Newborn Kit to Save Lives in Pakistan

NCT02130856 | Completed Phase 3 DMC

• 1 other identifier: 1000042963
• Study Type: interventional
• Target: 8,518
• Locations: 1 country
• Sites: 1

Brief Summary

There are over 3 million annual neonatal deaths. Approximately 2/3 of neonatal deaths are due to infection, low birth weight (LBW), and prematurity. Low tech but high impact interventions and commodities used in unconventional ways could save hundreds of thousands of newborn lives. We propose an integrated evidence-based toolkit usable by community health workers (CHW) to reduce neonatal deaths. The kit will include: Chlorhexidine to be applied to the umbilical stump, sunflower oil emollient to be applied to the skin, ThermoSpot to identify hypo/hyperthermia, and a Mylar infant sleeve with non-electric warmer.

Conditions

Neonatal Mortality

Keywords

Neonatal mortality; Neonatal kit; Pakistan; Randomized Control Trial; Chlorhexidine; ThermoSpot; Birth

Outcome Measures

Primary Outcomes (1)

• Neonatal mortality

  Death from any cause within the first 28 days of life

  During phase I of the study: Day 1 (or as soon as possible after notification of birth), 3, 7, 14, and 28 of life. During phase II of the study: Day 8 and day 28 of life.

Secondary Outcomes (7)

• Incidence of omphalitis

  During phase I of the study: Day 1 (or as soon as possible after notification of birth), 3, 7, 14, and 28 of life. During phase II of the study: Day 8 and day 28 of life.

• Incidence of severe infection

  During phase I of the study: Day 1 (or as soon as possible after notification of birth), 3, 7, 14, and 28 of life. During phase II of the study: Day 8 and day 28 of life.

• Cases of hypothermia identified

  During phase I of the study: Day 1 (or as soon as possible after notification of birth), 3, 7, 14, and 28 of life. During phase II of the study: Day 8 and day 28 of life.

• Cases of hyperthermia identified

  During phase I of the study: Day 1 (or as soon as possible after notification of birth), 3, 7, 14, and 28 of life. During phase II of the study: Day 8 and day 28 of life.

• Number of low birth weight (LBW) newborns identified

  During phase I of the study: Day 1 (or as soon as possible after notification of birth), 3, 7, 14, and 28 of life. During phase II of the study: Day 8 and day 28 of life.

Study Arms (2)

Neonatal Kit

EXPERIMENTAL

The neonatal kit will contain a clean birth kit to be used at the time of delivery either at home or in a facility, 4% chlorhexidine (CHX) lotion, sunflower oil emollient, ThermoSpot, a Mylar infant sleeve, and a reusable, non-electric, heating device. Lady Health Workers will be equipped with a hand held electric scale to identify low birth weight newborns.

Device: Neonatal kit

Control (Standard care)

NO INTERVENTION

In the control arm, Lady Health Workers will visit the home according to the regular schedule (same as in the intervention clusters) and will deliver the standard post-natal care consisting of: 1. be present at delivery (though not conduct the delivery) and thorough examination of newborn and mother post delivery 2. check mother for vaginal bleeding and abnormal blood pressure and make referral to nearest health facility as appropriate 3. refer any newborn with congenital anomaly or evidence of asphyxia 4. if unable to attend delivery for any reason, visit within first 24 hours post delivery 5. assess newborn in first month of life during visits and provide basic treatment for acute respiratory infections, pneumonia, and diarrhea in the home 6. encourage breastfeeding

Interventions

Neonatal kit DEVICE

Contents of the neonatal kit: 1. Clean birth kit: sterile blade, a clean plastic square, plastic gloves, hand soap, and cord ties/clamp. 2. 4% Chlorhexidine (CHX) lotion (15 mL) and a bag of cotton balls. 3. Sunflower oil emollient (50 mL) 4. ThermoSpot 5. Mylar infant sleeve 6. Click to heat warmer (http://www.heatinaclick.ca/products/pocket\_size.html) in a fitted cloth pouch. 7. Handheld electric scale with suspended cloth sling. The scale will not be included with the kit but rather one will be issued to each Lady Health Worker.

Neonatal Kit

Eligibility Criteria

• Sex: female
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• All pregnant women in parts of study clusters covered by Lady Health Worker program and their home- or facility-born live newborns
• Mother intending to maintain residence in study area for first month of newborn's life

You may not qualify if:

• Failure to provide consent to enroll in study (intervention or control clusters)

Sponsors & Collaborators

• The Hospital for Sick Children: lead
• Grand Challenges Canada: collaborator
• UBS Optimus Foundation: collaborator
• Mother and Child Care Trust (MCCT), Pakistan: collaborator
• Aga Khan University: collaborator
• March of Dimes: collaborator

Study Sites (1)

Aga Khan University

Karachi, 74800, Pakistan

Location

Related Publications (16)

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  PMID: 22579125 BACKGROUND

• Khan A, Kinney MV, Hazir T, Hafeez A, Wall SN, Ali N, Lawn JE, Badar A, Khan AA, Uzma Q, Bhutta ZA; Pakistan Newborn Change and Future Analysis Group. Newborn survival in Pakistan: a decade of change and future implications. Health Policy Plan. 2012 Jul;27 Suppl 3:iii72-87. doi: 10.1093/heapol/czs047.

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  PMID: 9069067 BACKGROUND

• Mullany LC, Darmstadt GL, Khatry SK, Katz J, LeClerq SC, Shrestha S, Adhikari R, Tielsch JM. Topical applications of chlorhexidine to the umbilical cord for prevention of omphalitis and neonatal mortality in southern Nepal: a community-based, cluster-randomised trial. Lancet. 2006 Mar 18;367(9514):910-8. doi: 10.1016/S0140-6736(06)68381-5.

  PMID: 16546539 BACKGROUND

• Soofi S, Cousens S, Imdad A, Bhutto N, Ali N, Bhutta ZA. Topical application of chlorhexidine to neonatal umbilical cords for prevention of omphalitis and neonatal mortality in a rural district of Pakistan: a community-based, cluster-randomised trial. Lancet. 2012 Mar 17;379(9820):1029-36. doi: 10.1016/S0140-6736(11)61877-1. Epub 2012 Feb 8.

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• Arifeen SE, Mullany LC, Shah R, Mannan I, Rahman SM, Talukder MR, Begum N, Al-Kabir A, Darmstadt GL, Santosham M, Black RE, Baqui AH. The effect of cord cleansing with chlorhexidine on neonatal mortality in rural Bangladesh: a community-based, cluster-randomised trial. Lancet. 2012 Mar 17;379(9820):1022-8. doi: 10.1016/S0140-6736(11)61848-5. Epub 2012 Feb 8.

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• Darmstadt GL, Saha SK, Ahmed AS, Ahmed S, Chowdhury MA, Law PA, Rosenberg RE, Black RE, Santosham M. Effect of skin barrier therapy on neonatal mortality rates in preterm infants in Bangladesh: a randomized, controlled, clinical trial. Pediatrics. 2008 Mar;121(3):522-9. doi: 10.1542/peds.2007-0213.

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• Green DA, Kumar A, Khanna R. Neonatal hypothermia detection by ThermoSpot in Indian urban slum dwellings. Arch Dis Child Fetal Neonatal Ed. 2006 Mar;91(2):F96-8. doi: 10.1136/adc.2005.078410. Epub 2005 Sep 13.

  PMID: 16159955 BACKGROUND

• Krautheim AB, Jermann TH, Bircher AJ. Chlorhexidine anaphylaxis: case report and review of the literature. Contact Dermatitis. 2004 Mar;50(3):113-6. doi: 10.1111/j.0105-1873.2004.00308.x.

  PMID: 15153122 BACKGROUND

• Rosenberg A, Alatary SD, Peterson AF. Safety and efficacy of the antiseptic chlorhexidine gluconate. Surg Gynecol Obstet. 1976 Nov;143(5):789-92.

  PMID: 982260 BACKGROUND

• Garland JS, Alex CP, Mueller CD, Otten D, Shivpuri C, Harris MC, Naples M, Pellegrini J, Buck RK, McAuliffe TL, Goldmann DA, Maki DG. A randomized trial comparing povidone-iodine to a chlorhexidine gluconate-impregnated dressing for prevention of central venous catheter infections in neonates. Pediatrics. 2001 Jun;107(6):1431-6. doi: 10.1542/peds.107.6.1431.

  PMID: 11389271 BACKGROUND

• Darmstadt GL, Mao-Qiang M, Chi E, Saha SK, Ziboh VA, Black RE, Santosham M, Elias PM. Impact of topical oils on the skin barrier: possible implications for neonatal health in developing countries. Acta Paediatr. 2002;91(5):546-54. doi: 10.1080/080352502753711678.

  PMID: 12113324 BACKGROUND

• Darmstadt GL, Saha SK, Ahmed AS, Chowdhury MA, Law PA, Ahmed S, Alam MA, Black RE, Santosham M. Effect of topical treatment with skin barrier-enhancing emollients on nosocomial infections in preterm infants in Bangladesh: a randomised controlled trial. Lancet. 2005 Mar 19-25;365(9464):1039-45. doi: 10.1016/S0140-6736(05)71140-5.

  PMID: 15781099 BACKGROUND

• Lawn JE, Kinney MV, Black RE, Pitt C, Cousens S, Kerber K, Corbett E, Moran AC, Morrissey CS, Oestergaard MZ. Newborn survival: a multi-country analysis of a decade of change. Health Policy Plan. 2012 Jul;27 Suppl 3:iii6-28. doi: 10.1093/heapol/czs053.

  PMID: 22692417 BACKGROUND

• Duby J, Pell LG, Ariff S, Khan A, Bhutta A, Farrar DS, Bassani DG, Hussain M, Bhutta ZA, Soofi S, Morris SK. Effect of an integrated neonatal care kit on cause-specific neonatal mortality in rural Pakistan. Glob Health Action. 2020 Dec 31;13(1):1802952. doi: 10.1080/16549716.2020.1802952.

  PMID: 32838701 DERIVED

• Turab A, Pell LG, Bassani DG, Soofi S, Ariff S, Bhutta ZA, Morris SK. The community-based delivery of an innovative neonatal kit to save newborn lives in rural Pakistan: design of a cluster randomized trial. BMC Pregnancy Childbirth. 2014 Sep 8;14:315. doi: 10.1186/1471-2393-14-315.

  PMID: 25201572 DERIVED

Study Officials

• Shaun K. Morris, MD, MPH

  The Hospital for Sick Children, Toronto

  PRINCIPAL INVESTIGATOR

• Zulfiqar A. Bhutta, PhD, MBBS

  Aga Khan University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 3
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Staff Physician

Study Record Dates

• First Submitted: May 1, 2014
• First Posted: May 5, 2014
• Study Start: April 1, 2014
• Primary Completion: February 26, 2017
• Study Completion: February 26, 2017
• Last Updated: April 25, 2017

Record last verified: 2017-04

Locations

PA (1)