Background: The Pediatric Advanced Warning Score (PAWS) facilitates early recognition of critically ill children and has been validated for predicting intensive care admission. However, its prognostic performance for in-hospital mortality and the incremental value of health-system factors such as triage–transit delay remains uncertain in resource-limited settings. We evaluated the prognostic performance of admission PAWS for predicting in-hospital mortality and determined whether incorporation of triage–transit delay and patient characteristics improved mortality risk prediction. Methods: We conducted a secondary prognostic analysis of a previously established prospective emergency department cohort comprising 110 children admitted to pediatric critical care at a tertiary referral hospital in Tanzania. Admission PAWS was recorded once at Emergency Medical Department presentation before inpatient treatment. The primary outcome was in-hospital mortality. Candidate predictors included admission PAWS, age, sex, referral status, and Emergency Medical Department (EMD)-to-ward transfer delay (>6 hours). Prognostic performance was evaluated using multivariable logistic regression with Firth penalized regression as a sensitivity analysis. Model discrimination, calibration, bootstrap internal validation, decision curve analysis, and restricted cubic spline modelling were performed. Results: Among 110 critically ill children, 58 (52.7%) died during hospitalization, while 59 (53.6%) experienced EMD-to-ward transfer delays exceeding six hours. Admission PAWS demonstrated moderate discrimination for predicting in-hospital mortality (AUC 0.657; 95% CI 0.551–0.753), with high sensitivity but limited specificity. Incorporation of age, referral status, sex, and triage–transit delay improved discrimination (AUC 0.746), with acceptable calibration and an optimism-corrected AUC of 0.701 following bootstrap internal validation. Decision curve analysis demonstrated greater net clinical benefit for the final multivariable model than PAWS alone across clinically relevant threshold probabilities. Younger age remained independently associated with mortality, whereas triage–transit delay was not independently associated with death after multivariable adjustment. Conclusions: Admission PAWS provides clinically meaningful but incomplete prognostic information for critically ill children. Integrating physiological assessment with patient characteristics and selected health-system variables improves prognostic performance, calibration, and clinical utility compared with PAWS alone. These findings extend the application of PAWS beyond intensive care triage towards individualized mortality risk prediction and support external validation of context-specific prognostic models for pediatric critical care in resource-limited settings.

To reach the Sustainable Development Goals 3.1 to 3.4 for maternal, newborn, and child health, effective and cost-effective interventions are required. The Safer Births Bundle of Care (SBBC) intervention aims to improve the quality of intra- and postpartum care. The SBBC Phase I implementation was conducted in 30 health facilities in Tanzania between 2021 and 2023. Outcome data show a significant decrease in perinatal and maternal mortality. This study presents the costs of the SBBC Phase I, and a cost-effectiveness analysis, where the cost per life saved, per life year gained, and per disability-adjusted life year (DALY) averted, and the benefit-cost ratio (BCR) were estimated.Methods Outcome data were based on the estimated number of newborn and maternal lives saved during the project. Cost data were collected retrospectively at the accounting centre at Haydom Lutheran Hospital.Results The total cost for implementing SBBC Phase I was 4,491,204 USD. The cost per life saved was 4,669 USD, per life year gained 80 USD, and per DALY averted 144 USD, and the BCR was 36.Conclusion The analysis of SBBC Phase I showed that it was highly cost-effective by World Health Organization classifications. An economic evaluation of SBBC Phase II will provide information about its sustainability and feasibility for further scaling up.

Background: The SimBegin® course prepares facilitators to deliver simulation-based training, which was key in the SaferBirths Bundle of Care (SBBC) implementation program in Tanzania. Despite SBBC’s success in reducing maternal and newborn mortality, facilitators’ perspectives on SimBegin® and its scalability remain underexplored Methods: The study, conducted from April to September 2025 in five regions of Tanzania, used a convergent parallel mixed-methods design. Quantitative data were collected via a validated questionnaire, and qualitative data through key informant interviews. Participants were SimBegin®-trained doctors and nurses. Quantitative data were analyzed in Excel, while qualitative data followed Braun and Clarke’s six-phase thematic approach. Results: A total of 71 Respondents completed the survey and 16 participated in interview. The median age was 35 years, with most being diploma-level nurses. Face-to-face training was perceived as most effective. Nearly all respondents (99%) considered SimBegin® essential for facilitator preparation and scaling simulation-based learning. Two themes emerged: effective facilitator preparation and the value of repeated training in strengthening competence. Conclusion: The findings suggest that SimBegin® course is key to enhance facilitators skills and confidence to facilitate simulation-based learning. SimBegin® course is critical for scale up of simulation-based lerning.

The ProRIDE randomized clinical trial (RCT) started participant recruitment in February 2022, successfully enrolling 2,000 infants within an 11-month period and achieving a follow-up rate of 97% at six months of age. This narrative article describes critical components of the research protocol, the composition of the research team, community sensitization efforts, and the local performance of the study. The research initiative was conceptualized by a collaborative group of scientists from both high- and low-income countries, and its successful implementation was contingent upon the active involvement and participation of a rural, low-income community. Based on previous study findings in Tanzania, which consistently indicated a high prevalence of severe infections related to multidrug-resistant bacteria, the research team recognized the urgent need for preventive strategies aimed at reducing the incidence of sepsis and severe bacterial infections. Given the scarcity of data from rural areas and the imperative for inclusivity, the rationale for conducting this RCT in a rural context was compelling. We believe that a key factor in the successful completion of this trial was the intentional design of a simple, straightforward, and practical intervention, and study framework. Caregivers administered the study medication at home, thereby mirroring real-world therapeutic practices and enhancing the generalizability of the findings. To ensure adherence to the one-month intervention regimen, the research team conducted a day-seven home visit to confirm proper administration of the investigational product and address any associated early challenges. During this interaction, the field workers reiterated the instructions for the proper application of the product, thereby serving as a reminder to the caretaker regarding its correct usage. Additionally, a thorough planning phase was undertaken prior to the study's commencement, involving extensive collaboration between the researchers from Norway, Muhimbili University of Health and Allied Sciences, Tanzania, and the leadership at Haydom Lutheran Hospital. Through a series of meetings and discussions, the research team in Norway and Tanzania identified specific areas requiring enhancement, particularly in laboratory infrastructure and the training of personnel in blood culture techniques and antimicrobial susceptibility testing. Despite facing numerous challenges both prior to and during the trial, this RCT successfully recruited 2,000 participants within 11 months. This accomplishment can be attributed to the strong collaboration and teamwork exhibited throughout the process. The insights gained from this study may be of particular interest to researchers and scientists aiming to conduct investigations involving infants and children in low-income settings. Trial registrations This trial is registered with ClinicalTrials.gov, NCT04172012. November 21, 2019.

BACKGROUND:The Safer Births Bundle of Care (SBBC) was introduced in five regions in Tanzania to improve the quality of care around birth. Among the interventions was an initiative to train healthcare providers on neonatal resuscitation following the Helping Babies Breathe curriculum, using innovative simulation tools. OBJECTIVES:This study aimed to assess simulated neonatal resuscitation skills retention and associated factors one year after implementation. METHODS:A longitudinal study among healthcare providers working in the labour wards of 12 facilities in two regions undergoing SBBC implementation. Healthcare providers were trained and evaluated at baseline and one year after implementation of in situ self-regulated individual skill training. A paired t-test was used to compare the mean difference in skills scores, while factors associated with skills retention were assessed using a modified Poisson regression analysis. RESULTS:Among 226 participants, 174 (77%) retained skills one year after the implementation. The mean skills score at baseline was 92.5% compared to 82.3% after one year, with a mean difference of 10.2 (95% CI: 8.7-11.7); p < 0.001. Sex was independently associated with skills retention; males were less likely to retain skills than females, with an adjusted prevalence ratio (APR) = 0.90 (95%CI: 0.86-0.97); p = 0.02. CONCLUSION:The majority of healthcare providers retained simulated neonatal resuscitation skills. There was an overall mean skills drop compared to baseline, highlighting the need to strengthen the approaches supporting long-term skills retention. Barriers to and facilitators of sustained effects and scalability should be explored.

Introduction: Newborn mortality is unacceptably high, especially in low- and middle-income countries. The Safer Births Bundle of Care (SBBC) was implemented in Tanzania, including training of healthcare workers on neonatal resuscitation by means of frequent in situ simulation training using improved training tools. We aimed to assess the acceptability of this training model among healthcare providers in selected health facilities under SBBC intervention. Methods: A cross-sectional study was conducted among healthcare workers in labor wards and obstetric theaters in selected facilities one year after the introduction of the SBBC model. The theoretical framework for assessment of the acceptability of healthcare interventions was used to assess the acceptability of the training model and accompanying tools. The chi-square test was used to assess the association between acceptability in specific constructs and average individual practice per month, while a modified Poisson regression analysis was used to assess factors associated with acceptability in specific framework constructs. Results: A total of 227 healthcare workers were enrolled in the study. Overall, 223 (98.2%) accepted the intervention. However, 207 (91.2%) reported that the intervention increased their work burden, while 39 (17.2%) reported that it interfered with other equally important activities. The level of health facility was independently associated with the reporting that engaging in simulation practice interfered with other equally important activities. Conclusions: In situ, low-dose, high-frequency facility-based simulation training for neonatal resuscitation was highly acceptable among healthcare providers. However, the perceived increased work burden of this intervention and interference with other equally important activities were identified as potential threats to successful implementation.

Introduction Enhancing the proficiency of healthcare workers (HCWs) in handling birth-related complications is crucial for reducing maternal and newborn morbidity and mortality. To achieve this, the Safer Births Bundle of Care offers a comprehensive set of innovative, simulation-based training interventions designed to strengthen the skills and competencies of HCWs working as skilled birth attendants. Objective To describe the use of in-situ low-dose, high-frequency simulation-based training, and the experiences of this usage among HCWs and stakeholders at facilities in Tanzania. Methods This mixed-methods study included quantitative and qualitative data collected between July 2021 and July 2022 across 30 health facilities in five regions of Tanzania. NeoNatalie Live (NNL) simulators were installed for independent skills and scenario training, and in-situ facilitator-led team simulations were introduced. The training frequency was analyzed using descriptive and analytical statistics, and mentorship and supervision reports were analyzed using qualitative content analysis. Results A large and sustained number of in-situ NNL skill-training sessions ( n = 35,101) and facilitator-led team simulations ( n = 266) were conducted during the first year. Clinical burden per HCW did not affect the frequency of NNL skills training at the health facility level ( r = −0.16, p = .40) nor facilitator-led team simulations. There was a positive but weak correlation between the frequency of facilitator-led team simulations and NNL skills training ( r = 0.34, p = .05). Qualitative data showed a high degree of motivation and participation among all stakeholders, and active use of hospital data, both clinical indicators and training data, was perceived as a success factor. Conclusion Facilitator-led in-situ simulation training was more likely to occur where individual skills-training sessions were recorded. Training sessions took place regardless of the increased workload.

BackgroundBirth-related mortality is a major contributor to the burden of deaths worldwide, especially in low-income countries. The Safer Births Bundle of Care program is a combination of interventions developed to improve the quality of care for mother and baby with the goal of reducing birth-related mortality.MethodsWe performed a 3-year stepped-wedge cluster-randomized study of the Safer Births program at 30 high-burden facilities in five regions in Tanzania. The bundle of interventions in the program was aimed at continuous quality improvement through regular onsite simulation-based training, the collection and use of local clinical data, the assistance of trained local facilitators, and the use of innovative tools for perinatal care. The primary outcome was perinatal death, which included intrapartum stillbirth (suspected death during labor) and neonatal death within the first 24 hours after birth.ResultsA total of 281,165 mothers and 277,734 babies were included in the final analysis. The estimated incidence of perinatal death decreased from 15.3 deaths per 1000 births in the baseline period of the program to 12.5 deaths per 1000 births after implementation (adjusted relative risk, 0.82; 95% confidence interval [CI], 0.73 to 0.92; P=0.001), with substantial heterogeneity among regions. The incidence of intrapartum stillbirths was 8.6 deaths per 1000 births in the baseline period and 8.7 deaths per 1000 births after implementation (adjusted relative risk, 1.01; 95% CI, 0.87 to 1.17), and the incidence of neonatal deaths within the first 24 hours after birth was 6.4 and 3.9 deaths per 1000 births, respectively (adjusted relative risk, 0.61; 95% CI, 0.49 to 0.77). No serious adverse events were reported.ConclusionsImplementation of the Safer Births Bundle of Care program showed the feasibility of integrating quality-improvement efforts targeting birth-related emergencies in resource-limited settings and was associated with a significant reduction in perinatal mortality. (Funded by the Global Financing Facility; ISRCTN Registry number, ISRCTN30541755.)

BACKGROUND:Probiotics are commonly given to preterm and term infants to reduce gut colonisation and prevent disease. Evidence for the beneficial effect of probiotic therapy is sparse, particularly in term infants from low-income and middle-income countries with high infant morbidity and mortality. This study aimed to assess whether a 4-week course of probiotic therapy might reduce death and hospitalisation up to age 6 months in healthy infants in Tanzania. METHODS:In this investigator-initiated, single-site, double-blind, placebo-controlled randomised trial conducted at Haydom Lutheran Hospital and in the surrounding area in northeast Tanzania, we randomly assigned healthy infants born in the hospital, in other local health facilities, or at home who weighed 2 kg or more (1:1) to receive a multistrain probiotic mixture (including Lactobacillus acidophilus, Bifidobacterium bifidum, and Bifidobacterium longum subsps infantis) or placebo once per day for 4 weeks. Caregivers of study participants, investigators, study staff, hospital clinicians, and individuals involved in data management or analysis were masked to treatment allocation during all the data collection and management phases of the trial. Caregivers were shown how to give five drops (0·2 mL) of allocated treatment solution orally to their infant and then requested to administer this treatment once per day for 4 weeks or until the bottle was empty. During scheduled study visits at ages 1 week, 6 weeks, and 6 months, trained field workers visited each participant's home and used a standardised questionnaire to obtain a history of recent illness, medication use, breastfeeding practice, and the current condition of the child. At the 6-week and 6-month follow-up visits, the participants' weights and lengths were measured, and stool samples were collected. Stool samples were used for analysis of extended-spectrum β-lactamase-producing Enterobacterales (to evaluate gut colonisation rates) and metagenomic sequencing. The primary outcome was a composite of death or hospitalisation during the first 6 months of life, assessed in three populations: a modified intention-to-treat population (mITT), which included all participants with a known primary outcome at 6 months of follow-up; the intention-to-treat population, which included all participants who were enrolled and randomly assigned to a treatment group; and the per-protocol population, which included only infants in the mITT whose caregivers reported having given them the study solution once per day during the 4-week intervention period. This trial is registered with ClinicalTrials.gov, NCT04172012, and is complete. FINDINGS:Between Feb 1, 2022, and Jan 4, 2023, 2000 participants were enrolled and randomly assigned to the probiotic (n=1000) or placebo (n=1000) groups, with administration of the probiotic or placebo treatment beginning on median day 1 (IQR 1-2) of life. 6 months after inclusion, data for the primary outcome were available for 1945 (97·3%) of the 2000 participants. By mITT, there was no statistically significant difference in the primary outcome between the two study groups. Hospitalisation or death occurred in 34 (3%) of 970 participants in the probiotic group and 31 (3%) of 975 participants in the placebo group (crude relative risk 1·10, 95% CI 0·68-1·78). There were also no differences in the overall incidence of adverse events between the groups, but fewer caregiver-reported gastrointestinal events were reported in the probiotic group. INTERPRETATION:Daily administration of a multistrain probiotic mixture in the first 4 weeks of life did not reduce the rate of death or hospitalisation up to age 6 months among infants in Tanzania and did not cause any short-term safety concerns. FUNDING:Western and Northern Norway Regional Health Authorities, Trond Mohn Foundation, and Joint Programming Initiative on Antimicrobial Resistance.

OBJECTIVE:To investigate the duration of active first and second stage of labour, specifically the new alert values recommended by the World Health Organisation in 2018, in relation to intrapartum stillbirths and 24-h newborn outcome (i.e. 24-h perinatal outcome). METHODS:A prospective observational study including deliveries at Haydom Lutheran Hospital in rural Tanzania between March 2013 through November 2018. Information about labour, delivery and newborn characteristics/outcome was recorded on data collection forms by trained data collectors, observing every delivery. Of 22,199 deliveries 12,481 were included. Exclusion criteria were: missing time variables, caesarean section, multiples and antepartum stillbirths. Logistic regression was used to model whether duration of labour was associated with risk of adverse outcome. Our main outcome measure was 24-h perinatal outcome. RESULTS:24-h postpartum, 454 (3.6 %) newborns were dead (intrapartum stillbirths n = 118, newborn deaths n = 63) or admitted to Neonatal Unit (n = 273). Duration of first stage was categorised: <6 (n = 900), 6- < 12 (n = 9204), and ≥ 12 h (n = 2377), with no significant relation to adverse perinatal outcome for either group (p = 0.431). Duration of second stage was categorised: <1 (n = 12,342) and ≥ 1 h (n = 139). Duration ≥1 h was associated with adverse perinatal outcome, OR 3.38 (95 % CI 1.95-5.88) when adjusted for foetal heart rate during labour and before delivery, gestational age and birth weight. CONCLUSIONS:Duration of first stage was not associated with adverse outcome. Second stage ≥1 h was associated with adverse outcome by more than a three-fold. Our findings are not in accordance with the new recommendations from the World Health Organisation.

Neonatal mortality is high in middle- and low-income countries, including Tanzania. Most of these deaths are preventable and linked to suboptimal quality of care. In this study, we assessed neonatal resuscitation skills acquisition after a 1-day Helping Babies Breathe (HBB) simulation training using improved tools and associated factors among healthcare providers in 12 facilities in Tanzania. A cross-sectional study was conducted among healthcare providers working in the labor wards in selected health facilities. The training was conducted in situ using the HBB second edition curriculum with improved simulation tools (Neonatalie Live simulator, NeoBeat heart rate meter, and Upright resuscitator). After training, skills acquisition was evaluated using Objectively Structured Clinical Evaluation. Participants who scored an average of 75

Rural communities in resource-limited settings are exposed to seasonal patterns in food insecurity. The pre- and early post-natal period is a key developmental window, sensitive to nutritional availability and quality. While season of birth has been associated with differences in epigenetic, developmental and health outcomes, it is unclear if this imprints on the developing metabolome and contributes to adverse phenotypic outcomes. Here we show that urinary and plasma metabolites in Tanzanian infants follow seasonal waveforms dependent upon their month of birth, persisting up to at least 18 months of life, which were related to food insecurity, breastmilk composition and rainfall. This includes developmentally relevant metabolites, including choline, trimethylamine-N-oxide, and polyunsaturated fatty acids. Cognitive measures at 18 months also followed seasonal waveforms based upon month of birth which correlated with seasonal metabolites. Additionally, variation in metabolic status modulated the effectiveness of a maternal-infant nicotinamide intervention targeting stunting. Our findings show that seasonal environmental pressures shape mother-infant dyad food insecurity with lasting ramifications for the infant metabolome and development. These findings support the need for season-dependent nutritional and lifestyle interventions targeting developmental shortfalls in these communities.

Antenatal attendance is critical for pregnant women to receive the screening, health education and care plans that can optimise positive perinatal outcomes. In Tanzania, few women achieve the WHO-recommended 8 contacts with health workers, partly due to the limited screening and diagnosis services offered and health workers’ disrespectful attitudes. Mobile health solutions have potential to support the provision of comprehensive and respectful antenatal consultations, but these need to be rigorously assessed. The study aimed to adapt the Pregnancy and Newborn Diagnostic Assessment e-health system (PANDA), to incorporate respectful care prompts, and assess the feasibility of the new PANDA system to deliver prenatal care to women in rural Tanzania. A prospective, pre- and post-cohort mixed-methods study over 12 months was carried out in two primary facilities and one linked referral hospital. One hundred and sixty pregnant women (1st or 2nd trimester) were recruited; 80 received usual prenatal care and 80 received care through PANDA. Feasibility outcomes comprised recruitment and retention of women into the study, acceptability of the intervention and research processes, intervention fidelity, feasibility of data collection, confirmation of trial outcome measure and quality of implementation. Incorporation of respectful care prompts was achieved and considered acceptable. The study recruited to target (> 90

This paper examines changes in the completeness of documentation in clinical practice before and during the implementation of the Safer Births Bundle of Care (SBBC) project. This observational study enrolled parturient women with a gestation age of at least 28 weeks at the onset of labour. Data collectors extracted information from facility registers and then a central data manager summarised and reported weekly statistics. Variables of clinical significance for CQI were selected, and the proportion of non-documentation was analysed over time. A Pearson chi-square test was used to test for significant differences in non-documentation between the periods. Between 1 March 2021 and 31 July 2022, a total of 138,442 deliveries were recorded. Overall, 75% of all patient cases had at least one missing variable among the selected variables across both periods. A lack of variable documentation occurred more frequently at the district hospital level (81% of patient cases) and health centres (74%) than at regional referral hospitals (56%) (p < 0.001). Non-documentation decreased significantly from 79% to 70% after the introduction of the SBBC (p < 0.001). A tendency towards negative correlations was noted for most variables. We noted an increased attention to data quality and use which may have a positive impact on the completeness of documentation. However, halfway through the project’s implementation, the completeness of documentation was still low. Our findings support the recommendation to establish short-spaced feedback loops of locally collected data using one data platform.

INTRODUCTION:Birth asphyxia-related deaths is a major global concern. Rapid initiation of ventilation within the "Golden Minute" is important for intact survival but reported to be challenging, especially in low-/middle-income countries. Helping Babies Breathe (HBB) is a simulation-based training program for newborn resuscitation. The aim of this HBB quality improvement (QI) intervention was to decrease time from birth to ventilation and document potential changes in perinatal outcomes. METHOD:Prospective observational QI study in a rural Tanzanian hospital, October 1, 2017, to August 31, 2021, first-year baseline, second-year QI/simulation intervention, and 2-year postintervention. Trained research assistants observed wide-ranging information from all births (N = 12,938). The intervention included monthly targeted HBB simulation training addressing documented gaps in clinical care, clinical debriefings, and feedback meetings. RESULTS:During the QI/simulation intervention, 68.5% nonbreathing newborns were ventilated within 60 seconds after birth compared with 15.8% during baseline and 42.2% and 28.9% during the 2 postintervention years ( P < 0.001). Time to first ventilation decreased from median 101 (quartiles 72-150) to 55 (45-67) seconds ( P < 0.001), before increasing to 67 (49-97) and 85 (57-133) seconds after intervention. More nonbreathing newborns were ventilated in the intervention period (12.9%) compared with baseline (8.5%) and the postintervention years (10.6% and 9.4%) ( P < 0.001). Assumed fresh stillborns decreased significantly from baseline to intervention (3.2%-0.7%) ( P = 0.013). CONCLUSIONS:This QI study demonstrates an increase in nonbreathing newborns being ventilated within the Golden Minute and a significant reduction in fresh stillborns after introduction of an HBB QI/simulation intervention. Improvements are partially reversed after intervention, highlighting the need for continuous simulation-based training and research into QI efforts essential for sustainable changes.

BACKGROUND:Food fortification with micronutrients is an insufficiently used technology in developing countries. Salt is consumed in small, constant daily amounts by most people globally. Salt has been instrumental in delivering iodine to a wide population globally through fortification. There is a proven effective technology for fortifying iodinated salt with iron, folate, and Vitamin B12. Findings have shown that both Double (Iodine and iron) fortified salt (DFS) and quadruple (iron, iodine, folate, and vitamin B12) fortified salt (QFS) are effective in raising hemoglobin levels.AIM:To assess the acceptability and gauge consumers' willingness to use double-fortified and quadruple-fortified salt formulations.METHODS:We conducted an observational study involving 300 households at Haydom Lutheran Hospital catchment area in Northern rural Tanzania between October 2021 and April 2022. Each household was supplied with one type of salt (iodized salt (IS), DFS or QFS) for cooking common family dishes for one week. Thereafter, at least two adult members of the family who used the dishes cooked with study salt were interviewed using the adopted 5-point Hedonic scale.RESULTS:A total of 899 individuals were interviewed after using study salt for one week: 286 IS, 305 DFS, and 308 QFS. The overall acceptability for the salts was QFS (82%), DFS (78%), and IS (79%). The mean sensory (taste, color and appearance) scores of the QFS (1.7) and DFS (1.7) were comparable to standard iodized salt (1.6).CONCLUSION:Quadruple-fortified salt and double-fortified salt are equally acceptable and have similar sensory scores as standard iodized salt when used to cook commonly eaten dishes in the study population.

Background: Micronutrients (iron, iodine, vitamin B12 and folate) deficiency is prevalent globally affecting more than two billion people majority being from low-and middle-income countries. Women of reproductive age are in an increased risk of iron deficiency. About 29.4% of women aged 15-49 years worldwide are estimated to be affected by iron deficiency. Food fortification with micronutrients is important in addressing micronutrients deficiency.Aim: To evaluate if the quadruple fortified with iodine, iron, vitamin B12, and folic acid (QFS), will be more effective in improving the hemoglobin level of women aged 18 to 49 years compared to the double fortified with iodine and iron (DFS) and iodized salt in rural Tanzania.Methods: A double-blinded three-arm randomized controlled trial was conducted between July 2020 and December 2021 at the Haydom Lutheran Hospital catchment area. We randomized women aged 18-49 years with haemoglobin between 8 and 12 g/dl who were neither pregnant nor lactating into three groups 55 Iodized salts (IS), 57 Double fortified salt (DFS), and 57 quadruple fortified salt (QFS). The participants used study salt for 10 months.Results: Over the ten months of use of study salts, the overall mean haemoglobin level of women was significantly higher in QFS by 0.43g/dl compared to IS. The ferritin levels were significantly higher in QFS and DFS by 9.60ng/mL and 9.09ng/mL, respectively, compared to IS. Vitamin B12 was insignificantly higher in QFS by 52.19pg/mL compared to DFS, and folate concentration were insignificantly higher in QFS by 7.57nmoL/L and 4.51nmoL/L compared to DFS and IS groups, respectively.Conclusion: Salt fortification with iron, iodine, folate, and Vitamin B12 is feasible and has the potential to increase the serum ferritin, Vitamin B12 and folate levels with subsequent improvement of haemoglobin levels of individuals with relatively low haemoglobin. ClinicalTrial.org Number: NCT04404751.

Newborn mortality is a global challenge with around 2.4 million neonatal deaths in 2019. One third of these occur within the first-and-only day of life with labour complications and birth asphyxia being the primary causes. Existing guidelines for newborn resuscitation are based on limited scientific evidence, and evidens based research is sought for. To increase our knowledge on resuscitation of newborns, it is crucial to first quantify what is currently being done in terms of therapeutic activities, such as ventilation and stimulation, and how they affect resuscitation outcomes. In the current study, the therapeutic activities during newborn resuscitation are quantified by estimating a timeline describing the start and stop of activities. The proposed approach is combining methods using both video and time series data recorded during resuscitation, where the predictions are based on the available sources. From video the activity recognition is done by a 3D CNN method. For the signal data feature extraction is performed on ECG and accelerometer signals and thereafter machine learning is done to perform stimulation detection. We show that best results are achieved with all signals and video available, for the activity "stimulation"we get an AUC of 0.86, sensitivity of 82.32%, specificity of 82.23%, and precision of 57.59%. If only signals or video is available we still get good results with AUC at 0.80, and 0.84 respectively.

Background: SaferBirths Bundle of Care (SBBC) is a package of innovative clinical and training tools coupled with low-dose high-frequency simulation-based on-job training guided by local data. This bundle of care is a new initiative being implemented in 30 health facilities from five regions of Tanzania aiming at improving birth outcomes.Objective: To assess the perception of healthcare workers and facility leaders on the "SaferBirths Bundle of Care" towards saving women's and newborns' lives at birth.Method: We used a qualitative approach using focused group discussion (FGD) and individual interviews. A total of 21 FGD and 43 individual interviews were conducted between August and November 2022. In total, 94 midwives and 12 doctors were involved, some of whom were in leadership roles. The framework method for the analysis of qualitative data was used for analysis.Results: Healthcare workers and facility leaders received the bundle well and regarded it as effective in saving lives and improving healthcare provision. Five themes emerged as facilitators to the acceptance of the bundle: (1) the bundle is appropriate to our needs, (2) the training modality and data use fit our context, (3) use of champions and periodic mentorship, (4) learning from our mistakes, and (5) clinical and training tools are of high quality but can be further improved.Conclusion: The relevance of SaferBirths Bundle of Care in addressing maternal and perinatal deaths, the quality and modality of training, and the culture that enhances learning from mistakes were among the facilitators of the acceptability of the SBBC. A well-accepted intervention has huge potential for bringing the intended impact in health provision.