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Clean cord care practices and neonatal mortality: evidence from rural Uttar Pradesh, India
  1. Praween K Agrawal1,
  2. Sutapa Agrawal2,
  3. Luke C Mullany3,
  4. Gary L Darmstadt4,
  5. Vishwajeet Kumar3,5,
  6. Usha Kiran6,
  7. Ramesh C Ahuja7,
  8. Vinod K Srivastava7,
  9. Mathuram Santosham3,
  10. Robert E Black3,
  11. Abdullah H Baqui3
  1. 1International Planned Parenthood Federation - South Asia Regional Office (IPPF-SARO), New Delhi, India
  2. 2South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India
  3. 3Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  4. 4Family Health Division, Bill & Melinda Gates Foundation, Seattle, Washington, USA
  5. 5International Clinical Epidemiology Network (INCLEN), Lucknow, India
  6. 6Bill & Melinda Gates Foundation, New Delhi, India
  7. 7Dean, Faculty of Medical Sciences, Integral University, Lucknow, India
  1. Correspondence to Dr Abdullah H Baqui, Professor, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Room - E-8138, 615 N. Wolfe Street, Baltimore, MD 21205, USA; abaqui{at}


Background About a million newborns die each year in India, accounting for about a fourth of total global neonatal deaths. Infections are among the leading causes of neonatal mortality. Care practices immediately following delivery contribute to newborns' risk of infection and mortality.

Objectives This study examined the association between clean cord care practices and neonatal mortality in rural Uttar Pradesh, India.

Methods The study used data from a household survey conducted to evaluate a community-based intervention program in two districts of Uttar Pradesh, India. Analysis included data from 5741 singleton live births delivered at home during 2005. The association between clean cord care (clean instrument used to cut cord, clean thread used to tie cord and antiseptics or nothing applied to the cord) and neonatal mortality was estimated using multivariate logistic regression models.

Results Thirty per cent of the study mothers practiced clean cord care. Neonatal mortality rate was significantly lower among newborns exposed to clean cord care (36.5/1000 live births, 95% CI 28.0 to 46.8) than those who did not practice (53.0/1000 live births, 95% CI 46.1 to 60.6). Clean cord care was associated with 37% lower neonatal mortality (OR=0.63; 95% CI 0.46 to 0.87) after adjusting for mother's age, education, caste/tribe, religion, household wealth, newborn thermal care practice and care-seeking during the first week after birth and study arms.

Conclusions Promoting clean cord care practice among neonates in community-based maternal and newborn care programs has the potential to improve neonatal survival in rural India and similar other settings.

  • Clean cord care
  • neonatal mortality
  • logistic regression
  • Uttar Pradesh, India
  • health behaviour
  • neonatal
  • mortality
  • epidemiology
  • international health
  • public health
  • child health
  • health impact assessment
  • health expectancy
  • health promotion
  • immunisation
  • infant mortality
  • social inequalities
  • Eastern Europe
  • infection
  • public health policy

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  • Funding The project was funded by United States Agency for International Development (USAID) India Mission through Global Research Activity Award No # HRN A-00-96-90006-00 to the Johns Hopkins Bloomberg School of Public Health.The funding source had no role in the design, implementation, analysis, or interpretation of data or presentation of findings. The corresponding author had full access to all data in the study and had final responsibility for the decision to submit for publication.

  • Competing interests None.

  • Ethics approval This research was approved by the Johns Hopkins Bloomberg School of Public Health Committee for Human Research and the King George Medical University Institutional Review Board (FWA00004806).

  • Provenance and peer review Not commissioned; externally peer reviewed.