title: Effect of cleansing the birth canal with antiseptic solution on maternal and newborn morbidity and mortality in Malawi: clinical trial.
abstract: OBJECTIVE
  To determine if cleansing the birth canal with an antiseptic at delivery reduces infections in mothers and babies postnatally.
  
  
  METHODS
  Clinical trial; two months of no intervention were followed by three months of intervention and a final month of no intervention.
  
  
  METHODS
  Queen Elizabeth Central Hospital (tertiary care urban hospital), Blantyre, Malawi.
  
  
  METHODS
  A total of 6965 women giving birth in a six month period and their 7160 babies.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore MD 21205, USA.
authors.forename: T E
authors.initials: TE
authors.lastname: Taha
authors.forename: R J
authors.initials: RJ
authors.lastname: Biggar
authors.forename: R L
authors.initials: RL
authors.lastname: Broadhead
authors.forename: L A
authors.initials: LA
authors.lastname: Mtimavalye
authors.forename: A B
authors.initials: AB
authors.lastname: Justesen
authors.forename: G N
authors.initials: GN
authors.lastname: Liomba
authors.forename: J D
authors.initials: JD
authors.lastname: Chiphangwi
authors.forename: P G
authors.initials: PG
authors.lastname: Miotti
mesh_terms: D000328:Adult; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D002710:Chlorhexidine / Q000008:administration & dosage; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods*; D007239:Infections / Q000453:epidemiology / Q000209:etiology; D008295:Malawi / Q000453:epidemiology; D008428:Maternal Mortality; D018743:Perinatal Care / Q000379:methods; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods; D011644:Puerperal Disorders / Q000401:mortality / Q000517:prevention & control; D018805:Sepsis / Q000401:mortality / Q000517:prevention & control / Q000635:transmission
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine