Selection of Maternal and Newborn Health Core Improvement Collaborative Indicators and Outcome Measures Used in Evaluating an All Babies Count Initiative Implemented in Rwanda
| Indicator | Numerator | Denominator | Data Source | Facility | |
|---|---|---|---|---|---|
| Antenatal carea | 1. ANC standard 4 visit coverage | Number of women who delivered in a HF who had 4 ANC visits | Total number of health facility deliveries PLUS total number of referrals of laboring women from HC to hospital PLUS home deliveries | HMIS | HCs |
| Delivery services | 2. Percentage of pregnant women with facility delivery | Total number of health facility deliveries | Total number of home deliveries PLUS total number of health facility deliveries | Community HMIS | HCs |
| 3. Time to cesarean delivery for emergency (from determination of need at hospital to time of delivery) | Average time to cesarean delivery for emergency (from determination of need by doctor at hospital to time of cesarean delivery incision) | Chart reviewb | Hospital | ||
| 4. Antenatal steroids for preterm labor | Number of women with preterm labor <34 weeks treated with dexamethasone | Number of women with preterm labor (<34 weeks) | Chart review | Hospital (HCs added later) | |
| Postnatal care | 5. Percentage of babies with immediate skin-to-skin after delivery | Number of babies placed immediately skin to skin | Number of babies born vaginally | Chart review | HCs and hospital |
| 6. Danger sign assessment within 24 hours | Newborns checked for danger signs in postpartum ward within 24 hours | Total deliveries MINUS stillbirths macerated MINUS stillbirths fresh MINUS death at birth of live born babies | HMIS | HC and hospitals | |
| Outcome | 7. Neonatal unit case fatality | Number of deaths in neonatal unit (<28 days) | Number of admissions to neonatal unit (<28 days) | Chart review | Hospital |
| 8. District-wide neonatal mortality | HMIS neonatal deaths PLUS death at birth of live born babies PLUS number of neonatal deaths at community | Live births PLUS number of home deliveries | HMIS | HCs and hospital | |
| 9. Facility neonatal mortality among preterm/LBWc | Hospital deaths due to prematurity PLUS HC deaths due to prematurity | Hospital LBW/non-preterm PLUS hospital preterm PLUS HC LBW/non-preterm PLUS HC preterm | HMIS | HCs and hospital | |
| 10. Facility neonatal mortality among non-preterm/LBWd | Hospital deaths of all causes except prematurity PLUS HC deaths of all causes except prematurity | Hospital and HC live births MINUS (hospital LBW/non-preterm PLUS hospital preterm PLUS HC LBW/non-preterm PLUS HC preterm) | HMIS | HCs and hospitals | |
| 11. Facility stillbirths (macerated and fresh)c | Stillbirths macerated PLUS stillbirths fresh | Total deliveries | HMIS | HCs and hospital |
Abbreviations: ANC, antenatal care; HC, health center; HF, health facility; HMIS, health management information system; LBW, low birth weight.
↵a Rwinkwavu health center did not have delivery services, so the denominator was changed to number of community HMIS health facility deliveries at district hospital plus number of community HMIS home deliveries.
↵b Chart review indicators were newly introduced at the start of the intervention.
↵c Prematurity defined as gestational age ≤37 weeks, and low birth weight defined as birth weight < 2500 g per World Health Organization standard definition.
↵d Stillbirths defined in national HMIS data dictionary as a baby born with no signs of life at or after 22 weeks gestation and with birth weight greater than or equal to 500 g. Stillbirth analysis restricted to facility level given the absence of community-based recording of stillbirths.