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Clean Delivery Kit

Many factors limit women’s access to health facilities that can provide skilled birth attendance and postnatal care in countries where PSI works. Regardless of where delivery takes place, clean delivery kits (CDKs) can reduce the risk of maternal and neonatal complications and mortality by preventing infection that can lead to sepsis. PSI also offers expanded CDKs with two additional and highly effective interventions that target the mother and neonate, respectively. Misoprostol is a uterotonic that is used to manage the third stage of labor and prevent postpartum hemorrhage. Chlorhexidine is an antiseptic that is used to prevent infection at the umbilical cord stump which greatly reduces the risk of sepsis for neonates.

Unit of intervention1 clean delivery kit

Standard kit contentsRazor blade, string/cord ligatures, plactic sheeting, soap

Additionla items in expanded kitchlorhexidine, misoprostol

Target populationpregnant women and neonates

For more information about how PSI is increasing access to CDKs to improve health and save lives, visit our website at:
http://www.psi.org/program/clean-delivery-kits/

Model Overview

PSI’s CDK impact model is based on the Lives Saved Tool (LiST). LiST is used to estimate the number of deaths averted by increasing coverage of CDKs in a country. This number of deaths averted at the population level is translated to deaths averted per CDK, using country specific parameters such as population size and the number of live births. Once we have deaths averted per CDK, we apply data from the 2010 Global Burden of Disease study to estimate the corresponding number of DALYs averted.

Model Outputs (impact metrics)

Estimates of DALYs averted, deaths averted, CYPs provided, and unintended pregnancies averted represent the projected health impact of the intervention. It is “projected” because it has not been directly measured.

Examples based on distribution of CDK in Myanmar in 2015 Statement of modeled results, examples:

In 2015, an estimated 8 deaths and 683 DALYs would be averted if 10,000 CDKs were distributed in Myanmar.

For more details about how PSI models CDK impact, see below.

Model Details

Step 1: Running a projection in the Lives Saved Tool (LiST)LiST is a multi-cause mortality model developed by Johns Hopkins Bloomberg School of Public Health that estimates the number of deaths averted (or lives saved) through the scale up of maternal and child health interventions.

PSI begins by running a projection in LiST for select countries. We use the intervention “Clean birth practices” in LiST as a proxy for CDKs, changing the effectiveness for unattended home deliveries to 0.1 from 0. For the expanded CDKs, we use the interventions clean birth practices, chlorhexidine, and active management of the third stage of labor (AMTSL – used as a proxy for misoprostol for post partum hemorrhage) simultaneously. In this projection, access to these three interventions is increased from the current, country-specific baseline to 100%. LiST then projects the number of deaths averted among neonates and mothers by this increased level of coverage.

Step 1 Output:
Number of additional deaths averted (or lives saved) among mothers and neonates if coverage of CDKs increased from baseline to 100% in select countries

Step 2: Estimating deaths averted per CDK among mothers and neonatesPSI uses the step 1 output (deaths averted at 100% coverage of CDKs) to estimate the number of deaths averted by a single CDK. To do this, we divide the number of deaths averted by increasing to 100% coverage by the number of CDKs needed to reach 100% coverage of births.

PSI estimates the number of CDKs needed to reach 100% coverage using a number of parameters, including baseline coverage of CDKs and the number of births. We also account for wastage of CDKs in the supply chain, assumed to be 10% across all interventions.

Step 2 Output:
Maternal and neonatal deaths averted coefficient for CDKs

Step 3: Estimating DALYs averted per CDK among mothers and neonatesA DALY (or disability adjusted life year) includes two components: years of life lost due to premature death (YLL) and years lived with disability (YLD). DALYs averted are in turn comprised of YLLs averted and YLDs averted or, put simply: death and disability that is prevented by PSI interventions.

To estimate YLLs averted per CDK among mothers and neonates, PSI first estimates the number of years of life lost per death among mothers and neonates due to maternal and neonatal sepsis in select countries. This is equal to the life expectancy at the average age of death from maternal and neonatal sepsis. Age specific life expectancies are taken from the 2010 Global Burden of Disease study (GBD 2010). The number of years of life lost per maternal and neonatal sepsis death is then multiplied by the number of deaths averted per CDK among mothers and neonates (maternal and neonatal deaths averted coefficients), calculated in step 2 above for a selected country. This gives us the YLLs averted per CDK.

To estimate YLDs averted per CDK among mothers neonates, we use a YLD/YLL ratio, based on the 2010 GBD. This ratio represents the relative number of years lived with disability for every year lost due to death from maternal or neonatal sepsis. We apply this ratio to the number of YLLs averted per CDK to estimate the number of YLDs averted per CDK among mothers and neonates.

Finally, YLLs averted and YLDs averted are added together to estimate the number of DALYs averted per CDK among neonates.

Step 3 Output:
Maternal and neonatal DALYs averted coefficient for CDKs