Discussion
infection, puerperal infection
INFECTION, NEONATAL INFECTION, PUERPERAL INFECTION
The effectiveness of CDKs has been investigated in poor-resource settings, mainly in light of home births along with other interventions. This has made it difficult to interpret results on effectiveness. In this study, CDKs were handed directly to TBAs in low-income areas of the state capital for their use during deliveries. This ensured that a TBA was identified as a kit user and that the only intervention received during the study was the CDK.As with most studies, TBAs were mostly older, female, community-based providers of maternal care without any education or formal training. The large number of TBAs in the study setting, as well as the births involved in the study, affirm that TBAs still account for a remarkable proportion of births, even in cities in developing countries. Although the drive for increased skilled birth attendance remains a top priority, the large number of births covered by TBAs during this transition to skilled birth attendance makes continuous engagement with them a critical component of maternal care [The incidence rate of puerperal infection (1.1%) in the study is similar to other reports from Nigeria and other sub-Saharan countries [The incidence of neonatal infection (11.2%) was comparable to similar studies in Nigeria and Sub-Saharan Africa [The differences in rates of reduction in neonatal and maternal infection between intervention and control groups were not statistically significant. The statistical power for the analysis of the effect of CDK on the outcomes in this study could be limited by the small size of CDK users recruited, as these outcomes are either rare (puerperal infection) or present non-specific signs and symptoms (neonatal infections). Studies in other LMICs have reported that the use of CDK during birth is associated with a reduced risk of infection and improvements in neonatal outcomes [A recent study in Northern Nigeria found no association between the use of CDKs and reduced maternal or neonatal morbidity and suggests the possibility of increased risk of adverse outcomes when CDKs are made available to women outside the context of a structured health system [The cost of local assembly of CDK ($2.20) compared to the lowest average patient cost of treating blood stream infection in neonates in Africa ($20.90) [