Table 3.
| Quality Assessment | Summary of Findings | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Generalisability | Intervention | Control | ||||||||||
| No of studies (ref) | Intervention | Design | Limitations of studies | Consistency | To population of interest | To intervention of interest | GRADE of evidence | No. events | No. births | No. events | No. births |
Effect size (95% CI) |
| Neonatal Mortality (Tetanus Deaths): | ||||||||||||
| 4 (60 - 64), | Birth Attendant hand washing prior to delivery | 1 Cohort, 4 Case Control | Very low quality | Consistent | All rural populations | Yes | Low | aOR = 0.51 (0.38 - 0.65)* |
||||
| 2 (55,66) | Clean delivery surface | 2 Case control | Very low quality | Consistent | Uganda and Pakistan | Yes | Low | aOR = 0.07 (0.00 - 0.23)* |
||||
| 2 (51, 62) | Clean perineum | 2 Case Control | Very low quality | Consistent | Both from Asia | Yes | Low | No association reported^ | ||||
| 6 (51, 54, 60 - 61, 66) | Clean cord cutting tool | 1 Cohort, 4 Case Control |
Low quality, Co-interventions (adjusted for TT) | Heterogeneous | 5 from Asia | Yes | Low | aOR 0.25 - 0.4^^ | ||||
| 4 (52, 55, 64, 66) | Clean cord tie | 4 Case Control | Very low quality | Heterogeneous | Yes | Yes | Low | single study aOR = 0.1 (0.01 - 1.1) 3 studies no association reported^ |
||||
| 3 (51, 62, 75) | Antimicrobial cord applications | 3 Case Control | Very low quality | Consistent | All from Asia | Yes | Low | aOR = 0.37* (0.14 - 0.59) |
||||
| Neonatal Mortality (Sepsis Deaths): | ||||||||||||
| No studies identified | ||||||||||||
| Neonatal Mortality (All Cause): | ||||||||||||
| 1 (21) | Birth Attendant hand washing with soap prior to delivery | Cohort | Co-interventions (adjusted for chlorhexidine) | Single study Nepal | Yes | Low | 371 | 13,255 | 342 | 9123 | aRR = 0.81 (0.66 - 0.99) |
|
| 1 (21) | Postnatal maternal handwashing | Cohort | Co-interventions (adjusted for chlorhexidine) | Single study Nepal | Yes | Low | 30 | 3403 | 427 | 19,592 | aRR = 0.56 (0.38-0.82) |
|
| Neonatal Sepsis incidence: | ||||||||||||
| No studies identified | ||||||||||||
| Cord infection/oomphalitis | ||||||||||||
| 2 (11,58) | Birth Attendant hand washing prior to delivery | 1 Cohort, 1 Observ-ational |
Consistent | Nepal only | Yes | Moderate | 470** | 9645** | 421** | 5990** | aRR = 0.73* (0.64 - 0.84) |
|
| 1 (59) | Clean cord cutting tool | Cohort | Low quality | Single study from Tanzania | Yes | Low | 48 | 2891 | 5 | 111 | aOR = 1.1 (0.43 - 3.05) |
|
| 1 (11) | Postnatal maternal handwashing | Cohort | Low quality | Single study Nepal | Yes | Low | 95 | 2206 | 539 | 8960 | aRR = 0.76 (0.60 - 0.95) |
|
**only available for study (11)
*from pooled analysis ^studies did not report aOR^^199 NT cases, 3 studies. 3 studies report no association but did not present aOR.