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Table 3

From: Clean birth and postnatal care practices to reduce neonatal deaths from sepsis and tetanus: a systematic review and Delphi estimation of mortality effect

   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)
  1. **only available for study (11)
  2. *from pooled analysis ^studies did not report aOR^^199 NT cases, 3 studies. 3 studies report no association but did not present aOR.