{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T02:07:18Z","timestamp":1784945238689,"version":"3.55.0"},"reference-count":12,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,10,13]],"date-time":"2023-10-13T00:00:00Z","timestamp":1697155200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,10,13]],"date-time":"2023-10-13T00:00:00Z","timestamp":1697155200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Educ"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Limited diagnostic capabilities, resources and health worker skills have deterred the advancement of birth defects surveillance systems in most low- and middle-income countries (LMICs). Empowering health workers to identify and diagnose major external birth defects (BDs) is crucial to establishing effective hospital-based BD surveillance. Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration BD Surveillance System consists of three diagnostic levels: (1) surveillance midwives, (2) MU-JHU clinical team, and (3) U.S. Centers for Disease Control and Prevention (CDC) birth defects subject matter experts (SMEs) who provide confirmatory diagnosis. The diagnostic concordance of major external BDs by surveillance midwives or MU-JHU clinical team with CDC birth defects SMEs were estimated.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Study staff went through a series of trainings, including birth defects identification and confirmation, before surveillance activities were implemented. To assess the diagnostic concordance, we analyzed surveillance data from 2015 to 2021 for major external BDs: anencephaly, iniencephaly, encephalocele, spina bifida, craniorachischisis, microcephaly, anophthalmia\/microphthalmia, anotia\/microtia, cleft palate alone, cleft lip alone, cleft lip with cleft palate, imperforate anus, hypospadias, talipes equinovarus, limb reduction, gastroschisis, and omphalocele. Positive predictive value (PPV) as the proportion of BDs diagnosed by surveillance midwives or MU-JHU clinical team that were confirmed by CDC birth defects SMEs was computed. PPVs between 2015 and 2018 and 2019\u20132021 were compared to assess the accuracy of case diagnosis over time.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of the 204,332 infants examined during 2015\u20132021, 870 infants had a BD. Among the 1,245 BDs identified, 1,232 (99.0%) were confirmed by CDC birth defects SMEs. For surveillance midwives, PPV for 7 of 17 BDs was &gt;\u200980%. For the MU-JHU clinical team, PPV for 13 of 17 BDs was &gt;\u200980%. Among surveillance midwives, PPV improved significantly from 2015 to 2018 to 2019\u20132021, for microcephaly (+\u200950.0%), cleft lip with cleft palate (+\u200917.0%), imperforate anus (+\u200930.0%), and talipes equinovarus (+\u200910.8%). Improvements in PPV were also observed among MU-JHU clinical team; however, none were significant.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The diagnostic accuracy of the midwives and clinical team increased, highlighting that BD surveillance, by front-line health care workers (midwives) in LMICs is possible when midwives receive comprehensive training, technical support, funding and continuous professional development.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12909-023-04760-w","type":"journal-article","created":{"date-parts":[[2023,10,13]],"date-time":"2023-10-13T17:02:20Z","timestamp":1697216540000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Strengthening capacity of health workers to diagnose birth defects in Ugandan hospitals from 2015 to 2021"],"prefix":"10.1186","volume":"23","author":[{"given":"Joyce","family":"Namale-Matovu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald","family":"Kusolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Serunjogi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Barlow-Mosha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Mumpe-Mwanja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Niombi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis","family":"Kalibbala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhelia","family":"Williamson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Valencia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia A.","family":"Moore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Mwambi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa J.","family":"Nelson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phoebe Monalisa","family":"Namukanja-Mayambala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cara T.","family":"Mai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan Ping","family":"Qi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippa","family":"Musoke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,10,13]]},"reference":[{"key":"4760_CR1","unstructured":"World Health Organization., Birth defects surveillance training: facilitator\u2019s guide 2015."},{"key":"4760_CR2","unstructured":"Christianson A, Howson CP, Modell B. March of Dimes: global report on birth defects, the hidden toll of dying and disabled children March of Dimes: global report on birth defects, the hidden toll of dying and disabled children., 2005."},{"issue":"1","key":"4760_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12884-019-2542-x","volume":"19","author":"D Mumpe-Mwanja","year":"2019","unstructured":"Mumpe-Mwanja D, et al. A hospital-based birth defects surveillance system in Kampala, Uganda. BMC Pregnancy Childbirth. 2019;19(1):1\u20139.","journal-title":"BMC Pregnancy Childbirth"},{"issue":"9492","key":"4760_CR4","doi-asserted-by":"publisher","first-page":"1142","DOI":"10.1016\/S0140-6736(05)67459-4","volume":"366","author":"RH Carmona","year":"2005","unstructured":"Carmona RH. The global challenges of birth defects and disabilities. The Lancet. 2005;366(9492):1142\u20134.","journal-title":"The Lancet"},{"issue":"6","key":"4760_CR5","doi-asserted-by":"publisher","first-page":"e0000662","DOI":"10.1371\/journal.pgph.0000662","volume":"2","author":"D Kalibbala","year":"2022","unstructured":"Kalibbala D, et al. Mobile tablets for real-time data collection for hospital-based birth defects surveillance in Kampala, Uganda: lessons learned. PLOS Global Public Health. 2022;2(6):e0000662.","journal-title":"PLOS Global Public Health"},{"key":"4760_CR6","doi-asserted-by":"crossref","unstructured":"Namale-Matovu J et al. Overcoming staffing challenges when implementing a birth defects surveillance system: a Ugandan experience. J Global Health Rep, 2020. 4.","DOI":"10.29392\/001c.12503"},{"key":"4760_CR7","unstructured":"WHO\/CDC\/ICBDSR. Birth defects surveillance: a manual for programme managers. World Health Organization: Geneva; 2014."},{"key":"4760_CR8","unstructured":"Flores A et al. Building capacity for birth defects surveillance in Africa: implementation of an intermediate birth defects surveillance workshop Journal of global health perspectives, 2015. 2015."},{"key":"4760_CR9","unstructured":"Pamela, Achom. Understaffing at Kawempe Referral Hospital Is Overwhelming Maternity Ward. 2021."},{"key":"4760_CR10","doi-asserted-by":"publisher","first-page":"989","DOI":"10.2147\/JMDH.S228951","volume":"12","author":"GT Feyissa","year":"2019","unstructured":"Feyissa GT, Balabanova D, Woldie M. How effective are Mentoring Programs for Improving Health Worker Competence and institutional performance in Africa? A systematic review of quantitative evidence. J Multidiscip Healthc. 2019;12:989\u20131005.","journal-title":"J Multidiscip Healthc"},{"key":"4760_CR11","unstructured":"Organization WH, Control CfD, Prevention. Birth defects surveillance: a manual for programme managers 2020."},{"issue":"1","key":"4760_CR12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1478-4491-10-9","volume":"10","author":"D Rouleau","year":"2012","unstructured":"Rouleau D, et al. The effects of midwives\u2019 job satisfaction on burnout, intention to quit and turnover: a longitudinal study in Senegal. Hum Resour Health. 2012;10(1):1\u201314.","journal-title":"Hum Resour Health"}],"container-title":["BMC Medical Education"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12909-023-04760-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12909-023-04760-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12909-023-04760-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,19]],"date-time":"2023-11-19T07:13:39Z","timestamp":1700378019000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmededuc.biomedcentral.com\/articles\/10.1186\/s12909-023-04760-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,13]]},"references-count":12,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["4760"],"URL":"https:\/\/doi.org\/10.1186\/s12909-023-04760-w","relation":{},"ISSN":["1472-6920"],"issn-type":[{"value":"1472-6920","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,13]]},"assertion":[{"value":"25 June 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 October 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 October 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the funding agencies.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclaimer"}},{"value":"This study and all methods involved were performed in accordance with the ethical principles for medical research involving human subjects, stipulated within the WMA declaration of Helsinki. Informed (written) consent was received from all participants. This study was reviewed and approved by the CDC Institutional Review Board (protocol #6606), the Joint Clinical Research Center (JCRC) Institutional Review Board, and the Uganda National Council for Science and Technology (UNCST).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Consent for publication is not applicable. No individual person\u2019s data was included in the manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"766"}}