Who is at the table and who has the power? Case study analysis of decision-making processes for the Global Financing Facility in Tanzania.

Background: In 2015, Tanzania joined the Global Financing Facility (GFF), a global health initiative for Reproductive, Maternal, Newborn, Child, and Adolescent Health and Nutrition (RMNCAH-N). Despite its resource mobilization goals, little is known about power dynamics in GFF policy processes. This paper presents the first power analysis of Tanzania's GFF engagement.

Small and sick newborn care: Changes in service readiness scoring between baseline and 2023 for 65 neonatal units implementing with NEST360 in Kenya, Malawi, Nigeria, and Tanzania.

Health Facility Assessments (HFAs) are important for measuring and tracking service readiness for small and sick newborn care (SSNC). NEST360 Alliance aims to reduce neonatal mortality in four countries (Kenya, Malawi, Nigeria, Tanzania). NEST360 and UNICEF facilitated HFA tool design with ministries of health in four African countries and developed two complimentary approaches to summarise readiness.

Born too soon: accelerating change to 2030 and beyond.

Progress Needed: Preterm birth rates have "flatlined" for a decade with major loss of human capital, hindering progress for many Sustainable Development Goals. Progress on the reduction of maternal, newborn and child mortality needs to accelerate by between 3 and 11-fold to reach national and global targets by 2030.

Priorities: Actions are required on two tracks: (1) prevention of preterm birth, including better management for women in preterm labour, and (2) provision of high-quality care to vulnerable newborns, including those born into fragile and conflict-affected settings.

Born Too Soon: Care for small and sick newborns, evidence for investment and implementation.

Progress: Over the past decade, the world has made policy progress for newborns including the first global Sustainable Development Goal (SDG) target 3.2 (< 12 neonatal deaths per 1000 live births) and the Every Newborn Action Plan (ENAP). However, gaps remain for investment and action, especially for babies born too soon, too small, or who become sick.

Intersectoral interventions: integration for impact on preterm birth.

Progress: The last two decades have seen a growing focus on intersectoral interventions to improve maternal and newborn health and well-being outcomes, as reflected in efforts to achieve the Millennium Development Goals (MDGs) and advance the Sustainable Development Goals (SDGs). Preterm births are linked to cross-sectoral determinants that affect health outcomes and human capital across the life-course, necessitating an intersectoral approach that addresses these multifaceted challenges.

Programmatic Priorities: Recognizing that social, biological and economic determinants significantly influence health outcomes, it is critical that robust health systems are reinforced by a comprehensive intersectoral approach.

Born Too Soon: learning from the past to accelerate action in the next decade.

Progress: This paper is a narrative review that takes stock of the progress in addressing preterm birth over the past decade - notably on policies, national plans, innovation, evidence, social mobilisation, and community engagement - to inform future progress on preterm birth. At the global policy level, many countries have strongly supported collective initiatives and resolutions on maternal and newborn health relevant to preterm birth in multilateral fora, most recently through a World Health Assembly resolution calling for a revival amongst the global community on stalled progress for maternal, newborn and child health. Following the adoption of other global plans, like the Every Newborn Action Plan and Strategies for Ending Preventable Maternal Mortality, most countries set corresponding national mortality and coverage targets, and many have national and subnational policies and plans for integrated maternal and newborn health.

Born too soon: global epidemiology of preterm birth and drivers for change.

Progress: There has been no measurable change in global preterm birth rates in the past decade, in any region. A handful of countries have reduced their preterm birth rates, but only marginally (0.5 percentage points annually), and there has been little progress in availability of preterm birth data globally.

Unwrapping the Global Financing Facility: understanding implications for women's children's and adolescent's health through layered policy analysis.

The Global Financing Facility (GFF), launched in 2015, aims to catalyse funding for reproductive, maternal, newborn, child, and adolescent health, and nutrition. Few independent assessments have evaluated its processes and impact. We conducted a multi-layered policy analysis of GFF documents - the Investment Cases (ICs) and the GFF-linked World Bank Project Appraisal Documents (PADs) - examining the content of GFF documents for 28 countries, comparing four tracer themes (maternal and newborn health, adolescent health, community health, and quality), and analysing the policy processes in four country studies (Burkina Faso, Mozambique, Tanzania, and Uganda).

Using implementation science to define the model and outcomes for improving quality in NEST360, a multicountry alliance for reducing newborn mortality in sub-Saharan Africa.

Background: Improving small and sick newborn care (SSNC) is crucial in resource-limited settings. Newborn Essential Solutions and Technologies (NEST360), a multicountry alliance, aims to reduce newborn mortality through evidence-based interventions. NEST360 developed a multipronged approach to improving quality.

Kangaroo mother care among hospitalised neonates: evaluation of the validity of duration measurement methods compared to observation linked to the OMWaNA trial in Uganda.

Background: Studies evaluating the impact of kangaroo mother care (KMC) on neonatal mortality and morbidity often rely on healthcare worker records or caregiver reports to measure intervention duration. However, the accuracy of these methods remains uncertain. We examined the validity of different methods of KMC duration measurement amongst neonates ≤ 2000 g in Uganda.

Beyond proximity: an observational study of stillbirth rates and emergency obstetric and newborn care accessibility in The Gambia.

Introduction: Stillbirths are disproportionately concentrated in sub-Saharan Africa, where geographical accessibility to basic/comprehensive emergency obstetric and newborn care (BEmONC and CEmONC) significantly influences maternal and perinatal outcomes. This study describes stillbirth rates within healthcare facilities in The Gambia and examines their distribution in relation to the geographical accessibility of these facilities.

Methods: We analysed 97 276 births recorded between 1 January 2013 and 31 December 2018, from 10 major public healthcare facilities in The Gambia.

Risk of Depression and Anxiety in Those Who Gave Birth to Children Who Developed Invasive Disease: A Population-Based Cohort Study.

Background: Mental disorders such as depression and anxiety are common for women of reproductive age and impact pregnancy and parenting. Invasive disease (iGBS) is a leading cause of neonatal morbidity and mortality worldwide. Little is known about the short and long-term risk of common mental disorders in birthing parents whose infants had iGBS in the first 89 days after birth.

Long-term risk of psychiatric disorders in childhood and adolescence following neonatal invasive group B Streptococcus disease-A Danish cohort study.

Objectives: The long-term risk of child and adolescent psychiatric disorders (PDs) after neonatal invasive group B Streptococcus disease (iGBS) and the modifying factors are poorly understood.

Methods: A population-based matched cohort study, including 1548 infants with iGBS diagnosed during the first 3 months of life from 1997 through 2020 and follow-up until 2022, based on data from Danish national health and administrative registers. A general population comparison cohort of infants without iGBS was randomly sampled and matched 1:10 by sex, the child's birth year and month, and gestational age (n= 15,345).

"I have to be strong": A qualitative study of parental bereavement experiences in Uganda following the death of their baby.

Background: The death of a child is profoundly distressing for parents, often leading to acute grief and psychological complications. Most bereavement research is from high-income countries, with limited generalisability to low- and middle-income contexts where 98 % of newborn deaths occur. We explore the experiences of parents in Uganda following the death of their baby.

Examining priorities and investments made through the Global Financing Facility for maternal and newborn health: a sub-analysis on quality.

Improving quality of care could avert most of the 4.5 million maternal and neonatal deaths and stillbirths that occur each year. The Global Financing Facility (GFF) aims to catalyse the national scale-up of maternal and newborn health (MNH) interventions through focused investments.

Neonatal indicator data in Tanzania District Health Information System: evaluation of availability and quality of selected newborn indicators, 2015-2022.

Background: The Every Newborn Action Plan (ENAP) indicators are essential in monitoring neonatal healthcare coverage and quality. The District Health Information System (DHIS2), an open-source platform in over 80 countries, supports health data collection and analysis, enabling progress tracking at national and subnational levels. This study evaluates the availability and quality of maternal and newborn health indicators, explicitly focusing on ENAP indicators within Tanzania's DHIS2.

How and why does mode of birth affect processes for routine data collection and use? A qualitative study in Bangladesh and Tanzania.

The World Health Organization recognises Routine Health Information System (RHIS) data as integral to data-driven health systems; needed to improve intrapartum outcomes for maternal and newborn health worldwide. However, research in Bangladesh and Tanzania suggests that mode of birth affects register data accuracy, but little is known about why. To address this gap, we undertook qualitative research in these two public-sector health systems.

Every Newborn-Reach Up Early Education Intervention for All Children (EN-REACH)- a parent group intervention for school readiness in Bangladesh, Nepal, and Tanzania: study protocol for a cluster randomized controlled trial.

Background: Vulnerable children, including those with neuro-developmental delays and disabilities, often face barriers in accessing early primary education, thus hindering progress toward Sustainable Development Goal 4.2. Evidence-based interventions are essential to enhancing inclusivity and establishing sustainable implementation strategies to address this challenge.

Kangaroo mother care prior to clinical stabilisation: Implementation barriers and facilitators reported by caregivers and healthcare providers in Uganda.

Kangaroo mother care (KMC) is an evidence-based method to improve newborn survival. However, scale-up even for stable newborns has been slow, with reported barriers to implementation. We examined facilitators and barriers to initiating KMC before stabilisation amongst neonates recruited to the OMWaNA study in Uganda.

Stillbirth risk by fetal size among 126.5 million births in 15 countries from 2000 to 2020: A fetuses-at-risk approach.

Objective: To compare stillbirth rates and risks for small for gestational age (SGA), large for gestational age (LGA) and appropriate for gestational age (AGA) pregnancies at 24-44 completed weeks of gestation using a birth-based and fetuses-at-risk approachs.

Design: Population-based, multi-country study.

Setting: National data systems in 15 high- and middle-income countries.