The Uganda Newborn Study (UNEST): an effectiveness study on improving newborn health and survival in rural Uganda through a community-based intervention linked to health facilities - study protocol for a cluster randomized controlled trial
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Date
2012
Authors
Waiswa, Peter
Peterson, Stefan S.
Namazzi, Gertrude
Kiracho Ekirapa, Elizabeth
Naikoba, Sarah
Byaruhanga, Romano
Kiguli, Juliet
Kallander, Karin
Tagoola, Abner
Nakakeeto, Margaret
Journal Title
Journal ISSN
Volume Title
Publisher
Trials
Abstract
Reducing neonatal-related deaths is one of the major bottlenecks to achieving Millennium
Development Goal 4. Studies in Asia and South America have shown that neonatal mortality can be reduced
through community-based interventions, but these have not been adapted to scalable intervention packages for
sub-Saharan Africa where the culture, health system and policy environment is different. In Uganda, health
outcomes are poor for both mothers and newborn babies. Policy opportunities for neonatal health include the new
national Health Sector Strategic Plan, which now prioritizes newborn health including use of a community model
through Village Health Teams (VHT). The aim of the present study is to adapt, develop and cost an integrated
maternal-newborn care package that links community and facility care, and to evaluate its effect on maternal and
neonatal practices in order to inform policy and scale-up in Uganda.
Methods/Design: Through formative research around evidence-based practices, and dialogue with policy and
technical advisers, we constructed a home-based neonatal care package implemented by the responsible VHT
member, effectively a Community Health Worker (CHW). This CHW was trained to identify pregnant women and
make five home visits - two before and three just after birth - so that linkages will be made to facility care and
targeted messages for home-care and care-seeking delivered. The project is improving care in health units to
provide standardized care for the mother and the newborn in both intervention and comparison areas.
The study is taking place in a new Demographic Surveillance Site in two rural districts, Iganga and Mayuge, in
Uganda. It is a two-arm cluster randomized controlled design with 31 intervention and 32 control areas (villages).
The comparison parishes receive the standard care already being provided by the district, but to the intervention
villages are added a system for CHWs to visit the mother five times in her home during pregnancy and the
neonatal period. Both areas benefit from a standardized strengthening of facility care for mothers and neonates.
Description
Keywords
UNEST, Newborn, Community health workers, Uganda, Africa, Trial
Citation
Waiswa, P., Peterson, S. S., Namazzi, G., Ekirapa, E. K., Naikoba, S., Byaruhanga, R., ... & Pariyo, G. (2012). The Uganda Newborn Study (UNEST): an effectiveness study on improving newborn health and survival in rural Uganda through a community-based intervention linked to health facilities-study protocol for a cluster randomized controlled trial. Trials, 13(1), 1-16.