Zaman Sojib Bin, Siddique Abu Bakkar, Ruysen Harriet, Kc Ashish, Peven Kimberly, Ameen Shafiqul, Thakur Nishant, Rahman Qazi Sadeq-Ur, Salim Nahya, Gurung Rejina, Tahsina Tazeen, Rahman Ahmed Ehsanur, Coffey Patricia S, Rawlins Barbara, Day Louise T, Lawn Joy E, Arifeen Shams El
Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.
The Maternal, Adolescent, Reproductive, & Child, Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
BMC Pregnancy Childbirth. 2021 Mar 26;21(Suppl 1):239. doi: 10.1186/s12884-020-03338-4.
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.
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.
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%).
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.
脐带卫生可预防败血症，败血症是新生儿死亡的主要原因。世界卫生组织建议，在高死亡率地区，家庭分娩后应在脐部涂抹7.1%的葡萄糖酸氯己定（CHX）。在孟加拉国和尼泊尔，国家政策建议在所有机构分娩中使用CHX。基于人群的家庭调查包含有关CHX使用情况的可选问题，但缺乏指标验证研究。“医院新生儿出生指标研究跟踪”（EN-BIRTH）是一项观察性研究，旨在评估孕产妇和新生儿指标的测量有效性。本文报告了有关CHX的研究结果。
EN-BIRTH研究（2017年7月至2018年7月）纳入了孟加拉国和尼泊尔的三家公立医院，在这些医院中，常规使用CHX处理脐带。临床观察员收集基于平板电脑的、带有时间戳的数据，这些数据记录了产妇入院待产及分娩期间的脐带护理情况，以此作为评估产妇在出院调查中的报告准确性以及常规登记数据准确性的金标准。我们计算了有效性比率和个体层面的验证指标；分析了覆盖率、质量和测量差距。我们进行了定性访谈，以评估常规登记记录的障碍和促进因素。
观察了12379例活产儿的脐带护理情况。观察员评估的CHX覆盖率在所有三家医院都非常高，为89.3%-99.4%，不过在孟加拉国阿济姆布尔，剖宫产术后的覆盖率略低（86.8%）。出院调查所报告的覆盖率（0.4%-45.9%）低估了观察到的覆盖率，有大量“不知道”的回答（55.5%-79.4%）。调查所报告的有效性比率都很低（0.01至0.38）。孟加拉国特定栏目的登记记录覆盖率在库什蒂亚被低估了0.2%，而在阿济姆布尔则被高估了9.0%。孟加拉国登记记录的有效性比率良好（0.9至1.1），而尼泊尔则较差（0.8）。尼泊尔博卡拉的非特定登记栏大幅低估了覆盖率（20.7%）。
出院调查所报告的结果严重低估了所有三家医院观察到的CHX覆盖率。在所有医院，包括剖宫产情况，常规登记记录的覆盖率比调查所报告的结果更接近观察员评估的覆盖率，并且在设有特定登记栏目的医院中记录得更准确。在有基于机构使用CHX的国家政策的国家，将CHX脐带护理纳入登记册并计入健康管理信息系统平台是合理的，但需要开展实施研究，以评估登记册设计和健康信息系统内的数据流。
