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J Glob Health. 2019 Jun;9(1):010902. doi: 10.7189/jogh.09.01902.

"Every Newborn-BIRTH" protocol: observational study validating indicators for coverage and quality of maternal and newborn health care in Bangladesh, Nepal and Tanzania.

Author information

1
Joint first authors.
2
Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK.
3
Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh.
4
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
5
Pokhara Academy of Health Science, Pokhara Ranipauwa, Nepal.
6
Department of Health Services, Ministry of Health, Kathmandu, Nepal.
7
Nepal Health Research Council, Kathmandu, Nepal.
8
Golden Community, Kathmandu, Nepal.
9
LifeLine Nepal, Kathmandu, Nepal.
10
Kanti Children's Hospital, Kathmandu, Nepal.
11
Matri Shishu Miteri Hospital, Pokhara, Nepal.
12
Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.
13
Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania.
14
Public Health Sciences - Global Health - Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden.
15
Deceased 2 September 2018.
16
Institute for International Programs, Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA.
17
MEAUSRE Evaluation, University of North Carolina, North Carolina, USA.
18
Knowledge Management & Implementation Research Unit, Health Section, UNICEF, New York, USA.
19
Family and Reproductive Health WHO Tanzania.
20
Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK.
21
Department for Sexual and Reproductive Health, UNFPA, New York, USA.
22
Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland.
23
Office of Health, Infectious Disease and Nutrition, Bureau for Global Health, United States Agency for International Development, Washington, DC, USA.
24
Jhpiego Baltimore, Baltimore, MD, USA.
25
Department for Informatics, University of Oslo, Oslo, Norway.
26
Division of Reproductive Health, Centres for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
27
Save the Children, Washington, DC, USA.

Abstract

Background:

To achieve Sustainable Development Goals and Universal Health Coverage, programmatic data are essential. The Every Newborn Action Plan, agreed by all United Nations member states and >80 development partners, includes an ambitious Measurement Improvement Roadmap. Quality of care at birth is prioritised by both Every Newborn and Ending Preventable Maternal Mortality strategies, hence metrics need to advance from health service contact alone, to content of care. As facility births increase, monitoring using routine facility data in DHIS2 has potential, yet validation research has mainly focussed on maternal recall surveys. The Every Newborn - Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study aims to validate selected newborn and maternal indicators for routine tracking of coverage and quality of facility-based care for use at district, national and global levels.

Methods:

EN-BIRTH is an observational study including >20 000 facility births in three countries (Tanzania, Bangladesh and Nepal) to validate selected indicators. Direct clinical observation will be compared with facility register data and a pre-discharge maternal recall survey for indicators including: uterotonic administration, immediate newborn care, neonatal resuscitation and Kangaroo mother care. Indicators including neonatal infection management and antenatal corticosteroid administration, which cannot be easily observed, will be validated using inpatient records. Trained clinical observers in Labour/Delivery ward, Operation theatre, and Kangaroo mother care ward/areas will collect data using a tablet-based customised data capturing application. Sensitivity will be calculated for numerators of all indicators and specificity for those numerators with adequate information. Other objectives include comparison of denominator options (ie, true target population or surrogates) and quality of care analyses, especially regarding intervention timing. Barriers and enablers to routine recording and data usage will be assessed by data flow assessments, quantitative and qualitative analyses.

Conclusions:

To our knowledge, this is the first large, multi-country study validating facility-based routine data compared to direct observation for maternal and newborn care, designed to provide evidence to inform selection of a core list of indicators recommended for inclusion in national DHIS2. Availability and use of such data are fundamental to drive progress towards ending the annual 5.5 million preventable stillbirths, maternal and newborn deaths.

PMID:
30863542
PMCID:
PMC6406050
DOI:
10.7189/jogh.09.01902
[Indexed for MEDLINE]
Free PMC Article

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