***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The potential for  traditional birth attendants ( TBAs )  to improve  neonatal health outcomes has largely been overlooked during the current debate regarding the role of TBAs in improving maternal health . R and omly-selected TBAs ( n=93 ) were interviewed to gain a more thorough underst and ing of their knowledge , attitudes , and practice s regarding maternal and newborn care . Practice s , such as using a  clean cord-cutting instrument  ( 89 % ) and h and -washing  before delivery ( 74 % ) , were common . Other beneficial practice s , such as thermal care , were low . Trained TBAs were more likely to wash h and s with soap before delivery , use a clean delivery-kit , and advise feeding colostrum . Although mustard oil massage was a universal practice , 52 % of the TBAs indicated their willingness to consider alternative oils . Low-cost , evidence -based interventions for improving neonatal outcomes might be implemented by TBAs in this setting where most births take place in the home and neonatal mortality risk is high . Continuing efforts to define the role of TBAs may benefit from an emphasis on their potential as active promoters of essential newborn care A study was carried out in Misungwi and Kwimba Districts , Tanzania to determine the effectiveness of clean delivery kits in preventing  cord infection and puerperal sepsis  and to provide qualitative information on community acceptability , correct use , and appropriateness of the kits . This study involved pregnant women aged 18 - 45 years old . In the delivery kit intervention population , the Maternal and Child Health Aide ( MCHA ) assigned to the health facility provided pregnant mothers with a clean delivery kit on their first antenatal visit . She explained how to use each of the kit components , with the aid of pictorial instructions included in the kit . The pregnant mothers were asked to convey the information to whoever assisted them during delivery . The MCHA also gave them health education based on the principles of the " six cleans " recognized by WHO ( i.e. , clean h and s , clean perineum , clean delivery surface , clean cord cutting and tying instruments , clean cutting surface ) . Women received the clean delivery kit free of charge in accordance with the r and omised stepped-wedge design schedule . During the first week following delivery , the Village Health Workers ( VHWs ) from both the intervention and control groups made two visits to the households of mothers who had delivered . They administered question naire about delivery to mother and birth attendant . During the two scheduled postpartum visits , those who were suspected to have puerperal sepsis or cord infection of the baby were referred to the health facility clinician for confirmation . Results indicated that use of clean delivery kit had a positive effect on reducing both cord infection and puerperal sepsis . The use of a clean home delivery kit coupled with an educational intervention about the " six cleans " had a significant effect on reducing the incidence of cord infection and puerperal sepsis among women enrolled in the study . In low re source setting s where home birth is common and clean delivery supplies are scarce , disposable kits can be made available through health clinics , markets , pharmacies or other channels to help reduce rates of infection BACKGROUND There are approximately 4 million neonatal deaths and half a million maternal deaths worldwide each year . There is limited evidence from clinical trials to guide the development of effective maternity services in developing countries . METHODS We performed a cluster-r and omized , controlled trial involving seven subdistricts ( talukas ) of a rural district in Pakistan . In three talukas r and omly assigned to the intervention group , traditional birth attendants were trained and issued disposable delivery kits ; Lady Health Workers linked traditional birth attendants with established services and documented processes and outcomes ; and obstetrical teams provided outreach clinics for antenatal care . Women in the four control talukas received usual care . The primary outcome measures were perinatal and maternal mortality . RESULTS Of the estimated number of eligible women in the seven talukas , 10,114 ( 84.3 percent ) were recruited in the three intervention talukas , and 9443 ( 78.7 percent ) in the four control talukas . In the intervention group , 9184 women ( 90.8 percent ) received antenatal care by trained traditional birth attendants , 1634 women ( 16.2 percent ) were seen antenatally at least once by the obstetrical teams , and 8172 safe-delivery kits were used . As compared with the control talukas , the intervention talukas had a cluster-adjusted odds ratio for perinatal death of 0.70 ( 95 percent confidence interval , 0.59 to 0.82 ) and for maternal mortality of 0.74 ( 95 percent confidence interval , 0.45 to 1.23 ) . CONCLUSIONS Training traditional birth attendants and integrating them into an improved health care system were achievable and effective in reducing perinatal mortality . This model could result in large improvements in perinatal and maternal health in developing countries OBJECTIVE To determine the feasibility and acceptability of providing clean birth kits ( CBKs ) containing misoprostol for self-administration in a rural setting in Papua New Guinea . METHODS A prospect i ve intervention study was conducted between April 8 , 2013 , and October 24 , 2014 . Eligible participants were women in the third trimester of pregnancy who attended a prenatal clinic in Unggai Bena . Participants received individual instruction and were then given a CBK containing 600μg misoprostol tablets for self-administration following an unsupervised birth if they could demonstrate their underst and ing of correct use of items in the CBK . Data regarding the use and acceptability of the CBK and misoprostol were collected during postpartum follow-up . RESULTS Among 200 participants , 106 ( 53.0 % ) had an unsupervised birth , and 99 ( 93.4 % ) of these women used the CBK . All would use the CBK again and would recommend it to others . Among these 99 women , misoprostol was self-administered by 98 ( 99.0 % ) , all of whom would take the drug again and would recommend it to others . CONCLUSION The findings strengthen the case for community-based use of misoprostol to prevent postpartum hemorrhage in remote communities . Large-scale interventions should be planned to further evaluate impact and acceptability 
    Output:
    
Quantitative studies showed a positive impact of CBKs on reducing the incidence of puerperal sepsis and neonatal tetanus .
The review also identified CBK use to be associated with a reduction in perinatal , neonatal and young infant mortality .
Qualitative studies suggested that a lack of awareness of the importance of CBKs and clean delivery practice s , unavailability of CBKs and financial constraints to purchase CBKs were the potential barriers .
CBKs appear to be a promising strategy to reduce maternal and neonatal morbidity and mortality .