Every 16 seconds, a baby dies before, during, or soon after birth—and more than three-quarters of these deaths happen in sub-Saharan Africa and South Asia, where research on prevention has been critically neglected. This new NIHR Global Health Research Unit will work across eight high-burden countries—Kenya, Malawi, Tanzania, Uganda, Zambia, Zimbabwe, India, and Pakistan—to generate evidence and implement low-cost, sustainable solutions. The problem is stark: despite previous gains, stillbirths and neonatal deaths remain stubbornly high in these settings, and parents who experience a loss often face stigma with little support. If successful, the Unit will accelerate the translation of research into routine maternity and newborn care, strengthening health systems from pre-conception through to the immediate postnatal period. It will also develop and test bereavement support packages for families and healthcare providers, and challenge the stigma surrounding perinatal death. By building research capacity among midwives and nurses, and embedding community engagement groups, the Unit aims to create lasting, locally owned change—ultimately making preventable stillbirths and neonatal deaths a thing of the past.
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Background/Rationale: One baby dies every 16 seconds, before, during or soon after birth, globally. Over 75% of stillbirths or neonatal deaths occur in sub-Saharan Africa and South Asia, but research has been critically neglected in these settings. Exploiting previous substantial gains (NIHR Stillbirth Group/Lugina Africa Midwives’ Research Network) and extended, synergistic partnerships (Imperial/India, Liverpool/Uganda, Manchester/Pakistan), the new NIHR Unit will be a multi-disciplinary, international centre of research excellence for the prevention and management of stillbirths and neonatal deaths in LMICs. From pre-conception to newborn care, across the highest burden settings, the Unit will be a dynamic force, catalysing step-change acceleration of evidence generation and transfer into health-care practice. Our ultimate goal is to end preventable stillbirths, improve support and reduce stigma for parents, focusing on communities with greatest potential for benefit. Aim: To establish a Unit that will generate new scientific knowledge and implement solutions for the prevention and management of stillbirths and neonatal deaths. Unit objectives are to: 1.Develop and evaluate sustainable, cost-effective solutions to strengthen maternity and newborn care and reduce stillbirths and neonatal deaths in high-burden settings. 2.Determine how best to support parents, families, attending health providers and communities who experience a stillbirth or neonatal death. 3.Strengthen research capacity with particular (but not exclusive) emphasis on midwives and nurses. 4.Create and embed mechanisms of knowledge-transfer in high-burden settings. Methods: We will work in Kenya, Malawi, Tanzania, Uganda, Zambia, Zimbabwe, India and Pakistan; countries with national priorities in perinatal death reduction. A whole systems approach, distinguished by its family-centred focus, strong community and stakeholder partnerships, south-south support and ‘fit-for-purpose’ research designs involving low-cost, sustainable interventions co-developed with front-line workers, women, partners and families. Capacity strengthening activities will target individual and institutional capability at all levels. Underpinned by the MRC Framework for Complex Interventions, and focusing on quality of care provision, activities will span the whole childbirth continuum, building on existing programmes. Development will include early phase evidence syntheses, exploratory studies and methodology; feasibility will include operationalisation to guide planning of subsequent evaluation; evaluations will include full scale trials. Implementation will enable tested interventions to be embedded into care. With our integrated and new Community Engagement and Involvement groups (CEI) (lay members/consumer advocates) in partner countries we will address identified knowledge gaps e.g. adolescent care; antenatal care quality/uptake; testing and implementation of strategies to improve intrapartum outcomes, including respectful care. We will challenge stigma and evaluate bereavement support packages, including women with co-morbidities. New partnerships will extend scope to exploring parent partnerships in the care of sick neonates and implementing optimum immediate newborn care. Development of LMIC-specific core outcome sets for perinatal death will address key measurement uncertainty. Creative multi-modal dissemination strategies will support maximal short and longer-term impacts.
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