title: Clean birth kits to improve birth practices: development and testing of a country level decision support tool.
abstract: BACKGROUND
  Clean birth practices can prevent sepsis, one of the leading causes of both maternal and newborn mortality. Evidence suggests that clean birth kits (CBKs), as part of package that includes education, are associated with a reduction in newborn mortality, omphalitis, and puerperal sepsis. However, questions remain about how best to approach the introduction of CBKs in country. We set out to develop a practical decision support tool for programme managers of public health systems who are considering the potential role of CBKs in their strategy for care at birth.
  
  
  METHODS
  Development and testing of the decision support tool was a three-stage process involving an international expert group and country level testing. Stage 1, the development of the tool was undertaken by the Birth Kit Working Group and involved a review of the evidence, a consensus meeting, drafting of the proposed tool and expert review. In Stage 2 the tool was tested with users through interviews (9) and a focus group, with federal and provincial level decision makers in Pakistan. In Stage 3 the findings from the country level testing were reviewed by the expert group.
  
  
  RESULTS
  The decision support tool comprised three separate algorithms to guide the policy maker or programme manager through the specific steps required in making the country level decision about whether to use CBKs. The algorithms were supported by a series of questions (that could be administered by interview, focus group or questionnaire) to help the decision maker identify the information needed. The country level testing revealed that the decision support tool was easy to follow and helpful in making decisions about the potential role of CBKs. Minor modifications were made and the final algorithms are presented.
  
  
  CONCLUSIONS
  Testing of the tool with users in Pakistan suggests that the tool facilitates discussion and aids decision making. However, testing in other countries is needed to determine whether these results can be replicated and to identify how the tool can be adapted to meet country specific needs.
authors.affiliation: School of Health & Social Care, Bournemouth University, Royal London House, Christchurch Road, Bournemouth, BH1 3LT, UK. vhundley@bournemouth.ac.uk
authors.forename: Vanora A
authors.initials: VA
authors.lastname: Hundley
authors.forename: Bilal I
authors.initials: BI
authors.lastname: Avan
authors.forename: Haris
authors.initials: H
authors.lastname: Ahmed
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Graham
mesh_terms: D000288:Administrative Personnel; D000465:Algorithms; D003661:Decision Support Techniques; D036861:Delivery, Obstetric / Q000295:instrumentation / Q000379:methods; D005260:Female; D017144:Focus Groups; D006700:Home Childbirth / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D010154:Pakistan; D011247:Pregnancy; D011645:Puerperal Infection / Q000517:prevention & control*; D018805:Sepsis / Q000517:prevention & control*