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Singh K, Simmons E, Garriga B, Hoover G, Ijdi RE, Kc A. National chlorhexidine coverage and factors associated with newborn umbilical cord care in Bangladesh and Nepal: a cross-sectional analysis using household data. Matern Health Neonatol Perinatol 2024; 10:12. [PMID: 38845007 PMCID: PMC11157876 DOI: 10.1186/s40748-024-00182-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 04/24/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Preventable newborn deaths are a global tragedy with many of these deaths concentrated in the first week and day of life. A simple low-cost intervention, chlorhexidine cleansing of the umbilical cord, can prevent deaths from omphalitis, an infection of the umbilical cord. Bangladesh and Nepal have national policies promoting chlorhexidine use, as well as routinely collected household survey data, which allows for an assessment of coverage and predictors of the intervention. METHODS We used data from the 2017-2018 Bangladesh Demographic and Health Survey and the 2016 Nepal Demographic and Health Survey, two large-scale nationally representative household surveys. We studied coverage of single application of chlorhexidine to the umbilical cord of newborns born in the past year using descriptive, bivariate and multivariable analyses. Key predictors of newborns receiving chlorhexidine cleansing, including socio-economic factors, healthcare related factors and the application of harmful and nonharmful substances, were explored in this study. RESULTS Coverage of chlorhexidine cleansing was 15.0% in Bangladesh and 50.7% in Nepal, while the application of a harmful substance was 16.9% in Bangladesh and 22.6% in Nepal. Results from the multivariable analyses indicated that delivery in a health facility was strongly associated with a newborn's receipt of chlorhexidine in both countries (Bangladesh: OR = 2.23, p = 0.002; Nepal: OR = 5.01, p = 0.000). In Bangladesh, delivery by Cesarean section and application of another non-harmful substance were significantly and positively associated with the receipt of chlorhexidine. In Nepal antenatal care was significantly and positively associated with chlorhexidine, while application of a harmful substance was significantly and negatively associated with receipt of chlorhexidine. Maternal education, urban/rural residence, religion and sex were not significant in the multivariable analysis. Wealth was not a significant factor in Bangladesh, but in Nepal newborns in the two highest wealth quintiles were significantly less likely to receive chlorhexidine than newborns in the lowest wealth quintile. CONCLUSION As Bangladesh and Nepal continue to scale-up chlorhexidine for newborn umbilical cord care, additional focus on newborns born in non-facility environments may be warranted. Chlorhexidine cleansing may have the potential to be an equitable intervention, as newborns from the poorest wealth quintiles and whose mothers had less education were not disadvantaged in receiving the intervention in these two settings.
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Affiliation(s)
- Kavita Singh
- Data for Impact (D4I), University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Elizabeth Simmons
- Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Bliss Garriga
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Grace Hoover
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Rashida E Ijdi
- Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Ashish Kc
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
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Gelano TF, Bacha YD, Abate D. Effect of chlorhexidine cord application on prevention of neonatal sepsis in developing countries: Systematic review and meta-analysis. Int J Health Sci (Qassim) 2019; 13:40-51. [PMID: 30842717 PMCID: PMC6392487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The aim of this review was to identify the pooled effect of chlorhexidine cord application on prevention of neonatal sepsis in developing countries. METHODS We have conducted systemic review and meta-analysis. Articles were searched from electronic databases such as PubMed, EMBASE, CINHAL, Cochrane central register of controlled trials (CENTRAL), and other sources such as direct Google search, Google Scholar, and POPline. Only randomized controlled trial studies were considered for this review. The effect of chlorhexidine cord application on prevention of neonatal sepsis and mortality was assessed as compared to dry cord care. RESULTS Five studies from developing countries were included in the review with a total of 129,293 participants. Pooled result of meta-analysis showed that chlorhexidine cord application reduces neonatal sepsis by 32% as compared to dry cord care (relative risk [RR] 0.68, 95% confidence interval [CI] 0.57-0.81, random effect model, I2 =93%). It also indicated that chlorhexidine cord application reduces severe sepsis by 77% (RR 0.23, 95% CI 0.11-0.48, random effect model, I2 = 63%) and neonatal mortality reduction by 13 % as compared to dry cord care (RR 0.87, 95% CI 0.79-0.97, random effect model, I2 = 0%). CONCLUSIONS Chlorhexidine cord application significantly reduces neonatal sepsis and mortality in developing countries. Therefore, we stress the importance of including chlorhexidine cord application into the essential newborn care in the setting with high burden of neonatal mortality. The review protocol was registered at PROSPERO with registration number CRD 42018089204.
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Affiliation(s)
- Tilayie Feto Gelano
- Department of Pediatrics and Neonatal Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia,Address for correspondence: Tilayie Feto Gelano, College of Health and Medical Sciences, Haramaya University, Harar Ethiopia, Po. Box 235, Ethiopia. Phone: +251921843248. E-mail:
| | - Yadeta Dassie Bacha
- Department of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Degu Abate
- Department of Medical Microbiology, School of Medical Laboratory, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Sitrin D, Perin J, Vaz LME, Carvajal–Aguirre L, Khan SM, Fishel J, Amouzou A. Evidence from household surveys for measuring coverage of newborn care practices. J Glob Health 2017; 7:020503. [PMID: 29423180 PMCID: PMC5804503 DOI: 10.7189/jogh.07.020503] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Aside from breastfeeding, there are little data on use of essential newborn care practices, such as thermal protection and hygienic cord care, in high mortality countries. These practices have not typically been measured in national household surveys, often the main source for coverage data in these settings. The Every Newborn Action Plan proposed early breastfeeding as a tracer for essential newborn care due to data availability and evidence for the benefits of breastfeeding. In the past decade, a few national surveys have added questions on other practices, presenting an opportunity to assess the performance of early breastfeeding initiation as a tracer indicator. METHODS We identified twelve national surveys between 2005-2014 that included at least one indicator for immediate newborn care in addition to breastfeeding. Because question wording and reference populations varied, we standardized data to the extent possible to estimate coverage of newborn care practices, accounting for strata and multistage survey design. We assessed early breastfeeding as a tracer by: 1) examining associations with other indicators using Pearson correlations; and 2) stratifying by early breastfeeding to determine differences in coverage of other practices for initiators vs non-initiators in each survey, then pooling across surveys for a meta-analysis, using the inverse standard error as the weight for each observation. FINDINGS Associations between pairs of coverage indicators are generally weak, including those with breastfeeding. The exception is drying and wrapping, which have the strongest association of any two interventions in all five surveys where measured; estimated correlations for this range from 0.47 in Bangladesh's 2007 DHS to 0.83 in Nepal's 2006 DHS. The contrast in coverage for other practices by early breastfeeding is generally small; the greatest absolute difference was 6.7%, between coverage of immediate drying for newborns breastfed early compared to those who were not. CONCLUSIONS Early initiation of breastfeeding is not a high performing tracer indicator for essential newborn care practices measured in previous national surveys. To have informative data on whether newborns are getting life-saving services, standardized questions about specific practices, in addition to breastfeeding initiation, need to be added to surveys.
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Affiliation(s)
- Deborah Sitrin
- Saving Newborn Lives, Save the Children, Washington, D.C., USA
| | - Jamie Perin
- Institute for International Programs, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Lara ME Vaz
- Saving Newborn Lives, Save the Children, Washington, D.C., USA
| | | | - Shane M Khan
- Data and Analytics, Division of Data, Research and Policy, UNICEF, New York, New York, USA
| | | | - Agbessi Amouzou
- Institute for International Programs, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
- Data and Analytics, Division of Data, Research and Policy, UNICEF, New York, New York, USA
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Paudel D, Shrestha IB, Siebeck M, Rehfuess E. Impact of the community-based newborn care package in Nepal: a quasi-experimental evaluation. BMJ Open 2017; 7:e015285. [PMID: 28982810 PMCID: PMC5640009 DOI: 10.1136/bmjopen-2016-015285] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the impact of the community-based newborn care package (CBNCP) on six essential practices to improve neonatal health. METHODS CBNCP pilot districts were matched to comparison districts using propensity scores. Impact on birth preparedness, antenatal care seeking, antenatal care quality, delivery by skilled birth attendant, immediate newborn care and postnatal care within 48 hours were assessed using Demographic and Health Survey (DHS) and Health Management Information System (HMIS) data through difference-in-differences and multivariate logistic regression analyses. FINDINGS Changes over time in intervention and comparison areas were similar in difference-in-differences analysis of DHS and HMIS data. Logistic regression of DHS data also did not reveal any significant improvement in combined outcomes: birth preparedness, adjusted OR (aOR)=0.8 (95% CI 0.4 to 1.7); antenatal care seeking, aOR=1.0 (0.6 to 1.5); antenatal care quality, aOR=1.4 (0.9 to 2.1); delivery by skilled birth attendant, aOR=1.5 (1.0 to 2.3); immediate newborn care, aOR=1.1 (0.7 to 1.9); postnatal care, aOR=1.3 (0.9 to 1.9). Health providers' knowledge and skills in intervention districts were fair but showed much variation between different providers and districts. CONCLUSIONS This study, while representing an early assessment of impact, did not identify significant improvements in newborn care practices and raises concerns regarding CBNCP implementation. It has contributed to revisions of the package and it being merged with the Integrated Management of Neonatal and Childhood Illness programme. This is now being implemented in 35 districts and carefully monitored for quality and impact. The study also highlights general challenges in evaluating the impacts of a complex health intervention under 'real life' conditions.
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Affiliation(s)
- Deepak Paudel
- Center for International Health, Ludwig Maximilians University, Munich, Germany
- Office of Health and Family Planning, United States Agency for International Development, Kathmandu, Nepal
| | - Ishwar B Shrestha
- Department of Community Medicine and Family Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Matthias Siebeck
- Center for International Health, Ludwig Maximilians University, Munich, Germany
| | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health and Center for International Health, Ludwig Maximilians University, Munich, Germany
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Muriuki A, Obare F, Ayieko B, Matanda D, Sisimwo K, Mdawida B. Health care providers' perspectives regarding the use of chlorhexidine gel for cord care in neonates in rural Kenya: implications for scale-up. BMC Health Serv Res 2017; 17:305. [PMID: 28446176 PMCID: PMC5406932 DOI: 10.1186/s12913-017-2262-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 04/24/2017] [Indexed: 12/04/2022] Open
Abstract
Background This paper explores the perspectives of health care providers regarding the use of 7.1% Chlorhexidine Digluconate (CHX) gel that releases 4% chlorhexidine for newborn umbilical cord care under a managed access program (MAP) implemented in Bungoma County of Kenya. Understanding the perspectives of providers regarding CHX is important since they play a key role in the health system and the fact that their views could be influenced by prior beliefs and inconsistent practices regarding umbilical cord care. Methods Data are from in-depth interviews conducted between April and June 2016 with 39 service providers from 21 facilities that participated in the program. The data were transcribed, typed in Word and analyzed for content. Analysis entailed identifying recurring themes based on the interview guides. Results Use of CHX gel for cord care in neonates was acceptable to the health care providers, with all of them supporting scaling up its use throughout the country. Their views were largely influenced by positive outcomes of the medication including fast healing of the cord as reported by mothers, minimal side effects, reduced newborn infections based on what their records showed and mothers’ reports, ease of use that made it simple for them to counsel mothers on how to apply it, positive feedback from mothers which demonstrated satisfaction with the medication, and general acceptance of the medication by the community. They further noted that successful scale-up of the medication required community sensitization, adequate follow-up mechanisms to ensure mothers use the medication correctly, addressing issues of staffing levels and staff training, developing guidelines and protocols for provision of the medication, adopting appropriate service delivery approaches to ensure all groups of mothers are reached, and ensuring constant supply of the medication. Conclusion Use of CHX gel for cord care in neonates is likely to be acceptable to health care workers in settings with high prevalence of neonatal morbidity and mortality arising from cord infections. In scaling up the use of the medication in such settings, some of the health systems requirements for successful roll-out can be addressed by programs while others are likely to be a persistent challenge.
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Affiliation(s)
- Angela Muriuki
- Save the Children, Matundu Close, Off School Lane, Westlands, P.O. Box 27679, Nairobi, 00506, Kenya
| | - Francis Obare
- Population Council, Avenue 5, Rose Avenue, P.O. Box 17643, Nairobi, 00500, Kenya.
| | - Bill Ayieko
- Save the Children, Matundu Close, Off School Lane, Westlands, P.O. Box 27679, Nairobi, 00506, Kenya
| | - Dennis Matanda
- Population Council, Avenue 5, Rose Avenue, P.O. Box 17643, Nairobi, 00500, Kenya
| | - Kenneth Sisimwo
- Save the Children, Matundu Close, Off School Lane, Westlands, P.O. Box 27679, Nairobi, 00506, Kenya
| | - Brian Mdawida
- Population Council, Avenue 5, Rose Avenue, P.O. Box 17643, Nairobi, 00500, Kenya
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Efficacy of chlorhexidine application to umbilical cord on neonatal mortality in Pemba, Tanzania: a community-based randomised controlled trial. LANCET GLOBAL HEALTH 2016; 4:e837-e844. [DOI: 10.1016/s2214-109x(16)30223-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 05/11/2016] [Accepted: 08/11/2016] [Indexed: 12/20/2022]
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Akter T, Dawson A, Sibbritt D. What impact do essential newborn care practices have on neonatal mortality in low and lower-middle income countries? Evidence from Bangladesh. J Perinatol 2016; 36:225-30. [PMID: 26633143 DOI: 10.1038/jp.2015.181] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 08/25/2015] [Accepted: 10/19/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To assess the impact of essential newborn care (ENC) practices on the mortality of neonates delivered at home in Bangladesh. STUDY DESIGN This study used cross-sectional data from the 2011 Bangladesh Demographic and Health Survey. Adjusted logistic regression model was used to examine the effect of ENC practices on neonatal mortality based on 3190 live-born infants. RESULT Delayed bathing (72 h after delivery) significantly contributed to reducing neonatal mortality. A significant but counterintuitive relation was observed between the dry cord care and neonatal deaths. CONCLUSION Neonatal mortality may be reduced through emphasizing delayed bathing. Specific guidelines on the cleanliness of the fabric used to dry and wrap newborns, as well as emphasizing the use of clean delivery kits and initiation of immediate and exclusive breastfeeding, may improve neonatal outcomes. Further, the ENC guidelines in Bangladesh should include the application of topical antiseptics to the cord stump.
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Affiliation(s)
- T Akter
- Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - A Dawson
- Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - D Sibbritt
- Faculty of Health, University of Technology, Sydney, NSW, Australia
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Waiswa P, Pariyo G, Kallander K, Akuze J, Namazzi G, Ekirapa-Kiracho E, Kerber K, Sengendo H, Aliganyira P, Lawn JE, Peterson S. Effect of the Uganda Newborn Study on care-seeking and care practices: a cluster-randomised controlled trial. Glob Health Action 2015; 8:24584. [PMID: 25843498 PMCID: PMC4385212 DOI: 10.3402/gha.v8.24584] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 11/06/2014] [Accepted: 11/12/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Care for women and babies before, during, and after the time of birth is a sensitive measure of the functionality of any health system. Engaging communities in preventing newborn deaths is a promising strategy to achieve further progress in child survival in sub-Saharan Africa. OBJECTIVE To assess the effect of a home visit strategy combined with health facility strengthening on uptake of newborn care-seeking, practices and services, and to link the results to national policy and scale-up in Uganda. DESIGN The Uganda Newborn Study (UNEST) was a two-arm cluster-randomised controlled trial in rural eastern Uganda. In intervention villages volunteer community health workers (CHWs) were trained to identify pregnant women and make five home visits (two during pregnancy and three in the first week after birth) to offer preventive and promotive care and counselling, with extra visits for sick and small newborns to assess and refer. Health facility strengthening was done in all facilities to improve quality of care. Primary outcomes were coverage of key essential newborn care behaviours (breastfeeding, thermal care, and cord care). Analyses were by intention to treat. This study is registered as a clinical trial, number ISRCTN50321130. RESULTS The intervention significantly improved essential newborn care practices, although many interventions saw major increases in both arms over the study period. Immediate breastfeeding after birth and exclusive breastfeeding were significantly higher in the intervention arm compared to the control arm (72.6% vs. 66.0%; p=0.016 and 81.8% vs. 75.9%, p=0.042, respectively). Skin-to-skin care immediately after birth and cord cutting with a clean instrument were marginally higher in the intervention arm versus the control arm (80.7% vs. 72.2%; p=0.071 and 88.1% vs. 84.4%; p=0.023, respectively). Half (49.6%) of the mothers in the intervention arm waited more than 24 hours to bathe the baby, compared to 35.5% in the control arm (p<0.001). Dry umbilical cord care was also significantly higher in intervention areas (63.9% vs. 53.1%, p<0.001). There was no difference in care-seeking for newborn illness, which was high (around 95%) in both arms. Skilled attendance at delivery increased in both the intervention (by 21%) and control arms (by 19%) between baseline and endline, but there was no significant difference in coverage across arms at endline (79.6% vs. 78.9%; p=0.717). Home visits were pro-poor, with more women in the poorest quintile visited by a CHW compared to families in the least poor quintile, and more women who delivered at home visited by a CHW after birth (73.6%) compared to those who delivered in a hospital or health facility (59.7%) (p<0.001). CHWs visited 62.8% of women and newborns in the first week after birth, with 40.2% receiving a visit on the critical first day of life. CONCLUSION Consistent with results from other community newborn care studies, volunteer CHWs can be effective in changing long-standing practices around newborn care. The home visit strategy may provide greater benefit to poorer families. However, CHW strategies require strong linkages with and concurrent improvement of quality through health system strengthening, especially in settings with high and increasing demand for facility-based services.
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Affiliation(s)
- Peter Waiswa
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Science, Makerere University, Kampala, Uganda
- Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Iganga-Mayuge Health and Demographic Surveillance Site, Iganga-Mayuge, Uganda;
| | - George Pariyo
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Science, Makerere University, Kampala, Uganda
- Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Karin Kallander
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Science, Makerere University, Kampala, Uganda
- Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Malaria Consortium, London, UK
| | - Joseph Akuze
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Science, Makerere University, Kampala, Uganda
| | - Gertrude Namazzi
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Science, Makerere University, Kampala, Uganda
| | - Elizabeth Ekirapa-Kiracho
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Science, Makerere University, Kampala, Uganda
| | | | | | | | - Joy E Lawn
- MARCH Unit, London School of Hygiene and Tropical Medicine, London, UK
| | - Stefan Peterson
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Science, Makerere University, Kampala, Uganda
- Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- International Maternal and Child Health Unit, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Kerber K, Peterson S, Waiswa P. Special issue: newborn health in Uganda. Glob Health Action 2015; 8:27574. [PMID: 25843501 PMCID: PMC4385224 DOI: 10.3402/gha.v8.27574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Stefan Peterson
- Makerere University, Kampala, Uganda
- Karolinska Institutet, Stockholm, Sweden
- Uppsala University, Uppsala, Sweden
- Iganga/Mayuge Health Demographic Surveillance Site, Kampala, Uganda
| | - Peter Waiswa
- Makerere University, Kampala, Uganda
- Karolinska Institutet, Stockholm, Sweden
- Iganga/Mayuge Health Demographic Surveillance Site, Kampala, Uganda
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Alabi O, Doctor HV. The Potential Role of a Health and Demographic Surveillance System in Rural Northern Nigeria to Reduce Maternal and Child Deaths. Health (London) 2015. [DOI: 10.4236/health.2015.712189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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