Implementing change for facility-based peripartum care in low-income and middle-income countries

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The quality gap in facility care for small and sick neonates in low-income and middle-income countries has to be bridged to achieve 12 or fewer deaths per 1,000 livebirths.

Dilys Walker and colleagues did a cluster-randomised facility-based trial in Kenya and Uganda to evaluate the effect of a multifaceted intervention on fresh stillbirth and neonatal mortality among preterm and low-birthweight births.

In the available literature, maternal mortality, stillbirths, and early neonatal mortality have been shown to be linked, but stillbirths are often not included in the studies even though fresh stillbirths are a key indicator of intrapartum care. By contrast, Walker and colleagues included stillbirths as a key target of the implemented package of care.

The investigators strengthened data collection and introduced a modified Safe Childbirth Checklist in all 20 sites.

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