Nepal Clean Home Delivery Kit: Evaluation of the Health Impact - Path

asked about use of the kit contents; disposal or reuse of the kit contents after the delivery;
and understanding of the key messages in the kit insert. All mothers were asked about
factors that might be related to the actual use of kits, their effectiveness or the analysis of
the kit’s impact, such as sociodemographic factors, health history factors, and events
associated with the delivery. Mothers were asked about acceptability of kits and access to
kits, such as preferred outlets for obtaining delivery kits.
Since the mother might not be aware of all the details of what happened during the
delivery, other women in the household who were present at the delivery were asked to
provide information as needed. The information recorded on the primary data collection
form represents a consensus of household opinion or recollection. A slightly altered
version of the standard questionnaire was used in the case of a neonatal death, with some
change in wording to take account of the newborn’s death and some additional questions
to determine whether the cause of death was related to newborn cord infection.
A supplementary interview form was used to gather information from a subset of trained
birth attendants to validate mothers’ reports on birth attendant practices. This follow-up
interview was conducted as soon as possible after the mother’s interview and covered
aspects of the behavior of the birth attendant during delivery with regard to hand washing
and wrapping the baby, mother’s initiation of breastfeeding within an hour of birth, use of
the kit contents, disposal or reuse of the kit contents after the delivery, and understanding
of the instructions and key messages in the kit insert. The data provided by the TBA was
compared with reports provided by the mother and her household members who observed
the delivery.
Data collection instruments were translated into the required local languages,
back-translated, and pretested before use. A field manual (translated into Nepali) was
prepared as a reference for the field workers. The six field interviewers received one
week of training, including role playing the interviews. The Field Director reviewed all
interview forms for accuracy and completeness and observed each field interviewer
periodically throughout the study, to ensure quality and uniformity of data collection. An
assistant coded open-ended questions.
Determination of infection status. Color photos of normal and infected cord stumps were
shown to respondents to help them determine whether or not the newborn had an episode
of cord infection. In addition, the interviewer inspected the baby’s cord and/or abdomen
to ascertain its status at the time of the interview, whenever possible. A neonatologist
reviewed all records with any indication of possible infection—including mother’s report
of symptoms and appearance and interviewer’s observations—and made the final
determination as to whether a cord-related infection was involved (rating it as “definite”,
“probable”, “possible”, or “unlikely”).
Data Analysis
The interview form was precoded for computer entry. Data were entered into an Epi Info
6.0 data entry program (with appropriate checks built into it) by a bilingual statistician in
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Nepal Delivery Kit Evaluation May 2000