title: Are birth kits a good idea? A systematic review of the evidence.
abstract: OBJECTIVE
  to identify the current state of knowledge regarding the effects of births kits on clean birth practices and on newborn and maternal outcomes.
  
  
  METHODS
  the scoping review was informed through a systematic literature review; a call for information distributed to experts in maternal and child health, relevant research centres and specialist libraries; and a search of the web sites of groups working in the area of maternal and child health. Data were synthesised to produce a summary of the state of knowledge regarding birth kits. Meta-analysis was not attempted because of the varied study designs and the heterogeneous nature of the interventions.
  
  
  METHODS
  births kit use was identified in 51 low resource countries, but evaluations were scarce, with only nine studies reporting effects of intervention packages including births kits.
  
  
  RESULTS
  the quality of evidence for inferring causality was weak, with only one randomised controlled trial. In two studies, births kit use along with co-interventions resulted in a statistically significant increase in the likelihood of the attendant having clean hands. The impact on other aspects of cleanliness was less clear. Intervention packages which include births kits were associated with reduced newborn mortality (three studies), omphalitis (four studies), and puerperal sepsis (three studies). The one study that considered maternal mortality was not large enough to estimate relative reduction with much precision. None of the studies reported any adverse effects; however, none explicitly described looking for negative consequences.
  
  
  CONCLUSIONS
  providing birth kits to facilitate clean practices seems commonsense, but there is no evidence to indicate effects, positive or negative, separate from those achieved by a broader intervention package. More robust methods and knowledge systems are needed to understand the contextual factors and share relevant implementation lessons.
authors.affiliation: School of Nursing, George Mason University, 4400 University Drive, Fairfax, VA 22030, USA. vhundley@gmu.edu
authors.forename: Vanora A
authors.initials: VA
authors.lastname: Hundley
authors.forename: Bilal I
authors.initials: BI
authors.lastname: Avan
authors.forename: David
authors.initials: D
authors.lastname: Braunholtz
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Graham
mesh_terms: D003695:Delivery of Health Care / Q000592:standards*; D036861:Delivery, Obstetric / Q000295:instrumentation* / Q000592:standards; D003906:Developing Countries; D005260:Female; D006700:Home Childbirth / Q000295:instrumentation* / Q000592:standards; D006801:Humans; D007231:Infant, Newborn; D009774:Obstetrics; D011247:Pregnancy; D011248:Pregnancy Complications