Publications

Here are the publications from our team members.

Year 2026

Aim: To explore co-design facilitators’ perspectives and experiences of using co-design to improve intrapartum care in four sub-Saharan African settings focusing on how they fostered engagement, built trust and mitigated unintended consequences during the co-design process. (Link to publication)

Why: Co-design is increasingly used in healthcare intervention development, actively involving patients and healthcare professionals as partners to create contextually relevant solutions. Co-design facilitators have a pivotal role in fostering trust, facilitating rapport-building, resolving conflicts and empowering participants to collaborate as equal partners. While several studies have explored participants’ experiences with co-design, less is known about co-design facilitators’ experiences or their views on its feasibility, usefulness and impact on research practice, policy or patient outcomes.

Aim: To understand how policymakers and health care managers perceive and practice governance of health management information data systems and processes, including the introduction of digital technology in Tanzania.
(Lin k to publication)

Why: Health management information systems are crucial for a country’s health service planning and monitoring. Research findings indicate however that data produced within this system is often of low quality or not used for decision-making in low-resource settings like Tanzania. To better understand how this complexity affects system governance, it is crucial to analyze perceptions and practices of national policymakers and subnational healthcare managers responsible for policy implementation.

Year 2025

Aim: To understand why caesarean sections are performed for stillborn babies by investigating caesarean section rates and indications in sub-Saharan African countries and to examine whether fetal vital status at admission is associated with caesarean section. (Link to publication)

Why: Rising rates of caesarean section worldwide are a concern because of their potential negative short- and long-term effects. Most global and regional reports on CS rates do not include stillbirths. Therefore, little information exists regarding rates and characteristics of CS for stillborn babies, which are relevant for regions where stillbirth rates are high, like SSA.

**Why**: The initial program theory (IPT) is a core element of realist evaluation. An IPT presents a hypothesis about how, for whom, why, and in what contexts an intervention is effective. Despite their importance within realist studies, methodological guidance on how to develop an IPT is relatively scarce.

**Aim**: To contribute to the methodological development of realist research by presenting the process of developing an initial programme theory through a worked example that focuses on facility-based maternal death reviews in Benin.
(Link to publication)

**Why**: Data are constructed by people, about people. People collecting and reporting maternal and neonatal health data across health system levels have different priorities and face varying constraints.

**Aim:** To analyse the power dynamics shaping routine health data collection and reporting
in labour wards of two hospitals in Southern Tanzania.
(Link to publication)

Year 2024

**Why**: Digital data systems have the potential to improve data quality and provide individual-level information to understand gaps in the quality of care.

**Aim**: To explore experiences and perceptions of a perinatal eRegistry in two hospitals in Mtwara region, Tanzania.
(Link to full publication)

**Why**: Growing evidence suggests that extreme heat events affect pregnant women and their infants, but few studies are available from sub-Saharan Africa.

**Aim**: To investigate the association between heat exposure in the final week of pregnancy and perinatal deaths, disaggregated by timing of death (before and during labor).
(Link to full publication)

**Why**: Evidence suggests that family-centered care for sick newborns, where parents are co-caregivers in newborn care units, can result in increased breastfeeding frequency, higher weight gain, earlier discharge, and reduced parental anxiety.

**Aim**: To explore healthcare providers’ perceptions and experiences of parental participation in care for sick newborns in the newborn care units in two high-volume maternity units in Uganda.
(Link to full publication)

**Why**: Patient autonomy is central to the provision of respectful maternity care. Enabling women to make decisions free of discrimination and coercion, and respecting their privacy and confidentiality can contribute to positive childbirth experiences.

**Aim**: To deepen the understanding of how patient autonomy is reflected through social practices during intrapartum care in Benin.
(Link to full publication)

**Why**: Women’s childbirth experiences provide a unique understanding of care received in health facilities from their voices as they describe their needs, what they consider good and what should be changed. Quality Improvement interventions in healthcare are often designed without inputs from women as end-users, leading to a lack of consideration for their needs and expectations.

**Aim**: To explore women’s childbirth experiences to inform a co-designed quality improvement intervention in Southern Tanzania.
(Link to full publication)

**Why**: The majority of women experience pain during childbirth. Offering and supporting women to use different methods for coping with pain is an essential competency for maternity care providers globally. Research suggests a gap between what women desire for pain management and what is available and provided in many low-and middle-income settings.

**Aim**: To understand how pain management is perceived by those involved: women experiencing childbirth and maternity care providers.
(Link to full publication)

**Why**: Globally, 1.9 million babies are stillborn and 2.3 million babies die within the first 28 days of life every year, mostly within the first hours and days postpartum. In high-mortality settings, including sub-Saharan Africa, half of stillbirths occur during childbirth.

**Aim**: To assess stillbirth mortality by Robson ten-group classification and the usefulness of this approach for understanding trends.
(Link to full publication)

Year 2023

**Why**: Birth asphyxia is a leading cause of neonatal mortality in sub-Saharan Africa. The relationship to grand multiparity (GM), a controversial pregnancy risk factor, remains largely unexplored, especially in the context of large multinational studies.

**Aim**: Investigate birth asphyxia and its association with grand multiparity and referral in Benin, Malawi, Tanzania and Uganda.
(Link to full publication)

**Why :** Evidence-based quality care is essential for reducing sub-Saharan Africa’s high burden of maternal and newborn mortality and morbidity. Provision of quality care results from interaction between several components of the health system including competent midwifery care providers and the working environment.

**Aim :** Assess midwifery care providers’ ability to provide quality intrapartum and newborn care and selected aspects of the working environmen.
(Link to full publication)

**Why**: The COVID-19 pandemic challenge health systems globally. Besides responding to and managing the disease itself, health systems have struggled to maintain the provision of essential services during this period includig maternal and newborn healthcare.

**Aim**: Describe how maternity care was provided during the COVID-19 pandemic and assesses patterns of service utilization and perinatal health outcomes in 16 referral hospitals (four each) in Benin, Malawi, Tanzania and Uganda.
(Link to full publication)

**Why :** Health information management system data is collected for national planning and evaluation but is rarely used for healthcare improvements at subnational or facility-level in low-and-middle-income countries. Research suggests that perceived data quality and lack of feedback are contributing factors.

**Aim :** Understand maternity care providers’ perceptions of data and how they use it, with a view to co-design interventions to improve data quality and use. (Link to full publication)

**Why :** Mothers’ participation in the care of their sick newborns in Newborn Care Units (NCUs) has been linked to several advantages including earlier discharge, fewer complications, better mother-baby bonding, and an easier transition to home after discharge.

**Aim**: Understand mothers’ perceptions and experiences while participating in the care of their sick newborns in the NCUs to inform interventions promoting mothers’ participation in public health facilities in Uganda. (Link to full publication)

Year 2022

**Why :** Pre-service training curricula for midwifery care providers act as a foundation on which students can develop the required competencies to provide quality evidence-based care. Evidence suggests that while countries report relatively high levels of birth attendance by skilled health personnel maternal and neonatal mortality have not decreased proportionately.

**Aim :** Map midwifery pre-service training curricula to identify main gaps in courses, registration, and licensing requirements.
(Link to full publication)

**Why :** Health facility assessments (HFAs) assessing facilities’ readiness to provide services are well-established. However, HFA questionnaires are typically quantitative and lack depth to understand systems in which health facilities operate—crucial to designing context-oriented interventions

**Aim :** Report lessons from implementing a maternity care-focused, mixed methods and flexible HFA conducted in 16 hospitals in four sub-Saharan African countries to inform a quality improvement project.
(Link to full publication)

**Why** : Despite a strong evidence base for developing interventions to reduce child mortality and morbidity related to pregnancy and delivery, major knowledge–implementation gaps remain.

**Aim :** The realist process evaluation of ALERT aims at identifying and testing the causal pathway through which the intervention achieves its impact.
(Link to full publication)

**Why** : The alarmingly high maternal and neonatal death rates in Benin need to be addressed

**Aim** : Assess the implementation of the Maternal and Perinatal Death Surveillance and Response (MPDSR) strategy institutionalized in Benin in 2013.
(Link to full publication )

**Why :** Levels of maternal and neonatal mortality remain high in sub-Saharan Africa, with an estimated 66% of global maternal deaths occurring in this region. Many deaths are linked to poor quality of care, which in turn has been linked to gaps in pre-service training programmes for midwifery care providers. In-service training packages have been developed and implemented across sub-Saharan Africa in an attempt to overcome the shortfalls in pre-service training.

**Aim :** Summarize in-service training materials used in sub-Saharan Africa for midwifery care providers between 2000 and 2020 and mapped their content to the International Confederation of Midwives (ICM) Essential Competencies for Midwifery Practice.(Link to full publication)

Year 2021

**Why :** More women in low- and middle-income countries give birth in health care facilities, reductions in maternal and neonatal mortality have been less than expected. This paradox may be explained by the standard and quality of intrapartum care provision which depends on several factors such as health workforce capacity and the readiness of the health system as well as access to care.

**Aim :** Assess competencies (knowledge, skills and attitudes) of midwifery care providers as well as their experiences and perceptions of in-service training
(Link to full publication)

**Why :** Overcoming the knowledge-do-gap to ensure implementation of known evidence-based interventions during this period has the potential to avert at least 2.5 million deaths in mothers and their offspring annually.

**Aim :** Describes a study protocol for implementing and evaluating a multi-faceted health care system intervention to strengthen the implementation of evidence-based interventions and responsive care during this crucial period
(Link to full publication)

**Why :** Training programmes that aim to prepare providers of midwifery care vary considerably across sub-Saharan Africa in terms of length, content and quality. To overcome the shortfalls of pre-service training and support the provision of quality care, in-service training packages for providers of midwifery care have been developed and implemented in many countries in sub-Saharan Africa.

**Aim :** Identify what in-service education and training materials have been used for providers of midwifery care between 2000 and 2020 and map their content to the International Confederation of Midwives’ Essential Competencies for Midwifery Practice (ICM Competencies), and the Lancet Midwifery Series Quality Maternal and Newborn Care (QMNC) framework.
(Link to full publication)

Updated by:

kiwp 2026-03-20