July 7, 2008 

Birth Attendant and Maternal Hand Washing Reduce Infant Mortality in Nepal

Washing hands with soap and water in preparation for delivery significantly reduced the risk of death for infants within the first month of life, according to a study in Nepal conducted by researchers at the Johns Hopkins Bloomberg School of Public Health. The study found a 19 percent lower risk of death among newborns born at home in rural Nepal when the birth attendant washed their hands before delivery. The study also found a 44 percent reduction in risk of death if mothers washed their hands prior to handling their newborn infant.  The findings are published in the July 2008 edition of the journal Archives of Pediatric and Adolescent Medicine.

“Several studies have shown that a mother’s hand washing can reduce the risk of diarrheal disease in preschool age children, but this is really the first to examine the benefits of hand washing on overall mortality during the first month of life when many deaths occur,” said James Tielsch, PhD, the study’s senior author and professor in the Bloomberg School’s Department of International Health.

The study enrolled 23,662 newborns who had been included in a larger evaluation of the effect of skin and umbilical cord cleaning on newborn mortality. More than 90 percent of the births took place at home or on the way to a medical facility. Researchers observed the newborns during the first 28 days of life through a series of 11 home visits. The mothers of the infants were questioned about their own hand washing practices and the birth attendant’s hand washing practices.

According to the study, 52.9 percent of birth attendants reported washing hands with soap and water prior to delivery while 14.8 percent of mothers reported washing hands prior to handling their infant. Newborns whose birth attendant washed his or her hands prior to assisting with delivery had a 19 percent lower risk of death compared to newborns whose attendant did not. Newborns whose mother washed her hands before handling their infants had a 44 percent lower risk of death compared to those whose did not. The overall mortality rate was 32.1 deaths per 1,000 births.

“More than 30,000 newborns die each year in Nepal. Our findings suggest that a substantial portion of these deaths could be prevented with routine hand washing practices,” said Tielsch.

Funding for the research was provided by grants from the National Institutes of Health, the Bill & Melinda Gates Foundation and U.S Agency for International Development.

“Maternal and Birth Attendant Hand Washing and Neonatal Mortality in Southern Nepal” was written Victor Rhee, MHS; Luke C. Mullany, PhD; Subrana K. Khatry, MBBS; Joanne Katz, ScD; Steven C. LeClerq, MPH; Gary L. Darmstadt, MD; and James M. Tielsch, PhD.