Newborn Signal Functions in Bangladesh: Identification Through Expert Consultation and Assessment of Readiness Among Public Health Facilities

Overview

Journal J Glob Health

Specialties Health Services
Public Health

Date 2025 Jan 8

PMID 39772287

Authors

Shema Mhajabin

Goutom Banik

Muhammad Shariful Islam

Md Jahurul Islam

Tazeen Tahsina

Farid Uddin Ahmed

Mushair Ul Islam

Md Abdul Mannan

Sanjoy Kumer Dey

Samina Sharmin

Fida Mehran

Mahbuba Khan

Anisuddin Ahmed

Ahmed Al Sabir

Shahin Sultana

Ziaul Ahsan

Sayed Rubayet

Joby George

Afsana Karim

Muhammad Shahidullah

Shams El Arifeen

Ahmed Ehsanur Rahman

Affiliations

Soon will be listed here.

Abstract

Background: This study aimed to identify a set of newborn signal functions (NSFs) that can categorize health facilities and assist policymakers and health managers in appropriately planning and adequately monitoring the progress and performance of health facilities delivering newborn health care in Bangladesh and similar low-income settings.

Methods: A modified Delphi method was used to identify a set of NSFs and a cross-sectional health facility assessment among the randomly selected facilities was conducted to test them in public health facilities in Bangladesh. In the modified Delphi approach, three main steps of listing, prioritizing, and testing were followed to identify the set of NSFs. Then, to finalize the set of NSFs and its variables, a total of five Delphi workshops and three rounds of Delphi surveys were conducted. Finally, 205 public health facilities located in 41 randomly selected districts were assessed for the availability and readiness of finalized NSFs using the updated tool of Bangladesh Health Facility Survey (BHFS) 2017.

Results: Twenty NSFs were identified and finalized, nine of which were categorized as primary NSFs, 13 as basic NSFs, 18 as comprehensive NSFs, and 20 as advanced NSFs. Almost all district hospitals (DHs), Upazila health complexes (UHCs,) and maternal and child welfare centres (MCWCs) performed the primary NSFs in the last three months. However, around one-third of the union health and family welfare centres (UH&FWCs) and very few community clinics (CCs) performed them during the same period. The basic, comprehensive, and advanced NSF readiness was inadequate and inappropriate across all types of facilities, including DHs and UHCs.

Conclusions: In the absence of internationally or nationally agreed-upon NSFs to measure a health facility's service availability and readiness for providing newborn care, this study becomes the first to identify and finalize a set of NSFs and to incorporate relevant variables in the health facility assessment tool which can be used to monitor the availability and readiness of a newborn care facility. The identified NSFs can also be adapted for the countries with similar contexts and can serve as a standard base to determine a global set of NSFs.

Citing Articles

Assessing health systems' capacities to provide post-abortion care: insights from seven low- and middle-income countries.

Raza S, Banik R, Noor S, Jahan E, Sayeed A, Huq N J Glob Health. 2025; 15():04020.

PMID: 39791404 PMC: 11719741. DOI: 10.7189/jogh.15.04020.

References

Steenbruggen R, van Oorsouw R, Maas M, Hoogeboom T, Brand P, van der Wees P . Development of quality indicators for departments of hospital-based physiotherapy: a modified Delphi study. BMJ Open Qual. 2020; 9(2). PMC: 7312452. DOI: 10.1136/bmjoq-2019-000812. View

Kinney M, Cocoman O, Dickson K, Daelmans B, Zaka N, Rhoda N . Implementation of the Every Newborn Action Plan: Progress and lessons learned. Semin Perinatol. 2015; 39(5):326-37. DOI: 10.1053/j.semperi.2015.06.004. View

Rahman A, Banik G, Mhajabin S, Tahsina T, Islam M, Ahmed F . Newborn signal functions in Bangladesh: identification through expert consultation and assessment of readiness among public health facilities-study protocol using Delphi technique. BMJ Open. 2020; 10(9):e037418. PMC: 7467517. DOI: 10.1136/bmjopen-2020-037418. View

Rahman A, Iqbal A, Hoque D, Moinuddin M, Zaman S, Rahman Q . Managing Neonatal and Early Childhood Syndromic Sepsis in Sub-District Hospitals in Resource Poor Settings: Improvement in Quality of Care through Introduction of a Package of Interventions in Rural Bangladesh. PLoS One. 2017; 12(1):e0170267. PMC: 5256881. DOI: 10.1371/journal.pone.0170267. View

Oza S, Lawn J, Hogan D, Mathers C, Cousens S . Neonatal cause-of-death estimates for the early and late neonatal periods for 194 countries: 2000-2013. Bull World Health Organ. 2015; 93(1):19-28. PMC: 4271684. DOI: 10.2471/BLT.14.139790. View

Halim A, Dewez J, Biswas A, Rahman F, White S, van den Broek N . When, Where, and Why Are Babies Dying? Neonatal Death Surveillance and Review in Bangladesh. PLoS One. 2016; 11(8):e0159388. PMC: 4968790. DOI: 10.1371/journal.pone.0159388. View

Vogel C, Zwolinsky S, Griffiths C, Hobbs M, Henderson E, Wilkins E . A Delphi study to build consensus on the definition and use of big data in obesity research. Int J Obes (Lond). 2019; 43(12):2573-2586. PMC: 6892733. DOI: 10.1038/s41366-018-0313-9. View

Woodcock T, Adeleke Y, Goeschel C, Pronovost P, Dixon-Woods M . A modified Delphi study to identify the features of high quality measurement plans for healthcare improvement projects. BMC Med Res Methodol. 2020; 20(1):8. PMC: 6961316. DOI: 10.1186/s12874-019-0886-6. View

Moran A, Kerber K, Sitrin D, Guenther T, Morrissey C, Newby H . Measuring coverage in MNCH: indicators for global tracking of newborn care. PLoS Med. 2013; 10(5):e1001415. PMC: 3646209. DOI: 10.1371/journal.pmed.1001415. View

10.

Hoque D, Rahman M, Billah S, Savic M, Karim A, Chowdhury E . An assessment of the quality of care for children in eighteen randomly selected district and sub-district hospitals in Bangladesh. BMC Pediatr. 2012; 12:197. PMC: 3561238. DOI: 10.1186/1471-2431-12-197. View

11.

Holey E, Feeley J, Dixon J, Whittaker V . An exploration of the use of simple statistics to measure consensus and stability in Delphi studies. BMC Med Res Methodol. 2007; 7:52. PMC: 2216026. DOI: 10.1186/1471-2288-7-52. View

12.

Bhutta Z, Das J, Bahl R, Lawn J, Salam R, Paul V . Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?. Lancet. 2014; 384(9940):347-70. DOI: 10.1016/S0140-6736(14)60792-3. View

13.

Gabrysch S, Civitelli G, Edmond K, Mathai M, Ali M, Bhutta Z . New signal functions to measure the ability of health facilities to provide routine and emergency newborn care. PLoS Med. 2012; 9(11):e1001340. PMC: 3496666. DOI: 10.1371/journal.pmed.1001340. View

14.

Birko S, Dove E, Ozdemir V . Evaluation of Nine Consensus Indices in Delphi Foresight Research and Their Dependency on Delphi Survey Characteristics: A Simulation Study and Debate on Delphi Design and Interpretation. PLoS One. 2015; 10(8):e0135162. PMC: 4535950. DOI: 10.1371/journal.pone.0135162. View

15.

Lawn J, Blencowe H, Oza S, You D, Lee A, Waiswa P . Every Newborn: progress, priorities, and potential beyond survival. Lancet. 2014; 384(9938):189-205. DOI: 10.1016/S0140-6736(14)60496-7. View

16.

Ntoburi S, Hutchings A, Sanderson C, Carpenter J, Weber M, English M . Development of paediatric quality of inpatient care indicators for low-income countries - A Delphi study. BMC Pediatr. 2010; 10:90. PMC: 3022793. DOI: 10.1186/1471-2431-10-90. View

17.

Hasson F, Keeney S, McKenna H . Research guidelines for the Delphi survey technique. J Adv Nurs. 2000; 32(4):1008-15. View

18.

Stewart D, Gibson-Smith K, MacLure K, Mair A, Alonso A, Codina C . A modified Delphi study to determine the level of consensus across the European Union on the structures, processes and desired outcomes of the management of polypharmacy in older people. PLoS One. 2017; 12(11):e0188348. PMC: 5695766. DOI: 10.1371/journal.pone.0188348. View

19.

You D, Hug L, Ejdemyr S, Idele P, Hogan D, Mathers C . Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. Lancet. 2015; 386(10010):2275-86. DOI: 10.1016/S0140-6736(15)00120-8. View

20.

Fink A, Kosecoff J, Chassin M, Brook R . Consensus methods: characteristics and guidelines for use. Am J Public Health. 1984; 74(9):979-83. PMC: 1651783. DOI: 10.2105/ajph.74.9.979. View