Percent of home births with cord cut with clean instrument
The coverage of clean cord care at the time of delivery, either from use of a clean delivery kit, a new blade or instrument, or a boiled blade or instrument, to cut the baby’s umbilical cord (KPC, 2000). This should be measured for home deliveries only.
This indicator is calculated as:
|# of births with a clean delivery kit or clean blade x 100
Total # of births recorded
Clean births kits typically include at least soap, a new razor blade, cord ties, gloves, and a plastic sheet.
Number of home births with a clean delivery kit or clean blade in a defined geographical place and time, based on self-reports of women with children 0-23 months and number of home births in the same place and time period
Where data on the numbers of live births for the denominator are unavailable, evaluators can calculate total estimated live births from the total population and crude birth rate in a specified area. Total expected births = population x crude birth rate.
Population-based survey (national, regional, district)
Although clean cord care is as important in facility-based deliveries as home deliveries, because women who deliver at a facility typically do not know what was used to cut the cord, the births that occurred in a facility should not be included in the survey.
This indicator is most appropriate in settings where facility births are rare. It measures the coverage of clean-delivery and cord-care practices at birth for deliveries that take place both outside a facility.
Tetanus and sepsis are two leading causes of maternal and neonatal morbidity in the developing world. These deaths result from contamination from an unclean environment but could be prevented with improved hygiene and cord care at the time of delivery. Use of clean home delivery kits and a new or sterile (i.e. boiled) blade or instrument for cutting the umbilical cord have been shown to reduce the incidence of simple cord infection, but no studies have assessed the impact on mortality or more serious infections because of the need for very large sample sizes (Tsu, 2000). Clean cord care is one of the key elements in the Essential Newborn Care Package (WHO, 1996a).
The many elements to clean cord care and a number of alternative or complementary indicators include the following:
Percent of births in which cord was cut with a new blade on a clean surface;
Percent of the intended audience who know the importance of clean cord care;
Percent of the intended audience who intend to observe clean cord care at their next birth; and
Percent of the intended audience who express satisfaction with the use of clean cord care at their last delivery (Koblinsky et al., 1995; Tsu, 2000).
In addition to including beneficial practices, some programs may wish to monitor the reduction in potentially harmful practices that encourage the spread of tetanus. For example:
Percent of babies whose cord stump was treated with dung or ashes.
Two caveats warrant mention. First, surveys that rely on a women‘s recall of events at the time of delivery are subject to a recall bias likely to increase with the length of the recall period. Furthermore, if a woman was attended by a traditional birth attendant, she may be unaware whether a clean delivery kit was used or how the cord was cut. A courtesy bias may affect the response if respondents are aware that programs are known to be promoting certain delivery practices.
newborn (NB), quality
Koblinsky, M., K. Mc Laurin, P. Russell-Brown, and P. Gorbach (eds). 1995. Indicators for Reproductive Health Program Evaluation. Final Report of the Subcommittee on Safe Pregnancy. Chapel Hill, NC: The EVALUATION Project.
Tsu, V. 2000. Clean Home Delivery Kit: Evaluation of the Health Impact. Seattle, WA: PATH.
WHO. 1996a. Mother-Baby Package: Implementing Safe Motherhood in Countries. Maternal Health and Safe Motherhood Program, Division of Family Health. WHO/FHE/MSM/94.11. Geneva: WHO.