Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2019 Jun;9(1):010902.
doi: 10.7189/jogh.09.010902.

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

Louise T Day  1   2 , Harriet Ruysen  1   2 , Vladimir S Gordeev  2 , Georgia R Gore-Langton  2 , Dorothy Boggs  2 , Simon Cousens  2 , Sarah G Moxon  2 , Hannah Blencowe  2 , Angela Baschieri  2 , Ahmed Ehsanur Rahman  3 , Tazeen Tahsina  3 , Sojib Bin Zaman  3 , Tanvir Hossain  3 , Qazi Sadeq-Ur Rahman  3 , Shafiqul Ameen  3 , Shams El Arifeen  3 , Ashish Kc  4 , Shree Krishna Shrestha  5 , Naresh P Kc  6 , Dela Singh  5 , Anjani Kumar Jha  7 , Bijay Jha  7 , Nisha Rana  4 , Omkar Basnet  8 , Elisha Joshi  9 , Asmita Paudel  10 , Parashu Ram Shrestha  6 , Deepak Jha  6 , Ram Chandra Bastola  11 , Jagat Jeevan Ghimire  7 , Rajendra Paudel  10 , Nahya Salim  12 , Donat Shamb  13 , Karim Manji  12 , Josephine Shabani  13 , Kizito Shirima  13 , Namala Mkopi  12 , Mwifadhi Mrisho  13 , Fatuma Manzi  13 , Jennie Jaribu  13 , Edward Kija  12 , Evelyne Assenga  12 , Rodrick Kisenge  12 , Andrea Pembe  12 , Claudia Hanson  14 , Godfrey Mbaruku  13   15 , Honorati Masanja  13 , Agbessi Amouzou  16 , Tariq Azim  17 , Debra Jackson  18 , Theopista John Kabuteni  19 , Matthews Mathai  20 , Jean-Pierre Monet  21 , Allisyn Moran  22 , Pavani Ram  23 , Barbara Rawlins  24 , Johan Ivar Sæbø  25 , Florina Serbanescu  26 , Lara Vaz  27 , Nabila Zaka  18 , Joy E Lawn  2
Affiliations
Observational Study

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

Louise T Day et al. J Glob Health. 2019 Jun.

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.

PubMed Disclaimer

Conflict of interest statement

Competing interests: The authors completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available upon request from the corresponding author), and declare no conflicts of interest.

Figures

Figure 1
Figure 1
Every Newborn Action Plan core and additional indicators. Shaded – not currently routinely tracked at global level. Bold red – indicator requiring additional testing to inform consistent measurement. Asterisk – also SDG core or complementary indicator. Indicators disaggregated by equity such as urban/rural, income, and education. Adapted from references [9,16,17].
Figure 2
Figure 2
Combined priority indicator table for relevant plans: Ending Preventable Maternal Mortality and Every Newborn [10]. Highlighted in red with box is the priority for measurement improvement and the focus of this research.
Figure 3
Figure 3
Data collection and use by level of health system. Adapted from [41].
Figure 4
Figure 4
EN-BIRTH study validation and analysis approach. Panel A. Validation "gold standard" comparison to routine data (eg, HMIS/DHIS2) and to maternal recall survey data (eg, for household surveys). Panel B. Analysis for validation of sensitivity and specificity. Asterisk – recorded in facility L&D or KMC register / reported in maternal recall survey.
Figure 5
Figure 5
EN-BIRTH study – overview of data flow in study sites. Data Collection – "ward registers" on one line. Data collector roles revised with "Data Verifier" added. Data Systems needed "web based database" (word database was missing). ACS – antenatal corticosteroids.
Figure 6
Figure 6
EN-BIRTH study software data collection showing examples of the tablet application screen shots.
See this image and copyright information in PMC

References

    1. United Nations. Sustainable Development Goals. 2016. Available: http://www.un.org/sustainabledevelopment/health/. Accessed: 5 April 2018.
    1. United Nations. Global Strategy for Women's, Children's and Adolescents' Health, 2016-2030. New York: United Nations; 2015.
    1. UN IGME. Levels and Trends in Child Mortality Report 2018. Estimates developed by United Nations inter-agency group for child mortality estimation (UN IGME). New York: United Nations Children's Fund: 2018.
    1. Blencowe H, Cousens S, Jassir FB, Say L, Chou D, Mathers C, et al. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. Lancet Glob Health. 2016;4:e98–108. doi: 10.1016/S2214-109X(15)00275-2. - DOI - PubMed
    1. World Health Organization, UNFPA, World Bank Group, United Nations Population Division. Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Available: http://www.who.int/reproductivehealth/publications/monitoring/maternal-m.... Accessed: 4 December 2018.

Publication types