title: Clean cord care practices and neonatal mortality: evidence from rural Uttar Pradesh, India.
abstract: BACKGROUND
  About a million newborns die each year in India, accounting for about a fourth of total global neonatal deaths. Infections are among the leading causes of neonatal mortality. Care practices immediately following delivery contribute to newborns' risk of infection and mortality.
  
  
  OBJECTIVE
  This study examined the association between clean cord care practices and neonatal mortality in rural Uttar Pradesh, India.
  
  
  METHODS
  The study used data from a household survey conducted to evaluate a community-based intervention program in two districts of Uttar Pradesh, India. Analysis included data from 5741 singleton live births delivered at home during 2005. The association between clean cord care (clean instrument used to cut cord, clean thread used to tie cord and antiseptics or nothing applied to the cord) and neonatal mortality was estimated using multivariate logistic regression models.
  
  
  RESULTS
  Thirty per cent of the study mothers practiced clean cord care. Neonatal mortality rate was significantly lower among newborns exposed to clean cord care (36.5/1000 live births, 95% CI 28.0 to 46.8) than those who did not practice (53.0/1000 live births, 95% CI 46.1 to 60.6). Clean cord care was associated with 37% lower neonatal mortality (OR=0.63; 95% CI 0.46 to 0.87) after adjusting for mother's age, education, caste/tribe, religion, household wealth, newborn thermal care practice and care-seeking during the first week after birth and study arms.
  
  
  CONCLUSIONS
  Promoting clean cord care practice among neonates in community-based maternal and newborn care programs has the potential to improve neonatal survival in rural India and similar other settings.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Room E-8138, 615 N. Wolfe Street, Baltimore, MD 21205, USA. abaqui@jhsph.edu
authors.forename: Praween K
authors.initials: PK
authors.lastname: Agrawal
authors.forename: Sutapa
authors.initials: S
authors.lastname: Agrawal
authors.forename: Luke C
authors.initials: LC
authors.lastname: Mullany
authors.forename: Gary L
authors.initials: GL
authors.lastname: Darmstadt
authors.forename: Vishwajeet
authors.initials: V
authors.lastname: Kumar
authors.forename: Usha
authors.initials: U
authors.lastname: Kiran
authors.forename: Ramesh C
authors.initials: RC
authors.lastname: Ahuja
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Srivastava
authors.forename: Mathuram
authors.initials: M
authors.lastname: Santosham
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Baqui
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006700:Home Childbirth / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D006801:Humans; D007194:India / Q000453:epidemiology; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D050498:Live Birth / Q000453:epidemiology; D008423:Maternal Age; D009035:Mothers / Q000523:psychology / Q000706:statistics & numerical data; D011181:Postnatal Care / Q000379:methods / Q000592:standards; D011247:Pregnancy; D011256:Pregnancy Outcome; D015397:Program Evaluation; D012424:Rural Population / Q000706:statistics & numerical data*; D018805:Sepsis / Q000517:prevention & control; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D015996:Survival Rate; D014470:Umbilical Cord