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Table 2 Proposed actions, targeted cause of death and behaviour

From: The Uganda Newborn Study (UNEST): an effectiveness study on improving newborn health and survival in rural Uganda through a community-based intervention linked to health facilities - study protocol for a cluster randomized controlled trial

Intervention Cause of death addressed Behaviour addressed
Community worker: pregnancy visit 1 and 2
Community health worker: pregnancy visit   
• Counsel on and refer for ANC including TT, IPT and ITNs • Neonatal tetanus, risk associated w/ maternal malaria • Low four-visit ANC rate, low malaria treatment rate
• Counsel on birth preparedness and use of clean delivery practices • All causes • Poor delivery practices
• Assess and counsel on danger signs of pregnancy • Prematurity, infection • Low HF use rate for emergencies
• Counsel on and refer for HIV testing for PMTCT • HIV/AIDs transmission • Lack of understanding of HIV/AIDs
• Introduce key neonatal behaviours such as immediate initiation of breastfeeding, delayed bathing, immediate wrapping, skin and cord hygiene, and skin-to-skin care • All causes • Poor delivery practices
Pregnancy visit 2
• Counsel on birth preparedness • Infection • Low HF use, lack of awareness
• Assess for maternal danger signs and refer if present • All causes • As above
• Counsel on clean delivery practices • Infection • Lack of awareness
• Counsel on immediate maternal and newborn care practices   • Lack of awareness
• Counsel on newborn danger signs   
Community worker: postnatal visit 1 and 2
Postnatal visit 1: birthday to day 2
• Screen for and counsel on maternal and newborn danger signs and refer if present • Prematurity, infection • Lack of HF use, lack of awareness
• Support temperature management (skin-to-skin for all babies, delayed bathing, and wrapping) • Risk from low birth weight, infection • Lack of HF use
• Support immediate and exclusive breastfeeding • Hypothermia • Low HF use for deliveries
• Encourage cleanliness especially cord care • Overall risk, infection • Lack of compliance
  • Infection • Low HF use for deliveries
  • Prematurity, infection • Low awareness
  • Hypothermia, infection • Low HF use for deliveries, awareness
  • Risk from immunizable diseases • Low TT and other EPI rates
  • Overall risk, infection • As above
Postnatal visit 2 and 3: day 3 and day 5 and 7 after birth
• Assess for maternal and newborn danger signs and refer if necessary   
• Refer for immunization   
• Counsel mother on breastfeeding and birth spacing   
If very low birth weight suspected 1
• Refer if also danger sign present or two extra visits to support home care (breast-feeding, warmth, early danger sign recognition) if no danger sign or referral not possible   
• Promote temperature management (skin-to-skin, wrapping and delayed bathing)   
• Assist with feeding if needed   
• Attention to hygiene   
Health facility strengthening
• Training • Sepsis • Poor quality of care, low HF use for deliveries, inadequate equipment
• Provision of supplies and medicines • Sepsis
• Improved sepsis management at lower HF • Sepsis
• Supervision and monitoring • Overall risk
  1. EPI, expanded programme of immunization; IPT, intermittent presumptive treatment; ITN, insecticide-treated net; HF, health facility; PMTCT, preventing mother-to-child transmission; TT, tetanus toxoid immunization.