Point of care diagnostic tools for prevention and care package to reduce infant mortality
Each year in sub-Saharan Africa 880,000 babies are stillborn and 1 million die in the first week of life. Many of these deaths are due to maternal infection with HIV, syphilis or malaria, or to maternal anaemia, which cause stillbirth, preterm birth and low birth weight, increasing the risk of neonatal death. In rural Tanzania, as in many other African countries, more than 80% of pregnant women attend antenatal clinic, but few are screened and treated for these conditions – an important missed opportunity to save newborn lives. We will scale up the use of point-of-care tests for same day testing and treatment for HIV, syphilis, malaria and anaemia at the district level in rural antenatal clinics in Tanzania, using a small solar-powered reader that increases rapid test accuracy, removes subjectivity and frees up health worker time. The reader has a quality control function and can relay results to the district hospital for patient records and for stock management of tests and drugs at central stores. Health workers will be given motivational packages to provide improved prenatal newborn care. We will measure the impact of this district-wide intervention on birth weight and perinatal mortality, and its cost-effectiveness, through an effectiveness trial with a stepped-wedge design. The intervention will be phased in one health centre at a time, and a process and context evaluation will enable us to assess the effect of different intervention components on the measured outcomes.