What Affects Clean Delivery Kit Utilization at Birth in Nepal? A Qualitative Study

Abstract

Background: Infection is one of the biggest causes of maternal and neonatal death in low-income countries. Clean Delivery Kits (CDKs) promote clean delivery and neonatal care. Our qualitative research explores reasons for low CDK utilization, and describes community perceptions of CDKs in Nepal. Methods: We conducted 18 focus group discussions and 40 interviews with CDK users and nonusers, service providers, birth attendants, and household decision makers in 6 districts. We also conducted interviews with central level personnel. CDK users were aware of its benefits, and utilization was largely compatible with birth practices. Utilization was prevented by lack of awareness about the benefits and lack of availability. Participants believed that CDKs were for home use. Conclusion: Poor promotion of CDK is related to the disjuncture of promoting CDK use, while encouraging institutional deliveries. If CDKs are made available and marketed for use in households and health institutions, utilization may increase.

Keywords

maternal and child health global health health communication child survival health systems

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References

Khan

Wojdyla

Say

Gulmezoglu

Van Look

. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367:1066-1074.

Lawn

Kerber

Enweronu-Laryea

Massee Bateman

. Newborn survival in low resource settings—are we delivering? BJOG. 2009;116(suppl 1):49-59.

Geoghegan

. State of the World’s Mothers. Westport, CT: Save The Children Fund; 2006.

World Health Organization. Essential Newborn Care. WHO/FRH/MSM/96.13. Geneva, Switzerland: World Health Organization; 1996. https://apps.who.int/rht/documents/MSM96-13/essential_newborn_care.htm. Accessed May 26, 2008.

Hundley

Bilal

Braunholtz

Graham

. Are birth kits a good idea? A systematic review of the evidence. Midwifery. 2012;28:204-215. doi:10.1016/j.midw.2011.03.004.

Jhokio

Winter

Cheng

. An intervention involving traditional birth attendants and perinatal and maternal mortality in Pakistan. N Engl J Med. 2005;352:2091-2099.

Tsu

. Nepal Clean Home Delivery Kit: Health Impact Evaluation. Seattle, WA: PATH; 2000.

Suvedi

. Nepal’s Newborn Health Strategy: The Way Forward to Achieve MDG-4. Kathmandu, Nepal: Family Health Division, Ministry of Health and Population; 2008.

Nepal Ministry of Health and Population. Nepal Demographic and Health Survey. Kathmandu, Nepal: Population Division, Ministry of Health and Population, Government of Nepal, New Era ORC Macro; 2006.

10.

Sreeramareddy

Joshi

Sreekumaran

Giri

Chuni

. Home delivery and newborn care practices among urban women in western Nepal: a questionnaire survey. BMC Pregnancy and Childbirth. 2006;6:27.

11.

Beun

Wood

. Acceptability and use of clean home delivery kits in Nepal: a qualitative study. J Health Popul Nutr. 2003;21:367-373.

12.

World Medical Association. WMA Declaration of Helsinki—Ethical Principles for Medical Research Involving Human Subjects. Ferney-Voltaire, France: World Medical Association; 1964.

13.

Manandhar

Osrin

Shrestha

; Members of the MIRA Makwanpur Trial Team. Effect of a participatory intervention with women’s groups on birth outcomes in Nepal: cluster-randomised controlled trial. Lancet. 2004;364:970-979.

14.

Morrison

Thapa

Hartley

. Understanding how women’s groups improve maternal and newborn health in Makwanpur, Nepal: a qualitative study. Int Health. 2010;2:25-35.

15.

Tripathy

Nair

Barnett

. Effect of a participatory intervention with women’s groups on birth outcomes and maternal depression in Jharkhand and Orissa, India: a cluster-randomised controlled trial. Lancet. 2010;375:1182-1192.

16.

Azad

Barnett

Banerjee

. Effect of scaling up women’s groups on birth outcomes in three rural districts of Bangladesh: a cluster-randomised controlled trial. Lancet. 2010;375:1193-1202.

17.

Wong

Y-L

. Taking stock of Alma-Ata Primary Health/Health for All: moving toward new directions in global preventive health. Asia Pac J Public Health. 2011;23:125-126.

18.

Mesko

Osrin

Tamang

. Care for perinatal illness in rural Nepal: a descriptive study with cross-sectional and qualitative components. BMC Int Health Hum Rights. 2003;3(1):3.

19.

Senarath

Gunawardena

. Women’s autonomy in decision making for health care in South Asia. Asia Pac J Public Health. 2009;21:137-143.

20.

Maine

. Detours and shortcuts on the road to maternal mortality reduction. Lancet. 2007;370:1380-1382.

21.

Campbell

Graham

, The Lancet Maternal Survival Series Steering Group. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;368:1284-1299.

22.

McCoy

Storeng

Filippi

. Maternal, neonatal and child health interventions and services: moving from knowledge of what works to systems that deliver. Int Health. 2010;2:87-98.

23.

Graham

Lawn

Wall

Morrissey

. Birth Kits Workshop 2010; London, UK.

24.

Hundley

Avan

Braunholtz

Fitzmaurice

Graham

. Lessons regarding the use of birth kits in low resource countries. Midwifery. 2011;27:e222-e230. doi:10.1016/j.midw.2010.10.003.

25.

Government of Nepal. Aama Surakchha Karyakram Working Guidelines. Kathmandu, Nepal: Government of Nepal; 2009.

26.

Moran

Choudhury

Uz Zaman Khan

. Newborn care practices among slum dwellers in Dhaka, Bangladesh: a quantitative and qualitative exploratory study. BMC Pregnancy Childbirth. 2009;9:54. doi:10.1186/1471-2393-1189-1154.

27.

Winch

Alam

Akther

; Bangladesh PROJAHNMO Study Group. Local understandings of vulnerability and protection during the neonatal period in Sylhet district, Bangladesh: a qualitative study. Lancet. 2005;366:478-485.

28.

Tielsch

Darmstadt

Mullany

. Impact of newborn skin-cleasing with chlorhexidine on neonatal mortality in southern Nepal: a community based, cluster randomized trial. Pediatrics. 2007;119:e330-e340.

29.

Derman

Kodkany

Goudar

. Oral misoprostol in preventing postpartum haemorrhage in resource-poor communities: a randomised controlled trial. Lancet. 2006;368:1248-1253.

30.

Blum

Winikoff

Raghavan

. Treatment to post-partum haemorrhage with sublingual misoprostol versus oxytocin in women receiving prophylactic oxytocin: a double-blind, randomised, non-inferiority trial. Lancet. 2010;375:217-223.

31.

Mullany

Darmstadt

Khatry

. Topical applications of chlorhexidine to the umbilical cord for prevention of omphalitis and neonatal mortality in southern Nepal: a community-based cluster randomized trial. Lancet. 2006;18:910-918.