1. Babies who have respiratory depression at birth 2. Preterm babies 3. Neonatal Infection 4. Babies with neonatal encephalopathy Neonatal Diseases 1. Babies who have respiratory depression at birth 2. Preterm babies 3. Neonatal Infection 4. Babies with neonatal encephalopathy
Conditions
Interventions
A stepped-wedge cluster-randomized design will be applied and the hospitals will be randomly allocated to four wedges with different time points for initiation of intervention
each wedge will thus include three hospitals. The delay in intervention start will be three months, meaning that the preparatory phase will be completed for each step before starting the next. Randomi
Sponsors
Swedish Foundation for International Cooperation in Research and Higher Education
Swedish Research Council (VR)
Einhorn Family Foundation
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: Mothers: 1. Pregnant women 2. Gestational age equal to or more than 22 weeks 3. With foetal heart sound at admission 4. Agree to participate in the study Neonates: Babies weighing 500 gram.
Exclusion criteria
Exclusion criteria: 1. Women who have antepartum stillbirth, i.e. women admitted to labour room with no fetal heart sound
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| 1. Intrapartum mortality measured as intrapartum stillbirth (death within uterus 22 weeks of gestation or birth weight 500 gram) as assessed by review of the patient record at the time of delivery 2. First-day neonatal mortality (deaths within first 24 hours of birth) is assessed by review of the patient record at the time of discharge | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Early (0-6 days) and late neonatal (7-27 days) in-hospital mortality is measured by review of the patient record at the time of discharge 2. Admittance to Sick Newborn Care Units (SNCU) and morbidity epidemiology is measured by review of the sick newborn chart and register at the time of discharge 3. Rate and severity of neonatal encephalopathy (NE) is measured by review of the NE scoring sheet at the time of discharge 4. Health workers’ performance on: 4.1. Fetal surveillance in clinical settings is measured by observation and review of the record by surveillance officer during the time of labour 4.2. Neonatal resuscitation in simulated settings is measured by observation by trainers at the time of training 4.3. Neonatal resuscitation in clinical settings is measured by clinical observation by surveillance officers at the time of birth 4.4. Essential newborn care (immediate newborn care, cord care practices, breast feeding, KMC, routine assessment of newborn) is measured by clinical observation at the time of birth and during first hour of life 4.5. Infection prevention and management is measured by clinical observation at delivery unit as well as sick newborn care unit 5. Beneficiaries' satisfaction on the received care is measured by interview with the client at the time of discharge 6. Acceptability and adequacy of each implementation strategy component is measured by focus group discussion and interview with health workers and stakeholders at 3, 6 and 9 months of implementation of the intervention 7. Mothers’ experiences regarding closeness and separation to their infants in the delivery room and at the neonatal care unit is measured by interview at the time of discharge 8. Postnatal staff perceptions on closeness between parents and newborns and what barriers that they can identify at their hospital is measured by interview at 3, 6 and 9 months of implementation of the intervention 9. Cost-effectiveness of the intervention is measured by interview with be | — |
Countries
Nepal
Outcome results
None listed