Clean birth kits in low and middle income countries



Clean birth practices can prevent sepsis, one of the leading causes of both maternal and newborn mortality. Achieving clean birth requires the application of skills by the care provider and the availability of a few essential supplies. For several decades now, birth kits have been recommended by WHO and other UN agencies, essentially as a means of ensuring supplies and more recently aimed explicitly to ‘strengthen standards of  cleanliness’ in home deliveries. This programme of work explores the evidence base for clean birth kits (CBKs) and looks at how programme managers can be supported in decisions about CBK use in their overall strategy for care at birth.



Systematic review of the evidence – completed (see publications below)

Development and testing of a decision support tool. This is a three stage process involving an international expert group and country level testing  completed (see publications below)

Questionnaire survey of District Health Officers to ascertain views regarding CBK use – final analysis & write up.



NORAD – systematic review.

Maternal Health Taskforce – development and testing of decision support tool, and questionnaire survey.


BU researchers

Vanora Hundley



Wendy Graham, Immpact, University of Aberdeen

Bilal Avan, IDEAS, London School of Hygiene & Tropical Medicine

Haris Ahmed, Pathfinder International, Pakistan

Ann Fitzmaurice, Impact, University of Aberdeen


Publications to date:

Hundley V, Avan B, Sullivan C, and Graham WJ. (2013) Should oral misoprostol be used to prevent postpartum haemorrhage in home birth settings in low resource countries? A systematic review of the evidence. British Journal of Obstetrics and Gynaecology; 120(3): 277-87.

Hundley V, Avan B, Ahmed H, and Graham WJ for the Birth Kit Working Group (2012) Clean Birth Kits to improve birth practices: development and testing of a country level decision support tool. BMC Pregnancy and Childbirth 12:158 doi:10.1186/1471-2393-12-158

Hundley, V, Avan B, Graham W, Blencowe H, and Lawn J. CBK Country Level Decision Support Tool. Aberdeen: Immpact. 2012

Hundley V, Avan B, Braunholtz D, and Graham WJ. Are birth kits a good idea? A systematic review of the evidence. Midwifery 2012; 28(2): 204-215

Hundley V, Avan B, Braunholtz D, Fitzmaurice A, & Graham W. Lessons regarding the use of birth kits in low resource countries. Midwifery 2011; 27(6):e222-30

Hundley, V, Avan B, Braunholtz D and Graham W. Inventory of disposable kits for use during pregnancy and childbirth. Aberdeen: Immpact. 2010.