Neonatal survival in low resource settings: Are disposable clean delivery kits effective in prevention of neonatal tetanus infections in the presence of skilled delivery attendants?

Objective: To identify if the use of disposable clean delivery kits (CDK) is effective in reducing neonatal tetanus (NNT) infection irrespective of skills of delivery attendants in resource poor settings of developing countries. Methods: A matched case-control study was carried out in Karachi, Pakistan, with 140 cases of NNT and 280 control infants. Conditional logistic regression was performed to assess the independent effect of CDK and skilled delivery attendants with NNT. Results: After adjustment for socioeconomic factors, both CDK [adjusted matched odds ratio (adj. mOR) = 2.0, 95% confidence interval (CI): 1.3, 3.1] and skilled attendant (adj. mOR = 1.7, 95%CI: 1.1, 2.7) were independently associated with NNT. CDK remained significant when additionally adjusted for skilled delivery attendant (mOR = 2.0; 95% CI: 1.0, 3.9, p = 0.05). The population attributable risk % for CDK was 24% in study setting. Conclusion: In the context of low resource settings of developing country where there is poor access to health care facilities, lack of skilled attendance, and poor coverage of tetanus toxoid immunization, the use of CDK seems to be an effective strategy to reduce NNT. This can hold true even when access to health care facilities are available but where the quality of clean deliveries remain sub-optimal. Approximately one-quarter of NNT cases could be prevented in low-income populations with the use of CDKs.