Effect of cleansing the birth canal with antiseptic solution on maternal and newborn morbidity and mortality in malawi: clinical trial

• Published in: BMJ Vol. 315; no. 7102; pp. 216 - 219
• Main Authors: Taha, Taha E, Biggar, Robert J, Broadhead, Robin L, Mtimavalye, Laban A R, Miotti, Paolo G, Justesen, Aafke B, Liomba, George N, Chiphangwi, John D
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 26.07.1997; British Medical Association; BMJ Publishing Group LTD
• Subjects: Adult; Anti-Infective Agents, Local - administration & dosage; Canals; Chlorhexidine - administration & dosage; Female; HIV; Hospital admissions; Hospitalization; Humans; Infant; Infant Mortality; Infant, Newborn; Infants; Infection - epidemiology; Infection - etiology; Infection Control - methods; Infections; Malawi - epidemiology; Maternal Mortality; Morbidity; Mortality; Mothers; Perinatal Care - methods; Population; Pregnancy; Prenatal Care - methods; Puerperal Disorders - mortality; Puerperal Disorders - prevention & control; Sepsis; Sepsis - mortality; Sepsis - prevention & control; Sepsis - transmission; Vivipary; Malawi; Eastern Africa; Age Factors; Infant Mortality; Parents; Infant; Neonatal Mortality; Research Methodology; Clinical Trials; English Speaking Africa; Mothers; Reproduction; Clinical Research; Malawi; Population Characteristics; Population; Research Report; Demographic Factors; Maternal Mortality; Family Relationships; Mortality; Africa; Youth; Diseases; Pregnancy Outcomes; Pregnancy; Family Characteristics; Developing Countries; Africa South Of The Sahara; Delivery; Infections > prevention and control; Family And Household; Population Dynamics
• ISSN: 0959-8138; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.315.7102.216

Objective: To determine if cleansing the birth canal with an antiseptic at delivery reduces infections in mothers and babies postnatally. Design: Clinical trial; two months of no intervention were followed by three months of intervention and a final month of no intervention. Setting: Queen Elizabeth Central Hospital (tertiary care urban hospital), Blantyre, Malawi. Subjects: A total of 6965 women giving birth in a six month period and their 7160 babies. Intervention: Manual wipe of the maternal birth canal with a 0.25% chlorhexidine solution at every vaginal examination before delivery. Babies born during the intervention were also wiped with chlorhexidine. Main outcome measures: Effects of the intervention on neonatal and maternal morbidity and mortality. Results: 3635 women giving birth to 3743 babies were enrolled in the intervention phase and 3330 women giving birth to 3417 babies were enrolled in the non-intervention phase. There were no adverse reactions related to the intervention among the mothers or their children. Among infants born in the intervention phase, overall neonatal admissions were reduced (634/3743 (16.9%) v 661/3417 (19.3%), P<0.01), as were admissions for neonatal sepsis (7.8 v 17.9 per 1000 live births, P<0.0002), overall neonatal mortality (28.6 v 36.9 per 1000 live births, P<0.06), and mortality due to infectious causes (2.4 v 7.3 per 1000 live births, P<0.005). Among mothers receiving the intervention, admissions related to delivery were reduced (29.4 v 40.2 per 1000 deliveries, P<0.02), as were admissions due to postpartum infections (1.7 v 5.1 per 1000 deliveries, P=0.02) and duration of hospitalisation (Wilcoxon P=0.008). Conclusions: Cleansing the birth canal with chlorhexidine reduced early neonatal and maternal postpartum infectious problems. The safety, simplicity, and low cost of the procedure suggest that it should be considered as standard care to lower infant and maternal morbidity and mortality.