Firehiwot Abathun

Neonatal mortality poses a significant burden on global health, particularly in low- and middle-income countries (LMICs). Neonatal deaths do not only have an emotional and psychological effects on families but can also have broader societal implications, straining healthcare systems, impeding economic development, and exacerbating inequalities. There were an estimated 2.3 million neonatal deaths globally in […]

The reduction of preventable newborn deaths remains a priority globally, but particularly in low- and middle-income countries (LMICs), where neonatal mortality and morbidity rates remain unacceptably high [1]. An estimated 2.3 million newborns die each year worldwide, with sub-Saharan Africa accounting for half of these deaths [1]. Achieving further reductions in neonatal mortality requires not […]

According to the latest estimates of 2022, 2.3 million newborns died globally, accounting for 47% of all child deaths under the age of five [1]. Sub-Saharan Africa recorded one of the highest neonatal mortality rates in 2022, at 27.1 deaths per 1000 live births and 21.1 stillbirths per 1000 total births [1–4]. The majority of […]

Every year, an estimated 2.3 million newborns die during the first 28 days of life, with around 1.9 million of these deaths being stillbirths, and nearly all (89%) occurring in low- and middle-income countries (LMICs) [1–3]. The sub-Saharan African region has the highest neonatal mortality and stillbirth rate in the world, with 27 neonatal deaths […]

Adequate functionality of electronic routine health information systems (eRHISs) is crucial for data use, yet few studies explored it in relation to newborn and stillbirth data in Africa. We conducted this cross-sectional study between November 2022 and July 2024 in data offices at central and subnational levels in 12 regions and 4 city administrations in the Central African Republic (CAR), Ethiopia, Tanzania, and Uganda. Except for end-user perspectives (collected via interviews), we collected data related to eRHIS functionalities by direct observation following standard operating procedures as for the Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) Tool 3.1, based on the Performance of Routine Information System Management (PRISM) framework. We analysed data according to the PRISM Users' Kit. We assessed 53 data offices in total. All countries used the same software application, the District Health Information Software 2 (DHIS2). Settings were heterogeneous across countries, with a tendency for DHIS2 to offer fewer functionalities to users in the CAR. Overall functionalities for generating facility annual summary reports (100% in all countries) and for calculating percentage of reports received/expected (75.0% in Ethiopia to 88.9% in Tanzania) were widely available. Data integration and data disaggregation, meanwhile, had lower availability. Functionalities for calculating coverage on specific indicators, such as respectful care, were lacking in all countries, those for quality assurance varied across countries, while those related to data visualisation were almost always available in Uganda and Tanzania, but showed specific gaps in Ethiopia (i.e. for early initiation breastfeeding), and most often lacked in the CAR. Most end-users indicated needs for eRHIS improvement (ranging from 37.5% in Ethiopia to 100% in the CAR; P = 0.001), with 17.0% reporting needs for major improvement (from 10.0% in Uganda to 28.6% in the CAR; P = 0.001). Subgroup analyses suggested high within-country heterogeneity and more eRHIS functionalities available at central vs. subnational level. Identified strengths and gaps in existing DHIS2 functionalities can inform the design of context-specific interventions that will enhance data use for reducing neonatal mortality and stillbirth rates.

In recent decades, there has been a growing recognition of the importance of quality newborn healthcare at the facility level [1]. Despite efforts in low- and middle-income countries (LMIC), studies have revealed persistent gaps and inequities in newborn quality of care [2–4]. In acknowledgement of this issue, a consensus emerged on the need for enhanced […]