Table 2. Comparison of deliveries with and without clean delivery kit use.
| Factors Associated with Use of a Clean Delivery Kit | India (n = 6,841) | Bangladesh (n = 7,041) | Nepal (n = 5,872) | |||
| Used a Kit (n = 1,256) | Did Not Use a Kit (n = 5,585) | Used a Kit (n = 1,294) | Did Not Use a Kit (n = 5,747) | Used a Kit (n = 335) | Did Not Use a Kit (n = 5,537) | |
| Newborn health | ||||||
| Neonatal death, n (%) | ||||||
| No | 1,221 (97.2) | 5,254 (94.1)* | 1,267 (97.9) | 5,550 (96.6)* | 329 (98.2) | 5,374 (97.1) |
| Yes | 35 (2.8) | 331 (5.9) | 27 (2.1) | 197 (3.4) | 6 (1.8) | 163 (2.9) |
| Baby exclusively breastfed, n (%) | ||||||
| Yes | 862 (68.6) | 3,839 (68.8) | 910 (70.3) | 3,497(60.9)* | 289 (86.8) | 5,186 (94.4)* |
| No | 394 (31.4) | 1,745 (31.2) | 384 (29.7) | 2,248 (39.1) | 44 (13.2) | 307 (5.6) |
| Missing | 0 | 1 (0.0) | 0 | 2 (0.0) | 2 (0.6) | 44 (0.8) |
| Clean delivery practices | ||||||
| Hand washing before assisting delivery, n (%) | ||||||
| No | 712 (59.7) | 4,255 (80.2)* | 72 (6.4) | 1,482 (29.9)* | 38 (12.5) | 1,792 (48.8)* |
| Yes | 480 (40.3) | 1,054 (19.8) | 1,056 (93.6) | 3,478 (70.1) | 267 (87.5) | 1,878 (51.2) |
| Missing | 64 (5.1) | 276 (4.9) | 166 (12.8) | 787 (13.7) | 30 (9.0) | 1,876 (33.7) |
| Use of plastic sheet, n (%) | ||||||
| No | 775 (61.7) | 5,520 (98.8)* | 66 (5.1) | 3,880 (67.5)* | naa | na |
| Yes | 481 (38.3) | 65 (1.2) | 1,228 (94.9) | 1,867 (32.5) | na | na |
| Use of boiled blade to cut cord, n (%) | ||||||
| No | 918 (77.9) | 4,699 (87.0)* | 288 (23.5) | 2,101 (38.1)* | 70 (21.1) | 4,025 (73.2)* |
| Yes | 260 (22.1) | 699 (13.0) | 938 (76.5) | 3,408 (61.9) | 262 (78.9) | 1,475 (26.8) |
| Missing | 78 (6.2) | 187 (3.4) | 68 (5.3) | 238 (4.1) | 3 (0.9) | 37 (0.7) |
| Use of boiled thread to tie the cord, n (%) | ||||||
| No | 970 (80.5) | 4,879 (89.8)* | 306 (25.1) | 2,417 (44.2)* | na | na |
| Yes | 235 (19.5) | 557 (10.2) | 912 (74.9) | 3,048 (55.8) | na | na |
| Missing | 51 (4.1) | 149 (2.7) | 76 (5.9) | 282 (4.9) | na | na |
| Use of gloves to assist delivery, n (%) | ||||||
| No | 1,041 (82.9) | 5,513 (98.7)* | 1,085 (83.8) | 5,545 (96.5)* | na | na |
| Yes | 214 (17.1) | 72 (1.3) | 209 (16.2) | 202 (3.5) | na | na |
| Use of antiseptic to clean the cord, n (%) | ||||||
| No | 1,212 (96.5) | 5,543 (99.2)* | 1,223 (95.0) | 5,509 (96.6)* | 309 (95.1) | 5,462 (99.8)* |
| Yes | 44 (3.5) | 42 (0.8) | 64 (5.0) | 192 (3.4) | 16 (4.9) | 12 (0.2) |
| Missing | 0 | 0 | 7 (0.5) | 46 (0.8) | 10 (34.0) | 63 (1.1) |
| Use of dry cord care practice, n (%) | ||||||
| No | 148 (11.8) | 626 (11.2) | 445 (34.6) | 2,191 (38.4)* | 109 (33.4) | 1,332 (24.3)* |
| Yes | 1,108 (88.2) | 4,959 (88.8) | 842 (65.4) | 3,510 (61.6) | 217 (66.6) | 4,142 (75.7) |
| Missing | 0 | 0 | 7 (0.5) | 46 (0.8) | 9 (2.7) | 63 (1.1) |
| Maternal characteristics | ||||||
| Maternal education, n (%) | ||||||
| No education | 818 (65.1) | 4,312 (77.2) | 359 (27.7) | 2,002 (34.8)* | 150 (45.7) | 4,237 (79.4) |
| Primary | 62 (4.9) | 262 (4.7) | 435 (33.6) | 2,033 (35.4) | 85 (25.9) | 788 (14.7) |
| Secondary | 376 (29.9) | 1,011 (18.1) | 500 (38.6) | 1,712 (29.8) | 93 (28.4) | 314 (5.9) |
| Missing | 0 | 0 | 0 | 0 | 7 (2.1) | 198 (3.6) |
| Maternal reading ability, n (%) | ||||||
| Unable to read | 833 (66.3) | 4,391 (78.6)* | 632 (48.9) | 2,339 (40.7)* | 146 (44.5) | 766 (14.4)* |
| Reads with difficulty | 83 (6.6) | 281 (5.0) | 234 (18.1) | 1,199 (20.9) | 78 (23.8) | 781 (14.6) |
| Reads with ease | 340 (27.1) | 913 (16.4) | 426 (33.0) | 2,204 (38.4) | 104 (31.7) | 3,792 (71.0) |
| Missing | 0 | 0 | 2 (0.1) | 5 (0.2) | 7 (2.1) | 198 (3.6) |
| Maternal age in years, n (%) | ||||||
| <20 | 143 (12.0) | 620 (12.0)* | 237 (18.3) | 903 (15.7)* | 46 (13.7) | 610 (11.0)* |
| 20–29 | 766 (64.4) | 3,131 (60.5) | 822 (63.5) | 3,671 (63.9) | 225 (67.2) | 3,249 (58.7) |
| 30–39 | 269 (22.6) | 1,355 (26.2) | 224 (17.3) | 1,098 (19.1) | 57 (17.0) | 1,381 (25.0) |
| 40+ | 11 (0.9) | 71 (1.4) | 11 (0.9) | 73 (1.3) | 7 (2.1) | 296 (5.3) |
| Missing | 67 (5.3) | 408 (7.3) | 0 | 2 (0.0) | 0 | 1 (0.0) |
| Caste or tribal group, n (%) | ||||||
| Scheduled tribeb | 880 (70.1) | 4,190 (75.0)* | na | na | na | na |
| Scheduled casteb | 53 (4.2) | 214 (3.8) | na | na | na | na |
| Other backward classb | 316 (25.2) | 1,160 (20.8) | na | na | na | na |
| Household assets, n (%) | ||||||
| All | 230 (18.3) | 922 (16.5) | 561 (43.4) | 1,807 (31.4) | 159 (47.5) | 1,094 (19.8) |
| Some | 810 (64.5) | 3,570 (63.9) | 228 (17.6) | 1,084 (18.9) | 114 (34.0) | 1,912 (34.5) |
| None | 216 (17.2) | 1,093 (19.6) | 505 (39.0) | 2,856 (49.7) | 62 (18.5) | 2,531 (45.7) |
| Parity, n (%) | ||||||
| 1 | 308 (24.5) | 1,195 (21.4)* | 483 (37.3) | 1,765 (30.7)* | na | na |
| 2 | 313 (24.9) | 1,304 (23.3) | 360 (27.8) | 1,558 (27.1) | na | na |
| 3 | 241 (19.2) | 1,079 (19.3) | 200 (15.5) | 1,062 (18.5) | na | na |
| 4 | 152 (12.1) | 742 (13.3) | 116 (9.0) | 632 (11.0) | na | na |
| 5 | 105 (8.4) | 494 (8.9) | 67 (5.2) | 370 (6.4) | na | na |
| 6 | 137 (10.9) | 771 (13.8) | 68 (5.2) | 360 (6.3) | na | na |
| Mother can access a health facility independently, n (%) | ||||||
| Always | 125 (10.0) | 661 (11.8)* | 43 (3.3) | 296 (5.1)* | na | na |
| Sometimes | 376 (29.9) | 1,470 (26.3) | 328 (25.3) | 2,026 (35.3) | na | na |
| Never without company | 731 (58.2) | 3,194 (57.2) | 887 (68.6) | 3,298 (57.4) | na | na |
| Never even with company | 24 (1.9) | 260 (4.7) | 36 (2.8) | 127 (2.2) | na | na |
| Antenatal period | ||||||
| Number of antenatal care visits, n (%) | ||||||
| 0 | 263 (21.0) | 1,765 (31.6)* | 292 (22.6) | 2,478 (43.1)* | 51 (15.2) | 3,389 (61.1)* |
| 1 | 144 (11.5) | 757 (13.6) | 217 (16.8) | 1,279 (22.3) | 33 (9.9) | 522 (9.4) |
| 2 | 299 (23.9) | 1,314 (23.5) | 254 (19.7) | 860 (15.0) | 34 (10.1) | 465 (8.4) |
| 3 | 218 (17.4) | 894 (16.0) | 198 (15.3) | 598 (10.4) | 54 (16.1) | 516 (9.3) |
| 4 | 329 (26.2) | 852 (15.3) | 331 (25.6) | 528 (9.2) | 163 (48.7) | 645 (11.7) |
| Missing | 3 (0.2) | 3 (0.1) | 2 (0.2) | 4 (0.1) | 0 | 0 |
| Bleeding during pregnancy, n (%) | ||||||
| No | 1,249 (99.4) | 5,541 (99.2) | 1,242 (95.6) | 5,601 (97.5)* | 320 (95.5) | 5,375 (97.1) |
| Yes | 7 (0.6) | 44 (0.8) | 52 (4.0) | 145 (2.5) | 15 (4.5) | 162 (2.9) |
| Missing | 0 | 3 (0.1) | 0 | 0 | 0 | 0 |
| Delivery period | ||||||
| Preterm birth, n (%) | ||||||
| Baby born at term | 1,201 (95.6) | 5,242 (93.9)* | 1,268 (98.0) | 5,521 (96.1)* | 316 (94.3) | 5,355 (96.7)* |
| Baby born after less than 9 mo gestation | 55 (4.4) | 343 (6.1) | 26 (2.0) | 226 (3.9) | 19 (5.7) | 182 (3.3) |
| Season of birth, n (%) | ||||||
| Summer (March–June) | 464(36.9) | 1,902 (34.1)* | 363 (28.1) | 1,612 (28.1) | 94 (28.1) | 1,638 (29.6) |
| Rainy (July–October) | 398 (31.7) | 1,826 (32.7) | 476 (36.8) | 2,163 (37.6) | 107 (31.9) | 2,061 (37.2) |
| Winter (November–February) | 394 (31.4) | 1,857 (33.2) | 455 (35.2) | 1,972 (34.3) | 134 (40.0) | 1,838 (33.2) |
| Baby delivered by skilled delivery attendant, n (%)c | ||||||
| Yes | 171 (13.7) | 166 (3.0)* | 42 (3.2) | 36 (0.6)* | 14 (4.2) | 10 (0.2)* |
| No | 1,080 (86.3) | 5,407 (97.0) | 1,252 (96.8) | 5711 (99.4) | 321 (95.8) | 5,527 (99.8) |
| Missing | 5 (0.4) | 12 (0.2) | 0 | 0 | 0 | 0 |
| Delivery by a TBA, n (%) | ||||||
| Yes | 475 (37.8) | 2,135 (38.2) | 186 (14.4) | 1,693 (29.5)* | 241 (72.4) | 5,312 (96.7)* |
| No | 781 (62.2) | 3,450 (61.8) | 1,108 (85.6) | 4,054 (70.5) | 92 (27.6) | 181 (3.3) |
| Missing | 0 | 0 | 0 | 0 | 2 (0.6) | 44 (0.7) |
| Excessive bleeding during delivery, n (%) | ||||||
| No | 1,186 (94.4) | 5,296 (94.9) | 1,268 (98.0) | 5,643 (98.2) | 300 (89.6) | 5,027 (90.8) |
| Yes | 70 (5.6) | 286 (5.1) | 26 (2.0) | 104 (1.8) | 35 (10.4) | 510 (9.2) |
| Missing | 0 | 1 (0.0) | 0 | 2 (0.0) | 2 (0.6) | 44 (0.8) |
| Malpresentation at birth | ||||||
| No | 1,239 (99.2) | 5,508 (99.0) | 1,265 (98.1) | 5,611 (97.8) | 334 (99.7) | 5,468 (99.2) |
| Yes | 10 (0.8) | 55 (1.0) | 24 (1.9) | 126 (2.2) | 1 (0.3) | 42 (0.8) |
| Missing | 7 (0.6) | 22 (0.4) | 5 (0.4) | 10 (0.2) | 0 | 27 (0.5) |
| Fever 3 d prior to delivery | ||||||
| No | 1,226 (97.6) | 5,388 (96.5)* | 1,274 (98.4) | 5,617 (97.7) | 303 (90.4) | 4,776 (86.3)* |
| Yes | 30 (2.4) | 197 (3.5) | 20 (1.6) | 130 (2.3) | 32 (9.6) | 760 (13.7) |
| Missing | 0 | 0 | 0 | 0 | 0 | 1 (0) |
| Infant appearance 5 min after delivery | ||||||
| Normal | 1,256 (100) | 5,571 (99.9) | 1,193 (94.2) | 5,291 (93.2) | na | na |
| Asphyxiated | 0 (0) | 7 (0.1) | 73 (5.8) | 386 (6.8) | na | na |
| Missing | 0 | 7 (0.1) | 28 (2.2) | 70 (91.2) | na | na |
| Umbilical cord wrapped around infant's neck at birth | ||||||
| No | 1,105 (88.0) | 4,929 (88.3) | 1,266 (97.8) | 5,606 (97.6) | na | na |
| Yes | 151 (12.0) | 656 (11.7) | 28 (2.2) | 141 (2.5) | na | na |
*Differences between clean delivery kit use and non-use tested using chi-square statistic and significant at p<0.05.
a
Not applicable: data were not collected in the study.
b
Standard terms used in Indian demographic surveys.
c
Doctor, nurse, or trained midwife.
na, not available.