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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.