{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T12:25:04Z","timestamp":1787660704493,"version":"build-2736575974"},"reference-count":30,"publisher":"Ubiquity Press, Ltd.","issue":"1","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["89"],"abstract":"<jats:p>Background: Despite notable progress in inpatient neonatal care expansion in Tanzania, expanding from 14 facilities in 2018 to 362 by 2025, a critical survival gap persists during the post\u2011discharge transition. National policies heavily prioritize pre\u2011discharge mortality, leaving the high\u2011risk, 60\u2011day post\u2011discharge window unaddressed. This study evaluates targeted policy, financing, and digital health interventions designed to mitigate post\u2011discharge neonatal mortality.\nMethods: We analyzed integrated implementation pathways within the Tanzanian health sector, specifically examining the institutional feasibility, scaling capacity, and clinical outcomes of the NEST360 Implementation Tracker (NEST\u2011IT) and the Essential Coaching for Every Mother Tanzania (ECEM\u2011TZ) mobile health framework.\nResults: Implementation data demonstrate that NEST\u2011IT is a highly viable data\u2011surveillance tool, achieving a 93% feasibility rate for daily clinical use and providing real\u2011time data to drive national quality improvement targets. Concurrently, the ECEM\u2011TZ digital platform effectively circumvents nurse\u2011midwife resource limitations by providing a 54\u2011message educational framework that improves caregiver knowledge and triples postnatal check\u2011up attendance.\nConclusion: Eliminating post\u2011discharge mortality requires expanding longitudinal care frameworks. To achieve Tanzania\u2019s national target of 15 neonatal deaths per 1000 live births, strategic imperatives must include institutionalizing zero\u2011rated mHealth tools, formalizing community health worker follow\u2011up protocols, and explicitly integrating specialized outpatient neonatal services into the standard benefit package of the 2026 universal health insurance rollout.<\/jats:p>","DOI":"10.5334\/aogh.5442","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T11:49:03Z","timestamp":1787658543000},"page":"83","source":"Crossref","is-referenced-by-count":0,"title":["Bridging the Survival Gap: Strengthening Post\u2011Discharge Care for Preterm Infants in Tanzania"],"prefix":"10.5334","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-9394-5399","authenticated-orcid":false,"given":"Erick","family":"Mahatara","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelvin","family":"Musa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Jerome","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3653-9213","authenticated-orcid":false,"given":"Linda Paul","family":"Athman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3285","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"1","doi-asserted-by":"crossref","unstructured":"Shabani J, Salim N, Bohne C, et al. Neonatal indicator data in Tanzania District Health Information System: Evaluation of availability and quality of selected newborn indicators, 2015\u20112022. BMC Pediatr. 2025;23(Suppl 2):658. doi:10.1186\/s12887-025-05417-x. PubMed PMID: 39849367; PubMed Central PMCID: PMC11755859.","DOI":"10.1186\/s12887-025-05417-x"},{"key":"2","unstructured":"Ministry of Health, Community Development, Gender, Elderly and Children, The United Republic of Tanzania. Draft Health Sector Analytical Review \u2011 2019. Published 2019. Accessed April 21, 2026. https:\/\/www.healthdatacollaborative.org\/fileadmin\/uploads\/hdc\/Documents\/Working_Groups\/RHIS\/B._Country-specific_documentation__case_studies__best_practices_\/RHIS_data_use_in_natonal_health_sector_reviews\/Official_RHIS_reports\/Tanzania_-_Draft__Health_Sector_Analytical_Review_-_2019.pdf."},{"key":"3","doi-asserted-by":"crossref","unstructured":"Abdallah Y, Namiiro F, Nankunda J, Mugalu J, Vaucher Y. Mortality among very low birth weight infants after hospital discharge in a low resource setting. BMC Pediatr. 2018;18(1):239. doi:10.1186\/s12887-018-1226-4.","DOI":"10.1186\/s12887-018-1226-4"},{"key":"4","doi-asserted-by":"crossref","unstructured":"Winkler LA, Stypulkowski A, Noon S, et al. A multi\u2011year analysis of kangaroo mother care outcomes in low birth weight babies at a Nyakahanga Hospital in rural Tanzania. Afr Health Sci. 2020;20(1):498\u2013508. doi:10.4314\/ahs.v20i1.56. PubMed PMID: 33402938; PubMed Central PMCID: PMC7750084.","DOI":"10.4314\/ahs.v20i1.56"},{"key":"5","doi-asserted-by":"crossref","unstructured":"Rees CA, Ideh RC, Kisenge R, et al. Identifying neonates at risk for post\u2011discharge mortality in Dar es Salaam, Tanzania, and Monrovia, Liberia: Derivation and internal validation of a novel risk assessment tool. BMJ Open. 2024;14(2):e079389. doi:10.1136\/bmjopen-2023-079389. PubMed PMID: 38365298; PubMed Central PMCID: PMC10875550.","DOI":"10.1136\/bmjopen-2023-079389"},{"key":"6","doi-asserted-by":"crossref","unstructured":"Isack MN, Mkoka DA, Zheng X. Mapping the implementation of neonatal care guidelines in sub\u2011Saharan Africa: A protocol for a scoping review of rates, barriers, facilitators and strategies using Tanzania as a case study. BMJ Open. 2026;16(3):e115670. doi:10.1136\/bmjopen-2025-115670.","DOI":"10.1136\/bmjopen-2025-115670"},{"key":"7","doi-asserted-by":"crossref","unstructured":"Msonda T, Moshiro R, Salim N, Naburi H. Trends in mortality and associated factors among neonates hospitalized at Muhimbili National Hospital, Tanzania: A three\u2011year retrospective study. PLoS One. 2024;19(11):e0310256. doi:10.1371\/journal.pone.0310256. PubMed PMID: 39514588; PubMed Central PMCID: PMC11548724.","DOI":"10.1371\/journal.pone.0310256"},{"key":"8","doi-asserted-by":"crossref","unstructured":"Bundala FA, Kamala BA, Moshiro R, et al. Availability and functioning of neonatal care units and neonatal mortality across five regions in Tanzania: A baseline cross\u2011sectional study in 127 CEmONC health facilities. BMJ Glob Health. 2025;10(5):e018758. doi:10.1136\/bmjgh-2024-018758.","DOI":"10.1136\/bmjgh-2024-018758"},{"key":"9","doi-asserted-by":"crossref","unstructured":"Isack MN, Mkoka DA, Zheng X. Mapping the implementation of neonatal care guidelines in sub\u2011Saharan Africa: A protocol for a scoping review of rates, barriers, facilitators and strategies using Tanzania as a case study. BMJ Open. 2026;21(621):e115670. doi:10.1136\/bmjopen-2025-115670.","DOI":"10.1136\/bmjopen-2025-115670"},{"key":"10","unstructured":"The Citizen. Tanzania\u2019s parents of premature babies call for national fund as care costs soar. Published 2026. Accessed April 21, 2026. https:\/\/www.thecitizen.co.tz\/tanzania\/news\/national\/tanzania-s-parents-of-premature-babies-call-for-national-fund-as-care-costs-soar-5381634."},{"key":"11","unstructured":"National Health Insurance Fund (NHIF), Ministry of Health, The United Republic of Tanzania. Price Schedule for NHIF Certified Health Facilities: Level III & IV Hospitals (Zonal and National Referral Level Facilities) \u2013 Benefit Package of Medical Services. 2024."},{"key":"12","unstructured":"Mutheu J. Together from the start: Tanzania unveils Zero Separation Care for mothers and newborns. Willow Health Media. Published 2026. Accessed April 21, 2026. https:\/\/willowhealthmedia.org\/together-from-the-start-tanzania-unveils-zero-separation-care-for-mothers-and-newborns\/."},{"key":"13","doi-asserted-by":"crossref","unstructured":"Chamhene N, Moshi FV. Level of knowledge on Kangaroo Mother Care and its associated factors among postnatal mothers with preterm babies in central Tanzania: Hospital\u2011based cross\u2011sectional study. SAGE Open Nurs. 2023;9:23779608231167813. doi:10.1177\/23779608231167813. PubMed PMID: 37077287; PubMed Central PMCID: PMC10107378.","DOI":"10.1177\/23779608231167813"},{"key":"14","doi-asserted-by":"crossref","unstructured":"Lomotey AY, James S, Ricks E. Navigating the care of preterm babies: Physical care challenges and psychosocial stressors of adolescent mothers in Ghana. BMC Pregnancy Childbirth. 2026;26(1):281. doi:10.1186\/s12884-026-08669-2. PubMed PMID: 41566253; PubMed Central PMCID: PMC12990419.","DOI":"10.1186\/s12884-026-08669-2"},{"key":"15","doi-asserted-by":"crossref","unstructured":"Nsubuga R, Rujumba J, Nyende S, Kisaka S, Idro R, Nankunda J. Predictors of mortality among low birth weight neonates after hospital discharge in a low\u2011resource setting: A case study in Uganda. PLoS One. 2024;19(6):e0303454. doi:10.1371\/journal.pone.0303454. PubMed PMID: 38861517; PubMed Central PMCID: PMC11166315.","DOI":"10.1371\/journal.pone.0303454"},{"key":"16","doi-asserted-by":"crossref","unstructured":"Sujon MSH, Ahmmad J, Sumon IH, et al. Risk factors of under\u2011five mortality in Tanzania: Insights from the Tanzania Demographic and Health Survey 2022. BMJ Glob Health. 2025;10(7):e018133. doi:10.1136\/bmjgh-2024-018133. PubMed PMID: 40681304; PubMed Central PMCID: PMC12273128.","DOI":"10.1136\/bmjgh-2024-018133"},{"key":"17","doi-asserted-by":"crossref","unstructured":"Geldsetzer P, Mboggo E, Larson E, et al. Community health workers to improve uptake of maternal healthcare services: A cluster\u2011randomized pragmatic trial in Dar es Salaam, Tanzania. PLOS Med. 2019;16(3):e1002768. doi:10.1371\/journal.pmed.1002768.","DOI":"10.1371\/journal.pmed.1002768"},{"key":"18","doi-asserted-by":"crossref","unstructured":"Dol J, Mselle LT, Campbell\u2011Yeo M, et al. Essential Coaching for Every Mother Tanzania (ECEM\u2011TZ): Protocol for a type 1 hybrid effectiveness\u2011implementation randomized controlled trial. JMIR Res Protoc. 2024;13:e63454. doi:10.2196\/63454.","DOI":"10.2196\/63454"},{"key":"19","unstructured":"PATH. Tanzania Advocacy Brief. Published 2026. Accessed April 21, 2026. https:\/\/media.path.org\/documents\/Tanzania-Advocacy-brief-260113.pdf."},{"key":"20","doi-asserted-by":"crossref","unstructured":"Lee HN, Lee SJ, Lee YK, Cho H. A mobile health app (mHealth)\u2011based post\u2011NICU discharge intervention for parents of preterm infants: A pilot study. J Perinat Neonatal Nurs. 2025. doi:10.1097\/JPN.0000000000000979.","DOI":"10.1097\/JPN.0000000000000979"},{"key":"21","doi-asserted-by":"crossref","unstructured":"WHO Immediate KMC Study Group, Arya S, Naburi H, et al. Immediate \u201cKangaroo Mother Care\u201d and survival of infants with low birth weight. N Engl J Med. 2021;384(21):2028\u20132038. doi:10.1056\/NEJMoa2026486.","DOI":"10.1056\/NEJMoa2026486"},{"key":"22","doi-asserted-by":"crossref","unstructured":"Abdallah Y, Namiiro F, Nankunda J, Mugalu J, Vaucher Y. Growth of preterm very low birth weight infants discharged with weight of less than 1500grams. BMC Pediatr. 2021;21(1):145. doi:10.1186\/s12887-021-02612-4.","DOI":"10.1186\/s12887-021-02612-4"},{"key":"23","doi-asserted-by":"crossref","unstructured":"Salim N, Shabani J, Peven K, et al. Kangaroo mother care: EN\u2011BIRTH multi\u2011country validation study. BMC Pregnancy Childbirth. 2021;21(Suppl 1):231. doi:10.1186\/s12884-020-03423-8. PubMed PMID: 33765950; PubMed Central PMCID: PMC7995571.","DOI":"10.1186\/s12884-020-03423-8"},{"key":"24","doi-asserted-by":"crossref","unstructured":"Gavine A, Marshall J, Buchanan P, et al. Remote provision of breastfeeding support and education: Systematic review and meta\u2011analysis. 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Accessed May 12, 2026. https:\/\/ihi.or.tz\/our-events\/1025\/details\/."},{"key":"30","unstructured":"Lameck D, Said M. Tanzania notes success in efforts to expand maternal health services. Daily News. Published 2026. Accessed April 30, 2026. https:\/\/dailynews.co.tz\/tanzania-notes-success-in-efforts-to-expand-maternal-health-services\/."}],"container-title":["Annals of Global Health"],"original-title":[],"link":[{"URL":"https:\/\/annalsofglobalhealth.org\/articles\/5442\/files\/6a8d8049052c0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/annalsofglobalhealth.org\/articles\/5442\/files\/6a8d80643d8ec.xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/annalsofglobalhealth.org\/articles\/5442\/files\/6a8d8049052c0.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T11:49:11Z","timestamp":1787658551000},"score":1,"resource":{"primary":{"URL":"https:\/\/annalsofglobalhealth.org\/articles\/10.5334\/aogh.5442"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,25]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,2]]}},"URL":"https:\/\/doi.org\/10.5334\/aogh.5442","relation":{},"ISSN":["2214-9996"],"issn-type":[{"value":"2214-9996","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,25]]}}}