"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, Harriet Ruysen, Vladimir S. Gordeev, Georgia R. Gore-Langton, Dorothy Boggs, Simon Cousens, Sarah G. Moxon, Hannah Blencowe, Angela Baschieri, Ahmed Ehsanur Rahman, Tazeen Tahsina, Sojib Bin Zaman, Tanvir Hossain, Qazi Sadeq Ur Rahman, Shafiqul Ameen, Shams El Arifeen, K. C. Ashish, Shree Krishna Shrestha, P. K.C. Naresh, Dela SinghAnjani Kumar Jha, Bijay Jha, Nisha Rana, Omkar Basnet, Elisha Joshi, Asmita Paudel, Parashu Ram Shrestha, Deepak Jha, Ram Chandra Bastola, Jagat Jeevan Ghimire, Rajendra Paudel, Nahya Salim, Donat Shamba, Karim Manji, Josephine Shabani, Kizito Shirima, Namala Mkopi, Mwifadhi Mrisho, Fatuma Manzi, Jennie Jaribu, Edward Kija, Evelyne Assenga, Rodrick Kisenge, Andrea Pembe, Claudia Hanson, Godfrey Mbaruku, Honorati Masanja, Agbessi Amouzou, Tariq Azim, Debra Jackson, Theopista John Kabuteni, Matthews Mathai, Jean Pierre Monet, Allisyn Moran, Pavani Ram, Barbara Rawlins, Johan Ivar Sæbø, Florina Serbanescu, Lara Vaz, Nabila Zaka, Joy E. Lawn

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


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.

Original languageEnglish (US)
Article number010902
JournalJournal of global health
Issue number1
StatePublished - 2019

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


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