Birth Attendant And Maternal Hand-washing Associated With Reduced Newborn Death Rate

"Although major achievements have been made in reducing mortality in children younger than 5 years, less progress has been made in reducing neonatal mortality," according to background information in the article. It is estimated that there are approximately 4 million neonatal (newborn) deaths each year, with more than 99 percent occurring in low- and middle-income countries. "About half of these deaths occur at home where mothers receive little or no perinatal care. These neonatal deaths are attributable primarily to infections, prematurity and birth asphyxia [suffocation]."

Victor Rhee, M.H.S., of Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues obtained data in an observational study of 23,662 newborns through 28 days of life in rural southern Nepal from 2002 to 2006. Mothers of the infants were given questionnaires the day after delivery and two weeks later to identify maternal and birth attendant hand-washing practices.

More than 90 percent of births occurred at home or outdoors while the mother was being transported to a facility. Birth attendants washed their hands before the delivery of 59.2 percent of live births, while only 14.8 percent of mothers washed their hands with soap and water or antiseptic before handling their newborn. The overall mortality rate was 32.1 per 1,000 live births.

"Newborns whose birth attendant washed his or her hands before assisting with delivery had a 25 percent lower risk of death compared with newborns whose birth attendant did not wash his or her hands," the authors write. "Infants whose mothers washed their hands prior to handling their infant had a 60 percent lower risk of neonatal death compared with those whose mothers did not wash their hands." Overall, there was a 41 percent lower death rate among newborns exposed to both hand-washing practices.

"In developing countries, where most births take place at home, the concept of washing with soap before delivery to protect against infection is not well understood," the authors write. "Measures to improve or promote birth attendant and maternal hand-washing could improve neonatal survival rates."