The goal of this observational study is to evaluate the implementation and impact of a comprehensive emergency obstetric and newborn care (CEmONC) program on maternal and perinatal health services and outcomes in Malawi. The study will include health facilities providing delivery care in Lilongwe and Blantyre districts, healthcare providers, and selected clients. The main questions it aims to answer are: 1. Does implementation of the program improve health facility readiness, availability and quality of CEmONC services, and maternal and perinatal death surveillance and response (MPDSR)? 2. Are improvements in facility readiness associated with changes in maternal and perinatal health outcomes over time? Participants and facilities will: * Participate in health facility assessments at baseline, midline, and endline. * Provide routine facility registers and records for retrospective abstraction of pregnancy outcomes, obstetric complications, and maternal and perinatal deaths. * Participate in interviews to describe provider training, clinical practices, and experiences with maternal and newborn care and MPDSR implementation.
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Availability of emergency obstetric and newborn care (EmONC)
Timeframe: From baseline through study completion, an average of 3 years and 8 months
Institutional delivery rate
Timeframe: From baseline through study completion, an average of 3 years and 8 months
Proportion of all births in EmONC facilities
Timeframe: From baseline through study completion, an average of 3 years and 8 months
Institutional C-section rate
Timeframe: From baseline through study completion, an average of 3 years and 8 months
Population-based C-section rate
Timeframe: From baseline through study completion, an average of 3 years and 8 months
Direct obstetric case fatality rate
Timeframe: From baseline through study completion, an average of 3 years and 8 months
Institutional maternal mortality ratio
Timeframe: From baseline through study completion, an average of 3 years and 8 months
Institutional maternal mortality ratio due to postpartum hemorrhage (PPH)
Timeframe: From baseline through study completion, an average of 3 years and 8 months
Postpartum hemorrhage (PPH)-specific case fatality rate
Timeframe: From baseline through study completion, an average of 3 years and 8 months
Institutional intrapartum stillbirth rate
Timeframe: From baseline through study completion, an average of 3 years and 8 months
Institutional perinatal mortality rate
Timeframe: From baseline through study completion, an average of 3 years and 8 months
Institutional neonatal mortality rate
Timeframe: From baseline through study completion, an average of 3 years and 8 months
Birth-weight specific institutional neonatal mortality rates
Timeframe: From baseline through study completion, an average of 3 years and 8 months
Met need for obstetric care
Timeframe: From baseline through study completion, an average of 3 years and 8 months
Percentage of vaginal or assisted deliveries in which calibrated drapes were used
Timeframe: From baseline through study completion, an average of 3 years and 8 months
Percentage of women who received prophylactic uterotonic (oxytocin, ergometrine, or misoprostol) during the third stage of labor
Timeframe: From baseline through study completion, an average of 3 years and 8 months
Percentage of postpartum hemorrhage (PPH) cases in which tranexamic acid (TXA) was administered for treatment of PPH
Timeframe: From baseline through study completion, an average of 3 years and 8 months
Percentage of women with companionship at birth (3 months)
Timeframe: From baseline through study completion, an average of 3 years and 8 months
Progress toward interim goal for scaling up emergency obstetric and newborn care (EmONC) availability
Timeframe: From baseline through study completion, an average of 3 years and 8 months
Equipment, drugs & supplies
Timeframe: From baseline through study completion, an average of 3 years and 8 months
Emergency referral readiness
Timeframe: From baseline through study completion, an average of 3 years and 8 months
Home to comprehensive emergency obstetric and newborn care (CEmONC) within 1 hour
Timeframe: From baseline through study completion, an average of 3 years and 8 months
Health workforce adequate for caseload
Timeframe: From baseline through study completion, an average of 3 years and 8 months
Facility maternal and perinatal death surveillance and review (MPDSR) implementation readiness
Timeframe: From baseline through study completion, an average of 3 years and 8 months