{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T16:47:54Z","timestamp":1787330874343,"version":"build-2736575974"},"reference-count":49,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2021,6,29]],"date-time":"2021-06-29T00:00:00Z","timestamp":1624924800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"LifeNet International"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,8,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Global and country-specific targets for reductions in maternal and neonatal mortality in low-resource settings will not be achieved without improvements in the quality of care for optimal facility-based obstetric and newborn care. This global call includes the private sector, which is increasingly serving low-resource pregnant women. The primary aim of this study was to estimate the impact of a clinical and management-training programme delivered by a non-governmental organization [LifeNet International] that partners with clinics on adherence to global standards of clinical quality during labour and delivery in rural Uganda. The secondary aim included describing the effect of the LifeNet training on pre-discharge neonatal and maternal mortality. The LifeNet programme delivered maternal and neonatal clinical trainings over a 10-month period in 2017\u201318. Direct clinical observations of obstetric deliveries were conducted at baseline (n\u2009=\u2009263 pre-intervention) and endline (n\u2009=\u2009321 post-intervention) for six faith-based, not-for-profit primary healthcare facilities in the greater Masaka area of Uganda. Direct observation comprised the entire delivery process, from initial client assessment to discharge, and included emergency management (e.g. postpartum haemorrhage and neonatal resuscitation). Data were supplemented by daily facility-based assessments of infrastructure during the study periods. Results showed positive and clinically meaningful increases in observed handwashing, observed delayed cord clamping, partograph use documentation and observed 1- and\/or 5-minute APGAR assessments (rapid scoring system for assessing clinical status of newborn), in particular, between baseline and endline. High-quality intrapartum facility-based care is critical for reducing maternal and early neonatal mortality, and this evaluation of the LifeNet intervention indicates that their clinical training programme improved the practice of quality maternal and neonatal healthcare at all six primary care clinics in Uganda, at least over a relatively short-term period. However, for several of these quality indicators, the adherence rates, although improved, were still far from 100% and could benefit from further improvement via refresher trainings and\/or a closer examination of the barriers to adherence.<\/jats:p>","DOI":"10.1093\/heapol\/czab072","type":"journal-article","created":{"date-parts":[[2021,6,26]],"date-time":"2021-06-26T19:10:14Z","timestamp":1624734614000},"page":"1103-1115","source":"Crossref","is-referenced-by-count":14,"title":["Impact evaluation of a maternal and neonatal health training intervention in private Ugandan facilities"],"prefix":"10.1093","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1783-8972","authenticated-orcid":false,"given":"Joy Noel","family":"Baumgartner","sequence":"first","affiliation":[{"name":"School of Social Work, University of North Carolina, 325 Pittsboro Street, Chapel Hill, NC 27599-3550, USA"},{"name":"Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Headley","sequence":"additional","affiliation":[{"name":"Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius","family":"Kirya","sequence":"additional","affiliation":[{"name":"LifeNet International, 64-25 Ring Road, Muyenga PO Box 21189, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josh","family":"Guenther","sequence":"additional","affiliation":[{"name":"LifeNet International, 64-25 Ring Road, Muyenga PO Box 21189, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Kaggwa","sequence":"additional","affiliation":[{"name":"LifeNet International, 64-25 Ring Road, Muyenga PO Box 21189, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Kyung","family":"Kim","sequence":"additional","affiliation":[{"name":"Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke","family":"Aldridge","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie","family":"Weiland","sequence":"additional","affiliation":[{"name":"American Leprosy Missions, Greenville, SC 29601, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Egger","sequence":"additional","affiliation":[{"name":"Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,6,29]]},"reference":[{"key":"2021082515510372800_R1","author":"American Academy of Pediatrics (AAP)","year":"2016"},{"key":"2021082515510372800_R2","author":"American Congress of Obstetricians and Gynecologists (ACOG)","year":"2015"},{"key":"2021082515510372800_R5","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-016-1141-3","article-title":"Helping Babies Breathe (HBB) training: what happens to knowledge and skills over time?","volume":"16","author":"Bang","year":"2016","journal-title":"BMC Pregnancy and Childbirth"},{"key":"2021082515510372800_R6","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0060669","article-title":"The impact of clinical social franchising on health services in low- and middle-income Countries: a systematic review","volume":"8","author":"Beyeler","year":"2013","journal-title":"PLoS One"},{"key":"2021082515510372800_R7","doi-asserted-by":"crossref","first-page":"2193","DOI":"10.1016\/S0140-6736(16)31528-8","article-title":"The scale, scope, coverage, and capability of childbirth care","volume":"388","author":"Campbell","year":"2016","journal-title":"The Lancet"},{"key":"2021082515510372800_R8","first-page":"20","article-title":"Saving mothers, giving life: it takes a system to save a mother (Republication)","volume":"7","author":"Conlon","year":"2019","journal-title":"Global Health: Science and Practice"},{"key":"2021082515510372800_R9","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1016\/S0140-6736(18)30104-1","article-title":"Countdown to 2030: tracking progress towards universal coverage for reproductive, maternal, newborn, and child health","volume":"391","author":"Countdown to 2030 Collaboration","year":"2018","journal-title":"Lancet (London, England)"},{"key":"2021082515510372800_R10","doi-asserted-by":"crossref","DOI":"10.7189\/jogh.09.010902","article-title":"\u201cEvery Newborn-BIRTH\u201d protocol: observational study validating indicators for coverage and quality of maternal and newborn health care in Bangladesh, Nepal and Tanzania","volume":"9","author":"Day","year":"2019","journal-title":"Journal of Global Health"},{"key":"2021082515510372800_R0010a","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1007\/s10995-019-02862-w","article-title":"Beneath the Surface: A Comparison of Methods for Assessment of Quality of Care for Maternal and Neonatal Health Care in Rural Uganda","volume":"24","author":"Egger","year":"2020","journal-title":"Maternal and child health journal"},{"key":"2021082515510372800_R11","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0207909","article-title":"Peer-assisted learning after onsite, low-dose, high-frequency training and practice on simulators to prevent and treat postpartum hemorrhage and neonatal asphyxia: a pragmatic trial in 12 districts in Uganda","volume":"13","author":"Evans","year":"2018","journal-title":"PLoS One"},{"key":"2021082515510372800_R12","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1177\/1536867X20931001","article-title":"xtgeebcv: a command for bias-corrected sandwich variance estimation for GEE analyses of cluster randomized trials","volume":"20","author":"Gallis","year":"2020","journal-title":"The Stata Journal"},{"key":"2021082515510372800_R13","author":"Republic of Uganda","year":"2016"},{"key":"2021082515510372800_R14","volume-title":"Cluster Randomised Trials","author":"Hayes","year":"2017","edition":"2nd"},{"key":"2021082515510372800_R15","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1093\/heapol\/czy032","article-title":"Technical quality of delivery care in private- and public-sector health facilities in Enugu and Lagos States, Nigeria","volume":"33","author":"Hirose","year":"2018","journal-title":"Health Policy and Planning"},{"key":"2021082515510372800_R16","first-page":"232","article-title":"The betterbirth program: pursuing effective adoption and sustained use of the WHO safe childbirth checklist through coaching-based implementation in Uttar Pradesh, India","volume":"5","author":"Kara","year":"2017","journal-title":"Global Health: Science and Practice"},{"key":"2021082515510372800_R17","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1198\/016214501753382309","article-title":"A note on the efficiency of sandwich covariance matrix estimation","volume":"96","author":"Kauermann","year":"2001","journal-title":"Journal of the American Statistical Association"},{"key":"2021082515510372800_R0017a","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.jclinepi.2021.02.024","article-title":"Medical record bias in documentation of obstetric and neonatal clinical quality of care indicators in Uganda","volume":"136","author":"Kim","year":"2021","journal-title":"Journal of Clinical Epidemiology"},{"key":"2021082515510372800_R18","doi-asserted-by":"crossref","first-page":"2307","DOI":"10.1016\/S0140-6736(16)31333-2","article-title":"Quality maternity care for every woman, everywhere: a call to action","volume":"388","author":"Koblinsky","year":"2016","journal-title":"The Lancet"},{"key":"2021082515510372800_R19","doi-asserted-by":"publisher","first-page":"e1196","DOI":"10.1016\/S2214-109X(18)30386-3","article-title":"High-quality health systems in the Sustainable Development Goals era: time for a revolution","volume":"6","author":"Kruk","year":"2018","journal-title":"The Lancet Global Health"},{"key":"2021082515510372800_R20","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1377\/hlthaff.2015.0902","article-title":"Evaluation of a maternal health program in Uganda And Zambia finds mixed results on quality of care and satisfaction","volume":"35","author":"Kruk","year":"2016","journal-title":"Health Affairs"},{"key":"2021082515510372800_R21","doi-asserted-by":"crossref","DOI":"10.1002\/14651858.CD005461.pub5","article-title":"Effect of partograph use on outcomes for women in spontaneous labour at term and their babies","volume":"2018","author":"Lavender","year":"2018","journal-title":"The Cochrane Database of Systematic Reviews"},{"key":"2021082515510372800_R22","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/S0140-6736(14)60496-7","article-title":"Every newborn: progress, priorities, and potential beyond survival","volume":"384","author":"Lawn","year":"2014","journal-title":"The Lancet"},{"key":"2021082515510372800_R23","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1016\/S0140-6736(16)00344-5","article-title":"Managing the public\u2013private mix to achieve universal health coverage","volume":"388","author":"McPake","year":"2016","journal-title":"The Lancet"},{"key":"2021082515510372800_R24","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1093\/heapol\/czw018","article-title":"Recent trends in working with the private sector to improve basic healthcare: a review of evidence and interventions","volume":"31","author":"Montagu","year":"2016","journal-title":"Health Policy and Planning"},{"key":"2021082515510372800_R25","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.1016\/S0140-6736(15)60251-3","article-title":"Understanding the roles of faith-based health-care providers in Africa: review of the evidence with a focus on magnitude, reach, cost, and satisfaction","volume":"386","author":"Olivier","year":"2015","journal-title":"The Lancet"},{"key":"2021082515510372800_R26","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2393-14-281","article-title":"Barriers to and incentives for achieving partograph use in obstetric practice in low- and middle-income countries: a systematic review","volume":"14","author":"Ollerhead","year":"2014","journal-title":"BMC Pregnancy and Childbirth"},{"key":"2021082515510372800_R27","doi-asserted-by":"publisher","first-page":"e1163","DOI":"10.1016\/S2214-109X(18)30398-X","article-title":"Effectiveness of strategies to improve health-care provider practices in low-income and middle-income countries: a systematic review","volume":"6","author":"Rowe","year":"2018","journal-title":"The Lancet Global Health"},{"key":"2021082515510372800_R28","doi-asserted-by":"crossref","first-page":"2313","DOI":"10.1056\/NEJMoa1701075","article-title":"Outcomes of a coaching-based who safe childbirth checklist program in India","volume":"377","author":"Semrau","year":"2017","journal-title":"The New England Journal of Medicine"},{"key":"2021082515510372800_R29","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0234320","article-title":"Effectiveness of utilizing the WHO safe childbirth checklist on improving essential childbirth practices and maternal and perinatal outcome: A systematic review and meta-analysis","volume":"15","author":"Tolu","year":"2020","journal-title":"PLoS One"},{"key":"2021082515510372800_R30","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1111\/1471-0528.13451","article-title":"Quality of care for pregnant women and newborns\u2014the WHO vision","volume":"122","author":"Tun\u00e7alp","year":"2015","journal-title":"BJOG: An International Journal of Obstetrics and Gynaecology"},{"key":"2021082515510372800_R31","volume-title":"Uganda Demographic and Health Survey 2016","author":"Uganda Bureau of Statistics (UBOS) and ICF","year":"2018"},{"key":"2021082515510372800_R32","volume-title":"Uganda Demographic and Health Survey 2011","author":"Uganda Bureau of Statistics (UBOS) and ICF International Inc","year":"2012"},{"key":"2021082515510372800_R33","volume-title":"Uganda Demographic and Health Survey 2006","author":"Uganda Bureau of Statistics (UBOS) and Macro International Inc","year":"2007"},{"key":"2021082515510372800_R34","author":"USAID & Maternal and Child Health Integrated Program (MCHIP)","year":"2013"},{"key":"2021082515510372800_R35","author":"USAID & Maternal and Child Health Integrated Program (MCHIP)","year":"2013"},{"key":"2021082515510372800_R36","volume-title":"WHO Recommendations for Prevention and Treatment of Pre-Eclampsia and Eclampsia","author":"WHO","year":"2011"},{"key":"2021082515510372800_R37","volume-title":"Guidelines on Basic Newborn Resuscitation","author":"WHO","year":"2012"},{"key":"2021082515510372800_R38","author":"WHO","year":"2012"},{"key":"2021082515510372800_R40","volume-title":"World Health Organization","author":"WHO","year":"2014"},{"key":"2021082515510372800_R39","author":"WHO","year":"2014"},{"key":"2021082515510372800_R41","volume-title":"World Health Organization","author":"WHO","year":"2015"},{"key":"2021082515510372800_R42","volume-title":"WHO Safe Childbirth Checklist Implementation Guide","author":"WHO","year":"2015"},{"key":"2021082515510372800_R43","volume-title":"Pregnancy, Childbirth, Postpartum and Newborn Care: A Guide for Essential Practice, 3rd Edition","author":"WHO","year":"2015"},{"key":"2021082515510372800_R44","volume-title":"World Health Organization","author":"WHO","year":"2016"},{"key":"2021082515510372800_R45","volume-title":"WHO Recommendations on Newborn Health: Guidelines Approved by the WHO Guidelines Review Committee","author":"WHO","year":"2017"},{"key":"2021082515510372800_R46","volume-title":"Primary Health Care Systems (PRIMASYS): Case Study from Uganda, Abridged Version","author":"WHO","year":"2017"},{"key":"2021082515510372800_R47","volume-title":"WHO Recommendations: Intrapartum Care for a Positive Childbirth Experience","author":"WHO","year":"2018"},{"key":"2021082515510372800_R48","author":"WHO, OECD & International Bank for Reconstruction and Development","year":"2018"},{"key":"2021082515510372800_R50","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1093\/aje\/kwh090","article-title":"A modified poisson regression approach to prospective studies with binary data","volume":"159","author":"Zou","year":"2004","journal-title":"American Journal of Epidemiology"}],"container-title":["Health Policy and Planning"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/heapol\/article-pdf\/36\/7\/1103\/39905015\/czab072.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/heapol\/article-pdf\/36\/7\/1103\/39905015\/czab072.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,25]],"date-time":"2021-08-25T15:51:40Z","timestamp":1629906700000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/heapol\/article\/36\/7\/1103\/6310919"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,29]]},"references-count":49,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,6,29]]},"published-print":{"date-parts":[[2021,8,12]]}},"URL":"https:\/\/doi.org\/10.1093\/heapol\/czab072","relation":{},"ISSN":["1460-2237"],"issn-type":[{"value":"1460-2237","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,8,1]]},"published":{"date-parts":[[2021,6,29]]}}}