EFFECT OF CLEANSING THE BIRTH CANAL WITH ANTISEPTIC SOLUTION ON MATERNAL AND NEWBORN MORBIDITY AND MORTALITY IN MALAWI - CLINICAL-TRIAL

Objective: To determine if cleansing the birth canal with an antisepti c at delivery reduces infections in mothers and babies postnatally. De sign: Clinical trial; two months of no intervention were followed by t hree months of intervention and a final month of no intervention. Sett ing: Queen Elizabeth Central Hospital (tertiary care urban hospital), Blantyre, Malawi. Subjects: A total of 6965 women giving birth in a si x month period and their 7160 babies. Intervention: Manual wipe of the maternal canal with a 0.25% chlorhexidine solution at every vaginal e xamination before delivery. Babies born during the intervention were a lso wiped with chlorhexidine. Main Outcome Measures: Effects of the in tervention on neonatal and maternal morbidity and mortality. Results: 3635 women giving birth to 3743 babies were enrolled in tile intervent ion phase and 3330 women giving birth to 3417 babies were enrolled in tile non-intervention phase, There were no adverse reactions related t o the intervention among the mothers al their children. Among infants bent in tile intervention phase, overall neonatal admissions were redu ced (634/3743 (16.9%) v 661/3417 (19.3%), P < 0.01), as were admission s for neonatal sepsis (7.8 v 17.9 per 1000 live births, P < 0.0002), o verall 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 birt hs, P < 0.005). Among mothers receiving the intervention, admissions r elated to delivery were reduced (29.4 v 40.2 per 1000 deliveries, P< 0 .02). as iz ere admissions due to postpartum infections (1.7 v 5.1 per 1000 deliveries, P = 0.02) and duration of hospitalisation (Wilcoxan P = 0.008). Conclusions: Cleansing the birth canal with chlorhexidine reduced early neonatal and maternal postpartum infectious problems, Ti le safety, simplicity and low cost of the procedure suggest that it sh ould be considered as standard care to lower infant and maternal morbi dity and mortality.