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Objective: To assess whether the Expanding Maternal and Neonatal Survival (EMAS) program was associated with improved care provided during hospital-based childbirth.Methods: A quasi-experimental study with two rounds of data collection examined whether EMAS interventions improved facility-based labor and childbirth care. Direct clinical observations were conducted for 1208 deliveries across 13 hospitals in 12 districts. Primary outcome measures included implementation of standard practices to reduce the risk of complications during labor and childbirth for both women and newborns.Results: Adjusted difference-in-difference analysis compared the mean difference in quality scores between EMAS intervention hospitals and comparison sites and consistently found significantly better performance in EMAS sites: 14 points higher for labor monitoring (β-coefficient 14.1; 95% confidence interval [CI], 7.1-21.0); 38 points higher for newborn resuscitation readiness (β-coefficient 38.1; 95% CI, 31.1-45.2); and 33 points higher for infection prevention practices (β-coefficient 32.6; 95% CI, 28.5-36.8).Conclusion: EMAS approaches emphasizing facility readiness and adherence to performance standards significantly improved labor monitoring and complication prevention practices during childbirth. [ABSTRACT FROM AUTHOR]

Background. Evaluating the impact of nutrition interventions on developmental outcomes in developing countries can be challenging since most assessment tests have been produced in and for developed country settings. Such tests may not be valid measures of children's abilities when used in a new context. Aims. We present several principles for the selection, adaptation, and evaluation of tests assessing the developmental outcomes of nutrition interventions in developing countries where standard assessment tests do not exist. We then report the application of these principles for a nutrition trial on the Indonesian island of Lombok. Sample. Three hundred children age 22-55 months in Lombok participated in a series of pilot tests for the purpose of test adaptation and evaluation. Four hundred and eighty-seven 42-month-old children in Lombok were tested on the finalized test battery. Methods. The developmental assessment tests were adapted to the local context and evaluated for a number of psychometric properties, including convergent and discriminant validity, which were measured based on multiple regression models with maternal education, depression, and age predicting each test score. Results. The adapted tests demonstrated satisfactory psychometric properties and the expected pattern of relationships with the three maternal variables. Maternal education significantly predicted all scores but one, maternal depression predicted socio-emotional competence, socio-emotional problems, and vocabulary, while maternal age predicted socio-emotional competence only. Conclusion. Following the methodological principles we present resulted in tests that were appropriate for children in Lombok and informative for evaluating the developmental outcomes of nutritional supplementation in the research context. Following this approach in future studies will help to determine which interventions most effectively improve child development in developing countries. [ABSTRACT FROM AUTHOR]