Clean birth kits to improve birth practices: development and testing of a country level decision support tool

Birth Kit Working Group

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)
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Background: Clean birth practices can prevent sepsis, one of the leading causes of both maternal and newborn mortality. Evidence suggests that clean birth kits (CBKs), as part of package that includes education, are associated with a reduction in newborn mortality, omphalitis, and puerperal sepsis. However, questions remain about how best to approach the introduction of CBKs in country. We set out to develop a practical decision support tool for programme managers of public health systems who are considering the potential role of CBKs in their strategy for care at birth.

Methods: Development and testing of the decision support tool was a three-stage process involving an international expert group and country level testing. Stage 1, the development of the tool was undertaken by the Birth Kit Working Group and involved a review of the evidence, a consensus meeting, drafting of the proposed tool and expert review. In Stage 2 the tool was tested with users through interviews (9) and a focus group, with federal and provincial level decision makers in Pakistan. In Stage 3 the findings from the country level testing were reviewed by the expert group.

Results: The decision support tool comprised three separate algorithms to guide the policy maker or programme manager through the specific steps required in making the country level decision about whether to use CBKs. The algorithms were supported by a series of questions (that could be administered by interview, focus group or questionnaire) to help the decision maker identify the information needed. The country level testing revealed that the decision support tool was easy to follow and helpful in making decisions about the potential role of CBKs. Minor modifications were made and the final algorithms are presented.

Conclusion: Testing of the tool with users in Pakistan suggests that the tool facilitates discussion and aids decision making. However, testing in other countries is needed to determine whether these results can be replicated and to identify how the tool can be adapted to meet country specific needs.
Original languageEnglish
Article number158
Number of pages9
JournalBMC Pregnancy and Childbirth
Publication statusPublished - 19 Dec 2012

Bibliographical note

This decision support tool was produced thanks to the experience, ideas and input of many different people and organisations. The Birth Kit Working Group was instrumental to its development, testing and review – the members are listed in Table 1. We are also grateful to all the decision makers who gave their time to test the decision support tool in country. Thanks are also due to our two interviewers Dr Munazza Haris and Dr Nadeem Hassan. This study was funded by the Maternal Health TaskForce, EngenderHealth. The funding body had no role in the design or conduct of the study, or in the writing of the paper. Funding for the article-processing charge is through the primary author’s institution, Bournemouth University.


  • clean birth practices
  • birth kits
  • decision support tool


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