Infection Prevention in Home Births in Sub-Saharan Africa: A Systematic Literature Review

Introduction

Maternal and neonatal infections are major contributors to mortality in Sub-Saharan Africa (SSA), especially in home birth settings with limited access to skilled care and hygienic conditions. Interventions during labour, birth, and the early postpartum period may reduce infection-related morbidity and mortality, but evidence specific to home births in SSA remains limited.

Objectives

To evaluate the effectiveness of infection-prevention interventions delivered during labour, birth, or within six hours postpartum in home birth settings in SSA.

Methods

Following PRISMA 2020 guidelines and a registered protocol (PROSPERO: CRD420251174104), seven databases and grey literature sources were searched (2000–2025). Eligible studies assessed infection-prevention interventions during birth or early postpartum in SSA and reported maternal or neonatal infection outcomes. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Due to methodological heterogeneity, findings were narratively synthesised.

Results

Ten studies were included. Delivery kits and clean birth or postpartum hygiene practices were generally associated with reductions in cord infection, puerperal sepsis, or neonatal mortality, although findings varied across settings and study designs. Evidence for chlorhexidine cord care was inconsistent: some studies showed reductions in omphalitis, while effects on neonatal mortality were unclear and context-dependent. Only two studies reported findings specifically for home births, limiting direct applicability.

Conclusions

Clean birth practices, including delivery kits, may reduce maternal and neonatal infections in home birth settings in SSA. Chlorhexidine cord care may reduce omphalitis, but evidence for mortality reduction is inconsistent. Further high-quality studies stratified by place of birth are needed to strengthen evidence for infection-prevention strategies in home birth environments.

Key messages

• Clean birth practices, including delivery kits and improved hygiene measures, may reduce maternal and neonatal infections in home birth settings in Sub-Saharan Africa.

• Evidence for chlorhexidine cord care is mixed, highlighting the need for more high-quality studies specifically focused on home births in Sub-Saharan Africa.