Lessons regarding the use of birth kits in low resource countries.
To synthesise implementation lessons regarding birth kits in terms of the context, the user, requirements for use and the logistics of supplying kits. The scoping review was informed through a systematic literature review; a call for information distributed to experts in maternal and child health, relevant research centres and specialist libraries; a search of the web sites of groups working in the area of maternal and child health; and data extraction from DHS surveys. Data synthesis involved the production of a simple descriptive summary of the state of knowledge regarding birth kits. The 28 articles included in the review described a total of 21 birth kits used in 40 different countries and in many cases the kits were part of a package of interventions. Although birth kits are available in more than 50 low resource countries, evidence regarding implementation is limited. Levels of birth kit use vary considerably (8-99%); with higher levels being reported where birth kits are distributed free as part of a research programme. Identifying the user of the birth kit was difficult in most reports and the evidence regarding training requirements for birth kit use was conflicting. Limited information exists regarding facilitators and barriers to birth kit use, and how birth kits fit within the wider service delivery of maternal and child health. Despite widespread use of birth kits, implementation lessons are hard to identify. The fact that birth kits are predominantly used in non-facility settings, and probably by non-skilled attendants, poses further challenges in synthesising the evidence. It would seem logical that government run programmes would increase utlisation rates; however in these countries national level data are not yet available. Such data are crucial to identifying how women obtain and use birth kits. The importance of context cannot be over emphasised, and better descriptive methods are needed to capture contextual factors that may impact on the implementation process. Birth kits are a promising technology to achieve MDG 5, however further research is needed before making recommendations to scale up mother held birth kits or to expand kit contents.