{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T03:44:45Z","timestamp":1774928685910,"version":"3.50.1"},"reference-count":21,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Global Financing Facility","award":["SC200411"],"award-info":[{"award-number":["SC200411"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Neonatal mortality remains a significant public health challenge in Ethiopia. Despite efforts to implement key evidence-based interventions, their coverage and utilization remain low. The Saving Little Lives (SLL) program aims to scale-up a Minimum Care Package (MCP) of synergistic, life-saving interventions for all liveborn neonates, with a focus on preterm and low birth weight (LBW) infants, across 290 hospitals in Ethiopia (206 primary, 69 general, and 15 referral hospitals), representing 82% of all hospitals in the country at the time of the study, and evaluate the impact on neonatal mortality. Methods: A non-randomized stepped-wedge trial will be conducted to evaluate the impact of implementing the SLL MCP interventions. Quantitative evaluation data will be collected from 36 primary hospitals, selected from 206 primary hospitals across four regions, receiving the interventions. An independent evaluation research assistant will be deployed in each of the hospitals to collect data using Open Data Kit (ODK) through interviewing mothers before discharge, on the 29th day of life if discharged, and reviewing medical records. A mixed-method, cross-sectional formative assessment will be conducted prior to implementation, employing quantitative facility assessment and qualitative interviews with mothers, healthcare providers, and facility managers. This will be followed by continuous program learning assessment once implementation begins. Descriptive data will be presented using numbers, percentages, tables, and graphs. Regression modeling and generalized estimating equations (GEEs) will be used to estimate the impact of the SLL MCP interventions. Qualitative data will be gathered through in-depth interviews, digitally recorded, transcribed, and thematically analyzed using ATLAS.ti Version 7.5 software to assess facility readiness, barriers, and enablers of implementing the SLL MCP interventions. Expected Outcome: We hypothesize that achieving 80% coverage of the SLL MCP interventions among eligible neonates will result in a 35% reduction in neonatal mortality at implementation facilities.<\/jats:p>","DOI":"10.3390\/children13020187","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T10:08:57Z","timestamp":1769681337000},"page":"187","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Saving Little Lives Minimum Care Package Interventions in 290 Public Health Facilities in Ethiopia: Protocol for a Non-Randomized Stepped-Wedge Cluster Implementation Trial"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6833-9823","authenticated-orcid":false,"given":"Abiy Seifu","family":"Estifanos","sequence":"first","affiliation":[{"name":"Center for Implementation Sciences (CIS) in Health, School of Public Health, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia"},{"name":"Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abebe Gebremaraim","family":"Gobezayehu","sequence":"additional","affiliation":[{"name":"Emory University Ethiopia Office, Addis Ababa P.O. Box 9086, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mekdes Shifeta","family":"Argaw","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health School of Medicine, College of Medicine and Health Sciences, Hawassa University, Hawassa P.O. Box 1560, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9328-684X","authenticated-orcid":false,"given":"Araya Abrha","family":"Medhanyie","sequence":"additional","affiliation":[{"name":"School of Public Health, College of Health Sciences, Mekelle University, Mekelle P.O. Box 1871, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Damen","family":"Hailemariam","sequence":"additional","affiliation":[{"name":"Center for Implementation Sciences (CIS) in Health, School of Public Health, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia"},{"name":"Department of Health Systems and Health Policy, School of Public Health, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bezaye Nigussie","family":"Kassahun","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health School of Medicine, College of Medicine and Health Sciences, Hawassa University, Hawassa P.O. Box 1560, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2595-5885","authenticated-orcid":false,"given":"Selamawit Asfaw","family":"Beyene","sequence":"additional","affiliation":[{"name":"School of Public Health, College of Health Sciences, Mekelle University, Mekelle P.O. Box 1871, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henok","family":"Tadele","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3293-9237","authenticated-orcid":false,"given":"Lamesgin Alamineh","family":"Endalamaw","sequence":"additional","affiliation":[{"name":"Emory University Ethiopia Office, Addis Ababa P.O. Box 9086, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2985-7240","authenticated-orcid":false,"given":"Abebech Demissie","family":"Aredo","sequence":"additional","affiliation":[{"name":"Center for Implementation Sciences (CIS) in Health, School of Public Health, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1242-4508","authenticated-orcid":false,"given":"Znabu Hadush","family":"Kahsay","sequence":"additional","affiliation":[{"name":"School of Public Health, College of Health Sciences, Mekelle University, Mekelle P.O. Box 1871, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4195-0243","authenticated-orcid":false,"given":"Kehabtimer Shiferaw","family":"Kotiso","sequence":"additional","affiliation":[{"name":"Ethiopian Pediatrics Society, Addis Ababa P.O. Box 14205, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akalewold","family":"Alemayehu","sequence":"additional","affiliation":[{"name":"School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa P.O. Box 1560, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0033-9450","authenticated-orcid":false,"given":"Mulusew Lijalem","family":"Belew","sequence":"additional","affiliation":[{"name":"Emory University Ethiopia Office, Addis Ababa P.O. Box 9086, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanuel Hadgu","family":"Berhe","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Mekelle P.O. Box 231, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simret Niguse","family":"Weldebirhan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Mekelle P.O. Box 231, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asrat","family":"Dimtse","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mesay Hailu","family":"Dangisso","sequence":"additional","affiliation":[{"name":"Ethiopian Public Health Institute, Addis Ababa P.O. Box 1242, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5425-1126","authenticated-orcid":false,"given":"Samson Yohannes","family":"Amare","sequence":"additional","affiliation":[{"name":"School of Computing, Ethiopian Institute of Technology-Mekelle, Mekelle University, Mekelle P.O. Box 1871, Tigray, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yayeh","family":"Negash","sequence":"additional","affiliation":[{"name":"United Nations Children\u2019s Fund, Addis Ababa P.O. Box 1169, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abrham","family":"Tariku","sequence":"additional","affiliation":[{"name":"Ministry of Health, Riyadh P.O. Box 21217, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Cramer","sequence":"additional","affiliation":[{"name":"Implementation Science in Global Reproductive Health (Ethiopia), Emory University, Atlanta, GA 30322, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4305-141X","authenticated-orcid":false,"given":"Siren","family":"Rettedal","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of Stavanger, 4068 Stavanger, Norway"},{"name":"Department of Paediatrics, Stavanger University Hospital, 4068 Stavanger, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abebe","family":"Bekele","sequence":"additional","affiliation":[{"name":"Oromia Regional Bureau, Addis Ababa P.O. Box 24341, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1405-0047","authenticated-orcid":false,"given":"Fisseha Ashebir","family":"Gebregizabher","sequence":"additional","affiliation":[{"name":"Tigray Regional Health Bureau, Mekelle P.O. Box 07, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Selamawit Mengesha","family":"Bilal","sequence":"additional","affiliation":[{"name":"Sidama Regional Health Bureau, Hawassa P.O. Box 149, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meseret Zelalem","family":"Tadesse","sequence":"additional","affiliation":[{"name":"Ministry of Health, Riyadh P.O. Box 21217, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dereje","family":"Duguma","sequence":"additional","affiliation":[{"name":"Ministry of Health, Riyadh P.O. Box 21217, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"key":"ref_1","unstructured":"(2024, March 13). United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME), Levels & Trends in Child Mortality: Report 2023, Estimates Developed by the United Nations Inter-Agency Group for Child Mortality Estimation, United Nations Children\u2019s Fund, New York, 2024. Available online: https:\/\/data.unicef.org\/wp-content\/uploads\/2024\/03\/UNICEF-2023-Child-Mortality-Report-1.pdf."},{"key":"ref_2","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":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e849","DOI":"10.1016\/S2214-109X(18)30565-5","article-title":"National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: A systematic analysis","volume":"7","author":"Blencowe","year":"2019","journal-title":"Lancet Glob. Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e1130","DOI":"10.1016\/S2214-109X(19)30220-7","article-title":"Major causes of death in preterm infants in selected hospitals in Ethiopia (SIP): A prospective, cross-sectional, observational study","volume":"7","author":"Muhe","year":"2019","journal-title":"Lancet Glob. Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1159\/000530496","article-title":"Ending Preventable Neonatal Deaths: Multicountry Evidence to Inform Accelerated Progress to the Sustainable Development Goal by 2030","volume":"120","author":"Lawn","year":"2023","journal-title":"Neonatology"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"(2023). Care of Preterm or Low Birthweight Infants, G. New World Health Organization recommendations for care of preterm or low birth weight infants: Health policy. 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