2 - EN-BIRTH multi-country validation study
AU - EN-BIRTH Study Group
AU - Zaman, Sojib Bin
AU - Siddique, Abu Bakkar
AU - Ruysen, Harriet
AU - Kc, Ashish
AU - Peven, Kimberly
AU - Ameen, Shafiqul
AU - Thakur, Nishant
AU - Rahman, Qazi Sadeq ur
AU - Salim, Nahya
AU - Gurung, Rejina
AU - Tahsina, Tazeen
AU - Rahman, Ahmed Ehsanur
AU - Coffey, Patricia S.
AU - Rawlins, Barbara
AU - Day, Louise T.
AU - Lawn, Joy E.
AU - Arifeen, Shams El
AU - Ali, Md Ayub
AU - Biswas, Bilkish
AU - Haider, Rajib
AU - Hasanuzzaman, Md Abu
AU - Hossain, Md Amir
AU - Jahan, Ishrat
AU - Jahan, Rowshan Hosne
AU - Khan, Jasmin
AU - Mannan, M. A.
AU - Mazumder, Tapas
AU - Rahman, Md Hafizur
AU - Shaikh, Md Ziaul Haque
AU - Siddika, Aysha
AU - Sumi, Taslima Akter
AU - Talha, Md Taqbir Us Samad
AU - Assenga, Evelyne
AU - Hanson, Claudia
AU - Kija, Edward
AU - Kisenge, Rodrick
AU - Manji, Karim
AU - Manzi, Fatuma
AU - Mkopi, Namala
AU - Mrisho, Mwifadhi
AU - Pembe, Andrea
AU - Ghimire, Jagat Jeevan
AU - Gurung, Regina
AU - Joshi, Elisha
AU - Sunny, Avinash K.
AU - Kc, Naresh P.
AU - Rana, Nisha
AU - Shrestha, Shree Krishna
AU - Amouzou, Agbessi
AU - Requejo, Jennifer
N1 - Publisher Copyright:
© 2021, The Author(s).
PY - 2021/3
Y1 - 2021/3
N2 - 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.
AB - 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.
KW - 7.1% chlorhexidine
KW - Birth
KW - Coverage
KW - Health management systems
KW - Hospital records
KW - Neonatal sepsis
KW - Newborn
KW - Survey
KW - Umbilical cord care
KW - Validity
UR - http://www.scopus.com/inward/record.url?scp=85103389353&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85103389353&partnerID=8YFLogxK
U2 - 10.1186/s12884-020-03338-4
DO - 10.1186/s12884-020-03338-4
M3 - Article
C2 - 33765947
AN - SCOPUS:85103389353
SN - 1471-2393
VL - 21
JO - BMC pregnancy and childbirth
JF - BMC pregnancy and childbirth
M1 - 239
ER -