Every Newborn (EN-BIRTH)

Every Newborn Action Plan (ENAP) launched in 2014 was developed in consultation with member states including many organizations and supported by World Health Organization (WHO).

Accurate data are crucial to track progress towards the Global Strategy and the Ending Preventable Maternal Mortality (EPMM)/ENAP vision to end preventable maternal and newborn mortality as well as stillbirth. Impact data, including mortality and birthweight/gestational age and data regarding coverage of interventions to ensure we are reaching those in need, are integral to global governance, finance planning and local program planning. In this regard, the global ENAP technical advisory team together with London School of Hygiene and Tropical Medicine (LSHTM), Nepal Health Research Council (NHRC) and Golden Community is committed to EN-BIRTH study to validate the newborn indicators collected from the health facilities, evaluate the quality of care provided at health facility and validate whether the health facility based indicator can be collected from the periodic national and sub-national survey by 2018. The objective of the study is to evaluate the accuracy and precision of the data collection on women receiving uterotonics, women receiving antenatal corticosteroids, neonatal resuscitation, essential newborn, newborn receiving Kangaroo Mother Care (KMC) and newborn with infection. The study is being conducted at Pokhara Academy of Health Sciences

Every Newborn Action Plan Metrics


This study is an extension to the Every Newborn Birth Indicator Research Tracking in Hospitals (EN-BIRTH) study in Tanzania, Bangladesh and Nepal. EN-BIRTH is an observational study of 20,000 births in five facilities in Tanzania, Bangladesh and Nepal, between mid-2017 and mid-2018. This add-on cohort study is called EN-SMILING, following these children to the age of 5 years to extend the current research on simplified metrics from the time of birth to include metrics for child development, and to promote early identification of adverse developmental outcomes after exposure to basic newborn interventions, including newborn resuscitation, KMC and treatment for presumed serious bacterial infections.

The link between newborn health and early child development (ECD) is crucial. Birth is a time of great risk and opportunity for death, disability and child development. Nearly 10% Disability Adjusted Life Years (DALYs) globally are due to newborn death and impairment after newborn complications. Less is known about developmental consequences for newborns who had basic interventions, such as basic resuscitation, kangaroo mother care (KMC) and inpatient treatment for presumed neonatal infection. Early Child development (ECD) is central to the SDGs, linking health (SDG3),educational attainment (SDG4), economic growth (SDG 8) and inequality reduction(SDG 10).1Impaired ECD reflects inequalities between and within countries and keep nations in poverty.2Prevention of impairment, early detection and intervention for developmental delays can transform individual and population potential.3 If routine measurement were simplified and integrated with newborn and child health care, this could lead to earlier intervention and improve school readiness.

The study’s objectives build on EN-BIRTH objectives as follows:

  1. MEASURE: Develop and test a structured approach to child development measurement (simple tools, timing, training) and evaluate accuracy compared to ‘gold standard’ developmental assessment as well as feasibility and acceptability for health workers and families.
  2. DETECT:Assess prevalence of developmental delay from birth to 5 years for a sub-sample of newborns across all three study sites who required basic newborn interventions, compared to randomly selected, matched newborns, not exposed to basic interventions.
  3. INTEGRATE METRICS AND CARE:Explore challenges and enablers for routine use of the simplified, structured early child development measurement approach, and how detection is linked to care for children with developmental delays or disability in these three countries.

Infants recruited from EN-BIRTH will be followed up from birth until 5 years of age. Using a simplified ECD measurement approach, they will be assessed at 6, 9, 12, 18, 24, 36 and 60 months. Through comparison with ‘gold standard’ comprehensive child development assessments (i.e. Bayley Scales of Infant and Toddler Development Third Edition (Bayley III) at 3 yrs and Wechsler Preschool and Primary Scale of Intelligence (WPPSI)at 5 yrs) performance of the simplified ECD measurement approach will be evaluated. A mixed method assessment of feasibility and acceptability, will inform the possibility of use at scale. This research will inform ECD measurement integration within newborn and child health (such as immunisation appointments), improve understanding of child development impact of basic newborn interventions and inform approaches to improving access to and design of early intervention for those at risk of adverse developmental outcomes.

Click here to read the detailed report.