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There are scarce resources and\/or support implementation of evidence-based training programs. SaferBirths Bundle of Care is a well-proven package of innovative tools coupled with data-driven on-the-job training aimed at reducing perinatal and maternal deaths. The aim of this project is to determine the effect of scaling up the bundle on improving quality of intrapartum care and perinatal survival.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>The project will follow a stepped-wedge cluster implementation design with well-established infrastructures for data collection, management, and analysis in 30 public health facilities in regions in Tanzania. Healthcare workers from selected health facilities will be trained in basic neonatal resuscitation, essential newborn care and essential maternal care. Foetal heart rate monitors (Moyo), neonatal heart rate monitors (NeoBeat) and skills trainers (NeoNatalie Live) will be introduced in the health facilities to facilitate timely identification of foetal distress during labour and improve neonatal resuscitation, respectively. Heart rate signal-data will be automatically collected by Moyo and NeoBeat, and newborn resuscitation training by NeoNatalie Live.<\/jats:p>\n                <jats:p>Given an average of 4000 baby-mother pairs per year per health facility giving an estimate of 240,000 baby-mother pairs for a 2-years duration, 25% reduction in perinatal mortality at a two-sided significance level of 5%, intracluster correlation coefficient (ICC) to be 0.0013, the study power stands at 0.99.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Discussion<\/jats:title>\n                <jats:p>Previous reports from small-scale Safer Births Bundle implementation studies show satisfactory uptake of interventions with significant improvements in quality of care and lives saved. Better equipped and trained birth attendants are more confident and skilled in providing care. Additionally, local data-driven feedback has shown to drive continuous quality of care improvement initiatives, which is essential to increase perinatal and maternal survival. Strengths of this research project include integration of innovative tools with existing national guidelines, local data-driven decision-making and training. Limitations include the stepwise cluster implementation design that may lead to contamination of the intervention, and\/or inability to address the shortage of healthcare workers and medical supplies beyond the project scope.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>Name of Trial Registry: ISRCTN Registry.<\/jats:p>\n                <jats:p>Trial registration number: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/doi.org\/10.1186\/ISRCTN30541755\">ISRCTN30541755<\/jats:ext-link>.<\/jats:p>\n                <jats:p>Date of Registration: 12\/10\/2020.<\/jats:p>\n                <jats:p>Type of registration: Prospectively Registered.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12913-021-07145-1","type":"journal-article","created":{"date-parts":[[2021,10,18]],"date-time":"2021-10-18T23:02:29Z","timestamp":1634598149000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["SaferBirths bundle of care protocol: a stepped-wedge cluster implementation project in 30 public health-facilities in five regions, Tanzania"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8969-2685","authenticated-orcid":false,"given":"Benjamin A.","family":"Kamala","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hege L.","family":"Ersdal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Estomih","family":"Mduma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Moshiro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sakina","family":"Girnary","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ole Terje","family":"\u00d8strem","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f8rgen","family":"Linde","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ingvild","family":"Dalen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elsa","family":"S\u00f8yland","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dunstan R.","family":"Bishanga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix Ambrose","family":"Bundala","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad M.","family":"Makuwani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boniphace Marwa","family":"Richard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pius David","family":"Muzzazzi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivony","family":"Kamala","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paschal F.","family":"Mdoe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,10,18]]},"reference":[{"key":"7145_CR1","volume-title":"A Neglected Tragedy The global burden of stillbirths","author":"UN IGME","year":"2020","unstructured":"UN IGME. 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Ethical approval to conduct the study and publish the protocol has been received from the Tanzania National Institute for Medical Research (Ref. NIMR\/HQ\/R.8a\/Vol.IX\/3458). The administration team in all included regions and health facilities have been informed and agreed to participate. All women admitted to the labour ward for delivery will be informed about the quality improvement project. They will be informed about the tools to be used for FHR monitoring (Moyo and Pinard), and newborn resuscitation (NeoBeat and Upright bag mask). Waiver of consent was applied and granted by the national ethical review board because this is a quality improvement project. However, all data collected during labour and delivery, which will be used for evaluation of the CQI program will be de-identified to ensure confidentiality.For the qualitative studies, only women and healthcare workers above 18\u2009years will be recruited. Written informed consent will be obtained from both recruited women and healthcare workers who will be interviewed. All research assistants and investigators in the project will be trained on good clinical practice, research ethics, research integrity and confidentiality, before starting the project. Electronic data will be stored in a password protected secure research server at Haydom Lutheran Hospital with access control, and hard data copies will be stored in secure locked cabinets in the research centre at Haydom.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"This is the study protocol, and no identifying data is being presented in this manuscript therefore consent to publish is not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Neither Global Financing Facility nor UNICEF has influenced the design of the study protocol. All authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1117"}}